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Oulkadi L, Rostom S, Hmamouchi I, Binoune IE, Amine B, Abouqal R, Achemlal L, Allali F, Bouchti IE, Maghraoui AE, Ghozlani I, Hassikou H, Harzy T, Ichchou L, Mkinsi O, Niamane R, Bahiri R. Therapeutic Maintenance Level of Methotrexate in Rheumatoid Arthritis: A RBSMR Study. Mediterr J Rheumatol 2022; 33:224-231. [PMID: 36128204 PMCID: PMC9450203 DOI: 10.31138/mjr.33.2.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives The aim of this study was to determine the therapeutic maintenance level of methotrexate for rheumatoid arthritis patients enrolled in the Moroccan biotherapy registry and to identify predictive factors for discontinuing MTX treatment. Methods A cross-sectional study was conducted using the baseline data of the Moroccan biotherapy registry for RBSMR (a multicentric study that aims to evaluate tolerance of biological therapy on patients affected with rheumatic diseases). Demographics and disease features were compared using descriptive statistics. Therapeutic maintenance levels were determined according to a Kaplan-Meier survival curve and a univariate Cox proportional hazards regression model was used to compare the strength of potential factors, followed by a multivariate Cox model to identify significant predictors of MTX discontinuation. Statistically significant results were considered for p values less than 0.05. Results 224 patients with rheumatoid arthritis were included in this study. The mean age of patients was 51.83±11.26 years with a majority of females (87.50%). The median duration of disease was 12 [1.66-41.02] years. The therapeutic maintenance level of MTX was 91.1% at 1 year, 87.1% at 2 years, and 68.3% at 5 years. The median of treatment duration was 2, 02 [0, 46-27,76] years. Causes of treatment interruption were side effects (66/88=75%), inefficiency (12/88=13.63%), and other reasons (10/88=11.36%). Predictive factors for stopping MTX were presence of rheumatoid factor (HR 2.24; 95% CI 1.14-5.15; p=0.02) and the access to education (HR 0.37; 95% CI 0.16-0.88; p=0.02). Conclusion The therapeutic maintenance level of MTX in our study was satisfactory and comparable to other series, and influenced by many factors such as the occurrence of a side effect. It is necessary to sensitise medical practitioners on symptomatic prevention and management of side effects.
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Affiliation(s)
- Lamia Oulkadi
- Department of Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - Samira Rostom
- Department of Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - Ihsane Hmamouchi
- Laboratory of Biostatistical, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Department of Rheumatology, Provincial Hospital of Temara, Morocco
| | - Imane El Binoune
- Department of Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - Bouchra Amine
- Department of Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - Redouane Abouqal
- Laboratory of Biostatistical, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Lahsen Achemlal
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - Fadoua Allali
- Department of Rheumatology B, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - Imane El Bouchti
- Department of Rheumatology, Arrazi University Hospital, Marrakech, Morocco
| | | | - Imad Ghozlani
- Department of Rheumatology, University Hospital of Agadir, Morocco
| | - Hasna Hassikou
- Department of Rheumatology, Military Hospital Moulay Ismail, Hassan II University Hospital, Meknès -Morocco
| | - Taoufik Harzy
- Department of Rheumatology, Hassan II University Hospital, Fès, Morocco
| | - Linda Ichchou
- Department of Rheumatology, Mohammed VI University Hospital, Oujda, Morocco
| | - Ouafae Mkinsi
- Department of Rheumatology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Radouane Niamane
- Department of Rheumatology, Military Hospital Avicenne, Mohammed VI University Hospital, Marrakech, Morocco
| | - Rachid Bahiri
- Department of Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
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Eddaoudi M, Rostom S, Hmamouchi I, Binoune IE, Amine B, Abouqal R, Achemlal L, Allali F, Bouchti IE, Maghraoui AE, Ghozlani I, Hassikou H, Harzy T, Ichchou L, Mkinsi O, Niamane R, Bahiri R. The first biological choice in patients with rheumatoid arthritis: data from the Moroccan register of biotherapies. Pan Afr Med J 2021; 38:183. [PMID: 33995789 PMCID: PMC8106777 DOI: 10.11604/pamj.2021.38.183.27081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/05/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction the aim of our study is to determine, from data of the Moroccan register of biotherapies, the factors influencing the choice of the first prescribed biological treatment. Methods cross-sectional multicenter study including rheumatoid arthritis patients who were initiated the first biological treatment either: Rituximab, an anti-TNF, or Tocilizumab. The determinants related to the patient and disease have been gathered. A univariate and then multivariate analysis to determine the factors associated with the choice of the first bDMARDs was realized. Results a total of 225 rheumatoid arthritis patients were included in the Moroccan registry. The mean age was 52 ± 11 years, with female predominance 88% (n = 197). The first prescribed biological treatment was Rituximab 74% (n = 166), the second one was Tocilizumab, 13.6% (n = 31) then comes the anti-TNF in 3rd position with 12.4% (n = 28). The factors associated with the choice of Rituximab as the first line bDMARDs prescribed in univariate analysis were: the insurance type, the positivity of the rheumatoid factor. In multivariate analysis, only the insurance type that remains associated with the choice of Rituximab as the first biological drugs. The Tocilizumab was associated with shorter disease duration and was more prescribed as mono-therapy compared to non Tocilizumab group. TNFi was associated with the insurance type. Conclusion our study suggests that Rituximab and TNFi are associated with the type of insurance and Tocilizumab is the most prescribed biologic mono-therapy in RA patients. Further studies are needed to confirm these results.
