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Kist MN, Svoboda R, Maczuga S, Wang L, Foulke GT, Helm MF. Annual tuberculosis screening in patients on biologics has questionable value. J Am Acad Dermatol 2024:S0190-9622(24)00484-5. [PMID: 38467307 DOI: 10.1016/j.jaad.2024.02.051] [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: 10/01/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Madison N Kist
- The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Ryan Svoboda
- Department of Dermatology, UMass Medical Center, Worcester, Massachusetts
| | - Steven Maczuga
- Department of Dermatology, Milton S. Hershey Penn State Medical Center, Hershey, Pennsylvania
| | - Li Wang
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Galen T Foulke
- Department of Dermatology, Milton S. Hershey Penn State Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Matthew F Helm
- Department of Dermatology, Milton S. Hershey Penn State Medical Center, Hershey, Pennsylvania.
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Bedir Demirdag T, Ozkaya Parlakay A, Aydin F, Tugcu GD, Santaflıoglu B, Kanik Yuksek S, Gulhan B, Cinel G, Celikel Acar B. Relationship between biologic modifying agents and development of latent tuberculosis in pediatrics. J Infect Dev Ctries 2024; 18:116-121. [PMID: 38377098 DOI: 10.3855/jidc.18000] [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: 02/01/2023] [Accepted: 05/29/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Biologic modifying agents are associated with an increased risk for infection with mycobacteria. The aim of this study is to document patients who received different biologic modifying therapies in our pediatric rheumatology department and the possibility of development of tuberculosis (TB). METHODOLOGY This retrospective study was conducted in Ankara City Hospital. Pediatric patients who were treated with biologic modifying agents between 2010-2020 were documented. Development of TB and the risk factors were assessed in this patient group. RESULTS There were 72 patients who were treated with different biologic modifying agents. Tuberculin skin test (TST) was positive in 7 (9.7%) patients during follow up. Three patients whose TST was positive had received canakinumab, 2 received etanercept, 1 received adalimumab and 1 received anakinra. Median duration of therapy was 43.5 (16.5-168) months for these patients and the duration was longer than patients who did not develop latent tuberculosis (p = 0.04). Patients who developed latent TB under treatment were significantly older than the patients who did not (p = 0.01). CONCLUSIONS According to our findings, 9.7% of pediatric patients who received biologic modifying agent therapy developed latent TB. Patients who developed latent TB were older, and the duration of treatment was longer than patients who did not develop latent TB. Although not statistically significant, canakinumab, which is known as an agent less likely to cause TST conversion, was in fact the most common agent that caused TST conversion.
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Affiliation(s)
- Tugba Bedir Demirdag
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Turkey
| | | | - Fatma Aydin
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Gokcen Dilsa Tugcu
- Department of Pediatric Rheumatology, Ankara City Hospital, Ankara, Turkey
| | | | - Saliha Kanik Yuksek
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Turkey
| | - Belgin Gulhan
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Turkey
| | - Guzin Cinel
- Department of Pediatric Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Banu Celikel Acar
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
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Minami D, Hosoya T, Hosoya M, Nagano A, Nakajima Y, Miyahara N, Kanehiro A. Dramatic Response to Tezepelumab as an Initial Biologic Agent for Refractory Asthma Associated with Type 2 and Non-type 2 Traits. Acta Med Okayama 2023; 77:671-674. [PMID: 38145943 DOI: 10.18926/amo/66161] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
A 74-year-old Japanese woman presented with a 45-year history of refractory asthma. She had been treated with inhaled corticosteroids, a long-acting β2-agonist, and a long-acting muscarinic antagonist for 6 months. She also had a repeated viral infection. Her condition had been characterized as a refractory asthma associated with type 2 and non-type 2 traits. We began treatment with tezepelumab. The control of the patient's asthma symptoms and quality of life improved greatly within 1 month (changes in eosinophil count from 748 to 96 /μL, in FeNO from 32 to 17 ppb, in the Asthma Quality of Life Questionnaire score from 3.59 to 6.68, and in the Asthma Control Test score from 13 to 23). Tezepelumab was effective as an initial biologic agent for a patient with refractory asthma associated with type 2 and non-type 2 traits.
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Affiliation(s)
- Daisuke Minami
- Department of Internal Medicine, Hosoya Hospital
- Department of Respiratory Medicine, Himeji Saint Mary's Hospital
- Department of Internal Medicine, Himeji Saint Mary's Hospital
| | | | | | - Akichika Nagano
- Department of Respiratory Medicine, Himeji Saint Mary's Hospital
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Ganesh N, Hanauer SB, Dulai PS. The importance of predicting patient responses to monoclonal antibodies for Crohn's disease. Expert Opin Biol Ther 2023; 23:941-949. [PMID: 37623370 DOI: 10.1080/14712598.2023.2252339] [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: 07/05/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Crohn's disease (CD) is a chronic immune-mediated inflammatory bowel disease that results in relapsing and remitting symptoms but progressive transmural bowel damage leading to significant morbidity. CD results from dysregulation of the immune system related to genetic and environmental factors. While the use of monoclonal antibodies targeting cytokines and adhesion molecules has been shown to improve outcomes in CD patients, their widespread use has been limited due to high costs as well as variable access. Here, we summarize the factors that have been shown to correlate with responsiveness to biologic agents for use in practice. AREAS COVERED We summarize the current literature regarding factors that have been shown to influence patient response to various biologic agents including: patient-related factors (e.g. age, gender, weight smoking history); disease-specific factors (e.g. disease duration, location/extension, behavior/phenotype, severity); genetic markers; transcription factors, and the gut microbiome. Finally, we review the utility of prediction models and present data supporting the use of recently developed decision support tools. EXPERT OPINION Clinical decision support tools developed by machine learning are currently available for the selection of biologic agents in CD patients. We expect these models to become an integral tool for clinicians in the treatment of CD in the coming years.
