scholarly journals Recent advances in managing axial spondyloarthritis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 697
Author(s):  
Priyanka Agrawal ◽  
Pedro M. Machado
Keyword(s):  
Radiographic Progression ◽  
Axial Spondyloarthritis ◽  
Axial Skeleton ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Treat To Target ◽  
First Line ◽  
Biologic Drugs ◽  
Inflammatory Drugs ◽  
Line Drug

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that predominantly affects the axial skeleton. The advent of biologic drugs has transformed the management of patients with axSpA. However, non-steroidal anti-inflammatory drugs remain the first-line drug treatment for axSpA. The optimal management of patients with axSpA requires a combination of pharmacological and non-pharmacological treatment modalities, namely exercise and physical therapy. This review looks at novel therapeutic options in patients with axSpA. It also summarises current evidence regarding radiographic progression and treat-to-target in axSpA.

scholarly journals AB0635 HOW ARE NON STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAID) PRESCRIBED IN AXIAL SPONDYLOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1613.1-1613
Author(s):  
K. Ben Abdelghani ◽  
Y. Gzam ◽  
A. Fazaa ◽  
S. Miladi ◽  
K. Ouenniche ◽  
...  
Keyword(s):  
Axial Spondyloarthritis ◽  
Maximum Dose ◽  
Tnf Alpha ◽  
First Line ◽  
Peripheral Arthritis ◽  
Biological Treatments ◽  
Synthetic Dmards ◽  
Nsaid Prescription ◽  
Axial Form ◽  
Inflammatory Drugs

Background:For decades, NSAID have been used as the first-line drugs to treat axial spondyloarthritis (ax-SpA). However, the NSAID prescription strategy is not clearly detailed and it varies from one clinician to another.Objectives:The aim of this study was to assess the NSAID prescription modalities adopted in ax-SpA and the differences between these modalities.Methods:This is a descriptive study including 200 cases of ax-SpA fulfilling the ASAS 2009 criteria and diagnosed between January 2000 and October 2019. The demographic and clinical features of the ax-SpA were collected and the modalities of prescription of NSAID were retrospectively assessed.Results:Our population consists of 138 men and 62 women with a mean age of 43,3 ± 11,2 years. The HLA B-27 antigen was present in 50,8% of cases. The ax-SpA was a pure axial form in 67% of patients, associated with peripheral arthritis, enthesitis and dactylitis in 19%, 21,5% and 1,5% respectively.One hundred eighty patients (90%) had been treated with NSAIDs. The NSAIDs used were: the Diclofenac (57.5%), Indomethacin (37.5%), Piroxicam (36%), clecoxib (34%), Naproxen (29.5%) and ketoprofen (13%). Seventy-three patients (36.5%) had used at least 3 NSAIDs.Among the 180 patients treated with NSAID, 88 patients (48,8%) were treated with conventional synthetic DMARDs (csDMARDs) in association with NSAID: Salazopyrine (43,3%) and Methotrexate (13,3%). Seventy-one patients (39,4%) had necessitated the use of anti-TNF alpha.NSAIDs were used continuously in 115 patients (63.8%) and the maximum dose of NSAIDs was used in 78 patients (43.3%). By comparing patients who used maximum doses of NSAIDs and those who used NSAID continuously with other patients, we noticed that the use of biological treatments was more frequent in those groups (p = 0,01 and p=0,004 respectively).In addition, while comparing the group of patients co-treated with csDMARDs with other patients treated with NSAID on monotherapy, we noted that this group of patients had more arthritis (p<0,0001), enthesitis (p=0,02), psoriasis (p=0,04) and necessitated more biological treatments (p=0,01).Conclusion:Our results suggest that maximal doses and/or continuous prescription of NSAID were mainly used if there was no response to that treatment. The csDMARDs were more prescribed if there were peripheral manifestations or psoriatic arthritis and those forms were also more candidates to biological treatments.References:[1]Wang R, et al. Arthritis Rheumatol Hoboken NJ. 2019;Disclosure of Interests:None declared

Axial spondyloarthritis

2013 ◽  
pp. 879-889 ◽  
Author(s):  
Denis Poddubnyy ◽  
Joachim Sieper
Keyword(s):  
Axial Spondyloarthritis ◽  
Axial Skeleton ◽  
Chronic Inflammatory Disease ◽  
Hla B27 ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Male Predominance ◽  
Inflammatory Drugs ◽  
Active Inflammation

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2% and 0.8% and is strongly dependent on the prevalence of HLA-B27 in a given population. AxSpA can be split in patients with radiographic axSpA (also termed ankylosing spondylitis (AS)) and in patients with non-radiographic axSpA (nr-axSpA). For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axSpA have been developed by the Assessment of Spondylo-Arthritis International Society (ASAS) which cover AS but also the earlier form of nr-axSpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA-B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.