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Affiliation(s)
- Meryem Eddaoudi
- Rheumatology Department A, El Ayachi Hospital, Ibn Sina University Hospital, Rabat-Sale, Morocco
| | - Samira Rostom
- Rheumatology Department A, El Ayachi Hospital, Ibn Sina University Hospital, Rabat-Sale, Morocco
| | - Ihsane Hmamouchi
- Laboratory of Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, Rabat, Morocco.,Provincial Hospital, Skhirat-Temara, Morocco
| | - Imane El Binoune
- Rheumatology Department A, El Ayachi Hospital, Ibn Sina University Hospital, Rabat-Sale, Morocco
| | - Bouchra Amine
- Rheumatology Department A, El Ayachi Hospital, Ibn Sina University Hospital, Rabat-Sale, Morocco
| | - Redouane Abouqal
- Laboratory of Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Lahsen Achemlal
- Rheumatology Department, Military Hospital Mohamed V, Ibn Sina University Hospital, Rabat, Morocco
| | - Fadoua Allali
- Rheumatology Department B, El Ayachi Hospital, Ibn Sina University Hospital, Rabat-Sale, Morocco
| | - Imane El Bouchti
- Rheumatology Department, Arrazi Hospital, University Hospital Mohammed VI, Marrakech, Morocco
| | | | - Imad Ghozlani
- Rheumatology Department, University Hospital, Agadir, Morocco
| | - Hasna Hassikou
- Rheumatology Department, Military Hospital, Hassan II University Hospital, Meknes, Morocco
| | - Taoufik Harzy
- Rheumatology Department, University Hospital Hassan II, Fez, Morocco
| | - Linda Ichchou
- Rheumatology Department, University Hospital Mohammed VI, Oujda, Morocco
| | - Ouafae Mkinsi
- Rheumatology Department, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Redouane Niamane
- Rheumatology Department, Military Hospital Avicenne, University Hospital Mohammed VI, Marrakech, Morocco
| | - Rachid Bahiri
- Rheumatology Department A, El Ayachi Hospital, Ibn Sina University Hospital, Rabat-Sale, Morocco
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Benchérifa S, Amine B, El Binoune I, Rostom S, Bahiri R. Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy. BMC Rheumatol 2020; 4:6. [PMID: 32055765 PMCID: PMC7006420 DOI: 10.1186/s41927-019-0108-1] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents. Case presentation Case 1: A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a pre-perforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye. Case 2: A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms. Conclusions Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.
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Affiliation(s)
- Sara Benchérifa
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Bouchra Amine
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Imane El Binoune
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Samira Rostom
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
| | - Rachid Bahiri
- Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco
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Erraoui M, Amine B, Tahiri L, El Binoune I, Bahha J, Hajjaj-Hassouni N. Noncontiguous multi-tiered spinal tuberculosis associated with sternal localization: a case report. J Med Case Rep 2017; 11:181. [PMID: 28676098 PMCID: PMC5497373 DOI: 10.1186/s13256-017-1323-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/15/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare. CASE PRESENTATION We report a case of multi-tiered tuberculous spondylodiscitis with sternal localization in an immunocompetent 41-year-old Arab woman who had inflammatory bilateral sciatica L5 and S1 and a history of low back pain caused by a trauma. Radiography, computed tomography, and a vertebral biopsy were useful for diagnosis. She reacted well to anti-bacillary treatment despite the occurrence of multiple paravertebral and subcutaneous abscesses. The medullar magnetic resonance imaging control performed at 4 months, 12 months, and 1 year after the end of treatment showed a favorable evolution. CONCLUSIONS To avoid the delay of diagnosis, especially in our endemic context, tuberculosis must be evoked usually. This will improve the prognosis of our patients.
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Affiliation(s)
- Mariam Erraoui
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Bouchra Amine
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Latifa Tahiri
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Imane El Binoune
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Jihane Bahha
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Najia Hajjaj-Hassouni
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
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