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OBJECTIVES: To describe the switch to biosimilar etanercept (bETN), evaluate factors associated with this switch, and evaluate the efficacy of this switch in a real-life setting METHODS: We included patients, from October 2016 to April 2017, with rheumatoid arthritis (RA) and spondyloarthritis (SpA) who received innovator ETN (iETN) for at least 6 months. After receiving information on biosimilars, all physicians were invited to propose a switch from iETN to bETN. Factors associated with bETN discontinuation were explored by univariate and multivariate analyses. We estimated the proportion of patients still on bETN over time by Kaplan-Meier survival analysis. We assessed serum trough concentrations of iETN and bETN and anti-drug antibodies to ETN. RESULTS: Overall, 183 outpatients were eligible for a potential switch; 94 (51.6%) switched from iETN to bETN. The probability of a switch was greater with an older than younger aged physician (mean [SD] age 50.4 [14.3] with a switch vs 44.8 [11.3] with no switch, p = 0.005) and the physician having a full-time academic position than other position (56.4% with a switch vs 13.5% with no switch, p < 0.001). After a 6-month follow-up, bETN retention rate was 83% (95% CI: 0.76-0.92). The first cause of bETN discontinuation was inefficacy (50%). On multivariate analysis, no factor was independently associated with a bETN switch or discontinuation. Drug trough levels did not significantly differ by discontinuation or continuation of bETN. No patient showed anti-drug antibodies. CONCLUSION: The probability of switching from iETN to bETN was likely related to physician characteristics.
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Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Biosimilares Farmacéuticos/uso terapéutico , Sustitución de Medicamentos , Etanercept/uso terapéutico , Pautas de la Práctica en Medicina , Espondiloartritis/tratamiento farmacológico , Adulto , Anciano , Antirreumáticos/sangre , Antirreumáticos/farmacocinética , Aptitud , Artritis Reumatoide/sangre , Artritis Reumatoide/mortalidad , Biosimilares Farmacéuticos/sangre , Biosimilares Farmacéuticos/farmacocinética , Femenino , Francia , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Espondiloartritis/sangre , Espondiloartritis/mortalidad , Centros de Atención TerciariaRESUMEN
AIM: Cardiovascular (CV) risk and mortality associated with spondyloarthritis (SpA) remain controversial. Herein, we performed a meta-analysis of the latest large-scale population-based studies to demonstrate the elevated risk of CV disease and mortality in patients with SpA than in the general population. METHODS: MEDLINE and EMBASE databases were searched systematically for population-based studies published between January 1997 and September 2019. Additional manual literature searches were also performed. All searches and data collection were performed independently by 2 reviewers. We calculated the risks of myocardial infarction (MI), stroke, and all-cause mortality in a meta-analysis and determined the risk ratios (RR) using the Mantel-Haenszel method. RESULTS: Among the 641 identified articles, 16 articles involving 18 cases met the inclusion criteria for our meta-analysis; these included 12 cases of ankylosing spondylitis, five cases of psoriatic arthritis, and 1 case of undifferentiated SpA. Our meta-analysis revealed a significantly high risk of MI (RR: 1.52; 95% CI: 1.29-1.80) and stroke (RR: 1.21; 95% CI: 1.0-1.47) in patients with SpA than in the general population. However, this increased risk was not significant in terms of all-cause mortality (RR: 1.23; 95% CI: 0.96-1.57). CONCLUSIONS: Our meta-analysis demonstrated that patients with SpA have a significantly increased risks of MI and stroke, but without a significant increase in the all-cause mortality, than that in the general population. The higher risk of CV in patients with SpA than that in the general population indicates the need for strict risk factor correction and disease management.
