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Coates LC, Bukhari M, Chan A, Choy E, Galloway J, Gullick N, Kent A, Savage L, Siebert S, Tillett W, Wood N, Conaghan PG. Enhancing current guidance for psoriatic arthritis and its comorbidities: recommendations from an expert consensus panel. Rheumatology (Oxford) 2024:keae172. [PMID: 38490262 DOI: 10.1093/rheumatology/keae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Existing guidelines for psoriatic arthritis (PsA) cover many aspects of management. Some gaps remain relating to routine practice application. An expert group aimed to enhance current guidance and develop recommendations for clinical practice that are complementary to existing guidelines. METHODS A steering committee comprising experienced, research-active clinicians in rheumatology, dermatology and primary care agreed on themes and relevant questions. A targeted literature review of PubMed and Embase following a PICO framework was conducted. At a second meeting, recommendations were drafted and subsequently an extended faculty comprising rheumatologists, dermatologists, primary care clinicians, specialist nurses, allied health professionals, non-clinical academic participants and members of the Brit-PACT patient group, was recruited. Consensus was achieved via an online voting platform when 75% of respondents agreed in the range of 7-9 on a 9-point scale. RESULTS The guidance comprised 34 statements covering four PsA themes. Diagnosis focused on strategies to identify PsA early and refer appropriately, assessment of diagnostic indicators, use of screening tools and use of imaging. Disease assessment centred on holistic consideration of disease activity, physical functioning and impact from a patient perspective, and on how to implement shared decision-making. For comorbidities, recommendations included specific guidance for high-impact conditions such as depression and obesity. Management statements (which excluded extant guidance on pharmacological therapies) covered multidisciplinary team working, implementation of lifestyle modifications and treat-to-target strategies. Minimising corticosteroid use was recommended where feasible. CONCLUSION The consensus group have made evidence-based best practice recommendations for the management of PsA to enhance the existing guidelines.
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Affiliation(s)
- Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Marwan Bukhari
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Antoni Chan
- University Department of Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ernest Choy
- Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Cardiff University, Cardiff, United Kingdom
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Nicola Gullick
- Rheumatology Department, University Hospitals of Coventry & Warwickshire, Coventry, United Kingdom
| | - Alison Kent
- Department of Rheumatology, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - Laura Savage
- Department of Dermatology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - William Tillett
- Rheumatology Department, Royal National Hospital for Rheumatic Disease, Bath, United Kingdom
| | - Natasha Wood
- The Wooda Surgery, Bideford, Devon, United Kingdom
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
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2
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Winthrop KL, Mease P, Kerschbaumer A, Voll RE, Breedveld FC, Smolen JS, Gottenberg JE, Baraliakos X, Kiener HP, Aletaha D, Isaacs JD, Buch MH, Crow MK, Kay J, Crofford L, van Vollenhoven RF, Ospelt C, Siebert S, Kloppenburg M, McInnes IB, Huizinga TW, Gravallese EM. Unmet need in rheumatology: reports from the Advances in Targeted Therapies meeting, 2023. Ann Rheum Dis 2024; 83:409-416. [PMID: 38123338 DOI: 10.1136/ard-2023-224916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
The Advances in Targeted Therapies meets annually, convening experts in the field of rheumatology to both provide scientific updates and identify existing scientific gaps within the field. To review the major unmet scientific needs in rheumatology. The 23rd annual Advances in Targeted Therapies meeting convened with more than 100 international basic scientists and clinical researchers in rheumatology, immunology, infectious diseases, epidemiology, molecular biology and other specialties relating to all aspects of immune-mediated inflammatory diseases. We held breakout sessions in five rheumatological disease-specific groups including: rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axSpa), systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and vasculitis, and osteoarthritis (OA). In each group, experts were asked to identify and prioritise current unmet needs in clinical and translational research. An overarching theme across all disease states is the continued need for clinical trial design innovation with regard to therapeutics, endpoint and disease endotypes. Within RA, unmet needs comprise molecular classification of disease pathogenesis and activity, pre-/early RA strategies, more refined pain profiling and innovative trials designs to deliver on precision medicine. Continued scientific questions within PsA include evaluating the genetic, immunophenotypic, clinical signatures that predict development of PsA in patients with psoriasis, and the evaluation of combination therapies for difficult-to-treat disease. For axSpA, there continues to be the need to understand the role of interleukin-23 (IL-23) in pathogenesis and the genetic relationship of the IL-23-receptor polymorphism with other related systemic inflammatory diseases (eg, inflammatory bowel disease). A major unmet need in the OA field remains the need to develop the ability to reliably phenotype and stratify patients for inclusion in clinical trials. SLE experts identified a number of unmet needs within clinical trial design including the need for allowing endpoints that reflect pharmacodynamic/functional outcomes (eg, inhibition of type I interferon pathway activation; changes in urine biomarkers). Lastly, within SSc and vasculitis, there is a lack of biomarkers that predict response or disease progression, and that allow patients to be stratified for therapies. There remains a strong need to innovate clinical trial design, to identify systemic and tissue-level biomarkers that predict progression or response to therapy, endotype disease, and to continue developing therapies and therapeutic strategies for those with treatment-refractory disease. This document, based on expert consensus, should provide a roadmap for prioritising scientific endeavour in the field of rheumatology.
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Affiliation(s)
- Kevin L Winthrop
- Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Philip Mease
- Department of Rheumatology, University of Washington, Seattle, Washington, USA
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | | | - Hans P Kiener
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - John D Isaacs
- Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Institute of Cellular Medicine, Newcastle upon Tyne, UK
| | - Maya H Buch
- Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
- Department of Rheumatology, University of Manchester, Manchester, UK
| | - Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York, NY, New York, USA
| | - Jonathan Kay
- Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Leslie Crofford
- Department of Rheumatology, Vanderbilt University, Nashville, Tennessee, USA
| | - Ronald F van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Caroline Ospelt
- Department of Rheumatology, Center of Experimental Rheumatology, Zurich, Switzerland
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, Glasgow University, Glasgow, UK
| | | | - Iain B McInnes
- MVLS College Office, University of Glasgow, Glasgow, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Tom Wj Huizinga
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M Gravallese
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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3
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Siebert S, Marzo-Ortega H. Difficult-to-treat psoriatic arthritis: moving out of the rheumatoid arthritis shadow. Nat Rev Rheumatol 2024; 20:135-136. [PMID: 38279015 DOI: 10.1038/s41584-024-01083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
| | - Helena Marzo-Ortega
- NIHR Leeds BRC, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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4
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Marzo-Ortega H, Harrison SR, Nagy G, Machado PM, McGonagle DG, Aydin SZ, Almodovar-González R, Bautista-Molano W, Gossec L, Lubrano E, Nash P, Pimentel Santos F, Soriano ER, Siebert S. Time to address the challenge of difficult to treat psoriatic arthritis: results from an international survey. Ann Rheum Dis 2024; 83:403-404. [PMID: 37963707 DOI: 10.1136/ard-2023-225087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Stephanie Rose Harrison
- NIHR Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - György Nagy
- Departmnent of Rheumatology and Clinical Immunology & Department of Internal Medicine and Oncology, and Heart and Vascular Center, Hospital of the Hospitaller Order of Saint John of God & Semmelweis University, Budapest, Hungary
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, UCL, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Dennis G McGonagle
- NIHR Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Sibel Zehra Aydin
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Raquel Almodovar-González
- Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
- Preventive Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Wilson Bautista-Molano
- Facultad de Medicina y Ciencias de la Salud, Universidad Militar Nueva Granada, Bogota, Colombia
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Peter Nash
- School of Medicine, Griffith University, Nathan, Queensland, Australia
| | | | - Enrique R Soriano
- Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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5
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Gerber JS, Ray DK, Makowski D, Butler EE, Mueller ND, West PC, Johnson JA, Polasky S, Samberg LH, Siebert S, Sloat L. Global spatially explicit yield gap time trends reveal regions at risk of future crop yield stagnation. Nat Food 2024; 5:125-135. [PMID: 38279050 PMCID: PMC10896731 DOI: 10.1038/s43016-023-00913-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/06/2023] [Indexed: 01/28/2024]
Abstract
Yield gaps, here defined as the difference between actual and attainable yields, provide a framework for assessing opportunities to increase agricultural productivity. Previous global assessments, centred on a single year, were unable to identify temporal variation. Here we provide a spatially and temporally comprehensive analysis of yield gaps for ten major crops from 1975 to 2010. Yield gaps have widened steadily over most areas for the eight annual crops and remained static for sugar cane and oil palm. We developed a three-category typology to differentiate regions of 'steady growth' in actual and attainable yields, 'stalled floor' where yield is stagnated and 'ceiling pressure' where yield gaps are closing. Over 60% of maize area is experiencing 'steady growth', in contrast to ∼12% for rice. Rice and wheat have 84% and 56% of area, respectively, experiencing 'ceiling pressure'. We show that 'ceiling pressure' correlates with subsequent yield stagnation, signalling risks for multiple countries currently realizing gains from yield growth.
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Affiliation(s)
- James S Gerber
- Institute on the Environment, University of Minnesota, St Paul, MN, USA.
- Project Drawdown, .
| | - Deepak K Ray
- Institute on the Environment, University of Minnesota, St Paul, MN, USA
| | - David Makowski
- Université Paris-Saclay, INRAE, AgroParisTech, Palaiseau, France
| | - Ethan E Butler
- Department of Forest Resources, University of Minnesota, St Paul, MN, USA
| | - Nathaniel D Mueller
- Department of Ecosystem Science and Sustainability, Department of Soil and Crop Sciences, Colorado State University, Fort Collins, CO, USA
| | - Paul C West
- Project Drawdown
- Department of Applied Economics, University of Minnesota, St Paul, MN, USA
| | - Justin A Johnson
- Department of Applied Economics, University of Minnesota, St Paul, MN, USA
| | - Stephen Polasky
- Department of Applied Economics, University of Minnesota, St Paul, MN, USA
| | | | - Stefan Siebert
- Department of Crop Sciences, University of Göttingen, Göttingen, Germany
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6
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Yongolo NM, Halliday J, Bunn C, Mtesha B, Kelly C, Krauth SJ, Mwingwa A, Biswaro SM, Siebert S, Kipengele AH, Walker RW, McIntosh E, Mmbaga BT. Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study. Pan Afr Med J 2024; 47:36. [PMID: 38586069 PMCID: PMC10998254 DOI: 10.11604/pamj.2024.47.36.38258] [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: 11/21/2022] [Accepted: 01/11/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population. Methods a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ). Results among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score. Conclusion this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being.
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Affiliation(s)
- Nateiya Mmeta Yongolo
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Liverpool School of Tropical Medicine, Liverpool, England
| | - Jo Halliday
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Bunn
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Benson Mtesha
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
| | - Clive Kelly
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stefanie Jennifer Krauth
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Anthon Mwingwa
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
| | | | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | | | - Richard William Walker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma McIntosh
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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7
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Siebert S, Coates LC, Schett G, Raychaudhuri SP, Chen W, Gao S, Seridi L, Chakravarty SD, Shawi M, Lavie F, Sharaf M, Zimmermann M, Kollmeier AP, Xu XL, Rahman P, Mease PJ, Deodhar A. Modulation of Interleukin-23 Signaling With Guselkumab in Biologic-Naive Patients Versus Tumor Necrosis Factor Inhibitor-Inadequate Responders With Active Psoriatic Arthritis. Arthritis Rheumatol 2024. [PMID: 38253404 DOI: 10.1002/art.42803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE We assessed and compared immunologic differences and associations with clinical response to guselkumab, a fully human interleukin (IL)-23p19 subunit inhibitor, in participants with active psoriatic arthritis (PsA) who were biologic-naive or had inadequate response to tumor necrosis factor inhibitors (TNFi-IR). METHODS Serum biomarker levels at baseline and after treatment with guselkumab 100 mg every 8 weeks were compared between biologic-naive (n = 251) and TNFi-IR (n = 93) subgroups identified in the pooled DISCOVER-1/DISCOVER-2/COSMOS data set. Baseline biomarker levels determined by achievement of week 24 clinical responses (≥75%/90% improvement in Psoriasis Area and Severity Index [PASI 75/90], Investigator's Global Assessment [IGA] of psoriasis score 0/1 and ≥2-point improvement], ≥20% improvement in American College of Rheumatology criteria [ACR20]) were compared between prior treatment subgroups. RESULTS Baseline IL-22, TNFα, and beta defensin-2 (BD-2) levels were significantly lower in biologic-naive than in TNFi-IR participants. With guselkumab, week 24 IL-17A, IL-17F, IL-22, serum amyloid A, C-reactive protein, IL-6, and BD-2 levels were significantly reduced from baseline in biologic-naive and TNFi-IR participants (≥1.4-fold difference, nominal P < 0.05). Clinical responders to guselkumab exhibited significantly higher baseline levels of several biomarkers than nonresponders (IL-17A, IL-17F, BD-2 in biologic-naive PASI 90 responders; IL-17A, BD-2 in TNFi-IR IGA 0/1 responders; IL-22, BD-2 in TNFi-IR PASI 90 responders [nominal P < 0.05]) and trended higher in TNFi-IR ACR20 responders. CONCLUSION Guselkumab modulates IL-23 signaling and provides consistent pharmacodynamic effects in both biologic-naive and TNFi-IR PsA patients. Significantly elevated baseline IL-22, TNFα, and BD-2 levels and associations between baseline IL-22, IL-17A, and BD-2 levels and skin responses to guselkumab suggest greater dysregulation of IL-23/Th17 signaling in patients with TNFi-IR.
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Affiliation(s)
| | | | - Georg Schett
- Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Siba P Raychaudhuri
- University of California Davis and Veterans Affairs Northern California Health Care System, Mather, California
| | - Warner Chen
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Sheng Gao
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Loqmane Seridi
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - May Shawi
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Frederic Lavie
- Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Issy les Moulineaux, France
| | | | | | | | - Xie L Xu
- Janssen Research & Development, LLC, San Diego, California
| | - Proton Rahman
- Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington
| | - Atul Deodhar
- Oregon Health & Science University, Portland, Oregon
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8
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Johnsson H, Cole J, McInnes IB, Graham G, Siebert S. Differences in transcriptional changes in psoriasis and psoriatic arthritis skin with immunoglobulin gene enrichment in psoriatic arthritis. Rheumatology (Oxford) 2024; 63:218-225. [PMID: 37137278 PMCID: PMC10765156 DOI: 10.1093/rheumatology/kead195] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES Approximately 20% of people with psoriasis develop PsA. Although genetic, clinical and environmental risk factors have been identified, it is not known why some people with psoriasis develop PsA. The skin disease is traditionally considered the same in both. This study compares transcriptional changes in psoriasis and PsA skin for the first time. METHODS Skin biopsies were collected from healthy controls (HC), and uninvolved and lesional skin from patients with PsA. Bulk tissue sequencing was performed and analysed using the pipeline Searchlight 2.0. Transcriptional changes in PsA skin were compared with existing sequencing data from participants with psoriasis without PsA (GSE121212). Psoriasis and PsA datasets could not be directly compared as different analysis methods were used. Data from participants with PsA in the GSE121212 dataset were used for validation. RESULTS Skin samples from 9 participants with PsA and 9 HC were sequenced, analysed and compared with available transcriptomic data for 16 participants with psoriasis compared with 16 HC. Uninvolved skin in psoriasis shared transcriptional changes with lesional skin in psoriasis, but uninvolved skin in PsA did not. Most transcriptional changes in psoriasis and PsA lesional skin were shared, but immunoglobulin genes were upregulated in PsA lesional skin specifically. The transcription factor POU2F1, which regulates immunoglobulin gene expression, was enriched in PsA lesional skin. This was confirmed in the validation cohort. CONCLUSIONS Immunoglobulin genes are upregulated in PsA but not in psoriasis skin lesions. This may have implications for the spread from the cutaneous compartment to other tissues.
