scholarly journals Outcomes in rheumatoid arthritis patients treated with abatacept: a UK multi-centre observational study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ernest Choy ◽  
Lara Groves ◽  
Daniel Sugrue ◽  
Michael Hurst ◽  
John Houghton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Observational Study ◽  
Medical Records ◽  
Functional Disability ◽  
Joint Destruction ◽  
Treatment Patterns ◽  
Chronic Synovitis ◽  
Line Of Therapy ◽  
The Uk ◽  
Inflammatory Autoimmune Disease

Abstract Background Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that causes chronic synovitis, resulting in progressive joint destruction and functional disability and affects approximately 400,000 people in the UK. This real-world study aimed to describe the characteristics, treatment patterns and clinical outcomes of patients who received abatacept in UK clinical practice. Methods This was a multi-centre, retrospective, observational study of patients with RA treated with abatacept at four UK centres between 01 January 2013 and 31 December 2017. Data were collected from medical records of each patient from the index date (date of first bDMARD initiation) until the most recent visit, death or end of study (31 December 2017). Results In total, 213 patients were included in the study. Patients received up to eight lines of therapy (LOTs). Treatment with abatacept, or any other bDMARD, was associated with reductions in DAS28-ESR and DAS28-CRP scores at 6 and 12 months. The distribution of EULAR responses (good/moderate/no response) tended to be more favourable for patients when receiving abatacept than when receiving other bDMARDs (22.8%/41.3%/35.9% versus 16.6%/41.4%/42.1% at 6 months, and 27.9%/36.1%/36.1% versus 21.2%/34.5%/44.2% at 12 months). Patients receiving abatacept at LOT1 (n = 68) spent significantly longer on treatment compared with patients receiving other bDMARDs (53.4 vs. 17.4 months; p< 0.01); a similar trend was observed for LOT2. Among patients who discontinued after 6 months, a greater proportion experienced infection requiring antibiotics when receiving other bDMARDs compared to those receiving abatacept. Conclusions RA patients who received bDMARDs, including abatacept, experienced reduced disease activity. When receiving abatacept as first or second line of therapy, patients persisted with treatment significantly longer than those receiving other bDMARDs.

scholarly journals Probiotic Supplementation for Rheumatoid Arthritis: A Promising Adjuvant Therapy in the Gut Microbiome Era

2021 ◽  
Vol 12 ◽  
Author(s):  
Margarida Ferro ◽  
Sofia Charneca ◽  
Eduardo Dourado ◽  
Catarina Sousa Guerreiro ◽  
João Eurico Fonseca
Keyword(s):  
Rheumatoid Arthritis ◽  
Adjuvant Therapy ◽  
Functional Disability ◽  
Current Knowledge ◽  
Joint Destruction ◽  
Current Evidence ◽  
Fermented Foods ◽  
Probiotic Supplementation ◽  
Chronic Inflammatory Response

Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease that ultimately leads to joint destruction and functional disability. Although the exact etiology of RA is not fully understood, it is well established that gut microbiota (GM) plays a vital role in the pathogenesis of RA, with accumulating evidence suggesting that gut dysbiosis induces a chronic inflammatory response that may be linked to disease development. Of interest, patients with RA have significant changes in the intestinal microbiota compared to healthy controls, and several studies have suggested the use of probiotics as a possible adjuvant therapy for RA. Benefits of probiotic supplementation were reported in animal models of arthritis and human studies, but the current evidence regarding the effect of probiotic supplementation in the management of RA remains insufficient to make definite recommendations. Several different strains of Lactobacillus and Bifidobacteria, as single species or in mixed culture, have been investigated, and some have demonstrated beneficial effects on disease activity in RA human subjects. As of now, L.casei probiotic bacteria seems to be the strongest candidate for application as adjuvant therapy for RA patients. In this review, we highlight the role of GM in the development and progression of RA and summarize the current knowledge on the use of probiotics as a potential adjuvant therapy for RA. We also review the proposed mechanisms whereby probiotics regulate inflammation. Finally, the role of fermented foods is discussed as a possible alternative to probiotic supplements since they have also been reported to have health benefits.

scholarly journals Continuous effectiveness and safety after a hospital-wide switch to adalimumab biosimilar: an observational study in rheumatoid arthritis patients

2021 ◽  
Author(s):  
Rianne Brouwer ◽  
Peter M. ten Klooster ◽  
Joost B. Masselink ◽  
Harald E. Vonkeman
Keyword(s):  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Observational Study ◽  
Disease Activity ◽  
Functional Disability ◽  
Activity Levels ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Sf 36 ◽  
Patient Reported