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Affiliation(s)
- Nisha Ganesh
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, United States of America
| | - Stephen B Hanauer
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, United States of America
| | - Parambir S Dulai
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, United States of America
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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Lu W, Soliman AM, Eldred A, Barcomb L, Behrens F. Efficacy and safety of risankizumab for active psoriatic arthritis: 52-week results from the KEEPsAKE 1 study. Rheumatology (Oxford) 2023; 62:2113-2121. [PMID: 36282530 PMCID: PMC10234205 DOI: 10.1093/rheumatology/keac607] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/15/2022] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE PsA is a chronic disease with heterogeneous clinical manifestations requiring treatment options with long-term efficacy and safety. In this follow-up analysis, the 52-week efficacy and safety of risankizumab 150 mg in patients with active PsA who had previous inadequate response/intolerance to one or more conventional synthetic DMARDs (csDMARD-IR) were evaluated. METHODS KEEPsAKE 1 is an ongoing, global, phase 3 study with a 24-week, double-blind, placebo-controlled period (period 1) and an open-label extension period (period 2). In period 1, eligible patients were randomized 1:1 to receive subcutaneous risankizumab 150 mg or placebo at weeks 0, 4 and 16. At week 24 (period 2), all continuing patients received open-label risankizumab 150 mg every 12 weeks through week 208. RESULTS At week 24, 57.3% of risankizumab-treated patients (n = 483) achieved ≥20% improvement in ACR criteria (ACR20) vs 33.5% of placebo-treated patients (n = 481; P < 0.001). At week 52, 70.0% of patients who were randomized to receive continuous risankizumab therapy and 63.0% of patients who were randomized to receive placebo in period 1 and then receive risankizumab at week 24 achieved ACR20. Similar result trends were observed for other efficacy measures. Risankizumab was well tolerated through 52 weeks of treatment with a consistent safety profile from week 24 through week 52. CONCLUSION In patients with active PsA who were csDMARD-IR, continuous risankizumab treatment demonstrated robust long-term efficacy and was well tolerated through 52 weeks of treatment. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, KEEPsAKE1, NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research–K Papp Clinical Research, Waterloo, ON, Canada
| | - Leslie McCasland
- Department of Rheumatology, Loyola University Medical Center, Maywood, IL, USA
- Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | | | | | | | | | - Frank Behrens
- Rheumatology & Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Fraunhofer Cluster of Excellence for Immune-Mediated Disease (CIMD), Goethe University, Frankfurt, Germany
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Östör A, Van den Bosch F, Papp K, Asnal C, Blanco R, Aelion J, Lu W, Wang Z, Soliman AM, Eldred A, Padilla B, Kivitz A. Efficacy and safety of risankizumab for active psoriatic arthritis: 52-week results from the KEEPsAKE 2 study. Rheumatology (Oxford) 2023; 62:2122-2129. [PMID: 36282537 PMCID: PMC10234194 DOI: 10.1093/rheumatology/keac605] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/15/2022] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE PsA is a chronic inflammatory disease in which the skin and joints are affected. In this follow-up analysis, the 52-week efficacy and safety of risankizumab 150 mg in patients with active PsA who had previous inadequate response/intolerance to one or two biologic therapies (Bio-IR) or one or more conventional synthetic DMARDs (csDMARD-IR) were evaluated. METHODS In the ongoing, phase 3, KEEPsAKE 2 trial, patients with active PsA were randomized 1:1 to receive subcutaneous risankizumab 150 mg or placebo at weeks 0, 4 and 16 (period 1). At week 24 (period 2), patients who received placebo were switched to risankizumab, and all patients received risankizumab 150 mg every 12 weeks from weeks 28 to 208. RESULTS At week 24, 51.3% of risankizumab-treated patients (n = 224) achieved ≥20% improvement in ACR criteria (ACR 20) vs 26.5% of placebo-treated patients (n = 220; P < 0.001). At week 52, 58.5% of patients randomized to receive continuous risankizumab achieved ACR20, and 55.7% of patients who switched from placebo to risankizumab at week 24 achieved ACR20. Similar trends were observed for other efficacy measures. Rates of serious treatment-emergent adverse events (TEAEs) and TEAEs leading to discontinuation remained stable through week 52, and no deaths were reported. CONCLUSION Risankizumab was well tolerated and improved symptoms of PsA in Bio-IR/csDMARD-IR patients, with a consistent long-term safety profile from weeks 24 to 52. TRIAL REGISTRATION United States National Library of Medicine clinical trials database www.clinicaltrials.gov; KEEPsAKE 2; NCT03671148.