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Affiliation(s)
- Hanna Johnsson
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - John Cole
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Iain B McInnes
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Gerard Graham
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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9
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Paul L, McDonald MT, McConnachie A, Siebert S, Coulter EH. Online physiotherapy for people with axial spondyloarthritis: quantitative and qualitative data from a cohort study. Rheumatol Int 2024; 44:145-156. [PMID: 37733042 PMCID: PMC10766789 DOI: 10.1007/s00296-023-05456-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
Life-long exercise is essential in axial spondyloarthritis (axSpA) management; however, long-term adherence is challenging. Online exercise programmes are an alternative to face-to-face physiotherapy. (1) To measure adherence to a 12-month, individualised, online physiotherapy programme for people with axSpA, and investigate the effects on disease activity, spinal mobility, work ability, quality of life and function. (2) To investigate associations between programme adherence and outcomes. (3) To explore participants' views of the programme and factors affecting adherence. Participants were 'non-exercisers' recruited from rheumatology outpatient services. Adherence was measured using online diary entries. Outcomes included the BATH indices, health status (EQ5D), Ankylosing Spondylitis Quality of Life (ASQOL), exercise capacity (6MWT), Work, Productivity and Activity Impairment in AS (WPAI), Exercise Attitude Questionnaire (EAQ) and Exercise Motivations Inventory-2 (EMI-2) at baseline, 6 and 12 months. Interviews determined views on the intervention and factors affecting adherence. Fifty participants were recruited. Over the 52-week intervention, adherence (five times/week) ranged from 19% (± 30%) to 44% (± 35%). Significant improvements were found in disease activity (BASDAI), spinal mobility (BASMI), 6MWT, AsQoL and EQ5D-VAS at 6 and 12 months. There were no associations between adherence and baseline variables or demographics. Interviews suggested support from others, routine, and feeling the benefit positively affected adherence. Conversely, lack of motivation, life events and symptoms negatively affected adherence. A 12-month online physiotherapy programme significantly improved symptoms in people with axSpA who were not regular exercisers. Adherence reduced over the intervention period. Online exercise programmes may benefit people with axSpA; however, strategies to improve adherence are required.
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Affiliation(s)
- L Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - M T McDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - A McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - E H Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK.
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10
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Laurie E, Siebert S, Yongolo N, Halliday JEB, Biswaro SM, Krauth SJ, Kilonzo KG, Mmbaga BT, McIntosh E. Evidencing the clinical and economic burden of musculoskeletal disorders in Tanzania: paving the way for urgent rheumatology service development. Rheumatol Adv Pract 2023; 8:rkad110. [PMID: 38143512 PMCID: PMC10748784 DOI: 10.1093/rap/rkad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Emma Laurie
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection & Immunity, University of Glasgow, Glasgow, UK
| | - Nateiya Yongolo
- Department of Clinical Research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Clinical Medical University College, Moshi, United Republic of Tanzania
| | - Jo E B Halliday
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Sanjura M Biswaro
- Department of Clinical Research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | | | - Kajiru Gad Kilonzo
- Department for Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Blandina T Mmbaga
- Department of Clinical Research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Clinical Medical University College, Moshi, United Republic of Tanzania
| | - Emma McIntosh
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
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11
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Chong HY, McNamee P, Bachmair EM, Martin K, Aucott L, Dhaun N, Dures E, Emsley R, Gray SR, Kidd E, Kumar V, Lovell K, MacLennan G, Norrie J, Paul L, Packham J, Ralston SH, Siebert S, Wearden A, Macfarlane G, Basu N. Cost-effectiveness of cognitive behavioural and personalized exercise interventions for reducing fatigue in inflammatory rheumatic diseases. Rheumatology (Oxford) 2023; 62:3819-3827. [PMID: 37018151 PMCID: PMC10691924 DOI: 10.1093/rheumatology/kead157] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness of a cognitive behavioural approach (CBA) or a personalized exercise programme (PEP), alongside usual care (UC), in patients with inflammatory rheumatic diseases who report chronic, moderate to severe fatigue. METHODS A within-trial cost-utility analysis was conducted using individual patient data collected within a multicentre, three-arm randomized controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis. RESULTS Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95% CI: £464, £665); CBA £845 (95% CI: £717, £993)] and, in the case of PEP, significantly more effective [adjusted mean quality-adjusted life year (QALY) difference: PEP 0.043 (95% CI: 0.019, 0.068); CBA 0.001 (95% CI: -0.022, 0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs UC, and £793 777 for CBA vs UC. Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI: £324, £511) and a non-significant QALY gain of 0.016 (95% CI: -0.003, 0.035), leading to an ICER of £26 822 vs UC. The estimates from sensitivity analyses were consistent with these results. CONCLUSION The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.
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Affiliation(s)
- Huey Yi Chong
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Eva-Maria Bachmair
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Kathryn Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Academic Primary Care Group), University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre of Healthcare and Randomised Trials (CHaRT), Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh/British Heart Foundation Centre of Research Excellence, Edinburgh, UK
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Elizabeth Kidd
- Department of Rheumatology, Freeman’s Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vinod Kumar
- Department of Rheumatology, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Karina Lovell
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Centre of Healthcare and Randomised Trials (CHaRT), Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Packham
- Physiotherapy and Paramedicine, Haywood Rheumatology Centre, Stoke-on-Trent, UK
| | - Stuart H Ralston
- Rheumatology and Bone Disease, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Alison Wearden
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Gary Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Academic Primary Care Group), University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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12
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Siebert S, Pennington SR, Raychaudhuri SP, Chaudhari AJ, Jin JQ, Liao W, Chandran V, FitzGerald O. Novel Insights From Basic Science in Psoriatic Disease at the GRAPPA 2022 Annual Meeting. J Rheumatol 2023; 50:66-70. [PMID: 37527860 DOI: 10.3899/jrheum.2023-0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
Recent basic science advances in psoriatic disease (PsD) were presented and discussed at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2022 annual meeting. Topics included clinical applications of biomarkers, what the future of biomarkers for PsD may hold, the challenges of developing biomarker research to the point of clinical utility, advances in total-body positron emission tomography/computed tomography imaging, and emerging concepts from single-cell studies in PsD.
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Affiliation(s)
- Stefan Siebert
- S. Siebert, MD, PhD, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Stephen R Pennington
- S.R. Pennington, PhD, O. FitzGerald, MD, School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Siba P Raychaudhuri
- S.P. Raychaudhuri, MD, Department of Internal Medicine-Rheumatology, UC Davis School of Medicine and Northern California Veterans Affairs Medical Center, Mather, California, USA
| | - Abhijit J Chaudhari
- A.J. Chaudhari, PhD, Department of Radiology, UC Davis School of Medicine, Sacramento, California, USA
| | - Joy Q Jin
- J.Q. Jin, AB, School of Medicine, and Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Wilson Liao
- W. Liao, MD, Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Vinod Chandran
- V. Chandran, DM, PhD, Departments of Medicine, Laboratory Medicine, and Pathobiology and Institute of Medical Science, University of Toronto, and Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Oliver FitzGerald
- S.R. Pennington, PhD, O. FitzGerald, MD, School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland;
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13
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Ng BCK, Jadon D, Adebajo A, Ayan G, Duffin KC, Chandran V, Coates LC, D'Agostino MA, de Vlam K, Deodhar A, Eder L, Garg A, Gladman DD, Goel N, Gottlieb AB, Husni ME, Katz A, Kavanaugh A, Lubrano E, Mease PJ, Merola JF, Nash P, Ogdie A, Pennington SR, Perez-Chada LM, Proft F, Rosen CF, Savage L, Goldenstein-Schainberg C, Siebert S, Soriano ER, Steinkoenig I, Tillett W, Armstrong AW, FitzGerald O. Proceedings of the GRAPPA 2022 Executive Retreat. J Rheumatol 2023; 50:71-77. [PMID: 37527861 DOI: 10.3899/jrheum.2023-0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) leadership congregated for a strategic planning meeting before the 2022 GRAPPA annual meeting in New York, USA. Meeting aims were to review GRAPPA's performance in relation to its 2016 goals and identify successes and areas for further improvement, identify key GRAPPA priorities and activities for the next 5 years, and explore committee structures to best support these aims.
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Affiliation(s)
- Beverly Cheok Kuan Ng
- B.C.K. Ng, MBBS, MSc, D. Jadon, MBBCh, PhD, Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Deepak Jadon
- B.C.K. Ng, MBBS, MSc, D. Jadon, MBBCh, PhD, Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Adewale Adebajo
- A. Adebajo, MD, MBE, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Gizem Ayan
- G. Ayan, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Kristina Callis Duffin
- K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Vinod Chandran
- V. Chandran, MD, DM, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Laura C Coates
- L.C. Coates, MD, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Kurt de Vlam
- K. de Vlam, MD, PhD, University Hospitals Leuven, Leuven, Belgium
| | - Atul Deodhar
- A. Deodhar, MD, Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute and University of Toronto, Toronto, Ontario, Canada
| | - Amit Garg
- A. Garg, MD, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Dafna D Gladman
- D.D. Gladman, MD, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Niti Goel
- N. Goel, MD, Patient Research Partner, Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alice B Gottlieb
- A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Elaine Husni
- M.E. Husni, MD, MPH, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arnon Katz
- A. Katz, MSc, Technion Israel Institute of Technology, Haifa, Israel
| | - Arthur Kavanaugh
- A. Kavanaugh, MD, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA
| | - Ennio Lubrano
- E. Lubrano, MD, PhD, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Philip J Mease
- P.J. Mease, MD, Rheumatology Research, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Nash
- P. Nash, MBBS, MD, School of Medicine, Griffith University, Brisbane, Australia
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Stephen R Pennington
- S.R. Pennington, PhD, O. FitzGerald, MBBCh, MD, School of Medicine, and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Lourdes M Perez-Chada
- L.M. Perez-Chada, MD, MMSc, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabian Proft
- F. Proft, MD, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cheryl F Rosen
- C.F. Rosen, MD, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laura Savage
- L. Savage, MBChB, PhD, Department of Dermatology, University of Leeds, Leeds, UK
| | - Claudia Goldenstein-Schainberg
- C. Goldenstein-Schainberg, MD, PhD, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Stefan Siebert
- S. Siebert, MD, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Enrique R Soriano
- E.R. Soriano, MD, MS, University Institute and Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - William Tillett
- W. Tillet, MBChB, PhD, Department of Life Sciences, Centre for Therapeutic Innovation, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - April W Armstrong
- A.W. Armstrong, MD, MPH, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Oliver FitzGerald
- S.R. Pennington, PhD, O. FitzGerald, MBBCh, MD, School of Medicine, and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland;
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14
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Van Kuijk AWR, Nurmohamed MT, Siebert S, Bergmans P, de Vlam K, Gremese E, Joven-Ibáñez B, Korotaeva TV, Lavie F, Sharaf M, Noël W, Theander E, Smolen JS, Gossec L, van der Horst-Bruinsma IE. Gender-specific differences in patients with psoriatic arthritis receiving ustekinumab or tumour necrosis factor inhibitor: real-world data. Rheumatology (Oxford) 2023; 62:3382-3390. [PMID: 36810788 PMCID: PMC10547514 DOI: 10.1093/rheumatology/kead089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Investigate effects of gender on disease characteristics and treatment impact in patients with PsA. METHODS PsABio is a non-interventional European study in patients with PsA starting a biological DMARD [bDMARD; ustekinumab or TNF inhibitor (TNFi)]. This post-hoc analysis compared persistence, disease activity, patient-reported outcomes and safety between male and female patients at baseline and 6 and 12 months of treatment. RESULTS At baseline, disease duration was 6.7 and 6.9 years for 512 females and 417 males respectively. Mean (95% CI) scores for females vs males were: clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA), 32.3 (30.3, 34.2) vs 26.8 (24.8, 28.9); HAQ-Disability Index (HAQ-DI), 1.3 (1.2, 1.4) vs 0.93 (0.86, 0.99); total PsA Impact of Disease-12 (PsAID-12) score, 6.0 (5.8, 6.2) vs 5.1 (4.9, 5.3), respectively. Improvements in scores were smaller in female than male patients. At 12 months, 175/303 (57.8%) female and 212/264 (80.3%) male patients achieved cDAPSA low disease activity, 96/285 (33.7%) and 137/247 (55.5%), achieved minimal disease activity (MDA), respectively. HAQ-DI scores were 0.85 (0.77, 0.92) vs 0.50 (0.43, 0.56), PsAID-12 scores 3.5 (3.3, 3.8) vs 2.4 (2.2, 2.6), respectively. Treatment persistence was lower in females than males (P ≤ 0.001). Lack of effectiveness was the predominant reason to stop, irrespective of gender and bDMARD. CONCLUSIONS Before starting bDMARDs, females had more severe disease than males and a lower percentage reached favourable disease states, with lower persistence of treatment after 12 months. A better understanding of the mechanisms underlying these differences may improve therapeutic management in females with PsA. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT02627768.
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Affiliation(s)
- Arno W R Van Kuijk
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, Netherlands
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | | | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Elisa Gremese
- Department of Medical and Surgical Sciences, Catholic University of the Sacred Heart, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | | | - T V Korotaeva
- Department of Spondyloarthritis and Psoriatic Arthritis, VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Frederic Lavie
- Medical Affairs, Janssen-Cilag, Issy-les-Moulineaux, Paris, France
| | | | - Wim Noël
- Medical Affairs, Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Josef S Smolen
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Laure Gossec
- Faculty of Medicine, Sorbonne Université, INSERM, IPLESP, Paris, France
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
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15
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Simons G, Birch R, Stocks J, Insch E, Rijckborst R, Neag G, McColm H, Romaniuk L, Wright C, Phillips BE, Jones SW, Pratt AG, Siebert S, Raza K, Falahee M. The student patient alliance: development and formative evaluation of an initiative to support collaborations between patient and public involvement partners and doctoral students. BMC Rheumatol 2023; 7:36. [PMID: 37789423 PMCID: PMC10548699 DOI: 10.1186/s41927-023-00359-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND While the integration of patient and public involvement (PPI) in clinical research is now widespread and recommended as standard practice, meaningful PPI in pre-clinical, discovery science research is more difficult to achieve. One potential way to address this is by integrating PPI into the training programmes of discovery science postgraduate doctoral students. This paper describes the development and formative evaluation of the Student Patient Alliance (SPA), a programme developed at the University of Birmingham that connects PPI partners with doctoral students. METHODS Following a successful pilot of the SPA by the Rheumatology Research Group at the University of Birmingham, the scheme was implemented across several collaborating Versus Arthritis / Medical Research Council (MRC) centres of excellence. Doctoral students were partnered with PPI partners, provided with initial information and guidance, and then encouraged to work together on research and public engagement activities. After six months, students, their PPI partners and the PPI coordinators at each centre completed brief surveys about their participation in the SPA. RESULTS Both doctoral students and their PPI partners felt that taking part in SPA had a positive impact on understanding, motivation and communication skills. Students reported an increased understanding of PPI and patient priorities and reported improved public engagement skills. Their PPI partners reported a positive impact of the collaboration with the students. They enjoyed learning about the student's research and contributing to the student's personal development. PPI coordinators also highlighted the benefits of the SPA, but noted some challenges they had experienced, such as difficulties matching students with PPI partners. CONCLUSIONS The SPA was valued by students and PPI partners, and it is likely that initiatives of this kind would enhance students' PPI and public engagement skills and awareness of patients' experiences on a wider scale. However, appropriate resources are needed at an institutional level to support the implementation of effective programmes of this kind on a larger scale.
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Affiliation(s)
- Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK
| | - Rebecca Birch
- Research & Knowledge Transfer Office, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joanne Stocks
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Centre for Sport Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Elspeth Insch
- Rheumatology Research Patient Partnership, University of Birmingham, Birmingham, UK
| | - Rob Rijckborst
- Rheumatology Research Patient Partnership, University of Birmingham, Birmingham, UK
| | - Georgiana Neag
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK
| | - Heidi McColm
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Leigh Romaniuk
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Claire Wright
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
- Research into Inflammatory Arthritis Centre Versus Arthritis, University of Glasgow, Glasgow, UK
| | - Bethan E Phillips
- Centre of Metabolism, Ageing & Physiology (COMAP), University of Nottingham, Royal Derby Hospital, Derby, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - Simon W Jones
- MRC- Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute for Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Arthur G Pratt
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Research into Inflammatory Arthritis Centre Versus Arthritis, Newcastle University, Newcastle, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
- Research into Inflammatory Arthritis Centre Versus Arthritis, University of Glasgow, Glasgow, UK
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK
- Research into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Birmingham Biomedical Research Centre, National Institute for Health and Care Research (NIHR), Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.
