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Distler O, Ofner C, Huscher D, Jordan S, Ulrich S, Stähler G, Grünig E, Held M, Ghofrani HA, Claussen M, Lange TJ, Klose H, Rosenkranz S, Vonk-Noordegraaf A, Vizza CD, Delcroix M, Opitz C, Pausch C, Scelsi L, Neurohr C, Olsson KM, Coghlan JG, Halank M, Skowasch D, Behr J, Milger K, Remppis BA, Skride A, Jureviciene E, Gumbiene L, Miliauskas S, Löffler-Ragg J, Wilkens H, Pittrow D, Hoeper MM, Ewert R. Treatment strategies and survival of patients with connective tissue disease and pulmonary arterial hypertension: a COMPERA analysis. Rheumatology (Oxford) 2024; 63:1139-1146. [PMID: 37462520 PMCID: PMC10986797 DOI: 10.1093/rheumatology/kead360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/27/2023] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES Pulmonary arterial hypertension (PAH) occurs in various connective tissue diseases (CTDs). We sought to assess contemporary treatment patterns and survival of patients with various forms of CTD-PAH. METHODS We analysed data from COMPERA, a European pulmonary hypertension registry, to describe treatment strategies and survival in patients with newly diagnosed PAH associated with SSc, SLE, MCTD, UCTD and other types of CTD. All-cause mortality was analysed according to the underlying CTD. For patients with SSc-PAH, we also assessed survival according to initial therapy with endothelin receptor antagonists (ERAs), phosphodiesterase type 5 inhibitors (PDE5is) or a combination of these two drug classes. RESULTS This analysis included 607 patients with CTD-PAH. Survival estimates at 1, 3 and 5 years for SSc-PAH (n = 390) were 85%, 59% and 42%; for SLE-PAH (n = 34) they were 97%, 77% and 61%; for MCTD-PAH (n = 33) they were 97%, 70% and 59%; for UCTD-PAH (n = 60) they were 88%, 67% and 52%; and for other CTD-PAH (n = 90) they were 92%, 69% and 55%, respectively. After multivariable adjustment, the survival of patients with SSc-PAH was significantly worse compared with the other conditions (P = 0.001). In these patients, the survival estimates were significantly better with initial ERA-PDE5i combination therapy than with initial ERA or PDE5i monotherapy (P = 0.016 and P = 0.012, respectively). CONCLUSIONS Mortality remains high in patients with CTD-PAH, especially for patients with SSc-PAH. However, for patients with SSc-PAH, our results suggest that long-term survival may be improved with initial ERA-PDE5i combination therapy compared with initial monotherapy.
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Affiliation(s)
- Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Ofner
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerd Stähler
- Klinik für Pneumologie, Klinik Fachklinik Löwenstein, Löwenstein, Germany
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Matthias Held
- Department of Internal Medicine, Respiratory Medicine and Ventilatory Support, Medical Mission Hospital, Central Clinic Würzburg, Würzburg, Germany
| | - H Ardeschir Ghofrani
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Martin Claussen
- Fachabteilung Pneumologie, LungenClinic Großhansdorf, Großhansdorf, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Hans Klose
- Department of Respiratory Medicine, Eppendorf University Hospital, Hamburg, Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Center for Molecular Medicine and the Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - C Dario Vizza
- Dipartimento di Scienze Cliniche Internistiche, Anestiologiche e Cardiolohiche, Sapienza, University of Rome, Rome, Italy
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven–University of Leuven, Leuven, Belgium
| | - Christian Opitz
- Department of Cardiology, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Christine Pausch
- GWT-TUD GmbH, Innovation Center Real World Evidence, Dresden, Germany
| | - Laura Scelsi
- Fondazione IRCSS S. Matteo Pavia, Division of Cardiology Stolfo Davide, Azienda Sanitaria Universitaria Giuliano Isontina, Pavia, Italy
| | - Claus Neurohr
- Department of Pulmonology and Respiratory Medicine, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - Karen M Olsson
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Center of Lung Research, Gießen, Germany
| | | | - Michael Halank
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany
| | - Dirk Skowasch
- Innere Medizin–Kardiologie/Pneumologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Andris Skride
- VSIA Pauls Stradins Clinical University Hospital, Riga, Lativa
| | - Elena Jureviciene
- Faculty of Medicine of Vilnius University, Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Lina Gumbiene
- Faculty of Medicine of Vilnius University, Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Skaidrius Miliauskas
- Department of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinrike Wilkens
- Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - David Pittrow
- GWT-TUD GmbH, Innovation Center Real World Evidence, Dresden, Germany
- Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Center of Lung Research, Gießen, Germany
| | - Ralf Ewert
- Clinic of Internal Medicine, Department of Respiratory Medicine, Universitätsmedizin Greifswald, Germany
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Midol C, Wiebe E, Siegert E, Huscher D, Béhal H, Launay D, Hachulla E, Matteson EL, Buttgereit F, Sobanski V. Osteoporosis is associated with anti-topoisomerase I positivity and glucocorticoids use in patients with systemic sclerosis. Rheumatology (Oxford) 2024:keae142. [PMID: 38452356 DOI: 10.1093/rheumatology/keae142] [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: 11/18/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES Patients with systemic sclerosis (SSc) are at increased risk for osteoporosis (OP) and associated fragility fractures. This study aimed to identify underlying risk factors for these conditions in patients with SSc. METHODS This cross-sectional study was based on a large prospective cohort of patients with SSc using retrospectively collected bone health data. OP was defined as the presence of a T-score below -2.5 at the femoral neck or lumbar spine, a previous major osteoporotic fracture, or the prescription of anti-osteoporotic therapy. RESULTS A total of 485 patients fulfilling the ACR/EULAR 2013 diagnostic criteria for SSc, followed in the Lille University Hospital, were included in the study. The prevalence of OP was 23%; fragility fractures occurred in 18% of patients. OP was associated with higher age, diffuse cutaneous subset, interstitial lung disease (ILD), anti-topoisomerase I positivity, treatment with glucocorticoids (GC) and DMARDs in univariable analysis. Multivariable analysis indicated that higher age (OR 1.06 [95%CI 1.04-1.08]), anti-topoisomerase I antibody positivity (OR 2.22 [1.18-4.16]) and treatment with GC (OR 4.48 [2.42-8.26]) were significantly and independently associated with OP. CONCLUSION Our study shows that OP risk in patients with SSc is determined by age, disease-related factors such as diffuse cutaneous subset, ILD and anti-topoisomerase I antibody positivity, but also treatment with GC independently of other factors.
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Affiliation(s)
- Charles Midol
- Service de Médecine Interne, U1286 - INFINITE-Institute for Translational Research in Inflammation CHU Lille, Univ. Lille, Inserm, Lille, France
| | - Edgar Wiebe
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hélène Béhal
- Biostatistics Department, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, CHU Lille, Univ. Lille, Lille, France
| | - David Launay
- Service de Médecine Interne, U1286 - INFINITE-Institute for Translational Research in Inflammation CHU Lille, Univ. Lille, Inserm, Lille, France
| | - Eric Hachulla
- Service de Médecine Interne, U1286 - INFINITE-Institute for Translational Research in Inflammation CHU Lille, Univ. Lille, Inserm, Lille, France
| | - Eric L Matteson
- Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Vincent Sobanski
- Service de Médecine Interne, U1286 - INFINITE-Institute for Translational Research in Inflammation CHU Lille, Univ. Lille, Inserm, Lille, France
- Institut Universitaire de France (IUF), Paris, France
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Lücht J, Seiler R, Herre AL, Brankova L, Fritsche-Guenther R, Kirwan J, Huscher D, Münzfeld H, Berger F, Photiadis J, Tong G, Schmitt KRL. Promising results of a clinical feasibility study: CIRBP as a potential biomarker in pediatric cardiac surgery. Front Cardiovasc Med 2024; 11:1247472. [PMID: 38361581 PMCID: PMC10867162 DOI: 10.3389/fcvm.2024.1247472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Objective Cold-inducible RNA binding Protein (CIRBP) has been shown to be a potent inflammatory mediator and could serve as a novel biomarker for inflammation. Systemic inflammatory response syndrome (SIRS) and capillary leak syndrome (CLS) are frequent complications after pediatric cardiac surgery increasing morbidity, therefore early diagnosis and therapy is crucial. As CIRBP serum levels have not been analyzed in a pediatric population, we conducted a clinical feasibility establishing a customized magnetic bead panel analyzing CIRBP in pediatric patients undergoing cardiac surgery. Methods A prospective hypothesis generating observational clinical study was conducted at the German Heart Center Berlin during a period of 9 months starting in May 2020 (DRKS00020885, https://drks.de/search/de/trial/DRKS00020885). Serum samples were obtained before the cardiac operation, upon arrival at the pediatric intensive care unit, 6 and 24 h after the operation in patients up to 18 years of age with congenital heart disease (CHD). Customized multiplex magnetic bead-based immunoassay panels were developed to analyze CIRBP, Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10), Monocyte chemotactic protein 1 (MCP-1), Syndecan-1 (SDC-1), Thrombomodulin (TM), Vascular endothelial growth factor (VEGF-A), Angiopoietin-2 (Ang-2), and Fibroblast growth factor 23 (FGF-23) in 25 µl serum using the Luminex MagPix® system. Results 19 patients representing a broad range of CHD (10 male patients, median age 2 years, 9 female patients, median age 3 years) were included in the feasibility study. CIRBP was detectable in the whole patient cohort. Relative to individual baseline values, CIRBP concentrations increased 6 h after operation and returned to baseline levels over time. IL-6, IL-8, IL-10, and MCP-1 concentrations were significantly increased after operation and except for MCP-1 concentrations stayed upregulated over time. SDC-1, TM, Ang-2, as well as FGF-23 concentrations were also significantly increased, whereas VEGF-A concentration was significantly decreased after surgery. Discussion Using customized magnetic bead panels, we were able to detect CIRBP in a minimal serum volume (25 µl) in all enrolled patients. To our knowledge this is the first clinical study to assess CIRBP serum concentrations in a pediatric population.
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Affiliation(s)
- Jana Lücht
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Raphael Seiler
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Alexa Leona Herre
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Liliya Brankova
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Raphaela Fritsche-Guenther
- Metabolomics Platform, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Kirwan
- Metabolomics Platform, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna Münzfeld
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Giang Tong
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Katharina R. L. Schmitt
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
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Lech S, Gellert P, Spang RP, Voigt-Antons JN, Huscher D, O'Sullivan JL, Schuster J. Effectiveness of a tablet-based intervention for people living with dementia in primary care-A cluster randomized controlled trial. Int J Geriatr Psychiatry 2023; 38:e6035. [PMID: 38038608 DOI: 10.1002/gps.6035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Primary care physicians (PCP) play a key role in the care of people living with dementia. However, the implementation and practicability of the German S3 Dementia Guideline in primary care remain unclear. The main objective of the present study was to evaluate an intervention for improving guideline-based dementia care in primary care. DESIGN A two-arm, 9-month follow-up cluster-randomized controlled trial with two parallel groups. SETTING 28 primary care practices in Berlin and the surrounding area in Germany. PARTICIPANTS A total of N = 28 PCP, N = 91 people living with dementia, and N = 88 informal caregivers participated in the trial. INTERVENTION A tablet-based intervention to improve adherence to the German S3 Dementia Guideline in primary care was compared to a control group (care as usual plus a handbook on dementia). MeasurementsAdherence to dementia guideline (primary outcome) was measured on PCP' (23 items) and informal caregivers' level (19 items) with a self-developed checklist. Secondary outcomes (quality of life, neuropsychiatric symptoms, activities of daily living, general health status, depression, and caregiver burden) were measured with standardized assessments. Also, post-hoc per-protocol analyses were conducted. RESULTS No differences in guideline adherence between the intervention and the control group were observed. Further, no significant impact of the intervention on secondary outcomes was detected. CONCLUSION The DemTab Study did not improve self-reported guideline adherence in PCP. However, important implementation barriers such as lack of interoperability and low applicability of existing German S3 Dementia Guideline in the primary care setting were identified and are being discussed. TRIAL REGISTRATION The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019, https://doi.org/10.1186/ISRCTN15854413.
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Affiliation(s)
- Sonia Lech
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Paul Gellert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Robert P Spang
- Technische Universität Berlin, Quality and Usability Lab, Berlin, Germany
| | - Jan-Niklas Voigt-Antons
- Immersive Reality Lab, University of Applied Sciences Hamm-Lippstadt, Lippstadt, Germany
- Deutsches Forschungszentrum für Künstliche Intelligenz GmbH (DFKI), Speech and Language Technology, Berlin, Germany
| | - Dörte Huscher
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Berlin, Germany
| | - Julie L O'Sullivan
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Johanna Schuster
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
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Douros A, Schneider A, Ebert N, Fietz AK, Huscher D, Kuhlmann MK, Martus P, Mielke N, van der Giet M, Wenning V, Schaeffner E. Kidney Measures and Risk of Incident Heart Failure Among Older Adults: Population-Based Prospective Cohort Study. JACC Heart Fail 2023; 11:1642-1644. [PMID: 37389505 DOI: 10.1016/j.jchf.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 07/01/2023]
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Dimou M, Speletas M, Milito C, Pyzik A, Huscher D, Kamieniak M, Pittrow D, Borte M. Insights into Facilitated Subcutaneous Immunoglobulin Use in Patients with Secondary Immunodeficiency Diseases: A FIGARO Subgroup Analysis. Cancers (Basel) 2023; 15:4524. [PMID: 37760493 PMCID: PMC10526788 DOI: 10.3390/cancers15184524] [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: 07/12/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
The Facilitated Immunoglobulin Administration Registry And Outcomes (FIGARO) Study was a European, multicenter, prospective, observational study conducted across Europe designed to provide insights on the clinical use and tolerability of facilitated subcutaneous immunoglobulin (fSCIG). Data herein are reported for the cohort of patients with secondary immunodeficiency (SID), with a subgroup analysis by age. The SID cohort included 31 patients: 1 pediatric, 15 adult, and 15 older adult patients. Over the 36-month observation period, the median monthly dose of fSCIG (30 g) and median monthly infusion volume per patient (300 mL) remained constant in both adult-age cohorts. Serum trough levels tended to increase over time. Most patients required only one infusion site and could receive the full dose every 3-4 weeks. There was a trend toward self-administration at home. In the adult group, infusion site inflammation and headache were reported at the inclusion visit (n = 1 each), with no adverse drug reactions reported at any of the follow-up visits. No acute severe bacterial infections were reported during the study follow-up. These results demonstrate the feasibility and tolerability of fSCIG use in patients with SID and the flexibility of administration settings including self-administration at home in patients aged ≥65 years.
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Affiliation(s)
- Maria Dimou
- First Department of Propaedeutic Internal Medicine, National & Kapodistrian University of Athens Medical School, General Hospital “LAIKO”, 11527 Athens, Greece
| | - Matthaios Speletas
- School of Health Sciences, Department of Immunology and Histocompatibility, Faculty of Medicine, University of Thessaly, GR-41500 Larissa, Greece;
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Aleksandra Pyzik
- Department of Clinical Immunology, Center of Oncology St. Jana, 20-090 Lublin, Poland;
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Marta Kamieniak
- Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA;
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University of Dresden, 01307 Dresden, Germany;
- Innovation Center Real World Evidence, GWT-TUD GmbH, 01067 Dresden, Germany
| | - Michael Borte
- Hospital for Children and Adolescents, St. Georg Hospital, Academic Teaching Hospital of the University of Leipzig, IDCL (ImmunoDeficiency Center Leipzig), 04129 Leipzig, Germany;
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Maleitzke T, Wiebe E, Huscher D, Spies CM, Tu J, Gaber T, Zheng Y, Buttgereit F, Seibel MJ, Zhou H. Transgenic disruption of endogenous glucocorticoid signaling in osteoblasts does not alter long-term K/BxN serum transfer-induced arthritis. Arthritis Res Ther 2023; 25:140. [PMID: 37542341 PMCID: PMC10401869 DOI: 10.1186/s13075-023-03112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Disruption of glucocorticoid (GC) signaling in osteoblasts results in a marked attenuation of acute antibody-induced arthritis. The role of endogenous GCs in chronic inflammatory arthritis is however not fully understood. Here, we investigated the impact of endogenous GC signaling in osteoblasts on inflammation and bone integrity under chronic inflammatory arthritis by inactivating osteoblastic GC signaling in a long-term K/BxN serum transfer-induced induced arthritis (STIA) model. METHODS Intracellular GC signaling in osteoblasts was disrupted by transgenic (tg) overexpression of 11beta-hydroxysteroid dehydrogenase type 2 (11ß-HSD2). Inflammatory arthritis was induced in 5-week-old male tg mice and their wild type (WT) littermates by intraperitoneal (i.p.) injection of K/BxN serum while controls (CTRLs) received phosphate-buffered saline (PBS). In a first cohort, K/BxN STIA was allowed to abate until the endpoint of 42 days (STIA). To mimic rheumatic flares, a second cohort was additionally injected on days 14 and 28 with K/BxN serum (STIA boost). Arthritis severity was assessed daily by clinical scoring and ankle size measurements. Ankle joints were assessed histopathologically. Systemic effects of inflammation on long bone metabolism were analyzed in proximal tibiae by micro-computed tomography (μCT) and histomorphometry. RESULTS Acute arthritis developed in both tg and WT mice (STIA and STIA boost) and peaked around day 8. While WT STIA and tg STIA mice showed a steady decline of inflammation until day 42, WT STIA boost and tg STIA boost mice exhibited an arthritic phenotype over a period of 42 days. Clinical arthritis severity did not differ significantly between WT and tg mice, neither in the STIA nor in the STIA boost cohorts. Correspondingly, histological indices of inflammation, cartilage damage, and bone erosion showed no significant difference between WT and tg mice on day 42. Histomorphometry revealed an increased bone turnover in tg CTRL and tg STIA boost compared to WT CTRL and WT STIA boost animals, respectively. CONCLUSIONS In contrast to the previously reported modulating effects of endogenous GC signaling in osteoblasts during acute K/BxN STIA, this effect seems to perish during the chronic inflammatory and resolution phase. These findings indicate that endogenous GC signaling in osteoblasts may mainly be relevant during acute and subacute inflammatory processes.
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Affiliation(s)
- Tazio Maleitzke
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Edgar Wiebe
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia.