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Enfermedades Cardiovasculares/epidemiología , Espondiloartritis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Prevalencia , Pronóstico , Medición de Riesgo , Espondiloartritis/diagnóstico , Espondiloartritis/mortalidad , Accidente Cerebrovascular/epidemiología , Adulto JovenRESUMEN
Objective: Although clinical trials support equivalence of originator products and biosimilars for etanercept and infliximab, real-world studies among biologics-naïve patients with spondyloarthritis (SpA) are lacking. The objectives were to compare treatment retention in biologics-naïve patients with SpA starting either the originator product or a biosimilar of infliximab and etanercept, and to explore the baseline characteristics of these patients. Methods: Patients with SpA (ankylosing spondylitis/non-radiographical axial SpA/undifferentiated SpA), starting infliximab or etanercept as their first-ever biological disease-modifying antirheumatic drug during January 2014-June 2017 were identified in five Nordic biologics-rheumatology registers. Baseline characteristics were retrieved from each registry; comorbidity data were identified through linkage to national health registers. Country-specific data were pooled, and data on infliximab and etanercept were analysed separately. Comparisons of treatment retention between originators and biosimilars were assessed through survival probability curves, retention rates (2 years for infliximab/1 year for etanercept) and Hazard Ratios (HR). Results: We included 1319 patients starting infliximab (24% originator/76% biosimilar), and 1015 patients starting etanercept (49% originator/51% biosimilar). Baseline characteristics were largely similar for the patients treated with the originators compared with the corresponding biosimilars. Survival probability curves were highly similar for the originator and its biosimilar, as were retention rates: infliximab 2-year retention originator, 44% (95% CI 38% to 50%)/biosimilar, 46% (95% CI: 42% to 51%); and etanercept 1-year retention originator, 66% (95% CI 61% to 70%)/biosimilar, 73% (95% CI 68% to 78%). HRs were not statistically significant. Conclusion: This observational study of biologics-naïve patients with SpA from five Nordic countries showed similar baseline characteristics and very similar retention rates in patients treated with originators versus biosimilars, for both infliximab and etanercept, indicating comparable effectiveness in clinical practice.
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Antirreumáticos/uso terapéutico , Biosimilares Farmacéuticos/uso terapéutico , Etanercept/uso terapéutico , Espondiloartritis/tratamiento farmacológico , Adulto , Antirreumáticos/administración & dosificación , Antirreumáticos/efectos adversos , Biosimilares Farmacéuticos/administración & dosificación , Biosimilares Farmacéuticos/efectos adversos , Quimioterapia Combinada , Etanercept/administración & dosificación , Etanercept/efectos adversos , Femenino , Humanos , Infliximab/administración & dosificación , Infliximab/efectos adversos , Infliximab/uso terapéutico , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Espondiloartritis/diagnóstico , Espondiloartritis/mortalidad , Resultado del TratamientoRESUMEN
Objective: To review long-term certolizumab pegol (CZP) safety across all approved indications: rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), psoriasis (PSO) and Crohn's disease (CD). Methods: Data were pooled across 49 UCB-sponsored CZP clinical trials (27 RA, one axSpA, one PsA, five PSO, 15 CD) to August 2017. Serious adverse events (SAEs) of interest (infections, malignancies, autoimmunity/hypersensitivity events, major adverse cardiovascular events (MACE), gastrointestinal (GI) perforations, psoriasis events, laboratory abnormalities) and deaths were medically reviewed by an external expert committee, using predefined case rules. Incidence rates (IRs)/100 patient-years (PY) are presented by indication; standardised mortality and malignancy rates were calculated using WHO/GLOBOCAN/SEER databases. Pregnancies with maternal CZP exposure are also reported. Results: Of 11 317 CZP-treated patients across indications (21 695 PY CZP exposure; maximum: 7.8 years), infections were the most common SAEs (overall IR: 3.62/100 PY; IRs ranged from 1.50/100 PY(PSO) to 5.97/100 PY(CD)). The IR for malignancies was 0.82/100 PY, including lymphoma (0.06/100 PY). MACE and GI perforation IRs in CZP-treated patients were 0.47/100 PY and 0.08/100 PY and were highest in RA and CD, respectively. Patients with PSO had the lowest SAE rates. The incidence of deaths and malignancies aligned with expected general population data. Conclusion: This extensive overview of the CZP safety profile in clinical trials, across all indications, provides large-scale confirmation of previous reports. No new safety signals or relevant non-disease-related laboratory abnormalities were identified. The study demonstrated some indication-specific differences in certain SAE rates that may be attributable to the underlying inflammatory disease.
