scholarly journals Abatacept in rheumatoid arthritis: survival on drug, clinical outcomes, and their predictors—data from a large national quality register

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Giovanni Cagnotto ◽  
Minna Willim ◽  
Jan-Åke Nilsson ◽  
Michele Compagno ◽  
Lennart T. H. Jacobsson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Response ◽  
Cox Regression ◽  
Population Based ◽  
Drug Survival ◽  
Quality Register ◽  
High Pain Score ◽  
Selection Of Variables ◽  
National Quality ◽  
Significant Difference

Abstract Background There are limited data regarding efficacy of abatacept treatment for rheumatoid arthritis (RA) outside clinical trials. Quality registers have been useful for observational studies on tumor necrosis factor inhibition in clinical practice. The aim of this study was to investigate clinical efficacy and tolerability of abatacept in RA, using a national register. Methods RA patients that started abatacept between 2006 and 2017 and were included in the Swedish Rheumatology Quality register (N = 2716) were investigated. Survival on drug was estimated using Kaplan-Meier analysis. The European League Against Rheumatism (EULAR) good response and Health Assessment Questionnaire (HAQ) response (improvement of ≥ 0.3) rates (LUNDEX corrected for drug survival) at 6 and at 12 months were assessed. Predictors of discontinuation were investigated by Cox regression analyses, and predictors of clinical response by logistic regression. Significance-based backward stepwise selection of variables was used for the final multivariate models. Results There was a significant difference in drug survival by previous biologic disease-modifying antirheumatic drug (bDMARD) exposure (p < 0.001), with longer survival in bionaïve patients. Men (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.74–0.98) and methotrexate users (HR 0.85, 95% CI 0.76–0.95) were less likely to discontinue abatacept, whereas a high pain score predicted discontinuation (HR 1.14 per standard deviation, 95% CI 1.07–1.20). The absence of previous bDMARD exposure, male sex, and a low HAQ score were independently associated with LUNDEX-corrected EULAR good response. The absence of previous bDMARD exposure also predicted LUNDEX-corrected HAQ response. Conclusions In this population-based study of RA, bDMARD naïve patients and male patients were more likely to remain on abatacept with a major clinical response.

scholarly journals Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study

BJPsych Open ◽  
2019 ◽  
Vol 5 (3) ◽  
Author(s):  
Ole Brus ◽  
Yang Cao ◽  
Åsa Hammar ◽  
Mikael Landén ◽  
Johan Lundberg ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Suicide Attempts ◽  
Cox Regression ◽  
Lithium Treatment ◽  
Unipolar Depression ◽  
Population Based ◽  
Register Study ◽  
Quality Register ◽  
National Quality ◽  
History Of

Background Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients. Aims This study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide. Method This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models. Results Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75–0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions. Conclusions More patients could benefit from lithium treatment. Declaration of interest None.

scholarly journals Gender- and age-related differences of statin use on incident dementia in patients with rheumatoid arthritis: a Nationwide population-based cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tsung-Kun Lin ◽  
Jing-Yang Huang ◽  
Lung-Fa Pan ◽  
Gwo-Ping Jong
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Subgroup Analysis ◽  
Cox Regression ◽  
Population Based ◽  
Age Related ◽  
Hazard Ratios ◽  
Incident Dementia ◽  
Gender And Age ◽  
New Onset

Abstract Background Some observational studies have found a significant association between the use of statin and a reduced risk of dementia. However, the results of these studies are unclear in patients with rheumatoid arthritis (RA). This study is to determine the association between the use of statins and the incidence of dementia according to sex and age-related differences in patients with RA. Methods We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed was the risk of dementia by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted hazard ratio of new-onset dementia. Subgroup analysis was also conducted. Results Among the 264,036 eligible patients with RA aged > 40 years, statin users were compared with non-statin users by propensity score matching at a ratio of 1:1 (25,764 in each group). However, no association was found between the use of statins and the risk of new-onset dementia (NOD) in patients with RA (HR: 1.01; 95% CI: 0.97–1.06). The subgroup analysis identified the use of statin as having a protective effect against developing NOD in male and older patients. Conclusion No association was observed between the use of a statin and the risk of NOD in patients with RA, including patients of both genders and aged 40–60 years, but these parameters were affected by gender and age. The decreased risk of NOD in patients with RA was greater among older male patients. Use of a statin in older male (> 60 years) patients with RA may be needed in clinical practice to prevent dementia.