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Cornelia M Spies
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Jinwen Tu
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Timo Gaber
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Yu Zheng
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology and Metabolism, Concord Repatriation Hospital, University of Sydney, Sydney, NSW, Australia
| | - Hong Zhou
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
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Mielke N, Schneider A, Barghouth MH, Ebert N, van der Giet M, Huscher D, Kuhlmann MK, Schaeffner E. Association of kidney function and albuminuria with frailty worsening and death in very old adults. Age Ageing 2023; 52:7165262. [PMID: 37192504 DOI: 10.1093/ageing/afad063] [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: 11/10/2022] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies analysing the association of albuminuria and prevalent frailty in community-dwelling very old adults are scarce and lack information on incident frailty. We investigated the association of kidney function decline and increase of albuminuria with frailty worsening or death in very old adults. DESIGN Longitudinal analyses with biennial visits of the Berlin Initiative (cohort) Study and a frailty follow-up of 2.1 years. SETTING/SUBJECTS 1,076 participants with a mean age of 84.3 (5.6) years of whom 54% were female. METHODS Partial proportional odds models were used to assess the association of estimated glomerular filtration rate (eGFR) decline and/or albuminuria (albumin creatinine ratio, ACR) with frailty worsening or death. RESULTS At frailty baseline, 1,076 participants with an eGFR of 50 (13) ml/min/1.73 m2, 48% being prefrail and 31% frail were included. After median 2.1 years, 960 (90%) participants had valid information on frailty transition: 187 (17.5%) worsened and 111 (10.3%) died. In the multivariable model, the odds of frailty worsening for participants with albuminuria in combination with eGFR <60 ml/min/1.73 m2 were elevated [OR (95% CI): 2.47 (1.41-4.31)] compared to participants without albuminuria and eGFR ≥60 ml/min/1.73 m2 as there was a rapid eGFR decline of ≥3 ml/min/1.73 m2 per year [1.55 (1.04-2.33)] and albuminuria trajectories six years prior [1.53 (1.11-2.10)] to frailty baseline. The odds of death for each exposure were even higher. CONCLUSIONS In older adults, advanced stages of CKD and albuminuria alone were associated with 2-fold odds of frailty worsening independent of death.
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Affiliation(s)
- Nina Mielke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Alice Schneider
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Muhammad Helmi Barghouth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Natalie Ebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Markus van der Giet
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Nephrology, Charitéplatz 1, 10117 Berlin, Germany
| | - Dörte Huscher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Elke Schaeffner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany
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9
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Borte M, Hanitsch LG, Mahlaoui N, Fasshauer M, Huscher D, Speletas M, Dimou M, Kamieniak M, Hermann C, Pittrow D, Milito C. Facilitated Subcutaneous Immunoglobulin Treatment in Patients with Immunodeficiencies: the FIGARO Study. J Clin Immunol 2023:10.1007/s10875-023-01470-2. [PMID: 37036560 PMCID: PMC10088636 DOI: 10.1007/s10875-023-01470-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE The FIGARO study aims to provide insights on real-world utilization and tolerability of facilitated subcutaneous immunoglobulin (fSCIG) for primary immunodeficiency disease (PID) or secondary immunodeficiency disease (SID). METHODS This prospective, multicenter, observational study, evaluated medical records, charts, and diaries of patients who had received at least 1 fSCIG infusion for PID or SID. Data were analyzed by cohort (PID, SID) and age groups (pediatric [< 18 years], adult [18-64 years], older adult [≥ 65 years]). Patients were followed up to 36 months. RESULTS The study enrolled 156 patients: 15 pediatric, 120 adult, 21 older-adult. Twelve-month follow-up data were available for 128 patients. fSCIG was mainly prescribed for PID among patients aged < 65 years and for SID among older adults. At inclusion, 75.6% received their fSCIG infusion at home, and 78.7% self-administered. Adults were more likely to receive their initial infusion at home and self-administer (81.7% and 86.6%, respectively) than pediatric patients (53.3% each) and older adults (57.1% and 52.4%, respectively). At 12 months, the proportion of patients infusing at home and self-administering increased to 85.8% and 88.2%. Regardless of age, most patients self-administered the full fSCIG dose at home every 3-4 weeks and required a single infusion site. The tolerability profile was consistent with previous pivotal trials. Acute severe bacterial infections occurred in 0%-9.1% of patients during follow-up visits (full cohort). CONCLUSIONS FIGARO confirms the feasibility, tolerability, and good infection control of fSCIG in PID and SID patients across the age spectrum in both the home-setting and medical facility. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03054181.
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Affiliation(s)
- Michael Borte
- IDCL (ImmunoDeficiency Center Leipzig), Hospital for Children and Adolescents, St. Georg Hospital, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Leif G Hanitsch
- Institute of Medical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nizar Mahlaoui
- Pediatric Immunology-Hematology and Rheumatology Unit and French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Maria Fasshauer
- IDCL (ImmunoDeficiency Center Leipzig), Hospital for Children and Adolescents, St. Georg Hospital, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthaios Speletas
- Faculty of Medicine, Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Dimou
- First Department of Propaedeutic Internal Medicine, General Hospital "LAIKO", National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Dresden, Germany.
- Innovation Center Real World Evidence, GWT-TUD GmbH, Dresden, Germany.
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Höppner J, Tabeling C, Casteleyn V, Kedor C, Windisch W, Burmester GR, Huscher D, Siegert E. Comprehensive autoantibody profiles in systemic sclerosis: Clinical cluster analysis. Front Immunol 2023; 13:1045523. [PMID: 36685532 PMCID: PMC9846214 DOI: 10.3389/fimmu.2022.1045523] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Background Systemic sclerosis (SSc) belongs to the group of connective tissue diseases and is associated with the occurrence of disease-specific autoantibodies. Although it is still controversial whether these antibodies contribute to pathogenesis, there are new insights into the development of these specific antibodies and their possible pathophysiological properties. Interestingly, they are associated with specific clinical manifestations, but for some rarer antibodies this association is not fully clarified. The aim of this study is a comprehensive analysis of the serum autoantibody status in patients with SSc followed by correlation analyses of autoantibodies with the clinical course of the disease. Methods Serum from SSc patients was analyzed using a line blot (EUROLINE, EUROIMMUN AG) for SSc-related autoantibodies. Autoantibodies to centromere, Topo-1, antimitochondrial antibodies (AMA) M2 subunit, angiotensin II type 1 receptors (AT1R) and endothelin-1 type-A-receptors (ETAR) were also determined by ELISA. We formed immunological clusters and used principal components analysis (PCA) to assign specific clinical characteristics to these clusters. Results A total of 372 SSc patients were included. 95.3% of the patients were antinuclear antibody positive and in 333 patients at least one SSc specific antibody could be detected. Four immunological clusters could be found by PCA. Centromere, Topo-1 and RP3 all formed own clusters, which are associated with distinct clinical phenotypes. We found that patients with an inverted phenotype, such as limited cutaneous SSc patients within the Topo-1 cluster show an increased risk for interstital lung disease compared to ACA positive patients. Anti-AT1R and anti-ETAR autoantibodies were measured in 176 SSc patients; no association with SSc disease manifestation was found. SSc patients with AMA-M2 antibodies showed an increased risk of cardiovascular events. Conclusion In our in large cluster analysis, which included an extended autoantibody profile, we were able to show that serologic status of SSc patients provides important clues to disease manifestation, co-morbidities and complications. Line blot was a reliable technique to detect autoantibodies in SSc and detected rarer autoantibodies in 42% of our patients.
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Affiliation(s)
- Jakob Höppner
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Pulmonology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Christoph Tabeling
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vincent Casteleyn
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kedor
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Windisch
- Department of Pulmonology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Gerd Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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11
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Zanatta E, Huscher D, Ortolan A, Avouac J, Airò P, Balbir-Gurman A, Siegert E, Matucci Cerinic M, Cozzi F, Riemekasten G, Hoffmann-Vold AM, Distler O, Gabrielli A, Heitmann S, Hunzelmann N, Montecucco C, Morovic-Vergles J, Ribi C, Doria A, Allanore Y. Phenotype of limited cutaneous systemic sclerosis patients with positive anti-topoisomerase I antibodies: data from the EUSTAR cohort. Rheumatology (Oxford) 2022; 61:4786-4796. [PMID: 35348643 DOI: 10.1093/rheumatology/keac188] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/09/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To characterize patients with positive anti-topoisomerase I (ATA) in lcSSc. METHODS SSc patients enrolled in the EUSTAR cohort with a disease duration of ≤3 years at database entry were considered. We assessed the risk of major organ involvement in the following groups: ATA-lcSSc vs ACA-lcSSc and vs ANA without specificity (ANA)-lcSSc, and ATA-lcSSc vs ATA-dcSSc. Cox regression models with time-dependent covariates were performed with the following outcomes: new-onset interstitial lung disease (ILD), ILD progression [forced vital capacity (FVC) decline ≥10% and ≥5% vs values at ILD diagnosis), primary myocardial involvement (PMI), pulmonary hypertension (PH), any organ involvement and all-cause mortality. RESULTS We included 1252 patients [194 ATA-lcSSc (15.5%)], with 7.7 years (s.d. 3.5) of follow-up. ILD risk was higher in ATA-lcSSc vs ACA- and ANA-lcSSc and similar to ATA-dcSSc, although with less frequent restrictive lung disease. The risk of FVC decline ≥10% (35% of ATA-lcSSc) was lower in ATA-lcSSc than in ATA-dcSSc, whereas FVC decline ≥5% occurs similarly between ATA-lcSSc (58% of patients) and other SSc subsets, including ATA-dcSSc. The risk of PMI was similar in ATA-lcSSc and ANA-lcSSc but lower than in ACA-lcSSc; no difference in PH and mortality risk was observed among lcSSc subsets. The risk of any organ involvement, PMI and PH was lower and the mortality tended to be lower in ATA-lcSSc vs ATA-dcSSc. CONCLUSION ATA-lcSSc patients have a high risk of ILD, albeit with a lower risk of progression compared with ATA-dcSSc, supporting careful screening for ILD in this subgroup.
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Affiliation(s)
- Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Jérôme Avouac
- Service de Rhumatologie, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Institute Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence
| | - Franco Cozzi
- Internal Medicine Unit, Ospedale Classificato Villa Salus, Venice, Italy
| | - Gabriela Riemekasten
- Department of Rheumatology, Universitatsklinikum Schleswig Holstein-Campus Lübeck, Lübeck, Germany
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Stefan Heitmann
- Department of Rheumatology, Marienhospital Stuttgart, Stuttgart
| | - Nicolas Hunzelmann
- Department of Dermatology, University of Cologne, Köln, Nordrhein-Westfalen, Germany
| | | | - Jadranka Morovic-Vergles
- Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Camillo Ribi
- Service d'immunologie et Allergie, Département de Médecine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
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12
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Lescoat A, Huscher D, Schoof N, Airò P, de Vries-Bouwstra J, Riemekasten G, Hachulla E, Doria A, Rosato E, Hunzelmann N, Montecucco C, Gabrielli A, Hoffmann-Vold AM, Distler O, Ben Shimol J, Cutolo M, Allanore Y. Systemic sclerosis-associated interstitial lung disease in the EUSTAR database: analysis by region. Rheumatology (Oxford) 2022:6759366. [PMID: 36222557 DOI: 10.1093/rheumatology/keac576] [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: 05/11/2022] [Revised: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The prevalence and characteristics of systemic sclerosis-associated interstitial lung disease (SSc-ILD) vary between geographical regions worldwide. The objectives of this study were to explore the differences in terms of prevalence, phenotype, treatment, and prognosis in patients with SSc-ILD from predetermined geographical regions in the EUSTAR database. METHODS Patients were clustered into seven geographical regions. Clinical characteristics and survival of patients with SSc-ILD were compared among these pre-determined regions. RESULTS For baseline analyses, 9260 SSc patients were included, with 6732 for survival analyses. The prevalence of SSc-ILD in the overall population was 50.2%, ranging from 44.0% in "Western Europe & Nordic countries" to 67.5% in "Eastern European, Russia & Baltic countries". In all regions, anti-topoisomerase antibodies were associated with SSc-ILD. Management also significantly differed; mycophenolate mofetil was prescribed at baseline in 31.6% of patients with SSc-ILD in "America (North & South)" and 31.7% in "Middle East" but only 4.3% in "Asia & Oceania" (P < 0.0001). Patients from "America (North & South)" and "Middle East" had the highest survival rate at the end of follow-up (85.8% and 85.2%, respectively). CONCLUSION Our study highlights key differences among regions in terms of clinical presentation and prognosis of SSc-ILD. This work also demonstrates that the management of SSc-ILD is highly variable among the different regions considered, suggesting that efforts are still needed for the standardisation of medical practice in the treatment of this disease.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes 1, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, France, Rennes
| | - Dörte Huscher
- Charité Universitätsmedizin, Institute of Biostatistics and Clinical Epidemiology, Berlin, Germany
| | - Nils Schoof
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Gabriela Riemekasten
- Department of Rheumatology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Eric Hachulla
- Univ. Lille, INFINITE-Institute for Translational Research in Inflammation, Lille, France.,Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, F-59000, France.,Inserm, Lille, U1286, F-59000, France
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Nicolas Hunzelmann
- Department of Dermatology, University of Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Carlomaurizio Montecucco
- Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Armando Gabrielli
- Dipartimento Di Scienze Cliniche E Molecolari, Clinica Medica, Università Politecnica Delle Marche, Ancona, Italy
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Jennifer Ben Shimol
- Department of Medicine, E. Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy-IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
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13
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Altendorf MB, Möckel M, Schenk L, Fischer-Rosinsky A, Frick J, Helbig L, Horenkamp-Sonntag D, Huscher D, Lichtenberg L, Reinhold T, Schindel D, Stier B, Sydow H, Wu YN, Zimmermann G, Slagman A. The Abdominal Pain Unit (APU). Study protocol of a standardized and structured care pathway for patients with atraumatic abdominal pain in the emergency department: A stepped wedged cluster randomized controlled trial. PLoS One 2022; 17:e0273115. [PMID: 36001620 PMCID: PMC9401147 DOI: 10.1371/journal.pone.0273115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
This study aims to improve emergency department (ED) care for patients suffering from atraumatic abdominal pain. An application-supported pathway for the ED will be implemented, which supports quick, evidence-based, and standardized diagnosis and treatment steps for patients with atraumatic abdominal pain at the ED. A mixed-methods multicentre cluster randomized controlled stepped wedge trial design will be applied. A total of 10 hospitals with EDs (expected n = 2.000 atraumatic abdominal pain patients) will consecutively (every 4 months) be randomized to apply the intervention. Inclusion criteria for patients are a minimum age of 18 years, suffering from atraumatic abdominal pain and being insured with a German statutory health insurance. Primary outcomes: acute pain score at time of discharge from ED, duration of treatment at the ED, patient-reported satisfaction. Secondary endpoints include patient safety and quality of care parameters, process evaluation parameters, and costs and cost-effectiveness parameters. Quantitative data will be gathered from patient-surveys, clinical records, and routine data from hospital information systems as well as from a participating German statutory health insurance. Descriptive and analytic statistical analysis will be performed to provide summaries and associations for primary patient-reported outcomes, process measures, quality measures, and costs. Qualitative data collection consists of participatory patient observations and semi-structured expert interviews, which will be inductively analysed. Findings will be disseminated in publications in peer-reviewed journals, on conferences, as well as via a project website. To ensure data protection, appropriate technical and organisational measures will be taken.
Trial registration: DRKS00021052.
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Affiliation(s)
- Maria B. Altendorf
- Charité–Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
- * E-mail:
| | - Martin Möckel
- Emergency and Acute Medicine (CVK, CCM), Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Liane Schenk
- Charité–Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Antje Fischer-Rosinsky
- Health Services Research in Emergency Medicine; Emergency and Acute Medicine (CVK, CCM), Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Frick
- Charité–Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Lukas Helbig
- Emergency and Acute Medicine (CVK, CCM), Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Dörte Huscher
- Charité–Universitätsmedizin Berlin, Institute of Medical Biometry and Clinical Epidemiology, and Berlin Institute of Health, Berlin, Germany
| | | | - Thomas Reinhold
- Charité–Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Daniel Schindel
- Charité–Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Britta Stier
- Emergency and Acute Medicine (CVK, CCM), Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Hanna Sydow
- Charité–Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Yves-Noel Wu
- Health Services Research in Emergency Medicine; Emergency and Acute Medicine (CVK, CCM), Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Grit Zimmermann
- TMF—Technology, Methods, and Infrastructure for Networked Medical Research, Berlin, Germany
| | - Anna Slagman
- Charité–Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
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14
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Wiebe E, Huscher D, Schaumburg D, Palmowski A, Hermann S, Buttgereit T, Biesen R, Burmester GR, Palmowski Y, Boers M, Stone JH, Dejaco C, Buttgereit F. Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease. Ann Rheum Dis 2022; 81:1313-1322. [PMID: 35680387 PMCID: PMC9380479 DOI: 10.1136/annrheumdis-2022-222339] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 02/11/2022] [Accepted: 05/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Inflammatory rheumatic and musculoskeletal diseases (iRMDs) are associated with increased systemic bone loss that is mediated by chronic inflammation, treatment with glucocorticoids (GCs) and other factors. Our objective was to analyse the impact of variables that influence osteoporosis (OP) in patients with iRMD treated with GC. METHODS Rh-GIOP (acronyme) is a prospective observational cohort study investigating bone health in consecutive patients with iRMD and current or prior GC treatment. We present an analysis of the patients' baseline data here. Bone mineral density (BMD) measured by dual X-ray absorptiometry was the primary outcome. Multivariable linear regression models were performed to identify variables associated with BMD. RESULTS Data from 1066 patients with iRMD were analysed. GC doses of <5 mg prednisone equivalent per day, cumulative dose and duration of GC therapy were not associated with negative effects on BMD. Dosages of ≥5 mg/day lost their negative association with BMD after adjustment for confounders. When subanalysing patients with exactly 5 mg/day, no negative effect was seen. For patients with rheumatoid arthritis (RA), GC doses of >7.5 mg/day showed a negative association with BMD overall, but this effect seemed to be specific only to patients with moderate or high disease activity (Disease Activity Score 28-C reactive protein >3.2). CONCLUSIONS GCs of ≤5 mg/day did not seem to be associated with a reduction of BMD in patients with iRMD and current or prior exposure to GC. This is most likely due to the dampening of inflammation by GC, which exerts a mitigating effect on the risk of OP. In RA, current GC doses of >7.5 mg/day were negatively associated with BMD, but only in patients with moderate to high disease activity. TRIAL REGISTRATION NUMBER NCT02719314.
