Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO Registry.

OBJECTIVES: The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS). METHODS: We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m2], overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated. RESULTS: There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 ± 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P = .003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P > .05). CONCLUSIONS: This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients.

Biological treatment in elderly and young patients with ankylosing spondylitis: TURKBIO real-life data results.

Objectives: This study aims to investigate the effect of age on disease activity and biological treatment in patients with ankylosing spondylitis (AS). Patients and methods: A total of 811 AS patients registered in the TURKBIO registry database between 2011 and 2019 were categorized according to their age at the time of entry into the registry and assigned to one of two groups: young patients, defined as <60 years of age (n=610), and those aged ≥60 years (n=201) were recorded as elderly patients. Demographic, clinical, and laboratory characteristics, along with disease activity markers and other follow-up parameters, as well as current and prior treatments, were electronically recorded during each visit using open-source software. Results: The mean age of the elderly patients was 67±5.8 years, while the mean age of the younger patients was 49.2±10.9 years. Male predominance was lower in the older AS group compared to the younger AS group (p=0.002). During follow-up period, 397 patients (comprising 318 young and 79 elderly individuals) had a history of using at least one biological disease-modifying agent (bDMARD). There was no significant difference between the groups in terms of DMARD and bDMARD-use distributions. First tumor necrosis factor inhibitor (TNFi) retention rates were found to be similar in both groups over 10 years of follow-up. Adverse events were found to be similar in young (19.9%) and elderly (26.8%) AS patients. Conclusion: Research in the TURKBIO cohort reveals that both older and younger patients with AS exhibited similar disease activity levels with comparable treatment approaches. Moreover, the results of TNFi treatments in elderly patients were the same as those observed in younger patients, with no notable increase in safety concerns.

Assessing safety and efficacy of TNFi treatment in late onset ankylosing spondylitis: a TURKBIO registry study.

Clinical data on the use of tumour necrosis factor inhibitors (TNFi) in late-onset ankylosing spondylitis (LoAS) are limited. The present study aimed to evaluate efficacy, safety, and treatment adherence associated with the initial use of TNFi therapy in biologic naive patients diagnosed with LoAS. Patients whose age of onset was ≥ 45 years and < 45 years were classified as having LoAS and YoAS, respectively, based on the age of symptom onset. There were 2573 patients with YoAS and 281 LoAS. Baseline disease activity measures were similar between the groups. No significant differences were seen between the two groups in response to treatment and in remaining on the first TNFi at 6, 12 and 24 months. In the LoAS group, the analysis showed that TNFi discontinuation was linked to VAS pain score (HR 1.04; 95% CI 1.01-1.06). Patient groups had similar rates of adverse events (YoAS: 8.7% vs. LoAS: 11.7%). In both biologic naive LoAS and YoAS patients, the study showed that the initial TNFi therapy was equally effective and safe.

How has the COVID-19 pandemic affected our rheumatology patients using biological/targeted DMARDs?

INTRODUCTION: We aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the course and treatment of patients with inflammatory rheumatic musculoskeletal disease (iRMD) using biologic or targeted synthetic disease modifying and rheumatic drugs (b/tsDMARDs). METHODOLOGY: The study was carried out in two stages: in the first stage we investigated the delay of b/tsDMARD treatment in the first 3 months of the pandemic; in the second stage, we investigated all patients who decided to continue treatment after interruption in the 12-month period. RESULTS: A total of 521 patients were included in the study. The iRMD diagnosis was listed as spondyloarthritis (SpA) (54.3%), rheumatoid arthritis (RA) (25.7%), psoriatic arthritis (PsA) (8.4%), vasculitis (6.1%), and others (5.4%). Concurrent use of hydroxychloroquine (hazard ratio [HR] = 1.49), iv bDMARD use (HR = 1.34), and a history of discontinuation of drug in the first 3 months of the pandemic (HR = 1.19) were determined as factors that reduced 12-month drug retention rates. The use of glucocorticoid (HR = 3.81) and having a diagnosis of interstitial lung disease/chronic obstructive lung disease (HR = 4.96) were found to increase the risk of being infected by SARS coronavirus 2 (SARS-CoV-2). CONCLUSIONS: It was shown that approximately 1/5 of iRMD patients using b/tsDMARDs delayed their treatment due to the fear of COVID-19 in the first three months of the pandemic process. However, with good communication with the patients, b/tsDMARD treatment was restarted and the 12-month drug retention status was quite high.