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16
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Ooms A, Al-Mossawi H, Bennett L, Bogale M, Bowness P, Francis A, Goodyear C, Kirkham BW, Lalnunhlimi S, McInnes IB, Richards D, Siebert S, Taams LS, Tulunay Virlan A, Yager N, Coates LC. Optimising psoriatic arthritis therapy with immunological methods to increase standard evaluation: the protocol of an open-label multicentre, parallel-group, two-arm randomised controlled study evaluation precision medicine approach in the treatment of psoriatic arthritis. BMJ Open 2023; 13:e078539. [PMID: 37770264 PMCID: PMC10546161 DOI: 10.1136/bmjopen-2023-078539] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) affects around 150 000 people in the UK of whom around 50% require treatment with biologics. The most used biologics for PsA target tumour necrosis factor (TNF) or interleukin-17A (IL-17A). About 50% of patients respond to each, but it is not currently possible to predict response for individual patients, necessitating sequential treatment steps. A recent proof of concept study in PsA suggested that using peripheral immunophenotype to choose therapy could improve time to treatment response.This study will test the hypothesis, within an open-label parallel-group biomarker-stratified multicentre randomised controlled trial, which the baseline proportion of CD4+T cells with an activated type 17 immunophenotype (Th17 levels) predicts response to IL-17A or TNF inhibitors in PsA. Additional analyses will identify if the model can be refined by combining additional clinical and immunophenotypic factors. Statistical modelling will be used to predict the likely effectiveness of these approaches compared with standard care. METHODS AND ANALYSIS Patients with PsA eligible to start their first biologic as part of standard care are recruited and baseline blood tests are taken for immunophenotyping. Participants are stratified equally by Th17 levels and randomised 1:1 to receive either TNF (adalimumab) or IL-17A (secukinumab) inhibitors. The primary analysis will establish the interaction between baseline immunophenotype and treatment on the primary outcome (achievement of minimal disease activity criteria at week 24). In secondary analysis, modelling will identify if this prediction model can be optimised further by incorporating clinical phenotypes and additional immunophenotyping techniques. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the North West Preston Research Ethics Committee (ref 21/NW/0016). Dissemination will be via conference presentations and peer-reviewed publications, aiming to impact on treatment guidelines. TRIAL REGISTRATION NUMBER ISRCTN17228602.
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Affiliation(s)
- Alexander Ooms
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Hussein Al-Mossawi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | | | - Mimi Bogale
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Paul Bowness
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Anne Francis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | | | - Bruce W Kirkham
- Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sylvine Lalnunhlimi
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
| | - Iain B McInnes
- MVLS College Office, University of Glasgow, Glasgow, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Duncan Richards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
| | | | - Nicole Yager
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Disorders, University of Oxford, Oxford, UK
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17
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Schett G, Chen W, Gao S, Chakravarty SD, Shawi M, Lavie F, Zimmermann M, Sharaf M, Coates LC, Siebert S. Correction: Effect of guselkumab on serum biomarkers in patients with active psoriatic arthritis and inadequate response to tumor necrosis factor inhibitors: results from the COSMOS phase 3b study. Arthritis Res Ther 2023; 25:170. [PMID: 37715280 PMCID: PMC10503169 DOI: 10.1186/s13075-023-03158-9] [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] [Indexed: 09/17/2023] Open
Affiliation(s)
- Georg Schett
- Department of Medicine 3 - Rheumatology and Immunology, Universitatsklinikum Erlangen, Erlangen, Germany.
| | - Warner Chen
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Sheng Gao
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Soumya D Chakravarty
- Immunology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - May Shawi
- Immunology, Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA
| | - Frederic Lavie
- Immunology, Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Issy Les Moulineaux, France
| | | | | | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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18
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FitzGerald O, Behrens F, Barton A, Bertheussen H, Boutouyrie-Dumont B, Coates L, Davies O, de Wit M, Fagni F, Goodyear CS, Gurke R, Hahnefeld L, Huppertz C, Ioannidis V, Ibberson M, Katz A, Klippstein M, Koehm M, Korish S, Mackay S, Martin DA, O’Sullivan D, Patel K, Rueping S, Schett G, Scholich K, Schwenk JM, Siebert S, Simon D, Vivekanantham A, Pennington SR. Application of clinical and molecular profiling data to improve patient outcomes in psoriatic arthritis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231192315. [PMID: 37694182 PMCID: PMC10492462 DOI: 10.1177/1759720x231192315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023] Open
Abstract
Achieving a good outcome for a person with Psoriatic Arthritis (PsA) is made difficult by late diagnosis, heterogenous clinical disease expression and in many cases, failure to adequately suppress inflammatory disease features. Single-centre studies have certainly contributed to our understanding of disease pathogenesis, but to adequately address the major areas of unmet need, multi-partner, collaborative research programmes are now required. HIPPOCRATES is a 5-year, Innovative Medicines Initiative (IMI) programme which includes 17 European academic centres experienced in PsA research, 5 pharmaceutical industry partners, 3 small-/medium-sized industry partners and 2 patient-representative organizations. In this review, the ambitious programme of work to be undertaken by HIPPOCRATES is outlined and common approaches and challenges are identified. It is expected that, when completed, the results will ultimately allow for changes in the approaches to diagnosing, managing and treating PsA allowing for better short-term and long-term outcomes.
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Affiliation(s)
- Oliver FitzGerald
- School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Ireland
| | - Frank Behrens
- Translational Rheumatology, Immunology – Inflammation Medicine, University Hospital Goethe-University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Anne Barton
- Centre for Musculoskeletal Research, the University of Manchester, Manchester, UK
| | | | | | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Maarten de Wit
- GRAPPA Patient Research Partner, Zaltbommel, the Netherlands
| | - Filippo Fagni
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Carl S. Goodyear
- School of Infection & Immunity, College of Medical, Veterinar & Life Sciences, University of Glasgow, Glasgow, UK
| | - Robert Gurke
- Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Johann Wolfgang Goethe University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Lisa Hahnefeld
- Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Johann Wolfgang Goethe University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | | | - Vassilios Ioannidis
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Mark Ibberson
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Maximilian Klippstein
- Translational Rheumatology, Immunology – Inflammation Medicine, University Hospital Goethe-University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Michaela Koehm
- Translational Rheumatology, Immunology – Inflammation Medicine, University Hospital Goethe-University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | | | - Sina Mackay
- Fraunhofer Institute for Intelligent Analysis and Information Systems IAIS, Sankt Augustin and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - David A. Martin
- Pfizer Immunology & Inflammation Research Unit, Cambridge, MA, USA
| | | | - Khadijah Patel
- Centre for Musculoskeletal Research, the University of Manchester, Manchester, UK
| | - Stefan Rueping
- Fraunhofer Institute for Intelligent Analysis and Information Systems IAIS, Sankt Augustin and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Georg Schett
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Scholich
- Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Johann Wolfgang Goethe University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Jochen M. Schwenk
- Affinity Proteomics, Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Solna, Sweden
| | - Stefan Siebert
- School of Infection & Immunity, College of Medical, Veterinar & Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simon
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arani Vivekanantham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephen R. Pennington
- School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Ireland
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Siebert S, Sweet KM, Ritchlin CT, Hsia EC, Kollmeier AP, Xu XL, Seridi L, Song Q, Gao S, Chen W, Miron M. Guselkumab Modulates Differentially Expressed Genes in Blood of Patients With Psoriatic Arthritis: Results from Two Phase 3, Randomized, Placebo-Controlled Trials. ACR Open Rheumatol 2023; 5:490-498. [PMID: 37553909 PMCID: PMC10502816 DOI: 10.1002/acr2.11589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To evaluate gene expression in blood of patients with psoriatic arthritis (PsA) versus healthy controls and identify changes associated with guselkumab treatment. METHODS Whole blood transcriptome profiling via paired-end RNA sequencing was conducted using samples from DISCOVER-1 and DISCOVER-2 at baseline (n = 673) and at weeks 4 and 24 from a representative subgroup that received placebo or guselkumab (n = 227 [longitudinal PsA cohort]). Baseline samples were compared with demographically matched healthy controls (n = 21). Guselkumab-mediated changes in gene expression were assessed in participants from the longitudinal PsA cohort who did versus did not achieve at least 20% improvement in American College of Rheumatology response criteria (ACR20) or at least 75% improvement in Psoriasis Area and Severity Index (PASI75). Differential gene expression was analyzed using edgeR. RESULTS At baseline, 355 upregulated and 314 downregulated genes (PsA-associated genes) were identified in patients with PsA versus healthy controls. Upregulated genes were related to neutrophil, mononuclear cell, and CD11b+ gene sets. No cell type-specific gene sets were identified among downregulated genes. Most PsA-associated genes were modulated by guselkumab treatment. At week 24, genes downregulated by guselkumab were enriched with neutrophil, monocyte, eosinophil, and macrophage gene sets; genes upregulated by guselkumab were enriched with B cell, T cell, and natural killer cell gene sets. Reductions in expression of upregulated PsA-associated gene sets were more pronounced in ACR20 and PASI75 responders than in nonresponders. CONCLUSION These findings suggest a dysregulation of immune cell profiles in blood from patients in the baseline PsA cohort that approached levels in healthy controls after guselkumab treatment.
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Affiliation(s)
| | | | | | - Elizabeth C. Hsia
- Janssen Research & Development, LLCSpring HousePennsylvaniaUSA
- University of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA
| | | | - Xie L. Xu
- Janssen Research & Development, LLCSan DiegoCaliforniaUSA
| | - Loqmane Seridi
- Janssen Research & Development, LLCSpring HousePennsylvaniaUSA
| | - Qingxuan Song
- Janssen Research & Development, LLCSpring HousePennsylvaniaUSA
| | - Sheng Gao
- Janssen Research & Development, LLCSpring HousePennsylvaniaUSA
| | - Warner Chen
- Janssen Research & Development, LLCSpring HousePennsylvaniaUSA
| | - Michelle Miron
- Janssen Research & Development, LLCSpring HousePennsylvaniaUSA
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20
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Zabotti A, De Marco G, Gossec L, Baraliakos X, Aletaha D, Iagnocco A, Gisondi P, Balint PV, Bertheussen H, Boehncke WH, Damjanov NS, de Wit M, Errichetti E, Marzo-Ortega H, Protopopov M, Puig L, Queiro R, Ruscitti P, Savage L, Schett G, Siebert S, Stamm TA, Studenic P, Tinazzi I, Van den Bosch FE, van der Helm-van Mil A, Watad A, Smolen JS, McGonagle DG. EULAR points to consider for the definition of clinical and imaging features suspicious for progression from psoriasis to psoriatic arthritis. Ann Rheum Dis 2023; 82:1162-1170. [PMID: 37295926 DOI: 10.1136/ard-2023-224148] [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: 03/11/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The transition from psoriasis (PsO) to psoriatic arthritis (PsA) and the early diagnosis of PsA is of considerable scientific and clinical interest for the prevention and interception of PsA. OBJECTIVE To formulate EULAR points to consider (PtC) for the development of data-driven guidance and consensus for clinical trials and clinical practice in the field of prevention or interception of PsA and for clinical management of people with PsO at risk for PsA development. METHODS A multidisciplinary EULAR task force of 30 members from 13 European countries was established, and the EULAR standardised operating procedures for development for PtC were followed. Two systematic literature reviews were conducted to support the task force in formulating the PtC. Furthermore, the task force proposed nomenclature for the stages before PsA, through a nominal group process to be used in clinical trials. RESULTS Nomenclature for the stages preceding PsA onset, 5 overarching principles and 10 PtC were formulated. Nomenclature was proposed for three stages towards PsA development, namely people with PsO at higher risk of PsA, subclinical PsA and clinical PsA. The latter stage was defined as PsO and associated synovitis and it could be used as an outcome measure for clinical trials evaluating the transition from PsO to PsA. The overarching principles address the nature of PsA at its onset and underline the importance of collaboration of rheumatologists and dermatologists for strategies for prevention/interception of PsA. The 10 PtC highlight arthralgia and imaging abnormalities as key elements of subclinical PsA that can be used as potential short-term predictors of PsA development and useful items to design clinical trials for PsA interception. Traditional risk factors for PsA development (ie, PsO severity, obesity and nail involvement) may represent more long-term disease predictors and be less robust for short-term trials concerning the transition from PsO to PsA. CONCLUSION These PtC are helpful to define the clinical and imaging features of people with PsO suspicious to progress to PsA. This information will be helpful for identification of those who could benefit from a therapeutic intervention to attenuate, delay or prevent PsA development.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Gabriele De Marco
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Nemanja S Damjanov
- Rheumatology, University of Belgrade Faculty of Medicine, Beograd, Serbia
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Enzo Errichetti
- Department of Medical and Biological Sciences University Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Helena Marzo-Ortega
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Lluis Puig
- Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Piero Ruscitti
- University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, L'Aquila, Italy
| | - Laura Savage
- Chapel Allerton Hospital Department of Dermatology, Leeds, UK
| | - Georg Schett
- Rheumatology, Erlangen University Hospital, Erlangen, Germany
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Paul Studenic
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Ilaria Tinazzi
- Unit of Rheumatology, Don Calabria Sacred Heart Hospital, Negrar, Italy
| | | | - Annette van der Helm-van Mil
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Abdulla Watad
- Internal Medicine, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Dennis G McGonagle
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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21
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Schett G, Chen W, Gao S, Chakravarty SD, Shawi M, Lavie F, Zimmermann M, Sharaf M, Coates LC, Siebert S. Effect of guselkumab on serum biomarkers in patients with active psoriatic arthritis and inadequate response to tumor necrosis factor inhibitors: results from the COSMOS phase 3b study. Arthritis Res Ther 2023; 25:150. [PMID: 37587493 PMCID: PMC10428525 DOI: 10.1186/s13075-023-03125-4] [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: 04/17/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Guselkumab is a selective interleukin (IL)-23 inhibitor targeting the IL-23p19 subunit. In the phase 3b COSMOS trial, guselkumab demonstrated efficacy in treating participants with active psoriatic arthritis (PsA) and inadequate response (IR; lack of efficacy or intolerance) to tumor necrosis factor inhibitors (TNFi). METHODS Adults with active PsA (≥ 3 swollen joints, ≥ 3 tender joints) and IR to one or two TNFi (TNFi-IR) were randomized 2:1 to guselkumab at Weeks 0, 4, then every 8 weeks (Q8W) or placebo➔guselkumab Q8W at Week 24 with possible early escape at Week 16. Levels of serum cytokines, including interferon ɣ (IFNɣ), IL-10, and tumor necrosis factor α (TNFα); T helper 17 (Th17) effector cytokines IL-17A, IL-17F, and IL-22; and acute phase proteins C-reactive protein (CRP), IL-6, and serum amyloid A (SAA), were assessed and compared with matched healthy controls; guselkumab pharmacodynamics through Week 24 were also assessed. Associations between baseline biomarker levels and 1) baseline disease activity (28-joint disease activity score using CRP [DAS28-CRP], psoriasis area and severity index [PASI], and % body surface area [BSA] affected by psoriasis) and 2) clinical response (including ≥ 20% improvement in American College of Rheumatology criteria [ACR20] response) at Week 24 were assessed. RESULTS Baseline serum levels of IL-6, IL-10, IL-17A, IL-17F, IL-22, TNFα, and IFNɣ were significantly higher in COSMOS TNFi-IR participants than in matched healthy controls. Baseline IL-6, CRP, and SAA levels were associated with baseline DAS28-CRP. IL-17A and IL-17F levels were associated with baseline PASI score and psoriasis BSA. Baseline swollen or tender joint counts did not associate with baseline biomarker levels. At Week 24, significant decreases from baseline in CRP, SAA, IL-17A, IL-17F, and IL-22 levels were seen in guselkumab, but not placebo-, treated participants. IL-17F and IL-22 levels at Week 24 in guselkumab-treated participants did not significantly differ from those of matched healthy controls. Guselkumab-treated participants achieving ACR20 response at Week 24 exhibited higher baseline IL-22 and IFNɣ levels versus nonresponders. CONCLUSIONS Results from COSMOS participants with active, TNFi-IR PsA suggest guselkumab reduces levels of effector cytokines associated with the IL-23/IL-17 pathway, including those associated with baseline arthritis and skin disease activity. TRIAL REGISTRATION ClinicalTrials.gov: NCT03796858.