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Affiliation(s)
- Edgar Wiebe
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Désireé Schaumburg
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Buttgereit
- Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
- Institute of Allergology, Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Yannick Palmowski
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maarten Boers
- Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - John H Stone
- Vasculitis and Glomerulonephritis Center, Rheumatology, Immunology and Allergy Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria
- Rheumatology, Brunico Hospital (SABES-ASDAA), Brunico, Italy
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Schaeffner ES, Ebert N, Kuhlmann MK, Martus P, Mielke N, Schneider A, van der Giet M, Huscher D. Age and the Course of GFR in Persons Aged 70 and Above. Clin J Am Soc Nephrol 2022; 17:1119-1128. [PMID: 35850785 PMCID: PMC9435992 DOI: 10.2215/cjn.16631221] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 12/23/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES In older adults, data on the age-related course of GFR are scarce, which might lead to misjudgment of the clinical relevance of reduced GFR in old age. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To describe the course of eGFR in older adults and derive reference values in population-based individuals, we used the longitudinal design of the Berlin Initiative Study (BIS) with a repeated estimation of GFR over a median of 6.1 years of follow-up. In 2069 community-dwelling older individuals (mean inclusion age 80 years, range 70-99), GFR was estimated biennially with the BIS-2 equation, including standardized creatinine and cystatin C levels, sex, and age. We described the crude and adjusted course using a mixed-effects model and analyzed the influence of death on the GFR course applying joint models. GFR slopes were compared using GFR equations on the basis of creatinine and/or cystatin C. RESULTS We observed a decreasing, thus nonlinear, eGFR decline with increasing age in a population of old adults. The estimated 1-year slope for ages 75 and 90 diminished for men from -1.67 to -0.99 and for women from -1.52 to -0.97. The modeled mean eGFR for men aged ≥79 and women ≥78 was below 60 ml/min per 1.73 m2. Multivariable adjustment attenuated slopes only minimally. Taking death into account by applying joint models did not alter the nonlinear eGFR decline. Using eGFR equations on the basis of creatinine only showed linear slope patterns in contrast to nonlinear patterns for equations including cystatin C. CONCLUSIONS The eGFR decline depended on sex and age and changed only marginally after multivariable adjustment but decelerated with increasing age. Equations including cystatin C demonstrated a nonlinear slope challenging the previously assumed linearity of the decline of eGFR in old age.
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Affiliation(s)
- Elke S. Schaeffner
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K. Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biostatistics, Friedrich Karls-University, Tübingen, Germany
| | - Nina Mielke
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, and Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Division of Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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16
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Douros A, Schneider A, Ebert N, Huscher D, Kuhlmann MK, Martus P, Mielke N, Van der Giet M, Wenning V, Schaeffner E. MO195: Kidney Function and the Risk of Heart Failure Among Older Adults: A Prospective Population-Based Cohort Study. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac066.097] [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 AND AIMS
Decreased kidney function is an established risk factor of cardiovascular morbidity including heart failure (HF) as well as cardiovascular and all-cause mortality among adults. However, the role of decreased kidney function with regard to these outcomes among old and very old adults remains poorly understood. This is an important knowledge gap given the common decline of kidney function in advanced age, which can affect both healthy individuals and patients with significant morbidity. To this end, we conducted a population-based study to assess whether decreased kidney function is associated with an increased risk of HF, cardiovascular and all-cause mortality in a prospective cohort of community-dwelling older adults.
METHOD
We included participants of the Berlin Initiative Study (BIS), age ≥70 years, with estimated glomerular filtration rate (eGFRBIS2) at baseline (between 2009 and 2011) and information on prior diagnosis of HF. Participants were followed from baseline until the occurrence of one of the study outcomes (see below) or December 2020, the latest date of data availability. Potential confounders included demographic characteristics, anthropometrics (body mass index), lifestyle factors (alcohol consumption, smoking, physical exercise), proxies of socioeconomic status (education, income), medications (major classes of antihypertensive drugs, oral anticoagulants, antiplatelet agents), and comorbidities measured at baseline using face-to-face interviews and administrative healthcare data. The three study outcomes were hospitalization for HF (HHF), cardiovascular death and all-cause mortality. HHF was defined based on inpatient diagnostic codes, and the mortality outcomes were defined based on a combination of administrative healthcare data, death certificates and hospital discharge notes. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of the three outcomes associated with decreased kidney function (eGFRBIS2 < 60 mL/min/1.73 m2) compared with retained kidney function (eGFRBIS2 ≥ 60 mL/min/1.73 m2). Analyses were repeated among BIS participants with prior HF.
RESULTS
Our study cohort included 1466 HF free older adults (mean age 79 years; 55% female). Compared with retained kidney function, decreased kidney function was associated with increased risks of HHF (crude incidence rates per 100/year: 2.7 versus 1.1; adjusted HR, 1.48; 95% CI, 1.06–2.07), cardiovascular death (crude incidence rates per 100/year: 2.7 versus 0.9; adjusted HR, 1.49; 95% CI, 1.06–2.09), and all-cause mortality (crude incidence rates per 100/year: 6.3 versus 2.8; adjusted HR, 1.27; 95% CI, 1.03–1.57). Kaplan-Meier curves for the three study outcomes are shown in Figure 1. Among the 590 older adults with prior HF (mean age 83 years; 54% female), the effect estimates were similar albeit less precise (HHF: HR, 1.32; 95% CI, 0.88–1.98/cardiovascular death: HR, 1.67; 95% CI, 1.06–2.63/all-cause mortality: HR, 1.22; 95% CI, 0.91–1.63).
CONCLUSION
Our population-based study showed that decreased kidney function is associated with increased risks of cardiovascular morbidity and cardiovascular and all-cause mortality among older adults, corroborating findings in younger populations.
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17
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Stammnitz C, Huscher D, Bauer UMM, Urban A, Nordmeyer J, Schubert S, Photiadis J, Berger F, Klaassen S. Nationwide Registry-Based Analysis of Infective Endocarditis Risk After Pulmonary Valve Replacement. J Am Heart Assoc 2022; 11:e022231. [PMID: 35179045 PMCID: PMC9075093 DOI: 10.1161/jaha.121.022231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Infective endocarditis (IE) after pulmonary valve replacements in congenital heart disease is a significant concern. This study aimed to identify specific long-term risk factors for IE after percutaneous pulmonary valve implantation or surgical pulmonary valve replacement. Methods and Results All patients with congenital heart disease from the National Register for Congenital Heart Defects with at least 1 pulmonary valve replacement before January 2018 were included. A total of 1170 patients (56.3% men, median age at study inclusion 12 [interquartile range {Q1-Q3} 5-20 years]) received 1598 pulmonary valve replacements. IE occurred in 4.8% of patients during a follow-up of total 9397 patient-years (median 10 [Q1-Q3, 6-10] years per patient). After homograft implantation 7 of 558 (1.3%) patients developed IE, after heterograft implantation 31 of 723 (4.3%) patients, and after Melody valve implantation 18 of 241 (7.5%) patients. Edwards Sapien and mechanical valves were used less frequently and remained without IE. The incidence of IE in heterografts excluding Contegra valves was 7 of 278 (2.5%), whereas the incidence of IE in Contegra valves was 24 of 445 (5.4%). The risk of IE was not increased compared with homografts if Contegra valves were excluded from the heterografts (hazard ratio [HR], 2.60; P=0.075). The risk of IE was increased for bovine jugular vein valves, Contegra valves (HR, 6.72; P<0.001), and Melody valves (HR, 5.49; P<0.001), but did not differ between Melody valves and Contegra valves (HR, 1.01; P=0.978). Conclusions Bovine jugular vein valves have the highest risk of IE, irrespective of the mode of deployment, either surgical or percutaneous.
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Affiliation(s)
- Clara Stammnitz
- Department of Pediatric Cardiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Competence Network for Congenital Heart Defects National Register for Congenital Heart Defects Berlin Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Ulrike M M Bauer
- Competence Network for Congenital Heart Defects National Register for Congenital Heart Defects Berlin Germany.,DZHK (German Centre for Cardiovascular Research) Berlin Germany
| | - Aleksandra Urban
- Competence Network for Congenital Heart Defects National Register for Congenital Heart Defects Berlin Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease - Pediatric Cardiology German Heart Center Berlin Berlin Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease - Pediatric Cardiology German Heart Center Berlin Berlin Germany.,Center for Congenital Heart Disease/Pediatric Cardiology Heart- and Diabetes Center NRW University Clinic of Ruhr-University Bochum Bad Oeynhausen Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery - Pediatric Heart Surgery German Heart Center Berlin Berlin Germany
| | - Felix Berger
- Department of Pediatric Cardiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Department of Congenital Heart Disease - Pediatric Cardiology German Heart Center Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany
| | - Sabine Klaassen
- Department of Pediatric Cardiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany.,Experimental and Clinical Research Center (ECRC), a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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18
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Kaemmerer AS, Gorenflo M, Huscher D, Pittrow D, Ewert P, Pausch C, Delcroix M, Ghofrani HA, Hoeper MM, Kozlik-Feldmann R, Skride A, Stähler G, Vizza CD, Jureviciene E, Jancauskaite D, Gumbiene L, Ewert R, Dähnert I, Held M, Halank M, Skowasch D, Klose H, Wilkens H, Milger K, Jux C, Koestenberger M, Scelsi L, Brunnemer E, Hofbeck M, Ulrich S, Vonk Noordegraaf A, Lange TJ, Bruch L, Konstantinides S, Claussen M, Löffler-Ragg J, Wirtz H, Apitz C, Neidenbach R, Freilinger S, Nemes A, Opitz C, Grünig E, Rosenkranz S. Medical treatment of pulmonary hypertension in adults with congenital heart disease: updated and extended results from the International COMPERA-CHD Registry. Cardiovasc Diagn Ther 2021; 11:1255-1268. [PMID: 35070795 PMCID: PMC8748472 DOI: 10.21037/cdt-21-351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is common in congenital heart disease (CHD). Because clinical-trial data on PAH associated with CHD (PAH-CHD) remain limited, registry data on the long-term course are essential. This analysis aimed to update information from the COMPERA-CHD registry on management strategies based on real-world data. METHODS The prospective international pulmonary hypertension registry COMPERA has since 2007 enrolled more than 10,000 patients. COMPERA-CHD is a sub-registry for patients with PAH-CHD. RESULTS A total of 769 patients with PAH-CHD from 62 specialized centers in 12 countries were included into COMPERA-CHD from January 2007 through September 2020. At the last follow-up in 09/2020, patients [mean age 45.3±16.8 years; 512 (66%) female] had either post-tricuspid shunts (n=359; 46.7%), pre-tricuspid shunts (n=249; 32.4%), complex CHD (n=132; 17.2%), congenital left heart or aortic valve or aortic disease (n=9; 1.3%), or miscellaneous CHD (n=20; 2.6%). The mean 6-minute walking distance was 369±121 m, and 28.2%, 56.0%, and 3.8% were in WHO functional class I/II, III or IV, respectively (12.0% unknown). Compared with the previously published COMPERA-CHD data, after 21 months of follow-up, the number of included PAH-CHD patients increased by 91 (13.4%). Within this group the number of Eisenmenger patients rose by 39 (16.3%), the number of "Non-Eisenmenger PAH" patients by 45 (26.9%). Currently, among the 674 patients from the PAH-CHD group with at least one follow-up, 450 (66.8%) received endothelin receptor antagonists (ERA), 416 (61.7%) PDE-5 inhibitors, 85 (12.6%) prostacyclin analogues, and 36 (5.3%) the sGC stimulator riociguat. While at first inclusion in the COMPERA-CHD registry, treatment was predominantly monotherapy (69.3%), this has shifted to favoring combination therapy in the current group (53%). For the first time, the nature, frequency, and treatment of significant comorbidities requiring supportive care and medication are described. CONCLUSIONS Analyzing "real life data" from the international COMPERA-CHD registry, we present a comprehensive overview about current management modalities and treatment concepts in PAH-CHD. There was an trend towards more aggressive treatment strategies and combination therapies. In the future, particular attention must be directed to the "Non-Eisenmenger PAH" group and to patients with complex CHD, including Fontan patients. TRIAL REGISTRATION www.clinicaltrials.gov, study identifier: Clinicaltrials.gov NCT01347216.
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Matthias Gorenflo
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Angelika-Lautenschläger-Klinik, Heidelberg, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin, Berlin, Germany
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University, Dresden, Germany
| | - Peter Ewert
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | | | - Marion Delcroix
- UZ Leuven, Campus Gasthuisberg, Department of Pneumology, Leuven, Belgium
| | - Hossein A. Ghofrani
- Universitätsklinikum Gießen und Marburg GmbH, Medizinische Klinik II/V, Gießen, Germany
| | - Marius M. Hoeper
- Medizinische Hochschule Hannover, Abt. Pneumologie, Hannover, Germany
| | - Rainer Kozlik-Feldmann
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Germany
| | - Andris Skride
- Riga Stradins University, Clinical University Hospital, Riga, Lativa
| | - Gerd Stähler
- Klinik Löwenstein, Medizinische Klinik I, Löwenstein, Germany
| | - Carmine Dario Vizza
- Pulmonary Hypertension Center, Department of Clinical Anestesiologic and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Elena Jureviciene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dovile Jancauskaite
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Gumbiene
- Faculty of Medicine of Vilnius University, Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ralf Ewert
- Universitätsmedizin Greifswald, Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, Greifswald, Germany
| | - Ingo Dähnert
- Herzzentrum Leipzig GmbH, Klinik für Kinderkardiologie, Leipzig, Germany
| | - Matthias Held
- Med. Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg, Germany
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Dirk Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Innere Medizin - Kardiologie/Pneumologie, Bonn
| | - Hans Klose
- Abteilung für Pneumologie, Zentrum für Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Heinrike Wilkens
- Universitätsklinikum des Saarlandes, Innere Medizin V, Homburg, Germany
| | - Katrin Milger
- LMU Klinikum, Medizinische Klinik und Poliklinik V, München, Germany
| | - Christian Jux
- Kinderherzzentrum und Zentrum für angeborene Herzfehler, Justus-Liebig-Universität, Zentrum für Kinderheilkunde, Abteilung Kinderkardiologie, Gießen, Germany
| | - Martin Koestenberger
- LKH - Univ. Klinikum Graz, Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Kardiologie, Graz, Austria
| | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo University of Pavia, Pavia, Italy
| | - Eva Brunnemer
- Medizinische Universitätsklinik (Krehl-Klinik), Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), Heidelberg, Germany
| | - Michael Hofbeck
- Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Kinderkardiologie, Pulmologie, Intensivmedizin, Tübingen, Germany
| | - Silvia Ulrich
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich, Switzerland
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, dept of Pulmonary Medicine, Amsterdam, Netherlands
| | - Tobias J. Lange
- Universitätsklinikum Regensburg, Medizinische Klinik und Poliklinik II, Regensburg, Germany
| | - Leonhard Bruch
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin, Berlin, Germany
| | | | - Martin Claussen
- LungenClinic Grosshansdorf, Fachabteilung Pneumologie, Großhansdorf, Germany
| | | | - Hubert Wirtz
- Universitätsklinikum Leipzig, Medizinische Klinik und Poliklinik I, Abteilung für Pneumologie, Leipzig, Germany
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Kardiologie, Ulm, Germany
| | - Rhoia Neidenbach
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Sebastian Freilinger
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Attila Nemes
- University of Szeged, Department of Medicine, Szeged, Hungary
| | - Christian Opitz
- DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Schwerpunkt Kardiologie, Berlin, Germany
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg gGmbH, Zentrum für Pulmonale Hypertonie, Heidelberg, and German Centre for Lung Research, Heidelberg, Germany
| | - Stephan Rosenkranz
- Universitätsklinik Köln – Herzzentrum, Klinik III für Innere Medizin, Köln, Germany
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19
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Bellando-Randone S, Del Galdo F, Lepri G, Minier T, Huscher D, Furst DE, Allanore Y, Distler O, Czirják L, Bruni C, Guiducci S, Avouac J, Cutolo M, Smith V, Matucci-Cerinic M. Progression of patients with Raynaud's phenomenon to systemic sclerosis: a five-year analysis of the European Scleroderma Trial and Research group multicentre, longitudinal registry study for Very Early Diagnosis of Systemic Sclerosis (VEDOSS). Lancet Rheumatol 2021; 3:e834-e843. [PMID: 38287630 DOI: 10.1016/s2665-9913(21)00244-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/30/2021] [Accepted: 07/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preliminary criteria for the very early diagnosis of systemic sclerosis (VEDOSS) have been previously proposed to identify signs and symptoms in patients with Raynaud's phenomenon. Patients with all signs or symptoms of the VEDOSS criteria already fulfil the 2013 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) classification criteria for systemic sclerosis. However, prospective data for the evolution to fulfilling these criteria do not exist. We therefore aimed to determine the clinical value of the VEDOSS criteria to identify patients with Raynaud's phenomenon who progress to systemic sclerosis within 5 years. METHODS The VEDOSS project was a multicentre, longitudinal registry study done in 42 European Scleroderma Trial and Research group centres located in 20 countries in Europe, North America, and South America. Patients with Raynaud's phenomenon were eligible for enrolment. Those who had fulfilled the 1980 ACR or the 2013 ACR-EULAR classification criteria for systemic sclerosis, as well as of any other ACR or EULAR classification criteria for other definite connective tissue diseases at enrolment were excluded. Data were recorded each year during follow-up visits and included the four VEDOSS criteria (ie, positivity for antinuclear antibodies [ANAs], puffy fingers, systemic sclerosis-specific autoantibodies, and abnormal nailfold capillaroscopy). The primary endpoint was the fulfilment of the 2013 ACR-EULAR classification criteria for systemic sclerosis (ie, progression from enrolment to follow-up). Proportion of progressors and VEDOSS criteria interaction were reported descriptively. Predictors of progression of the distinct VEDOSS criteria interactions were determined based on the point prevalence at 5 years. To investigate the intermediate course of progression of the distinct VEDOSS criteria and their combinations, Kaplan-Meier analysis was done. RESULTS Between March 1, 2010, and Oct 4, 2018, we enrolled 1150 patients with Raynaud's phenomenon in the VEDOSS database. 764 (66·4%) of 1150 patients met the VEDOSS criteria for study inclusion. Of the 764 patients, 553 (72·4%) had at least one available follow-up visit and the median duration of follow-up was 3·6 years (IQR 1·7-5·8). The mean age was 45·9 years (SD 15·0), 507 (91·7%) of 553 participants were female, and the median time since the onset of Raynaud's phenomenon was 4·0 years (IQR 1·7-10·0). At baseline, 401 (73·7%) of 544 patients with Raynaud's phenomenon had detectable ANA, with 208 (39·5%) of 527 patients positive for systemic sclerosis-specific autoantibodies. Nailfold capillaroscopy abnormalities were present in 182 (36·0%) of 505 patients and puffy fingers were detected in 96 (17·8%) of 540 at baseline. 1885 follow-up visits were recorded. 254 (45·9%) of 553 patients completed the study with progression or a 5-year follow-up; of whom, 133 reached the primary endpoint, resulting in an overall progression rate of 52·4%. The absence of ANA at baseline was the factor most strongly associated with a lack of progression within 5 years, with only four (10·8%) of 37 ANA-negative patients progressing. Conversely, positivity at baseline for systemic sclerosis-specific autoantibodies and puffy fingers was the combination having the highest risk of progression (16 [94·1%] of 17). INTERPRETATION Our results from the VEDOSS project offers a useful tool for a stratified risk approach to patients with Raynaud's phenomenon. The absence of ANA is a strong protective factor that identifies patients with very low risk of developing systemic sclerosis whereas the presence of one or two VEDOSS criteria in patients with Raynaud's phenomenon confers a progressively higher risk for systemic sclerosis over time. This stratification tool can be used both for clinical management and to inform early interventional trials. FUNDING European Scleroderma Trial And Research and World Scleroderma Foundation.
