THU0243 Proper Initiation of Biologic Treatment (TREAT-TO-TARGET STRATEGY) Favors Better Outcome in Patients with Rheumatoid Arthritis

2014 ◽  
Vol 73 (Suppl 2) ◽  
pp. 266.1-266
Author(s):  
C.E. Lampropoulos ◽  
F. Orfanos ◽  
V.-K. Bournia ◽  
T. Karatsourakis ◽  
K. Mavragani ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Treat To Target ◽  
Biologic Treatment ◽  
Target Strategy

scholarly journals AB0304 EXTRA-ARTICULAR MANIFESTATIONS IN A COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING BIOLOGIC TREATMENT

2019 ◽  
Author(s):  
Anahy Brandy-Garcia ◽  
Annika Nack ◽  
águeda Prior-Español ◽  
Susana Holgado ◽  
Melania Martínez-Morillo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Biologic Treatment

scholarly journals P228 Risk of sinusitis in patients with rheumatoid arthritis: association with different treatment strategies

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Kapil Halai ◽  
Katie Bechman ◽  
Sam Norton ◽  
Andrew P Cope ◽  
Kimme L Hyrich ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Smoking Status ◽  
Treatment Strategies ◽  
Risk Difference ◽  
British Society ◽  
Published Data ◽  
Biologic Treatment ◽  
Surgical Interventions ◽  
Increase Risk ◽  
Anti Cd20

Abstract Background There is an established increase risk of infection in rheumatoid arthritis (RA). Most published data examine serious events, which affect 3-5% of patients annually. Approximately half of the patients experience non-serious infection, which does not require parental antibiotics or hospitalisation. Sinusitis events affecting patients on biologics (particularly TNF inhibition) have been observed but not well described, with a prevalence of 2-17%. Sinusitis is associated with treatment discontinuation and surgical interventions. We aim to describe the rates of sinusitis with different RA treatment strategies and provide estimates of risk difference. Methods The population was adults with RA, enrolled in the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis registry (BSRBR-RA) during the first 3 years of study on biologic treatment. The predictor was treatment strategy at the time of event (csDMARD only, TNF inhibitors, IL-6 inhibitors and anti-CD20). The primary outcome was sinusitis according to MeddraPT codes reported by patients (via patient diary) or clinician (on an adverse event form). A multi-failure Cox survival model was used to compare risk across treatment groups. A multivariate model adjusted for confounders (age, gender, entry year in BSRBR-RA, disease duration, baseline disease activity by DAS-28, HAQ, comorbidities, smoking status and steroid use. Results 23,584 patients were included, contributing to a total of 64,035 patient-years of follow up. There were 797 infective events in 580 patients. This corresponded to a rate of 0.95 per year (95% CI 0.87 to 0.1.02). The sinusitis rate was numerically highest with anti-CD20 (Rituximab) and lowest with csDMARDs (Table 1). In the adjusted Cox proportional hazard model, all 3 biologics strategies had a significantly higher rate of sinusitis compared to csDMARD cohort; (TNFi 2.76 (95%CI 1.85 to 4.12); IL-6R 2.51 (1.00 to 6.29); anti-CD20 3.14 (1.46 to 6.72). Conclusion Sinusitis is more common in patients prescribed biologics compared to the csDMARD. The highest rate was seen with rituximab. This would fit biologically, as the primary immunodeficiency phenotype of recurrent sinusitis aligns with antibody defects e.g. common variable immunodeficiency. However, it is interesting to observe that sinusitis is more common across the treatment classes. Disclosures K. Halai None. K. Bechman None. S. Norton None. A.P. Cope None. K.L. Hyrich Honoraria; AbbVie paid to the institution and grant income from Pfizer and Bristol-Myers Squibb for activities outside of this work. J.B. Galloway Honoraria; or speaking or attending conferences from AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Pfizer and Union Chimique Belge.

scholarly journals Total Ankle Arthroplasty for Rheumatoid Arthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0024
Author(s):  
Makoto Hirao ◽  
Jun Hashimoto ◽  
Hideki Tsuboi ◽  
Takaaki Noguchi
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Group ◽  
Soft Tissue ◽  
Bone Strength ◽  
Total Ankle Arthroplasty ◽  
Soft Tissue Balance ◽  
Biologic Treatment ◽  
Ankle Arthroplasty ◽  
Loading Axis

Category: Ankle Introduction/Purpose: Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (1. augmentation of bone strength, 2. control of soft tissue balance, 3. adjustment of the loading axis) for rheumatoid arthritis (RA) cases were evaluated after mid to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated. Methods: We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment. Results: This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the latest follow-up were all significantly lower in the biologic treatment group. Conclusion: TAA is recommended for RA cases, if disease control, augmentation of bone strength, control of soft tissue balance, and adjustment of loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.

scholarly journals Defining response to TNF-inhibitors in rheumatoid arthritis: the negative impact of anti-TNF cycling and the need for a personalized medicine approach to identify primary non-responders

2019 ◽  
Vol 38 (11) ◽  
pp. 2967-2976 ◽  
Author(s):  
Keith J. Johnson ◽  
Helia N. Sanchez ◽  
Nancy Schoenbrunner
Keyword(s):  
Rheumatoid Arthritis ◽  
Personalized Medicine ◽  
Negative Impact ◽  
Alternative Mechanism ◽  
First Line ◽  
Biologic Treatment ◽  
Necrosis Factor Alpha ◽  
Treatment Target ◽  
Treatment Targets ◽  
Factor Alpha

Abstract Current guidelines recommend treating rheumatoid arthritis (RA) patients to reach low disease activity or remission, however, most biologic-naive RA patients fail to reach treatment targets on their first biologic therapy. Approximately 90% of biologic-naive RA patients receive a tumor necrosis factor alpha inhibitor (anti-TNF) as their first biologic treatment, even though several alternative mechanism of action (MOA) therapies are approved as first-line options. After 3 months of therapy, patients may remain on anti-TNF therapy even if they fail to achieve the treatment target, mainly due to formulary structures. This means patients have to endure a second and even a third ineffective anti-TNF—called anti-TNF cycling—before changing MOA. This significantly delays patients from reaching their treatment targets. All anti-TNF drugs target the same molecular and inflammatory pathways; thus, it is not surprising that most patients who are primary non-responders to their initial anti-TNF therapy fail to achieve their treatment targets when cycled through alternative anti-TNFs. This suggests that primary non-responders should be switched to an alternative MOA therapy rather than enduring anti-TNF cycling. Avoiding anti-TNF cycling would prevent disease progression and improve quality of life for RA patients who are primary non-responders to anti-TNFs. The development of a personalized medicine approach to identify primary non-responders to anti-TNFs prior to treatment would allow significantly more patients to reach their treatment target by treating them with alternative MOA therapies as first-line therapies.

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