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Affiliation(s)
- Georg Schett
- Department of Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany.
| | - Warner Chen
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Sheng Gao
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Soumya D Chakravarty
- Immunology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - May Shawi
- Immunology, Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA
| | - Frederic Lavie
- Immunology, Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Issy Les Moulineaux, France
| | | | | | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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O’Brien CM, Kitas GD, Rayner F, Isaacs JD, Baker KF, Pratt AG, Buckley CD, Raza K, Filer A, Siebert S, McInnes I, McGucken A, Fenton SAM. Number of days required to measure sedentary time and physical activity using accelerometery in rheumatoid arthritis: a reliability study. Rheumatol Int 2023; 43:1459-1465. [PMID: 37227468 PMCID: PMC10261182 DOI: 10.1007/s00296-023-05342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
This study aimed to determine the minimum number of days required to reliably estimate free-living sedentary time, light-intensity physical activity (LPA) and moderate-intensity physical activity (MPA) using accelerometer data in people with Rheumatoid Arthritis (RA), according to Disease Activity Score-28-C-reactive protein (DAS-28-CRP). Secondary analysis of two existing RA cohorts with controlled (cohort 1) and active (cohort 2) disease was undertaken. People with RA were classified as being in remission (DAS-28-CRP < 2.4, n = 9), or with low (DAS-28-CRP ≥ 2.4-≤ 3.2, n = 15), moderate (DAS-28-CRP > 3.2-≤ 5.1, n = 41) or high (DAS-28-CRP > 5.1, n = 16) disease activity. Participants wore an ActiGraph accelerometer on their right hip for 7 days during waking hours. Validated RA-specific cut-points were applied to accelerometer data to estimate free-living sedentary time, LPA and MPA (%/day). Single-day intraclass correlation coefficients (ICC) were calculated and used in the Spearman Brown prophecy formula to determine the number of monitoring days required to achieve measurement reliability (ICC ≥ 0.80) for each group. The remission group required ≥ 4 monitoring days to achieve an ICC ≥ 0.80 for sedentary time and LPA, with low, moderate and high disease activity groups requiring ≥ 3 monitoring days to reliably estimate these behaviours. The monitoring days required for MPA were more variable across disease activity groups (remission = ≥ 3 days; low = ≥ 2 days; moderate = ≥ 3 days; high = ≥ 5 days). We conclude at least 4 monitoring days will reliably estimate sedentary time and LPA in RA, across the whole spectrum of disease activity. However, to reliably estimate behaviours across the movement continuum (sedentary time, LPA, MPA), at least 5 monitoring days are required.
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Affiliation(s)
- Ciara M. O’Brien
- School of Psychology, University of Surrey, Guildford, UK
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands, Dudley, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - George D. Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands, Dudley, UK
| | - Fiona Rayner
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Musculoskeletal Services Directorate, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - John D. Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Musculoskeletal Services Directorate, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Kenneth F. Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Musculoskeletal Services Directorate, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Arthur G. Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Musculoskeletal Services Directorate, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Christopher D. Buckley
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Rheumatology Research Group, Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Unit, University of Birmingham, Birmingham, UK
- Research Into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karim Raza
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- Rheumatology Research Group, Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Unit, University of Birmingham, Birmingham, UK
- Research Into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Andrew Filer
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- Rheumatology Research Group, Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Unit, University of Birmingham, Birmingham, UK
- Research Into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Iain McInnes
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Andrew McGucken
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Sally A. M. Fenton
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands, Dudley, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- Rheumatology Research Group, Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Unit, University of Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - The BIOFLARE Consortium
- School of Psychology, University of Surrey, Guildford, UK
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands, Dudley, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Musculoskeletal Services Directorate, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Rheumatology Research Group, Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Unit, University of Birmingham, Birmingham, UK
- Research Into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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23
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Moshi B, Yongolo N, Biswaro SM, Maro H, Linus S, Siebert S, Nkenguye W, McIntosh E, Shirima F, Njau RE, Andongolile AA, Mwanswila MJ, Halliday JEB, Krauth S, Kilonzo K, Walker RW, Temu GA, Mmbaga BT. Trends of frequency, mortality and risk factors among patients admitted with stroke from 2017 to 2019 to the medical ward at Kilimanjaro Christian Medical Centre hospital: a retrospective observational study. BMJ Open 2023; 13:e071918. [PMID: 37524544 PMCID: PMC10391824 DOI: 10.1136/bmjopen-2023-071918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The burden of stroke has increased in recent years worldwide, particularly in low-income and middle-income countries. In this study we aim to determine the number of stroke admissions, and associated comorbidities, at a referral hospital in Northern Tanzania. DESIGN This was a retrospective observational study. SETTING The study was conducted at a tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC), in the orthern zone of Tanzania. PARTICIPANTS The study included adults aged 18 years and above, who were admitted to the medical wards from 2017 to 2019. OUTCOME The primary outcome was the proportion of patients who had a stroke admitted in the medical ward at KCMC and the secondary outcome was clinical outcome such as mortality. METHODS We conducted a retrospective audit of medical records from 2017 to 2019 for adult patients admitted to the medical ward at KCMC. Data extracted included demographic characteristics, previous history of stroke and outcome of the admission. Factors associated with stroke were investigated using logistic regression. RESULTS Among 7976 patients admitted between 2017 and 2019, 972 (12.2%) were patients who had a stroke. Trends show an increase in patients admitted with stroke over the 3 years with 222, 292 and 458 in 2017, 2018 and 2019, respectively. Of the patients who had a stroke, 568 (58.4%) had hypertension while 167 (17.2%) had diabetes mellitus. The proportion of admitted stroke patients aged 18-45 years, increased from 2017 (n=28, 3.4%) to 2019 (n=40, 4.3%). The in-hospital mortality related to stroke was 229 (23.6%) among 972 patients who had a stroke and female patients had 50% higher odds of death as compared with male patients (OR:1.5; CI 1.30 to 1.80). CONCLUSION The burden of stroke on individuals and health services is increasing over time, which reflects a lack of awareness on the cause of stroke and effective preventive measures. Prioritising interventions directed towards the reduction of non-communicable diseases and associated complications, such as stroke, is urgently needed.
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Affiliation(s)
- Baraka Moshi
- Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Nateiya Yongolo
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Sanjura Mandela Biswaro
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Hans Maro
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Epidemiology, Tanzania Health Promotion Support (THPS), Moshi, United Republic of Tanzania
| | - Sakanda Linus
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Depatment of Inflammation Medicine and Rheumatology, Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - William Nkenguye
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Emma McIntosh
- Depatment of Inflammation Medicine and Rheumatology, Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Febronia Shirima
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Rosalia E Njau
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Alice A Andongolile
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Manasseh Joel Mwanswila
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Jo E B Halliday
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, London, UK
| | - Stefanie Krauth
- Depatment of Inflammation Medicine and Rheumatology, Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, London, UK
| | - Kajiru Kilonzo
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Richard William Walker
- Depatment of One health and Veterinary Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Gloria August Temu
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Blandina T Mmbaga
- Department of Clinical research, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Depatment of Epidemiology and Applied Biostatistics and Depatment of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
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24
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Barnes E, Goodyear CS, Willicombe M, Gaskell C, Siebert S, I de Silva T, Murray SM, Rea D, Snowden JA, Carroll M, Pirrie S, Bowden SJ, Dunachie SJ, Richter A, Lim Z, Satsangi J, Cook G, Pope A, Hughes A, Harrison M, Lim SH, Miller P, Klenerman P, Basu N, Gilmour A, Irwin S, Meacham G, Marjot T, Dimitriadis S, Kelleher P, Prendecki M, Clarke C, Mortimer P, McIntyre S, Selby R, Meardon N, Nguyen D, Tipton T, Longet S, Laidlaw S, Orchard K, Ireland G, Thomas D, Kearns P, Kirkham A, McInnes IB. SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease. Nat Med 2023; 29:1760-1774. [PMID: 37414897 PMCID: PMC10353927 DOI: 10.1038/s41591-023-02414-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune responses and infection outcomes were evaluated in 2,686 patients with varying immune-suppressive disease states after administration of two Coronavirus Disease 2019 (COVID-19) vaccines. Overall, 255 of 2,204 (12%) patients failed to develop anti-spike antibodies, with an additional 600 of 2,204 (27%) patients generating low levels (<380 AU ml-1). Vaccine failure rates were highest in ANCA-associated vasculitis on rituximab (21/29, 72%), hemodialysis on immunosuppressive therapy (6/30, 20%) and solid organ transplant recipients (20/81, 25% and 141/458, 31%). SARS-CoV-2-specific T cell responses were detected in 513 of 580 (88%) patients, with lower T cell magnitude or proportion in hemodialysis, allogeneic hematopoietic stem cell transplantation and liver transplant recipients (versus healthy controls). Humoral responses against Omicron (BA.1) were reduced, although cross-reactive T cell responses were sustained in all participants for whom these data were available. BNT162b2 was associated with higher antibody but lower cellular responses compared to ChAdOx1 nCoV-19 vaccination. We report 474 SARS-CoV-2 infection episodes, including 48 individuals with hospitalization or death from COVID-19. Decreased magnitude of both the serological and the T cell response was associated with severe COVID-19. Overall, we identified clinical phenotypes that may benefit from targeted COVID-19 therapeutic strategies.
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Affiliation(s)
- Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl S Goodyear
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Charlotte Gaskell
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Stefan Siebert
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Thushan I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Sheffield, UK
| | - Sam M Murray
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Miles Carroll
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Sarah J Bowden
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Susanna J Dunachie
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Richter
- Clinical Immunology Service, University of Birmingham, Edgbaston, Birmingham, UK
| | - Zixiang Lim
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jack Satsangi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gordon Cook
- National Institute for Health Research, Leeds MIC, University of Leeds, Leeds, UK
| | - Ann Pope
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Ana Hughes
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Molly Harrison
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Sean H Lim
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Paul Miller
- British Society of Blood and Marrow Transplantation and Cellular Therapy, Guy's Hospital, London, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Basu
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Ashley Gilmour
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Sophie Irwin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina Meacham
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas Marjot
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Peter Kelleher
- Department of Infectious Diseases, Imperial College London, School of Medicine Chelsea and Westminster Hospital, London, UK
| | - Maria Prendecki
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Candice Clarke
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Paige Mortimer
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Stacey McIntyre
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Rachael Selby
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Naomi Meardon
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Sheffield, UK
| | - Dung Nguyen
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Tom Tipton
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Stephanie Longet
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Stephen Laidlaw
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Kim Orchard
- Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Georgina Ireland
- UK Health Security Agency (UKHSA), Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - David Thomas
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Amanda Kirkham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Iain B McInnes
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
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25
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Gossec L, Siebert S, Bergmans P, de Vlam K, Gremese E, Joven-Ibáñez B, Korotaeva TV, Lavie F, Noël W, Nurmohamed MT, Sfikakis PP, Sharaf M, Theander E, Smolen JS. Improvement in patient-reported outcomes and work productivity following 3-year ustekinumab or tumour necrosis factor inhibitor treatment in patients with psoriatic arthritis: results from the PsABio real-world study. Arthritis Res Ther 2023; 25:109. [PMID: 37353788 PMCID: PMC10288720 DOI: 10.1186/s13075-023-03058-y] [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: 11/22/2022] [Accepted: 04/27/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND To evaluate the real-world effect of the IL-12/23 inhibitor ustekinumab or of a tumour necrosis factor inhibitor (TNFi) on patient-reported outcomes (PRO) and their association with effectiveness endpoints in psoriatic arthritis (PsA) patients over 3 years. METHODS In PsABio (NCT02627768), a prospective, observational study, patients with PsA that were prescribed first- to third-line ustekinumab or a TNFi, and remained on that drug for 3 years, were analysed for change in baseline in PROs (EuroQol-5 dimensions health state VAS [EQ-5D VAS], 12-item Psoriatic Arthritis Impact of Disease questionnaire [PsAID-12; range 0-10], Work Productivity and Activity Impairment for Psoriatic Arthritis questionnaire [WPAI; results expressed as a percentage for each domain]), and the association between PROs and WPAI with effectiveness endpoints, clinical disease activity index for psoriatic arthritis (cDAPSA), low disease activity (LDA)/remission, minimal disease activity (MDA) and very low disease activity (VLDA). RESULTS In 437 patients (mean age 49.1 years, 47.8% female), at 3 years, ustekinumab and TNFi treatment led to comparable improvements in EQ-5D VAS; mean change from baseline (95% confidence intervals [CI]) was 11.0 (6.5; 15.4) and 18.9 (14.0; 23.9), respectively. Both groups improved PsAID-12 after 3 years; mean change from baseline (95% CI) was -2.9 (-3.2; -2.5) and -3.5 (-3.9; -3.2), respectively. At baseline, due to their PsA, TNFi-treated patients had lower work productivity compared to ustekinumab-treated patients; mean productivity reduction (95% CI) was 58.8 [52.4; 65.2] and 43.3 [35.6; 51.1]. Over 3 years, TNFi-treated patients had a greater improvement in work productivity compared to ustekinumab-treated patients, ultimately leaving work productivity to be comparable between groups; mean improvement (95% CI) was 44.5% (38.4; 50.6) and 24.9% (15.8; 34.0), respectively. A similar trend was observed in activity impairment. Patients in both treatment groups who achieved effectiveness endpoints, cDAPSA LDA/remission, MDA, and VLDA had greater improvement in PROs and WPAI than patients who did not achieve these endpoints. CONCLUSIONS At 3 years, improvements in PROs following ustekinumab or TNFi treatment were generally comparable; however, TNFi-treated patients achieved a greater improvement in work productivity, although this group started from a lower baseline. Achievement of effectiveness endpoints, independent of treatment group, also improved PROs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02627768. Registered on 11 December 2015.
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Affiliation(s)
- Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
- Rheumatology Department, Pitié-Salpêtrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | | | | | | | - Elisa Gremese
- Fondazione Policlinico A Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Frederic Lavie
- The Janssen Pharmaceutical Companies of Johnson & Johnson, Paris, France
| | - Wim Noël
- Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Petros P Sfikakis
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Elke Theander
- Janssen, Solna, Sweden
- Present address: Malmö University Hospital, Malmö, Sweden
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26
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Gossec L, Theander E, Chakravarty SD, Bergmans P, Lavie F, Noël W, Sharaf M, Siebert S, Smolen JS. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther 2023; 25:100. [PMID: 37296456 PMCID: PMC10251537 DOI: 10.1186/s13075-023-03078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND This post-hoc analysis of PsABio (NCT02627768) evaluated safety, effectiveness and treatment persistence in patients < 60 and ≥ 60 years of age receiving ustekinumab over 3 years. METHODS Measures included adverse events (AE), clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) low disease activity (LDA) including remission, Psoriatic Arthritis Impact of Disease-12 (PsAID-12), Minimal Disease Activity, dactylitis, nail/skin involvement and time to treatment stop. Data were analysed descriptively. RESULTS Overall, 336 patients < 60 and 103 ≥ 60 years received ustekinumab, with a similar gender balance. A numerically lower proportion of younger patients reported at least one AE: 124/379 (32.7%) vs 47/115 (40.9%) for patients < 60 and ≥ 60 years, respectively. Serious AEs were low (< 10%) in both groups. At 6 months, the proportion of patients with cDAPSA LDA was 138/267 (51.7%) and 35/80 (43.8%) for patients < 60 and ≥ 60 years, respectively, with the effectiveness being maintained through 36 months. PsAID-12 mean scores reduced for both groups from a baseline mean of 5.73 and 5.61 for patients < 60 and ≥ 60 years, respectively, to 3.81 and 3.88, respectively, at 6 months, and 2.02 and 3.24, respectively, at 36 months. Regarding treatment persistence, 173/336 (51.5%) vs 47/103 (45.6%) patients < 60 and ≥ 60 years, respectively, stopped or switched treatment. CONCLUSION Fewer AEs were observed over 3 years for younger versus older patients with PsA. There were no clinically meaningful treatment response differences. Persistence was numerically higher in the older age group.
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Affiliation(s)
- Laure Gossec
- Faculty of Medicine, Sorbonne Université, INSERM, IPLESP, Paris, France.