Effect of abdominal fat distribution on severity of acute pancreatitis.

AIM OF THE STUDY: Obesity is a well-determined risk factor for acute pancreatitis. Increased visceral fat has been shown to increase the proinflammatory environment experienced by patients. In this study, we aimed to research the correlation between abdominal fat distribution parameters measured with computed tomography (CT) and severity of acute pancreatitis (AP). MATERIAL AND METHODS: The study included patients monitored due to AP in the internal medicine clinic of GOP Education and Research Hospital from January 2015 to December 2018. The Acute Physiology and Chronic Health Evaluation (APACHE) score, the Imrie score and the Bedside Index of Severity in Acute Pancreatitis (BISAP) scores were calculated. Advanced image processing analysis software (INFINIT Xelis, v 1.0.6.3) was used to calculate individual abdominal fat distribution parameters from CT screening with division of abdominal tissues. Measurements were performed from -50 to -250 Hounsfield units (HU) between vertebrae L2-L3. RESULTS: When mild and moderate AP groups were compared, there were statistically significant differences in duration of hospital stay and scoring (APACHE, Imrie and BISAP) (p < 0.001), while there were no significant differences in abdominal fat distribution parameters (p > 0.05). There was no significant correlation of visceral and subcutaneous fat volumes with development of systemic complications, while a significant correlation was identified for visceral to total fat tissue area ratio (VTR) with local complications (p < 0.001). Pearson correlation analysis found no correlations of mortality and pancreatitis severity with visceral (VFA) and subcutaneous fat area (SFA) (p > 0.05). Positive correlations were identified for VFA with Imrie, BISAP and APACHE scores (p < 0.01), and positive correlations were identified for visceral adipose tissue (VAT) with visceral to subcutaneous fat ratio (VSR) and APACHE scores (r = 0.256 and 0.252, respectively, p < 0.001). Positive correlations were identified for VTR and VSR ratios with BISAP scores (r = 0.266 and r = 0.277, respectively, p < 0.001). CONCLUSIONS: In patients with AP diagnosis and abdominal CT scans, increased VFA and VTR ratio were found to be associated with increased AP clinical scores with no significant correlation identified in terms of local/systemic complication development. Our study shows that VFA is linked to AP clinical scoring systems and should be included in AP predictive scoring systems.

Evaluation of limited hand mobility in systemic sclerosis patients by using "prayer sign" and "tabletop sign".

OBJECTIVES: To determine limited joint mobility (LJM) of the hand in patients with systemic sclerosis (SSc). METHODS: LJM was evaluated with "prayer sign" and "tabletop sign" tests. LJM staging was done by Rosenbloom classification method. LJM (+) and LJM (-) patients were compared in terms of demographic findings (gender, age and duration of disease), laboratory results (ESR, CRP, anti-nuclear antibody (ANA), anti-topoisomerase I and anti-centromere), and modified Rodnan skin score (mRss) results. RESULTS: In our study, a total of 217 patients, including 113 patients with a diagnosis of SSc, and 104 as a healthy control group with similar age and gender distribution to these patients, were included. A total of 113 (F=98, M=15) patients (limited cutaneous SSc (lcSSc=71), diffuse cutaneous SSc (dcSSc=42)) were included in this study and LJM positivity was found in 66.4% (lcSSc=38, dcSSc=37). A statistically significant difference was observed in between lcSSc and dcSSc patients according to the presence of LJM (p<0.001). There was a moderate positivity relationship between LJM and mRss (lcSSc r=0.449, p<0.001; dcSSc r=0.565, p<0.001). CONCLUSIONS: In our study, it was found that LJM staging correlated with mRss and dcSSc patients had more severe LJM findings than lcSSc. We conclude that "prayer sign" and "tabletop sign" tests used in hand evaluation in SSc patients have similar clinical results with mRss and can be simple bedside tests in daily practice. Key Points • This is the first study examining limited joint mobility (LJM) with "prayer sign" and "tabletop sign" tests in systemic sclerosis (SSc) patients. • "Prayer sign" and "tabletop sign" tests can be easily performed in daily practice. • We found Rosenbloom LJM staging correlated with modified Rodnan skin score. LJM of the hand can be a good prognostic indicator for early stage SSc patients.