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de Vlam K, Maksymowych WP, Gallo G, Rahman P, Mease P, Krishnan V, McVeigh CJ, Lisse J, Zhu D, Bolce RJ, Conaghan PG. Exploring the Effects of Ixekizumab on Pain in Patients with Ankylosing Spondylitis Based on Objective Measures of Inflammation: Post Hoc Analysis from a Large Randomized Clinical Trial. Rheumatol Ther 2024:10.1007/s40744-024-00660-7. [PMID: 38637464 DOI: 10.1007/s40744-024-00660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION The objective of this analysis is to evaluate the improvement in spinal pain with ixekizumab, placebo, and adalimumab based on objective measures of inflammation response in patients with ankylosing spondylitis (AS). METHODS The COAST-V 52-week, double-blind, placebo-controlled, randomized phase III trial examined the efficacy of ixekizumab in patients with active AS; adalimumab was used as an active reference arm. Treatment effects on reduction in pain were assessed by objective measures of controlled and persisting inflammation (defined by magnetic resonance imaging [MRI], C-reactive protein [CRP], or MRI + CRP status). Pathway analysis was used to analyze treatment effect that was not attributable to reduction in inflammation biomarkers. RESULTS In patients with AS, when inflammation was controlled as assessed by MRI, patients treated with ixekizumab experienced a reduction in spinal pain at night (SP-N, numeric rating scale, ixekizumab mean = - 3.9, p < 0.001, adalimumab mean = - 2.6, p < 0.05) compared to placebo (mean = - 1.6) at week 16. When inflammation was controlled as assessed by MRI + CRP, ixekizumab and adalimumab had numerically greater reductions at week 16 in SP-N versus placebo. All ixekizumab groups had further improvements at week 52. When inflammation was persisting as assessed by MRI + CRP, ixekizumab-treated patients had significant reduction in SP-N (mean = - 3.7, p < 0.001) versus placebo (mean = - 1.7), improvement with adalimumab did not reach significance (mean = - 2.6, p = 0.06). In the pathway analysis at week 16, ixekizumab had a greater effect on pain outcomes compared to adalimumab. CONCLUSION This post hoc analysis is supportive of the hypothesis that ixekizumab reduces pain in AS by additional mechanisms other than the reduction of measurable inflammation. TRIAL REGISTRATION NUMBER NCT02696785.
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Affiliation(s)
| | - Walter P Maksymowych
- Department of Medicine, Division of Rheumatology at the University of Alberta, Edmonton, Alberta, Canada
| | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, USA
| | - Proton Rahman
- Department of Medicine, Memorial University, St. John's, Newfoundland, A1C 5B8, Canada
| | - Philip Mease
- Swedish Medical Center/Providence St, Joseph Health and University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Østergaard M, Wetterslev M, Hadsbjerg AE, Maksymowych WP, Eshed I, Jans L, Emad Y, Pedersen SJ, Stoenoiu MS, Bird P, Foltz V, Mathew AJ, Paschke J, Carron P, De Marco G, Marzo-Ortega H, Møller-Bisgaard S, Conaghan PG, Lambert RG. The OMERACT whole-body MRI scoring system for inflammation in peripheral joints and entheses (WIPE) in spondyloarthritis - reference image atlas for the knee region. Semin Arthritis Rheum 2024; 65:152384. [PMID: 38325053 DOI: 10.1016/j.semarthrit.2024.152384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To develop a reference image atlas for the Outcome Measures in Rheumatology whole-body MRI scoring system for inflammation in peripheral joints and entheses (OMERACT MRI-WIPE) of the knee region. METHODS Image examples of each pathology, location and grade, were collected and discussed at web-based, interactive meetings within the OMERACT MRI in Arthritis Working Group. Subsequently, reference images were selected by consensus. RESULTS Reference images for each grade, pathology and location are depicted, along with definitions, reader rules and recommended MRI-sequences. CONCLUSION The atlas guides scoring whole-body MRIs for inflammation in joints and entheses of the knee region according to MRI-WIPE methodology in clinical trials and cohorts.
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Affiliation(s)
- Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Wetterslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Anna Ef Hadsbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CARE Arthritis, Edmonton, Alberta, Canada
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the School of Medicine, Tel-Aviv University, Israel
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Yasser Emad
- Department of Rheumatology, Faculty of Medicine, Cairo University, Egypt
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Maria S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgium
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, Australia
| | - Violaine Foltz
- Department of Rheumatology, Sorbonne University, APHP, Pitié-Salpètrière Hospital, Paris, France
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | | | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
| | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Signe Møller-Bisgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Østergaard M, Lambert RG, Hadsbjerg AE, Eshed I, Maksymowych WP, Mathew AJ, Jans L, Pedersen SJ, Carron P, Emad Y, De Marco G, Bird P, Stoenoiu MS, Foltz V, Paschke J, Marzo-Ortega H, Møller-Bisgaard S, Conaghan PG, Wetterslev M. Hip and pelvis region MRI reference image atlas for scoring inflammation in peripheral joints and entheses according to the OMERACT-MRI WIPE scoring system in patients with spondyloarthritis. Semin Arthritis Rheum 2024; 65:152383. [PMID: 38325055 DOI: 10.1016/j.semarthrit.2024.152383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To develop a reference image atlas for scoring the hip/pelvis region according to the OMERACT whole-body MRI scoring system for inflammation in peripheral joints and entheses (MRI-WIPE). METHODS We collected image examples of each pathology, location and grade, discussed them at web-based, interactive meetings and, finally, selected reference images by consensus. RESULTS Reference images for each grade and location of osteitis, synovitis and soft tissue inflammation are provided, as are definitions, reader rules and recommended MRI-sequences. CONCLUSION A reference image atlas was created to guide scoring whole-body MRIs for arthritis and enthesitis in the hip/pelvis region in spondyloarthritis/psoriatic arthritis clinical trials and cohorts.
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Affiliation(s)
- Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Ef Hadsbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the School of Medicine, Tel-Aviv University, Israel
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CARE Arthritis, Edmonton, Alberta, Canada
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
| | - Yasser Emad
- Department of Rheumatology, Faculty of Medicine, Cairo University, Egypt
| | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, Australia
| | - Maria S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgium
| | - Violaine Foltz
- Department of Rheumatology, Sorbonne University, APHP, Pitié-Salpètrière Hospital, Paris, France
| | | | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Signe Møller-Bisgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marie Wetterslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
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Felfeliyan B, Wichuk S, Hareendranathan AR, Lambert RG, Maksymowych WP, Jaremko J. OMERACT validation of a deep learning algorithm for automated absolute quantification of knee joint effusion versus manual semi-quantitative assessment. Semin Arthritis Rheum 2024; 66:152420. [PMID: 38422727 DOI: 10.1016/j.semarthrit.2024.152420] [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: 09/01/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To begin evaluating deep learning (DL)-automated quantification of knee joint effusion-synovitis via the OMERACT filter. METHODS A DL algorithm previously trained on Osteoarthritis Initiative (OAI) knee MRI automatically quantified effusion volume in MRI of 53 OAI subjects, which were also scored semi-quantitatively via KIMRISS and MOAKS by 2-6 readers. RESULTS DL-measured knee effusion correlated significantly with experts' assessments (Kendall's tau 0.34-0.43) CONCLUSION: The close correlation of automated DL knee joint effusion quantification to KIMRISS manual semi-quantitative scoring demonstrated its criterion validity. Further assessments of discrimination and truth vs. clinical outcomes are still needed to fully satisfy OMERACT filter requirements.
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Affiliation(s)
- Banafshe Felfeliyan
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada.
| | - Stephanie Wichuk
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada; Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada; CARE Arthritis, Edmonton, Alberta, Canada
| | - Jacob Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada; Medical Imaging Consultants, Edmonton, Alberta, Canada
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Maksymowych WP, Claudepierre P, de Hooge M, Lambert RG, Landewé R, Molto A, van der Heijde D, Bukowski JF, Jones H, Pedersen R, Szumski A, Vlahos B, Dougados M. Erosions on T1-weighted MRI vs Radiography of Sacroiliac Joints in Recent-onset Axial SpA: 2-year Data (EMBARK Trial and DESIR Cohort). J Rheumatol 2024:jrheum.2023-0906. [PMID: 38359938 DOI: 10.3899/jrheum.2023-0906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To (1) compare the capacity to detect sacroiliac joint (SIJ) erosions and baseline-to-Week-104 change in erosions between magnetic resonance imaging (MRI) and radiographs in recent-onset axial spondyloarthritis (axSpA); (2) compare treatment discriminatory capacities of MRI and radiographic scores for erosion detection in patients receiving etanercept in the EMBARK trial vs controls in the DESIR cohort. METHODS Anonymized SIJ MRI and radiographs were assessed at patient and joint surface levels. Three readers evaluated MRI; 3 different readers evaluated radiographs. Final scores for comparison of radiographs and MRI for detection of erosions were assigned based on agreement of ≥2 of 3 readers' assessments. RESULTS At baseline, discordance in erosion detection between imaging methods was more frequent for MRI erosions in the absence of radiographic erosions (48/224 [21.4%] patients) than for radiographic erosions in the absence of MRI erosions (14/224 [6.3%] patients; P<0.001). After 104 weeks, decrease in erosions was observed on MRI but not radiographs in 49 (22.2%) patients and on radiographs but not MRI in 6 (2.7%) (P<0.001). In the treatment-discriminant capacity analysis, the largest standardized differences between etanercept and control cohorts at Week 104 were changes in Spondyloarthritis Research Consortium of Canada MRI erosion discrete score, erosion average score, and meeting the modified New York criteria on radiographs, with unadjusted/adjusted Hedge's G effect sizes of 0.40/0.50, 0.40/0.56, and 0.40/0.43, respectively. CONCLUSION In recent-onset axSpA, SIJ erosions and erosion change were observed more frequently on MRI than radiography. The significance of interval improvement of MRI erosions warrants further research.
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Affiliation(s)
- Walter P Maksymowych
- W.P. Maksymowych, MD, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pascal Claudepierre
- P. Claudepierre, MD, Department of Rheumatology, CHU Henri Mondor, Paris, France
| | - Manouk de Hooge
- M. de Hooge, PhD, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Robert G Lambert
- R.G. Lambert, MB, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Landewé
- R. Landewé, MD, Amsterdam University Medical Center, Amsterdam
| | - Anna Molto
- A. Molto, MD, Department of Rheumatology, CHU Cochin, Paris, France
| | - Désirée van der Heijde
- D. van der Heijde, MD, , Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jack F Bukowski
- J.F. Bukowski, MD, Global Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Heather Jones
- H. Jones, RN, Global Medical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Ron Pedersen
- R. Pedersen, MS, Department of Biostatistics, Pfizer, Collegeville, Pennsylvania, USA
| | | | - Bonnie Vlahos
- B. Vlahos, MBA, BSN, RN, Global Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Maxime Dougados
- M. Dougados, MD, Department of Rheumatology, CHU Cochin, Paris, France
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Maksymowych WP, Herregods N, Varma N, Meyers AB, Stimec J, Doria AS, Tzaribachev N, Otobo TM, van Rossum MA, Paschke J, Wichuk S, Lambert RG. Systematic calibration reduces sources of variability for the preliminary OMERACT juvenile idiopathic arthritis MRI- sacroiliac joint score (OMERACT JAMRIS-SIJ). Semin Arthritis Rheum 2024; 64:152299. [PMID: 38039747 DOI: 10.1016/j.semarthrit.2023.152299] [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: 08/20/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To determine whether systematic calibration enhances scoring proficiency of the OMERACT juvenile idiopathic arthritis MRI-Sacroiliac Joint score (JAMRIS-SIJ) and whether contrast-enhancement enhances its performance. METHODS MRI SIJ scans of 50 cases with juvenile spondyloarthritis were scored by 7 raters after calibration with 3 different knowledge transfer tools. RESULTS Calibrated readers achieved greater reliability for scoring certain inflammatory and structural lesions. Sensitivity and reliability for scoring inflammatory lesions was greater on fluid-sensitive compared to contrast-enhanced sequences. CONCLUSION Systematic calibration should be implemented prior to the use of JAMRIS-SIJ for clinical trials. It is unlikely that contrast-enhanced MRI will improve the performance of this method.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada; CARE Arthritis, Edmonton, Alberta, Canada.
| | - Nele Herregods
- Division of Pediatric Radiology, Universitair Ziekenhuis Ghent, Ghent, Belgium
| | - Nisha Varma
- Department of Paediatric Radiology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Medical Imaging Department, Western Health, Melbourne, Victoria, Australia
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada; Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Nikolay Tzaribachev
- Department of Pediatric Rheumatology, Medical Center Bad Bramstedt, Bramstedt, Germany
| | - Tarimobo M Otobo
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Marion A van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
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Capelusnik D, Ramiro S, Nikiphorou E, Maksymowych WP, Magrey MN, Marzo-Ortega H, Boonen A. Thresholds for unacceptable work state in radiographic axial Spondyloarthritis of four presenteeism and two clinical outcome measurement instruments. Rheumatology (Oxford) 2024:keae033. [PMID: 38273699 DOI: 10.1093/rheumatology/keae033] [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: 09/13/2023] [Revised: 12/11/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To a) identify threshold values of presenteeism measurement instruments that reflect unacceptable work state in employed r-axSpA patients; b) determine whether those thresholds accurately predict future adverse work outcomes (AWO) (sick leave or short/long-term disability); c) evaluate the performance of traditional health-outcomes for r-axSpA; d) explore whether thresholds are stable across contextual factors. METHODS Data from the multinational AS-PROSE study was used. Thresholds to determine whether patients consider themselves in an 'unacceptable work state' were calculated at baseline for four instruments assessing presenteeism and two health-outcomes specific for r-axSpA. Different approaches derived from the receiver operating characteristic methodology were used. Validity of the optimal thresholds was tested across contextual factors and for predicting future AWO over 12 months. RESULTS Of 366 working patients, 15% reported an unacceptable work state; 6% experienced at least one AWO in 12 months. Optimal thresholds were: WPAI-presenteeism ≥40 (AUC 0.85), QQ-method <97 (0.76), WALS ≥0.75 (AUC 0.87), WLQ-25 ≥ 29 (AUC 0.85). BASDAI and BASFI performed similarly to the presenteeism instruments: ≥4.7 (AUC 0.82) and ≥3.5 (AUC 0.79), respectively. Thresholds for WALS and WLQ-25 were stable across contextual factors, while for all other instruments they overestimated unacceptable work state in lower educated persons. Proposed thresholds could also predict future AWO, although with lower performance, especially for QQ-method, BASDAI and BASFI. CONCLUSIONS Thresholds of measurement instruments for presenteeism and health status to identify unacceptable work state have been established. These thresholds can help in daily clinical practice to provide work related support to r-axSpA patients at risk for AWO.