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, 47-83 Bd Hôpital, 75013, Paris, France.
| | - Elke Theander
- Department of Medical Affairs, Janssen-Cilag AB, Solna, Sweden
| | - Soumya D Chakravarty
- Department of Immunology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Department of Rheumatology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Paul Bergmans
- Department of Biostatistics, Janssen-Cilag BV, Breda, Netherlands
| | - Frederic Lavie
- Department of Medical Affairs, Janssen-Cilag, Cedex, France
| | - Wim Noël
- Department of Medical Affairs, Janssen Pharmaceuticals NV, Beerse, Belgium
| | - Mohamed Sharaf
- Department of Medical Affairs, Janssen, Dubai, United Arab Emirates
| | - Stefan Siebert
- School of Infection & Immunity, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Josef S Smolen
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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27
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Johnsson H, Cole J, Siebert S, McInnes IB, Graham G. Cutaneous lesions in psoriatic arthritis are enriched in chemokine transcriptomic pathways. Arthritis Res Ther 2023; 25:73. [PMID: 37131254 PMCID: PMC10152590 DOI: 10.1186/s13075-023-03034-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/20/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Skin from people with psoriasis has been extensively studied and is assumed to be identical to skin from those with psoriatic arthritis (PsA). Chemokines and the CC chemokine scavenger receptor ACKR2 are upregulated in uninvolved psoriasis. ACKR2 has been proposed as a regulator of cutaneous inflammation in psoriasis. The aim of this study was to compare the transcriptome of PsA skin to healthy control (HC) skin and evaluate ACKR2 expression in PsA skin. METHODS Full-thickness skin biopsies from HC, lesional and uninvolved skin from participants with PsA were sequenced on NovaSeq 6000. Findings were validated using qPCR and RNAscope. RESULTS Nine HC and nine paired PsA skin samples were sequenced. PsA uninvolved skin was transcriptionally similar to HC skin, and lesional PsA skin was enriched in epidermal and inflammatory genes. Lesional PsA skin was enriched in chemokine-mediated signalling pathways, but uninvolved skin was not. ACKR2 was upregulated in lesional PsA skin but had unchanged expression in uninvolved compared with HC skin. The expression of ACKR2 was confirmed by qPCR, and RNAscope demonstrated strong expression of ACKR2 in the suprabasal layer of the epidermis in PsA lesions. CONCLUSION Chemokines and their receptors are upregulated in lesional PsA skin but relatively unchanged in uninvolved PsA skin. In contrast to previous psoriasis studies, ACKR2 was not upregulated in uninvolved PsA skin. Further understanding of the chemokine system in PsA may help to explain why inflammation spreads from the skin to the joints in some people with psoriasis.
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Affiliation(s)
- Hanna Johnsson
- School of Infection and Immunity, University of Glasgow, 120 University Place, Glasgow, G12 8TA, UK
| | - John Cole
- School of Infection and Immunity, University of Glasgow, 120 University Place, Glasgow, G12 8TA, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, 120 University Place, Glasgow, G12 8TA, UK
| | - Iain B McInnes
- School of Infection and Immunity, University of Glasgow, 120 University Place, Glasgow, G12 8TA, UK
| | - Gerard Graham
- School of Infection and Immunity, University of Glasgow, 120 University Place, Glasgow, G12 8TA, UK.
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28
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Crowe LAN, Akbar M, de Vos RJ, Kirwan PD, Kjaer M, Pedret C, McInnes IB, Siebert S, Millar NL. Pathways driving tendinopathy and enthesitis: siblings or distant cousins in musculoskeletal medicine? Lancet Rheumatol 2023; 5:e293-e304. [PMID: 38251592 DOI: 10.1016/s2665-9913(23)00074-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 01/23/2024]
Abstract
Tendinopathy and enthesitis share clinical, anatomical, and molecular parallels. However, their relationship is complex, presenting challenges in diagnosis and treatment. The biomechanics underlying these pathologies, together with relative immune and stromal contributions to pathology, are characterised by crucial comparative elements. However, methodologies used to study enthesitis and tendinopathy have been divergent, which could account for discrepancies in how these conditions are perceived and treated. In this Review, we summarise key clinical parallels between these two common presentations in musculoskeletal medicine and address factors that currently preclude development of more effective therapeutics. Furthermore, we describe molecular similarities and disparities that govern pathological mechanisms in tendinopathy and enthesitis, thus informing translational studies and treatment strategies.
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Affiliation(s)
- Lindsay A N Crowe
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Moeed Akbar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paul D Kirwan
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland; Physiotherapy Department, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Michael Kjaer
- Institute of Sports Medicine, Copenhagen University Hospital-Bispebjerg Frederiksberg, Copenhagen, Denmark
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Mapfre de Medicina del Tenis C/Muntaner, Barcelona, Spain
| | - Iain B McInnes
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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29
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Lechable M, Tang X, Siebert S, Feldbacher A, Fernández-Quintero ML, Breuker K, Juliano CE, Liedl KR, Hobmayer B, Hartl M. High Intrinsic Oncogenic Potential in the Myc-Box-Deficient Hydra Myc3 Protein. Cells 2023; 12:cells12091265. [PMID: 37174665 PMCID: PMC10177328 DOI: 10.3390/cells12091265] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The proto-oncogene myc has been intensively studied primarily in vertebrate cell culture systems. Myc transcription factors control fundamental cellular processes such as cell proliferation, cell cycle control and stem cell maintenance. Myc interacts with the Max protein and Myc/Max heterodimers regulate thousands of target genes. The genome of the freshwater polyp Hydra encodes four myc genes (myc1-4). Previous structural and biochemical characterization showed that the Hydra Myc1 and Myc2 proteins share high similarities with vertebrate c-Myc, and their expression patterns suggested a function in adult stem cell maintenance. In contrast, an additional Hydra Myc protein termed Myc3 is highly divergent, lacking the common N-terminal domain and all conserved Myc-boxes. Single cell transcriptome analysis revealed that the myc3 gene is expressed in a distinct population of interstitial precursor cells committed to nerve- and gland-cell differentiation, where the Myc3 protein may counteract the stemness actions of Myc1 and Myc2 and thereby allow the implementation of a differentiation program. In vitro DNA binding studies showed that Myc3 dimerizes with Hydra Max, and this dimer efficiently binds to DNA containing the canonical Myc consensus motif (E-box). In vivo cell transformation assays in avian fibroblast cultures further revealed an unexpected high potential for oncogenic transformation in the conserved Myc3 C-terminus, as compared to Hydra Myc2 or Myc1. Structure modeling of the Myc3 protein predicted conserved amino acid residues in its bHLH-LZ domain engaged in Myc3/Max dimerization. Mutating these amino acid residues in the human c-Myc (MYC) sequence resulted in a significant decrease in its cell transformation potential. We discuss our findings in the context of oncogenic transformation and cell differentiation, both relevant for human cancer, where Myc represents a major driver.
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Affiliation(s)
- Marion Lechable
- Institute of Zoology, University of Innsbruck, 6020 Innsbruck, Austria
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
| | - Xuechen Tang
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
- Institute of Inorganic and Theoretical Chemistry, University of Innsbruck, 6020 Innsbruck, Austria
| | - Stefan Siebert
- Department of Molecular and Cellular Biology, University of California, Davis, CA 95616, USA
| | - Angelika Feldbacher
- Institute of Zoology, University of Innsbruck, 6020 Innsbruck, Austria
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
| | - Monica L Fernández-Quintero
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
- Institute of Inorganic and Theoretical Chemistry, University of Innsbruck, 6020 Innsbruck, Austria
| | - Kathrin Breuker
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
- Institute of Organic Chemistry, University of Innsbruck, 6020 Innsbruck, Austria
| | - Celina E Juliano
- Department of Molecular and Cellular Biology, University of California, Davis, CA 95616, USA
| | - Klaus R Liedl
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
- Institute of Inorganic and Theoretical Chemistry, University of Innsbruck, 6020 Innsbruck, Austria
| | - Bert Hobmayer
- Institute of Zoology, University of Innsbruck, 6020 Innsbruck, Austria
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
| | - Markus Hartl
- Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria
- Institute of Biochemistry, University of Innsbruck, 6020 Innsbruck, Austria
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Tamaoki N, Siebert S, Maeda T, Ha NH, Good ML, Huang Y, Vodnala SK, Haro-Mora JJ, Uchida N, Tisdale JF, Sweeney CL, Choi U, Brault J, Koontz S, Malech HL, Yamazaki Y, Isonaka R, Goldstein DS, Kimura M, Takebe T, Zou J, Stroncek DF, Robey PG, Kruhlak MJ, Restifo NP, Vizcardo R. Self-organized yolk sac-like organoids allow for scalable generation of multipotent hematopoietic progenitor cells from induced pluripotent stem cells. Cell Rep Methods 2023; 3:100460. [PMID: 37159663 PMCID: PMC10163025 DOI: 10.1016/j.crmeth.2023.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/11/2022] [Accepted: 03/27/2023] [Indexed: 05/11/2023]
Abstract
Although the differentiation of human induced pluripotent stem cells (hiPSCs) into various types of blood cells has been well established, approaches for clinical-scale production of multipotent hematopoietic progenitor cells (HPCs) remain challenging. We found that hiPSCs cocultured with stromal cells as spheroids (hematopoietic spheroids [Hp-spheroids]) can grow in a stirred bioreactor and develop into yolk sac-like organoids without the addition of exogenous factors. Hp-spheroid-induced organoids recapitulated a yolk sac-characteristic cellular complement and structures as well as the functional ability to generate HPCs with lympho-myeloid potential. Moreover, sequential hemato-vascular ontogenesis could also be observed during organoid formation. We demonstrated that organoid-induced HPCs can be differentiated into erythroid cells, macrophages, and T lymphocytes with current maturation protocols. Notably, the Hp-spheroid system can be performed in an autologous and xeno-free manner, thereby improving the feasibility of bulk production of hiPSC-derived HPCs in clinical, therapeutic contexts.
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Affiliation(s)
- Naritaka Tamaoki
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Center of Cell-based Therapy, National Cancer Institute, NIH, Bethesda, MD 20892, USA
- Corresponding author
| | - Stefan Siebert
- Department of Molecular and Cellular Biology, University of California, Davis, Davis, CA 95616, USA
| | - Takuya Maeda
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Center of Cell-based Therapy, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Ngoc-Han Ha
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Meghan L. Good
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Center of Cell-based Therapy, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Yin Huang
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Center of Cell-based Therapy, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Suman K. Vodnala
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Center of Cell-based Therapy, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Juan J. Haro-Mora
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute/National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - Naoya Uchida
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute/National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - John F. Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute/National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - Colin L. Sweeney
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
| | - Uimook Choi
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
| | - Julie Brault
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
| | - Sherry Koontz
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
| | - Harry L. Malech
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
| | - Yasuhiro Yamazaki
- Immune Deficiency Genetics Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
| | - Risa Isonaka
- Autonomic Medicine Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - David S. Goldstein
- Autonomic Medicine Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Masaki Kimura
- Division of Gastroenterology, Hepatology & Nutrition, Developmental Biology, Center for Stem Cell and Organoid Medicine (CuSTOM), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Takanori Takebe
- Division of Gastroenterology, Hepatology & Nutrition, Developmental Biology, Center for Stem Cell and Organoid Medicine (CuSTOM), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe), and Division of Stem Cell and Organoid Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | - Jizhong Zou
- iPSC Core, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892, USA
| | - David F. Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, MD 20892, USA
| | - Pamela G. Robey
- Skeletal Biology Section, National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, USA
| | - Michael J. Kruhlak
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Nicholas P. Restifo
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Center of Cell-based Therapy, National Cancer Institute, NIH, Bethesda, MD 20892, USA
- Corresponding author
| | - Raul Vizcardo
- Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA
- Center of Cell-based Therapy, National Cancer Institute, NIH, Bethesda, MD 20892, USA
- Corresponding author
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Siebert S, Behrens F, Lubrano E, Martin N, Sharaf M, Contré C, Theander E, Queiro R, Zimmermann M, Gossec L. PsABIOnd Study and eDaily Substudy Design: Long-Term Effectiveness and Safety of Guselkumab and IL-17 Inhibitors in Routine Clinical Practice in Patients with Psoriatic Arthritis. Rheumatol Ther 2023; 10:489-505. [PMID: 36585602 PMCID: PMC10011238 DOI: 10.1007/s40744-022-00518-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Randomised clinical studies in psoriatic arthritis (PsA) do not always reflect patients in routine clinical practice. Large-scale data from routine practice are needed to better understand drug persistence, effectiveness and long-term safety of therapeutic agents. METHODS PsABIOnd is an international, prospective, observational study designed to collect long-term routine care data in patients with PsA who receive guselkumab (an interleukin-23 [IL-23] inhibitor) or an interleukin-17 (IL-17) inhibitor. Adult patients (≥ 18 years) with a confirmed diagnosis of PsA who are starting guselkumab or any approved IL-17 inhibitor as a first, second, third or fourth line of PsA treatment and who provide written informed consent will be eligible to participate. Participants will be followed for a maximum of 36 months (+3 months) from the start of treatment. Study visits will occur in line with the standard of care, approximately every 6 months, plus an additional visit at 3 months after the start of treatment. eDaily by PsABIOnd - aneHealth substudy, will document the impact of these treatments on wellbeing and symptoms in a subgroup of participants over a 24-week (+4 weeks) observation period on treatment. PLANNED OUTCOMES The primary objective of PsABIOnd is to evaluate treatment persistence with guselkumab and IL-17 inhibitors. Data sources will include validated electronic patient-reported outcomes (ePROs) and physician-completed assessments. Safety data will be collected through reporting adverse events. The eDaily by PsABIOnd substudy will use wearable and digital technologies for continuous activity and sleep monitoring, and frequent patient eDiary and ePRO collection to provide a more detailed and comprehensive picture of PsA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05049798.
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Affiliation(s)
- Stefan Siebert
- School of Infection and Immunity, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
| | - Frank Behrens
- Rheumatology and Fraunhofer TMP, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ennio Lubrano
- Vincenzo Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Nicolas Martin
- Janssen Pharmaceutical Companies of Johnson & Johnson, Allschwil, Switzerland
| | - Mohamed Sharaf
- Johnson and Johnson Middle East, Dubai, United Arab Emirates
| | | | - Elke Theander
- Previous Employee of Janssen-Cilag AB, Solna, Sweden
| | - Rubén Queiro
- Rheumatology Division & ISPA Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo University, Oviedo, Spain
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
- Pitié-Salpêtrière Hospital, APHP, Rheumatology Department, Paris, France
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32
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Gossec L, Siebert S, Bergmans P, de Vlam K, Gremese E, Joven-Ibáñez B, Korotaeva TV, Lavie F, Noël W, Nurmohamed MT, Sfikakis PP, Sharaf M, Theander E, Smolen JS. Long-term effectiveness and persistence of ustekinumab and TNF inhibitors in patients with psoriatic arthritis: final 3-year results from the PsABio real-world study. Ann Rheum Dis 2023; 82:496-506. [PMID: 36600178 PMCID: PMC10086293 DOI: 10.1136/ard-2022-222879] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate real-world persistence and effectiveness of the IL-12/23 inhibitor, ustekinumab or a tumour necrosis factor inhibitor (TNFi) for psoriatic arthritis over 3 years. METHODS PsABio (NCT02627768), a prospective, observational study, followed patients with PsA prescribed first-line to third-line ustekinumab or a TNFi. Persistence and effectiveness (achievement of clinical Disease Activity for PSA (cDAPSA) low disease activity (LDA)/remission and minimal disease activity/very LDA (MDA/VLDA)) were assessed every 6 months. Safety data were collected over 3 years. Analyses to compare the modes of action were adjusted on baseline differences by propensity scores (PS). RESULTS In 895 patients (mean age 49.8 years, 44.7% males), at 3 years, the proportion of patients still on their initial treatments was similar with ustekinumab (49.9%) and TNFi (47.8%). No difference was seen in the risk of stopping/switching; PS-adjusted hazard ratio (95% CI) for stopping/switching ustekinumab versus TNFi was 0.87 (0.68 to 1.11). In the overall population, cDAPSA LDA/remission was achieved in 58.6%/31.4% ustekinumab-treated and 69.8%/45.0% TNFi-treated patients; PS-adjusted ORs (95% CI) were 0.89 (0.63 to 1.26) for cDAPSA LDA; 0.72 (0.50 to 1.05) for remission. MDA/VLDA was achieved in 41.4%/19.2% of ustekinumab-treated and 54.2%/26.9% of TNFi-treated patients with overlapping PS-adjusted ORs. A greater percentage of TNFi-treated patients achieved effectiveness outcomes. Both treatments exhibited good long-term safety profiles, although ustekinumab-treated patients had a lower rate of adverse events (AEs) versus TNFi. CONCLUSION At 3 years, there was generally comparable persistence after ustekinumab or TNFi treatment, but AE rates were lower with ustekinumab.