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Artritis Psoriásica/tratamiento farmacológico , Artritis Reumatoide/tratamiento farmacológico , Certolizumab Pegol/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Espondiloartritis/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Artritis Psoriásica/epidemiología , Artritis Psoriásica/mortalidad , Artritis Reumatoide/epidemiología , Artritis Reumatoide/mortalidad , Certolizumab Pegol/farmacología , Ensayos Clínicos como Asunto , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/mortalidad , Femenino , Humanos , Inmunosupresores/farmacología , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Espondiloartritis/epidemiología , Espondiloartritis/mortalidad , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To compare the risk of major adverse cardiovascular events (MACE) in a large observational cohort of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (SpA) patients. METHODS: We conducted a mixed retrospective and prospective cohort study using data from patients with RA, PsA, or axial SpA included in the Swiss Clinical Quality Management registry. The primary outcome of interest was a composite of myocardial infarction, transient or permanent cerebrovascular event, or cardiovascular-associated death. RESULTS: A total of 5,315 patients were eligible for the analysis of incidence, with a total follow-up time of 37,495 patient-years for RA, 19,837 patient-years for axial SpA, and 9,171 patient-years for PsA. The unadjusted incidence rate of MACE per 1,000 patient-years was 2.67 for RA, 1.41 for axial SpA, and 1.42 for PsA. Compared to the unadjusted incidence rate ratios (IRRs) in patients with RA, those in patients with axial SpA were 0.53 (95% confidence interval [95% CI] 0.34-0.80; P = 0.003) and in patients with PsA were 0.53 (95% CI 0.30-0.95; P = 0.03). After adjustment for traditional cardiovascular risk factors, age at disease onset, sex, and disease duration, the difference was not significant between RA and axial SpA (adjusted IRR 0.93 [95% CI 0.51-1.69]; P = 0.80) or between RA and PsA (adjusted IRR 0.56 [95% CI 0.27-1.14]; P = 0.11). We found a similar result with the analysis of prevalence. CONCLUSION: There was no significant difference in the incidence and prevalence of MACE between RA and axial SpA or PsA, suggesting that inflammation, rather than a particular disease, drives the increased risk of cardiovascular disease.
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Artritis Psoriásica/epidemiología , Artritis Reumatoide/epidemiología , Enfermedades Cardiovasculares/epidemiología , Espondiloartritis/epidemiología , Adulto , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/mortalidad , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/mortalidad , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Trastornos Cerebrovasculares/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Prevalencia , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Espondiloartritis/diagnóstico , Espondiloartritis/mortalidad , Suiza/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the efficacy and drug survival of anti-tumour necrosis factor (anti-TNF) therapy in non-radiographic axial spondyloarthritis (nr-axSpA) patients treated in clinical practice in Southern Sweden. METHOD: In this cohort study we prospectively included 112 patients with nr-axSpA and high disease activity as well as inadequate response or intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) receiving their first course of anti-TNF therapy. Patients fulfilling modified New York criteria for ankylosing spondylitis (AS) were excluded. The Assessment of SpondyloArthritis International Society (ASAS) criteria for axial SpA were fulfilled by 77% (n = 86) of the included patients. RESULTS: At baseline, the median age of the cohort was 38 years, 59% were males, 79% of the patients had imaging suggestive of sacroiliitis (primarily inflammation on magnetic resonance imaging, MRI), 71% were HLA-B27 positive, and the median disease duration was 6 years and 10 months. At 6 months of follow-up, the median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) decreased from 5.6 to 3.2 (p = 0.002), the Bath Ankylosing Spondylitis Functional Index (BASFI) decreased from 3.9 to 1.8 (p = 0.005), and C-reactive protein (CRP) level decreased from 4.4 to 1.7 mg/L (p = 0.001). After 1 year of treatment the Kaplan-Meier estimated drug survival was 76%, and at 2 years of follow-up this value decreased to 65%. Patients with inflammatory MRI findings at baseline had significantly better drug survival [hazard ratio (HR) 0.24, 95% confidence interval (CI) 0.10-0.55, p = 0.001]. Male sex was also associated with higher drug survival (HR 0.45, 95% CI 0.24-0.85, p = 0.011). CRP level at baseline was not associated with drug survival. CONCLUSIONS: Anti-TNF treatment of patients with nr-axSpA in clinical practice resulted in reduced BASDAI and BASFI scores and good drug survival. The results from this study suggest that male gender and positive imaging at baseline are associated with a favourable treatment course.