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Affiliation(s)
- Dafne Capelusnik
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sofia Ramiro
- Department of Rheumatology, Leiden, University Medical Center, Leiden, the Netherlands. Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK. Department of Rheumatology, King's College Hospital, London, UK
| | | | - Marina Nighat Magrey
- Department of Rheumatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, LTHT and LIRMM, University of Leeds, Leeds, UK
| | - Annelies Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. Department of Rheumatology, Maastricht University medical center, Maastricht, the Netherlands
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Baraliakos X, Deodhar A, van der Heijde D, Magrey M, Maksymowych WP, Tomita T, Xu H, Massow U, Fleurinck C, Ellis AM, Vaux T, Shepherd-Smith J, Marten A, Gensler LS. Bimekizumab treatment in patients with active axial spondyloarthritis: 52-week efficacy and safety from the randomised parallel phase 3 BE MOBILE 1 and BE MOBILE 2 studies. Ann Rheum Dis 2024; 83:199-213. [PMID: 37793792 DOI: 10.1136/ard-2023-224803] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Bimekizumab (BKZ), a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A, has demonstrated superior efficacy versus placebo in patients with non-radiographic (nr-) and radiographic (r-) axial spondyloarthritis (axSpA) at Week 16. Here, the objective is to report the efficacy and safety of BKZ at Week 52. METHODS BE MOBILE 1 (nr-axSpA; NCT03928704) and BE MOBILE 2 (r-axSpA; NCT03928743) comprised a 16-week, double-blind, placebo-controlled period, then a 36-week maintenance period. From Week 16, all patients received subcutaneous BKZ 160 mg every 4 weeks. RESULTS Improvements versus placebo in Assessment of SpondyloArthritis International Society ≥40% response (primary endpoint), Ankylosing Spondylitis Disease Activity Score, high-sensitivity C-reactive protein levels and MRI inflammation of the sacroiliac joints/spine at Week 16 were sustained to Week 52 in BKZ-randomised patients. At Week 52, responses of patients switching from placebo to BKZ at Week 16 were comparable to BKZ-randomised patients. At Week 52, ≥1 treatment-emergent adverse events (TEAEs) were reported in 183 (75.0%) and 249 (75.5%) patients with nr-axSpA and r-axSpA, respectively. Serious TEAEs occurred in 9 (3.7%) patients with nr-axSpA and 20 (6.1%) patients with r-axSpA. Oral candidiasis was the most frequent fungal infection (nr-axSpA: 18 (7.4%); r-axSpA: 20 (6.1%)). Uveitis occurred in three (1.2%) and seven (2.1%) patients with nr-axSpA and r-axSpA, and inflammatory bowel disease in two (0.8%) and three (0.9%). CONCLUSIONS At Week 52, dual inhibition of IL-17A and IL-17F with BKZ resulted in sustained efficacy across the axSpA spectrum; the safety profile was consistent with the known safety of BKZ. TRIAL REGISTRATION NUMBER NCT03928704; NCT03928743.
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Affiliation(s)
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Marina Magrey
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Tetsuya Tomita
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka City, Osaka, Japan
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Affiliated to Second Military Medical University, Shanghai, China
| | | | | | | | | | | | | | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
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Port H, Hausgaard CM, He Y, Maksymowych WP, Wichuk S, Sinkeviciute D, Bay-Jensen AC, Holm Nielsen S. A novel biomarker of MMP-cleaved cartilage intermediate layer protein-1 is elevated in patients with rheumatoid arthritis, ankylosing spondylitis and osteoarthritis. Sci Rep 2023; 13:21717. [PMID: 38066013 PMCID: PMC10709337 DOI: 10.1038/s41598-023-48787-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Rheumatic joints have an altered cartilage turnover. Cartilage intermediate layer protein 1 (CILP-1) is secreted from articular chondrocytes and deposited into the cartilage extracellular matrix. We developed an immunoassay targeting a Matrix Metalloproteinase (MMP)-generated neo-epitope of CILP-1, named CILP-M. Human articular cartilage was cleaved with proteolytic enzymes and CILP-M levels were measured. We also quantified CILP-M in two studies from patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and osteoarthritis (OA) and explored the monitoring and prognostic potential of CILP-M in TNF-α inhibitory treatment and modified Stoke AS Spine Score (mSASSS) progression. CILP-M was generated by MMP-1, -8 and -12. In the discovery study, CILP-M was significantly higher in patients with RA, AS and OA than healthy donors (p < 0.01, p < 0.001, p < 0.05) with an area under the curve (AUC) between the diseased groups and healthy donors > 0.95 (p < 0.001). In the validation study, patients with RA and AS had significantly higher CILP-M levels than healthy controls (p < 0.001) and AUC > 0.90 (p < 0.001). Patients with AS treated with TNF- α inhibitory treatment in the validation study had significantly lower CILP-M levels after treatment (p = 0.004). CILP-M may provide useful insights into cartilage degradation processes in rheumatic diseases.
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Affiliation(s)
- Helena Port
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Immunoscience, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark.
| | | | - Yi He
- Immunoscience, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | | | - Stephanie Wichuk
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dovile Sinkeviciute
- Immunoscience, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | | | - Signe Holm Nielsen
- Immunoscience, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
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10
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Østergaard M, Maksymowych WP. Advances in the Evaluation of Peripheral Enthesitis by Magnetic Resonance Imaging in Patients With Psoriatic Arthritis. J Rheumatol 2023; 50:18-22. [PMID: 37419626 DOI: 10.3899/jrheum.2023-0518] [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: 07/09/2023]
Abstract
Enthesitis is a key disease manifestation in patients with psoriatic arthritis (PsA) that considerably contributes to pain, lower physical function, and reduced quality of life. Clinical assessment of enthesitis lacks sensitivity and specificity, and therefore better methods are urgently needed. Magnetic resonance imaging (MRI) allows detailed assessment of the components of enthesitis, and consensus-based validated MRI scoring systems exist. These include the Outcome Measures in Rheumatology (OMERACT) Heel Enthesitis MRI Scoring System (HEMRIS) method, which assesses the entheses of the heel region in a detailed manner, and the OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses (MRI-WIPE) method, which provides an overall assessment of the inflammatory burden in the peripheral entheses and joints in the entire body using whole-body MRI. At an MRI workshop at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2022 meeting in Brooklyn, the MRI appearances of peripheral enthesitis were described, as were the scoring methods. The utility of MRI for improved assessment of enthesitis was demonstrated with examples of patient cases. Clinical trials in PsA that evaluate enthesitis by MRI as a key endpoint should include the presence of MRI enthesitis as an inclusion criterion, and apply validated MRI outcomes to assess the effect of therapeutics on enthesitis are recommended.
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Affiliation(s)
- Mikkel Østergaard
- M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty for Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Walter P Maksymowych
- W.P. Maksymowych, MD, MB ChB, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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11
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Weiss PF, Brandon TG, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Herregods N, Hendry AM, Maksymowych WP. Consensus-Driven Definition for Unequivocal Sacroiliitis on Radiographs in Juvenile Spondyloarthritis. J Rheumatol 2023; 50:1173-1177. [PMID: 37061228 PMCID: PMC10524560 DOI: 10.3899/jrheum.2022-0890] [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] [Accepted: 03/14/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE Radiography is still used worldwide for the detection of sacroiliitis in juvenile spondyloarthritis (JSpA), despite its low sensitivity and reliability. We aimed to define unequivocal evidence of sacroiliitis on pelvic radiography in skeletally immature youth for use in classification criteria when magnetic resonance imaging (MRI) is unavailable. METHODS Subjects were a retrospective cohort of juvenile patients with spondyloarthritis with a radiograph and MRI as part of a diagnostic evaluation for axial disease. Six musculoskeletal imaging experts underwent an iterative consensus process to define unequivocal sacroiliitis on radiography in skeletally immature youth. Radiographs were graded using the modified New York (mNY) criteria and the unequivocal sacroiliitis criteria. Interrater agreement was assessed with the Fleiss [Formula: see text] statistic. Specificity, area under the receiver operator characteristic curve (AUROC), and sensitivity of the 2 measures were tested using 2 MRI reference standards. RESULTS A total of 112 subjects, with a median age of 14.9 (range 6.7-20.1) years, were included. The Fleiss [Formula: see text] was fair for the mNY criteria (0.54, 95% CI 0.42-0.67) and the unequivocal sacroiliitis criteria (0.58, 95% CI 0.46-0.69). The unequivocal sacroiliitis criteria achieved > 90% specificity using both MRI reference standards. Sensitivity (59.26 and 57.14 vs 44.83 and 43.33) and AUROC (0.76 and 0.76 vs 0.71 and 0.71) were higher, for both reference standards, for the unequivocal sacroiliitis in youth definition than for the mNY criteria, respectively. CONCLUSION In this study, we propose the first consensus-derived definition to our knowledge of unequivocal sacroiliitis by radiography in skeletally immature youth. This definition achieved excellent specificity and had higher AUROC and sensitivity values than the mNY criteria using both MRI reference standards. This definition has applicability to the JSpA axial disease classification imaging criterion when MRI is unavailable.
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Affiliation(s)
- Pamela F Weiss
- P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Timothy G Brandon
- T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert G Lambert
- R.G. Lambert, MB BCh, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - David M Biko
- D.M. Biko, MD, Department of Radiology, Children's Hospital of Philadelphia, and Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy A Chauvin
- N.A. Chauvin, MD, Department of Radiology, Penn State Health Milton S. Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Michael L Francavilla
- M.L. Francavilla, MD, Department of Radiology, Whiddon College of Medicine, University of South Alabama, Mobile, Alabama USA
| | - Nele Herregods
- N. Herregods, MD, Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Alison M Hendry
- A.M. Hendry, PGDipHealMgt, PGDipHSc, General Medicine and Rheumatology, Division of Medicine, Emergency and Integrated Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Walter P Maksymowych
- W.P. Maksymowych, MD, Department of Medicine, University of Alberta and CARE Arthritis, Edmonton, Alberta, Canada
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12
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Ramiro S, Landewé R, van der Heijde D, Sepriano A, FitzGerald O, Østergaard M, Homik J, Elkayam O, Thorne JC, Larché MJ, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel AG, Allaart CF, Barnabe C, Bingham CO, van Schaardenburg D, Hammer HB, Dadashova R, Hutchings E, Paschke J, Maksymowych WP. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford) 2023; 62:2989-2997. [PMID: 36645243 DOI: 10.1093/rheumatology/kead021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. METHODS Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. RESULTS In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: -0.04, 0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. CONCLUSIONS In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, School of Medicine, University College Dublin, Ireland
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Carter Thorne
- The Arthritis Program Research Group, University of Toronto, Toronto, Canada
| | - Maggie J Larché
- Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Marina Backhaus
- Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gilles Boire
- Department of Medicine/Division of Rheumatology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), University of Sherbrooke, Sherbrooke, Canada
| | - Bernard Combe
- Department of Rheumatology, Montpellier University, Montpellier, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, France
| | - Alain Saraux
- LBAI, U1227, Université Brest, Inserm, CHU Brest, Brest, France
| | - Maxime Dougados
- Rheumatology Department, Paris Cité University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Luigi Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Alain G Cantagrel
- Department of Rheumatology, CHU Toulouse, Paul Sabatier University, Toulouse, France
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
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Østergaard M, Wu J, Fallon L, Sherlock SP, Wang C, Fleishaker D, Kanik KS, Maksymowych WP. Tofacitinib Reduces Spinal Inflammation in Vertebral Bodies and Posterolateral Elements in Ankylosing Spondylitis: Results from a Phase 2 Trial. Rheumatol Ther 2023; 10:1001-1020. [PMID: 37331992 PMCID: PMC10326231 DOI: 10.1007/s40744-023-00564-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION This post hoc analysis of phase 2 trial data assessed the efficacy of tofacitinib on magnetic resonance imaging (MRI) outcomes with the detailed anatomy-based Canada-Denmark (CANDEN) MRI scoring system and evaluated tofacitinib suppression of spinal inflammation in patients with active ankylosing spondylitis (AS). METHODS Patients with active AS (per modified New York criteria) were randomized 1:1:1:1 to receive tofacitinib 2, 5, or 10 mg twice daily (BID), or placebo, in a 16-week, phase 2, double-blind clinical trial. Spine MRI assessments were performed at baseline and week 12. For post hoc analysis, MRI images from patients receiving tofacitinib 5 or 10 mg BID, or placebo, were re-evaluated by two readers blinded to time point/treatment and assessed by the CANDEN MRI scoring system. Least squares mean changes from baseline to week 12 were reported for CANDEN-specific MRI outcomes, with analysis of covariance used for comparisons of pooled tofacitinib and tofacitinib 5 or 10 mg BID versus placebo. p values without multiplicity adjustment were reported. RESULTS MRI data from 137 patients were analyzed. At week 12, CANDEN spine inflammation score and vertebral body, posterior elements, corner, non-corner, facet joint, and posterolateral inflammation subscores were significantly reduced with pooled tofacitinib versus placebo (p < 0.0001; except non-corner subscore, p < 0.05). Total spine fat score was numerically increased with pooled tofacitinib versus placebo. CONCLUSIONS In patients with AS, tofacitinib treatment was associated with significant reductions in MRI scores of spinal inflammation versus placebo, as assessed by the CANDEN MRI scoring system. Tofacitinib reduced inflammation in posterolateral elements of the spine and facet joints, which has not been described previously. TRIAL REGISTRATION ClinicalTrials.gov registry (NCT01786668).
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Affiliation(s)
- Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Copenhagen, Denmark.
| | | | | | | | | | | | | | - Walter P Maksymowych
- Department of Medicine, University of Alberta, and CARE Arthritis, Edmonton, AB, Canada
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Maksymowych WP, Jaremko JL, Pedersen SJ, Eshed I, Weber U, McReynolds A, Bird P, Wichuk S, Lambert RG. Comparative validation of the knee inflammation MRI scoring system and the MRI osteoarthritis knee score for semi-quantitative assessment of bone marrow lesions and synovitis-effusion in osteoarthritis: an international multi-reader exercise. Ther Adv Musculoskelet Dis 2023; 15:1759720X231171766. [PMID: 37457557 PMCID: PMC10345937 DOI: 10.1177/1759720x231171766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/05/2023] [Indexed: 07/18/2023] Open
Abstract
Background Bone marrow lesions (BMLs) and synovitis on magnetic resonance imaging (MRI) are associated with symptoms and predict degeneration of articular cartilage in osteoarthritis (OA). Validated methods for their semiquantitative assessment on MRI are available, but they all have similar scoring designs and questionable sensitivity to change. New scoring methods with completely different designs need to be developed and compared to existing methods. Objectives To compare the performance of new web-based versions of the Knee Inflammation MRI Scoring System (KIMRISS) with the MRI OA Knee Score (MOAKS) for quantification of BMLs and synovitis-effusion (S-E). Design Retrospective follow-up cohort. Methods We designed web-based overlays outlining regions in the knee that are scored for BML in MOAKS and KIMRISS. For KIMRISS, both BML and S-E are scored on consecutive sagittal slices. The performance of these methods was compared in an international reading exercise of 8 readers evaluating 60 pairs of scans conducted 1 year apart from cases recruited to the OA Initiative (OAI) cohort. Interobserver reliability for baseline status and baseline to 1 year change in BML and S-E was assessed by intra-class correlation coefficient (ICC) and smallest detectable change (SDC). Feasibility was assessed using the System Usability Scale (SUS). Results Mean change in BML and S-E was minimal over 1 year. Pre-specified targets for acceptable reliability (ICC ⩾ 0.80 and ⩾ 0.70 for status and change scores, respectively) were achieved more frequently for KIMRISS for both BML and synovitis. Mean (95% CI) ICC for change in BML was 0.88 (0.83-0.92) and 0.69 (0.60-0.78) for KIMRISS and MOAKS, respectively. KIMRISS mean SUS usability score was 85.7 and at the 95th centile of ranking for usability versus a score of 55.4 and 20th centile for MOAKS. Conclusion KIMRISS had superior performance metrics to MOAKS for quantification of BML and S-E. Both methods should be further compared in trials of new therapies for OA.