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Affiliation(s)
- Andrew Östör
- Department of Medicine, Monash University; Department of Rheumatology, Cabrini Hospital; and Emeritus Research, Melbourne, Victoria, Australia
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University, and Unit for Molecular Immunology and Inflammation, VIB Center for Inflammation Research, Ghent, Belgium
| | - Kim Papp
- Probity Medical Research–K. Papp Clinical Research, Waterloo, Ontario, Canada
| | | | - Ricardo Blanco
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Jacob Aelion
- Arthritis Clinic and West Tennessee Research Institute, Jackson, TN, USA
| | | | | | | | | | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
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Aizawa H, Fujino N, Matsumoto S, Sano H, Saito T, Hatakeyama T, Kyogoku Y, Ichikawa T, Koarai A, Horino S, Miura K, Sugiura H. [A SURVEY ON MEDICAL CARE FOR ALLERGIC DISEASES IN MIYAGI]. Arerugi 2023; 72:26-36. [PMID: 36792158 DOI: 10.15036/arerugi.72.26] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE In Miyagi, the number of allergy specialists per population is higher at Sendai city compared to the other areas (non-Sendai areas). Therefore, the healthcare delivery for allergic diseases are unevenly distributed. In the current study, we investigated differences of medical care for allergic diseases between Sendai city and non-Sendai areas. METHODS We conducted a web-based questionnaire survey to all of hospitals and clinics in the prefecture. The questionnaire responses were analyzed and compared between the Sendai city and non-Sendai areas. RESULTS Responses to the questionnaire were obtained from 175 hospitals and clinics, including 72 internal physicians, 34 pediatricians, 17 dermatologists, 15 otorhinolaryngologists, 12 ophthalmologists and 25 others. More clinicians in non-Sendai areas felt the difficulty in treating asthma and chronic urticaria than those in Sendai city. Fewer institutions prescribed biologics for severe allergic diseases in non-Sendai areas than in Sendai city, which might be due to the lack of knowledge on the biologic agents. On the other hand, referring patients with anaphylaxis to specialized hospitals tended to be more difficult in Sendai city compared to in non-Sendai areas. Additionally, the regional medical liaison system is needed to refer patients with severe allergic diseases to advanced medical institutions. CONCLUSION There are unique problems about allergy care in Miyagi.
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Affiliation(s)
- Hiroyuki Aizawa
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Naoya Fujino
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Shuichiro Matsumoto
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Hirohito Sano
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Takuya Saito
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Tetsuya Hatakeyama
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Yorihiko Kyogoku
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiro Ichikawa
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | - Akira Koarai
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
| | | | | | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
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Singh R, Brown AM, Chan WH, Farr MA, Venkataraman S, Feldman SR. Psoriatic arthritis improved on risankizumab: does the presence of psoriatic arthritis mean a drug approved for psoriatic arthritis has to be prescribed? Expert Opin Biol Ther 2022; 22:1439-1441. [PMID: 35678210 DOI: 10.1080/14712598.2022.2088278] [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] [Indexed: 01/25/2023]
Affiliation(s)
- Rohan Singh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alexandria M Brown
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Warren H Chan
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Morgan A Farr
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sid Venkataraman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Fukuda M, Miyazono M, Ubara Y. Perirenal Abscess in a Patient with Rheumatoid Arthritis. Intern Med 2022; 61:3463. [PMID: 35400700 PMCID: PMC9751731 DOI: 10.2169/internalmedicine.9060-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Makoto Fukuda
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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Nishio Y, Taniguchi H, Takeda A, Hori J. Immunopathological Analysis of a Mouse Model of Arthritis-Associated Scleritis and Implications for Molecular Targeted Therapy for Severe Scleritis. Int J Mol Sci 2021; 23:341. [PMID: 35008766 PMCID: PMC8745222 DOI: 10.3390/ijms23010341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/30/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/20/2022] Open
Abstract
Scleritis involves inflammation of the sclera, which constitutes 75% of the wall of the eye. This pathology is often seen as an ocular lesion associated with systemic inflammatory diseases. Severe types of scleritis such as posterior scleritis require urgent immunosuppressive treatments, including molecularly targeted therapies to avoid permanent visual impairment. Which molecules should be selected as targets has remained unclear. To clarify the pathogenesis of scleritis and propose appropriate target molecules for therapy, we have established novel animal model of scleritis by modifying the Collagen-II Induced Arthritis (CIA) model. Immunization twice with collagen II emulsified with complete Freund's adjuvant (CFA) caused arthritis and scleritis. The clinical appearance resembled human diffuse scleritis. Histopathological analysis suggested that macrophages, plasma cells, deposition of immune complexes, and growth of blood and lymphatic vessels are involved in the pathogenesis of CIA-associated scleritis. In addition, we analysed the background diseases of posterior scleritis and responses to molecularly targeted therapies as a case series study. We inferred from both the animal model and case series study that targets should not be T cells, but factors inhibiting macrophage activity such as tumor necrosis factor (TNF) and interleukin (IL)-6, and molecules suppressing antibody-producing cells such as CD20 on B cells should be targeted by molecularly targeted therapies.
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Affiliation(s)
| | | | | | - Junko Hori
- Department of Ophthalmology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo 2068512, Japan; (Y.N.); (H.T.); (A.T.)
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Affiliation(s)
- Warren H Chan
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rohan Singh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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12
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Quartuccio L, Zabotti A, Gallo T, De Vita S, Valent F. Influenza vaccination in chronic inflammatory arthritis undergoing immunosuppressive treatments: temporal trend and factors of adherence. Rheumatology (Oxford) 2021; 60:2456-2460. [PMID: 33083815 DOI: 10.1093/rheumatology/keaa454] [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: 04/14/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To verify the level of adherence to the influenza vaccination program in a population of patients suffering from RA, PsA or AS undergoing immunosuppressive treatment. METHODS Administrative databases from the Regional Health Information System of Friuli Venezia Giulia (FVG), Italy, were used. Subjects were residents in FVG, suffered from chronic inflammatory arthritis and had at least one prescription for a DMARD in the 9 months before the start of the vaccination season (from 1 October to 31 December). The observation ranged from 2006 to 2018. Logistic regression was used to assess the association between vaccination and the patient's characteristics in the 2018-2019 influenza season. RESULTS Overall, vaccination adherence decreased from the highest value of 35.7% (662/1853) in 2006 to the lowest value of 25.3% (926/3663) in 2014; in people ≥65 years of age it also decreased over time from 61.6% (577/936) in 2008 to 43.9% (701/1595) in the 2014. By logistic analysis on the 2018-2019 season, which included 4460 patients, older subjects were more likely to be vaccinated [people 65-74 years, odds ratio (OR) 4.58 (95% CI 3.72, 5.64); people 75-84 years, OR 6.47 (95% CI 5.04, 8.32); both vs <65] as were those with diabetes [OR 1.66 (95% CI 1.05, 2.64)]. Treatment with a biologic agent alone [OR 0.64 (95% CI 0.52, 0.80)] and RA diagnosis [OR 0.69 (95% CI 0.51, 0.93)] were associated with lower adherence. CONCLUSION Influenza vaccination adherence is alarmingly low in a population at higher risk of infectious complications, in particular in elderly patients.
