Care Pathway for TNF α-Blockers for Patients with Rheumatoid Arthritis at the Royal National Hospital for Rheumatic Diseases

2005 ◽  
Vol 9 (3) ◽  
pp. 116-122
Author(s):  
Nicholas Shenker ◽  
Chris Fokke ◽  
Elizabeth Michell
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatic Diseases ◽  
Care Pathway ◽  
Clinical Excellence ◽  
National Hospital ◽  
Tnf Α ◽  
Nice Guidance ◽  
Integrated Care Pathway ◽  
Necrosis Factor

Tumour necrosis factor (TNF) blockers are effective in the treatment of rheumatoid arthritis. These drugs are expensive, however, and there is uncertainty over their long-term safety. The National Institute for Clinical Excellence has issued guidance over the use of these drugs in rheumatoid arthritis. The Royal National Hospital for Rheumatic Diseases developed an integrated care pathway following the patient's journey from referral to the TNF services until the administration and continued monitoring of their response in accordance with NICE Guidance, taking into account local issues. This paper reviews the development and implementation of this pathway.

scholarly journals Safety and Effectiveness of Rituximab in Patients with Rheumatoid Arthritis Following an Inadequate Response to 1 Prior Tumor Necrosis Factor Inhibitor: The RESET Trial

2011 ◽  
Vol 38 (12) ◽  
pp. 2548-2556 ◽  
Author(s):  
BOULOS HARAOUI ◽  
MARIA BOKAREWA ◽  
IAN KALLMEYER ◽  
VIVIAN P. BYKERK
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Patient Reported Outcomes ◽  
Tumor Necrosis ◽  
Primary Treatment ◽  
Tnf Α ◽  
Patient Reported ◽  
Infusion Reactions ◽  
Moderate Nausea ◽  
Necrosis Factor

Objective.To evaluate the safety and effectiveness of rituximab (RTX) in combination with methotrexate in patients with active rheumatoid arthritis (RA) after failure of a single tumor necrosis factor-α (TNF-α) inhibitor. Changes in patient-reported outcomes after primary treatment or retreatment with RTX and factors determining retreatment in clinical practice were also evaluated.Methods.In this phase 3b open-label, multicenter trial, patients received 2 slow infusions of RTX 1000 mg 14 days apart after premedication (primary treatment). Patients with a clinically relevant response could receive retreatment between 24 and 48 weeks. The primary endpoint was evaluation of safety. Secondary outcomes were safety of retreatment, effectiveness of primary treatment and retreatment, and changes in patient-reported outcomes after primary treatment or retreatment.Results.Of 120 patients enrolled at 36 centers and receiving primary RTX treatment, 77 received retreatment, 112 completed the 24-week primary treatment period, and 25 completed the 48-week primary treatment and retreatment period following a single course of RTX. The most common adverse events were mild to moderate nausea, vomiting, nasopharyngitis, and headache. No infections or infusion reactions were considered life-threatening. At 24 weeks, 58%, 27%, and 7% of patients achieved American College of Rheumatology 20, 50, and 70 improvements, respectively, and similar improvements were seen after retreatment.Conclusion.RTX was well tolerated, with a low incidence of infusion reactions and infections. Efficacy results, including enhanced response in rheumatoid factor-positive patients, were comparable to those reported in the literature. Based on its efficacy and safety profile and retreatment schedule, RTX is an attractive treatment option for patients that have not responded to a single TNF-α inhibitor.

Physiological persona differences based on stress and inflammation between meditators and healthy controls

2019 ◽  
Vol 17 (2) ◽  
Author(s):  
Dipti Magan ◽  
Raj Kumar Yadav
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Plasma Levels ◽  
Inflammatory Markers ◽  
Tumor Necrosis ◽  
Healthy Controls ◽  
Short Term ◽  
Tnf Α ◽  
Necrosis Factor

AbstractBackgroundNowadays, yoga is endorsed and advised routinely to stay fit and healthy, as well as control many chronic diseases including diabetes type 2, hypertension, coronary artery diseases, etc. Now, our assumption is that those who do regular yoga have different persona than who do not do yoga regularly. We planned to test our hypothesis scientifically, and therefore baseline physiological characteristics with stress and inflammation levels in long-term and short-term meditators and healthy novice controls were analyzed.MethodsIn this retrospective analysis, 97 male participants were included for their Baseline analysis. Fifteen apparently healthy subjects practicing preksha meditation (since >5 years, at least 5 days a week) were included as long-term meditators (LTMs); 58 subjects who attended one of our short-term yoga-based lifestyle intervention programs for 2 weeks were included as short-term meditators (STMs); 24 male novice subjects, who did not participate in any yogic intervention, were included as healthy controls. Here, we analyzed the Baseline plasma levels of stress and inflammatory markers, cortisol, β-endorphin, interleukin (IL)-6 and tumor necrosis factor (TNF)-α in long-term meditators vs. short-term meditators vs. healthy controls.Outcome measuresThe study parameters body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), plasma levels of stress and immune markers, cortisol, β-endorphin (β-Ed), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), were assessed in all the three groups at baseline.ResultsSignificant (p<0.05) differences were observed at baseline for plasma levels of stress and inflammatory markers as well as body mass index and systolic blood pressure among LTM vs. STM vs. healthy controls.ConclusionsOur observations suggest that the subjects who do regular yoga-meditation practice have better stress & inflammation status than comparable age matched healthy controls.