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Affiliation(s)
| | - Jacob L. Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
| | - Susanne J. Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Iris Eshed
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | - Andrew McReynolds
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, Canada
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Stephanie Wichuk
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Robert G. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
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Mauro D, Gandolfo S, Tirri E, Schett G, Maksymowych WP, Ciccia F. The bone marrow side of axial spondyloarthritis. Nat Rev Rheumatol 2023:10.1038/s41584-023-00986-6. [PMID: 37407716 DOI: 10.1038/s41584-023-00986-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
Spondyloarthritis (SpA) is characterized by the infiltration of innate and adaptive immune cells into entheses and bone marrow. Molecular, cellular and imaging evidence demonstrates the presence of bone marrow inflammation, a hallmark of SpA. In the spine and the peripheral joints, bone marrow is critically involved in the pathogenesis of SpA. Evidence suggests that bone marrow inflammation is associated with enthesitis and that there are roles for mechano-inflammation and intestinal inflammation in bone marrow involvement in SpA. Specific cell types (including mesenchymal stem cells, innate lymphoid cells and γδ T cells) and mediators (Toll-like receptors and cytokines such as TNF, IL-17A, IL-22, IL-23, GM-CSF and TGFβ) are involved in these processes. Using this evidence to demonstrate a bone marrow rather than an entheseal origin for SpA could change our understanding of the disease pathogenesis and the relevant therapeutic approach.
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Affiliation(s)
- Daniele Mauro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Saviana Gandolfo
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Enrico Tirri
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Maksymowych WP. Evidence in support of the bone marrow as the primary lesion in axial spondyloarthritis. Curr Opin Rheumatol 2023; 35:213-218. [PMID: 37115850 DOI: 10.1097/bor.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW Over the past several decades, the concept that the primary lesion accounting for the development of axSpA is an enthesopathy has been widely accepted. However, the hallmark abnormality of axSpA occurs in the sacroiliac joint at the interface of cartilage and bone at a location remote from any anatomical enthesis. Both imaging and histopathological data from the sacroiliac joint point to immunopathogenetic events in the bone marrow as being of primary importance. Here, we discuss new developments in our understanding of immune events in the bone marrow relevant to axSpA that reinforce the need for a change in our conceptual paradigm for the pathogenesis of axSpA. RECENT FINDINGS Human spinal enthesis samples contain myeloperoxidase-expressing cells, a marker of neutrophils, and mucosal-associated invariant T cells in the perientheseal bone marrow, which may be activated by stromal cells and circulating microbial products to express IL-17A and IL-17F and tumor necrosis factor (TNF). Evaluation of transcriptomes of monocytes from patients with axSpA demonstrates a lipopolysaccharide/TNF signature characterized by the expression of genes associated with granulocytopoietic bone marrow cells. This neutrophil-like phenotype is more evident in established and more severe axSpA and may be activated by microbial products from the gut. A similar expansion of granulocyte-monocyte progenitor-driven hematopoiesis occurs in the SKG mouse driven by granulocyte-macrophage colony-stimulating factor. Mesenchymal stem cells (MSCs) from ankylosing spondylitis patients are more likely to exhibit osteogenic differentiation than MSCs from healthy donors, which may be mediated by the formation of specific clusters of transcriptional factors, super enhancers, regulated by axSpA-associated single nucleotide polymorphisms located mostly in noncoding regions. TNF-α may enhance directional migration of AS-MSC compared with MSC from healthy controls from the bone marrow to entheseal soft tissue, which is mediated by increased expression of engulfment and cell motility protein 1 (ELMO1). TNF and IL-17A display differential effects on adipogenesis and osteogenesis of MSC in perientheseal bone marrow and soft tissue. SUMMARY Bone marrow has the capacity to undergo rapid adaptation in terms of cell composition, differentiation, and immune function, resulting in inflammation and osteogenesis in axSpA.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, University of Alberta
- CARE Arthritis, Edmonton, Alberta, Canada
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Bressem KK, Adams LC, Proft F, Hermann KGA, Diekhoff T, Spiller L, Niehues SM, Makowski MR, Hamm B, Protopopov M, Rios Rodriguez V, Haibel H, Rademacher J, Torgutalp M, Lambert RG, Baraliakos X, Maksymowych WP, Vahldiek JL, Poddubny D. Deep Learning Detects Changes Indicative of Axial Spondyloarthritis at MRI of Sacroiliac Joints. Radiology 2023; 307:e239007. [PMID: 37093751 DOI: 10.1148/radiol.239007] [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: 04/25/2023]
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Maksymowych WP, Inman RD, Bessette L, Rahman P, Rampakakis E, Asin-Milan O, Rachich M, Marrache AM, Lehman AJ. Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this? Arthritis Res Ther 2023; 25:70. [PMID: 37118833 PMCID: PMC10148455 DOI: 10.1186/s13075-023-03055-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES To (i) determine whether sustained disease activity states, as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), impact function, and (ii) evaluate characteristics predicting sustained low functional impairment in a prospective axial spondyloarthritis (axSpA) cohort. METHODS Biologic Treatment Registry Across Canada (BioTRAC) was a multi-center, prospective registry that collected real-world data on axSpA patients receiving infliximab or golimumab between 2006 and 2017. Generalized estimating equations (GEE) were used to test baseline characteristics, treatment, and duration (at 6 and 12 months vs. only at 6 or 12 months vs. neither) of low BASDAI (< 3), ASDAS-inactive disease (ID)(< 1.3), and ASDAS-low disease activity (LDA) in predicting sustained low Bath Ankylosing Spondylitis Functional Index (BASFI)(< 3) between 12 and 18 months. The adjusted impact of achieving low disease state at 6 and/or 12 months on BASFI at 18 months was analyzed by generalized linear models. RESULTS Eight hundred ten patients were enrolled. 33.7%, 13.4%, and 24.7% achieved sustained low BASDAI, ASDAS-ID, and ASDAS-LDA, respectively. In univariable GEE of baseline variables, age and baseline BASDAI, BASFI, and ASDAS significantly predicted sustained low BASFI. In multivariable GEE, sustained low BASDAI (p < 0.001), low BASDAI only at 6 or 12 months (p = 0.001), and baseline BASFI (p < 0.001) were the only predictors of sustained low BASFI. Sustained ASDAS-ID (p = 0.040) and ASDAS-LDA (p < 0.001) were also predictors when forced into the model. Similar results were obtained when evaluating the BASFI score at 18 months. CONCLUSION Sustained BASDAI < 3 may be a valid and feasible target for a treat-to-target strategy in axSpA having function as treatment goal.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, 568 Heritage Medical Research Building, T6G 2S2, Edmonton, Canada.
- CARE Arthritis, Edmonton, Canada.
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Louis Bessette
- Department of Medicine, Université Laval, Quebec, QC, Canada
| | - Proton Rahman
- Faculty of Medicine, Memorial University, St John's, NL, Canada
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19
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van der Heijde D, Deodhar A, Baraliakos X, Brown MA, Dobashi H, Dougados M, Elewaut D, Ellis AM, Fleurinck C, Gaffney K, Gensler LS, Haroon N, Magrey M, Maksymowych WP, Marten A, Massow U, Oortgiesen M, Poddubnyy D, Rudwaleit M, Shepherd-Smith J, Tomita T, Van den Bosch F, Vaux T, Xu H. Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials. Ann Rheum Dis 2023; 82:515-526. [PMID: 36649967 PMCID: PMC10086273 DOI: 10.1136/ard-2022-223595] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 11/07/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Axial spondyloarthritis (axSpA) is a complex disease with diverse manifestations, for which new treatment options are warranted. BE MOBILE 1 (non-radiographic (nr)-axSpA) and BE MOBILE 2 (radiographic axSpA (r-axSpA)) are double-blind, phase 3 trials designed to evaluate efficacy and safety of bimekizumab, a novel dual interleukin (IL)-17A and IL-17F inhibitor, across the axSpA spectrum. METHODS In parallel 52-week trials, patients with active disease were randomised 1:1 (nr-axSpA) or 2:1 (r-axSpA) to bimekizumab 160 mg every 4 weeks:placebo. From week 16, all patients received bimekizumab 160 mg every 4 weeks. Primary (Assessment of SpondyloArthritis international Society ≥40% improvement (ASAS40)) and secondary endpoints were assessed at week 16. Here, efficacy and treatment-emergent adverse events (TEAEs) are reported up to week 24. RESULTS 254 patients with nr-axSpA and 332 with r-axSpA were randomised. At week 16, primary (ASAS40, nr-axSpA: 47.7% bimekizumab vs 21.4% placebo; r-axSpA: 44.8% vs 22.5%; p<0.001) and all ranked secondary endpoints were met in both trials. ASAS40 responses were similar across TNFi-naïve and TNFi-inadequate responder patients. Improvements were observed in Ankylosing Spondylitis Disease Activity Score (ASDAS) states and objective measures of inflammation, including high-sensitivity C-reactive protein (hs-CRP) and MRI of the sacroiliac joints and spine. Most frequent TEAEs with bimekizumab (>3%) included nasopharyngitis, upper respiratory tract infection, pharyngitis, diarrhoea, headache and oral candidiasis. More fungal infections (all localised) were observed with bimekizumab vs placebo; no major adverse cardiovascular events (MACE) or active tuberculosis were reported. Incidence of uveitis and adjudicated inflammatory bowel disease was low. CONCLUSIONS Dual inhibition of IL-17A and IL-17F with bimekizumab resulted in significant and rapid improvements in efficacy outcomes vs placebo and was well tolerated in patients with nr-axSpA and r-axSpA.
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Affiliation(s)
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, University Paris Cité, Paris, France
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | | | | | - Karl Gaffney
- Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK
| | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California, San Francisco, California, USA
| | - Nigil Haroon
- University Health Network, Schroeder Arthritis Institute, Department of Medicine/Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Marina Magrey
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Tetsuya Tomita
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka City, Osaka, Japan
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University and VIB Center for Inflammation Research, Ghent, Belgium
| | | | - Huji Xu
- Affiliated to Second Military Medical University, Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Shanghai, China
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20
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Weiss PF, Brandon TG, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Jaremko JL, Herregods N, Kasapcopur O, Yildiz M, Hendry AM, Maksymowych WP. Data-Driven Magnetic Resonance Imaging Definitions for Active and Structural Sacroiliac Joint Lesions in Juvenile Spondyloarthritis Typical of Axial Disease: A Cross-Sectional International Study. Arthritis Care Res (Hoboken) 2022; 75:1220-1227. [PMID: 36063392 PMCID: PMC9985663 DOI: 10.1002/acr.25014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We aimed to determine quantitative sacroiliac (SI) joint magnetic resonance imaging (MRI) cutoffs for active and structural lesions that will be incorporated as imaging domains in classification criteria of axial disease in juvenile spondyloarthritis (SpA). METHODS MRI scans from an international cross-section of juvenile SpA patients were reviewed by 6 musculoskeletal imaging experts blinded to clinical details. Raters globally assessed the presence/absence of lesions typical of axial SpA and performed SI joint quadrant- or joint-based scoring. Sensitivity and specificity of lesion cutoffs were calculated using a rater majority (≥4 of 6 raters) on a global assessment of the presence/absence of active or structural lesions typical of axial SpA with high confidence as the reference standard. Cutoffs were validated in an independent cohort. RESULTS Imaging from 243 subjects, 61% male, median age 14.9 years, had sequences available for detailed MRI scoring. Optimal cutoffs for defining lesions typical of axial disease in juvenile SpA were: 1) inflammatory lesion: bone marrow edema in ≥3 SI joint quadrants across all SI joint MRI slices (sensitivity 98.6%, specificity 96.5%); 2) structural lesions: erosion in ≥3 quadrants or sclerosis or fat lesion in ≥2 SI joint quadrants or backfill or ankylosis in ≥2 joint halves across all SI joint MRI slices (sensitivity 98.6%, specificity 95.5%). Sensitivity and specificity of the optimal cutoffs in the validation cohort were excellent. CONCLUSION We propose data-driven cutoffs for active inflammatory and structural lesions on MRI typical of axial disease in juvenile SpA that have high specificity and sensitivity using central imaging global assessment as the reference standard and excellent reliability.
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Affiliation(s)
- Pamela F. Weiss
- Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Timothy G. Brandon
- Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert G. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - David M. Biko
- Department of Radiology, Children’s Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A. Chauvin
- Department of Radiology, Penn State Health Milton S. Hershey Children’s Hospital, Hershey, PA, USA
| | - Michael L. Francavilla
- Department of Radiology, Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Jacob L. Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa Cerrahpasa Medical School, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa Cerrahpasa Medical School, Istanbul, Turkey
| | - Alison M. Hendry
- General Medicine and Rheumatology, Division of Medicine, Emergency and Integrated Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Walter P. Maksymowych
- Department of Medicine, University of Alberta and CARE Arthritis, Edmonton, AB, Canada
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21
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Robinson PC, Maksymowych WP, Gensler LS, Hall S, Rudwaleit M, Hoepken B, Bauer L, Kumke T, Kim M, de Peyrecave N, Deodhar A. Certolizumab Pegol Efficacy in Patients With
Non‐Radiographic
Axial Spondyloarthritis Stratified by Baseline
MRI
and
C‐Reactive
Protein Status: An Analysis From the
C‐axSpAnd
Study. ACR Open Rheumatol 2022; 4:794-801. [PMID: 35733363 PMCID: PMC9469479 DOI: 10.1002/acr2.11469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Tumor necrosis factor inhibitors (TNFi) are an effective treatment for non‐radiographic axial spondyloarthritis (nr‐axSpA). To be eligible, however, many authorities require patients with nr‐axSpA to show active sacroiliitis on magnetic resonance imaging (MRI) and/or an elevated C‐reactive protein (CRP) level, possibly resulting in a perception that patients with nr‐axSpA without both factors have only low responses to TNFi treatment. We evaluated clinical responses to certolizumab pegol (CZP) in patients with nr‐axSpA stratified by baseline MRI/CRP status. Methods C‐axSpAnd was a phase 3, multicenter study on CZP in adult patients with active nr‐axSpA and objective signs of inflammation. This analysis assessed efficacy of CZP over the 52‐week randomized, double‐blind, placebo‐controlled period in patients stratified into subgroups based on the presence of active sacroiliitis on MRI and CRP level at baseline. Results CZP‐treated patients across all MRI/CRP subgroups achieved clinical responses greater than placebo. Across outcome measures, CZP‐treated MRI+/CRP+ patients demonstrated the greatest clinical responses, but substantial improvements were also observed in CZP‐treated MRI+/CRP− and MRI−/CRP+ patients. Ankylosing Spondylitis Disease Activity Score Major Improvement response rates at week 52 among CZP‐treated patients (75.6% MRI+/CRP+; 47.5% MRI−/CRP+; and 29.7% MRI+/CRP−) were higher than rates in placebo groups (range: 3.9%‐12.5%). Assessment of SpondyloArthritis international Society 40% response, Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondyloarthritis Functional Index had similar response patterns, although differences between the CZP‐treated MRI/CRP subgroups were smaller. Clinical responses among CZP‐treated patients were also observed in additional subgroups, including those with low Spondyloarthritis Research Consortium of Canada MRI sacroiliac joint inflammation scores and those with normal baseline CRP levels. Conclusion Our findings indicate that CZP treatment benefits patients with nr‐axSpA across MRI+/CRP+, MRI−/CRP+, and MRI+/CRP− subgroups.