scholarly journals IMPACT OF THE FREQUENCY OF USING NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ON THE RADIOGRAPHIC PROGRESSION OF SACROILIITIS IN PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS

2018 ◽  
Vol 56 (3) ◽  
pp. 346-350 ◽  
Author(s):  
D. G. Rumyantseva ◽  
T. V. Dubinina ◽  
Sh. F. Erdes
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Radiographic Progression ◽  
Axial Spondyloarthritis ◽  
On Demand ◽  
Number Of Patients ◽  
Inflammatory Drugs ◽  
The Mean ◽  
Group 1

Objective: to compare the impact of continuous or on-demand use of nonsteroidal anti-inflammatory drugs (NSAIDs) on the activity and radiographic progression of early axial spondyloarthritis (axSpA).Subjects and methods. The investigation enrolled patients from the early spondyloarthritis cohort who met the 2009 Assessment of Spondyloarthritis International Society (ASAS) criteria for axSpA. This analysis included 68 patients who had been followed up for at least 24 months. The mean age at the time of inclusion in the investigation was 28.5±5.8 years; the mean disease duration was 24.1±15.4 months; 63 (92.6%) patients were HLA-B27-positive. The patients were divided into two groups: 1) 35 patients used NSAIDs at maximum therapeutic doses continuously during the follow-up period; 2) 33 patients received these drugs on-demand, depending on the presence and severity of back pain.Results and discussion. After 2-year follow-up, the median stage of radiographic sacroiliitis (SI) in Group 1 was unchanged and remained equal to 4; that in Group 2 in this period significantly increased from 3 to 4 scores (p < 0.05). At baseline, the patient groups did not differ in C-reactive protein (CRP) levels, the Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), and the Bath Ankylosing Spondylitis Functional Index (BASFI); however, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was higher in Group 1 (p < 0.05). The number of patients with active SI, as evidenced by magnetic resonance imaging (MRI), and the degree of its severity did not differ significantly between groups. After 2 years, all the patients retained low disease activity according to ASDAS-CRP, BASDAI, and CRP levels; and these measures did not differ significantly between groups either; the BASFI became higher in Group 1. MRI findings indicated that the number of patients with active SI decreased, but no differences were found between the groups.Conclusion. In patients with early axSpA, the continuous intake of NSAIDs can slow radiographic progression to a greater extent than their on-demand use. 

scholarly journals Treat-to-target strategy with secukinumab as a first-line biological disease modifying anti-rheumatic drug compared to standard-of-care treatment in patients with active axial spondyloarthritis: protocol for a randomised open-label phase III study, AScalate

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039059
Author(s):  
Denis Poddubnyy ◽  
Ludwig Hammel ◽  
Marvin Heyne ◽  
Justyna Veit ◽  
Claudia Jentzsch ◽  
...  
Keyword(s):  
Axial Spondyloarthritis ◽  
Treatment Options ◽  
Standard Of Care ◽  
Phase Iii ◽  
Treat To Target ◽  
Institutional Review Boards ◽  
Inadequate Response ◽  
First Line ◽  
Open Label ◽  
Disease Modifying

IntroductionIn patients with axial spondyloarthritis (axSpA), biological disease-modifying anti-rheumatic drugs (bDMARDs) are recommended to those with inadequate response or contraindications to non-steroidal anti-inflammatory drugs (NSAIDs). In case of failure of the first bDMARD, a switch within the class or to other bDMARD is recommended. Despite these treatment options, there is no optimal treat-to-target (T2T) strategy. This study aims to evaluate the efficacy of a T2T strategy in patients with axSpA, with secukinumab as a first-line bDMARD, compared with standard-of-care (SOC) treatment.Methods and analysesThis is a randomised, parallel-group, open-label, multicentre ongoing study in patients with axSpA who are naïve to bDMARD and who have had an inadequate response to NSAIDs. The study will include an 8-week screening period, a 36-week treatment period and a 20-week safety follow-up period. At baseline, patients will be randomised (1:1) to T2T or SOC group. In the T2T group, patients will be treated with secukinumab 150 mg subcutaneous (s.c.) weekly until week 4 and then at week 8. For non-responders (patients without Ankylosing Spondylitis Disease Activity Score [ASDAS] clinically important improvement; change from baseline ≥1.1) at week 12, dose will be escalated to 300 mg s.c. every 4 weeks until week 24. Non-responders at week 24 will be switched to adalimumab biosimilar 40 mg s.c. every 2 weeks until week 34. In the SOC group, patients will receive treatment at the discretion of the physician. The primary endpoint is the proportion of patients achieving an Assessment in SpondyloArthritis International Society 40% (ASAS40) response at week 24.Ethics and disseminationThe study is being conducted as per the ethical principles of the Declaration of Helsinki and after approval from independent ethics committees/institutional review boards. The first results are expected to be published in early 2022.Trial registration numberThis study is registered with ClinicalTrials.gov, NCT03906136.

scholarly journals Treatment strategies in axial spondyloarthritis: what, when and how?