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Affiliation(s)
- Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Francesco Del Galdo
- Raynaud's and Scleroderma Programme, National Institute for Health Research Biomedical Research Centre, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK.
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Tunde Minier
- Department of Rheumatology and Immunology, Medical School, University of Pecs, Hungary
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology and Berlin Institute of Health, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Daniel E Furst
- Division of Rheumatology, Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Rheumatology, University of Washington, Seattle, WA, USA
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pecs, Hungary
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jerome Avouac
- Division of Rheumatology, Hospital Cochin, Paris, France
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Division of Rheumatology, University of Genoa, Genoa, Italy; Clinical Rheumatology Unit, IRCCS AOU San Martino, Genova, Italy
| | - Vanessa Smith
- Department of Internal Medicine and Department of Rheumatology, Ghent University, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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Douros A, Schneider A, Ebert N, Huscher D, Kuhlmann MK, Martus P, Mielke N, Van Der Giet M, Wenning V, Schaeffner E. Control of blood pressure in older patients with heart failure and the risk of mortality: a population-based prospective cohort study. Age Ageing 2021; 50:1173-1181. [PMID: 33320927 DOI: 10.1093/ageing/afaa261] [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: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND treatment goals for blood pressure (BP) lowering in older patients with heart failure (HF) are unclear. OBJECTIVE to assess whether BP control < 140/90 mmHg is associated with a decreased risk of mortality in older HF patients. DESIGN population-based prospective cohort study. SETTING/SUBJECTS participants of the Berlin Initiative Study, a prospective cohort of community-dwelling older adults launched in 2009. Clinical information was obtained in face-to-face interviews and linked to administrative healthcare data. METHODS Cox proportional hazards models estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular death and all-cause mortality associated with normalised BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) compared with non-normalised BP (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) in HF patients. The primary analysis considered only baseline BP ('time-fixed'); an additional analysis updated BP during follow-up ('time-dependent'). RESULTS at baseline, 544 patients were diagnosed with HF and treated with antihypertensive drugs (mean age 82.8 years; 45.4% female). During a median follow-up of 7.5 years and compared with non-normalised BP, normalised BP was associated with similar risks of cardiovascular death (HR, 1.24; 95% CI, 0.84-1.85) and all-cause mortality (HR, 1.16; 95% CI, 0.89-1.51) in the time-fixed analysis but with increased risks of cardiovascular death (HR, 1.79; 95% CI, 1.23-2.61) and all-cause mortality (HR, 1.48; 95% CI, 1.15-1.90) in the time-dependent analysis. CONCLUSIONS BP control < 140/90 mmHg was not associated with a decreased risk of mortality in older HF patients. The increased risk in the time-dependent analysis requires further corroboration.
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Affiliation(s)
- Antonios Douros
- Departments of Medicine and Epidemiology, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alice Schneider
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Peter Martus
- Institut für Klinische Epidemiologie und angewandte Biometrie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Nina Mielke
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Van Der Giet
- Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Elke Schaeffner
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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21
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Zanatta E, Huscher D, Airò P, Balbir-Gurman A, Siegert E, Ortolan A, Matucci-Cerinic M, Cozzi F, Riemekasten G, Hoffmann-Vold AM, Distler O, Gabrielli A, Heitmann S, Hunzelmann N, Montecucco C, Morovic-Vergles J, Ribi C, Doria A, Allanore Y. POS0318 CLINICAL PHENOTYPE IN SCLERODERMA PATIENTS WITH ANTI-TOPOISOMERASE I POSITIVITY AND LIMITED CUTANEOUS FORM: DATA FROM THE EUSTAR DATABASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:There is renewed interest in the role of autoantibodies to predict outcomes in systemic sclerosis (SSc). Among the newly identified subsets, patients with limited cutaneous form (lcSSc) but anti-topoisomerase I antibodies (Scl70) positivity draw particular attention, and namely, assessing the risk of developing interstitial lung disease (ILD) —the main cause of death in SSc—to improve the management of Scl70-lcSSc patients.Objectives:We aimed to characterize patients with Scl70-lcSSc in the large multicenter European Scleroderma Trial and Research (EUSTAR) cohort.Methods:The EUSTAR database was locked in July 2019. We included all patients fulfilling 1980 ACR and/or 2013 ACR/EULAR criteria for SSc, with disease duration at database entry ≤3 yrs and known and stable skin form during the first 3 yrs. Patients with lcSSc were compared: Scl70-lcSSc (target group) vs. ACA-lcSSc and ANA-lcSSc (Step 1); and Scl70-lcSSc vs. Scl70-dcSSc (Step 2). In the ANA subgroup we included ANA+ patients with negative SSc-specific antibodies (Scl70, ACA, RNA polymerase III). In each step, we performed 5 generalized mixed models (GMM) for the risk of the new onset of ILD (defined by imaging), primary myocardial involvement (PMI), pulmonary hypertension (PH), “any severe” (ILD+PMI+PH+scleroderma renal crisis) and all-cause-mortality. An additional GMM assessed the risk of forced vital capacity (FVC) decline ≥10% vs. FVC value at ILD onset. Each GMM was adjusted for age, sex and confounders.Results:Overall, 1285 SSc patients were included: 1068 (83%) females, 860 (67%) lcSSc and 425 (33%) dcSSc. Among patients with lcSSc, 537 (62%) had ACA+, 194 (23%) Scl70+ and 129 (15%) ANA+; 425 patients had dcSSc and Scl70+. Median follow-up was similar in all 4 groups: 7.2 to 8.1 yrs.Step 1: At baseline, Scl70-lcSSc patients had significantly shorter time from Raynaud’s phenomenon (RP) to SSc onset, higher mRSS (5.8±4.8 vs. 4.3±4, p=0.001), and higher rate of articular and muscular involvement vs. ACA-lcSSc patients (Figure 1). No differences were found between Scl70-lcSSc and ANA-lcSSc comparing the aforementioned variables. ILD was more frequent in Scl70-lcSSc (46%) than in ACA-lcSSc (10%) and ANA-lcSSc (25%), as well as restrictive lung disease. GMM showed that Scl70-lcSSc carries a higher risk of ILD than both ACA-lcSSc (HR 4.55, 95%CI 3.23-6.67) and ANA-lcSSc (HR 2.17, 95%CI 1.39-3.45), with a rate of FVC decline ≥10% over time similar to the other limited forms. In Scl70-lcSSc patients the risk of “any severe” organ involvement was similar to ANA-lcSSc and higher than ACA-lcSSc (HR 1.89, 95%CI 1.40-2.50). In particular, Scl70-lcSSc shows a risk of PMI similar to ANA-lcSSc and lower than ACA-lcSSc; no differences regarding PH risk. The mortality risk in patients with Scl70-lcSSc was similar to the other limited forms’.Step 2: At baseline, time from RP to SSc onset was longer in patients with Scl70-lcSSc, with less frequent joint synovitis and tendon friction rubs vs. patients with Scl70-dcSSc. Conversely, the frequency of muscular, cardiac and pulmonary involvement was similar. The risk of ILD in Scl70-lcSSc patients was similar to Scl70-dcSSc, with a lower risk of FVC decline ≥10% over time. The risk of “any severe” involvement (HR 0.66, 95%CI 0.49-0.83), PMI and PH was lower and the mortality risk tended to be lower (HR 0.57, 95%CI 0.33-1.01, p=0.053) vs. Scl70-dcSSc.Conclusion:In our large multicenter EUSTAR cohort one quarter of lcSSc patients were Scl70+. We show a ranking for major organ involvement within lcSSc: Scl70 the most severe, ANA+ intermediate and ACA the milder form. Scl70-dcSSc patients present the most severe phenotype, and Scl70 positivity, more than the cutaneous subset, is strongly predictive of ILD, whereas other variables may influence progression. These results may provide new insight to improve the management of Scl70-lcSSc patients.Disclosure of Interests:Elisabetta Zanatta: None declared, Dörte Huscher: None declared, Paolo Airò: None declared, Alexandra Balbir-Gurman: None declared, Elise Siegert: None declared, Augusta Ortolan: None declared, Marco Matucci-Cerinic: None declared, Franco Cozzi: None declared, Gabriela Riemekasten: None declared, Anna-Maria Hoffmann-Vold: None declared, Oliver Distler Speakers bureau: has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: Kymera Therapeutics, Mitsubishi Tanabe, Armando Gabrielli: None declared, Stefan Heitmann: None declared, Nicolas Hunzelmann: None declared, Carlomaurizio Montecucco: None declared, Jadranka Morovic-Vergles: None declared, Camillo Ribi: None declared, Andrea Doria: None declared, Yannick Allanore: None declared
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Hoffmann-Vold AM, Huscher D, Airò P, Zanatta E, Carreira P, Allanore Y, Müller-Ladner U, Giollo A, Pozzi MR, Souza Muller C, Bečvář R, Iudici M, Majewski D, Gabrielli A, Alves M, Schoof N, Distler O. POS0316 MODELLING SHORT-TERM FVC CHANGES FROM SENSCIS TO LONG-TERM FVC COURSE IN SSc-ILD DEMONSTRATES CLINICALLY MEANINGFUL REDUCTION OF FVC DECLINE AND SURVIVAL BENEFITS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Nintedanib has shown to slow FVC decline by 41ml over 52 weeks in systemic sclerosis-associated interstitial lung disease (SSc-ILD). However, the long-term effect of nintedanib treatment on ILD progression and mortality in SSc patients is so far unknown.Objectives:Here, the 52-week treatment efficacy of nintedanib was modeled and extrapolated on the long-term FVC course and survival in SSc-ILD patients from the European Scleroderma Trial and Research (EUSTAR) database.Methods:SSc patients from the EUSTAR database fulfilling the inclusion criteria of the SENSCIS trial (SSc classification criteria, ILD confirmed by imaging, disease duration of <7 years, FVC≥40%pred, diffusion capacity of the lung for carbon monoxide (DLCO) 30-89%pred); and matched for baseline characteristics as well as matched for the 52-week FVC change of SENSCIS patients were included (n=236). Linear mixed models including time, risk factors at baseline (sex, age, dyspnea class, DLCO%, CRP, modified Rodnan skin score, SSc subtype, SSc auto-antibodies, disease duration, synovitis and muscle weakness) were used to estimate the natural FVC course over time. On this natural course of FVC, the observed effect from the SENSCIS trial representing the absolute 52-week difference of FVC decline between the nintedanib and the placebo group was applied as continuous annual effect (SENSCIS effect model). Survival was estimated for both the natural course as well as the SENSCIS effect model using Cox regression.Results:Of the 236 included patients, 75% were females, 65% had diffuse cutaneous SSc. Mean age was 50.6 years, mean FVC 78.2%pred and DLCO 56.3%pred at time of inclusion. Mean FVC change after 12±3 months was -2.3 ±6.9%pred. These parameters were largely similar to the characteristics of the SENSCIS population.In the longitudinal follow up of this population, the natural course of FVC showed a total FVC decline of -16.3%pred over 5 years. With assumed SENSCIS effects (effects of nintedanib treatment reported in SENSCIS), the 5-year FVC decline was reduced to -10.3%pred (Figure 1).The reduced FVC progression translated into an improved survival. The natural 5-year survival of this SSc-ILD population was 88.2%. When extrapolating also a severe FVC decline early in the course, frequently terminated by early mortality of SSc patients excluding them from long-term outcome assessment, the estimated 5-year survival was reduced to 81.6%. When the SENSCIS effects on FVC were considered, the 5-year extrapolated survival was increased to 86.3% (Figure 2).Conclusion:Long-term experience of nintedanib treatment in SSc-ILD patients is lacking so far, therefore we modeled and extrapolated the 52-week treatment efficacy of nintedanib on the long-term FVC course and survival in SSc-ILD patients from the EUSTAR database. We could demonstrate a significant reduction of FVC decline by extrapolating the annual treatment effects of nintedanib from the SENSCIS trial from 1 to 5 years in EUSTAR. Translating these reductions of FVC decline into survival, the 5-year mortality rate was reduced from 18% to 13%.Disclosure of Interests:Anna-Maria Hoffmann-Vold Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Merck Sharp & Dohme, Lilly, Consultant of: Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp & Dohme, ARXX, Lilly and Medscape, Grant/research support from: Boehringer Ingelheim, Dörte Huscher: None declared, Paolo Airò Speakers bureau: Boehringer Ingelheim, Consultant of: Bristol-Myers-Squibb, Novartis, Elisabetta Zanatta Speakers bureau: Boehringer Ingelheim, Actelion, GSK, Paid instructor for: GSK, Consultant of: Boehringer Ingelheim, GSK, Patricia Carreira Speakers bureau: Actelion, Boehringer Ingellheim, Janssen, GSK, Paid instructor for: Boehringer Ingelheim, Consultant of: AbbVie, Boehringer Ingelheim, VivaCell, Emerald Health Pharmaceuticals, Gesynta Pharma, Sanofi Genzyme, Grant/research support from: Roche, GSK, Yannick Allanore Consultant of: Honorarium received from Boehringer, MedsenicSanofi, Menarini, Grant/research support from: Grants received from Alpine, Ose Immunogenetics, Ulf Müller-Ladner Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Alessandro Giollo: None declared, Maria Rosa Pozzi: None declared, CAROLINA SOUZA MULLER Speakers bureau: Boehinger Ingelheim, Janssen, Roche, LIBBS, Bristol-Myers-Squib, Radim Bečvář Consultant of: Actelion, Boehringer Ingelheim, Michele Iudici: None declared, Dominik Majewski Speakers bureau: Boehringer Ingelheim - 2 x paid as a speaker, Armando Gabrielli Grant/research support from: Pfizer, CSL Behring, Margarida Alves Employee of: Boehringer Ingelheim, Nils Schoof Employee of: Boehringer Ingelheim International GmbH, Oliver Distler Speakers bureau: Boehringer Ingelheim, Medscape, IQone, Roche, Consultant of: Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, Kymera Therapeutics, Lilly, Medac, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB, Grant/research support from: Kymera Therapeutics, Mitsubishi Tanabe
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Ebert N, Schneider A, Balabanova Y, Brobert G, Huscher D, Mielke N, Schaeffner E. FC 046INCIDENCE OF NOSOCOMIAL ACUTE KIDNEY INJURY (AKI) IN A COHORT OF COMMUNITY-DWELLING OLDER ADULTS OVER 8 YEARS OF OBSERVATION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab116.002] [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 and Aims
Acute kidney injury (AKI) is amongst the most common in-hospital complications especially in old age. Epidemiological data on incidence rates (IR) of nosocomial AKI in individuals aged 70+ years, stratified by age, gender and pre-existing diseases are scarce because older adults are usually underrepresented in clinical research.
Method
We used data from the Berlin Initiative Study (BIS), a longitudinal, population-based cohort of adults aged ≥70 with biennial follow-up visits (including blood and urine tests) in combination with claims data from the AOK Nordost insurance fund to complement information on diagnoses and in-hospital procedures (based on ICD-10 and OPS coding). Nosocomial AKI was defined as documented in-hospital diagnosis (ICD-10: N17.xx) excluding cases with AKI as admission diagnosis. Incidence rates (IR) and 95% confidence intervals (CI) of the first nosocomial AKI were calculated with the number of incident cases during observation divided by the total person-years of follow-up, for AKI cases truncated at the first incidence of nosocomial AKI. IR are reported by age strata, sex and preexisting diseases (diabetes, arterial hypertension, atrial fibrillation, heart failure, angina pectoris, peripheral artery disease and impaired kidney function).
Results
In 2020 individuals (mean age 80.5 years; 52.6% women), 383 developed nosocomial AKI over the median [IQR] follow up time of 8.8 [5.9-9.3] years (Fig.1). The IR of nosocomial AKI was 26.8 (95%CI 24.1-29.6) per 1000 person years among all patients, with higher IR in men compared to women, and - when stratified by age - lowest IR in age category 70-75 versus the highest IR in age category of ≥ 90 years (Fig.1).
IR per 1000 person years were higher in patients with diabetes mellitus (IR: 39.3 vs 22.7), arterial hypertension (IR: 31.1 vs 12.2), chronic heart failure (IR: 41.9 vs 22.3), angina pectoris (IR: 37.6 vs 25.7), peripheral artery disease (IR: 55.0 vs 25.1) and impaired kidney function (IR: 43.3 vs 12.4), respectively (Fig.2).
Conclusion
Nosocomial AKI is an in-hospital complication common in older adults with IRs rising continuously with age above the age of 70 years. IR of AKI are considerably higher in patients with cardiovascular comorbidities. A better understanding of the patient population at risk is of great clinical relevance when aiming to improve prevention strategies.
