Janus kinase inhibitors and tumour necrosis factor inhibitors show a favourable safety profile and similar persistence in rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: real-world data from the BIOBADASER registry.

OBJECTIVES: To compare the safety of Janus kinase inhibitors (JAKi) with that of tumour necrosis factor inhibitors (TNFi) and determine drug persistence among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). METHODS: We analysed data from patients included in BIOBADASER 3.0 and treated with JAKi or TNFi from 2015 to 2023 and estimated the incidence rate ratio (IRR) of adverse events and persistence. RESULTS: A total of 6826 patients were included. Of these, 52% had RA, 25% psoriatic arthritis and 23% axial SpA. Treatment was with TNFi in 86%. The mean duration of treatment was 2.2±2.0 years with TNFi versus 1.8±1.5 with JAKi. JAKis were prescribed in older patients with longer term disease, greater comorbidity and later treatment lines and more frequently as monotherapy. The IRR of all infections and gastrointestinal events was higher among patients with RA treated with JAKi. Drug persistence at 1, 2 and 3 years was 69%, 55% and 45% for TNFi and 68%, 54% and 45% for JAKi. Multivariate regression models showed a lower probability of discontinuation for JAKi (HR=0.85; 95% CI 0.78-0.92) and concomitant conventional synthetic disease-modifying antirheumatic drugs (HR=0.90; 95% CI 0.84-0.96). The risk of discontinuation increased with glucocorticoids, comorbidities, greater disease activity and later treatment lines. CONCLUSIONS: Infections, herpes zoster and gastrointestinal adverse events in patients with RA tended to be more frequent with JAKi. However, prognosis was poor in patients receiving JAKi. Persistence was similar for TNFi and JAKi, although factors associated with discontinuation differed by diagnostic group.

Síndrome de Cogan: análisis descriptivo y experiencia clínica de 7 casos diagnosticados y tratados en 2 hospitales de tercer nivel / Cogan syndrome: Descriptive analysis and clinical experience of 7 cases diagnosed and treated in two third level hospitals

Objetivo: El síndrome de Cogan (SC) es una enfermedad inflamatoria clasificada como vasculitis de vaso variable. Se trata de una enfermedad rara con escasas series publicadas, por lo que revisamos nuestra experiencia en 2 centros en los últimos 10 años. Material y métodos: Descripción de 7 casos diagnosticados de SC, atendiendo a los criterios de clasificación (típico o atípico), sus manifestaciones clínicas, tratamientos utilizados y sus complicaciones. Se realizó un análisis comparativo con las series y casos descritos en la literatura. Resultados: Se incluyeron 7 casos, 3 varones y 4 mujeres, con una edad media al diagnóstico de 43 años, y un tiempo de evolución medio de 47 meses. Cinco pacientes cumplían las características típicas según los criterios clásicos de 1980, siendo el resto casos atípicos, uno por ausencia de queratitis intersticial y otro por un periodo entre la aparición de clínica ocular y auditivo-vestibular mayor de 2 años. Todos recibieron inmunosupresores, siendo el más utilizado el metotrexato, seguido de la azatioprina. En 5 casos se utilizaron fármacos biológicos: infliximab en 4 ocasiones y en 2 tocilizumab. Un paciente falleció por endocarditis bacteriana y shock séptico. Conclusión: Las características de la serie presentada son similares a las publicadas hasta ahora, con diferencias clínicas fundamentalmente en la afectación de grandes vasos. Ante la escasa casuística, parece necesario la creación de registros multicéntricos para mejorar la evidencia en cuanto al manejo de pacientes con SC.(AU)