scholarly journals Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study

2018 ◽  
Vol 7 (11) ◽  
pp. 439 ◽  
Author(s):  
Jih-Chen Yeh ◽  
Chang-Chin Wu ◽  
Cheuk-Sing Choy ◽  
Shu-Wei Chang ◽  
Jian-Chiun Liou ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Alkaline Phosphatase ◽  
Cox Regression ◽  
High Sensitivity ◽  
Population Based ◽  
Reactive Protein ◽  
Prognostic Assessment ◽  
Product Term ◽  
Hs Crp ◽  
Stratified Analysis

Background: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could serve as a promising dual biomarker for prognostic assessment of VF progression. Methods: Unadjusted and adjusted hazard ratios (aHRs) of VF progression were calculated for different categories of serum NHALP and hs-CRP using the Cox regression model in RA patients. The modification effect between serum NHALP and hs-CRP on VF progression was determined using an interaction product term. Results: During 4489 person-years of follow-up, higher NHALP (>125 U/L) and hs-CRP (>3.0 mg/L) were robustly associated with incremental risks of VF progression in RA patients (aHR: 2.2 (95% confidence intervals (CIs): 1.2–3.9) and 2.0 (95% CI: 1.3–3.3) compared to the lowest HR category, respectively). The interaction between NHALP and hs-CRP on VF progression was statistically significant (p < 0.05). In the stratified analysis, patients with combined highest NHALP and hs-CRP had the greatest risk of VF progression (aHR: 4.9 (95% CI: 2.5–9.6)) compared to the lowest HR group (NHALP < 90 U/L and hs-CRP < 1 mg/L). Conclusions: In light of underdiagnoses of VFs and misleading diagnosis by single test, NHALP and hs-CRP could serve as compensatory biomarkers to predict subclinical VF progression in RA patients.

scholarly journals Tuberculosis in biologic-naïve patients with rheumatoid arthritis - risk factors and tuberculosis characteristics

2021 ◽  
pp. jrheum.201251
Author(s):  
Johanna Karlsson Sundbaum ◽  
Elizabeth V. Arkema ◽  
Judith Bruchfeld ◽  
Jerker Jonsson ◽  
Johan Askling ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Population Based ◽  
Rheumatoid Arthritis Risk ◽  
Obstructive Pulmonary Disease ◽  
Quality Register ◽  
National Patient ◽  
Latent Tb ◽  
The Individual ◽  
Control Study

Objective To investigate risk factors and characteristics of active tuberculosis (TB) in biologics-naïve rheumatoid arthritis (RA) patients. Methods Population-based case-control study using the Swedish Rheumatology Quality Register, the National Patient Register and the Tuberculosis Register to identify RA cases with active TB and matched RA controls without TB 2001-2014. Clinical data were obtained from medical records. TB risk was estimated as adjusted (adj) odds ratios (OR) with 95% confidence intervals (CI) using univariate and multivariable logistic regression analyses. Results After validation of diagnoses, the study included 31 RA cases with TB, and 122 matched RA controls. All except three cases had reactivation of latent TB. Pulmonary TB dominated (84%). Ever use of methotrexate was not associated with increased TB risk (adj OR 0.8; 95% CI 0.3-2.0), whereas ever treatment with leflunomide (adj OR 6.0; 95% CI 1.5-24.6), azathioprine (adj OR 3.8; 95% CI 1.1-13.8) and prednisolone (adj OR 2.4 (95% CI 1.0-5.9) was. There were no significant differences of maximum dose of prednisolone, treatment duration with prednisolone before TB, or cumulative dose of prednisolone the year before TB diagnosis between cases and controls. Obstructive pulmonary disease was associated with an increased TB risk (adj OR 3.9; 95% CI 1.4-10.7). Conclusion Several RA-associated factors may contribute to the increased TB risk in biologics-naïve RA patients, making risk of TB activation difficult to predict in the individual patient. To further decrease TB in RA patients, the results suggest that screening for latent TB should also be considered in biologics-naïve patients.

scholarly journals Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022812 ◽  
Author(s):  
Kristin Gustafsson ◽  
Ola Rolfson ◽  
Marit Eriksson ◽  
Leif Dahlberg ◽  
Joanna Kvist
Keyword(s):  
Knee Osteoarthritis ◽  
Population Based ◽  
Good Prognosis ◽  
Ethical Review ◽  
Swedish Population ◽  
Arthroplasty Register ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Quality Register ◽  
National Quality

IntroductionHip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery.Methods and analysisThis nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden.Ethics and disseminationThe study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059–16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.Trial registration numberNCT03438630.