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Affiliation(s)
- Natalie Ebert
- Institute of Public Health, Charite Universitätsmedizin, Berlin, Germany
| | - Alice Schneider
- Charité - Institut für Biometrie und Klinische Epidemiologie, Berlin, Germany
| | - Yanina Balabanova
- Bayer AG, Epidemiology - Medical Affairs & Pharmacovigilance, Pharmaceuticals, Berlin, Germany
| | | | - Dörte Huscher
- Charité - Institut für Biometrie und Klinische Epidemiologie, Berlin, Germany
| | - Nina Mielke
- Institute of Public Health, Charite Universitätsmedizin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charite Universitätsmedizin, Berlin, Germany
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Richter JG, Nannen C, Chehab G, Acar H, Becker A, Willers R, Huscher D, Schneider M. Mobile App-based documentation of patient-reported outcomes - 3-months results from a proof-of-concept study on modern rheumatology patient management. Arthritis Res Ther 2021; 23:121. [PMID: 33874994 PMCID: PMC8054360 DOI: 10.1186/s13075-021-02500-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mobile medical applications (Apps) offer innovative solutions for patients' self-monitoring and new patient management opportunities. Prior to routine clinical application feasibility and acceptance of disease surveillance using an App that includes electronic (e) patient-reported outcome measures (PROMs) warrant evaluation. Therefore, we performed a proof-of-concept study in which rheumatoid arthritis (RA) patients used an App (RheumaLive) to document their disease. METHODS Accurate PROM reporting via an App in comparison to paper-based versions was investigated to exclude media bias. Sixty participants recruited from 268 consecutive RA outpatients completed paper-based and electronic PROMs (Hannover Functional Questionnaire/derived HAQ; modified RA disease activity index) using the App at baseline and follow-up visits. Between visits, patients used their App on their own smartphone according to their preferences. The equivalence of PROM data and user experiences from patients and physicians were evaluated. RESULTS Patients' (78.3% female) mean (SD) age was 50.1 (13.1) years, disease duration 10.5 (9.1) years, and paper-based HAQ 0.78 (0.59). Mean confidence in Apps scored 3.5 (1.1, Likert scale 1 to 6). ePROMs' scores obtained by patients' data entry in the App were equivalent to paper-based ones and preferred by the patients. After 3 months, the App retention rate was 71.7%. Patients' overall satisfaction with the App was 2.2 (0.9, Likert scale 1 to 6). Patients and physicians valued the App, i.e., for patient-physician interaction: 87% reported that it was easier for them to document the course of the disease using the App than "only" answering questions about their current health during routine outpatient visits. Further App use was recommended in 77.3% of the patients, and according to physicians, in seven patients, the App use contributed to an increased adherence to therapy. CONCLUSION Our study provides an essential basis for the broader implementation of medical Apps in routine care. We demonstrated the feasibility and acceptance of disease surveillance using a smartphone App in RA. App use was convincing as a reliable option to perform continuous, remote monitoring of disease activity and treatment efficacy. TRIAL REGISTRATION ClinicalTrials.gov, NCT02565225 . Registered on September 16, 2015 (retrospectively registered).
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Affiliation(s)
- Jutta G Richter
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany.
| | - Christina Nannen
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Gamal Chehab
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Hasan Acar
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Arnd Becker
- Ortenau Klinikum Offenburg-Kehl, Offenburg, Germany
| | - Reinhart Willers
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité - Universitaetsmedizin, Berlin, Germany
- German Rheumatism Research Center Berlin, Berlin, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
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Raab A, Kallinich T, Huscher D, Foeldvari I, Weller-Heinemann F, Dressler F, Kuemmerle-Deschner JB, Klein A, Horneff G. Outcome of children with oligoarticular juvenile idiopathic arthritis compared to polyarthritis on methotrexate- data of the German BIKER registry. Pediatr Rheumatol Online J 2021; 19:41. [PMID: 33752685 PMCID: PMC7986501 DOI: 10.1186/s12969-021-00522-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Oligoarticular juvenile idiopathic arthritis (oligoJIA) is the most commonly diagnosed category of chronic arthritis in children. Nevertheless, there are no evidence- based guidelines for its treatment, in particular for the use of methotrexate (MTX). The primary objective of this analysis is to evaluate the outcomes in patients with persistent oligoJIA compared to those with extended oligoJIA and rheumatoid factor (RF) negative polyarthritis treated with methotrexate. METHODS Patients with persistent or extended oligoJIA or RF negative PA recorded in the Biologics in Pediatric Rheumatology Registry (BiKeR), receiving methotrexate for the first time were included in the analyses. Efficacy was determined using the Juvenile Arthritis Disease Activity Score 10 (JADAS 10). Safety assessment included the documentation of adverse and serious adverse events. RESULTS From 2005 through 2011, 1056 patients were included: 370 patients with persistent oligoJIA, 221 patients with extended oligoJIA and 467 patients with RF negative PA. Therapeutic efficacy was observed following the start of methotrexate. Over a period of 24 months JADAS-minimal disease activity (JADAS ≤2) was reached in 44% of patients with persistent oligoJIA, 38% with extended oligoJIA, 46% with RF negative PA, JADAS-remission defined as JADAS ≤1 was reached in 33% of patients with persistent oligoJIA, 29% with extended oligoJIA and 35% (RF negative PA). Patients with extended oligoJIA achieved JADAS remission significantly later and received additional biologic disease-modifying drugs significantly more often than patients with persistent oligoJIA or RF negative PA (p < 0.001). Tolerability was comparable. New onset uveitis occurred in 0.3 to 2.2 per 100 patient years. CONCLUSIONS Patients with persistent oligoJIA taking methotrexate are at least as likely to enter remission as patients with extended oligo JIA or polyarticular JIA. Patients with extended oligoJIA achieved JADAS remission significantly later. Within 2 years, almost half of the patients with persistent oligoJIA achieved JADAS-minimal disease activity.
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Affiliation(s)
- A. Raab
- grid.6363.00000 0001 2218 4662Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Children’s university hospital Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - T. Kallinich
- grid.6363.00000 0001 2218 4662Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Children’s university hospital Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - D. Huscher
- grid.6363.00000 0001 2218 4662Institute of Biometry and Clinical Epidemiology and Berlin Institute of Health, Charité – Universitätsmedizin, Berlin, Germany
| | - I. Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence, Hamburg, Germany
| | - F. Weller-Heinemann
- Division of Pediatric Rheumatology, Prof. Hess Children’s Hospital, Bremen, Germany ,grid.411097.a0000 0000 8852 305XDepartment of Paediatric and Adolescents medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - F. Dressler
- grid.10423.340000 0000 9529 9877Division of Pediatric Pneumology, Hannover Medical School, Hannover, Germany
| | - J. B. Kuemmerle-Deschner
- grid.411544.10000 0001 0196 8249Division of Rheumatology, Department of Pediatrics and autoinflammation reference center Tuebingen, University Hospital Tuebingen, Tuebingen, Germany
| | - A. Klein
- Department of Paediatrics, Centre for Paediatric Rheumatology, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - G. Horneff
- Department of Paediatrics, Centre for Paediatric Rheumatology, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
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March C, Huscher D, Preis E, Makowka A, Hoeppner J, Buttgereit F, Riemekasten G, Norman K, Siegert E. Response to the Letter to the Editor: Prevalence, Risk Factors and Assessment of Depressive Symptoms in Patients With Systemic Sclerosis. Arch Rheumatol 2021; 35:460-461. [PMID: 33458675 PMCID: PMC7788653 DOI: 10.46497/archrheumatol.2020.00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christine March
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Department of Rheumatology, Deutsches Rheumaforschungszentrum, Berlin, Germany
| | - Emelina Preis
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Alexander Makowka
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Jakob Hoeppner
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology, Universitätsklinikum Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Kristina Norman
- Charité-Universitatsmedizin Berlin, Research Group on Geriatrics, Berlin, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
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Wiebe E, Freier D, Huscher D, Dallagiacoma G, Biesen R, Hermann S, Burmester GR, Buttgereit F. OP0300 A CROSS-SECTIONAL, MATCHED-PAIR ANALYSIS OF ACPA POSITIVE AND ACPA NEGATIVE RHEUMATOID ARTHRITIS PATIENTS COMPARING THE PREVALENCE OF OSTEOPOROSIS, FRAGILITY FRACTURES AND UNDERLYING RISK FACTORS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) is associated with increased systemic bone loss, leading to a high risk for fragility fractures. Especially anti-citrullinated protein antibody (ACPA) positivity is considered a risk factor for local bone erosions and systemic bone loss1.Objectives:The purpose of this study was to compare ACPA positive versus ACPA negative RA patients in terms of the prevalence of osteoporosis and fragility fractures and to identify differences in underlying risk factors that influence bone health.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic rheumatic diseases or psoriasis treated with glucocorticoids (GC). In this cross-sectional analysis, we performed a matched-pair analysis, matching 114 ACPA positive to 114 ACPA negative RA patients according to age (5-year-steps), sex, and body mass index (BMI, 2-unit-steps). Descriptive analyses were performed, with values displayed as mean ± standard deviation for continuous variables. Non-parametric tests were used at a two-sided significance level of 5% to compare differences in underlying and potential risk factors without adjustment for multiple testing.Results:At same mean age (63.9 ±10.2 years) and BMI (27.9 ±5.6kg/m2), the matched groups had a female proportion of 82.5%. APCA positive patients had a significantly longer mean disease duration (13.9 vs 9.9 years, p<0.001), a higher mean cumulative GC-dose (22.3 vs 13.2g, p<0.01) and mean duration of GC therapy (10.1 vs 6.6 years, p<0.01). There was no significant difference in the prevalence of osteoporosis as defined by dual-energy X-ray absorptiometry (DXA) (18.4 vs 20.2%), nor in the prevalence of vertebral (7.0 vs 5.3%) or non-vertebral fractures (31.6 vs 29.8%). C-reactive protein levels as a marker of disease activity were significantly higher in ACPA positive patients (mean: 8.8 vs 4.3mg/l, p= 0.02), while mean disease activity score (DAS)28 levels were slightly lower in ACPA positive patients (2.4 vs 2.7, p= 0.05). No difference in health assessment questionnaire (HAQ) score was found. RA-specific treatments were similar, especially concerning current mean daily GC-dose (6.7 vs 4.9mg/day), except for Rituximab and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) which were more commonly used in ACPA positive patients (9.6 vs 2.6%, p=0.05) and (5.3 vs 0%, p=0.029), respectively. ACPA positive patients did not differ significantly from ACPA negative patients in specific anti-osteoporotic treatment, nor in the prevalence of comorbidities or concomitant medication. There were no significant differences in bone-specific laboratory parameters.Conclusion:In a cross-sectional analysis of our cohort, the prevalence of osteoporosis and fragility fractures was similar between ACPA positive and ACPA negative RA patients, despite longer disease duration and GC-treatment in ACPA positive patients. This is remarkable since it implies that ACPA negative patients are at a similar risk for osteoporosis and associated fractures. Optimal management of disease activity with or without GCs may represent a mainstay in preventing disease-related comorbidities such as osteoporosis.References:[1]Steffen, U., Schett, G., & Bozec, A. (2019). How Autoantibodies Regulate Osteoclast Induced Bone Loss in Rheumatoid Arthritis. Frontiers in immunology, 10, 1483. doi:10.3389/fimmu.2019.01483Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, gloria dallagiacoma: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.
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Douros A, Schneider A, Huscher D, Ebert N, Mielke N, Van der Giet M, Schaeffner E. P0154BLOOD PRESSURE CONTROL IN ELDERLY PATIENTS WITH HEART FAILURE AND MORTALITY RISK: A POPULATION-BASED PROSPECTIVE COHORT STUDY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0154] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Current guidelines on the management of heart failure (HF) recommend control of blood pressure (BP) in elderly patients. However, the exact treatment goals in this vulnerable population are unclear. Thus, our population-based prospective cohort study aimed to assess whether BP values <140/90 mmHg are associated with a decreased risk of cardiovascular (CV) death and all-cause mortality in HF patients ≥70 years.
Method
The study included participants of the Berlin Initiative Study (BIS), all ≥70 years, who were treated with antihypertensive drugs and had a diagnosis of HF (ICD-10 codes: I11.0, I13.0, I13.2, I50.x) at baseline. The study period was from 2009 to 2017. Demographics, lifestyle factors, medications, and comorbidities were assessed in face-to-face interviews and from linked administrative healthcare data. Outcomes were adjudicated using death certificates and hospital discharge notes. Cox proportional hazards models yielded crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of CV death and all-cause mortality associated with normalized BP (systolic BP <140 mmHg and diastolic BP <90 mmHg) compared with non-normalized BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) in patients with HF. In sensitivity analyses we restricted to high-risk HF patients (≥80 years or with previous CV events). We also repeated the analyses in patients without HF to assess a potential effect modification.
Results
Among 1623 BIS participants treated with antihypertensive drugs at baseline, 544 (33.5%) had a diagnosis of HF. Of those, 255 (46.9%) showed normalized BP and 289 (53.1%) had non-normalized values. Mean age (standard deviation [SD]) was 82.8 (6.8) years (45.4% female). Selected patient characteristics are shown in the Table. Median (interquartile range) duration of follow-up was 6.7 (4.1-7.3) years. Compared with non-normalized BP, normalized BP was associated with a numerically increased risk of CV death (HR, 1.40; 95% CI, 0.90-2.17) and all-cause mortality (HR, 1.28; 95% CI, 0.96-1.71) in patients with HF. The associations were more pronounced or reached statistical significance when restricting to HF patients ≥80 years (CV death: HR, 1.54; 95% CI, 0.94-2.53 / all-cause mortality: HR, 1.56; 95% CI, 1.11-2.18) or HF patients with previous CV events (CV death: HR, 1.65; 95% CI, 0.83-3.29 / all-cause mortality: HR, 1.33; 95% CI, 0.85-2.07) (Figure). The effect estimates in patients without HF were comparable to those with HF (CV death: HR, 1.18; 95% CI, 0.78-1.78; p for interaction, 0.695 / all-cause mortality: HR, 1.20; 95% CI, 0.93-1.54; p for interaction, 0.604).
Conclusion
Our study suggests that normalized BP does not decrease the risk of CV death or all-cause mortality in elderly patients with HF and it could even increase the risk especially in high-risk subgroups. Thus, individualized benefit-risk assessment is required for the pharmacotherapy of HF in this vulnerable population.
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Wiebe E, Freier D, Huscher D, Biesen R, Hermann S, Buttgereit F. SAT0450 GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A MULTIVARIATE LINEAR REGRESSION ANALYSIS IDENTIFYING PREDICTIVE FACTORS FOR LOW BONE MASS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatic diseases are associated with increased systemic bone loss and fracture risk related to chronic inflammation, disease-specific, general and demographic risk factors as well as treatment with glucocorticoids (GC). Yet, there is evidence that GCs may, by adequately suppressing systemic inflammation, also have a positive effect on bone mineral density (BMD) and fracture risk1.Objectives:The purpose of this study was to investigate the prevalence of osteoporosis and fragility fractures in patients with inflammatory rheumatic diseases and to analyze the impact that treatment with GCs, other known risk factors and preventive measures have on bone health in these patients.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic inflammatory rheumatic diseases and psoriasis treated with GCs. In this cross-sectional analysis, we evaluated the initial visit of 1091 patients. A multivariate linear regression model with known or potentially influential factors adjusted for age and sex was used to identify predictors of BMD as measured by dual-energy X-ray absorptiometry (DXA). Multiple imputation was applied for missing baseline covariate data.Results:In the total cohort of 1091 patients (75% female of which 87.5% were postmenopausal) with a mean age of 62.1 (±13.2) years, the prevalence of osteoporosis by DXA was 21.7%, while fragility fractures have occurred in 31.2% of the study population (6.7% vertebral, 27.7% non-vertebral). Current GC therapy was common (64.9%), with a median daily dose of 5.0mg [0.0;7.5], a mean life-time total GC dose of 17.7g (±24.6), and a mean GC therapy duration of 7.8 years (±8.5). Bisphosphonates were the most commonly used anti-osteoporotic drug (12.6%).Multivariate analysis showed that BMD as expressed by the minimum T-Score at all measured sites was negatively associated with higher age, female sex and menopause as well as Denosumab and Bisphosphonate treatment. A positive association with BMD was found for body mass index as well as current and life-time (cumulative) GC dose. While comedication with proton-pump-inhibitors significantly predicted low bone mass, concomitant use of non-steroidal anti-inflammatory drugs showed a positive association with BMD. Of the measured bone-specific laboratory parameters, higher alkaline phosphatase levels were determinants of low DXA-values, while the association was positive for gamma-glutamyltransferase.BMD was neither predicted by duration of GC treatment nor by treatment with disease modifying anti-rheumatic drugs.Predictive variables for BMD differed at the respective anatomical site. While treatment with Denosumab predicted low bone mass at the lumbar spine and not at the femoral neck, the opposite was true for health assessment questionnaire (HAQ) score. Current and life-time GC-dose as well as direct sun-exposure of more than 30 minutes daily were positively associated with bone mass at the femoral sites only.Conclusion:This cross-sectional analysis of a prospective cohort study quantified the prevalence of osteoporosis and identified predictive variables of BMD in patients with rheumatic diseases.Multivariate analyses corroborated low BMD to be predicted by traditional factors like age, female sex and menopause but showed current and well as life-time GC dose to be positively associated with BMD in our cohort of patients with chronic inflammatory rheumatic diseases. This suggests that optimal management of disease activity with GCs might be beneficial in order to avoid bone loss due to inflammation.References:[1]Güler-Yüksel et al. “Glucocorticoids, Inflammation and Bone.” Calcified Tissue International (January 08 2018).Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.
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Kaemmerer H, Gorenflo M, Huscher D, Pittrow D, Apitz C, Baumgartner H, Berger F, Bruch L, Brunnemer E, Budts W, Claussen M, Coghlan G, Dähnert I, D’Alto M, Delcroix M, Distler O, Dittrich S, Dumitrescu D, Ewert R, Faehling M, Germund I, Ghofrani HA, Grohé C, Grossekreymborg K, Halank M, Hansmann G, Harzheim D, Nemes A, Havasi K, Held M, M. Hoeper M, Hofbeck M, Hohenfrost-Schmidt W, Jurevičienė E, Gumbienè L, Kabitz HJ, Klose H, Köhler T, Konstantinides S, Köestenberger M, Kozlik-Feldmann R, Kramer HH, Kropf-Sanchen C, Lammers A, Lange T, Meyn P, Miera O, Milger-Kneidinger K, Neidenbach R, Neurohr C, Opitz C, Perings C, Remppis BA, Riemekasten G, Scelsi L, Scholtz W, Simkova I, Skowasch D, Skride A, Stähler G, Stiller B, Tsangaris I, Vizza CD, Vonk Noordegraaf A, Wilkens H, Wirtz H, Diller GP, Grünig E, Rosenkranz S. Pulmonary Hypertension in Adults with Congenital Heart Disease: Real-World Data from the International COMPERA-CHD Registry. J Clin Med 2020; 9:jcm9051456. [PMID: 32414075 PMCID: PMC7290703 DOI: 10.3390/jcm9051456] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/25/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a common complication in patients with congenital heart disease (CHD), aggravating the natural, post-operative, or post-interventional course of the underlying anomaly. The various CHDs differ substantially in characteristics, functionality, and clinical outcomes among each other and compared with other diseases with pulmonary hypertension. OBJECTIVE To describe current management strategies and outcomes for adults with PH in relation to different types of CHD based on real-world data. METHODS AND RESULTS COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension) is a prospective, international PH registry comprising, at the time of data analysis, >8200 patients with various forms of PH. Here, we analyzed a subgroup of 680 patients with PH due to CHD, who were included between 2007 and 2018 in 49 specialized centers for PH and/or CHD located in 11 European countries. At enrollment, the patients´ median age was 44 years (67% female), and patients had either pre-tricuspid shunts, post-tricuspid shunts, complex CHD, congenital left heart or aortic disease, or miscellaneous other types of CHD. Upon inclusion, targeted therapies for pulmonary arterial hypertension (PAH) included endothelin receptor antagonists, PDE-5 inhibitors, prostacyclin analogues, and soluble guanylate cyclase stimulators. Eighty patients with Eisenmenger syndrome were treatment-naïve. While at inclusion the primary PAH treatment for the cohort was monotherapy (70% of patients), with 30% of the patients on combination therapy, after a median observation time of 45.3 months, the number of patients on combination therapy had increased significantly, to 50%. The use of oral anticoagulants or antiplatelets was dependent on the underlying diagnosis or comorbidities. In the entire COMPERA-CHD cohort, after follow-up and receiving targeted PAH therapy (n = 511), 91 patients died over the course of a 5-year follow up. The 5-year Kaplan-Meier survival estimate for CHD associated PH was significantly better than that for idiopathic PAH (76% vs. 54%; p < 0.001). Within the CHD associated PH group, survival estimates differed particularly depending on the underlying diagnosis and treatment status. CONCLUSIONS In COMPERA-CHD, the overall survival of patients with CHD associated PH was dependent on the underlying diagnosis and treatment status, but was significantly better as than that for idiopathic PAH. Nevertheless, overall survival of patients with PAH due to CHD was still markedly reduced compared with survival of patients with other types of CHD, despite an increasing number of patients on PAH-targeted combination therapy.