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Affiliation(s)
- Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | | | - Elisa Gremese
- Fondazione Policlinico A Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Frederic Lavie
- The Janssen Pharmaceutical Companies of Johnson & Johnson, Paris, France
| | - Wim Noël
- Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Petros P Sfikakis
- National and Kapodistrian University of Athens Medical School, Athens, Greece
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Kennedy J, Kennedy N, Cooksey R, Choy E, Siebert S, Rahman M, Brophy S. Predicting a diagnosis of ankylosing spondylitis using primary care health records-A machine learning approach. PLoS One 2023; 18:e0279076. [PMID: 37000839 PMCID: PMC10065228 DOI: 10.1371/journal.pone.0279076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/01/2022] [Indexed: 04/03/2023] Open
Abstract
Ankylosing spondylitis is the second most common cause of inflammatory arthritis. However, a successful diagnosis can take a decade to confirm from symptom onset (via x-rays). The aim of this study was to use machine learning methods to develop a profile of the characteristics of people who are likely to be given a diagnosis of AS in future. The Secure Anonymised Information Linkage databank was used. Patients with ankylosing spondylitis were identified using their routine data and matched with controls who had no record of a diagnosis of ankylosing spondylitis or axial spondyloarthritis. Data was analysed separately for men and women. The model was developed using feature/variable selection and principal component analysis to develop decision trees. The decision tree with the highest average F value was selected and validated with a test dataset. The model for men indicated that lower back pain, uveitis, and NSAID use under age 20 is associated with AS development. The model for women showed an older age of symptom presentation compared to men with back pain and multiple pain relief medications. The models showed good prediction (positive predictive value 70%-80%) in test data but in the general population where prevalence is very low (0.09% of the population in this dataset) the positive predictive value would be very low (0.33%-0.25%). Machine learning can be used to help profile and understand the characteristics of people who will develop AS, and in test datasets with artificially high prevalence, will perform well. However, when applied to a general population with low prevalence rates, such as that in primary care, the positive predictive value for even the best model would be 1.4%. Multiple models may be needed to narrow down the population over time to improve the predictive value and therefore reduce the time to diagnosis of ankylosing spondylitis.
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Affiliation(s)
- Jonathan Kennedy
- Data Science Building, Swansea University, Wales, United Kingdom
| | - Natasha Kennedy
- Data Science Building, Swansea University, Wales, United Kingdom
| | - Roxanne Cooksey
- Data Science Building, Swansea University, Wales, United Kingdom
| | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Stefan Siebert
- Institute of Infection Immunity & Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Muhammad Rahman
- Data Science Building, Swansea University, Wales, United Kingdom
| | - Sinead Brophy
- Data Science Building, Swansea University, Wales, United Kingdom
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34
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Heino M, Kinnunen P, Anderson W, Ray DK, Puma MJ, Varis O, Siebert S, Kummu M. Increased probability of hot and dry weather extremes during the growing season threatens global crop yields. Sci Rep 2023; 13:3583. [PMID: 36869041 PMCID: PMC9984494 DOI: 10.1038/s41598-023-29378-2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 02/03/2023] [Indexed: 03/05/2023] Open
Abstract
Although extreme weather events recur periodically everywhere, the impacts of their simultaneous occurrence on crop yields are globally unknown. In this study, we estimate the impacts of combined hot and dry extremes as well as cold and wet extremes on maize, rice, soybean, and wheat yields using gridded weather data and reported crop yield data at the global scale for 1980-2009. Our results show that co-occurring extremely hot and dry events have globally consistent negative effects on the yields of all inspected crop types. Extremely cold and wet conditions were observed to reduce crop yields globally too, although to a lesser extent and the impacts being more uncertain and inconsistent. Critically, we found that over the study period, the probability of co-occurring extreme hot and dry events during the growing season increased across all inspected crop types; wheat showing the largest, up to a six-fold, increase. Hence, our study highlights the potentially detrimental impacts that increasing climate variability can have on global food production.
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Affiliation(s)
- Matias Heino
- Water and Development Research Group, Aalto University, Finland, Tietotie 1E, 02150, Espoo, Finland.
| | - Pekka Kinnunen
- Water and Development Research Group, Aalto University, Finland, Tietotie 1E, 02150, Espoo, Finland
| | - Weston Anderson
- International Research Institute for Climate and Society, Columbia University, Palisades, NY, 10964, USA
- Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Deepak K Ray
- Institute On the Environment, University of Minnesota, Saint Paul, MN, USA
| | - Michael J Puma
- Center for Climate Systems Research, Columbia University, 2880 Broadway, New York, NY, 10025, USA
- NASA Goddard Institute for Space Studies, 2880 Broadway, New York, NY, 10025, USA
| | - Olli Varis
- Water and Development Research Group, Aalto University, Finland, Tietotie 1E, 02150, Espoo, Finland
| | - Stefan Siebert
- Department of Crop Sciences, University of Goettingen, Von-Siebold-Str. 8, 37075, Goettingen, Germany
| | - Matti Kummu
- Water and Development Research Group, Aalto University, Finland, Tietotie 1E, 02150, Espoo, Finland.
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Jadon DR, Corp N, van der Windt DA, Coates LC, Soriano ER, Kavanaugh A, Raine T, Rieder F, Siebert S, Zummer M, Schwartzman S, Rosenbaum JT, Michelsen B, Laxminarayan R, Wu D, Gupta L, Ng B, Jethwa H, De Windt N, Gudu T, Hutton J, O'Sullivan D, Luchetti MM, Stoll M, Singh JA, Peluso R, Rademacher J, Husni ME. Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients with Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2023; 50:438-450. [PMID: 36455946 PMCID: PMC10921838 DOI: 10.3899/jrheum.220317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Several advanced therapies have been licensed across the related conditions of psoriatic arthritis (PsA), Crohn disease (CD), ulcerative colitis (UC), and noninfectious uveitis. We sought to summarize results from randomized controlled trials (RCTs) investigating the efficacy and safety of advanced therapies for these related conditions in patients with PsA. METHODS We updated the previous systematic search conducted in 2013 with literature reviews of MEDLINE, Embase, and the Cochrane Library (from February 2013 to August 2020) on this subject; only those new studies are presented here. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. RESULTS The number of RCTs meeting eligibility criteria were 12 for CD, 15 for UC, and 5 for uveitis. The tumor necrosis factor inhibitor (TNFi) class appears to be efficacious and safe across CD, UC, and uveitis, with the exception of etanercept. Interleukin 12/23 inhibitors (IL-12/23i) are efficacious for CD and UC. Phase II and III RCTs of Janus kinase inhibitors (JAKi) and IL-23i in CD and UC are promising in terms of efficacy and safety. IL-17i must be used with great caution in patients with PsA at high risk of inflammatory bowel disease (IBD). RCTs in uveitis have mainly studied adalimumab. CONCLUSION We have identified 32 recent RCTs in IBD and uveitis and updated recommendations for managing patients with PsA and these related conditions. A multispecialty approach is essential to effectively, safely, and holistically manage such patients. Advanced therapies are not equally efficacious across these related conditions, with dosing regimens and safety varying.
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Affiliation(s)
- Deepak R Jadon
- D.R. Jadon, MBBCh, PhD, Department of Rheumatology, University of Cambridge, Cambridge, UK;
| | - Nadia Corp
- N. Corp, PhD, D.A. van der Windt, PhD, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Danielle A van der Windt
- N. Corp, PhD, D.A. van der Windt, PhD, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Laura C Coates
- L.C. Coates, MBChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Enrique R Soriano
- E.R. Soriano, MD, MSc, Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Arthur Kavanaugh
- A. Kavanaugh, MD, Division of Rheumatology Allergy and Immunology, University of California, San Diego, California, USA
| | - Tim Raine
- T. Raine, MB, BChir, PhD, Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Florian Rieder
- F. Rieder, MD, Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan Siebert
- S. Siebert, MD, Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Michel Zummer
- M. Zummer, MD, Division of Rheumatology, CH Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Sergio Schwartzman
- S. Schwartzman, MD, Hospital for Special Surgery, Weill Cornell Medical Center, New York City, New York, USA
| | - James T Rosenbaum
- J.T. Rosenbaum, MD, Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and the Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Brigitte Michelsen
- B. Michelsen, MD, PhD, Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Ramasharan Laxminarayan
- R. Laxminarayan, MD, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, UK
| | - Dongze Wu
- D. Wu, PhD, Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Latika Gupta
- L. Gupta, MD, DM, Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, and Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Beverly Ng
- B. Ng, MBBS, MSc, Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hannah Jethwa
- H. Jethwa, MBChB, PhD, Department of Rheumatology, Royal Free London NHS Foundation Trust, Imperial College Healthcare NHS Trust, London, UK
| | - Nick De Windt
- N. De Windt, BS, Department of Rheumatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tania Gudu
- T. Gudu, MD, PhD, Rheumatology Department, Cambridge University Hospitals NHS FT, Cambridge, UK
| | - Joseph Hutton
- J. Hutton, MBChB, University of Cambridge, Cambridge, UK
| | - Denis O'Sullivan
- D. O'Sullivan, BE, Rheumatic & Musculoskeletal Disease Unit, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Michele M Luchetti
- M.M. Luchetti, MD, Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Matthew Stoll
- M. Stoll, MD, PhD, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder A Singh
- J.A. Singh, MBBS, MPH, Medicine Service, VA Medical Center, and Department of Medicine, School of Medicine, University of Alabama at Birmingham, and Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama, USA
| | - Rosario Peluso
- R. Peluso, MD, PhD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Judith Rademacher
- J. Rademacher, MD, Department of Gastroenterology, Infection, and Rheumatology, Universitätsmedizin Berlin, and Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - M Elaine Husni
- M.E. Husni, MD, MPH, Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA
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Blanke ES, Schmiedek F, Siebert S, Richter D, Brose A. Perspectives on resilience: Trait resilience, correlates of resilience in daily life, and longer-term change in affective distress. Stress Health 2023; 39:59-73. [PMID: 35603817 DOI: 10.1002/smi.3164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 02/07/2023]
Abstract
Resilience describes successful adaptation in the face of adversity, commonly inferred from trajectories of well-being following major life events. Alternatively, resilience was conceptualised as a psychological trait, facilitating adaptation through stable individual characteristics. Both perspectives may relate to individual differences in how stress is regulated in daily life. In the present study, we combined these perspectives on resilience. Our sample consisted of N = 132 middle-aged adults, who experienced major life events in between two waves of a longitudinal study. We implemented latent change regression models to predict change in affective distress. As predictors, we investigated trait resilience and correlates of resilience in daily life (stressor occurrence, stress reactivity, positive reappraisal, mindful attention, and acceptance), measured using experience sampling (T = 70 occasions). Unexpectedly, trait resilience was not associated with change in distress. In contrast, resilience correlates in daily life, most notably lower stress reactivity, were associated with more favourable change. Higher trait resilience related to higher average mindfulness, higher reappraisal, and lower negative affect. Overall, while trait resilience translated into everyday correlates of resilience, it was not predictive of changes in affective distress. Instead, precursors of changes in well-being may be found in correlates of resilience in daily life.
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Affiliation(s)
- Elisabeth S Blanke
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Developmental Psychology, Leipzig University, Leipzig, Germany
| | - Florian Schmiedek
- DIPF
- Leibniz Institute for Research and Information in Education, Frankfurt, Germany
| | - Stefan Siebert
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David Richter
- German Institute for Economic Research (DIW Berlin), Berlin, Germany.,Department of Psychology, Free University Berlin, Berlin, Germany
| | - Annette Brose
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,German Institute for Economic Research (DIW Berlin), Berlin, Germany
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Fluet-Chouinard E, Stocker BD, Zhang Z, Malhotra A, Melton JR, Poulter B, Kaplan JO, Goldewijk KK, Siebert S, Minayeva T, Hugelius G, Joosten H, Barthelmes A, Prigent C, Aires F, Hoyt AM, Davidson N, Finlayson CM, Lehner B, Jackson RB, McIntyre PB. Extensive global wetland loss over the past three centuries. Nature 2023; 614:281-286. [PMID: 36755174 DOI: 10.1038/s41586-022-05572-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/17/2022] [Indexed: 02/10/2023]
Abstract
Wetlands have long been drained for human use, thereby strongly affecting greenhouse gas fluxes, flood control, nutrient cycling and biodiversity1,2. Nevertheless, the global extent of natural wetland loss remains remarkably uncertain3. Here, we reconstruct the spatial distribution and timing of wetland loss through conversion to seven human land uses between 1700 and 2020, by combining national and subnational records of drainage and conversion with land-use maps and simulated wetland extents. We estimate that 3.4 million km2 (confidence interval 2.9-3.8) of inland wetlands have been lost since 1700, primarily for conversion to croplands. This net loss of 21% (confidence interval 16-23%) of global wetland area is lower than that suggested previously by extrapolations of data disproportionately from high-loss regions. Wetland loss has been concentrated in Europe, the United States and China, and rapidly expanded during the mid-twentieth century. Our reconstruction elucidates the timing and land-use drivers of global wetland losses, providing an improved historical baseline to guide assessment of wetland loss impact on Earth system processes, conservation planning to protect remaining wetlands and prioritization of sites for wetland restoration4.
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Affiliation(s)
- Etienne Fluet-Chouinard
- Department of Earth System Science, Stanford University, Stanford, CA, USA. .,Center for Limnology, University of Wisconsin-Madison, Madison, WI, USA. .,Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland.
| | - Benjamin D Stocker
- Department of Environmental Systems Science, ETH Zurich, Zürich, Switzerland.,Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Birmensdorf, Switzerland.,Institute of Geography, University of Bern, Bern, Switzerland.,Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Zhen Zhang
- Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Avni Malhotra
- Department of Earth System Science, Stanford University, Stanford, CA, USA
| | - Joe R Melton
- Climate Research Division, Environment and Climate Change Canada, Victoria, British Columbia, Canada
| | - Benjamin Poulter
- NASA Goddard Space Flight Center, Biospheric Sciences Laboratory, Greenbelt, MD, USA
| | - Jed O Kaplan
- Department of Earth Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Kees Klein Goldewijk
- Faculty of Geosciences, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Stefan Siebert
- Department of Crop Sciences, Georg-August-Universität Göttingen, Goettingen, Germany.,Centre of Biodiversity and Sustainable Land Use, University of Göttingen, Göttingen, Germany
| | | | - Gustaf Hugelius
- Department of Earth System Science, Stanford University, Stanford, CA, USA.,Department of Physical Geography, Stockholm University, Stockholm, Sweden.,Bolin Centre for Climate Research, Stockholm University, Stockholm, Sweden
| | - Hans Joosten
- Faculty of Mathematics and Natural Sciences, Peatland Studies and Paleoecology, University of Greifswald, Greifswald, Germany.,Greifswald Mire Centre, Greifswald, Germany
| | - Alexandra Barthelmes
- Faculty of Mathematics and Natural Sciences, Peatland Studies and Paleoecology, University of Greifswald, Greifswald, Germany.,Greifswald Mire Centre, Greifswald, Germany
| | - Catherine Prigent
- Sorbonne Université, Observatoire de Paris, Université PSL, CNRS, LERMA, Paris, France.,Estellus, Paris, France
| | - Filipe Aires
- Sorbonne Université, Observatoire de Paris, Université PSL, CNRS, LERMA, Paris, France.,Estellus, Paris, France
| | - Alison M Hoyt
- Department of Earth System Science, Stanford University, Stanford, CA, USA
| | - Nick Davidson
- Nick Davidson Environmental, Queens House, Wigmore, UK.,Gulbali Institute for Land, Water and Society, Charles Sturt University, Elizabeth Mitchell Drive, Albury, New South Wales, Australia
| | - C Max Finlayson
- Gulbali Institute for Land, Water and Society, Charles Sturt University, Elizabeth Mitchell Drive, Albury, New South Wales, Australia.,IHE Delft, Institute for Water Education, Delft, The Netherlands
| | - Bernhard Lehner
- Department of Geography, McGill University, Montreal, Quebec, Canada
| | - Robert B Jackson
- Department of Earth System Science, Stanford University, Stanford, CA, USA.,Woods Institute for the Environment and Precourt Institute for Energy, Stanford University, Stanford, CA, USA
| | - Peter B McIntyre
- Center for Limnology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Natural Resources and the Environment, Cornell University, Ithaca, NY, USA
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Morton FR, Jani BD, Mair FS, McLoone P, Canning J, Macdonald S, McQueenie R, Siebert S, Nicholl BI. Association between risk, duration and cause of hospitalisations in people with rheumatoid arthritis and multimorbidity in the UK Biobank and Scottish Early Rheumatoid Arthritis (SERA) cohorts: Longitudinal observational study. Semin Arthritis Rheum 2023; 58:152130. [PMID: 36459724 DOI: 10.1016/j.semarthrit.2022.152130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate association between presence of multimorbidity in people with established and early rheumatoid arthritis (RA) and risk, duration and cause of hospitalisations. DESIGN Longitudinal observational study. SETTING UK Biobank, population-based cohort recruited between 2006 and 2010, and the Scottish Early Rheumatoid Arthritis (SERA), inception cohort recruited between 2011 and 2015. Both linked to mortality and hospitalisation data. PARTICIPANTS 4757 UK Biobank participants self-reporting established RA; 825 SERA participants with early RA meeting the 2010 ACR/EULAR classification criteria. Participants stratified by number of long-term conditions (LTCs) in addition to RA (RA only, RA + 1 LTC and RA + ≥ 2 LTCs) and matched to five non-RA controls. MAIN OUTCOME MEASURES Number and duration of hospitalisations and their causes. Incidence rate ratios (IRR) and 95% confidence intervals (CI) calculated using negative binomial regression models. RESULTS Participants with RA + ≥ 2 LTCs experienced higher hospitalisation rates compared to those with RA alone (UK Biobank: IRR 2.10, 95% CI 1.91 to 2.30; SERA: IRR 1.74, 95% CI 1.23 to 2.48). Total duration of hospitalisation in RA + ≥ 2 LTCs was also higher (UK Biobank: IRR 2.48, 95% CI 2.17 to 2.84; SERA: IRR 1.90, 95% CI 1.07 to 3.38) than with RA alone. Rate and total duration of hospitalisations was higher in UK Biobank RA participants than non-RA controls with equivalent number of LTCs. Hospitalisations for respiratory infection were higher in early RA than established RA and were the commonest cause of hospital admission in early RA. CONCLUSIONS Participants with established or early RA with multimorbidity experienced a higher rate and duration of hospitalisations than those with RA alone and with non-RA matched controls.