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Affiliation(s)
- Philip C. Robinson
- University of Queensland School of Clinical Medicine Brisbane Queensland Australia
| | | | | | - Stephen Hall
- Monash University and Emeritus Research Melbourne Victoria Australia
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22
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Maksymowych WP, Baraliakos X, Lambert RG, Landewé R, Sandoval D, Carlier H, Lisse J, Li X, Hojnik M, Østergaard M. Effects of ixekizumab treatment on structural changes in the sacroiliac joint: MRI assessments at 16 weeks in patients with non-radiographic axial spondyloarthritis. Lancet Rheumatol 2022; 4:e626-e634. [PMID: 38288892 DOI: 10.1016/s2665-9913(22)00185-0] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2024]
Abstract
BACKGROUND There is limited understanding regarding the inhibition of structural damage in the sacroiliac joint of patients with non-radiographic axial spondyloarthritis. This study evaluated the effect of the interleukin-17A inhibitor ixekizumab versus placebo on structural lesions in the sacroiliac joints as assessed by MRI at week 16 in patients with non-radiographic axial spondyloarthritis from the COAST-X study. METHODS COAST-X was a 52-week, randomised, double-blind, placebo-controlled, parallel-group study done at 107 sites in 15 countries in Europe, Asia, North America, and South America. Eligible participants were adults (aged ≥18 years) with active axial spondyloarthritis without definite radiographic sacroiliitis (non-radiographic axial spondyloarthritis), objective signs of inflammation (via MRI or C-reactive protein), and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs. Patients were randomly allocated to placebo or double-blind ixekizumab 80 mg every 4 weeks (Q4W) or 2 weeks (Q2W), with an 80 mg or 160 mg starting dose. We report a post-hoc analysis of 266 patients with available MRI scans from baseline and week 16. MRI scans were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint structural score (SSS) method independently by two masked readers. Treatment comparisons used analysis of covariance based on observed cases. Correlations were evaluated among changes in SPARCC SSS for erosion, fat lesions, and backfill, and between changes in SPARCC SSS and sacroiliac joint inflammation scores and clinical measures. COAST-X was registered with ClinicalTrials.gov, NCT02757352. FINDINGS Between Aug 2, 2016, and Jan 29, 2018, 303 patients were enrolled to the COAST-X study. 290 (96%) of 303 participants completed the week 16 visit (95 in the ixekizumab Q4W group, 98 in the ixekizumab Q2W group, and 97 in the placebo group), and MRI scans were available for 266 patients at baseline and week 16 (85 in the ixekizumab Q4W group, 91 in the ixekizumab Q2W group, and 90 in the placebo group). Changes from baseline to week 16 in mean SPARCC SSS for erosion were -0·39 for ixekizumab Q4W (p=0·003 vs placebo), -0·40 for ixekizumab Q2W (p=0·002), and 0·16 for placebo; for fat lesions: 0·16 for ixekizumab Q4W (p=0·013), 0·10 for ixekizumab Q2W (p=0·067), and -0·04 for placebo; and for backfill: 0·21 for ixekizumab Q4W (p=0·011), 0·22 for ixekizumab Q2W (p=0·006), and -0·10 for placebo. Ankylosis did not change. Effects of ixekizumab versus placebo on structural changes were most pronounced in patients with baseline inflammation in the sacroiliac joints. Changes from baseline at week 16 in erosion, fat lesions, and backfill were correlated. INTERPRETATION Although the clinical relevance is not yet clear, patients with non-radiographic axial spondyloarthritis receiving ixekizumab had significant reductions in erosions and increases in fat lesions and backfill in the sacroiliac joints versus placebo at week 16, suggesting an early repair process with ixekizumab treatment. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada
| | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; Medical Imaging Consultants, Edmonton, AB, Canada
| | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Xiaoqi Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Maja Hojnik
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, and Center of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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23
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Protopopov M, Proft F, Wichuk S, Machado PM, Lambert RG, Weber U, Juhl Pedersen S, Østergaard M, Sieper J, Rudwaleit M, Baraliakos X, Maksymowych WP, Poddubnyy D. Comparing MRI and conventional radiography for the detection of structural changes indicative of axial spondyloarthritis in the ASAS cohort. Rheumatology (Oxford) 2022; 62:1631-1635. [PMID: 35951746 DOI: 10.1093/rheumatology/keac432] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/10/2022] [Accepted: 07/02/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare magnetic resonance imaging (MRI) and conventional radiography of sacroiliac joints (SIJs) for detection of structural lesions typical for axial spondyloarthritis (axSpA). METHODS Adult patients from the Assessment of SpondyloArthritis international Society (ASAS) cohort with symptoms suggestive of axSpA and both SIJ MRIs and radiographs available for central reading were included. Radiographs were evaluated by three readers according to the modified New York (mNY) criteria grading system. The presence of structural damage on radiographs was defined as 1) fulfilment of the radiographic mNY criterion and 2) additionally, a lower threshold for sacroiliitis of at least grade 2 unilaterally. MRI scans were assessed for the presence of structural changes indicative of axSpA by 7 readers. Diagnostic performance (sensitivity-Se, specificity-Sp, positive and negative predictive values-PPV and NPV-and positive and negative likelihood ratios-LR+ and LR-) of MRI and radiographs (vs rheumatologist's diagnosis of axSpA) were calculated. RESULTS Overall, 183 patients were included, 135 (73.7%) were diagnosed with axSpA. Structural lesions indicative of axSpA on MRI had Se 38.5%, Sp 91.7%, PPV 92.9%, NPV 34.6%, LR + 4.62, LR- 0.67. Sacroiliitis according to the mNY criteria had Se 54.8%, Sp 70.8%, PPV 84.1%, NPV 35.8%, positive LR + 1.88, LR- 0.64. Radiographic sacroiliitis of at least grade 2 unilaterally had Sn 65.2%, Sp 50.0%, PPV 78.6%, NPV 33.8%, LR + 1.30, LR- 0.69. CONCLUSION Structural lesions of SIJ detected by MRI demonstrated better diagnostic performance and better inter-reader reliability compared with conventional radiography.
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Affiliation(s)
| | - Fabian Proft
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Wichuk
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pedro M Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Ulrich Weber
- 6Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Martin Rudwaleit
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | | | - Denis Poddubnyy
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Rheumatism Research Centre, Berlin, Germany
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24
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Bressem KK, Adams LC, Proft F, Hermann KGA, Diekhoff T, Spiller L, Niehues SM, Makowski MR, Hamm B, Protopopov M, Rios Rodriguez V, Haibel H, Rademacher J, Torgutalp M, Lambert RG, Baraliakos X, Maksymowych WP, Vahldiek JL, Poddubnyy D. Deep Learning Detects Changes Indicative of Axial Spondyloarthritis at MRI of Sacroiliac Joints. Radiology 2022; 305:655-665. [PMID: 35943339 DOI: 10.1148/radiol.212526] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background MRI is frequently used for early diagnosis of axial spondyloarthritis (axSpA). However, evaluation is time-consuming and requires profound expertise because noninflammatory degenerative changes can mimic axSpA, and early signs may therefore be missed. Deep neural networks could function as assistance for axSpA detection. Purpose To create a deep neural network to detect MRI changes in sacroiliac joints indicative of axSpA. Materials and Methods This retrospective multicenter study included MRI examinations of five cohorts of patients with clinical suspicion of axSpA collected at university and community hospitals between January 2006 and September 2020. Data from four cohorts were used as the training set, and data from one cohort as the external test set. Each MRI examination in the training and test sets was scored by six and seven raters, respectively, for inflammatory changes (bone marrow edema, enthesitis) and structural changes (erosions, sclerosis). A deep learning tool to detect changes indicative of axSpA was developed. First, a neural network to homogenize the images, then a classification network were trained. Performance was evaluated with use of area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. P < .05 was considered indicative of statistically significant difference. Results Overall, 593 patients (mean age, 37 years ± 11 [SD]; 302 women) were studied. Inflammatory and structural changes were found in 197 of 477 patients (41%) and 244 of 477 (51%), respectively, in the training set and 25 of 116 patients (22%) and 26 of 116 (22%) in the test set. The AUCs were 0.94 (95% CI: 0.84, 0.97) for all inflammatory changes, 0.88 (95% CI: 0.80, 0.95) for inflammatory changes fulfilling the Assessment of SpondyloArthritis international Society definition, and 0.89 (95% CI: 0.81, 0.96) for structural changes indicative of axSpA. Sensitivity and specificity on the external test set were 22 of 25 patients (88%) and 65 of 91 patients (71%), respectively, for inflammatory changes and 22 of 26 patients (85%) and 70 of 90 patients (78%) for structural changes. Conclusion Deep neural networks can detect inflammatory or structural changes to the sacroiliac joint indicative of axial spondyloarthritis at MRI. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Keno K Bressem
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Lisa C Adams
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Fabian Proft
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Kay Geert A Hermann
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Torsten Diekhoff
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Laura Spiller
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Stefan M Niehues
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Marcus R Makowski
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Bernd Hamm
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Mikhail Protopopov
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Valeria Rios Rodriguez
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Hildurn Haibel
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Judith Rademacher
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Murat Torgutalp
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Robert G Lambert
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Xenofon Baraliakos
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Walter P Maksymowych
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Janis L Vahldiek
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
| | - Denis Poddubnyy
- From the Institute for Radiology (K.K.B., L.C.A., K.G.A.H., T.D., S.M.N., B.H., J.L.V.) and Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine) (F.P., L.S., M.P., V.R.R., H.H., J.R., M.T., D.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany (K.K.B., L.C.A., J.R.); Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany (M.R.M.); Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (R.G.L., W.P.M.); Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Germany (X.B.); and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany (D.P.)
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Ciccia F, Maksymowych WP. Thirteenth International Congress on Spondyloarthritides. Clin Exp Rheumatol 2022; 40:1817-1910. [PMID: 36129797 DOI: 10.55563/clinexprheumatol/4spc2y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Francesco Ciccia
- University della Campania "Luigi Vanvitelli" School of Medicine and Surgery, Department of Precision Medicine Naples, Italy
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Deodhar A, Van den Bosch F, Poddubnyy D, Maksymowych WP, van der Heijde D, Kim TH, Kishimoto M, Blanco R, Duan Y, Li Y, Pangan AL, Wung P, Song IH. Upadacitinib for the treatment of active non-radiographic axial spondyloarthritis (SELECT-AXIS 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2022; 400:369-379. [PMID: 35908570 DOI: 10.1016/s0140-6736(22)01212-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Upadacitinib, a Janus kinase inhibitor, has been shown to be effective in patients with ankylosing spondylitis. We aimed to assess the efficacy and safety of upadacitinib in non-radiographic axial spondyloarthritis. METHODS The SELECT-AXIS 2 non-radiographic axial spondyloarthritis study was a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial at 113 sites across 23 countries (Argentina, Australia, Belgium, Brazil, Bulgaria, Canada, China, Czech Republic, France, Germany, Hungary, Israel, Japan, Mexico, Poland, Russia, Slovakia, South Korea, Spain, Taiwan, Turkey, Ukraine, and the USA). Eligible adults had active non-radiographic axial spondyloarthritis, with objective signs of inflammation based on MRI or elevated C-reactive protein and an inadequate response to non-steroidal anti-inflammatory drugs. Patients were randomly assigned (1:1) to receive oral upadacitinib 15 mg once daily or placebo using interactive response technology. Random treatment assignment was stratified by MRI inflammation in the sacroiliac joints and screening high-sensitivity C-reactive protein status (MRI-positive and C-reactive protein-positive, MRI-positive and C-reactive protein-negative, and MRI-negative and C-reactive protein-positive) and previous exposure to biologic disease-modifying antirheumatic drugs (yes vs no). Treatment assignment was masked from patients, investigators, study site personnel, and the study sponsor. The primary endpoint was the proportion of patients with an Assessment of SpondyloArthritis international Society 40 (ASAS40) response at week 14. Analyses were performed on the full analysis set of patients, who underwent random allocation and received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT04169373. FINDINGS Between Nov 26, 2019, and May 20, 2021, 314 patients with active non-radiographic axial spondyloarthritis were enrolled into the study, and 313 received study drug (156 in the upadacitinib group and 157 in the placebo group); 295 (94%) patients (145 in the upadacitinib group and 150 in the placebo group) received treatment for the full 14 weeks. A significantly higher ASAS40 response rate was achieved with upadacitinib compared with placebo at week 14 (70 [45%] of 156 patients vs 35 [23%] of 157 patients; p<0·0001; treatment difference 22%, 95% CI 12-32). The rate of adverse events up to week 14 was similar in the upadacitinib group (75 [48%] of 156 patients) and placebo group (72 [46%] of 157 patients). Serious adverse events and adverse events leading to discontinuation of study drug occurred in four (3%) of 156 patients in the upadacitinib group and two (1%) of 157 patients in the placebo group. Few patients had serious infections or herpes zoster in either treatment group (each event occurred in two [1%] of 156 patients in the upadacitinib group and one [1%] of 157 patients in the placebo group). Five (3%) of 156 patients in the upadacitinib group had neutropenia; no events of neutropenia occurred in the placebo group. No opportunistic infections, malignancies, major adverse cardiovascular events, venous thromboembolic events, or deaths were reported with upadacitinib treatment. INTERPRETATION Upadacitinib significantly improved the signs and symptoms of non-radiographic axial spondyloarthritis compared with placebo at week 14. These findings support the potential of upadacitinib as a new therapeutic option in patients with active non-radiographic axial spondyloarthritis. FUNDING AbbVie.
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Affiliation(s)
- Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA.