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Affiliation(s)
- Harald Kaemmerer
- Deutsches Herzzentrum München, Klinik für Angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, 80636 Munich, Germany;
- Correspondence: (H.K.); (M.G.); Tel.: +49-89-1218-3011(H.K.); Fax: +49-89-1218-3013 (H.K.)
| | - Matthias Gorenflo
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Angelika-Lautenschläger-Klinik, 69120 Heidelberg, Germany
- Correspondence: (H.K.); (M.G.); Tel.: +49-89-1218-3011(H.K.); Fax: +49-89-1218-3013 (H.K.)
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité Universitätsmedizin, 10117 Berlin, Germany;
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University, 01307 Dresden, Germany;
- GWT-TUD GmbH, Pharmacoepidemiology, 01307 Dresden, Germany
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Kardiologie, 89075 Ulm, Germany;
| | - Helmut Baumgartner
- Universitätsklinik Münster, Klinik für Angeborene (EMAH) und Erworbene Herzfehler, 48149 Münster, Germany; (H.B.); (G.-P.D.)
| | - Felix Berger
- Deutsches Herzzentrum Berlin, Klinik für Angeborene Herzfehler/Kinderkardiologie, 13353 Berlin, Germany; (F.B.); (O.M.)
| | - Leonhard Bruch
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin, 12683 Berlin, Germany;
| | - Eva Brunnemer
- Medizinische Universitätsklinik (Krehl-Klinik), Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), 69120 Heidelberg, Germany;
| | - Werner Budts
- UZ Leuven, Congenital and Structural Cardiology, Campus Gasthuisberg, 3000 Leuven, Belgium;
| | - Martin Claussen
- LungenClinic Grosshansdorf, Fachabteilung Pneumologie, 22927 Großhansdorf, Germany;
| | - Gerry Coghlan
- Royal Free Hospital, Cardiology, London NW3 2QG, UK;
| | - Ingo Dähnert
- Herzzentrum Leipzig GmbH, Klinik für Kinderkardiologie, 04289 Leipzig, Germany;
| | | | - Marion Delcroix
- Department of Respiratory Diseases, University Hospitals of Leuven, 3000 Leuven, Belgium;
| | - Oliver Distler
- Universitätsspital Zürich, Klinik für Rheumatologie, 8091 Zürich, Switzerland;
| | - Sven Dittrich
- Universitätsklinikum Erlangen, Kinderkardiologie, 91054 Erlangen, Germany;
| | - Daniel Dumitrescu
- HDZ NRW, Klinik für Thorax- und Kardiovaskularchirurgie, 32545 Bad Oeynhausen, Germany;
| | - Ralf Ewert
- Universitätsmedizin Greifswald, Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, 17475 Greifswald, Germany;
| | - Martin Faehling
- Klinikum Esslingen GmbH, Klinik für Kardiologie, Angiologie und Pneumologie, 73730 Esslingen a.N., Germany;
| | - Ingo Germund
- Uniklinik Köln—Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, 50937 Köln, Germany;
| | | | - Christian Grohé
- Evangelische Lungenklinik Berlin, Klinik für Pneumologie, 13125 Berlin, Germany;
| | - Karsten Grossekreymborg
- Kinderherzzentrum und Zentrum für Angeborene Herzfehler, Justus-Liebig Universität, Zentrum für Kinderheilkunde, Abteilung Kinderkardiologie, 35390 Giessen, Germany;
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Medizinische Klinik und Poliklinik I, 01307 Dresden, Germany;
| | - Georg Hansmann
- Medizinische Hochschule Hannover, Zentrum für Pulmonale Hypertonie im Kindesalter/Klinik für pädiatrische Kardiologie und Intensivmedizin, 30625 Hannover, Germany;
| | - Dominik Harzheim
- Waldburg Zeil Kliniken Gmbh & Co. KG, Fachkliniken Wangen, Lungenzentrum Süd-West, Klinik für Pneumologie, Beatmungsmedizin und Allergologie, 88239 Wangen im Allgäu, Germany; (D.H.); (P.M.)
| | - Attila Nemes
- 2nd Dep. of Internal Medicine and Cardiology Center Hungary, Faculty of Medicine, Szent-Györgyi Albert Clinical Center, University of Szeged, 6725 Szeged, Hungary; (A.N.); (K.H.)
| | - Kalman Havasi
- 2nd Dep. of Internal Medicine and Cardiology Center Hungary, Faculty of Medicine, Szent-Györgyi Albert Clinical Center, University of Szeged, 6725 Szeged, Hungary; (A.N.); (K.H.)
| | - Matthias Held
- Missionsärztliche Klinik gGmbH, Abteilung für Innere Medizin, 97074 Würzburg, Germany;
| | - Marius M. Hoeper
- Medizinische Hochschule Hannover, Abt. Pneumologie, 30625 Hannover, Germany;
| | - Michael Hofbeck
- Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Kinderkardiologie, Pulmologie, Intensivmedizin, 72076 Tübingen, Germany;
| | | | - Elena Jurevičienė
- Faculty of Medicine of Vilnius University; Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros klinikos, 08661 Vilnius, Lithuania; (E.J.); (L.G.)
| | - Lina Gumbienè
- Faculty of Medicine of Vilnius University; Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros klinikos, 08661 Vilnius, Lithuania; (E.J.); (L.G.)
| | - Hans-Joachim Kabitz
- Gemeinnützige Krankenhausbetriebsgesellschaft Konstanz mbH, Medizinische Klinik II, 78464 Konstanz, Germany;
| | - Hans Klose
- Universitätsklinikum Hamburg Eppendorf, Studienzentrale Pneumologie, 20251 Hamburg, Germany;
| | - Thomas Köhler
- Universitätsklinikum Freiburg, Medizinische Klinik, Abteilung Pneumologie, 79106 Freiburg, Germany;
| | | | - Martin Köestenberger
- LKH - Univ. Klinikum Graz, Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Kardiologie, 8036 Graz, Austria;
| | - Rainer Kozlik-Feldmann
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Kinderkardiologie, 20251 Hamburg, Germany;
| | - Hans-Heiner Kramer
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler & Kinderkardiologie (Haus 9), 24105 Kiel, Germany;
| | | | - Astrid Lammers
- Westfälische Wilhelms-Universität Münster, Klinik für Kinder- und Jugendmedizin - Pädiatrische Kardiologie, 48149 Münster, Germany;
| | - Tobias Lange
- Universitätsklinikum Regensburg, Medizinische Klinik und Poliklinik II, 93053 Regensburg, Germany;
| | - Philipp Meyn
- Waldburg Zeil Kliniken Gmbh & Co. KG, Fachkliniken Wangen, Lungenzentrum Süd-West, Klinik für Pneumologie, Beatmungsmedizin und Allergologie, 88239 Wangen im Allgäu, Germany; (D.H.); (P.M.)
| | - Oliver Miera
- Deutsches Herzzentrum Berlin, Klinik für Angeborene Herzfehler/Kinderkardiologie, 13353 Berlin, Germany; (F.B.); (O.M.)
| | | | - Rhoia Neidenbach
- Deutsches Herzzentrum München, Klinik für Angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, 80636 Munich, Germany;
| | - Claus Neurohr
- Klinik Schillerhöhe, Abteilung für Pneumologie und Beatmungsmedizin, 70839 Gerlingen, Germany;
| | - Christian Opitz
- DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Schwerpunkt Kardiologie, 14050 Berlin, Germany;
| | | | | | - Gabriele Riemekasten
- Clinic of Rheumatology and Clinical Immunology, University of Lübeck, University Clinic Schleswig Holstein, 23562 Lübeck, Germany;
| | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo University of Pavia, 27100 Pavia- PV Italy, Germany;
| | - Werner Scholtz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany;
| | - Iveta Simkova
- Dept. Cardiology and Angiology, Faculty of Medicine, Slovak Medical University and National Institute of Cardiovascular Diseases, 83348 Bratislava, Slovakia;
| | - Dirk Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Innere Medizin-Kardiologie/Pneumologie, 53127 Bonn, Germany;
| | - Andris Skride
- Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia;
| | - Gerd Stähler
- Klinik Löwenstein, Medizinische Klinik I, 74245 Löwenstein, Germany;
| | - Brigitte Stiller
- Universitäts-Herzzentrum Freiburg - Bad Krozingen, Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie, 79189 Freiburg, Germany;
| | - Iraklis Tsangaris
- 2nd Critical Care Department, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Carmine Dario Vizza
- Pulmonary Hypertension Center, Dept. Clnical, Anestesiologic and Cardiovascular Sciences, University of Rome La Sapienza, 00185 Rome, Italy;
| | | | - Heinrike Wilkens
- Universitätsklinikum des Saarlandes, Innere Medizin V, 66421 Homburg, Germany;
| | - Hubert Wirtz
- Universitätsklinikum Leipzig, Medizinische Klinik und Poliklinik I, Abteilung für Pneumologie, 04103 Leipzig, Germany;
| | - Gerhard-Paul Diller
- Universitätsklinik Münster, Klinik für Angeborene (EMAH) und Erworbene Herzfehler, 48149 Münster, Germany; (H.B.); (G.-P.D.)
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg gGmbH, Zentrum für Pulmonale Hypertonie, 69126 Heidelberg, Germany;
| | - Stephan Rosenkranz
- Universitätsklinik Köln- Herzzentrum, Klinik III für Innere Medizin, 50937 Köln, Germany;
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Piccininni M, Rohmann JL, Huscher D, Mielke N, Ebert N, Logroscino G, Schäffner E, Kurth T. Correction: Performance of risk prediction scores for cardiovascular mortality in older persons: External validation of the SCORE OP and appraisal. PLoS One 2020; 15:e0233051. [PMID: 32374778 PMCID: PMC7202620 DOI: 10.1371/journal.pone.0233051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0231097.].
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Mielke N, Huscher D, Douros A, Ebert N, Gaedeke J, van der Giet M, Kuhlmann MK, Martus P, Schaeffner E. Self-reported medication in community-dwelling older adults in Germany: results from the Berlin Initiative Study. BMC Geriatr 2020; 20:22. [PMID: 31964342 PMCID: PMC6974973 DOI: 10.1186/s12877-020-1430-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/14/2020] [Indexed: 01/10/2023] Open
Abstract
Background Older adults have the highest drug utilization due to multimorbidity. Although the number of people over age 70 is expected to double within the next decades, population-based data on their medication patterns are scarce especially in combination with polypharmacy and potentially inappropriate medication (PIM). Our objective was to analyse the frequency of polypharmacy, pattern of prescription (PD) and over-the-counter (OTC) drug usage, and PIMs according to age and gender in a population-based cohort of very old adults in Germany. Methods Cross-sectional baseline data of the Berlin Initiative Study, a prospective cohort study of community-dwelling adults aged ≥70 years with a standardized interview including demographics, lifestyle variables, co-morbidities, and medication assessment were analysed. Medication data were coded using the Anatomical Therapeutic Chemical (ATC) classification. Age- and sex-standardized descriptive analysis of polypharmacy (≥5 drugs, PD and OTC vs. PD only and regular and on demand drugs vs regular only), medication frequency and distribution, including PIMs, was performed by age (</≥80) and gender. Results Of 2069 participants with an average age of 79.5 years, 97% (95%CI [96%;98%]) took at least one drug and on average 6.2 drugs (SD = 3.5) with about 40 to 66% fulfilling the criteria of polypharmacy depending on the definition. Regarding drug type more female participants took a combination of PD and OTC (male: 68%, 95%CI [65%;72%]); female: 78%, 95%CI [76%;80%]). Most frequently used were drugs for cardiovascular diseases (85%, 95%CI [83%;86%]). Medication frequency increased among participants aged ≥80 years, especially for cardiovascular drugs, antithrombotics, psychoanaleptics and dietary supplements. Among the top ten prescription drugs were mainly cardiovascular drugs including lipid-lowering agents (simvastatin), beta-blockers (metoprolol, bisoprolol) and ACE inhibitors (ramipril). The most common OTC drug was acetylsalicylic acid (35%; 95%CI [33%;37%])). Dose-independent PIM were identified for 15% of the participants. Conclusions Polypharmacy was excessive in older adults, with not only PD but also OTC drugs contributing to the high point prevalence. The medication patterns reflected the treatment of chronic diseases in this age group. There was even an increase in medication frequency between below and above 80 years especially for drugs of cardiovascular diseases, antithrombotic medication, psychoanaleptics, and dietary supplements.
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Affiliation(s)
- Nina Mielke
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Dörte Huscher
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonios Douros
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
| | - Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Gaedeke
- Departement of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Departement of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Medical Biostatistics, Eberhard Karls-University, Tübingen, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Humrich JY, von Spee-Mayer C, Siegert E, Bertolo M, Rose A, Abdirama D, Enghard P, Stuhlmüller B, Sawitzki B, Huscher D, Hiepe F, Alexander T, Feist E, Radbruch A, Burmester GR, Riemekasten G. Low-dose interleukin-2 therapy in refractory systemic lupus erythematosus: an investigator-initiated, single-centre phase 1 and 2a clinical trial. Lancet Rheumatol 2019; 1:e44-e54. [PMID: 38229359 DOI: 10.1016/s2665-9913(19)30018-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND An acquired deficiency of interleukin-2 (IL-2) and related defects in regulatory T cell homeostasis are thought to play a crucial role in the pathogenesis of systemic lupus erythematosus. We hypothesised that reconstitution of regulatory T-cell homoeostasis with low doses of IL-2 would be beneficial to patients with systemic lupus erythematosus. METHODS In this uncontrolled, phase 1 and 2a trial done in the Department of Rheumatology and Clinical Immunology at Charité-University Medicine Berlin (Berlin, Germany), we assessed the safety and tolerability of low-dose recombinant human IL-2 (aldesleukin) and its effects on regulatory T cells. We recruited patients aged 18-75 years with a confirmed diagnosis of systemic lupus erythematosus and moderate-to-severe disease activity despite previous treatment with at least two conventional therapies. Patients were given four cycles of low-dose aldesleukin daily for 5 days followed by a 9-16 day rest. The primary endpoints were safety and the number of patients who achieved at least a 100% increase in the proportion of CD25hi-expressing cells among circulating CD3 + CD4 + FOXP3 + CD127lo regulatory T cells at day 62 (ie, after four treatment cycles). Secondary endpoints included disease activity as measured by the Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and the British Isles Lupus Assessment Group (BILAG) score, disease flares as measured by the SLEDAI flare index, auto-antibody and complement concentrations at day 62. Exploratory endpoints included various cellular and immunological parameters. The trial is registered with WHO/ICTRP, number DRKS00004858. FINDINGS Between March 31, 2014, and May 27, 2016, 13 patients were screened, of whom ten met eligibility criteria and were enrolled in the trial. Two additional patients were treated between April 1, 2013, and March 11, 2014, in a compassionate use setting. Eleven (92%) of the 12 patients achieved the primary endpoint. 159 adverse events were recorded, 75 (47%) of which were treatment related. Most treatment-related adverse events were transient and mild to moderate (grade 1-2). The most common adverse event was injection-site reaction (20%). No serious adverse events occurred during the treatment period. In ten (83%) of 12 patients, SELENA-SLEDAI scores were lower at day 62 than at baseline, and no severe disease flares were observed during the treatment period. Decreased disease activity correlated with the magnitude of increase in the proportion of activated regulatory T cells. IL-2 treatment resulted in a preferential proliferation of regulatory T cells that retained suppressive capacity. We observed decreases in cells that are involved in the regulation of germinal-centre reactions. INTERPRETATION Low-dose IL-2 therapy is safe and well tolerated and selectively promotes the expansion of functional regulatory T cells in patients with moderate-to-severe systemic lupus erythematosus. Low-dose IL-2 treatment might also be beneficial in reducing disease activity, although larger trials are needed to address efficacy. FUNDING German Research Foundation.