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_4) ◽  
pp. iv79-iv89
Author(s):  
George E Fragoulis ◽  
Stefan Siebert
Keyword(s):  
Radiographic Progression ◽  
Axial Spondyloarthritis ◽  
Unmet Need ◽  
Treatment Strategies ◽  
Pharmacological Interventions ◽  
Symptomatic Management ◽  
Proven Efficacy ◽  
Line Drug ◽  
Optimal Treatment Strategy

Abstract There have been major advances in the management of axial spondyloarthritis (axSpA) with the introduction of effective biologic agents targeting TNF and IL-17A. Clinicians now have more choice but, despite treatment recommendations, are still faced with significant uncertainty when deciding on the optimal treatment strategy for an individual patient in clinical practice. Management of axSpA typically requires both non-pharmacological and pharmacological interventions. NSAIDs remain the first line drug therapies for axSpA with proven efficacy for symptomatic management but uncertainty remains regarding their optimal long-term use relating to radiographic progression and safety in axSpA. To-date there are no head-to-head trials of biologics in axSpA. Clinicians need to consider other factors, including extra-articular manifestations, comorbidities, safety and radiographic progression when deciding on which biologic to recommend for an individual patient. This article will explore the evidence relating to these factors and highlight areas of unmet need.

scholarly journals Search of Official Nationwide Database in Japan for Adverse Events Associated with Disease-modifying Antirheumatic Drug Therapies: Focus on Therapies in Combination with Methotrexate Author

2021 ◽  
Author(s):  
Shigeko Inokuma
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Lymphoproliferative Disease ◽  
The Other ◽  
First Line ◽  
Disease Modifying Antirheumatic Drugs ◽  
Biologic Drugs ◽  
Dmard Therapy ◽  
Disease Modifying ◽  
Line Drug

Abstract Disease-modifying antirheumatic drugs (DMARDs) are essential for rheumatoid arthritis (RA) therapy, and many synthetic and biologic drugs are available. DMARDs are frequently prescribed in combination with methotrexate (MTX), as it is the first-line drug. The adverse events (AEs) associated with DMARDs have sometimes unfavorable outcomes. Major AEs, particularly therapies in combination with methotrexate, were investigated in this study. A search of the website of the Japanese Pharmaceuticals and Medical Devices Agency for AEs associated with therapies with five DMARDs (MTX, tacrolimus, adalimumab, tocilizumab, and abatacept) reported from 2014 to 2016 was performed. The AEs searched included lymphoproliferative disease (LPD), cytopenia, interstitial pneumonia (IP), infectious pneumonia other than Pneumocystis jirovecii pneumonia (PCP) (i-Pn), and PCP. The number of cases of each AE and its ratio to the total number of cases of all AEs associated with each DMARD therapy were examined. Data were compared among AEs and DMARDs. MTX therapy in combination with other DMARDs was examined for rheumatoid arthritis (RA) cases. On the website, a total of 8874 cases were listed as having AEs associated with therapies with the five DMARDs. For MTX therapy, LPD was the most frequent (1438 cases, 36.4% of all AE cases), followed by cytopenia (10.9%), IP (6.2%), i-Pn (4.1%), and PCP (2.6%). Under therapy with any of the other four DMARDs, i-Pn showed the largest number of cases and the highest ratio (4.2–15.3%); other AEs varied in number and ratio. The proportion of use of MTX in combination with the four DMARDs was highest for PCP (67/71, 94.4%), followed by LPD (50/73, 68.5%), cytopenia (48/73, 65.8%), i-Pn (101/173, 58.4%,), and IP (36/80, 45.0%) (Table 1). In total, including cases reported for MTX therapy, 98.2% (1286/1309) of LPD cases, 88.5% (193/218) of cytopenia cases, 79.8% (174/218) of IP cases, 76.4% (233/305) of i-Pn cases, and 97.6% (165/169) of PCP cases had MTX. In conclusion, LPD was by far the most frequent AE associated with MTX therapy. PCP was strongly associated with the use of MTX in combination with another DMARD. For therapy with any of the other four DMARDs, i-Pn showed the highest ratio.