Objective: Cogan's syndrome (CS) is an inflammatory disease classified as variable vessel vasculitis. It is a rare disease with few published series, and therefore we reviewed our experience in the last ten years in two centres. Materials and methods: Description of 7 diagnosed cases of CS, according to the classification criteria (typical or atypical), their clinical manifestations, treatments used and their complications. A comparative analysis was performed with the series and cases described in the literature. Results: Seven cases were included, three men and four women, with a mean age at diagnosis of 43 years, and an average disease duration of 47 months. Five patients met the typical characteristics according to the 1980 classical criteria, the rest being atypical cases, one due to the absence of interstitial keratitis and another due to a period between the onset of ocular and auditory-vestibular clinical symptoms greater than two years. All received immunosuppressants, methotrexate being the most commonly used, followed by azathioprine. In 5 cases, biological drugs were used, infliximab in 4 times and 2 tocilizumab. One patient died from bacterial endocarditis and septic shock. Conclusion: The characteristics of the series presented are like those published to date, with clinical differences mainly in the involvement of large vessels. Given the low frequency, it seems necessary to create multicentre records to improve the evidence regarding the management of patients with CS.(AU)

Cogan syndrome: Descriptive analysis and clinical experience of 7 cases diagnosed and treated in two third level hospitals. / Síndrome de Cogan: análisis descriptivo y experiencia clínica de 7 casos diagnosticados y tratados en 2 hospitales de tercer nivel.

OBJECTIVE: Cogan's syndrome (CS) is an inflammatory disease classified as variable vessel vasculitis. It is a rare disease with few published series, and therefore we reviewed our experience in the last ten years in two centres. MATERIALS AND METHODS: Description of 7 diagnosed cases of CS, according to the classification criteria (typical or atypical), their clinical manifestations, treatments used and their complications. A comparative analysis was performed with the series and cases described in the literature. RESULTS: Seven cases were included, three men and four women, with a mean age at diagnosis of 43 years, and an average disease duration of 47 months. Five patients met the typical characteristics according to the 1980 classical criteria, the rest being atypical cases, one due to the absence of interstitial keratitis and another due to a period between the onset of ocular and auditory-vestibular clinical symptoms greater than two years. All received immunosuppressants, methotrexate being the most commonly used, followed by azathioprine. In 5 cases, biological drugs were used, infliximab in 4 times and 2 tocilizumab. One patient died from bacterial endocarditis and septic shock. CONCLUSION: The characteristics of the series presented are like those published to date, with clinical differences mainly in the involvement of large vessels. Given the low frequency, it seems necessary to create multicentre records to improve the evidence regarding the management of patients with CS.

Long-term Follow-up and Optimization of Infliximab in Refractory Uveitis Due to Behçet Disease: National Study of 103 White Patients.

OBJECTIVE: In a large series of White patients with refractory uveitis due to Behçet disease (BD) being treated with infliximab (IFX), we assessed (1) long-term efficacy and safety of IFX, and (2) IFX optimization when ocular remission was achieved. METHODS: Our multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressant agents treated 103 patients/185 affected eyes with IFX as first biologic therapy in the following intervals: 3-5 mg/kg intravenous at 0, 2, 6, and then every 4-8 weeks. The main outcome variables were analyzed at baseline, first week, first month, sixth month, first year, and second year of IFX therapy. After remission, based on a shared decision between patient and clinician, IFX optimization was performed. Efficacy, safety, and cost of IFX therapy were evaluated. RESULTS: In the whole series (n = 103), main outcome variables showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Serious adverse events were observed in 9 patients: infusion reactions (n = 4), tuberculosis (n = 1), Mycobacterium avium pneumonia (n = 1), severe oral ulcers (n = 1), palmoplantar psoriasis (n = 1), and colon carcinoma (n = 1). In the optimization subanalysis, the comparative study between optimized and nonoptimized groups showed (1) no differences in clinical characteristics at baseline, (2) similar maintained improvement in most ocular outcomes, (3) lower severe adverse events, and (4) lower mean IFX costs in the optimized group (€4826.52 vs €9854.13 per patient/yr). CONCLUSION: IFX seems to be effective and relatively safe in White patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective.