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Affiliation(s)
- Jens Y Humrich
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany; Department of Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Caroline von Spee-Mayer
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany; Centre for Chronic Immunodeficiency, University Hospital Freiburg, Freiburg, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Martina Bertolo
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany; Department of Nephrology and Intensive Care Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Angelika Rose
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Dimas Abdirama
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Philipp Enghard
- Department of Nephrology and Intensive Care Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Bruno Stuhlmüller
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Birgit Sawitzki
- Institute of Medical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Falk Hiepe
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Andreas Radbruch
- German Rheumatism Research Centre Berlin, a Leibniz Institute, Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany; Department of Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein, Lübeck, Germany
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Valentini G, Huscher D, Riccardi A, Fasano S, Irace R, Messiniti V, Matucci-Cerinic M, Guiducci S, Distler O, Maurer B, Avouac J, Tarner IH, Frerix M, Riemekasten G, Siegert E, Czirják L, Lóránd V, Denton CP, Nihtyanova S, Walker UA, Jaeger VK, Del Galdo F, Abignano G, Ananieva LP, Gherghe AM, Mihai C, Henes JC, Schmeiser T, Vacca A, Moiseev S, Foeldvari I, Gabrielli A, Krummel-Lorenz B, Rednic S, Allanore Y, Müeller-Ladner U. Vasodilators and low-dose acetylsalicylic acid are associated with a lower incidence of distinct primary myocardial disease manifestations in systemic sclerosis: results of the DeSScipher inception cohort study. Ann Rheum Dis 2019; 78:1576-1582. [PMID: 31391176 DOI: 10.1136/annrheumdis-2019-215486] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the influence of vasodilator drugs on the occurrence of features depending on myocardial ischaemia/fibrosis (ventricular arrhythmias, Q waves, cardiac blocks, pacemaker implantation, left ventricular ejection fraction (LVEF) <55%, and/or congestive heart failure and sudden cardiac death) in systemic sclerosis (SSc). METHODS 601 patients with SSc were enrolled from 1 December 2012 to 30 November 2015 and had a second visit 0.5-4 years apart. 153 received no vasodilators; 448 received vasodilator therapy (ie, calcium channel blockers and/or ACE inhibitors or angiotensin II receptor blockers or combinations of them), 89 of them being also treated with either endothelin receptor antagonists or PDE5 inhibitors or prostanoids. Associations between the occurrence of myocardial disease manifestations and any demographic, disease and therapeutic aspect were investigated by Cox regression analysis. A Cox frailty survival model with centre of enrolment as random effect was performed. RESULTS During 914 follow-up patient-years, 12 ventricular arrhythmias, 5 Q waves, 40 cardiac blocks, 6 pacemaker implantations and 19 reduced LVEF and/or congestive heart failure (CHF) occurred. In multivariate Cox regression analysis, vasodilator therapy was associated with a lower incidence of ventricular arrhythmias (p=0.03); low-dose acetylsalicylic acid (ASA) with a lower incidence of cardiac blocks and/or Q waves and/or pacemaker implantation (p=0.02); active disease with a higher incidence of LVEF <55% and/or CHF and cardiac blocks and/or Q waves and/or pacemaker implantation (p=0.05). CONCLUSIONS The present study might suggest a preventative effect on the occurrence of distinct myocardial manifestations by vasodilator therapy and low-dose ASA.
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Affiliation(s)
- Gabriele Valentini
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Dörte Huscher
- Institute of Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Antonella Riccardi
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Serena Fasano
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rosaria Irace
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Valentina Messiniti
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Jérôme Avouac
- Department of Rheumatology, Cochin Hospital, University of Paris Descartes, Paris, France
| | - Ingo H Tarner
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology, Universitatsklinikum Schleswig Holstein-Campus Lubeck, Lübeck, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitäetsmedizin Berlin, Berlin, Germany
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Veronika Lóránd
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Christopher P Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom
| | - Svetlana Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom
| | - Ulrich A Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | | | - Francesco Del Galdo
- Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
| | - Giuseppina Abignano
- Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom.,Rheumatology Institute of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Lidia P Ananieva
- Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russian Federation
| | - Ana Maria Gherghe
- Internal Medicine and Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carina Mihai
- Internal Medicine and Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Joerg Christoph Henes
- Department of Internal Medicine II, University Hospitals Tübingen, Tübingen, Germany
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | | | - Sergey Moiseev
- Sechenov First Moscow State Medical University and Lomonosov Moscow State University, Moscow, Russia
| | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Armando Gabrielli
- Clinical Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Simona Rednic
- Department of Rheumatology, University of Medicine and Pharmacy 'luliu Hatieganu' Cluj, Cluj-Napoca, Romania
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, University of Paris Descartes, Paris, France
| | - Ulf Müeller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
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Radic M, Becker MO, Distler O, Huscher D, Siegert E, Riemekasten G. Does angiotensin and endothelin receptor blockade have an impact on lung function? An analysis from the EUSTAR database. Clin Exp Rheumatol 2019; 37 Suppl 119:154-155. [PMID: 31573474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Mislav Radic
- University Hospital Split, Rheumatology and Clinical Immunology, Split, Croatia, and University Hospital Charité, Rheumatology and Clinical Immunology, Berlin, Germany.
| | - Mike Oliver Becker
- University Hospital Charité, Rheumatology and Clinical Immunology, Berlin, Germany, and Rheumatology, University Hospital Zurich, Switzerland
| | | | - Dörte Huscher
- German Rheumatism Research Centre Berlin, Epidemiology, Berlin, Germany
| | - Elise Siegert
- University Hospital Charité, Rheumatology and Clinical Immunology, Berlin, Germany
| | - Gabriela Riemekasten
- University Hospital Charité, Rheumatology and Clinical Immunology, Berlin, and University Hospital Schleswig-Holstein, Rheumatology, Lübeck, Germany
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Ebert N, Huscher D, Lakenbrink C, Jens G, Van Der Giet M, Kuhlmann M, Mielke N, Loesment-Wendelmuth A, Schaeffner E. SP212INCIDENCE OF ACUTE KIDNEY INJURY IN A COMMUNITY-BASED POPULATION OF OLDER ADULTS - DATA FROM THE BERLIN INITIATIVE STUDY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Nina Mielke
- Charité University, Berlin, Germany, Germany
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Ebert N, Huscher D, Soerensen-Zender I, Mielke N, Schaeffner E, Schmitt R. FP415NO ASSOCIATION OF AZGP1 SERUM LEVELS WITH MORTALITY AND CARDIOVASCULAR EVENTS IN A COMMUNITY-BASED POPULATION OF OLDER ADULTS - DATA FROM THE BERLIN INITIATIVE STUDY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Nina Mielke
- Charité University, Berlin, Germany, Germany
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Becker MO, Radic M, Schmidt K, Huscher D, Riedlinger A, Michelfelder M, Meisel C, Ewert R, Burmester GR, Riemekasten G. Serum cytokines and their predictive value in pulmonary involvement of systemic sclerosis. Sarcoidosis Vasc Diffuse Lung Dis 2019; 36:274-284. [PMID: 32476963 DOI: 10.36141/svdld.v36i4.7612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/20/2019] [Indexed: 11/02/2022]
Abstract
Objective To identify serum cytokines which predict mortality and/or disease progression in patients with systemic sclerosis, especially with pulmonary involvement. Methods Serum cytokines (IL-6, IL-7, IL-8, IL-10, CCL2, CCL4, TGF-β, TNF-α) were measured in 125 SSc patients, who were recruited and observed in our outpatient clinic. Of these, 60 had pulmonary involvement, classified as either interstitial lung disease (ILD, 43 patients), pulmonary arterial hypertension (PAH, 7 patients) or pulmonary hypertension and ILD (PH-ILD, 10 patients). The association of serum cytokines with clinical features was analysed and their correlation with BAL cytokines measured in a subset of SSc patients with ILD. Results Serum cytokines were detected at different levels: high (TGF-β, median 287.5 pg/ml; CCL2, median 89.7 pg/ml; CCL4, median 104.2 pg/ml), low (IL-6, median 3.2 pg/ml; IL-7 median 2.3 pg/ml; IL-8, median 5.2 pg/ml; TNF-α, median 0 pg/ml but with a bimodal distribution) and very low (IL-10, median 0.4 pg/ml). IL-6 and IL-7 were predictive for death in a Cox regression analysis in all SSc patients as well as in all patients with pulmonary involvement; IL-6 was predictive for mortality in SSc-ILD patients. In a multivariate analysis, cytokine levels could also predict a change in lung function, e.g. IL-7 was a predictor for a decline of diffusion capacity (DLCO) by 20 or 30% in ILD patients. In a subset of ILD patients, serum cytokines were compared to BAL cytokines, but revealed only few correlations. Conclusion In conclusion, the analysis of serum cytokines implicates a role as biomarkers, distinct from BAL.
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Affiliation(s)
- Mike Oliver Becker
- equal contribution.,University Hospital Zürich, Dept of Rheumatology, Zürich, Switzerland
| | - Mislav Radic
- equal contribution.,University Hospital Split, Dept of Rheumatology and Clinical Immunology, Croatia
| | - Katrin Schmidt
- University Hospital Charité, Dept of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Dörte Huscher
- German Rheumatism Research Centre (DRFZ), a Leibniz Institute, Epidemiology Unit, Berlin, Germany
| | - Arne Riedlinger
- University Hospital Charité, Dept of Rheumatology and Clinical Immunology, Berlin, Germany.,Dept of Neurology, Asklepios Hospital, Teupitz, Germany
| | - Marissa Michelfelder
- University Hospital Charité, Dept of Rheumatology and Clinical Immunology, Berlin, Germany.,Dept of Anesthesiology, University Hospital Bonn, Germany
| | - Christian Meisel
- University Hospital Charité, Clinical Laboratory, Berlin, Germany
| | - Ralf Ewert
- University Medicine Greifswald, Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases
| | - Gerd-Rüdiger Burmester
- University Hospital Charité, Dept of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Gabriela Riemekasten
- University Hospital Lübeck, Dept of Rheumatology and Research Center Borstel, a Leibniz institute
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Douros A, Tölle M, Ebert N, Gaedeke J, Huscher D, Kreutz R, Kuhlmann MK, Martus P, Mielke N, Schneider A, Schuchardt M, van der Giet M, Schaeffner E. Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study. Eur Heart J 2019; 40:2021-2028. [DOI: 10.1093/eurheartj/ehz071] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/09/2018] [Accepted: 02/02/2019] [Indexed: 01/21/2023] Open
Abstract
Abstract
Aims
To assess whether blood pressure (BP) values below 140/90 mmHg during antihypertensive treatment are associated with a decreased risk of all-cause mortality in community-dwelling older adults.
Methods and results
Within the Berlin Initiative Study, we assembled a cohort of patients ≥70 years treated with antihypertensive drugs at baseline (November 2009–June 2011). End of prospective follow-up was December 2016. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality associated with normalized BP [systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg] compared with non-normalized BP (SBP ≥140 mmHg or DBP ≥90 mmHg) overall and after stratification by age or previous cardiovascular events. Among 1628 patients (mean age 81 years) on antihypertensive drugs, 636 exhibited normalized BP. During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with an increased risk of all-cause mortality (incidence rates: 60.3 vs. 48.5 per 1000/year; HR 1.26; 95% CI 1.04–1.54). Increased risks were observed in patients ≥80 years (102.2 vs. 77.5 per 1000/year; HR 1.40; 95% CI 1.12–1.74) and with previous cardiovascular events (98.3 vs. 63.6 per 1000/year; HR 1.61; 95% CI 1.14–2.27) but not in patients aged 70–79 years (22.6 vs. 22.7 per 1000/year; HR 0.83; 95% CI 0.54–1.27) or without previous cardiovascular events (45.2 vs. 44.4 per 1000/year; HR 1.16, 95% CI 0.90–1.48).
Conclusion
Blood pressure values below 140/90 mmHg during antihypertensive treatment may be associated with an increased risk of mortality in octogenarians or elderly patients with previous cardiovascular events.
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Affiliation(s)
- Antonios Douros
- Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, 1020 Pine Ave. West, Montreal, Quebec, Canada
| | - Markus Tölle
- Department of Nephrology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
| | - Jens Gaedeke
- Department of Nephrology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
| | - Dörte Huscher
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
- Institute of Biostatistics and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Medical Biostatistics, Eberhard Karls-University, Silcherstraße 5, Tübingen, Germany
| | - Nina Mielke
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
| | - Alice Schneider
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
- Institute of Biostatistics and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
| | - Mirjam Schuchardt
- Department of Nephrology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, Berlin, Germany
| | - Markus van der Giet
- Department of Nephrology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany
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Blagojevic J, Bellando-Randone S, Abignano G, Avouac J, Cometi L, Czirják L, Denton CP, Distler O, Frerix M, Guiducci S, Huscher D, Jaeger VK, Lóránd V, Maurer B, Nihtyanova S, Riemekasten G, Siegert E, Tarner IH, Vettori S, Walker UA, Allanore Y, Müller-Ladner U, Del Galdo F, Matucci-Cerinic M. Classification, categorization and essential items for digital ulcer evaluation in systemic sclerosis: a DeSScipher/European Scleroderma Trials and Research group (EUSTAR) survey. Arthritis Res Ther 2019; 21:35. [PMID: 30678703 PMCID: PMC6346551 DOI: 10.1186/s13075-019-1822-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/06/2018] [Accepted: 01/11/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A consensus on digital ulcer (DU) definition in systemic sclerosis (SSc) has been recently reached (Suliman et al., J Scleroderma Relat Disord 2:115-20, 2017), while for their evaluation, classification and categorisation, it is still missing. The aims of this study were to identify a set of essential items for digital ulcer (DU) evaluation, to assess if the existing DU classification was useful and feasible in clinical practice and to investigate if the new categorisation was preferred to the simple distinction of DU in recurrent and not recurrent, in patients with systemic sclerosis (SSc). METHODS DeSScipher is the largest European multicentre study on SSc. It consists of five observational trials (OTs), and one of them, OT1, is focused on DU management. The DeSScipher OT1 items on DU that reached ≥ 60% of completion rate were administered to EUSTAR (European Scleroderma Trials and Research group) centres via online survey. Questions about feasibility and usefulness of the existing DU classification (DU due to digital pitting scars, to loss of tissue, derived from calcinosis and gangrene) and newly proposed categorisation (episodic, recurrent and chronic) were also asked. RESULTS A total of 84/148 (56.8%) EUSTAR centres completed the questionnaire. DeSScipher items scored by ≥ 70% of the participants as essential and feasible for DU evaluation were the number of DU defined as a loss of tissue (level of agreement 92%), recurrent DU (84%) and number of new DU (74%). For 65% of the centres, the proposed classification of DU was considered useful and feasible in clinical practice. Moreover, 80% of the centres preferred the categorisation of DU in episodic, recurrent and chronic to simple distinction in recurrent/not recurrent DU. CONCLUSIONS For clinical practice, EUSTAR centres identified only three essential items for DU evaluation and considered the proposed classification and categorisation as useful and feasible. The set of items needs to be validated while further implementation of DU classification and categorisation is warranted. TRIAL REGISTRATION Observational trial on DU (OT1) is one of the five trials of the DeSScipher project (ClinicalTrials.gov; OT1 Identifier: NCT01836263 , posted on April 19, 2013).
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Affiliation(s)
- J. Blagojevic
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Villa Monna Tessa, viale Pieraccini 18, 50139 Florence, Italy
| | - S. Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Villa Monna Tessa, viale Pieraccini 18, 50139 Florence, Italy
| | - G. Abignano
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - J. Avouac
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | - L. Cometi
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Villa Monna Tessa, viale Pieraccini 18, 50139 Florence, Italy
| | - L. Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - C. P. Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - O. Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - M. Frerix
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Campus of the Justus-Liebig University Giessen, Bad Nauheim, Germany
| | - S. Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Villa Monna Tessa, viale Pieraccini 18, 50139 Florence, Italy
| | - D. Huscher
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - V. K. Jaeger
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - V. Lóránd
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - B. Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - S. Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - G. Riemekasten
- Clinic of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - E. Siegert
- Department of Rheumatology and Clinical Immunology, Charité – Universitaetsmedizin Berlin, Corporate member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - I. H. Tarner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Campus of the Justus-Liebig University Giessen, Bad Nauheim, Germany
| | - S. Vettori
- Rheumatology Section, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - U. A. Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - Y. Allanore
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | - U. Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Campus of the Justus-Liebig University Giessen, Bad Nauheim, Germany
| | - F. Del Galdo
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - M. Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Villa Monna Tessa, viale Pieraccini 18, 50139 Florence, Italy
| | - EUSTAR co-workers
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Villa Monna Tessa, viale Pieraccini 18, 50139 Florence, Italy
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
- Department of Rheumatology, University of Paris Descartes, Paris, France
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Campus of the Justus-Liebig University Giessen, Bad Nauheim, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Rheumatology, University of Basel, Basel, Switzerland
- Clinic of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
- Department of Rheumatology and Clinical Immunology, Charité – Universitaetsmedizin Berlin, Corporate member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Rheumatology Section, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Jaeger VK, Distler O, Maurer B, Czirják L, Lóránd V, Valentini G, Vettori S, Del Galdo F, Abignano G, Denton C, Nihtyanova S, Allanore Y, Avouac J, Riemekasten G, Siegert E, Huscher D, Matucci-Cerinic M, Guiducci S, Frerix M, Tarner IH, Garay Toth B, Fankhauser B, Umbricht J, Zakharova A, Mihai C, Cozzi F, Yavuz S, Hunzelmann N, Rednic S, Vacca A, Schmeiser T, Riccieri V, García de la Peña Lefebvre P, Gabrielli A, Krummel-Lorenz B, Martinovic D, Ancuta C, Smith V, Müller-Ladner U, Walker UA. Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group. Rheumatology (Oxford) 2018; 57:441-450. [PMID: 28499034 DOI: 10.1093/rheumatology/kex182] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives The multisystem manifestations of SSc can greatly impact patients' quality of life. The aim of this study was to identify factors associated with disability in SSc. Methods SSc patients from the prospective DeSScipher cohort who had completed the scleroderma health assessment questionnaire (SHAQ), a disability score that combines the health assessment questionnaire and five visual analogue scales, were included in this analysis. The effect of factors possibly associated with disability was analysed with multiple linear regressions. Results The mean SHAQ and HAQ scores of the 944 patients included were 0.87 (s.d. = 0.66) and 0.92 (s.d. = 0.78); 59% of the patients were in the mild to moderate difficulty SHAQ category (0 ⩽ SHAQ < 1), 34% in the moderate to severe disability category (1 ⩽ SHAQ < 2) and 7% in the severe to very severe disability category (2 ⩽ SHAQ ⩽ 3). The means of the visual analogue scales scores were in order of magnitude: overall disease severity (37 mm), RP (31 mm), pulmonary symptoms (24 mm), gastrointestinal symptoms (20 mm) and digital ulcers (19 mm). In multiple regression, the main factors associated with high SHAQ scores were the presence of dyspnoea [modified New York Heart Association (NYHA) class IV (regression coefficient B = 0.62), modified NYHA class III (B = 0.53) and modified NYHA class II (B = 0.21; all vs modified NYHA class I)], FM (B = 0.37), muscle weakness (B = 0.27), digital ulcers (B = 0.20) and gastrointestinal symptoms (oesophageal symptoms, B = 0.16; stomach symptoms, B = 0.15; intestinal symptoms, B = 0.15). Conclusion SSc patients perceive dyspnoea, pain, digital ulcers, muscle weakness and gastrointestinal symptoms as the main factors driving their level of disability, unlike physicians who emphasize objective measures of disability.