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, VIB Center for Inflammation Research, Ghent, Belgium
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ricardo Blanco
- Rheumatology Division, Hospital University Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Yuanyuan Duan
- Department of Immunology, AbbVie, North Chicago, IL, USA
| | - Yihan Li
- Department of Immunology, AbbVie, North Chicago, IL, USA
| | | | - Peter Wung
- Department of Immunology, AbbVie, North Chicago, IL, USA
| | - In-Ho Song
- Department of Immunology, AbbVie, North Chicago, IL, USA
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van der Heijde D, Deodhar A, Maksymowych WP, Sieper J, Van den Bosch F, Kim TH, Kishimoto M, Östör AJ, Combe B, Sui Y, Duan Y, Wung PK, Song IH. Upadacitinib in active ankylosing spondylitis: results of the 2-year, double-blind, placebo-controlled SELECT-AXIS 1 study and open-label extension. RMD Open 2022; 8:rmdopen-2022-002280. [PMID: 35896281 PMCID: PMC9335045 DOI: 10.1136/rmdopen-2022-002280] [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: 02/08/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Long-term safety and efficacy of upadacitinib in patients with active ankylosing spondylitis (AS) has not been previously reported. Methods In SELECT-AXIS 1, patients receiving placebo were switched to upadacitinib 15 mg once daily at week 14 while patients initially randomised to upadacitinib continued their regimen through week 104. Efficacy was assessed using as-observed (AO) and non-responder imputation (NRI). Results Of 187 patients randomised, 144 patients (77%) completed week 104. Among patients receiving continuous upadacitinib, 85.9% (AO) and 65.6% (NRI) achieved Assessment of SpondyloArthritis international Society 40 response (ASAS40) at week 104. Similar magnitude of ASAS40 responses were observed among patients who switched from placebo to upadacitinib (88.7% and 63.8%, respectively). The mean change from baseline to week 104 in Spondyloarthritis Research Consortium of Canada MRI spine and sacroiliac joint inflammation scores were –7.3 and –5.3, respectively, in the continuous upadacitinib group and –7.9 and –4.9 in the placebo-to-upadacitinib switch group. The mean (95% CI) change from baseline to week 104 in the modified Stoke Ankylosing Spondylitis Spine Score was 0.7 (0.3, 1.1) in the total group. Adverse event rate was 242.7/100 patient-years. No serious infections, adjudicated major adverse cardiovascular events, lymphoma, non-melanoma skin cancer, or gastrointestinal perforations were observed. Conclusions Upadacitinib 15 mg once daily showed sustained and consistent efficacy over 2 years for ASAS40 and other clinically relevant endpoints. A low rate of radiographic progression was observed and no new safety findings were observed.
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Affiliation(s)
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, VIB Center for Inflammation Research, Ghent, Belgium
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Andrew J Östör
- Cabrini Medical Centre and Monash University, Melbourne, Victoria, Australia
| | - Bernard Combe
- Department of Rheumatology, Montpellier University, Montpellier, France
| | - Yunxia Sui
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | - In-Ho Song
- AbbVie Inc, North Chicago, Illinois, USA
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Antony A, Holland R, Mathew AJ, D'Agostino MA, Maksymowych WP, Mease PJ, Goel N, Ogdie A, Coates LC, Strand V, Christensen R, Gladman DD, Orbai AM, Leung YY, Tillett W. Plain Radiographic Instruments for Structural Damage in Peripheral Joints in Psoriatic Arthritis: A Report From the GRAPPA-OMERACT Working Group. J Rheumatol 2022; 49:20-25. [PMID: 35169049 DOI: 10.3899/jrheum.211322] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis (PsA) Core Set working group is focused on the development of a core set of instruments used to assess the domains described in the 2016 PsA Core Domain Set. At the 2021 annual meeting, the group presented an update on the domain of structural damage. In this report, we discuss the steps taken to assess the domain match and feasibility of plain radiographic instruments in the assessment of structural damage in PsA.
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Affiliation(s)
- Anna Antony
- A. Antony, MBBS, FRACP, School of Clinical Sciences, Monash University, and Department of Rheumatology, Monash Health, Melbourne, Australia;
| | - Richard Holland
- R. Holland, MBChB, FRACP, Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Ashish J Mathew
- A.J. Mathew, MBBS, DNB, DM, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Maria-Antoinetta D'Agostino
- M.A. D'Agostino, MD, PhD, Università Cattolica del Sacro Cuore, and Rheumatology UOC, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy, and Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | - Walter P Maksymowych
- W.P. Maksymowych, MB ChB, FACP, FRCP(C), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philip J Mease
- P.J. Mease, MD, MACR, Division of Rheumatology, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA
| | - Niti Goel
- N. Goel, MD, Patient Research Partner, Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Division of Rheumatology, University of Pennsylvania, Pennsylvania, USA
| | - Laura C Coates
- L.C. Coates, MBChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Vibeke Strand
- V. Strand, MD, Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Robin Christensen
- R. Christensen, BSc, MSc, PhD, Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Dafna D Gladman
- D.D. Gladman, MD, FRCPC, Schroeder Arthritis Institute, Krembil Research Institute, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ana-Maria Orbai
- A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ying Ying Leung
- Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - William Tillett
- W. Tillett, PhD, Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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Maksymowych WP, Østergaard M, Landewé R, Barchuk W, Liu K, Gilles L, Hendrikx T, Besuyen R, Baraliakos X. Filgotinib decreases both vertebral body and posterolateral spine inflammation in ankylosing spondylitis: results from the TORTUGA trial. Rheumatology (Oxford) 2022; 61:2388-2397. [PMID: 34647992 PMCID: PMC9157176 DOI: 10.1093/rheumatology/keab758] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/28/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To assess the effects of filgotinib on inflammatory and structural changes at various spinal locations, based on MRI measures in patients with active AS in the TORTUGA trial. METHODS In the TORTUGA trial, patients with AS received filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, spine MRIs were evaluated using the Canada-Denmark (CANDEN) MRI scoring system to assess changes from baseline to week 12 in total spine and subscores for inflammation, fat, erosion and new bone formation (NBF) at various anatomical locations. Correlations were assessed between CANDEN inflammation and clinical outcomes and Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scores and between baseline CANDEN NBF and baseline BASFI and BASMI scores. RESULTS MRIs from 47 filgotinib- and 41 placebo-treated patients were evaluated. There were significantly larger reductions with filgotinib vs placebo in total spine inflammation score and most inflammation subscores, including posterolateral elements (costovertebral joints, transverse/spinous processes, soft tissues), facet joints and vertebral bodies. No significant differences were observed for corner or non-corner vertebral body inflammation subscores, spine fat lesion, bone erosion or NBF scores. In the filgotinib group, the change from baseline in the total inflammation score correlated positively with the SPARCC spine score. Baseline NBF scores correlated with baseline BASMI but not BASFI scores. CONCLUSIONS Compared with placebo, filgotinib treatment was associated with significant reductions in MRI measures of spinal inflammation, including in vertebral bodies, facet joints and posterolateral elements. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT03117270.
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Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Landewé
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - William Barchuk
- Clinical Research, Gilead Sciences, Inc., Foster City, CA, USA
| | - Ke Liu
- Clinical Research, Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | - Robin Besuyen
- Clinical Development, Galapagos BV, Leiden, Netherlands
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Baraliakos X, Østergaard M, Lambert RG, Eshed I, Machado PM, Pedersen SJ, Weber U, de Hooge M, Sieper J, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewé RB, Maksymowych WP. MRI lesions of the spine in patients with axial spondyloarthritis: an update of lesion definitions and validation by the ASAS MRI working group. Ann Rheum Dis 2022; 81:annrheumdis-2021-222081. [PMID: 35609977 DOI: 10.1136/annrheumdis-2021-222081] [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: 12/30/2021] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Spinal MRI is used to visualise lesions associated with axial spondyloarthritis (axSpA). The ASAS MRI working group (WG) updated and validated the definitions for inflammatory and structural spinal lesions in the context of axSpA. METHODS After review of the existing literature on all possible types of spinal MRI pathologies in axSpA, the group (12 rheumatologists and two radiologists) consented on the required revisions of lesion definitions compared with the existing nomenclature of 2012. In a second step, using 62 MRI scans from the ASAS classification cohort, the proposed definitions were validated in a multireader campaign by global (absent/present) and detailed (inflammation and structural) lesion assessment at the vertebral corner (VC), vertebral endplate, facet joints, transverse processes, lateral and posterior elements. Intraclass correlation coefficient (ICC) was used for analysis. RESULTS Revisions were made for both inflammatory (bone marrow oedema, BMO) and structural (fat, erosion, bone spur and ankylosis) lesions, including localisation (central vs lateral), extension (VC vs vertebral endplate) and extent (minimum number of slices needed), while new definitions were suggested for the type of lesion based on lesion maturity (VC monomorphic vs dimorphic). The most reliably assessed lesions were VC fat lesion and VC monomorphic BMO (ICC (mean of all 36 reader pairs/overall 9 readers): 0.91/0.92; 0.70/0.67, respectively. CONCLUSIONS The lesion definitions for spinal MRI lesions compatible with SpA were updated by consensus and validated by a group of experienced readers. The lesions with the highest frequency and best reliability were fat and monomorphic inflammatory lesions at the VC.
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Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada and Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler school of medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Pedro M Machado
- Department of Rheumatology, University College London, London, UK
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Weber
- Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Manouk de Hooge
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium and Rheumatology Department, Ghent University Hospital, Gent, Belgium
| | - Joachim Sieper
- Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | - Denis Poddubnyy
- Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | | | | | - Robert Bm Landewé
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Atrium Medical Center, Heerlen, The Netherlands
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada; CARE Arthritis, Edmonton, Alberta, Canada
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Maksymowych WP, Østergaard M, Landewé R, Barchuk W, Liu K, Tasset C, Gilles L, Hendrikx T, Besuyen R, Baraliakos X. Impact of filgotinib on sacroiliac joint magnetic resonance imaging structural lesions at 12 weeks in patients with active ankylosing spondylitis (TORTUGA trial). Rheumatology (Oxford) 2022; 61:2063-2071. [PMID: 34352069 PMCID: PMC9071516 DOI: 10.1093/rheumatology/keab543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess the effect of filgotinib, which preferentially inhibits Janus kinase 1 (JAK1), on MRI measures of structural change in the SI joint in patients with active AS in the TORTUGA trial. METHODS Adults with active AS and inadequate response/intolerance to two or more NSAIDs were randomized 1:1 to filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, T1-weighted MRI scans of the SI joint were evaluated by two independent readers using Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Structural Score (SSS) definitions for erosion, backfill, fat metaplasia and ankylosis. Correlations between SPARCC SSS and improvement in clinical outcomes were also assessed. RESULTS MRI scans from 87 patients (48 filgotinib, 39 placebo) were evaluated. At baseline there were no notable differences between filgotinib and placebo for any MRI structural lesion types. From baseline to week 12, filgotinib was associated with a significant reduction in SI joint erosion score (P = 0.02) and an increase in backfill score (P = 0.005) vs placebo, with no significant between-group differences for ankylosis (P = 0.46) or fat metaplasia (P = 0.17). At week 12, the change in SPARCC MRI SI joint inflammation scores correlated positively with erosion scores but negatively with backfill scores. CONCLUSION The significant changes in MRI structural lesions induced by filgotinib in the SI joint by week 12 demonstrate that tissue repair can be observed very soon after starting treatment with a JAK1 preferential inhibitor. This could have prognostic implications for development of ankylosis. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT03117270.
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Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Landewé
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam and Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Ke Liu
- Clinical Research, Gilead Sciences, Foster City, CA, USA
| | | | - Leen Gilles
- Biostatistics, LACO, Contracted by Galapagos NV, Mechelen, Belgium
| | | | - Robin Besuyen
- Clinical Development, Galapagos BV, Leiden, The Netherlands
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Marzo-Ortega H, Tsai WC, Kameda H, Konomi A, Bradley AJ, Ng KJ, Schymura Y, Liu-Leage S, Maksymowych WP, Østergaard M. OA34 Post-hoc analysis of spinal MRI SPARCC inflammation scores in patients with radiographic axial spondyloarthritis treated with ixekizumab: results from the COAST-V study at week 16. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac132.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Ixekizumab, an interleukin-17A inhibitor, has demonstrated efficacy in radiographic axial spondyloarthritis (r-axSpA) irrespective of baseline local inflammation as measured by spinal magnetic resonance imaging (MRI) Spondyloarthritis Research Consortium of Canada (SPARCC) inflammation scores. This post-hoc analysis assessed the efficacy of ixekizumab in patients with r-axSpA categorized by MRI SPARCC score at baseline and 16-week change from baseline (CFB).
Methods
COAST-V (NCT02696785) was a phase 3, randomized, controlled trial enrolling patients with active r-axSpA naïve to biologic disease-modifying antirheumatic drugs, randomized 1:1:1:1 to 80-mg ixekizumab every 2 weeks, 80-mg ixekizumab every 4 weeks (Q4W), adalimumab, or placebo for the 16-week blinded treatment period. Three categories were defined according to spinal MRI SPARCC inflammation score at baseline and CFB (based on published minimally important change): 1) low baseline (baseline SPARCC score <5.0 points), 2) low responder (baseline SPARCC score ≥5.0 points and CFB <5.0 points), 3) high responder (baseline SPARCC score ≥5.0 points and CFB ≥5.0 points). Proportions of patients achieving Assessment in SpondyloArthritis international Society 40% (ASAS40), Ankylosing Spondylitis Disease Activity Score (ASDAS) <2.1, and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) 50 were determined. Means at baseline and week-16 least squares means of CFBs were calculated for ASDAS, BASDAI, Spinal Pain, Bath Ankylosing Spondylitis Functional Index (BASFI), and 36-item Short Form Health Survey Physical Component Summary (SF-36 PCS). Non-responder imputation and modified baseline observation carried forward were used for missing week-16 data in discrete and continuous variables, respectively.
Results
Of 78 patients receiving ixekizumab Q4W, 35 (44.9%), 11 (14.1%), and 32 (41.0%), were MRI SPARCC low baseline, low responders, and high responders, respectively. Similar proportions of ixekizumab-treated patients in all categories achieved ASAS40, ASDAS<2.1, and BASDAI50 week-16 responses; week-16 improvements in other efficacy endpoints were broadly similar, with high responders showing greater improvements in ASAS40 and ASDAS CFB (Table). In adalimumab-treated patients, week-16 improvements were less pronounced in the low baseline and low responder categories.
Conclusion
Patients with r-axSpA receiving ixekizumab Q4W showed broadly similar reduction in the signs and symptoms of r-axSpA irrespective of their spinal MRI SPARCC inflammation score category at week 16.