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Affiliation(s)
- Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Alen Zabotti
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Tolinda Gallo
- Department of Prevention, Azienda sanitaria universitaria Friuli Centrale
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, University of Udine
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
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Adiguzel Dundar H, Acari C, Turkucar S, Unsal E. Treatment of systemic JIA: When do we need a biologic? Real world data of a single center. Mod Rheumatol 2021; 31:684-690. [PMID: 32343644 DOI: 10.1080/14397595.2020.1761079] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This paper aimed to present real-world data of treatment results of a single center in patients with systemic Juvenile Idiopathic arthritis (SJIA), in which methotrexate (MTX) along with glucocorticoids was preferred as the first-line treatment option. METHODS The medical records of 50 patients (58 episodes) with SJIA were evaluated. All patients with SJIA were hospitalized and were given high dose glucocorticoid treatment along with subcutaneous MTX. A biological agent was added in which disease activity control was not available with MTX. RESULTS Forty-one (70.6%) of 58 episodes were controlled by MTX, following discontinuation of steroids, while a biologic drug was needed in the remaining 17 (29.4%) episodes. The patients receiving MTX were divided into two groups: Group I (n = 36) (41 episodes) consisted of patients receiving MTX alone, and Group II (n = 14) (17 episodes) consisted of patients receiving MTX plus a biologic agent. Group I was dominated by the monocyclic course (56.1%), whereas group II was dominated by persistent course (70.6%). The initial erythrocyte sedimentation rate (82 vs 67 mm/h) and neutrophil/lymphocyte ratio (8.6 vs 4.1) were significantly elevated in the Group II (p = .003 and p = .007, respectively). NLR of 5.23 predicted the requirement for biological agents with a sensitivity of 66.7%, specificity 71.4%. Odds ratio for NLR ≥ 5.23 was 5.1 in Group II. CONCLUSION This study suggested that MTX was highly successful in cases with any SJIA episode, regardless of whether arthritis was present or not, even in cases presenting with MAS. A biologic drug is needed, if NLR is greater than 5.23.Key messagesHigh dose glucocorticoids with high dose SC methotrexate are the initial treatment option in systemic JIA.In glucocorticoid dependent patients, where methotrexate is ineffective, biologic therapy is mandatory.A neutrophil/lymphocyte ratio greater than 5.23 predicts the need for early biologic treatment.High dose S.C. MTX could be an option as an initial treatment in SJIA, especially biologics are not available.
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Affiliation(s)
- Hatice Adiguzel Dundar
- Division of Pediatric Rheumatolgy, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ceyhun Acari
- Division of Pediatric Rheumatolgy, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Serkan Turkucar
- Division of Pediatric Rheumatolgy, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Erbil Unsal
- Division of Pediatric Rheumatolgy, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Choong DJ, Ng JL, Vinciullo C. Pyoderma gangrenosum associated with Takayasu's arteritis in a young Caucasian woman and response to biologic therapy with tocilizumab. JAAD Case Rep 2021; 9:4-6. [PMID: 33598515 PMCID: PMC7868742 DOI: 10.1016/j.jdcr.2020.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Dean J Choong
- Dermatology Department, Fiona Stanley Hospital, Western Australia
| | - Jeremy L Ng
- Dermatology Department, Royal Perth Hospital, Perth, Western Australia
| | - Carl Vinciullo
- Dermatology Department, Royal Perth Hospital, Perth, Western Australia
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15
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Damask CC, Ryan MW, Casale TB, Castro M, Franzese CB, Lee SE, Levy JM, Lin SY, Lio PA, Peters AT, Platt MP, White AA. Targeted Molecular Therapies in Allergy and Rhinology. Otolaryngol Head Neck Surg 2020; 164:S1-S21. [PMID: 33138725 DOI: 10.1177/0194599820965233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biologic agents, monoclonal antibodies that target highly-specific molecular pathways of inflammation, are becoming integrated into care pathways for multiple disorders that are relevant in otolaryngology and allergy. These conditions share common inflammatory mechanisms of so-called Type 2 inflammation with dysregulation of immunoglobulin E production and eosinophil and mast cell degranulation leading to tissue damage. Biologic agents are now available for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, eosinophilic granulomatosis with polyangiitis (EGPA), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU). This paper summarizes the diagnosis and management of these conditions and critically reviews the clinical trial data that has led to regulatory approval of biologic agents for these conditions.
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Affiliation(s)
| | | | | | - Mario Castro
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Stella E Lee
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sandra Y Lin
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Peter A Lio
- Northwestern Medicine, Chicago, Illinois, USA
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16
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Abstract
Objective Psoriasis is an immune-mediated chronic inflammatory disease with skin and
joint manifestations. Smoking is considered an unfavorable lifestyle factor
for psoriasis. We aimed to explore the association between smoking, disease
risk, and treatment efficacy in relation to psoriasis. Methods We searched the Cochrane Library, Embase, and PubMed databases for studies
examining the relationship between smoking and psoriasis, up to 12 April
2020. We then conducted a meta-analysis using a fixed-effects model to
obtain odds ratios (ORs) with 95% confidence intervals (CIs). Results Ever, current, and former smokers all had higher risks of developing
psoriasis than non-smokers (pooled ORs (95% CIs): 1.60 (1.51–1.69), 1.63
(1.48–1.80), and 1.36 (1.13–1.64), respectively). Ever smokers were less
likely to show disease improvement at 6 months following treatment with
biologic agents than non-smokers (pooled OR (95% CI): 0.80 (0.67–0.95)). Conclusions Smoking increases psoriasis risk and negatively impacts the benefits of
biologic agents. However, the number of reports is limited and more studies
are needed to confirm the effects of smoking and smoking cessation on
therapeutic response in patients with psoriasis. Education to encourage a
healthy lifestyle remains a valuable approach in clinical practice.
