scholarly journals Use of biologic agents and methotrexate improves renal manifestation and outcome in patients with rheumatoid arthritis: a retrospective analysis

2021 ◽  
Author(s):  
Masato Sawamura ◽  
Naoki Sawa ◽  
Masayuki Yamanouchi ◽  
Daisuke Ikuma ◽  
Akinari Sekine ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Kidney Biopsy ◽  
Treatment Strategies ◽  
Biologic Agents ◽  
Renal Outcome ◽  
Biologic Agent ◽  
Aa Amyloidosis ◽  
Renal Manifestation ◽  
Renal Complications ◽  
Period 2

Abstract Background and purpose We examined whether advances in treatment strategies from older disease-modifying antirheumatic drugs (DMARDs) to new biologic agents and methotrexate improved renal complications and outcome in patients with rheumatoid arthritis (RA). Methods We reviewed records of 156 patients with RA who underwent kidney biopsy at our institute between January 1990 and December 2019. All patients were assigned to one of three periods: period 1, 1990–1999 (n = 48); period 2, 2000–2009(n = 57); period 3, 2010–2019 (n = 51). Results Membranous nephropathy, nephrosclerosis, AA-amyloidosis, and IgA nephropathy were the four major renal manifestations of RA. AA-amyloidosis was diagnosed by kidney biopsy in 21 patients: period 1, 7 patients (15%); period 2, 10 patients (18%); and period 3, 4 patients (8%). The 4 patients in period 3 were in the years 2010–2014, and no new case of AA-amyloidosis was recorded from 2015 to 2019. In all 21 of the patients with AA-amyloidosis, neither a biologic agent nor methotrexate was administered. Fifteen of the 21 patients required dialysis, and 13 died in periods 1–3 because of amyloid-related cardiac dysfunction less than 2 years after the initiation of dialysis. Two of them are doing well using biologic agent despite dialysis. The remaining three patients who received a biologic agent or methotrexate does not progress to end-stage renal failure. In addition, the other renal complications showing progression to dialysis also decreased over time. Conclusion Advances in treatment strategies have improved renal outcome and reduced mortality in patients with RA.

Treatment with Biologic Agents Improves the Prognosis of Patients with Rheumatoid Arthritis and Amyloidosis

2012 ◽  
Vol 39 (7) ◽  
pp. 1348-1354 ◽  
Author(s):  
TAKESHI KURODA ◽  
NAOHITO TANABE ◽  
DAISUKE KOBAYASHI ◽  
HIROE SATO ◽  
YOKO WADA ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Biologic Therapy ◽  
Statistical Significance ◽  
Biologic Agents ◽  
Aa Amyloidosis ◽  
Free Survival ◽  
Risk Of Death ◽  
Amyloid A ◽  
Systemic Complication

Objective.Reactive amyloid A (AA) amyloidosis is a serious and life-threatening systemic complication of rheumatoid arthritis (RA). We evaluated the safety of therapy with anti-tumor necrosis factor and anti-interleukin 6 biologic agents in RA patients with reactive AA amyloidosis, together with prognosis and hemodialysis (HD)-free survival, in comparison with patients with AA amyloidosis without such therapy.Methods.One hundred thirty-three patients with an established diagnosis of reactive AA amyloidosis participated in the study. Clinical data were assessed from patient records at the time of amyloid detection and administration of biologics. Survival was calculated from the date when amyloid was first demonstrated histologically or the date when biologic therapy was started until the time of death or to the end of 2010 for surviving patients. Patients who had started HD were selected for inclusion only after the presence of amyloid was demonstrated.Results.Fifty-three patients were treated with biologic agents (biologic group) and 80 were not (nonbiologic group). Survival rate was significantly higher in the biologic group than in the nonbiologic group. Nine patients in the biologics group and 33 in the nonbiologic group started HD. Biologic therapy had a tendency for reduced risk of initiation of HD without any statistical significance.Conclusion.Patients with amyloidosis have a higher mortality rate, but the use of biologic agents can reduce risk of death. The use of biologics may not significantly influence the HD-free survival rate.

scholarly journals Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis

2013 ◽  
Vol 72 (12) ◽  
pp. 1897-1904 ◽  
Author(s):  
Paul Emery ◽  
Anthony Sebba ◽  
Tom W J Huizinga
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Evidence ◽  
Real Life ◽  
Biologic Agents ◽  
Oral Disease ◽  
Biologic Agent ◽  
Factor Inhibitor ◽  
Disease Modifying ◽  
Necrosis Factor ◽  
Biologic Monotherapy

Clinical evidence demonstrates coadministration of tumour necrosis factor inhibitor (TNFi) agents and methotrexate (MTX) is more efficacious than administration of TNFi agents alone in patients with rheumatoid arthritis, leading to the perception that coadministration of MTX with all biologic agents or oral disease-modifying antirheumatic drugs is necessary for maximum efficacy. Real-life registry data reveal approximately one-third of patients taking biologic agents use them as monotherapy. Additionally, an analysis of healthcare claims data showed that when MTX was prescribed in conjunction with a biologic agent, as many as 58% of patients did not collect the MTX prescription. Given this discrepancy between perception and real life, we conducted a review of the peer-reviewed literature and rheumatology medical congress abstracts to determine whether data support biologic monotherapy as a treatment option for patients with rheumatoid arthritis. Our analysis suggests only for tocilizumab is there evidence that the efficacy of biologic monotherapy is comparable with combination therapy with MTX.