Disclosure
H. Marzo-Ortega: Honoraria; Abbvie, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, Takeda, UCB, Biogen. Grants/research support; Janssen, Novartis. W. Tsai: Consultancies; Abbvie, Pfizer, Roche. H. Kameda: Consultancies; Abbvie, Asahikasei Pharma, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe Pharma, Novartis, Chugai, Pfizer. Member of speakers’ bureau; Abbvie, Asahikasei Pharma, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe Pharma, Novartis, Chugai, Pfizer. A. Konomi: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. A.J. Bradley: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. K. Ng: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. Y. Schymura: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. S. Liu-Leage: Shareholder/stock ownership; Eli Lilly and Company. Other; Employment - Eli Lilly and Company. W.P. Maksymowych: Corporate appointments; CARE Arthritis Limited. Consultancies; Abbvie, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Galapagos, Janssen, Novartis, Pfizer, UCB. Member of speakers’ bureau; Abbvie, Janssen, Novartis, Pfizer, UCB. Grants/research support; Abbvie, Novartis, Pfizer, UCB. M. Østergaard: Consultancies; Abbvie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, UCB. Member of speakers’ bureau; Abbvie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, UCB. Grants/research support; Abbvie, Celgene, Centocor, Merck, Novartis.
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Affiliation(s)
- Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust & LIRMM, University of Leeds, Leeds, UNITED KINGDOM
| | - Wen-Chan Tsai
- Division of Rheumatology, Department of Internal Medicine, Kaoshiung Medical Hospital, Kaoshiung City, TAIWAN
| | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, JAPAN
| | - Ayako Konomi
- Rheumatology, Eli Lilly and Company, Indianapolis, IN
| | | | - Khai Jing Ng
- Rheumatology, Eli Lilly and Company, Indianapolis, IN
| | - Yves Schymura
- Rheumatology, Eli Lilly and Company, Indianapolis, IN
| | | | | | - Mikkel Østergaard
- COPECARE, Righospitalet, University of Copenhagen, Copenhagen, DENMARK
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van der Heijde D, Gensler LS, Maksymowych WP, Landewé R, Rudwaleit M, Bauer L, Kumke T, Kim M, Auteri SE, Hoepken B, Deodhar A. Long-term safety and clinical outcomes of certolizumab pegol treatment in patients with active non-radiographic axial spondyloarthritis: 3-year results from the phase 3 C-axSpAnd study. RMD Open 2022; 8:rmdopen-2021-002138. [PMID: 35296532 PMCID: PMC8928377 DOI: 10.1136/rmdopen-2021-002138] [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: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background 52-week results from C-axSpAnd demonstrated the safety and efficacy of certolizumab pegol (CZP) in patients with active non-radiographic axial spondyloarthritis (nr-axSpA) and objective signs of inflammation (sacroiliitis on MRI and/or elevated C-reactive protein levels). Long-term safety and clinical outcomes, including MRI assessments, are evaluated up to 3 years for CZP-treated patients with nr-axSpA. Methods C-axSpAnd was a phase 3 study comprising a 1-year double-blind, placebo-controlled period and 2-year open-label safety follow-up extension (SFE). At baseline, 317 patients were randomised 1:1 to placebo or CZP 200 mg every 2 weeks. Patients completing the double-blind phase who enrolled into the SFE received open-label CZP for an additional 104 weeks. Long-term safety and clinical outcomes are reported to Week 156. Continuous outcomes are presented as observed case (OC) and dichotomous outcomes as OC and with non-responder imputation. Results 243/317 (76.7%) patients entered the SFE, during which 149 (61.3%) experienced ≥1 treatment-emergent adverse event (TEAE); 15 (3.3/100 patient-years) experienced serious TEAEs. Continuous outcome scores (including Ankylosing Spondylitis Disease Activity Score [ASDAS]: 1.8; Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]: 2.7) at Week 52 were maintained at Week 156 (ASDAS: 1.8; BASDAI: 2.6) for the initial CZP-randomised group. Mean SPARCC MRI sacroiliac joint inflammation scores for these patients decreased at Week 52 (baseline: 7.6; Week 52: 1.7), remaining low at Week 156 (2.4). Conclusions CZP treatment was well tolerated up to 3 years, with no new safety signals versus previous reports. Clinical outcomes achieved after 1 year were sustained to 3 years. Trial registration number NCT02552212.
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Affiliation(s)
| | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | | | - Robert Landewé
- Rheumatology Department, Amsterdam Rheumatology & Clinical Immunology Center, Amsterdam, The Netherlands.,Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, University of Bielefeld, Bielefeld, Germany
| | | | | | | | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
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Maksymowych WP, Østergaard M. What Constitutes a Positive MRI for Clinical Trial Recruitment of Psoriatic Arthritis Patients With Axial Involvement? J Rheumatol 2022; 49:72-74. [DOI: 10.3899/jrheum.211340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/22/2022]
Abstract
There has been a resurgence of interest in defining the axial inflammation component of psoriatic arthritis (PsA) since recent randomized controlled trials (RCTs) raised the possibility that this entity may respond differentially to therapeutics compared to patients with axial spondyloarthritis. A workshop was conducted during the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis annual meeting to review the literature on diagnosing PsA and to determine which criteria might be most appropriate. There was quite strong agreement that magnetic resonance imaging (MRI) had an important role to play in helping to define axial inflammation in PsA and that a data-driven methodology for generating optimal MRI quantitative cut-offs for lesions in the sacroiliac joints and/or spine that reflect imaging typical of axial inflammation in PsA would be most desirable.
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van der Heijde D, Østergaard M, Reveille JD, Baraliakos X, Kronbergs A, Sandoval DM, Li X, Carlier H, Adams DH, Maksymowych WP. Spinal Radiographic Progression and Predictors of Progression in Patients With Radiographic Axial Spondyloarthritis Receiving Ixekizumab Over 2 Years. J Rheumatol 2022; 49:265-273. [PMID: 34853086 DOI: 10.3899/jrheum.210471] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the long-term effect of ixekizumab (IXE) on radiographic changes in the spine in patients with radiographic axial spondyloarthritis (r-axSpA) by measuring change from baseline through 2 years in modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS), and to identify potential predictors of progression. METHODS This study evaluates patients from COAST-V (ClinicalTrials.gov: NCT02696785, biologic disease-modifying antirheumatic drug-naïve) and COAST-W (NCT02696798, tumor necrosis factor inhibitor-experienced) who had mSASSS data at baseline in the originating studies and 108 weeks after baseline in the extension study COAST-Y (NCT03129100). We examined the proportion of patients who did not have spinal radiographic progression through 2 years (108 weeks) of treatment with IXE (80 mg every 2 or 4 weeks) and the change from baseline to year 2 in mSASSS. Potential predictors of spinal radiographic progression were also evaluated. RESULTS Among patients with evaluable radiographs who were originally assigned to IXE (n = 230), mean (SD) change in mSASSS from baseline at year 2 was 0.3 (1.8). The proportion of nonprogressors over 2 years was 89.6% if defined as mSASSS change from baseline < 2 and 75.7% if defined as mSASSS change from baseline ≤ 0. Predictors of structural progression at year 2 (mSASSS change > 0) were age ≥ 40, baseline syndesmophytes, HLA-B27 positivity, and male sex. Week 52 inflammation in Spondyloarthritis Research Consortium of Canada spine was also a predictor of radiographic progression at year 2 in patients with magnetic resonance imaging data in COAST-V (n = 109). CONCLUSION The majority of patients with r-axSpA receiving IXE had no radiographic progression in the spine through 2 years of treatment. Predictors were generally consistent with previous studies.
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Affiliation(s)
- Désirée van der Heijde
- D. van der Heijde, MD, Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands;
| | - Mikkel Østergaard
- M. Østergaard, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - John D Reveille
- J.D. Reveille, MD, Division of Rheumatology and Clinical Immunogenetics, University of Texas-McGovern Medical School, Houston, Texas, USA
| | - Xenofon Baraliakos
- X. Baraliakos, MD, Ruhr-University Bochum, Bochum, Germany, and Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Andris Kronbergs
- A. Kronbergs, PhD, D.M. Sandoval, MD, X. Li, PhD, H. Carlier, MD, D.H. Adams, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - David M Sandoval
- A. Kronbergs, PhD, D.M. Sandoval, MD, X. Li, PhD, H. Carlier, MD, D.H. Adams, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Xiaoqi Li
- A. Kronbergs, PhD, D.M. Sandoval, MD, X. Li, PhD, H. Carlier, MD, D.H. Adams, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Hilde Carlier
- A. Kronbergs, PhD, D.M. Sandoval, MD, X. Li, PhD, H. Carlier, MD, D.H. Adams, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - David H Adams
- A. Kronbergs, PhD, D.M. Sandoval, MD, X. Li, PhD, H. Carlier, MD, D.H. Adams, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Walter P Maksymowych
- W.P. Maksymowych, MD, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Maksymowych WP, Bolce R, Gallo G, Seem E, Geneus VJ, Sandoval DM, Østergaard M, Tada K, Baraliakos X, Deodhar A, Gensler LS. Ixekizumab in radiographic axial spondyloarthritis with and without elevated C-reactive protein or positive magnetic resonance imaging. Rheumatology (Oxford) 2022; 61:4324-4334. [DOI: 10.1093/rheumatology/keac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To evaluate response rates at week 16 with ixekizumab in patients with radiographic axial spondyloarthritis (r-axSpA) and elevated or normal/low baseline inflammation, measured by serum C-reactive protein (CRP) or spinal MRI, using data from 2 randomized, double-blind, placebo-controlled phase III trials.
Methods
Biologic-naive (COAST-V) or tumor necrosis factor inhibitor-experienced (COAST-W) adults with active r-axSpA received 80 mg ixekizumab every 2 weeks (IXEQ2W) or 4 weeks (IXEQ4W) or placebo (PBO); or active reference (40 mg adalimumab Q2W; ADA) in COAST-V. At week 16, patients receiving ixekizumab continued as assigned; patients receiving PBO or ADA were re-randomized 1:1 to IXEQ2W or IXEQ4W through week 52. ASAS40 response rates were examined by baseline CRP (≤5 or > 5 mg/l) and SPARCC MRI spine inflammation score (<2 or ≥ 2).
Results
In the COAST-V/W integrated dataset (N = 567), significantly more patients treated with ixekizumab achieved ASAS40 response at week 16 by CRP ≤5 mg/l (27% IXEQ4W p<0.05, 35% IXEQ2W p<0.01 vs 12% PBO), CRP >5 mg/l (39% IXEQ4W p<0.001, 43% IXEQ2W p<0.001 vs 17% PBO), SPARCC MRI spine score <2 (40% IXEQ4W p<0.01, 52% IXEQ2W p<0.001 vs 16% PBO), and SPARCC MRI spine score ≥2 (44% IXEQ4W p<0.001, 47% IXEQ2W p<0.001 vs 19% PBO). ASAS40 response was observed with CRP ≤5 mg/l and SPARCC MRI spine score <2 with IXEQ4W (29%) and was significant with IXEQ2W (48%, p<0.05) vs PBO (13%).
Conclusion
Ixekizumab demonstrated efficacy in the treatment of ankylosing spondylitis/r-axSpA in patients with and without elevated CRP or evidence of spinal inflammation on MRI.
Trial registration
ClinicalTrials.gov, https://clinicaltrials.gov: NCT02696785, NCT02696798
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Affiliation(s)
| | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Emily Seem
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kurisu Tada
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Xenofon Baraliakos
- Ruhr-University Bochum, Bochum, Germany; and Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Atul Deodhar
- Oregon Health & Science University, Portland, Oregon, USA
| | - Lianne S Gensler
- University of California at San Francisco, School of Medicine, San Francisco, California, USA
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Buch MH, Maksymowych WP, Boers M. Managing the selection of placebo group switched to experimental treatment group in post-randomised controlled trial extension studies. Ann Rheum Dis 2022; 81:741-742. [PMID: 35027401 DOI: 10.1136/annrheumdis-2021-221775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Maya H Buch
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK .,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Maarten Boers
- Department of Epidemiology & Data Science and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Poddubnyy D, Baraliakos X, Van den Bosch F, Braun J, Coates LC, Chandran V, Diekhoff T, van Gaalen FA, Gensler LS, Goel N, Gottlieb AB, van der Heijde D, Helliwell PS, Hermann KGA, Jadon D, Lambert RG, Maksymowych WP, Mease P, Nash P, Proft F, Protopopov M, Sieper J, Torgutalp M, Gladman DD. Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Ther Adv Musculoskelet Dis 2021; 13:1759720X211057975. [PMID: 34987619 PMCID: PMC8721378 DOI: 10.1177/1759720x211057975] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Involvement of the axial skeleton (sacroiliac joints and spine) is a relatively frequent manifestation associated with psoriatic skin disease, mostly along with involvement of peripheral musculoskeletal structures (peripheral arthritis, enthesitis, dactylitis), which are referred to as psoriatic arthritis (PsA). Data suggest that up to 30% of patients with psoriasis have PsA. Depending on the definition used, the prevalence of axial involvement varies from 25% to 70% of patients with PsA. However, there are currently no widely accepted criteria for axial involvement in PsA.Objective: The overarching aim of the Axial Involvement in Psoriatic Arthritis (AXIS) study is to systematically evaluate clinical and imaging manifestations indicative of axial involvement in patients with PsA and to develop classification criteria and a unified nomenclature for axial involvement in PsA that would allow defining a homogeneous subgroup of patients for research. DESIGN Prospective, multicenter, multinational, cross-sectional study. METHODS AND ANALYSES In this multicenter, multinational, cross-sectional study, eligible patients [adult patients diagnosed with PsA and fulfilling Classification Criteria for Psoriatic Arthritis (CASPAR) with musculoskeletal symptom duration of ⩽10 years not treated with biological or targeted synthetic disease-modifying anti-rheumatic drugs] will be recruited prospectively. They will undergo study-related clinical and imaging examinations. Imaging will include radiography and magnetic resonance imaging examinations of sacroiliac joints and spine. Local investigators will evaluate for the presence of axial involvement based on clinical and imaging information which will represent the primary outcome of the study. In addition, imaging will undergo evaluation by central review. Finally, the central clinical committee will determine the presence of axial involvement based on all available information. ETHICS The study will be performed according to the ethical principles of the Declaration of Helsinki and International Council for Harmonisation Good Clinical Practice guidelines. The study protocol will be approved by the individual Independent Ethics Committee / Institutional Review Board of participating centers. Written informed consent will be obtained from all included patients.Registration: ClinicalTrials.gov ID: NCT04434885.