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Affiliation(s)
- Hang Zhou
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ruifang Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yi Kong
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuwen Su
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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17
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Molinelli E, Sapigni C, Campanati A, Brisigotti V, Offidani A. Metabolic, pharmacokinetic, and toxicological issues of biologic therapies currently used in the treatment of hidradenitis suppurativa. Expert Opin Drug Metab Toxicol 2020; 16:1019-1037. [PMID: 32896186 DOI: 10.1080/17425255.2020.1810233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa is a chronic, relapsing, debilitating inflammatory dermatologic disease of the terminal hair follicles at intertriginous sites clinically characterized by painful inflammatory nodules, abscesses, draining sinus tracts, and dermal fibrosis. The management of hidradenitis suppurativa is a challenge and usually consists of both medical and surgical approaches, which must often be combined for best outcome. The introduction of biological therapies, specifically TNFα-inhibitors such as adalimumab, has profoundly changed the therapeutic armamentarium of the disease. AREAS COVERED The PubMed database was searched using combinations of the following keywords: hidradentis suppurativa, biologic therapy, TNF-α inhibitors, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects, pharmacodynamics, pharmacology, adverse events, pharmacokinetics, drug interaction. This article reviews and updates the chemistry, pharmacokinetics, mechanism of action, adverse effects, drug interactions of on-label and off-label use of TNF-α inhibitors in HS. EXPERT OPINION Biologic agents, particularly adalimumab, exhibit clinical efficacy in patients with hidradenitis suppurativa. Careful patient selection and close monitoring during treatment are mandatory to provide safe and effective use of the TNF-α inhibitor. Familiarity with biologic agents is crucial because these agents could become a consolidated treatment option in the clinician's therapeutic approaches.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Anna Campanati
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
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18
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Unal C, Fadiloglu E, Tanacan A, Zaim OC, Beksac MS. Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey. Int J Rheum Dis 2019; 23:101-105. [PMID: 31713329 DOI: 10.1111/1756-185x.13746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate obstetrical and perinatal outcomes of pregnancies with ankylosing spondylitis (AS). METHODS This was a retrospective study evaluating obstetric outcomes of 52 patients with AS who were followed up at our institution between 2006 and 2019. Patients were classified as having disease greater than or less than 5 years, and according to disease-related medical treatment during pregnancy, as drug free, single medication or multiple medication. RESULTS Overall rates of preterm delivery, intrauterine growth retardation and preeclampsia were 17.3%, 13.4% and 7.7%, respectively. Thirty-three of the patients were followed up without any medication, while 19 patients used drugs during pregnancy. Seven patients used a single drug and 12 patients had multiple drugs. There was no significant difference in terms of obstetrical and neonatal outcomes. However, a higher rate of neonatal intensive care unit (NICU) admission was observed in the group using medication for AS, despite a lack of statistical significance (31.5% vs 15%, P = .162). On the other hand, patients having disease more than 5 years had higher rates of Apgar scores less than <7 and admission to the NICU despite a lack of statistical significance (4% vs 7.4% and 16% vs 26%; P = .267 and P = .297, respectively). CONCLUSION In conclusion, pregnancies of patients with AS must be considered as high risk due to increased rates of adverse outcomes such as preterm delivery, intrauterine growth retardation or preeclampsia.
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Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Onur Can Zaim
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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19
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Kim J, Kim SH, Kim TO. Evaluation of CT enterography findings for endoscopic complete remission after anti-TNF-α therapy in patients with Crohn's disease. Acta Radiol 2019; 60:1200-1208. [PMID: 30628841 DOI: 10.1177/0284185118820062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jieun Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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20
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Aeschlimann FA, Chong SL, Lyons TW, Beinvogl BC, Góez-Mogollón LM, Tan S, Laxer RM. Risk of Serious Infections Associated with Biologic Agents in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analyses. J Pediatr 2019; 204:162-171.e3. [PMID: 30318371 DOI: 10.1016/j.jpeds.2018.08.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess whether treatment with biologic response modifying agents during clinical trial study periods increases the risk of serious infections in children with juvenile idiopathic arthritis (JIA). STUDY DESIGN A systematic literature review using Medline, Embase, Cochrane library, and the clinical trial registry was performed up to July 2017. Random effects meta-analyses were used to compare rates of serious infections in children with JIA given biologic agents compared with controls, and the pooled relative risk calculated. Subanalyses were performed for different biologic agent classes. RESULTS In total, 19 trials accounting for 21 individual studies were included (11 for tumor necrosis factor-alpha inhibitors [n = 814 patients], 3 for interleukin-6 inhibitors [n = 318], 6 for interleukin-1 inhibitors [n = 353], and 1 for selective T-lymphocyte costimulation modulators [n = 122]). Patients (68% female) had a mean age of 10.8 years. Seventeen serious infections were reported among 810 children receiving biologic agents and 15 among 797 controls. The most frequent infections were bronchopulmonary and varicella. No statistically significant difference in risk of serious infections was found between children receiving biologic agents compared with control groups (pooled relative risk = 1.13; 95% CI [0.63, 2.03]) during the trial study periods. The risk remained nonsignificant when evaluating the different classes of biologic agents separately. However, the analyses were underpowered to detect differences in the risk of serious infections overall or differences between classes of biologic agents. CONCLUSIONS In this systematic review and meta-analyses, serious infections were uncommon and not significantly increased among patients with JIA receiving biologic agents compared with controls. However, the analyses were underpowered and study periods were relatively short. Ongoing careful monitoring for serious infections remains necessary for all patients with JIA, and particularly those receiving biologic agents.