Abstract Objectives Only few observational studies have investigated the actual effectiveness of switching to biosimilars in daily clinical practice in unselected patients. The objective of this study was to examine the maintenance of effect and safety after a hospital-wide switch for economic reasons from adalimumab originator Humira® to biosimilar Amgevita® in real-world rheumatoid arthritis (RA) patients and patient satisfaction with the switch. Methods A single centre retrospective observational study of RA patients on the course of their disease activity (DAS28, ESR and CRP), health-related quality of life (SF-36) and functional disability (HAQ-DI) before and up to one year after the switch, supplemented with a cross-sectional survey on satisfaction and experienced side effects approximately 18 months after the switch. Treatment outcomes were analysed with linear mixed modelling and generalized estimation equations. Results On November 1st 2018, 239 rheumatology patients switched to the adalimumab biosimilar. Of 52 RA patients who met the inclusion criteria sufficient data were available. Disease activity levels, the proportion of patients in remission (DAS28 < 2.6), and SF-36 and HAQ-DI scores did not significantly change from before the switch. 38 of the 52 analysed patients returned the questionnaire. Overall, patients were satisfied with the switch. Three patients (7.9%) stopped the biosimilar due to side effects. Conclusion Switching to the adalimumab biosimilar did not result in increased disease activity or worse patient-reported outcomes over an observation period of 9 to 12 months. Also, there was no apparent evidence of increased side effects. Patients themselves were mostly satisfied with the switching experience.

scholarly journals Rheumatoid arthritis: a joint venture

2020 ◽  
pp. 193-195
Author(s):  
E Potgieter
Keyword(s):  
Rheumatoid Arthritis ◽  
Joint Venture ◽  
Functional Disability ◽  
Joint Destruction ◽  
Developed Countries ◽  
Western World ◽  
Inflammatory Disorder ◽  
Full Time ◽  
Industrialised Countries ◽  
Full Time Employment

Rheumatoid arthritis (RA) is a chronic auto-immune inflammatory disorder, usually affecting the joints. Its prevalence is estimated at 0.3–1% in industrialised countries and areas of urban living. RA leads to functional disability, significant pain and joint destruction, and subsequent loss of income: in developed countries half of people diagnosed with RA are unable to sustain full-time employment ten years after diagnosis. It also carries substantial cardiovascular risk if inadequately treated. RA is possibly the largest cause of treatable disability in the Western World. The exact prevalence of RA in South Africa is currently not known, but its significant impact is compounded by frequent late diagnoses and a scarcity of treating specialists.

scholarly journals The Relationship Between Vitamin D Serum Levels and Rheumatoid Arthritis Activity in a Sample of Syrian Patients- a cross-sectional observational study

2021 ◽  
Author(s):  
Zaynab Alourfi ◽  
Nisreen Aldahhan
Keyword(s):  
Rheumatoid Arthritis ◽  
Vitamin D ◽  
Observational Study ◽  
Functional Disability ◽  
Serum Vitamin ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
The Relationship ◽  
Rheumatoid Arthritis Activity

Abstract Background. Rheumatoid Arthritis (RA) is a systemic auto immune disease that mainly affects joints. It might cause functional disability and increased morbidity and mortality.Vitamin D was reported to have an immunomodulation role in reducing the inflammation process in many auto immune diseases; RA is one of them.The aim was to determine the relationship between serum vitamin D levels and rheumatoid arthritis activity in a sample of Syrian patients.Methods This cross-sectional observational study was carried out in Al-Mouwasat and Al-Assad University Hospitals(Damascus University - Syria). RA patients were diagnosed according to the American College of Rheumatology (ACR) and the European League Against Rheumatism(EULAR)classification criteria for rheumatoid arthritis 2010 standards.Results Vitamin D was significantly higher in RA patients in remission (27.92 ± 13 ng/ml) than in patients with active RA (21.22 ± 13 ng/ml). There was an inverse relationship between serum vitamin D levels and RA activity.Conclusion Serum vitamin D levels were inversely correlated with RA activity in a sample of Syrian RA patients.

Treatment Response Patterns and Related Prognostic Indicators in Chronic Myeloid Leukemia (CML) Patients: A Multi-Country Medical Record Review Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3131-3131
Author(s):  
Peter C Trask ◽  
Debanjali Mitra ◽  
Shrividya Iyer ◽  
Sean D Candrilli ◽  
James A. Kaye
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Medical Records ◽  
Myeloid Leukemia ◽  
Chronic Phase ◽  
Prognostic Indicators ◽  
Black Race ◽  
Line Therapy ◽  
Sokal Score ◽  
Line Of Therapy ◽  
The Uk