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Affiliation(s)
- Fraser R Morton
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
| | - Bhautesh D Jani
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Philip McLoone
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jordan Canning
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ross McQueenie
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Winthrop KL, Isaacs JD, Mease PJ, Boumpas DT, Baraliakos X, Gottenberg JE, Siebert S, Mosca M, Basu N, Orange D, Lories R, Aletaha D, McInnes IB, Huizinga TWJ, Voll RE, Gravallese EM, Breedveld FC, Smolen JS. Unmet need in rheumatology: reports from the Advances in Targeted Therapies meeting, 2022. Ann Rheum Dis 2023; 82:594-598. [PMID: 36702529 DOI: 10.1136/ard-2022-223528] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023]
Abstract
To detail the unmet clinical and scientific needs in the field of rheumatology. After a 2-year hiatus due to the SARS-CoV-2 pandemic, the 22nd annual international Advances in Targeted Therapies meeting brought together more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. Breakout sessions were convened with experts in five rheumatological disease-specific groups including: rheumatoid arthritis (RA), psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus and connective tissue diseases (CTDs). In each group, experts were asked to identify and prioritise current unmet needs in clinical and translational research, as well as highlight recent progress in meeting formerly identified unmet needs. Clinical trial design innovation was emphasised across all disease states. Within RA, developing therapies and trials for refractory disease patients remained among the most important identified unmet needs and within lupus and spondyloarthritis the need to account for disease endotypes was highlighted. The RA group also identified the need to better understand the natural history of RA, pre-RA states and the need ultimately for precision medicine. In CTD generally, experts focused on the need to better identify molecular, cellular and clinical signals of early and undifferentiated disease in order to identify novel drug targets. There remains a strong need to develop therapies and therapeutic strategies for those with treatment-refractory disease. Increasingly it is clear that we need to better understand the natural history of these diseases, including their 'predisease' states, and identify molecular signatures, including at a tissue level, which can facilitate disease diagnosis and treatment. As these unmet needs in the field of rheumatic diseases have been identified based on consensus of expert clinicians and scientists in the field, this document may serve individual researchers, institutions and industry to help prioritise their scientific activities.
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Affiliation(s)
- Kevin L Winthrop
- Department of Medicine, Oregon Health and Sciences University (OHSU), Portland, Oregon, USA
| | - John D Isaacs
- Department of Clinical Rheumatology, Newcastle University, Newcastle upon Tyne, UK
| | - Philip J Mease
- Swedish Medical Center; University of Washington, Seattle, Washington, USA
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, Rheumatology and Clinical Immunology Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Jacques-Eric Gottenberg
- Centre National de Référence des Maladies AutoImmunes Systémiques Rares CHU Strasbourg-Hautepierre, Strasbourg, France
| | - Stefan Siebert
- College of Medical, Veterinary & Life Sciences; University of Glasgow, Glasgow, UK
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Neil Basu
- College of Medical, Veterinary & Life Sciences; University of Glasgow, Glasgow, UK
| | - Dana Orange
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Lories
- Division of Rheumatology Hospital for Special Surgery, New York, NY, USA
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
| | - Iain B McInnes
- College of Medical, Veterinary & Life Sciences; University of Glasgow, Glasgow, UK
| | - Tom W J Huizinga
- Division of Rheumatology, University of Leuven, Leuven, The Netherlands
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University of Freiburg, Freiburg, Germany
| | - Ellen M Gravallese
- Brigham and Women‟s Hospital, Harvard University, Boston, Massachusetts, USA
| | - Ferry C Breedveld
- Department of Rheumatology, University of Leiden, Leiden, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
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Nyirenda MH, Nijjar JS, Frleta-Gilchrist M, Gilchrist DS, Porter D, Siebert S, Goodyear CS, McInnes IB. JAK inhibitors disrupt T cell-induced proinflammatory macrophage activation. RMD Open 2023; 9:rmdopen-2022-002671. [PMID: 36599629 PMCID: PMC9815080 DOI: 10.1136/rmdopen-2022-002671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Macrophage subsets, activated by T cells, are increasingly recognised to play a central role in rheumatoid arthritis (RA) pathogenesis. Janus kinase (JAK) inhibitors have proven beneficial clinical effects in RA. In this study, we investigated the effect of JAK inhibitors on the generation of cytokine-activated T (Tck) cells and the production of cytokines and chemokines induced by Tck cell/macrophage interactions. METHODS CD14+ monocytes and CD4+ T cells were purified from peripheral blood mononuclear cells from buffy coats of healthy donors. As representative JAK inhibitors, tofacitinib or ruxolitinib were added during Tck cell differentiation. Previously validated protocols were used to generate macrophages and Tck cells from monocytes and CD4+ T cells, respectively. Cytokine and chemokine including TNF, IL-6, IL-15, IL-RA, IL-10, MIP1α, MIP1β and IP10 were measured by ELISA. RESULTS JAK inhibitors prevented cytokine-induced maturation of Tck cells and decreased the production of proinflammatory cytokines TNF, IL-6, IL-15, IL-1RA and the chemokines IL-10, MIP1α, MIP1β, IP10 by Tck cell-activated macrophages in vitro (p<0.05). CONCLUSIONS Our findings show that JAK inhibition disrupts T cell-induced macrophage activation and reduces downstream proinflammatory cytokine and chemokine responses, suggesting that suppressing the T cell-macrophage interaction contributes to the therapeutic effect of JAK inhibitors.
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Affiliation(s)
- Mukanthu H Nyirenda
- School of Infection and Immunity, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK .,The Research into inflammatory Arthritis Centre of Excellence - Versus Arthritis (RACE-VA) Universities of Glasgow, Birmingham, Newcastle, Oxford, and Newcastle, UK
| | - Jagtar Singh Nijjar
- School of Infection and Immunity, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Marina Frleta-Gilchrist
- School of Infection and Immunity, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Derek S Gilchrist
- School of Infection and Immunity, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Duncan Porter
- School of Infection and Immunity, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK,Gartnavel General Hospital, Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Carl S Goodyear
- School of Infection and Immunity, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK,The Research into inflammatory Arthritis Centre of Excellence - Versus Arthritis (RACE-VA) Universities of Glasgow, Birmingham, Newcastle, Oxford, and Newcastle, UK
| | - Iain B McInnes
- The Research into inflammatory Arthritis Centre of Excellence - Versus Arthritis (RACE-VA) Universities of Glasgow, Birmingham, Newcastle, Oxford, and Newcastle, UK,College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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41
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McLoone P, Jani BD, Siebert S, Morton FR, Canning J, Macdonald S, Mair FS, Nicholl BI. Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study. J Multimorb Comorb 2023; 13:26335565221148616. [PMID: 36798088 PMCID: PMC9926377 DOI: 10.1177/26335565221148616] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE We aimed to classify individuals with RA and ≥2 additional long-term conditions (LTCs) and describe the association between different LTC classes, number of LTCs and adverse health outcomes. METHODS We used UK Biobank participants who reported RA (n=5,625) and employed latent class analysis (LCA) to create classes of LTC combinations for those with ≥2 additional LTCs. Cox-proportional hazard and negative binomial regression were used to compare the risk of all-cause mortality, major adverse cardiac events (MACE), and number of emergency hospitalisations over an 11-year follow-up across the different LTC classes and in those with RA plus one additional LTC. Persons with RA without LTCs were the reference group. Analyses were adjusted for demographic characteristics, smoking, BMI, alcohol consumption and physical activity. RESULTS A total of 2,566 (46%) participants reported ≥2 LTCs in addition to RA. This involved 1,138 distinct LTC combinations of which 86% were reported by ≤2 individuals. LCA identified 5 morbidity-classes. The distinctive condition in the class with the highest mortality was cancer (class 5; HR 2.66 95%CI (1.91-3.70)). The highest MACE (HR 2.95 95%CI (2.11-4.14)) and emergency hospitalisations (rate ratio 3.01 (2.56-3.54)) were observed in class 3 which comprised asthma, COPD & CHD. There was an increase in mortality, MACE and emergency hospital admissions within each class as the number of LTCs increased. CONCLUSIONS The risk of adverse health outcomes in RA varied with different patterns of multimorbidity. The pattern of multimorbidity should be considered in risk assessment and formulating management plans in patients with RA.
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Affiliation(s)
- Philip McLoone
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Fraser R Morton
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Jordan Canning
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Sara Macdonald
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
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Zhao SS, Harrison SR, Chan A, Clarke N, Davis C, Eddison J, Gregory WJ, Jones GT, Marzo-Ortega H, Murphy DJ, Sandhu V, Sengupta R, Siebert S, Thompson B, Webb D, Yates M, Gaffney K. Treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs: British Society for Rheumatology guideline scope. Rheumatol Adv Pract 2023; 7:rkad039. [PMID: 37197377 PMCID: PMC10183299 DOI: 10.1093/rap/rkad039] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 05/19/2023] Open
Abstract
Pharmacological management has advanced considerably since the 2015 British Society for Rheumatology axial spondyloarthritis (axSpA) guideline to incorporate new classes of biologic DMARDs (bDMARDs, including biosimilars), targeted synthetic DMARDs (tsDMARDs) and treatment strategies such as drug tapering. The aim of this guideline is to provide an evidence-based update on pharmacological management of adults with axSpA (including AS and non-radiographic axSpA) using b/tsDMARDs. This guideline is aimed at health-care professionals in the UK who care directly for people with axSpA, including rheumatologists, rheumatology specialist nurses, allied health professionals, rheumatology specialty trainees and pharmacists; people living with axSpA; and other stakeholders, such as patient organizations and charities.
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Affiliation(s)
- Sizheng Steven Zhao
- Correspondence to: Sizheng Steven Zhao, Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9LJ, UK. E-mail:
| | - Stephanie R Harrison
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Antoni Chan
- Department of Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | | | - Charlotte Davis
- Department of Rheumatology, Leeds Teaching Hospitals Trust, UK
| | | | - William J Gregory
- Rheumatology Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Greater Manchester, UK
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Daniel J Murphy
- Department of Rheumatology, Honiton Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - Virinderjit Sandhu
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Ben Thompson
- Rheumatology Department, The Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Dale Webb
- National Axial Spondyloarthritis Society (NASS), London, UK
| | - Max Yates
- Centre for Epidemiology, Norwich Medical School, University of East Anglia, Norwich, UK
- Rheumatology Department, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Karl Gaffney
- Rheumatology Department, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Balakrishnan NK, Siebert S, Richter C, Groten R, Seide G. Effect of Colorants and Process Parameters on the Properties of Dope-Dyed Polylactic Acid Multifilament Yarns. Polymers (Basel) 2022; 14:polym14225021. [PMID: 36433148 PMCID: PMC9692423 DOI: 10.3390/polym14225021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
The color of textile fibers is typically imparted by submersion in a high-temperature dye bath. However, the treatment of the effluent is challenging and the textile industry is therefore a major source of water pollution. Current fashion trends favor biobased polymers such as polylactic acid (PLA) but exhaust dyeing at high temperatures causes hydrolytic degradation, reducing the crystallinity and tenacity of the yarn. To preserve the mechanical properties of PLA-based textiles, an alternative to exhaust dyeing called dope dyeing can be used, wherein colorants are incorporated into the polymer matrix during melt spinning. We evaluated this process by dope dyeing PLA with several colorants, then testing the thermal, physical, and mechanical properties of the yarn and the physical properties of circular-knitted fabrics. Although the colorants affected the crystallization behavior at lower cooling rates, during the melt-spinning process, the drawing speed had a greater effect on the crystallinity and mechanical properties of the dyed yarn. Scanning electron microscopy revealed that the colorants were well dispersed in the PLA matrix. We found that the colorants did not affect the physical properties of the knitted fabric. Our results can be used to develop more environmentally beneficial dope-dyed PLA yarn with improved mechanical properties.
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Affiliation(s)
- Naveen Kumar Balakrishnan
- Aachen-Maastricht Institute for Biobased Materials (AMIBM), Maastricht University, Brightlands Chemelot Campus, Urmonderbaan 22, 6167 RD Geleen, The Netherlands
| | - Stefan Siebert
- Aachen-Maastricht Institute for Biobased Materials (AMIBM), Maastricht University, Brightlands Chemelot Campus, Urmonderbaan 22, 6167 RD Geleen, The Netherlands
| | - Christoph Richter
- Department of Textile and Clothing Technology, Niederrhein University of Applied Sciences, Campus Moenchengladbach, Webschulstrasse 31, 41065 Moenchengladbach, Germany
| | - Robert Groten
- Department of Textile and Clothing Technology, Niederrhein University of Applied Sciences, Campus Moenchengladbach, Webschulstrasse 31, 41065 Moenchengladbach, Germany
| | - Gunnar Seide
- Aachen-Maastricht Institute for Biobased Materials (AMIBM), Maastricht University, Brightlands Chemelot Campus, Urmonderbaan 22, 6167 RD Geleen, The Netherlands
- Correspondence:
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Stanciu I, Anderson J, Siebert S, Mackay D, Lyall DM. Associations of rheumatoid arthritis and rheumatoid factor with mental health, sleep and cognition characteristics in the UK Biobank. Sci Rep 2022; 12:19844. [PMID: 36400784 PMCID: PMC9674828 DOI: 10.1038/s41598-022-22021-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022] Open
Abstract
While previous rheumatoid arthritis (RA) studies have focussed on cardiometabolic and lifestyle factors, less research has focussed on psychological variables including mood and cognitive health, and sleep. Cross-sectional analyses tested for associations between RA and RF+ (positive rheumatoid factor) vs. mental health (depression, anxiety, neuroticism), sleep variables and cognition scores in UK Biobank (total n = 484,064). Those RF+ were more likely to report longer sleep duration (β = 0.01, SE = 0.004, p < 0.01) and less likely to get up in the morning easily (OR 0.95, 95% CI 0.92-0.99, p = 0.01). Those reporting RA were more likely to score higher for neuroticism (β = 0.05, SE = 0.01, p < 0.001), to nap during the day (OR 1.10, 95% CI 1.06-1.14, p < 0.001), have insomnia (OR 1.28, 95% CI 1.22-1.35, p < 0.001), have slower reaction times (β = 0.02, SE = 0.008, p < 0.005) and score less for fluid intelligence (β = - 0.03, SE = 0.01, p < 0.05) and less likely to get up easily (OR 0.61, 95% CI 0.58-0.64, p < 0.001). The current study suggests that prevalent RA, and RF+ status are associated with differences in mental health, sleep, and cognition, highlighting the importance of addressing these aspects in clinical settings and future research.
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Affiliation(s)
- Ioana Stanciu
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jana Anderson
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Stefan Siebert
- School of Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
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Fragoulis GE, Siebert S. The role of IL-23 and the use of IL-23 inhibitors in psoriatic arthritis. Musculoskeletal Care 2022; 20 Suppl 1:S12-S21. [PMID: 36069174 PMCID: PMC9825973 DOI: 10.1002/msc.1694] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a chronic inflammatory arthritis characterised by musculoskeletal and extra-articular manifestations, most notably psoriasis. While the underlying pathogenetic mechanisms are not yet fully understood, a central role has been identified for the IL-23/IL-17 pathway. OBJECTIVES We briefly describe the role of IL-23 in the pathogenesis of PsA and go on to describe the available anti-IL-23 agents and their place in the management of PsA. METHODS This is a narrative review of the current literature, focussing on the results of the phase 3 studies in PsA for the IL-12/23 p40 inhibitor ustekinumab and the more recent IL-23 p19 inhibitors guselkumab, risankizumab and tildrakizumab. RESULTS IL-23 triggers expression of IL-17 and other effector cytokines in a variety of cells, leading to tissue inflammation and injury. Targeting IL-23, particularly with p19 inhibitors, appears to be an effective and safe strategy for multiple clinical domains in PsA, most notably the skin, with some differences in efficacy emerging between these agents. CONCLUSION The development of IL-23 inhibitors represents a significant advance in the management of psoriatic disease. In the absence of head-to-head studies, future data emerging from real-world experiences of individual IL-23 p19 inhibitors will help inform the use of these agents in relation to other biologics in PsA.
