ABSTRACT
To assess the long-term effectiveness and safety of tocilizumab, abatacept, and tumor necrosis factor-α inhibitors (TNFi), in the Italian real-world setting of rheumatoid arthritis (RA). The records of adult RA patients from the Italian biologics' registry Gruppo Italiano Studio Early Arthritis (GISEA) were analyzed. Demographic and clinical data were obtained at entry. The disease remission rate (28-joint disease activity score calculated using the erythrocyte sedimentation rate [DAS28-ESR] ≤ 2.6) and frequency of adverse events (AEs) were evaluated at 2 years. From 1999 to 2014, 7539 patients were treated with biologics (61.3% in first- and 22.6% in second-line), 68% of cases received TNFi, 9.1% tocilizumab, and 8.6% abatacept. Treatment groups showed a similar DAS28 at entry. As first-line, tocilizumab induced a significantly higher remission rate than abatacept or TNFi at 6 (51 vs 23.3 and 26.2%, respectively; p < 0.0001) and 24 months (52.3 vs 33.3 and 34.4%, respectively; p < 0.01). A similar pattern was observed in later lines. The most common AEs reported were infections, reactions to biologics (more frequent among TNFi-treated patients), increased transaminase (more frequent among TCZ-treated patients), and cardiovascular events. In clinical practice, TCZ induced a rapid and long-lasting remission and in a higher percentage of patients compared to abatacept and TNFi, with a good safety profile.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Biological Products/therapeutic use , Abatacept/adverse effects , Abatacept/therapeutic use , Adult , Antibodies, Monoclonal, Humanized/adverse effects , Antirheumatic Agents/adverse effects , Biological Products/adverse effects , Female , Humans , Italy , Male , Middle Aged , Registries , Remission Induction/methods , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
UNLABELLED: The management of neuropsychiatric systemic lupus erythematosus (NPSLE) still remains empirical and based on clinical experience due to the lack of randomized controlled trials. OBJECTIVE: To report the experience accumulated in a single tertiary referral centre about treatment of severe cases of NPSLE patients and to discuss therapeutic strategies on the background of EULAR recommendations. METHODS: Retrospective analysis of all consecutive cases of severe NPSLE treated in our centre since 1990 to 2010, satisfying the 1999 ACR criteria. RESULTS: Among 633 SLE patients who consecutively attended our centre, 231 (36%) displayed at least one neuropsychiatric (NP) manifestation for a total of 408 events attributable to SLE. Thirty-one patients (4.8%), 27 females and 4 males, experienced 35 major NP events requiring immunosuppressive therapy (including 3 relapses and 1 new event). An aggressive immunosuppressive strategy was applied to those patients with an immune mediated inflammatory NP event and to those patients with an increased disease activity as judged by ECLAM and SLEDAI scores. Overall at the end of the therapy 74% of the patients reached clinical remission or significant improvement of their symptoms measured by mean SLEDAI (from 10.09 ± 1.09 to 2.04 ± 0.52, P<0.0001) and ECLAM (from 4 ± 0.34 to 1.38 ± 0.37, P<0.001) scores. CONCLUSIONS: The prevalence of NP involvement, described in our case series, is similar to those reported in literature as well as the treatment strategies applied. Nowadays, it is not possible to establish a standardized approach for each single NPSLE manifestation, and different therapeutic strategies must be tailored taking into account the most probable pathogenic mechanism involved, the general disease activity background, the co-morbidities, the type and the stage of the systemic involvement.
Subject(s)
Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Mental Disorders/etiology , Nervous System Diseases/etiology , Adult , Aged , Autoantibodies/blood , Brain/pathology , Comorbidity , Disease Management , Drug Therapy, Combination , Female , HELLP Syndrome/drug therapy , HELLP Syndrome/etiology , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Italy , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/psychology , Magnetic Resonance Imaging , Male , Mental Disorders/drug therapy , Middle Aged , Nervous System Diseases/drug therapy , Pregnancy , Prevalence , Remission Induction , Retrospective Studies , Severity of Illness Index , Tertiary Care Centers , Young AdultSubject(s)
Accounting , Agriculture , Economics , Efficiency , Food Supply , Accounting/economics , Accounting/history , Agriculture/economics , Agriculture/education , Agriculture/history , Archives/history , Commerce/economics , Commerce/education , Commerce/history , Crops, Agricultural/economics , Crops, Agricultural/history , Economics/history , Food Supply/economics , Food Supply/history , Food Technology/economics , Food Technology/education , Food Technology/history , History, 18th Century , History, 19th Century , Rationalization , Spain/ethnologyABSTRACT
A lamellar keratoplasty was used to treat corneal sequestrum in four Persian cats (six eyes). Following a superficial keratectomy, lamellar corneal allografts (feline corneal tissue) or heterografts (canine corneal tissue) which had been preserved at -20 degrees C were placed in the recipient cornea. All grafts became optically transparent within 2 months following surgery and no recurrences of the sequestrum have been noted during the follow-up period (4-30 months). We conclude that feline corneal sequestrum may be successfully treated with feline or canine donor corneal tissue using this technique.