Epithelioid haemangioendothelioma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10569-10569
Author(s):  
Nadia Yousaf ◽  
Charlotte Benson ◽  
Omar Al-muderis ◽  
Cyril Fisher ◽  
Ian Robert Judson
Keyword(s):  
Median Overall Survival ◽  
Treatment Modalities ◽  
Published Data ◽  
First Line ◽  
Clinical Behaviour ◽  
Diffuse Disease ◽  
Mediastinal Disease ◽  
Royal Marsden Hospital ◽  
Inflammatory Drugs ◽  
Epithelioid Haemangioendothelioma

10569 Background: Epithelioid haemangioendothelioma (EHE) is a rare vascular tumour which can arise in any site. There is little published data about the clinical behaviour and management of these tumours. Methods: A retrospective review of the management of patients with histologically proven EHE presenting to the Royal Marsden Hospital from January 1999 to January 2012. Demographics, site, treatment and survival outcomes were collected. Results: 28 patients (21 females) were identified with a mean (SD) age of 44 (17). 20 patients presented with diffuse disease involving one or more organs at presentation. The predominant site of disease was identified as liver n=8, mediastinum n=6, lung n= 2, limb n=1, pancreas n=1, spleen n=1, back n=1, abdominal wall n=1, oesophagus n=1, neck n=1, pelvis n=1, not known n=2. Median overall survival (Interquartile range) [OS (IQR)] in months was the longest in 10 patients who had localised operable disease at presentation, 116 (71). Amongst those with inoperable disease (n=16), patients with liver disease had the longest OS (IQR), 18 (43) months and those with lung and mediastinal disease had the shortest OS (IQR), 10 (2.5) and 11 (17) months respectively. A variety of treatment modalities were used for patients with inoperable disease and these are summarised in the Table. Conclusions: The clinical behaviour of EHE can vary depending on the site of disease. Surgery, if feasible, has the best outcome. In those with inoperable disease a period of observation to assess the clinical behaviour of the tumour is recommended. Non-steroidal anti-inflammatory drugs are a reasonable, relatively non-toxic first line treatment option. The use of anti-angiogenic drugs merits further exploration. [Table: see text]

Systemic analgesics (including paracetamol and opioids)

2016 ◽  
Author(s):  
Bernard Bannwarth ◽  
Francis Berenbaum
Keyword(s):  
Side Effects ◽  
Treatment Modalities ◽  
First Line ◽  
Short Term ◽  
Knee Oa ◽  
Clinical Benefits ◽  
Inflammatory Drugs ◽  
Mu Receptors ◽  
Meta Analyses ◽  
Current Guidelines

Apart from non-steroidal anti-inflammatory drugs (NSAIDs), there are only two categories of systemic analgesics, namely paracetamol (acetaminophen) and opioids, that are currently available worldwide for clinical use. Paracetamol is poorly effective in relieving pain and improving function in patients with symptomatic osteoarthritis (OA). Furthermore, its safety profile is less favourable than classically thought. In fact, there is evidence paracetamol acts as a weak inhibitor of the cyclooxygenase enzymes. Given that paracetamol poses a lower risk of severe adverse events than NSAIDs while being better tolerated than opioids, it is usually considered as the first-line systemic analgesic for OA. Commonly prescribed opioids are primarily agonists of the mu receptors, thereby producing similar desirable (analgesia) and untoward effects. Meta-analyses of short-term clinical trials showed that, on average, the modest clinical benefits of opioids did not outweigh the side effects in patients with knee or hip OA. Accordingly, most current guidelines support the use of opioids for selected OA patients only (e.g. patients who have not had an adequate response to other treatment modalities and are not candidates for total joint arthroplasty). In view of the limited efficacy and/or potential harms of available analgesics, particular attention was paid to novel painkillers, especially nerve growth factor (NGF) antagonists. Although these agents provided clinically meaningful improvements in pain and physical function in patients with hip or knee OA, they lead to severe side effects, including rapidly destructive arthropathies and neuropathies. Thus, if approved for marketing, NGF antagonists would be reserved for selected and well-defined patients with OA.

Update Treatment for Prolactinoma

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Chávez Hernández María Margarita ◽  
Jiménez Báez María Valeria ◽  
Armijo Medina María Fernanda ◽  
Domínguez Leyva Jorge Miguel ◽  
Góngora Valencia Karen Alejandra ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Safety Profile ◽  
Pituitary Tumor ◽  
Common Type ◽  
Treatment Modalities ◽  
First Line ◽  
Agonist Therapy ◽  
Dopamine Agonist Therapy ◽  
Gonadal Dysfunction

Prolactinomas are the most common type of functional pituitary tumor. The present manuscript is an update on the treatment modalities for prolactinomas. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas; recurrence of disease after cessation of the drug may occur in patients. Its safety profile remains high, allowing its use during pregnancy.

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