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Affiliation(s)
- Florence A Aeschlimann
- Pediatric Immunology-Hematology and Rheumatology Unit, University Hospital Necker-Enfants Malades, Paris, France.
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Beate C Beinvogl
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | | | - Sally Tan
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Department of Pediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada
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21
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Latourte A, Gottenberg JE, Luxembourger C, Pane I, Claudepierre P, Richette P, Lafforgue P, Combe B, Cantagrel A, Sibilia J, Flipo RM, Gaudin P, Vittecoq O, Schaeverbeke T, Dougados M, Sellam J, Ravaud P, Mariette X, Seror R. Safety of surgery in patients with rheumatoid arthritis treated by abatacept: data from the French Orencia in Rheumatoid Arthritis Registry. Rheumatology (Oxford) 2017; 56:629-637. [PMID: 28053274 DOI: 10.1093/rheumatology/kew476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Indexed: 01/04/2023] Open
Abstract
Objective To investigate the frequency and risk factors of postoperative complications in RA patients treated with abatacept (ABA). Methods The Orencia RA registry recruited 1012 patients receiving ABA for RA in routine care. Data from patients treated with ABA who underwent surgery were reviewed to describe the frequency of postoperative complications. Characteristics of patients and surgeries with and without complications were compared to identify factors associated with complications. Results We identified 205 (20.3%) patients who underwent 263 surgeries, including 176 (66.9%) orthopaedic surgeries. Nineteen (7.2%) surgeries, in 19 patients (9.3%), entailed complications, including 7 delayed wound healing (2.7% of surgeries) and 6 surgical site infections (2.3% of surgeries). The median time between the last infusion of ABA and surgery was 5.9 weeks (range: 0.3-12.0 weeks), with no significant difference between patients with and without complications. The median corticosteroids daily dosage was higher in the group with complications [10.0 (6.25-15.0) vs 6.0 (5.0-10.0) mg/day, P = 0.042]. In multivariate analysis, only the duration of ABA treatment was significantly associated with postoperative complications [adjusted odds ratio (aOR) = 0.94 (95% CI: 0.89, 0.99) for each month of treatment], as were orthopaedic surgeries compared with other kinds of surgery [aOR = 4.45 (95% CI: 1.01, 20.2)]. Conclusion In RA patients treated with ABA, the rate of surgical complications was low: 7.2% and higher in case of orthopaedic procedure and a more recent initiation of ABA. The median time between surgery and the last infusion of ABA was short and did not influence the rate of postoperative complications.
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Affiliation(s)
- Augustin Latourte
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre.,Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
| | - Jacques-Eric Gottenberg
- Centre National de Référence des Maladies Auto-Immunes Rares, Fédération de Médecine Translationelle de Strasbourg, University Hospital of Strasbourg, Strasbourg University, Strasbourg
| | | | - Isabelle Pane
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris
| | | | - Pascal Richette
- Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
| | - Pierre Lafforgue
- Rheumatology Department, Hopital de la Conception, University of Marseille, Marseille
| | - Bernard Combe
- Rheumatology Department, Lapeyronie University Hospital, Montpellier University, Montpellier
| | - Alain Cantagrel
- Rheumatology Center, Purpan Hospital, Paul Sabatier University, Toulouse
| | - Jean Sibilia
- Centre National de Référence des Maladies Auto-Immunes Rares, Fédération de Médecine Translationelle de Strasbourg, University Hospital of Strasbourg, Strasbourg University, Strasbourg
| | - René-Marc Flipo
- Rheumatology Department, CHRU de Lille, Université de Lille-2, Lille
| | | | - Olivier Vittecoq
- Rheumatology Department, Rouen University Hospital & Inserm U905, Rouen
| | | | - Maxime Dougados
- Department of Rheumatology - Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris Descartes University.,INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité
| | - Jeremie Sellam
- Inflammation-Immunopathology-Biotherapy Department (I2B), Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris 06, Paris, France
| | - Philippe Ravaud
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris
| | - Xavier Mariette
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre
| | - Raphaèle Seror
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre
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Abstract
Strategies in rheumatoid arthritis (RA) based on 'treat to target' aim to control disease activity, minimize structural damage, and promote longer life. Several disease-modifying antirheumatic drugs (DMARDs) have been shown to be effective including biological DMARDs (bDMARDs). Treatment guidelines and recommendations for RA have also been published. According to those guidelines, conventional synthetic DMARDs (csDMARDs), as monotherapy or combination therapy, should be used in DMARD-naïve patients, irrespective of the addition of glucocorticoids (GCs). Combination therapies with bDMARDs are also essential for conducting treatment strategies for RA, because in every recommendation or guideline for the management of RA, combination therapies of csDMARDs with bDMARDs are recommended for RA patients with moderate or high disease activity after failure of csDMARD treatment. bDMARDs are more efficacious if used concomitantly with methotrexate (MTX) than with MTX monotherapy or bDMARD monotherapy. Thus, retention has been reported to be longer when combined with MTX. The superior efficacy of combination therapy compared with MTX monotherapy or bDMARD monotherapy could be because: (1) it could help to minimize MTX toxicity by reducing the dose of MTX, thus retention rate of the same therapeutic regimen would become high; (2) anti-bDMARD antibodies are observed at lower concentrations when using MTX concomitantly, so less clearance of bDMARDs via less formation of bDMARD and an anti-bDMARD immune complex; (3) of the additive effects of MTX to bDMARD, especially the combination of tumor necrosis factor inhibitors (TNFis) with MTX. Hence, evidence suggests that combination therapy with bDMARDs is more efficacious than monotherapy using a csDMARD or bDMARD, and that MTX is the best drug for this purpose (if MTX is not contraindicated). Finding the most effective drug regimen at the lowest cost will be the aim of RA treatment in the future.