Gender- and Age-related Differences of Statin Use on Incident Dementia in Patients with Rheumatoid Arthritis: A Nationwide Population-based Cohort Study

2021 ◽  
Author(s):  
Tsung-Kun Lin ◽  
Jing-Yang Huang ◽  
Lung-Fa Pan ◽  
Gwo-Ping Jong
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Subgroup Analysis ◽  
Older Patients ◽  
Cox Regression ◽  
Population Based ◽  
Age Related ◽  
Hazard Ratios ◽  
Gender And Age ◽  
New Onset

Abstract Background: Some observational studies have found a significant association between the use of statin and a reduced risk of dementia. However, the results of these studies are unclear in patients with rheumatoid arthritis (RA). This study is to determine the association between the use of statins and the incidence of dementia according to sex and age-related differences in patients with RA.Methods: We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed was the risk of dementia by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted hazard ratio of new-onset dementia. Subgroup analysis was also conducted.Results: Among the 264,036 eligible patients with RA aged > 40 years, statin users were compared with non-statin users by propensity score matching at a ratio of 1:1 (25,764 in each group). However, no association was found between the use of statins and the risk of new-onset dementia (NOD) in patients with RA (HR: 1.01; 95%CI: 0.97–1.06). The subgroup analysis identified the use of statin as having a protective effect against developing NOD in male and older patients.Conclusion: There is no association between the use of statin and the risk of NOD in patients with RA, but these parameters are influenced by gender and age. The decreased risk of NOD in patients with RA was greater among male and older patients. The use of statin in older male patients with RA for the prevention of dementia may be needed in clinical practice.

Treatment Sequencing and Efficacy in Newly Diagnosed Non-Transplant Eligible Myeloma Patients in the Netherlands: A Population Based Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4284-4284 ◽  
Author(s):  
S GR Verelst ◽  
Y van Norden ◽  
H M Blommestein ◽  
J Roobol ◽  
M Schoenmaker ◽  
...  
Keyword(s):  
The Netherlands ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Population Based ◽  
Response To Treatment ◽  
Age Group ◽  
First Line ◽  
Treatment Regimens ◽  
Significant Difference ◽  
Treatment Sequences

Abstract Abstract 4284 Background The introduction of immunomodulatory drugs (IMiDs) and proteosome-inhibitors changed the treatment strategies for non-transplant eligible myeloma patients in the last decade. Results on efficacy of these treatment regimens result primarily from randomized controlled trials. Population based results on treatment sequences and efficacy of the different treatment regimens are sparse but necessary to provide complementary information from daily practice. Method PHAROS, the Population based Haematological Registry in the Netherlands collects detailed information on patient characteristics, treatment and response to treatment of myeloma patients. We studied treatment sequences for non-transplant eligible patients above 65-years diagnosed between January 2004 and December 2009 in the South West of the Netherlands. Although data collection in the PHAROS registry is ongoing, the mentioned subset in this region is (almost) complete. The treatment regimens were divided into five main groups: 1) proteosome-Inhibitor based; 2) IMiD-based; 3) combination of proteosome-inhibitor and IMiD, 4) alkylating-based and 5) other (including steroid based). We determined the number of treatment lines and the sequence of the treatment regimens. Overall survival (OS) was analysed in the whole group, by type of first line regimen and by age group (66–69 years; 70–79 years; 80+ years) using Kaplan-Meier. Subgroup differences were also analysed using Cox regression. Results 408 patients were included with a median follow up time of 45 months. Mean age at diagnosis was 76-years (range 66–99) and 53% of the patients were male. 59% had stage IIIA/B at diagnosis, 13% previous MGUS. 87 % of patients had WHO 0–2. There was large diversity in number of pre-existing co-morbidities: ranging from 14% without any to 20% having 3 or more co-morbidities at diagnosis. 11% of the patients participated in trial setting for initial treatment. Of the whole group 24% received at least two lines of treatment and 8% at least three since diagnosis. 16% of the patients did not receive treatment so far: 52% because of smouldering myeloma; 33% because of refusal of patients, short life expectancy or poor functional status. 23% of the last group of patients without treatment was 80+ years of age. Choice of treatment regimens was significantly related with age and year of diagnosis. For patients diagnosed between 2004 and 2006, more patients of age 66–69 received an IMiD-based first line than patients aged 70–79 and they, in turn, received more often an IMiD based as patients of 80+ years of age (40% versus 26% versus 12% respectively). Patients of 80+ years of age mainly received an alkylating based 1st line treatment (73%). In the period 2007–2009 an increase in IMiD-based 1st line was observed (69% overall: 63%, 77% and 58% respectively per age group). 13% of patients aged 66–69 received proteosome-inhibitor based 1st line compared to 1% of the patient aged 70–79 and non of patients aged 80+. Patients receiving an alkylating-based 1st line 70% of them received an IMiD-based 2nd line. If patients received an IMiD-based 1st line 54% of them received a proteosome-inhibitor based 2nd line and 29% again an IMiD-based 2nd line. If patients received an alkylating 2nd line, 56% than received an IMiD-based 3rd line. 83% of patients who had proteosome-inhibitor based 2nd line received an IMiD based 3rd line. 59% of the patients who had received IMiD based 2nd line received a proteosome-inhibitor based 3rd line. OS significantly improved when patients received IMiD in 1st line compared to alkylating (p=0.03, HR 0.73). This improvement was seen for all patients up to 80 years of age. We observed significant difference in OS between the age groups (p<.001) with median survival of 13 months for patients aged 80+ to 40 months for patient aged 66–69 years. WHO performance status was also significant (p <0.001) related with OS while number co-morbidities at diagnosis did not have significant impact (p=0.07). Conclusion Population based results seem to confirm the significant improvement in OS of IMiD-based regimens in 1st line compared to alkylating based for elderly patients. An increase in the use of IMiD based 1st line regimens was observed for patients diagnosed since 2007. While there is large treatment diversity we observed a sequence ordering in treatment lines from alkylating based followed by IMiD-based followed by proteosome-inhibitor based regimens. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Efficacy, safety, and adherence of tocilizumab therapy in elderly patients with rheumatoid arthritis: A real-world observational study