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Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Laszlo Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | - Veronika Lóránd
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | | | - Serena Vettori
- Department of Rheumatology, Second University of Naples, Naples, Italy
| | - Francesco Del Galdo
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Giuseppina Abignano
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Christopher Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Svetlana Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Yannick Allanore
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | - Jerome Avouac
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | | | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, University Hospital Charité
| | | | | | - Serena Guiducci
- Department of Rheumatology, University of Florence, Florence, Italy
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ingo H Tarner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Beata Garay Toth
- Federation of European Scleroderma Associations Aisbl, Budapest, Hungary
| | | | | | | | - Carina Mihai
- Department of Internal Medicine and Rheumatology, Dr Ion Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Sule Yavuz
- Department of Rheumatology, University of Marmara, Altunizade-Istanbul, Turkey
| | | | - Simona Rednic
- Clinica Reumatologie, University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Vacca
- II Chair of Rheumatology, University of Cagliari-Policlinico Universitario, Monserrato, Italy
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Krankenhaus St Josef, Wuppertal, Germany
| | - Valeria Riccieri
- Divisione di Reumatologia, Università di Roma La Sapienza, Roma, Italy
| | | | - Armando Gabrielli
- Istituto di Clinica Medica Generale, Ematologia ed Immunologia Clinica, Università Politecnica delle Marche, Ancona, Italy
| | | | - Duska Martinovic
- Division of Rheumatology, University Hospital of Split, Split, Croatia
| | - Codrina Ancuta
- Rheumatology 2 Department, Clinical Rehabilitation Hospital, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania
| | - Vanessa Smith
- Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel
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Adler S, Huscher D, Siegert E, Allanore Y, Czirják L, DelGaldo F, Denton CP, Distler O, Frerix M, Matucci-Cerinic M, Mueller-Ladner U, Tarner IH, Valentini G, Walker UA, Villiger PM, Riemekasten G. Systemic sclerosis associated interstitial lung disease - individualized immunosuppressive therapy and course of lung function: results of the EUSTAR group. Arthritis Res Ther 2018; 20:17. [PMID: 29382380 PMCID: PMC5791165 DOI: 10.1186/s13075-018-1517-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/11/2018] [Indexed: 12/27/2022] Open
Abstract
Background Interstitial lung disease in systemic sclerosis (SSc-ILD) is a major cause of SSc-related death. Imunosuppressive treatment (IS) is used in patients with SSc for various organ manifestations mainly to ameliorate progression of SSc-ILD. Data on everyday IS prescription patterns and clinical courses of lung function during and after therapy are scarce. Methods We analysed patients fulfilling American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) 2013 criteria for SSc-ILD and at least one report of IS. Types of IS, pulmonary function tests (PFT) and PFT courses during IS treatment were evaluated. Results EUSTAR contains 3778/11,496 patients with SSc-ILD (33%), with IS in 2681/3,778 (71%). Glucocorticoid (GC) monotherapy was prescribed in 30.6% patients with GC combinations plus cyclophosphamide (CYC) (11.9%), azathioprine (AZA) (9.2%), methotrexate (MTX) (8.7%), or mycophenolate mofetil (MMF) (7.3%). Intensive IS (MMF + GC, CYC or CYC + GC) was started in patients with the worst PFTs and ground glass opacifications on imaging. Patients without IS showed slightly less worsening in forced vital capacity (FVC) when starting with FVC 50–75% or >75%. GC showed negative trends when starting with FVC <50%. Regarding diffusing capacity for carbon monoxide (DLCO), negative DLCO trends were found in patients with MMF. Conclusions IS is broadly prescribed in SSc-ILD. Clusters of clinical and functional characteristics guide individualised treatment. Data favour distinguished decision-making, pointing to either watchful waiting and close monitoring in the early stages or start of immunosuppressive treatment in moderately impaired lung function. Advantages of specific IS are difficult to depict due to confounding by indication. Data do not support liberal use of GC in SSc-ILD. Electronic supplementary material The online version of this article (10.1186/s13075-018-1517-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabine Adler
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.
| | - Dörte Huscher
- German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany.,Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pecs, Pecs, Hungary
| | | | - Christopher P Denton
- UCL Division of Medicine, Centre for Rheumatology, Royal Free Hospital, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Osteology and Physical Therapy, Justus-Liebig-University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Osteology and Physical Therapy, Justus-Liebig-University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Ingo-Helmut Tarner
- Department of Rheumatology and Clinical Immunology, Osteology and Physical Therapy, Justus-Liebig-University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - Ulrich A Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Gabriela Riemekasten
- Department of Rheumatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Zelniker TA, Huscher D, Vonk-Noordegraaf A, Ewert R, Lange TJ, Klose H, Dumitrescu D, Halank M, Held M, Gall H, Pittrow D, Hoeper MM, Frankenstein L. The 6MWT as a prognostic tool in pulmonary arterial hypertension: results from the COMPERA registry. Clin Res Cardiol 2018; 107:460-470. [PMID: 29368137 DOI: 10.1007/s00392-018-1207-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/08/2017] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with pulmonary arterial hypertension, the 6-Minute Walk Test (6MWT) is recommended for risk stratification and follow-up by all guidelines. However, the prognostic value of the 6MWT has been discussed controversially. We sought to compare and validate all published 6MWT cut-off points. METHODS From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)-registry we identified 2391 patients with pulmonary arterial hypertension who had at least one documented 6MWT measurement. A Medline search identified a total of 21 different threshold values for either single-point or change of 6MWT. All values were tested individually for prognostication of 1-year, 2-year and 3-year all-cause mortality. RESULTS The highest positive likelihood ratio was a cut-off value < 165 ms, whereas the best negative likelihood ratio was found to be a threshold of 440 ms. Furthermore, improvement in 6MWT had considerably less predictive value on mortality and survival than deterioration. Moreover, absolute single-point values outperformed change values for both improvement and worsening. CONCLUSION Our data confirmed the prognostic relevance of the 6MWT and support the cut-off values stated in most recent guidelines. Furthermore, these results explain why changes in 6MWT did not correlate consistently with prognosis in previous studies.
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Affiliation(s)
- Thomas A Zelniker
- Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Dörte Huscher
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Ralf Ewert
- Department of Internal Medicine, University of Greifswald, Greifswald, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, Division of Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Hans Klose
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Center of Oncology, Hamburg, Germany
| | - Daniel Dumitrescu
- Herzzentrum der Universität zu Köln, Klinik III für Innere Medizin, Cologne, Germany
| | - Michael Halank
- Department of Internal Medicine I, Carl Gustav Carus University Hospital, Technical University of Dresden, Dresden, Germany
| | - Matthis Held
- Department of Internal Medicine, Respiratory Medicine and Cardiology, MissioClinic, Würzburg, Germany
| | - Henning Gall
- Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University Dresden, Dresden, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, 30623, Hannover, Germany
- German Centre of Lung Research (DZL/BREATHE), Hannover, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Hoff P, Gaber T, Strehl C, Schmidt-Bleek K, Lang A, Huscher D, Burmester GR, Schmidmaier G, Perka C, Duda GN, Buttgereit F. Immunological characterization of the early human fracture hematoma. Immunol Res 2017; 64:1195-1206. [PMID: 27629117 DOI: 10.1007/s12026-016-8868-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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] [Indexed: 11/25/2022]
Abstract
The initial inflammatory phase of fracture healing is of great importance for the clinical outcome. We aimed to develop a detailed time-dependent analysis of the initial fracture hematoma. We analyzed the composition of immune cell subpopulations by flow cytometry and the concentration of cytokines and chemokines by bioplex in 42 samples from human fractures of long bones <72 h post-trauma. The early human fracture hematoma is characterized by maturation of granulocytes and migration of monocytes/macrophages and hematopoietic stem cells. Both T helper cells and cytotoxic T cells proliferate within the fracture hematoma and/or migrate to the fracture site. Humoral immunity characteristics comprise high concentration of pro-inflammatory cytokines such as IL-6, IL-8, IFNγ and TNFα, but also elevated concentration of anti-inflammatory cytokines, e.g., IL-1 receptor antagonist and IL-10. Furthermore, we found that cells of the fracture hematoma represent a source for key chemokines. Even under the bioenergetically restricted conditions that exist in the initial fracture hematoma, immune cells are not only present, but also survive, mature, function and migrate. They secrete a cytokine/chemokine cocktail that contributes to the onset of regeneration. We hypothesize that this specific microenvironment of the initial fracture hematoma is among the crucial factors that determine fracture healing.
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Affiliation(s)
- Paula Hoff
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany.
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany.
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany.
| | - T Gaber
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
| | - C Strehl
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
| | - K Schmidt-Bleek
- Julius Wolff Institute, Charité University Hospital, 13353, Berlin, Germany
| | - A Lang
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies (BSRT), 13353, Berlin, Germany
| | - D Huscher
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
| | - G Schmidmaier
- Department of Orthopedics, University Hospital Heidelberg, 69118, Heidelberg, Germany
| | - C Perka
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité University Hospital, 10117, Berlin, Germany
| | - G N Duda
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
- Julius Wolff Institute, Charité University Hospital, 13353, Berlin, Germany
| | - F Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
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Richter JG, Muth T, Li J, Brinks R, Chehab G, Koch T, Siegrist J, Angerer P, Huscher D, Schneider M. Elevated Psychosocial Stress at Work in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis. J Rheumatol 2017; 45:227-234. [DOI: 10.3899/jrheum.170233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 01/03/2023]
Abstract
Objective.Psychosocial stress at work not only affects the healthy working population, but also workers with chronic diseases. We aimed to investigate the psychosocial work stress levels in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Methods.A cross-sectional study applied the Effort-Reward Imbalance (ERI) questionnaire — an internationally established instrument that measures work stress — to patients with SLE and RA who were capable of work and to a group of controls without these diseases. Participants were recruited through rheumatologists in private practices, hospitals, and from self-help groups by personal communication, paper-based flyers, and online advertisements. Because very few studies tested the ERI’s applicability in patient groups, with a lack of evidence in patients with inflammatory rheumatic diseases, internal consistency and construct validity of the ERI measure were evaluated.Results.Data came from 270 patients with RA and 247 with SLE, and 178 controls. Patients showed elevated psychosocial stress at work compared to controls. Across the total sample and all groups, satisfactory internal consistencies of the scales effort, reward, and overcommitment were obtained (Cronbach’s alpha coefficients > 0.70), and confirmatory factor analysis replicated the theoretical structure of the ERI model (goodness-of-fit index > 0.80).Conclusion.We found elevated psychosocial stress at work in patients with SLE and RA compared to controls by applying the ERI model. Despite some heterogeneity in the sample, we achieved satisfactory psychometric properties of the ERI questionnaire. Our results suggest that the ERI questionnaire is a psychometrically useful tool to be implemented in epidemiological studies of employed patients with SLE and RA.
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Albrecht K, Huscher D, Buttgereit F, Aringer M, Hoese G, Ochs W, Thiele K, Zink A. Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database. Rheumatol Int 2017; 38:569-577. [PMID: 29124397 DOI: 10.1007/s00296-017-3874-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 07/11/2017] [Accepted: 11/03/2017] [Indexed: 11/27/2022]
Abstract
The objective of this study was to evaluate glucocorticoid (GC) use in patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) or both diseases (PMR + GCA) under rheumatological care. Data from patients with PMR (n = 1420), GCA (n = 177) or PMR + GCA (n = 261) from the National Database of the German Collaborative Arthritis Centers were analyzed regarding GCs and related comorbidities (osteoporosis, diabetes and cardiovascular disease), stratified by disease duration (DD). Longitudinal data were analyzed for all patients with a DD ≤ 2 years at database entry (n = 1397). Three-year data were available for 256 patients. Predictors of GC use ≥ 3 years were examined by logistic regression analyses. A total of 76% received GCs, and 19% (PMR) to 40% (GCA) received methotrexate. Median GC doses were 12.5 mg (PMR), 11.3 mg (GCA), and 20.0 mg/day (PMR + GCA) in a 0-6-month DD. Median GC doses ≤ 5 mg/day were reached at a 13-18-month DD in PMR patients and at a 19-24-month DD in GCA or PMR + GCA patients. In the multivariate analysis, baseline methotrexate (OR 2.03, [95% CI 1.27-3.24]), GCs > 10 mg/day (OR 1.65, [1.07-2.55]), higher disease activity (OR 1.12, [1.02-1.23]) (median 0.6 years DD), and female sex (OR 1.63 [1.09-2.43]) were predictive for GC therapy at ≥ 3 years. Of the examined comorbidities, only osteoporosis prevalence increased within 3 years. GC use for ≥ 3 years was reported in one-fourth of all the patients. A difficult-to-control disease activity within the first year was a good predictor of long-term GC need.
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Affiliation(s)
- Katinka Albrecht
- Epidemiology Unit, German Rheumatism Research Center, A Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany.
| | - Dörte Huscher
- Epidemiology Unit, German Rheumatism Research Center, A Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Martin Aringer
- Department of Rheumatology and Clinical Immunology, TU Dresden, Dresden, Germany
| | - Guido Hoese
- Private Specialty Practice for Rheumatology, Stadthagen, Germany
| | - Wolfgang Ochs
- Private Specialty Practice for Rheumatology, Bayreuth, Germany
| | - Katja Thiele
- Epidemiology Unit, German Rheumatism Research Center, A Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Center, A Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
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Reiser M, Borte M, Huscher D, Baumann U, Pittrow D, Sommer C, Stangel M, Fasshauer M, Gold R, Hensel M. Management of patients with malignancies and secondary immunodeficiencies treated with immunoglobulins in clinical practice: Long-term data of the SIGNS study. Eur J Haematol 2017; 99:169-177. [PMID: 28467615 DOI: 10.1111/ejh.12900] [Citation(s) in RCA: 20] [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] [Accepted: 04/24/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We aimed to describe the current management and outcomes of patients with secondary immunodeficiencies (SID) on intravenous (IV) or subcutaneous (SC) immunoglobulins (IG) as maintenance therapy to prevent infections. METHODS Non-interventional, prospective study (average follow-up 20.5 months). RESULTS Of the 307 SID patients (mean age 63.7±14.4 years, 52% males, in 31% IG newly initiated), 95.4% received IV IG (mean dosing interval 4.6 weeks, average dose 199 mg/kg per 4 weeks) and 4.6% were treated with SC IG (2.6 weeks, 343 mg/kg per 4 weeks). Median IG through level at first documentation was 5.8 g/L and did not differ between IV and SC treatment or between underlying malignancies. In 24.1% of patients, treatment was interrupted temporarily, over a mean of 11.6±6.3 months. In patients with newly initiated IG treatment the 82% overall infection rate prior to treatment dropped to 21% at 1 year. CONCLUSIONS Under clinical practice conditions, IG replacement therapy in SID patients was feasible, diminished infection rates and improved quality of life. Average IG doses were relatively low. Tolerability of IV IG treatment was excellent.
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Affiliation(s)
- Marcel Reiser
- PIOH - Praxis internistischer Onkologie und Hämatologie, Köln, Germany
| | - Michael Borte
- Paediatric Rheumatology, Immunology and Infectiology, Hospital St. Georg, Leipzig, Germany
| | - Dörte Huscher
- Epidemiology unit, German Rheumatism Research Centre, A Leibniz institute, Berlin, Germany
| | - Ulrich Baumann
- Paediatric Pulmonology, Allergy and Neonatology, Hanover Medical School, Hanover, Germany
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University Dresden, Dresden, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin Stangel
- Department of Neurology, Hanover Medical School, Hanover, Germany
| | - Maria Fasshauer
- Paediatric Rheumatology, Immunology and Infectiology, Hospital St. Georg, Leipzig, Germany
| | - Ralf Gold
- Department for Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
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Beyer C, Huscher D, Ramming A, Bergmann C, Avouac J, Guiducci S, Meier F, Vettori S, Siegert E, Jaeger VK, Maurer B, Riemekasten G, Walker U, Müller-Ladner U, Valentini G, Matucci-Cerinic M, Allanore Y, Distler O, Schett G, Distler JHW. Elevated serum levels of sonic hedgehog are associated with fibrotic and vascular manifestations in systemic sclerosis. Ann Rheum Dis 2017; 77:626-628. [DOI: 10.1136/annrheumdis-2016-210834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 01/23/2023]
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Amann J, Wessels AM, Breitenfeldt F, Huscher D, Bijlsma JWJ, Jacobs JWG, Buttgereit F. Quantifying cutaneous adverse effects of systemic glucocorticoids in patients with rheumatoid arthritis: a cross-sectional cohort study. Clin Exp Rheumatol 2017; 35:471-476. [PMID: 28094753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES EULAR guidelines state that adverse effects (AEs) of glucocorticoid (GC) therapy should be considered and discussed with the patient before treatment is initiated. However, reliable quantitative data, especially on cutaneous AEs of low-to-medium dose GCs are lacking. We performed a study assessing the occurrence of cutaneous AEs of GCs and its association with current and cumulative GC doses in patients with rheumatoid arthritis (RA). METHODS In a cross-sectional study performed in 2 outpatient rheumatology centres, 381 RA patients were enrolled. They were classed into 4 groups, according their mean daily dose during the past 12 months: 0 mg (n=87), <5mg (n=108), 5-7.5 mg (n=130), and >7.5 mg (n=56) of prednisone equivalent. AEs of GC on the skin were assessed by physical examination using a predefined scoring system, and by patients' self-assessments. Data were analysed according GC dose categories and cumulative doses. RESULTS Cushingoid habitus, easy bruising, skin atrophy, and impaired wound healing as reported by patients occurred significantly more frequently in those using a GC the past 12 months, compared to those not using a GC. At physicians' assessments, only Cushingoid habitus and ecchymosis were more prevalent in GC users. The prevalence of these AEs was statistically significantly positively associated with current and cumulative GC dose. There was low occurrence of abnormal stretch marks, acne, perioral dermatitis, alopecia and hirsutism, which were not correlated with GC use. CONCLUSIONS Certain GC-associated cutaneous AEs are common in RA, but other AEs of GC occur infrequently at the low-to-medium GC doses used in RA.
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Affiliation(s)
- Jonna Amann
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Anne-Marie Wessels
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands
| | - Friederike Breitenfeldt
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Dörte Huscher
- German Rheumatism Research Center Berlin, Epidemiology, Berlin, Germany
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands.
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
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Albrecht K, Huscher D. Verordnen wir ausreichend Physikalische Medizin? Aktuelle Daten aus der Kerndokumentation der Arbeitsgemeinschaft Regionaler Kooperativer Rheumazentren. AKTUEL RHEUMATOL 2017. [DOI: 10.1055/s-0042-116425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katinka Albrecht
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiologie, Berlin
| | - Dörte Huscher
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiologie, Berlin
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