La comunidad orquideológica en la Reserva de la Biosfera Sierra del Rosario, Cuba

The orchid community in the Biosphere Reserve Sierra del Rosario, Cuba. The Biosphere Reserve Sierra del Rosario is located in Western Cuba and two different areas can be characterized: one for tourism and forestry activities, El Taburete (ET), and the other for conservation and research, El Salón (ES). With the aim to know the effect of visitation activities on the orchid community in the Reserve, a comparative study between the disturbed area and the preserved one was undertaken. The field work, held between 2004-2005, consisted on four transects in each locality (10x100m, 0.1ha). For each transect, the existing orchid species (terrestrial and epiphytic), kind of phorophytes, and level of occupation were identified. Different analysis were considered: dominance-diversity, Sorensen similarity, the dominance index and the relative abundance of the most abundant species. Our results showed 27 phorophytes species, 20 species in ET (98 phorophytes), and 16 species in ES (76 phorophytes). A total of 22 genus, 26 species and 8 326 individuals of orchids were identified. In ET, 17 genus, 18 species and 5 075 individuals were found, while for ES were 15 genus, 18 species and 3 251 individuals. Both locations have a similarity of species of 57.14%. Oeceoclades maculata, an invasive species, was the most abundant. The most dominant species were Microchilus plantagineus in ES and O. maculata in ET. The dominance in ET was of 81.79%, while in ES of 69.27%. It is important to sketch management plans focused on controlling O. maculata in both areas, and the restoration of the disturbed area. Rev. Biol. Trop. 59 (4): 1805-1812. Epub 2011 December 01.

Teniendo en cuenta la escasez de estudios previos que permitan apreciar el efecto de la antropización sobre las comunidades de orquídeas en la Reserva de la Biosfera Sierra del Rosario, al occidente de Cuba; se procedió a realizar un estudio comparativo entre un hábitat conservado (El Salón; ES) y uno antropizado (El Taburete; ET) y se encontraron en total 27 especies de forófitos, 20 especies presentes en ET (98 forófitos) y 16 especies en ES (76 forófitos). Por lo tanto se identificaron 22 géneros de orquídeas, 26 especies y 8 326 plantas. En ES fueron 15 géneros, 18 especies y 3 251 plantas, en ET, 17 géneros, 18 especies y 5 075 plantas. Oeceoclades maculata, una especie invasora, fue la más abundante. Ambas localidades tienen una similaridad de especies de 57.14%. Las especies más dominantes fueron: Microchilus plantagineus en ES y O. maculata en ET. La dominancia en ES es de 69.27% y en ET de 81.79%. Es importante elaborar planes de manejo enfocados a controlar O. maculata en ambas áreas, y en restablecer el estrato arbóreo original de la zona antropizada.

[The orchid community in the Biosphere Reserve Sierra del Rosario, Cuba]. / La comunidad orquideológica en la Reserva de la Biosfera Sierra del Rosario, Cuba.

The Biosphere Reserve Sierra del Rosario is located in Western Cuba and two different areas can be characterized: one for tourism and forestry activities, El Taburete (ET), and the other for conservation and research, El Salón (ES). With the aim to know the effect of visitation activities on the orchid community in the Reserve, a comparative study between the disturbed area and the preserved one was undertaken. The field work, held between 2004-2005, consisted on four transects in each locality (10 x 100m, 0.1ha). For each transect, the existing orchid species (terrestrial and epiphytic), kind of phorophytes, and level of occupation were identified. Different analysis were considered: dominance-diversity, Sorensen similarity, the dominance index and the relative abundance of the most abundant species. Our results showed 27 phorophytes species, 20 species in ET (98 phorophytes), and 16 species in ES (76 phorophytes). A total of 22 genus, 26 species and 8 326 individuals of orchids were identified. In ET, 17 genus, 18 species and 5 075 individuals were found, while for ES were 15 genus, 18 species and 3 251 individuals. Both locations have a similarity of species of 57.14%. Oeceoclades maculata, an invasive species, was the most abundant. The most dominant species were Microchilus plantagineus in ES and O. maculata in ET. The dominance in ET was of 81.79%, while in ES of 69.27%. It is important to sketch management plans focused on controlling O. maculata in both areas, and the restoration of the disturbed area.