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Affiliation(s)
- Kentaro Inui
- Department of Rheumatosurgery, Osaka City University Medical School, Abenoku, Asahimachi 1-4-3, Osaka 545-8585, Japan
| | - Tatsuya Koike
- Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, Abenoku, Asahimachi, Osaka, and Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Nishimurogun, Shirahamacho, Wakayama, Japan
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23
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Ong N, McMeniman E, Pillans P, Soyer HP. A clinical audit of high-cost and off-label drug use in dermatology. Australas J Dermatol 2015; 58:30-34. [PMID: 26344939 DOI: 10.1111/ajd.12392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES The use of high-cost, off-label, unsubsidised drugs has become valuable in the management of dermatology patients with challenging conditions unresponsive to conventional therapy. Currently, there is no dedicated funding and a paucity of evidence for such drugs. The aim of this audit was to review outcomes and costs. METHODS A retrospective clinical audit of high-cost off-label dermatology drug applications to the High Cost Drug's Subcommittee was undertaken at a tertiary public hospital in Brisbane, Queensland, between 2002 and 2013. RESULTS Of 28 applications, 25 were approved. The medications included thalidomide, mycophenolate mofetil, cyclosporin, infliximab, rituximab and adalimumab. Over 70% of patients responded to treatment. Individual annual costs for these medications ranged from $2068 to $36 984. Adverse effects resulted in drug withdrawal in five cases. CONCLUSIONS Despite the absence of dedicated funding for high-cost drugs and a rigorous committee approval process, most applications were approved, of which >70% benefited from treatment. This audit provides useful clinical experience with off-label use of high-cost drugs in difficult dermatological conditions.
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Affiliation(s)
- Natalie Ong
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia.,Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
| | - Erin McMeniman
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia.,Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
| | - Peter Pillans
- Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Australia
| | - H Peter Soyer
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia.,Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
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24
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Abstract
INTRODUCTION The highest incidence of inflammatory bowel disease (IBD) is seen between the second and fourth decades of life, which is the most fertile age for women. Increased disease activity has been shown to effect female fertility and pregnancy outcomes, stressing the need for drugs that can safely induce and maintain clinical remission without harming either the mother or fetus. AREAS COVERED Anti-TNF-α agents have been shown to be effective in both inducing and maintaining remission among IBD patients. This review highlights the results of previous studies conducted on pregnant women who were exposed to anti-TNF-α agents during the course of their pregnancy. The drugs reviewed include infliximab (IFX), adalimumab (ADA), certolizumab pegol (CZP) and golimumab (GMB). Of > 200 articles reviewed, 105 were included in the manuscript based on relevance. The keywords used were anti-TNF, infliximab, adalimumab, certolizumab, golimumab, biologics, pregnancy and inflammatory bowel disease. EXPERT OPINION Anti-TNF agents have been studied extensively during pregnancy from the early case reports to the more recent prospective Pregnancy in IBD and Neonatal Outcomes study. A comprehensive review of the literature has shown that biologics can be safely used during pregnancy. In view of this safety data, it is recommended to maintain therapy during pregnancy.
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Affiliation(s)
- Nabeel Khan
- University of Pennsylvania Perelman School of Medicine, Department of Gastroenterology , Philadelphia, PA , USA
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25
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Anink J, Prince FHM, Dijkstra M, Otten MH, Twilt M, ten Cate R, Gorter SL, Koopman-Keemink Y, van Rossum MAJ, Hoppenreijs EPA, van Suijlekom-Smit LWA. Long-term quality of life and functional outcome of patients with juvenile idiopathic arthritis in the biologic era: a longitudinal follow-up study in the Dutch Arthritis and Biologicals in Children Register. Rheumatology (Oxford) 2015; 54:1964-9. [PMID: 26078219 DOI: 10.1093/rheumatology/kev195] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To carry out a longitudinal investigation of functional outcome, health-related quality of life (HRQoL) and treatment strategies in JIA patients who started etanercept >5 years ago. METHODS We approached patients whose HRQoL changes were described previously in a subanalysis of the Dutch Arthritis and Biologicals in Children register. Recent disease status, co-morbidities and structural damage were retrieved. Disability and HRQoL were assessed by (Childhood) HAQ [(C)HAQ], Child Health Questionnaire, Short Form 36 and Health Utilities Index Mark 3. Changes over time were analysed with linear mixed models. RESULTS Forty-three patients (81% response) started etanercept a median 8.5 years ago. At the time of this long-term analysis, median age was 22 years (interquartile range: 18-24 years). HRQoL outcome was similar to HRQoL 15-27 months after the initiation of etanercept; 42% had a (C)HAQ of 0.00 and 67% had achieved inactive disease. Patients reported increasing levels of bodily pain compared with earlier measurements. Unemployment (12%) was comparable to the general population; educational level was higher. Use of biologic agents was as follows: 40% etanercept; 40% other biologic agents; and 20% none. Joint surgery occurred in 14% of patients. CONCLUSION At a median 8.5 years after the commencement of etanercept treatment, JIA patients maintain most of the acquired improvement in HRQoL. Although disability and disease activity are low, chronic pain remains an issue. Persistence and possible deterioration of radiological damage emphasize the importance of early treatment. The fact that 20% of patients do not use any anti-rheumatic medication shows that clinical remission of medication might be an achievable goal.
