Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease: results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study.

BACKGROUND: Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD). AIM: To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to the second, irrespective of drug sequence METHODS: We conducted a UK-wide, multicentre, retrospective cohort study to report rates of immunogenicity and treatment failure of second anti-TNF therapies in 1058 patients with IBD who underwent therapeutic drug monitoring for both infliximab and adalimumab. The primary outcome was immunogenicity to the second anti-TNF agent, defined at any timepoint as an anti-TNF antibody concentration ≥9 AU/ml for infliximab and ≥6 AU/ml for adalimumab. RESULTS: In patients treated with infliximab and then adalimumab, those who developed antibodies to infliximab were more likely to develop antibodies to adalimumab, than patients who did not develop antibodies to infliximab (OR 1.99, 95%CI 1.27-3.20, p = 0.002). Similarly, in patients treated with adalimumab and then infliximab, immunogenicity to adalimumab was associated with subsequent immunogenicity to infliximab (OR 2.63, 95%CI 1.46-4.80, p < 0.001). For each 10-fold increase in anti-infliximab and anti-adalimumab antibody concentration, the odds of subsequently developing antibodies to adalimumab and infliximab increased by 1.73 (95% CI 1.38-2.17, p < 0.001) and 1.99 (95%CI 1.34-2.99, p < 0.001), respectively. Patients who developed immunogenicity with undetectable drug levels to infliximab were more likely to develop immunogenicity with undetectable drug levels to adalimumab (OR 2.37, 95% CI 1.39-4.19, p < 0.001). Commencing an immunomodulator at the time of switching to the second anti-TNF was associated with improved drug persistence in patients with immunogenic, but not pharmacodynamic failure. CONCLUSION: Irrespective of drug sequence, immunogenicity to the first anti-TNF agent was associated with immunogenicity to the second, which was mitigated by the introduction of an immunomodulator in patients with immunogenic, but not pharmacodynamic treatment failure.

Exploring the role of gender and gendered pain expectation in physiotherapy students.

Introduction: Gender and gender role pain expectations may influence how health care providers interact with and manage their patients' symptoms. Purpose: The purpose of this study was to describe gendered traits and gender role pain expectations among physical therapy students. Method: A survey assessing gendered traits and gender role expectations in relation to pain was completed by a sample of 171 physical therapy students (120 women, 51 men). Data were analyzed using descriptive statistics and differences between men and women were tested with chi-square or Kruskal-Wallis. Results: Men and women in physical therapy training were not different on 13 out of 16 of the gendered traits. The exceptions were that men rated themselves as more "decisive" compared to women (mean rank = 103.8 vs. mean rank = 78.4, P = 0.001) and women rated themselves as more "emotional" (mean rank = 91.95 vs. mean rank = 72.01, P = 0.009) and more "nurturing" (mean rank = 90.89 vs. mean rank = 72.91, P = 0.020). No significant differences were found in terms of gendered expectations of pain sensitivity, endurance, or in terms of personal experience of pain between the men and women in the sample. However, the majority (75%) of participants reported that women were more willing to report pain compared to men. Finally, both groups rated themselves as no different in handling pain compared to a typical man or woman. Conclusion: In conclusion, men and women in training to be physical therapists demonstrate similar gendered trait profiles and little gender bias in relation to pain expectations.

Introduction: Le sexe des prestataires de soins et leurs attentes à l'égard du rôle des hommes et des femmes en ce qui concerne la douleur peuvent influencer la façon dont ils interagissent avec les patients et prennent en charge leurs symptômes.But: Le but de cette étude était de décrire les caractéristiques sexospécifiques et les attentes à l'égard du rôle des hommes et des femmes en ce qui concerne la douleur chez des étudiants en physiothérapie.Méthode: Un sondage évaluant les caractéristiques sexospécifiques et les attentes à l'égard du rôle des hommes et des femmes en ce qui concerne la douleur a été mené auprès d'un échantillon de 171 étudiants de physiothérapie (120 femmes, 51 hommes), Les données ont été analysées à l'aide de statistiques descriptives tandis que les différences entre les hommes et les femmes ont été vérifiées à l'aide du test du chi carré ou du test de Kruskal-Wallis.Résultats: Les hommes et les femmes étudiant la physiothérapie n'étaient pas différents pour 13/16 des caractéristiques sexospécifiques. Les exceptions étaient que les hommes se disaient plus « déterminés ¼ comparativement aux femmes (valeur moyenne = 103,8 comparativement à valeur moyenne = 78,4, P = 0,001), tandis que les femmes se considéraient plus « émotives ¼ (valeur moyenne = 91,95 comparativement à valeur moyenne = 2,01, P = 0,009) et plus « attentionnées ¼ (valeur moyenne = 90,89 comparativement à valeur moyenne = 72,91, P = 0,020).Aucune différence significative entre les hommes et les femmes faisant partie de l'échantillon n'a été observée en ce qui concerne les attentes sexospécifiques à l'égard de la sensibilité ou de l'endurance à la douleur, ou l'expérience personnelle de la douleur. Toutefois, la majeure partie des participants (75%) ont déclaré que les femmes étaient plus disposées que les hommes à signaler la douleur. Finalement, les deux groupes ont déterminé qu'ils ne géraient pas la douleur différemment de l"homme-type ou de la femme-type.Conclusion: En conclusion, les hommes et les femmes qui étudient pour devenir physiothérapeutes présentent des profils aux caractéristiques sexospécifiques similaires et ont peu de préjugés sexistes relativement aux attentes concernant la douleur.