scholarly journals Mental Health and Rheumatoid Arthritis: Toward Understanding the Emotional Status of People with Chronic Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Michał Ziarko ◽  
Katarzyna Siemiątkowska ◽  
Michał Sieński ◽  
Włodzimierz Samborski ◽  
Joanna Samborska ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psychological Functioning ◽  
Biologic Agents ◽  
Anxiety And Depression ◽  
Biologic Agent ◽  
Regression Equations ◽  
Affective States ◽  
Choice Of Treatment ◽  
Anti Inflammatory ◽  
Ego Resiliency

Introduction. Rheumatoid arthritis (RA) is a long-term disorder significantly impairing the somatic, emotional, and psychological functioning of its sufferers. Previous research has shown that affected individuals are characterized by an increased level of anxiety and depression. Currently, there are two main treatment schemes for RA; the first uses anti-inflammatory drugs, and the second utilizes biologic agents. This begs the question whether sufferers differ in intensities of pain, anxiety, and depression depending on the type of treatment and what the determinants of these affective states in patients treated using different methods are. Methods. The study comprised 85 patients affected by RA (including 57 receiving biologically inactive medication). Research participants filled out a set of questionnaires measuring levels of anxiety and depression, intensity of experienced pain, strategies of coping with pain, and ego resiliency. Results. The collected data was analyzed through intergroup comparisons, calculating simple correlation coefficients, developing and solving regression equations. The results imply that the choice of treatment differentiates the intensity of pain experienced by patients. Those receiving biologic agents reported lower levels of pain compared to those taking anti-inflammatory medication. It has also been noted that there are distinct configurations of conditions conducive to anxiety and depression in both anti-inflammatory and biologic agent groups. Discussion. The observed constellation of dependencies between variables indicates that the choice of treatment scheme differentiates pain levels. This confirms the assumption that pain intensity, coping strategies, and ego resiliency depend on the severity of anxiety and depression.

scholarly journals Cardiotoxicity in Biological Agent-Targeted Therapy for Rheumatoid Arthritis: ADR Signal Mining and Analysis of Food and Drug Administration Adverse Event Reporting System Database

2021 ◽  
Vol 9 ◽  
Author(s):  
Xiaoyan Tang ◽  
Xiaolin Xu ◽  
Ji Li ◽  
Bin Zhao
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Event ◽  
Reporting System ◽  
Adverse Event Reporting System ◽  
Adverse Event Reporting ◽  
Biological Agents ◽  
Biologic Agents ◽  
Biologic Agent ◽  
Reporting Odds Ratio ◽  
Event Reporting

Purpose: Biologic agent-induced cardiotoxicity is markedly concerning. Rheumatoid arthritis (RA) treated with biologic agents is known to have the potential for cardiotoxicity; however, existing clinical evidence is not adequate to explain real-world patterns of cardiotoxicity. In this study, we quantify the risk of cardiotoxicity in patients with rheumatoid arthritis treated with biological agents.Methods: Cardiotoxicity reports induced by four types of biologic agents, abatacept, adalimumab, tocilizumab, and etanercept were used to mine data from the FDA's adverse event reporting system (FAERS) database from January 1, 2004 through September 30, 2020. Reports of cardiotoxic events were analyzed using a reporting odds ratio (ROR) algorithm, the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), the multi-item gamma Poisson shrinker (MGPS), and logistic regression methods. We use the preferred term of the Medical Dictionary of Regulatory Activities to identify such events.Results: A total of 3,969 reports of cardiotoxic events were identified involving biologic agents used for RA as the suspect drugs in this study, 317 reports of abatacept, 2,137 reports of adalimumab, 273 reports of tocilizumab, and 1,242 reports of etanercept. Adalimumab was the most reported, followed by etanercept. The proportion of death and disability outcomes reported for each targeted treatment represents approximately 20–25% of the total reported severe adverse events. In addition, relatively low cardiotoxicity reporting rates were found with abatacept.Conclusion: Analysis of FAERS data offers a more precise profile on the characteristics and occurrences of cardiotoxic events. The findings are a clinical reminder to physicians that an increased vigilance concerning the cardiotoxic effects of biological agents needs to be implemented. Also, more comparative studies are required in the future to explain the mechanisms that cause these cardiac phenomena.

scholarly journals Olokizumab for treatment of rheumatoid arthritis

2021 ◽  
Vol 30 (2) ◽  
pp. 67-74
Author(s):  
S. Moiseev ◽  
P. Novikov ◽  
N. Chebotareva ◽  
S. Gulyaev ◽  
N. Bulanov ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Monoclonal Antibody ◽  
Tumour Necrosis ◽  
Active Rheumatoid Arthritis ◽  
Biologic Agents ◽  
Aa Amyloidosis ◽  
Antirheumatic Drugs ◽  
Humanized Monoclonal Antibody ◽  
Favorable Safety ◽  
Necrosis Factor

Olokizumab is a new humanized monoclonal antibody targeting IL-6 that is approved for treatment of patients with moderately severe or severe active rheumatoid arthritis despite therapy with methotrexate and other conventional diseasemodifying antirheumatic drugs or biologic agents. The efficacy and favorable safety profile of olokizumab in combination with methotrexate in rheumatoid arthritis patients who had previously failed methotrexate or tumour necrosis factor inhibitors were established in the several international 3 phase clinical trials (CREDO). The authors present two cases of successful olokizumab administration and discuss the indications for its use in patients with rheumatoid arthritis to achieve clinical improvement and to prevent progression of AA-amyloidosis.

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