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Affiliation(s)
- Janneke Anink
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam,
| | - Femke H M Prince
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Maryanne Dijkstra
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Marieke H Otten
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Marinka Twilt
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Rebecca ten Cate
- Department of Paediatrics/Paediatric Rheumatology, Leiden University Medical Centre, Leiden
| | - Simone L Gorter
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht
| | | | - Marion A J van Rossum
- Department of Paediatrics/Paediatric Rheumatology, Emma Children's Hospital/Academic Medical Centre and Reade location Jan van Breemen, Amsterdam and
| | - Esther P A Hoppenreijs
- Department of Paediatrics/Paediatric Rheumatology, St Maartenskliniek and Radboud University Medical Centre, Nijmegen, The Netherlands
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26
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Ichihara A, Jinnin M, Fukushima S, Inoue Y, Ihn H. Case of disseminated cutaneous Mycobacterium chelonae infection mimicking cutaneous vasculitis. J Dermatol 2015; 41:414-7. [PMID: 24801916 DOI: 10.1111/1346-8138.12459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/30/2014] [Indexed: 11/30/2022]
Abstract
Mycobacterium chelonae is a non-tuberculous, rapidly growing mycobacteria and is widely distributed in the natural environment. In the immunocompetent status, localized cutaneous infections such as cellulitis and subcutaneous abscesses commonly occur after traumatic injury. However, disseminated cutaneous infections occur on a background of immunosuppression. Cutaneous M. chelonae infection presents with a variety of skin eruptions. We report a case of disseminated M. chelonae infection mimicking cutaneous vasculitis. The patient was treated with long-term oral corticosteroids and injected etanercept for the treatment of rheumatoid arthritis and asthma. Because the skin eruptions were preceded by asthma and rheumatoid arthritis and the pathological findings showed fibrinoid necrosis around the vascular of dermis, cutaneous vasculitis was first suspected. The culture from the pus revealed the bacterium which grew within 5 days on Ogawa's culture medium suggesting a rapidly growing mycobacteria. This bacterium was identified as M. chelonae by the DNA-DNA hybridization method. We chose 800 mg/day clarithromycin and 500 mg/day levofloxacin as a result of the drug-sensitivity test. After 6 months of the treatment, infection symptoms disappeared. Rapidly growing mycobacteria should be considered in the differential diagnosis of infections in patients under immunosuppression caused by diseases or drugs such as corticosteroids and biologic agents. Repeated bacterial examinations are important and required for the diagnosis of rapidly growing mycobacteria.
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Affiliation(s)
- Asako Ichihara
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Abstract
Adalimumab is a fully humanized anti-tumor necrosis factor alpha monoclonal antibody that was recently granted regulatory approval in the USA for the treatment of moderate to severe Crohn’s disease (CD) in children. Like infliximab, the first biologic agent used to treat pediatric CD, regulatory approval was secured many years following approval for adults. The long delay between adult and pediatric approval has led to many years of off-label use of adalimumab, although it is anticipated that the use of adalimumab may further increase with official regulatory approval. To date, pediatric literature on the use of adalimumab for treatment of CD is limited, and pediatric practitioners have mostly extrapolated from research and experience provided by the adult literature. The aim of this paper is to review the literature regarding adalimumab for the treatment of pediatric CD, and includes a review of landmark adult studies as well as the pivotal pediatric study that facilitated regulatory approval. We also discuss the role of anti-tumor necrosis factor alpha agents including adalimumab in the current treatment paradigm for pediatric CD.
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Affiliation(s)
- Bella Zeisler
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center Hartford, University of Connecticut School of Medicine, Department of Pediatrics, Farmington, CT, USA
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center Hartford, University of Connecticut School of Medicine, Department of Pediatrics, Farmington, CT, USA
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Abstract
Evaluation of: Kavanaugh A, Ritchlin C, Rahman P et al.; on behalf of the PSUMMIT-1 and -2 Study Groups. Ustekinumab, an anti-IL-12/23 p40 monoclonal antibody, inhibits radiographic progression in patients with active psoriatic arthritis: results of an integrated analysis of radiographic data from the Phase 3, multicentre, randomised, double-blind, placebo-controlled PSUMMIT-1 and PSUMMIT-2 trials. Ann. Rheum. Dis. 73(6), 1000-1006 (2014). The IL-23/IL-17 axis plays a major role in the immunopathogenesis of psoriatic arthritis (PsA), inducing the production of proinflammatory cytokines (e.g., IL-1, TNF-α, IL-6 and IL8), osteoclastogenesis and cartilage degradation. This pathway represents a novel target in the treatment of PsA. Ustekinumab is a human monoclonal antibody that prevents the human IL-12/IL-23 p40 subunit from binding to the IL12Rβ1 receptor chain. The current paper sustains that clinical efficacy of ustekinumab is associated with inhibition of radiological progression in active PsA.
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Affiliation(s)
- Antonio Spadaro
- Dipartimento di Medicina Interna e Specialità Mediche, UOC di Reumatologia, "Sapienza", Università di Roma, Italy
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Abstract
Psoriasis is a chronic, immune-mediated inflammatory skin disease, affecting approximately 2-4% of the population in western countries. Patients with a more severe form of the disease are typically considered for systemic therapy, including biologics. In spite of the overall superiority of biologic agents, the treatment response may differ substantially among individual patients. As with other medical conditions, a range of factors contribute to response heterogeneity observed in psoriasis. Proper identification of these factors can significantly improve the therapeutic decisions. This review focuses on potential genetic and nongenetic factors that may affect the treatment response and outcomes in patients with psoriasis.
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