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Affiliation(s)
- George E. Fragoulis
- Joint Rheumatology ProgramNational and Kapodistrian University of AthensAthensGreece,School of Infection and ImmunityUniversity of GlasgowGlasgowUK
| | - Stefan Siebert
- School of Infection and ImmunityUniversity of GlasgowGlasgowUK
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Hanlon P, Morrison H, Morton F, Jani BD, Siebert S, Lewsey J, McAllister D, Mair FS. Frailty in people with rheumatoid arthritis: a systematic review of observational studies. Wellcome Open Res 2022; 6:244. [PMID: 37746318 PMCID: PMC10511856 DOI: 10.12688/wellcomeopenres.17208.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 09/26/2023] Open
Abstract
Background: Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and disease activity or clinical outcomes. Methods: We searched four electronic databases (January 2001 to April 2021) for observational studies assessing the prevalence of frailty (any frailty measure) in adults (≥18 years) with rheumatoid arthritis, or analysing the relationship between frailty and disease activity or clinical outcomes (e.g. quality of life, hospitalisation or mortality) in people with rheumatoid arthritis. Study quality was assessed using an adapted Newcastle-Ottawa Scale. Screening, quality assessment and data extraction were performed independently by two reviewers. We used narrative synthesis. Results: We identified 17 analyses, from 14 different populations. 15/17 were cross-sectional. Studies used 11 different measures of frailty. Frailty prevalence ranged from 10% (frailty phenotype) to 36% (comprehensive rheumatologic assessment of frailty) in general adult populations with rheumatoid arthritis. In younger populations (<60 or <65 years) prevalence ranged from 2.4% (frailty phenotype) to 19.9% (Kihon checklist) while in older populations (>60 or >65) prevalence ranged from 31.2% (Kihon checklist) to 55% (Geriatric 8 tool). Frailty was cross-sectionally associated with higher disease activity (10/10 studies), lower physical function (7/7 studies) and longer disease duration (2/5 studies), and with hospitalization and osteoporotic fractures (1/1 study, 3.7 years follow-up). Conclusion: Frailty is common in rheumatoid arthritis, including those aged <65 years, and is associated with a range of adverse features. However, these is heterogeneity in how frailty is measured. We found few longitudinal studies making the impact of frailty on clinical outcomes over time and the extent to which frailty is caused by rheumatoid arthritis unclear.
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Affiliation(s)
- Peter Hanlon
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Holly Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fraser Morton
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David McAllister
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Dueri S, Brown H, Asseng S, Ewert F, Webber H, George M, Craigie R, Guarin JR, Pequeno DNL, Stella T, Ahmed M, Alderman PD, Basso B, Berger AG, Mujica GB, Cammarano D, Chen Y, Dumont B, Rezaei EE, Fereres E, Ferrise R, Gaiser T, Gao Y, Garcia-Vila M, Gayler S, Hochman Z, Hoogenboom G, Kersebaum KC, Nendel C, Olesen JE, Padovan G, Palosuo T, Priesack E, Pullens JWM, Rodríguez A, Rötter RP, Ramos MR, Semenov MA, Senapati N, Siebert S, Srivastava AK, Stöckle C, Supit I, Tao F, Thorburn P, Wang E, Weber TKD, Xiao L, Zhao C, Zhao J, Zhao Z, Zhu Y, Martre P. Simulation of winter wheat response to variable sowing dates and densities in a high-yielding environment. J Exp Bot 2022; 73:5715-5729. [PMID: 35728801 PMCID: PMC9467659 DOI: 10.1093/jxb/erac221] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
Crop multi-model ensembles (MME) have proven to be effective in increasing the accuracy of simulations in modelling experiments. However, the ability of MME to capture crop responses to changes in sowing dates and densities has not yet been investigated. These management interventions are some of the main levers for adapting cropping systems to climate change. Here, we explore the performance of a MME of 29 wheat crop models to predict the effect of changing sowing dates and rates on yield and yield components, on two sites located in a high-yielding environment in New Zealand. The experiment was conducted for 6 years and provided 50 combinations of sowing date, sowing density and growing season. We show that the MME simulates seasonal growth of wheat well under standard sowing conditions, but fails under early sowing and high sowing rates. The comparison between observed and simulated in-season fraction of intercepted photosynthetically active radiation (FIPAR) for early sown wheat shows that the MME does not capture the decrease of crop above ground biomass during winter months due to senescence. Models need to better account for tiller competition for light, nutrients, and water during vegetative growth, and early tiller senescence and tiller mortality, which are exacerbated by early sowing, high sowing densities, and warmer winter temperatures.
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Affiliation(s)
- Sibylle Dueri
- LEPSE, Univ. Montpellier, INRAE, Institut Agro Montpellier, Montpellier, France
| | - Hamish Brown
- The New Zealand Institute for Plant & Food Research Limited, Christchurch, New Zealand
| | - Senthold Asseng
- Department of Life Science Engineering, Digital Agriculture, Technical University of Munich, Freising, Germany
| | - Frank Ewert
- Institute of Crop Science and Resource Conservation INRES, University of Bonn, Bonn, Germany
- Leibniz Centre for Agricultural Landscape Research, Müncheberg, Germany
| | - Heidi Webber
- Leibniz Centre for Agricultural Landscape Research, Müncheberg, Germany
- Brandenburg University of Technology, Faculty of Environment and Natural Sciences, Cottbus, Germany
| | - Mike George
- The New Zealand Institute for Plant & Food Research Limited, Christchurch, New Zealand
| | - Rob Craigie
- Foundation for Arable Research, Templeton, New Zealand
| | - Jose Rafael Guarin
- Agricultural & Biological Engineering Department, University of Florida, Gainesville, FL, USA
- Center for Climate Systems Research, Earth Institute, Columbia University, New York, NY, USA
- NASA Goddard Institute for Space Studies, New York, NY, USA
| | - Diego N L Pequeno
- International Maize and Wheat Improvement Center (CIMMYT), Mexico DF, Mexico
| | - Tommaso Stella
- Institute of Crop Science and Resource Conservation INRES, University of Bonn, Bonn, Germany
- Leibniz Centre for Agricultural Landscape Research, Müncheberg, Germany
| | - Mukhtar Ahmed
- Department of Agronomy, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
- Department of Agricultural Research for Northern Sweden, Swedish University of Agricultural Sciences Umeå, Sweden
| | - Phillip D Alderman
- Department of Plant and Soil Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Bruno Basso
- Department of Earth and Environmental Sciences, Michigan State University, East Lansing, MI, USA
- W. K. Kellogg Biological Station, Michigan State University, East Lansing, MI, USA
| | - Andres G Berger
- National Institute of Agricultural Research (INIA), Colonia, Uruguay
| | - Gennady Bracho Mujica
- Tropical Plant Production and Agricultural Systems Modelling (TROPAGS), University of Göttingen, Göttingen, Germany
| | | | - Yi Chen
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Science, Beijing, China
| | - Benjamin Dumont
- Plant Sciences Axis – Crop Science, Gembloux Agro-Bio Tech, University of Liege, Gembloux, Belgium
| | | | - Elias Fereres
- IAS-CSIC & DAUCO, University of Cordoba, Cordoba, Spain
| | - Roberto Ferrise
- Department of Agriculture, food, environment and forestry (DAGRI), University of Florence, Florence, Italy
| | - Thomas Gaiser
- Institute of Crop Science and Resource Conservation INRES, University of Bonn, Bonn, Germany
| | - Yujing Gao
- Agricultural & Biological Engineering Department, University of Florida, Gainesville, FL, USA
| | | | - Sebastian Gayler
- Institute of Soil Science and Land Evaluation, University of Hohenheim, Stuttgart, Germany
| | - Zvi Hochman
- CSIRO Agriculture and Food, Brisbane, Queensland, Australia
| | - Gerrit Hoogenboom
- Agricultural & Biological Engineering Department, University of Florida, Gainesville, FL, USA
- Institute for Sustainable Food Systems, University of Florida, Gainesville, FL, USA
| | - Kurt C Kersebaum
- Leibniz Centre for Agricultural Landscape Research, Müncheberg, Germany
- Tropical Plant Production and Agricultural Systems Modelling (TROPAGS), University of Göttingen, Göttingen, Germany
- Global Change Research Institute, Academy of Sciences of the Czech Republic, Brno, Czech Republic
| | - Claas Nendel
- Leibniz Centre for Agricultural Landscape Research, Müncheberg, Germany
- Global Change Research Institute, Academy of Sciences of the Czech Republic, Brno, Czech Republic
- Institute of Biochemistry and Biology, University of Potsdam, Potsdam, Germany
| | - Jørgen E Olesen
- Department of Agroecology, Aarhus University, Tjele, Denmark
- Global Change Research Institute, Academy of Sciences of the Czech Republic, Brno, Czech Republic
| | - Gloria Padovan
- Department of Agriculture, food, environment and forestry (DAGRI), University of Florence, Florence, Italy
| | - Taru Palosuo
- Natural Resources Institute Finland (Luke), Helsinki, Finland
| | - Eckart Priesack
- Institute of Biochemical Plant Pathology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Alfredo Rodríguez
- CEIGRAM, Technical University of Madrid, Madrid, Spain
- Department of Economic Analysis and Finances, University of Castilla-La Mancha, Toledo, Spain
| | - Reimund P Rötter
- Tropical Plant Production and Agricultural Systems Modelling (TROPAGS), University of Göttingen, Göttingen, Germany
- Centre of Biodiversity and Sustainable Land Use (CBL), University of Göttingen, Göttingen, Germany
| | | | | | | | - Stefan Siebert
- Centre of Biodiversity and Sustainable Land Use (CBL), University of Göttingen, Göttingen, Germany
- Department of Crop Sciences, University of Göttingen, Göttingen, Germany
| | - Amit Kumar Srivastava
- Institute of Crop Science and Resource Conservation INRES, University of Bonn, Bonn, Germany
| | - Claudio Stöckle
- Biological Systems Engineering, Washington State University, Pullman, WA, USA
| | - Iwan Supit
- Water Systems & Global Change Group, Wageningen University, Wageningen, The Netherlands
| | - Fulu Tao
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Science, Beijing, China
- Natural Resources Institute Finland (Luke), Helsinki, Finland
| | - Peter Thorburn
- CSIRO Agriculture and Food, Brisbane, Queensland, Australia
| | - Enli Wang
- CSIRO Agriculture and Food, Canberra, Australian Capital Territory, Australia
| | | | - Liujun Xiao
- College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, Zhejiang, China
- National Engineering and Technology Center for Information Agriculture, Key Laboratory for Crop System Analysis and Decision Making, Ministry of Agriculture, Jiangsu Key Laboratory for Information Agriculture, Jiangsu Collaborative Innovation Center for Modern Crop Production, Nanjing Agricultural University, Nanjing, China
| | - Chuang Zhao
- College of Resources and Environmental Sciences, China Agricultural University, Beijing, China
| | - Jin Zhao
- Department of Agroecology, Aarhus University, Tjele, Denmark
- College of Resources and Environmental Sciences, China Agricultural University, Beijing, China
| | - Zhigan Zhao
- CSIRO Agriculture and Food, Canberra, Australian Capital Territory, Australia
| | - Yan Zhu
- National Engineering and Technology Center for Information Agriculture, Key Laboratory for Crop System Analysis and Decision Making, Ministry of Agriculture, Jiangsu Key Laboratory for Information Agriculture, Jiangsu Collaborative Innovation Center for Modern Crop Production, Nanjing Agricultural University, Nanjing, China
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Sandström V, Chrysafi A, Lamminen M, Troell M, Jalava M, Piipponen J, Siebert S, van Hal O, Virkki V, Kummu M. Food system by-products upcycled in livestock and aquaculture feeds can increase global food supply. Nat Food 2022; 3:729-740. [PMID: 37118146 DOI: 10.1038/s43016-022-00589-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 08/10/2022] [Indexed: 04/30/2023]
Abstract
Many livestock and aquaculture feeds compete for resources with food production. Increasing the use of food system by-products and residues as feed could reduce this competition. We gathered data on global food system material flows for crop, livestock and aquaculture production, focusing on feed use and the availability of by-products and residues. We then analysed the potential of replacing food-competing feedstuff-here cereals, whole fish, vegetable oils and pulses that account for 15% of total feed use-with food system by-products and residues. Considering the nutritional requirements of food-producing animals, including farmed aquatic species, this replacement could increase the current global food supply by up to 13% (10-16%) in terms of kcal and 15% (12-19%) in terms of protein content. Increasing the use of food system by-products as feed has considerable potential, particularly when combined with other measures, in the much-needed transition towards circular food systems.
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Affiliation(s)
- Vilma Sandström
- Water & Development Research Group, Aalto University, Espoo, Finland.
| | - Anna Chrysafi
- Water & Development Research Group, Aalto University, Espoo, Finland
| | - Marjukka Lamminen
- Department of Agricultural Sciences, University of Helsinki, Helsinki, Finland
| | - Max Troell
- Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Mika Jalava
- Water & Development Research Group, Aalto University, Espoo, Finland
| | | | - Stefan Siebert
- Department of Crop Sciences, University of Göttingen, Göttingen, Germany
| | - Ollie van Hal
- Louis Bolk Institute, Bunnik, the Netherlands
- Animal Production Systems group, Wageningen University, Wageningen, the Netherlands
| | - Vili Virkki
- Water & Development Research Group, Aalto University, Espoo, Finland
| | - Matti Kummu
- Water & Development Research Group, Aalto University, Espoo, Finland.
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Hsieh PH, Geue C, Wu O, McIntosh E, Siebert S. How do multiple long-term conditions impact on the cost-of-illness in early rheumatoid arthritis? RMD Open 2022; 8:rmdopen-2022-002454. [PMID: 36104116 PMCID: PMC9476122 DOI: 10.1136/rmdopen-2022-002454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Multiple long-term conditions (MLTCs) are prevalent in rheumatoid arthritis (RA) and associated with worse outcomes and greater economic burden. However, little is known about the impact of MLTCs on the cost-of-illness (COI) in early RA, including direct and indirect costs. The objective of this study was to quantify this impact on COI. METHODS The Scottish Early Rheumatoid Arthritis study is a national cohort of adults with new-onset RA. Direct costs were estimated applying relevant unit costs to health resource utilisation; indirect costs were measured by productivity loss due to health conditions. Two-part models were used, adjusting for age, gender, baseline functional disability and health-related quality of life. The Charlson Comorbidity Index score was calculated using ICD-10 diagnoses. Individuals were defined as 'RA alone', 'RA plus LTC' and 'RA plus MLTCs' according to the number of coexisting LTCs. RESULTS Data were available for 818 participants. Average annualised direct costs incurred by people with early RA plus MLTCs (£4444; 95% CI £3100 to £6371) were twice as, and almost five times higher than, those with a single LTC (£2184; 95% CI £1596 to £2997) and those without LTC (£919; 95% CI £694 to £1218), respectively. Indirect costs incurred by RA plus MLTCs (£842; 95% CI £377to £1521) were 3.1 times higher than RA alone (£530; 95% CI £273to £854). The relative proportion of direct costs increased with LTC category, ranging from 77.2% to 84.1%. In addition to increased costs with LTCs, costs also increased with age and were higher for men regardless of LTC category. CONCLUSIONS MLTCs impact on COI early in the course of RA. The presence of LTCs is associated with significant increases in both direct and indirect costs among people with early RA.
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Affiliation(s)
- Ping-Hsuan Hsieh
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan .,Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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Siebert S, Sweet KM, Ritchlin CT, Hsia EC, Kollmeier AP, Yang YW, Xu XL, Song Q, Miron M. 32938 Guselkumab treatment modulates genes differentially expressed in blood samples of patients with psoriatic arthritis vs healthy controls in two phase 3 clinical trials (DISCOVER-1 and -2). J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.711] [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: 10/14/2022]
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