Long-term Survival of Subcutaneous Anti-tumor Necrosis Factor Biological Drugs Administered Between 2008 and 2012 in a Cohort of Rheumatoid Arthritis Patients

2019 ◽  
Vol 15 (1) ◽  
pp. 54-57
Author(s):  
Noelia Alvarez Rivas ◽  
Tomas R. Vazquez Rodriguez ◽  
Jose A. Miranda Filloy ◽  
Carlos Garcia-Porrua ◽  
Amalia Sanchez-Andrade Fernández
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Biological Drugs ◽  
Term Survival ◽  
Long Term Survival ◽  
Necrosis Factor

scholarly journals Using the Immunophenotype to Predict Response to Biologic Drugs in Rheumatoid Arthritis

2019 ◽  
Vol 9 (4) ◽  
pp. 46 ◽  
Author(s):  
Mulhearn ◽  
Barton ◽  
Viatte
Keyword(s):  
Rheumatoid Arthritis ◽  
Immunological Study ◽  
Biologic Drugs ◽  
Genetic Studies ◽  
Immune Biomarkers ◽  
Tnf Α ◽  
Immune Pathways ◽  
Necrosis Factor ◽  
Predict Treatment Response

Tumour necrosis factor (TNF)-α is a key mediator of inflammation in rheumatoid arthritis, and its discovery led to the development of highly successful anti-TNF therapy. Subsequently, other biologic drugs targeting immune pathways, namely interleukin-6 blockade, B cell depletion, and T cell co-stimulation blockade, have been developed. Not all patients respond to a biologic drug, leading to a knowledge gap between biologic therapies available and the confident prediction of response. So far, genetic studies have failed to uncover clinically informative biomarkers to predict response. Given that the targets of biologics are immune pathways, immunological study has become all the more pertinent. Furthermore, advances in single-cell technology have enabled the characterization of many leucocyte subsets. Studying the blood immunophenotype may therefore, define biomarker profiles relevant to each individual patient’s disease and treatment outcome. This review summarises our current understanding of how immune biomarkers might be able to predict treatment response to biologic drugs.

scholarly journals Can very high-dose anti-tumor necrosis factor blockade at onset of rheumatoid arthritis produce long-term remission?

2002 ◽  
Vol 46 (7) ◽  
pp. 1971-1972 ◽  
Author(s):  
Philip G. Conaghan ◽  
Mark A. Quinn ◽  
Philip O'Connor ◽  
Richard J. Wakefield ◽  
Zunaid Karim ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
High Dose ◽  
Very High ◽  
Necrosis Factor

Serum IgG antibodies to peptidylarginine deiminase 4 predict radiographic progression in patients with rheumatoid arthritis treated with tumour necrosis factor-α blocking agents

2008 ◽  
Vol 68 (2) ◽  
pp. 249-252 ◽  
Author(s):  
E H Halvorsen ◽  
E A Haavardsholm ◽  
S Pollmann ◽  
A Boonen ◽  
D van der Heijde ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Radiographic Progression ◽  
Severe Disease ◽  
Peptidylarginine Deiminase ◽  
Association Analyses ◽  
Peptidylarginine Deiminase 4 ◽  
Tnf Α ◽  
Factor Α ◽  
Necrosis Factor

Background:Peptidylarginine deiminase 4 (PAD4) may generate epitopes targeted by anticitrullinated protein antibodies in rheumatoid arthritis (RA). A subset of patients with RA has serum autoantibodies to human recombinant PAD4 (hPAD4). Here, we assessed whether anti-hPAD4 status in RA predicted disease outcome after antitumour necrosis factor (anti-TNF)-α therapy.Methods:We analysed RA sera obtained at baseline (n = 40) and after 1 year on anti-TNF-α therapy (n = 33) for anti-hPAD4 IgG. Association analyses between baseline anti-hPAD status and disease progression were performed.Results:We found that 17 of 40 patients (42.5%) were serum anti-hPAD4 positive at baseline, and the anti-hPAD4 IgG levels were stable over 1 year on anti-TNF-α therapy. At baseline, there were indications that anti-hPAD4 positive patients had more severe disease than the negative patients. After 1 year on anti-TNF-α therapy, the anti-hPAD4 positive patients displayed a persistently elevated disease activity score using 28 joint counts score and increased progression in the van der Heijde–modified Sharp erosion score. Accordingly, more anti-hPAD4 positive than negative patients presented an increase in van der Heijde–modified Sharp erosion scores >0 over 1 year.Conclusions:Anti-hPAD4 IgG can be detected in a subset of RA sera and the levels are stable after initiation of anti-TNF-α therapy. Serum anti-hPAD4 may predict persistent disease activity and radiographic progression in patients with RA receiving anti-TNF-α therapy.

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