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Affiliation(s)
- Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, VIB Center for Inflammation Research, Ghent, Belgium
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany
| | - Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Vinod Chandran
- Division of Rheumatology, Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Torsten Diekhoff
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Floris A. van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lianne S. Gensler
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Niti Goel
- Patient Research Partner; Abcuro, Inc., Newton, MA, USA; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alice B. Gottlieb
- Department of Dermatology, Mount Sinai-Beth Israel Hospital, Icahn School of Medicine, New York, NY, USA
| | | | - Philip S. Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | | | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Robert G. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; Medical Imaging Consultants, Edmonton, AB, Canada
| | - Walter P. Maksymowych
- Department of Medicine, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada
| | - Philip Mease
- Division of Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, WA, USA
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Fabian Proft
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dafna D. Gladman
- Division of Rheumatology, Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
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Maksymowych WP, Kumke T, Auteri SE, Hoepken B, Bauer L, Rudwaleit M. Predictors of long-term clinical response in patients with non-radiographic axial spondyloarthritis receiving certolizumab pegol. Arthritis Res Ther 2021; 23:274. [PMID: 34715908 PMCID: PMC8556993 DOI: 10.1186/s13075-021-02650-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Identification of predictive clinical factors of long-term treatment response may contribute to improved management of non-radiographic axSpA (nr-axSpA) patients. This analysis aims to identify whether any baseline characteristics or Week 12 clinical outcomes in nr-axSpA patients with elevated C-reactive protein (CRP) and/or sacroiliitis on magnetic resonance imaging (MRI) enrolled in the C-axSpAnd study are predictive of achieving clinical response after 1 year of certolizumab pegol (CZP). METHODS C-axSpAnd (NCT02552212) was a phase 3, multicentre study, including a 52-Week double-blind, placebo-controlled period. Enrolled patients were randomised to CZP 200 mg Q2W or placebo. Predictors of Week 12 (CZP group only) and Week 52 clinical response were identified using a multivariate stepwise logistic regression analysis. Response variables included Ankylosing Spondylitis Disease Activity Score major improvement (ASDAS-MI), Assessment of SpondyloArthritis International Society 40% response (ASAS40), Bath Ankylosing Spondylitis Disease Activity Index 50% response (BASDAI50) and ASDAS inactive disease (ASDAS-ID). Predictive factors assessed included demographic and baseline characteristics and clinical outcomes at Week 12. A p-value <0.05 was required for forward selection into the model and p ≥0.1 for backward elimination. Missing data or values collected after switching to open-label treatment were accounted for using non-responder imputation. Sensitivity analyses accounted for patients with changes in non-biologic background medication. RESULTS Of 317 enrolled patients, 159 and 158 were randomised to CZP and placebo, respectively. Younger age and male sex were identified as predictors of Week 12 response across all assessed efficacy outcomes in CZP-treated patients. Consistent predictors of Week 52 response, measured by ASDAS-MI, ASAS40 and BASDAI50, included human leukocyte antigen (HLA)-B27 positivity and sacroiliitis on MRI at baseline. MRI positivity was also predictive of achieving ASDAS-ID at Week 52. Sensitivity analyses were generally consistent with the primary analysis. In placebo-treated patients, no meaningful predictors of Week 52 response were identified. CONCLUSIONS In this 52-Week, placebo-controlled study in nr-axSpA patients with elevated CRP and/or active sacroiliitis on MRI at baseline, MRI sacroiliitis and HLA-B27 positivity, but not elevated CRP or responses at Week 12, were predictive of long-term clinical response to CZP. Findings may support rheumatologists to identify patients suitable for TNFi treatment. TRIAL REGISTRATION ClinicalTrials.gov, NCT02552212 . Registered on 15 September 2015.
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40
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McInnes IB, Szekanecz Z, McGonagle D, Maksymowych WP, Pfeil A, Lippe R, Song IH, Lertratanakul A, Sornasse T, Biljan A, Deodhar A. A review of JAK-STAT signalling in the pathogenesis of spondyloarthritis and the role of JAK inhibition. Rheumatology (Oxford) 2021; 61:1783-1794. [PMID: 34668515 PMCID: PMC9071532 DOI: 10.1093/rheumatology/keab740] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
Spondyloarthritis (SpA) comprises a group of chronic inflammatory diseases with overlapping clinical, genetic and pathophysiological features including back pain, peripheral arthritis, psoriasis, enthesitis and dactylitis. Several cytokines are involved in the pathogenesis of SpA, variously contributing to each clinical manifestation. Many SpA-associated cytokines, including IL-23, IL-17, IL-6, type I/II interferon and tumour necrosis factor signal directly or indirectly via the Janus kinase (JAK)–signal transducer and activator of transcription pathway. JAK signalling also regulates development and maturation of cells of the innate and adaptive immune systems. Accordingly, disruption of this signalling pathway by small molecule oral JAK inhibitors can inhibit signalling implicated in SpA pathogenesis. Herein we discuss the role of JAK signalling in the pathogenesis of SpA and summarize the safety and efficacy of JAK inhibition by reference to relevant SpA clinical trials.
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Affiliation(s)
- Iain B McInnes
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals, Leeds, UK
| | - Walter P Maksymowych
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Ralph Lippe
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | | | | | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Kiltz U, Boonen A, van der Heijde D, Bautista-Molano W, Vargas RB, Chiowchanwisawakit P, El-Zorkany B, Gaydukova I, Geher P, Gossec L, Gilio M, Grazio S, Gu J, Khan MA, Kim TJ, Maksymowych WP, Marzo-Ortega H, Navarro-Compán V, Ozgocmen S, Patrikos D, Pimentel-Santos FM, Reveille J, Schirmer M, Stebbings S, Van den Bosch F, Weber U, Braun J. Development of an environmental contextual factor item set relevant to global functioning and health in patients with axial Spondyloarthritis. Rheumatology (Oxford) 2021; 61:2054-2062. [PMID: 34534275 DOI: 10.1093/rheumatology/keab653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the development of an Environmental contextual factors (EF) Item Set (EFIS) accompanying the disease specific Assessment of SpondyloArthritis international Society Health Index (ASAS HI). METHOD First, a candidate item pool was developed by linking items from existing questionnaires to 13 EF previously selected for the ICF/ASAS Core Set. Second, using data from two international surveys, which contained the EF item pool as well as the items from the ASAS HI, the number of EF-items was reduced based on the correlation between the item and the ASAS HI sum score combined with expert opinion. Third, the final English EFIS was translated into 15 languages and cross-culturally validated. RESULTS The initial item pool contained 53 EF addressing 4 ICF EF-chapters: products and technology (e1), support and relationship (e3), attitudes (e4) and health services (e5). Based on 1754 responses of axial spondyloarthritis patients in an international survey, 44 of 53 initial items were removed based on low correlations to the ASAS HI or redundancy combined with expert opinion. 9 items of the initial item pool (range correlation 0.21-0.49) form the final EFIS. The EFIS was translated into 15 languages and field tested in 24 countries. CONCLUSIONS An EFIS is available complementing the ASAS HI and helps to interpret the ASAS HI results by gaining an understanding of the interaction between a health condition and contextual factors. The EFIS emphasizes the importance of support and relationships, as well as attitudes of the patient and health services in relation to self-reported health.
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Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne Germany; and.,Ruhr-Universität Bochum, Germany
| | - Annelies Boonen
- Department of Internal MedicineDivision of Rheumatology, Maastricht University Medical Center, the Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands
| | | | - Wilson Bautista-Molano
- University Hospital Fundación Santa Fe de Bogotá, and Universidad El Bosque, Bogotá, Colombia
| | | | | | | | | | - Pal Geher
- Semmelweis University, Budapest, Hungary
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris France.,Pitié-Salpêtrière hospital, AP-HP Sorbonne Université, Rheumatology department, Paris, France
| | - Michele Gilio
- Department of Internal Medicine - "San Carlo" Hospital Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Simeon Grazio
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - Muhammad Asim Khan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tae-Jong Kim
- Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Salih Ozgocmen
- Department of RheumatologyIstinye University, Medicalpark Gaziosmanpasa Hospital, Istanbul, Turkey
| | | | | | - John Reveille
- Department of Internal MedicineUniversity of Texas Health Science Center at Houston, USA
| | - Michael Schirmer
- Innsbruck Medical University, Department of Internal Medicine, Clinic IIAustria
| | - Simon Stebbings
- University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Filip Van den Bosch
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Rheumatology Ghent University Hospital, Ghent, Belgium
| | - Ulrich Weber
- Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Herne Germany; and.,Ruhr-Universität Bochum, Germany
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Wang R, Maksymowych WP. Targeting the Interleukin-23/Interleukin-17 Inflammatory Pathway: Successes and Failures in the Treatment of Axial Spondyloarthritis. Front Immunol 2021; 12:715510. [PMID: 34539646 PMCID: PMC8446672 DOI: 10.3389/fimmu.2021.715510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022] Open
Abstract
The IL-23/IL-17 pathway has been implicated in the etiopathogenesis of axial spondyloarthritis through studies of genetic polymorphisms associated with disease, an animal model with over-expression of IL-23 that resembles human disease, and observations that cytokines in this pathway can be found at the site of disease in both humans and animal models. However, the most direct evidence has emerged from clinical trials of agents targeting cytokines in this pathway. Monoclonal antibodies targeting IL-17A have been shown to ameliorate signs and symptoms, as well as MRI inflammation in the spine and sacroiliac joints, in patients with radiographic and non-radiographic axial spondyloarthritis. This was evident in patients refractory to non-steroidal anti-inflammatory agents as well as patients failing treatment with tumor necrosis factor inhibitor therapies. Treatment with a bispecific antibody targeting both IL-17A and IL-17F was also effective in a phase II study. Post-hoc analyses have even suggested a potential disease-modifying effect in reducing development of spinal ankylosis. However, benefits for extra-articular manifestations were limited to psoriasis and did not extend to colitis and uveitis. Conversely, trials of therapies targeting IL-23 did not demonstrate any significant impact on signs, symptoms, and MRI inflammation in axial spondyloarthritis. These developments coincide with recent observations that expression of these cytokines is evident in many different cell types with roles in innate as well as adaptive immunity. Moreover, evidence has emerged for the existence of both IL-23-dependent and IL-23-independent pathways regulating expression of IL-17, potentially associated with different roles in intestinal and axial skeletal inflammation.
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Affiliation(s)
- Runsheng Wang
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, United States
- Garden State Rheumatology Consultants, Union, NJ, United States
| | - Walter P. Maksymowych
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- CARE Arthritis, Edmonton, AB, Canada
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43
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D'Agostino MA, Beaton DE, Maxwell LJ, Cembalo SM, Hoens AM, Hofstetter C, Zabalan C, Bird P, Christensen R, de Wit M, Doria AS, Maksymowych WP, Oo WM, Østergaard M, Serban T, Sloan VS, Terslev L, van Rossum MA, Conaghan PG, Boers M. Improving domain definition and outcome instrument selection: Lessons learned for OMERACT from imaging. Semin Arthritis Rheum 2021; 51:1125-1133. [PMID: 34452758 DOI: 10.1016/j.semarthrit.2021.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Imaging is one of the most rapidly evolving fields in medicine. Unfortunately, many imaging technologies have been applied as measurement instruments without rigorous evaluation of the evidence supporting their truth, discriminatory capability and feasibility for that context of use. The Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Instrument Selection Algorithm (OFISA) is used to evaluate such evidence for use of an instrument in a research setting. The objectives of this work are to: [1] define and describe the key conceptual aspects that are essential for the evaluation of imaging as an outcome measurement instrument and [2] describe how these aspects can be assessed through OFISA. METHODS Experts in imaging and/or methodology met to formalize concepts and define key steps. These concepts were discussed with a team of patient research partners with interest in imaging to refine technical and methodological aspects into comprehensible information. A workshop was held at OMERACT2020 and feedback was incorporated into existing OMERACT process for domain and instrument selection. RESULTS Three key lessons were identified: (1) a clear definition of the domain we want to measure is a necessary prerequisite to the selection of a good instrument, (2) the sources of variability that can directly influence the instrument should be clearly identified, (3) incorporating these first two lessons into OFISA improves the quality of every instrument selection process. CONCLUSIONS The incorporation of these lessons in the updated OMERACT Filter (now 2.2) will improve the quality of the selection process for all types of outcome measurement instruments.
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Affiliation(s)
- Maria Antonietta D'Agostino
- Università Cattolica del Sacro Cuore; Rheumatology UOC, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy; UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France.
| | - Dorcas E Beaton
- Institute for Work & Health and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Alison Maria Hoens
- OMERACT Patient Research Partner; University of British Columbia Faculty of Medicine Department of Physical Therapy, Canada; Patient Partner, Arthritis Research Canada
| | | | - Codruta Zabalan
- OMERACT Patient Research Partner; Romanian League against Rheumatism
| | - Paul Bird
- University of New South Wales, Sydney, Australia
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg, Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | | | - Andrea S Doria
- The Hospital for Sick Children, Medical Imaging Department, University of Toronto, Toronto, Canada
| | | | - Win Min Oo
- Rheumatology Department, Institute of Bone and Joint Disease, Kolling Institute, Sydney University, Sydney, Australia; Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Teodora Serban
- La Colletta Hospital, Rheumatology Department, ASL3 Genovese, Genoa, Italy
| | - Victor S Sloan
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; The Peace Corps, USA
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marion A van Rossum
- Amsterdam Rheumatology and Immunology Center
- Reade and Emma Children's Hospital Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, UK
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Navarro-Compán V, Boel A, Boonen A, Mease P, Landewé R, Kiltz U, Dougados M, Baraliakos X, Bautista-Molano W, Carlier H, Chiowchanwisawakit P, Dagfinrud H, de Peyrecave N, El-Zorkany B, Fallon L, Gaffney K, Garrido-Cumbrera M, Gensler LS, Haroon N, Kwan YH, Machado PM, Maksymowych WP, Poddubnyy D, Protopopov M, Ramiro S, Shea B, Song IH, van Weely S, van der Heijde D. The ASAS-OMERACT core domain set for axial spondyloarthritis. Semin Arthritis Rheum 2021; 51:1342-1349. [PMID: 34489113 DOI: 10.1016/j.semarthrit.2021.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND The current core outcome set for ankylosing spondylitis (AS) has had only minor adaptations since its development 20 years ago. Considering the significant advances in this field during the preceding decades, an update of this core set is necessary. OBJECTIVE To update the ASAS-OMERACT core outcome set for AS into the ASAS-OMERACT core outcome set for axial spondyloarthritis (axSpA). METHODS Following OMERACT and COMET guidelines, an international working group representing key stakeholders (patients, rheumatologists, health professionals, pharmaceutical industry and drug regulatory agency representatives) defined the core domain set for axSpA. The development process consisted of: i) Identifying candidate domains using a systematic literature review and qualitative studies; ii) Selection of the most relevant domains for different stakeholders through a 3-round Delphi survey involving axSpA patients and axSpA experts; iii) Consensus and voting by ASAS; iv) Endorsement by OMERACT. Two scenarios are considered based on the type of therapy investigated in the trial: symptom modifying therapies and disease modifying therapies. RESULTS The updated core outcome set for axSpA includes 7 mandatory domains for all trials (disease activity, pain, morning stiffness, fatigue, physical function, overall functioning and health, and adverse events including death). There are 3 additional domains (extra-musculoskeletal manifestations, peripheral manifestations and structural damage) that are mandatory for disease modifying therapies and important but optional for symptom modifying therapies. Finally, 3 other domains (spinal mobility, sleep, and work and employment) are defined as important but optional domains for all trials. CONCLUSION The ASAS-OMERACT core domain set for AS has been updated into the ASAS-OMERACT core domain set for axSpA. The next step is the selection of instruments for each domain.