Abstract Abstract 3131 Objective: To assess treatment responses and prognostic indicators of response among patients with chronic myeloid leukemia (CML) in multiple countries. Methods: Physicians in United States (N=60), United Kingdom (N=45), Germany (N=49), and Japan (N=60) were recruited to abstract data retrospectively from medical records of patients diagnosed with CML between 1/1/2005 and 12/31/2009. Patients selected were age ≥18 years and in chronic phase at the time of diagnosis and were Philadelphia chromosome and/or BCR-ABL positive. Patients were also required to have received 1st-line treatment with imatinib and not be enrolled in a randomized clinical trial during the study period. We included a subgroup who had also received 2nd-line therapy with nilotinib or dasatinib. We assessed rates of complete hematological response (CHR) at 3 months (mos), complete cytogenetic response (CCyR) at 12 mos, and complete or major molecular response (MMR) at 18 mos, stratified by line of therapy. We used multivariable logistic regression models to evaluate the independent prognostic effects of age, gender, Sokal score, spleen size, race, Charlson comorbidity index score (CCIS), dose, and time to initiation of therapy. For patients on 1st line therapy, only those in chronic phase at the time of imatinib initiation and with non-missing data on the variables of interest (n=751) were included in the regression analyses. Results: Data were abstracted from medical records of 1, 063 patients in US (N=300), Japan (N=300), Germany (N=243), and in the UK (N=220). The average patient age was 55 years and a majority were male (60%). Response rates by line of therapy are listed in Table 1. The proportion of patients achieving 1st-line response was similar across countries except that a greater percentage of patients from the UK obtained CHR at 3 mos (70.5%) compared to other countries (range: 46% [US] to [50.6% [Germany]) and MMR at 12 mos (55%) compared to the other countries (range: 26% [Japan] to 40% [Germany]). In 1st-line therapy, age ≤45 years (odds ratio [OR]=1.57, 95% CI=1.05–2.33 reference [ref] age 45–65) and low Sokal score (OR=1.64, 95% CI=1.16–2.33; ref intermediate) were associated with a greater likelihood of CHR response at 3 mos while Black race (OR=0.40, 95% CI=0.16–0.98; ref White race) and a CCIS score of 2 or higher (OR=0.48, 95% CI=0.25–0.75; ref: CCIS 0) were associated with a lower likelihood of CHR response at 3 mos. Age ≤45 years (OR=1.49, 95% CI=1.02–2.17) and Black race (OR=0.33, 95% CI=0.14–0.77) had similar associations with CCyR at 12 mos as for CHR at 3 mos. We did not find any significant prognostic indicators of MMR at 18 mos. In 2nd line therapy, choice of dasatinib as the 2nd-line drug (OR=2.77, 95% CI=1.19–6.43; ref: nilotinib), CHR to 1st-line therapy (OR=5.97, 95% CI=1.72–20.71; ref: no CHR), and low Sokal score (OR=7.93, 95% CI=2.93–21.51) were indicative of higher likelihood of CHR. Treatment with dasatinib (OR=7.43, 95% CI=2.36–23.40) and initial dose > 100mg for dasatinib or 600mg for nilotinib (OR=3.25, 95% CI=1.11–9.51; ref: dose ≤ 100mg for dasatinib or ≤ 600mg for nilotinib) predicted a greater likelihood of CCyR at 12 mos. We found no variables prognostic of MMR at 18 mos. Conclusions: We found several factors in addition to Sokal score to be prognostic for clinical response in 1st-line therapy, including younger age, White race, and no comorbidity. In addition, in 2nd-line therapy, the likelihood of response was higher in patients treated with dasatinib than in those who received nilotinib. To our knowledge, this difference has not been reported previously and could reflect a real difference in outcomes. However, it may also be due to residual confounding by factors that we could not control in a retrospective observational study. Disclosures: Trask: Pfizer: Employment. Mitra:Pfizer: Consultancy. Iyer:Pfizer: Employment. Candrilli:Pfizer: Consultancy. Kaye:Pfizer: Consultancy.

scholarly journals A cost-effective analysis of various disease modifying anti-rheumatic drugs for patients with Rheumatoid Arthritis

2018 ◽  
Vol 7 (6) ◽  
pp. 1153
Author(s):  
Soniya Krishnan ◽  
Balan C. S. ◽  
Seema P. Mohamedali
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Functional Disability ◽  
Joint Destruction ◽  
Health Assessment ◽  
Cost Effective ◽  
Term Therapy ◽  
Significant Difference ◽  
Disease Modifying ◽  
Effective Analysis

Background: Rheumatoid Arthritis (RA) is a chronic disabling disorder that lowers quality of life in the affected patients. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs, provides better control of disease and minimize joint destruction. Long term therapy imparts considerable economic burden to the patients. Cost effective analysis was performed among the patients treated with methotrexate (MTX) alone, hydroxychloroquine (HCQ) alone, and both (MTX+HCQ).Methods: A prospective, observational study for six months to analyze the cost-effectiveness in RA patients with DMARDs-MTX, HCQ and MTX+HCQ. A total of 91 patients were included for analysis; 43 patients in MTX and HCQ group; 37 patients in MTX group and 11 patients in HCQ group. To assess the functional disability,” Stanford Health Assessment Questionnaire - Disability Index” (HAQ-DI) was administered. The patients were followed up for four months. The HAQ-DI at the baseline was compared with that of final follow up. The change in HAQ-DI and the total costs were used to find out the average cost- effective ratio (ACER).Results: The least ACER was obtained for Hydroxychloroquine and highest was for Methotrexate. But there was no statistically significant difference in ACER between various treatment groups. There was no significant difference in the disease activity improvement between the three groups.Conclusions: MTX, HCQ and MTX+HCQ showed improvement in disease activity without any significant difference. MTX is superior considering direct cost but there is no difference in the total cost between three groups.

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