2021 ◽  
Vol 19 ◽  
pp. 205873922110457
Author(s):  
Yoshinobu Nakao ◽  
Yu Funakubo Asanuma ◽  
Takuma Tsuzuki Wada ◽  
Mayumi Matsuda ◽  
Hiroaki Yazawa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Elderly Patients ◽  
Disease Activity ◽  
Activity Index ◽  
The Elderly ◽  
Young Group ◽  
Elderly Group ◽  
Drug Survival ◽  
Significant Difference

Objective: We evaluated the efficacy, safety, and drug survival rate of tocilizumab in the elderly patients with rheumatoid arthritis (RA). Methods: This study was conducted in 108 RA patients who started tocilizumab between 2008 and 2018. The patients were divided into a young group (<65 years) and an elderly group (≥65 years). The efficacy, safety, and drug survival rate of tocilizumab were compared between the two groups. Results: At baseline, there were no significant differences between the elderly ( n = 45) and the young group ( n = 63) in RA duration, percentage of biologic-naïve, and RA disease activity. Health Assessment Questionnaire-Disability Index (HAQ-DI) was higher, renal function was worse, and frequency of using methotrexate was lower in the elderly group. Tocilizumab demonstrated similar efficacy in the elderly and the young group with Clinical Disease Activity Index and HAQ-DI. Compared with baseline, the frequency of steroid use was lower at one year after initiation of tocilizumab in both groups. There was no significant difference between the groups in the drug survival rate of tocilizumab for three years. Discontinuation rates of TCZ due to toxic adverse events were similar between the two groups. Conclusions: The efficacy, steroid-sparing effect, and safety of tocilizumab therapy, as well as the drug survival rate for three years, were not inferior in elderly RA compared to young RA patients.

Survival among colorectal cancer patients with a history of previous cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16146-e16146
Author(s):  
Sandi Pruitt ◽  
David E. Gerber ◽  
Hong Zhu ◽  
Daniel Heitjan ◽  
Bhumika Maddineni ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Population Based ◽  
Competing Risk ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

e16146 Background: A growing number of patients with colorectal cancer (CRC) have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. We examined the impact of previous cancer on overall and cancer-specific survival in a population-based cohort of patients diagnosed with incident CRC. Methods: We identified patients aged ≥66 years and diagnosed with CRC between 2005-2015 in linked SEER-Medicare data. For patients with and without previous cancer, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression, separately by CRC stage, while adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident CRC. Results: Of 112,769 CRC patients diagnosed with incident CRC, 15,935 (14.1%) had a previous cancer – most commonly prostate (32.9%) or breast (19.4%) cancer, with many 7505 (47.1%) diagnosed ≤5 years of CRC. For all CRC stages except IV in which there was no significant difference in survival, patients with previous cancer had modestly worse overall survival (hazard ratios from fully adjusted models range from 1.11-1.28 across stages; see Table). This survival disadvantage was driven by deaths due to previous cancer and other causes. Notably, most patients with previous cancer had improved CRC-specific survival. Conclusions: CRC patients who have survived a previous cancer have generally worse overall survival but superior CRC-specific survival. This evidence should be considered concurrently with concerns about trial generalizability, low accrual, and heterogeneity of participants when determining exclusion criteria. [Table: see text]

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