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Affiliation(s)
- V Navarro-Compán
- Rheumatology Service, Hospital Universitario la Paz-IdiPaz, Madrid, Spain
| | - A Boel
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, the Netherlands and Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands
| | - P Mease
- Division of Rheumatology, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
| | - R Landewé
- Department of rheumatology & clinical immunology, Amsterdam University Medical Center loc. amC, Amsterdam & Zuyderland MC
- loc. Heerlen, The Netherlands
| | - U Kiltz
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
| | - M Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité. Paris, France
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
| | - W Bautista-Molano
- Rheumatology Department, University Hospital Fundación Santa Fe de Bogotá and School of Medicine Universidad El Bosque. Bogotá, Colombia
| | - H Carlier
- Global Clinical Development Immunology, S.A. Eli Lilly Benelux N.V., Brussels, Belgium
| | | | - H Dagfinrud
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - L Fallon
- Inflammation and Immunology - Global Medical Affairs, Pfizer Inc, Kirkland, Quebec, Canada
| | - K Gaffney
- Rheumatology Department, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UH
| | - M Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, Seville, Spain. Spanish Federation of Spondyloartrhtis Associations (CEADE), Madrid, Spain
| | - L S Gensler
- Division of Rheumatology, Department of Medicine, University of Calfornia, San Francisco, CA, USA
| | - N Haroon
- University of Toronto, Departement of Medicine, University Health Network, Schroder Artritis Institute, Toronto
| | - Y H Kwan
- Program in Health Systems and Services Research, Duke-NUS Medical School, Department of Pharmacy, National University of Singapore, Department of Rheumatology and Immunology, Singapore General Hospital
| | - P M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
| | - W P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - D Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany
| | - S Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - B Shea
- Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, ON, Canada
| | - I H Song
- Immunology Clinical Development, 1 North Waukegan Road Building AP31-2, North Chicago, IL 60064, USA
| | - S van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - D van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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Herregods N, Maksymowych WP, Jans L, Otobo TM, Sudoł-Szopińska I, Meyers AB, Van Rossum M, Kirkhus E, Panwar J, Appenzeller S, Weiss P, Tse S, Doria AS, Lambert R, Jaremko JL. Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part I: Active lesions. Semin Arthritis Rheum 2021; 51:1089-1098. [PMID: 34311986 DOI: 10.1016/j.semarthrit.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023]
Abstract
Magnetic resonance imaging (MRI) is an increasingly important tool for identifying involvement of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis (JIA). The key feature for diagnosing active sacroiliitis is bone marrow edema (BME), but other features of active arthritis such as joint space inflammation, inflammation in an erosion cavity, capsulitis and enthesitis can be seen as well. Structural changes may also be seen. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the disease course, choice of therapeutics and evaluating treatment response. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of SIJ inflammation. This atlas demonstrates fundamental MRI disease features of active inflammation in a format that can serve as a reference for assessing SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 2, Structural Lesions.
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Affiliation(s)
- N Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | | | - Lbo Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - T M Otobo
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning, University of Toronto, Toronto, Canada
| | - I Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - A B Meyers
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Maj Van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - E Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - J Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - S Appenzeller
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - P Weiss
- University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, Philadelphia, USA
| | - Sml Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - A S Doria
- Department of Medical Imaging, University of Toronto, Toronto and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Rgw Lambert
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - J L Jaremko
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
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Deodhar A, van der Heijde D, Sieper J, Van den Bosch F, Maksymowych WP, Kim TH, Kishimoto M, Ostor A, Combe B, Sui Y, Chu AD, Song IH. Upadacitinib in Active Ankylosing Spondylitis: 1-Year Results From the Double-Blind, Placebo-Controlled SELECT-AXIS 1 Study and Open-Label Extension. Arthritis Rheumatol 2021; 74:70-80. [PMID: 34196498 PMCID: PMC9299108 DOI: 10.1002/art.41911] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 04/20/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To report efficacy and safety of upadacitinib through 1 year in patients with ankylosing spondylitis (AS). METHODS In the SELECT-AXIS 1 study, adults with active AS and inadequate response to non-steroidal anti-inflammatory drugs were randomized to upadacitinib 15 mg once daily (QD) or placebo. At week 14, patients continued in the open-label extension and received upadacitinib up to week 104; reported here are interim data up to week 64. RESULTS Of 187 patients, 178 completed week 14 on study drug and entered the open-label extension. Similar proportions of patients in either group (continuous upadacitinib or placebo-to-upadacitinib) achieved Assessment of SpondyloArthritis international Society (ASAS) 40 or Ankylosing Spondylitis Disease Activity Score (ASDAS) low-disease activity at week 64: ≥70% of patients achieved these endpoints based on non-responder imputation (NRI) and ≥81% based on as-observed (AO) analyses. Furthermore, ≥34% (NRI) and ≥39% (AO) of patients achieved ASDAS inactive disease or ASAS partial remission at week 64. Mean changes from baseline (week 0) to week 64 in pain, function, and inflammation showed consistent improvement or sustained maintenance through the study. Among 182 patients receiving upadacitinib (237.6 PY), 618 adverse events (260.1/100 PY) were reported. No serious infections, major adverse cardiovascular events, venous thromboembolic events, gastrointestinal perforation, or deaths were reported. CONCLUSION Upadacitinib 15 mg QD showed sustained and consistent efficacy over 1 year. Patients who switched from placebo to upadacitinib at week 14 showed similar efficacy versus those who received continuous upadacitinib.
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Affiliation(s)
- Atul Deodhar
- Oregon Health & Science University, Portland, OR, United States
| | | | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, VIB Center for Inflammation Research, Ghent, Belgium
| | | | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | - Andrew Ostor
- Cabrini Medical Center, Monash University, Melbourne, VIC, Australia
| | - Bernard Combe
- CHU Montpellier, Montpellier University, Montpellier, France
| | - Yunxia Sui
- AbbVie Inc, North Chicago, IL, United States
| | | | - In-Ho Song
- AbbVie Inc, North Chicago, IL, United States
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47
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Wetterslev M, Maksymowych WP, Lambert RG, Eshed I, Pedersen SJ, Stoenoiu MS, Krabbe S, Bird P, Foltz V, Mathew AJ, Gandjbakhch F, Paschke J, Carron P, De Marco G, Marzo-Ortega H, Poulsen AE, Jaremko JL, Conaghan PG, Østergaard M. Joint and entheseal inflammation in the knee region in spondyloarthritis - reliability and responsiveness of two OMERACT whole-body MRI scores. Semin Arthritis Rheum 2021; 51:933-939. [PMID: 34176643 DOI: 10.1016/j.semarthrit.2021.05.013] [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: 01/28/2021] [Revised: 05/19/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To perform region-based development of whole-body MRI through validation of knee region scoring systems in spondyloarthritis (SpA). METHODS Assessment of knee inflammatory pathologies using 2 systems, OMERACT MRI Whole-body score for Inflammation in Peripheral joints and Entheses (MRI-WIPE) and Knee Inflammation MRI Scoring System (KIMRISS), in 4 iterative multi-reader exercises. RESULTS In the final exercise, reliability was mostly good for readers with highest agreement in previous exercise. Median pairwise single-measure ICCs for osteitis and synovitis/effusion status/change were 0.71/0.48 (WIPE-osteitis), 0.48/0.77 (WIPE-synovitis/effusion), 0.59/0.91 (KIMRISS-osteitis) and 0.92/0.97 (KIMRISS-synovitis/effusion). SRMs were 0.74 (WIPE-synovitis/effusion) and 0.78 (KIMRISS-synovitis/effusion). CONCLUSION MRI-WIPE and KIMRISS may both be useful in SpA whole-body evaluation studies.
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Affiliation(s)
- Marie Wetterslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CARE Arthritis, Edmonton, Alberta, Canada
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark
| | - Maria S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Bruxelles, Belgium
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, Australia
| | - Violaine Foltz
- Department of Rheumatology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frédérique Gandjbakhch
- Department of Rheumatology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
| | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal medicine, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal medicine, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Anna Ef Poulsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal medicine, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Maksymowych WP, McReynolds A, Pedersen SJ, Weber U, Paschke J, Wichuk S, Jaremko JL, Lambert RG. The OMERACT Knee Inflammation MRI Scoring System: Validation of quantitative methodologies and tri-compartmental overlays in osteoarthritis. Semin Arthritis Rheum 2021; 51:925-928. [PMID: 34167825 DOI: 10.1016/j.semarthrit.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To validate a revised version of the KIMRISS method for quantification of BML and synovitis-effusion in the knee by comparison with an established method, MOAKS. METHODS Novel calibration tools were developed for both methods. We compared reliability for status and change scores of BML and synovitis-effusion on baseline and one-year MRI scans. RESULTS Significant increase in both BML and synovitis-effusion was evident using KIMRISS but only for synovitis-effusion using MOAKS. Pre-specified targets for acceptable reliability (≥0.80 and ≥0.70 for status and change scores, respectively) were achieved more frequently for KIMRISS for both BML and synovitis. CONCLUSION Per OFISA criteria, KIMRISS should progress to assessment of discrimination.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton T6G 2G3, Alberta, Canada; CARE Arthritis, CARE Arthritis Ltd. 316 Windermere Road NW Unit 210, Edmonton T6W 2Z8, Alberta, Canada.
| | - Andrew McReynolds
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WC Mackenzie Health Sciences Centre, 8440 112 Street NW, T6G 2B7, Medical Imaging Consultants, 202-11010 - 101 Street NW, T5H 4B9, Edmonton, Alberta, Canada
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansen Vej 17, 2600 Glostrup, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | | | - Joel Paschke
- CARE Arthritis, CARE Arthritis Ltd. 316 Windermere Road NW Unit 210, Edmonton T6W 2Z8, Alberta, Canada
| | - Stephanie Wichuk
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton T6G 2G3, Alberta, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WC Mackenzie Health Sciences Centre, 8440 112 Street NW, T6G 2B7, Medical Imaging Consultants, 202-11010 - 101 Street NW, T5H 4B9, Edmonton, Alberta, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WC Mackenzie Health Sciences Centre, 8440 112 Street NW, T6G 2B7, Medical Imaging Consultants, 202-11010 - 101 Street NW, T5H 4B9, Edmonton, Alberta, Canada
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Sepriano A, Ramiro S, Wichuk S, Chiowchanwisawakit P, Paschke J, van der Heijde D, Landewé R, Maksymowych WP. Tumor Necrosis Factor Inhibitors Reduce Spinal Radiographic Progression in Patients With Radiographic Axial Spondyloarthritis: A Longitudinal Analysis From the Alberta Prospective Cohort. Arthritis Rheumatol 2021; 73:1211-1219. [PMID: 33538097 PMCID: PMC8361759 DOI: 10.1002/art.41667] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/26/2021] [Indexed: 02/06/2023]
Abstract
Objective To investigate whether tumor necrosis factor inhibitors (TNFi) impact spinal radiographic progression in patients with axial spondyloarthritis (SpA) and whether this is coupled to their effect on inflammation. Methods Patients with axial SpA fulfilling the modified New York criteria were included in a prospective cohort (the ALBERTA Follow Up Research Cohort in Ankylosing Spondylitis Treatment). Spine radiographs, performed every 2 years for up to 10 years, were scored by 2 central readers, using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The indirect effect of TNFi on mSASSS was evaluated with generalized estimating equations by testing the interaction between TNFi and Ankylosing Spondylitis Disease Activity Score (ASDAS) at the start of each 2‐year interval (t). If significant, the association between ASDAS at t and mSASSS at the end of the interval (t+1) was assessed in 1) patients treated with TNFi at all visits, 2) patients treated with TNFi at some visits, and 3) patients who were never treated with TNFi. In addition, the association between TNFi at t and mSASSS at t+1 (adjusting for ASDAS at t) was also tested (direct effect). Results In total, 314 patients were included. A gradient was seen for the effect of ASDAS at t on mSASSS at t+1 (interaction P = 0.10), with a higher progression in patients never treated with TNFi (β = 0.41 [95% confidence interval (95% CI) 0.13, 0.68]) compared to those continuously treated (β = 0.16 [95% CI 0.00, 0.31]) (indirect effect). However, TNFi also directly slowed progression, as treated patients had on average an mSASSS 0.85 units lower at t+1 compared to untreated patients (β = −0.85 [95% CI −1.35, −0.35]). Conclusion Our findings indicate that TNFi reduce spinal radiographic progression in patients with radiographic axial SpA, which might be partially uncoupled from their effects on inflammation as measured by the ASDAS.
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Affiliation(s)
- Alexandre Sepriano
- Leiden University Medical Center, Leiden, The Netherlands, and Universidade Nova de Lisboa, Lisboa, Portugal
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, The Netherlands, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Stephanie Wichuk
- University of Alberta and CARE Arthritis, Edmonton, Alberta, Canada
| | | | | | | | - Robert Landewé
- Amsterdam University Medical Center, Amsterdam, The Netherlands, and Zuyderland Medical Center, Heerlen, the Netherlands
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Wetterslev M, Lambert RG, Maksymowych WP, Eshed I, Pedersen SJ, Bird P, Stoenoiu MS, Krabbe S, Mathew AJ, Foltz V, Gandjbakhch F, Paschke J, De Marco G, Marzo-Ortega H, Carron P, Poulsen AE, Jaremko JL, Conaghan PG, Østergaard M. Arthritis and enthesitis in the hip and pelvis region in spondyloarthritis - OMERACT validation of two whole-body MRI methods. Semin Arthritis Rheum 2021; 51:940-945. [PMID: 34140185 DOI: 10.1016/j.semarthrit.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To validate reliability, correlation and responsiveness of two whole-body MRI scores for the hip/pelvis region in spondyloarthritis. METHODS Assessment of hip/pelvis inflammation in 4 multi-reader exercises using the OMERACT MRI Whole-body score for Inflammation in Peripheral joints and Entheses (MRI-WIPE) and Hip Inflammation Magnetic Resonance Imaging Scoring System (HIMRISS). RESULTS In exercises 3-4 (11/20 cases, respectively; 9 readers) reliability was mostly good for the 3 best calibrated readers. Median pairwise single-measure ICC for status were 0.58-0.65 (WIPE-osteitis), 0.10-0.88 (HIMRISS-osteitis) and for status/change 0.38-0.72/0.52-0.60 (WIPE-synovitis/effusion) and 0.68-0.89/0.78-0.85 (HIMRISS-synovitis/effusion). SRM was 1.23 for WIPE-osteitis, while lower for WIPE-synovitis/effusion and HIMRISS. CONCLUSION MRI-WIPE and HIMRISS may after further validation be useful in future spondyloarthritis trials.
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Affiliation(s)
- Marie Wetterslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CARE Arthritis, Edmonton, Alberta, Canada
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, Australia
| | - Maria S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Violaine Foltz
- Department of Rheumatology, Sorbonne Universités, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédérique Gandjbakhch
- Department of Rheumatology, Sorbonne Universités, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
| | - Anna Ef Poulsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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