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Espondiloartritis/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Proteína C-Reactiva/análisis , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espondiloartritis/mortalidad , SueciaRESUMEN
The spondyloarthritides (SpA) are a group of idiopathic inflammatory diseases affecting the axial and/or peripheral skeleton. Recent evidence points towards an increased mortality and morbidity due to cardiovascular disease, especially within the two major forms of SpA, ankylosing spondylitis and psoriatic arthritis. Several studies have identified alterations of the lipid profile, insulin sensitivity and other metabolic cardiovascular risk factors in SpA patients. An array of vascular morphologic and functional abnormalities has also been reported in these diseases, supporting the hypothesis of accelerated atherosclerosis in SpA. Inflammation appears to be a major player, involved both in the impairment of the classic cardiovascular risk factors, as well as directly in the process of endothelial injury, dysfunction and ultimately atherosclerosis. Multiple studies in rheumatoid arthritis have suggested that effective suppression of inflammation with synthetic disease-modifying anti-rheumatic drugs or with biologics may also exert favourable effects in the cardiovascular risk. Although such evidence is currently lacking for SpA, there is little doubt that physicians caring for patients with SpA should aim at controlling both inflammation and traditional cardiovascular risk factors. Such an integrated approach is expected to benefit patients in multiple levels.
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Artritis Psoriásica/mortalidad , Aterosclerosis/mortalidad , Enfermedades Cardiovasculares/mortalidad , Espondiloartritis/mortalidad , Espondilitis Anquilosante/mortalidad , Artritis Psoriásica/metabolismo , Aterosclerosis/metabolismo , Enfermedades Cardiovasculares/metabolismo , Humanos , Morbilidad , Espondiloartritis/metabolismo , Espondilitis Anquilosante/metabolismoAsunto(s)
Artritis Reumatoide/mortalidad , Causas de Muerte , Lupus Eritematoso Sistémico/mortalidad , Espondiloartritis/mortalidad , Vasculitis/mortalidad , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Estudios Transversales , Diagnóstico Precoz , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Espondiloartritis/diagnóstico , Espondiloartritis/tratamiento farmacológico , Tasa de Supervivencia , Vasculitis/diagnóstico , Vasculitis/tratamiento farmacológicoRESUMEN
This review presents data on morbidity and mortality in patients with spondyloarthritis (SpA). Morbidity in patients with SpA is mainly determined by impairment of function and development of structural lesions. The course of illness in patients with ankylosing spondylitis (AS) is influenced by comorbidities, such as cardiovascular disease and fractures of the spine and in patients with psoriatic arthritis by peripheral joint manifestations. The mortality of patients with SpA has probably not increased but exact data are lacking. Approximately one third of AS patients will develop a severe disease state in which the mortality rate is increased by 50%.
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Causas de Muerte , Espondiloartritis/mortalidad , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/mortalidad , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Comorbilidad , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Fracturas Espontáneas/diagnóstico , Fracturas Espontáneas/mortalidad , Humanos , Masculino , Factores de Riesgo , Factores Sexuales , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/mortalidad , Espondiloartritis/diagnóstico , Espondiloartritis/tratamiento farmacológico , Espondilitis Anquilosante/diagnóstico , Espondilitis Anquilosante/tratamiento farmacológico , Espondilitis Anquilosante/mortalidad , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
BACKGROUND AND OBJECTIVE: The involvement of the cervical spine in rheumatoid arthritis can be essential regarding prognosis and mortality. The cervical myelopathy due to pannus formation and/or subluxation can be fatal. Aim of this study was to demonstrate the possible changes seen by MRI, and to establish a risk-profile for the individual patient. PATIENTS AND METHOD: Within a period of 24 months 214 patients with active RA were included. Clinical and laboratory data were obtained and plain radiographs of the cervical spine were taken. In patients with pathological findings on X-ray an MRI was performed (36 patients). RESULTS: Within the group of 214 patients 36 were identified to get an cervical spine MRI. In all cases the MRI showed significant changes: in 7 (19.5 %) pannus surrounded the dens, with additional erosions in one patient (2.7 %). In 25 (69.5 %) atlanto-axial-subluxation was present, 7 (19.5 %) showed a spondylodiscitis below C2. In 10 (27.8 %) a cervical myelopathy due to pannus or subluxation was present. There was no correlation of the MRI-results with symptoms and findings by examination. The patients with cervical spine disease were in all stages of RA. The majority was rheumatoid-factor positive. 5 out of 10 patients with cervical myelopathy showed neurological deficits: 3 patients died in consequence of neural compression, 2 patients underwent surgery successfully. CONCLUSION: The early detection of a cervical spine involvement in RA is essential to avoid possibly fatal complications. The only reliable method to achieve this goal has to include radiographic diagnostic including MRI of the cervical spine. Only this approach can answer the question of the right time-point for surgery. In daily clinical practice the cervical-spine involvement in RA is still underestimated.