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1.
Medicine (Baltimore) ; 99(19): e20019, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384461

RESUMO

This study aimed to assess the efficacy of needle-knife (NK) combined with etanercept (NKCE) in attenuating pain, inflammation, disease activity, and improving hip joint function in ankylosing spondylitis (AS) patients with hip joint involvement.Totally, 90 patients with active AS involving unilateral hip joint were enrolled and randomly assigned in 1:1:1 ratio to receive NKCE, NK or conventional drugs (control). The ESR, CRP, hip joint pain Visual Analogue Scale (VAS) score, bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), modified Harris hip score (mHHS), and range of motion (ROM) of affected hip joint were assessed at baseline (W0), after 1-week treatment (W1) and after 24-week treatment (W24).ESR and CRP were decreased in NKCE group compared with NK and control groups, while was not attenuated in NK group compared with control group. Regrading pain and disease activity, NKCE group presented a reduction in hip pain VAS score and BASDAI compared with NK and control groups, and NK group showed a decrease in hip pain VAS score and BASDAI compared with control group. Besides, BASFI was lowered in NKCE and NK groups compared with control group, but similar between NKCE and NK groups. mHHS and hip ROM were raised in NKCE and NK groups compared with control group, but similar between NKCE and NK groups.NKCE decreases hip pain, inflammation, disease activity and improves hip joint function in AS patients with hip joint involvement.


Assuntos
Terapia por Acupuntura/métodos , Artralgia , Etanercepte/administração & dosagem , Articulação do Quadril , Espondilite Anquilosante , Adolescente , Adulto , Antirreumáticos/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/terapia , Feminino , Articulação do Quadril/patologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor/métodos , Gravidade do Paciente , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Espondilite Anquilosante/terapia , Resultado do Tratamento
2.
Rev Soc Bras Med Trop ; 53: e20200016, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348434

RESUMO

INTRODUCTION: Sepsis is an important cause of mortality and morbidity, and inflammatory response and oxidative stress play major roles underlying its pathophysiology. Here, we evaluated the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats. METHODS: Twenty-eight adult Sprague Dawley rats were classified into Control (Group 1), Sepsis (Group 2), Sepsis+Cefazolin (Group 3), and Sepsis+Cefazolin+Etanercept (Group 4) groups. Kidney tissue and serum samples were obtained for biochemical and histopathological investigations and examined for the C reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), triggering receptor expressed on myeloid cells (TREM), and malondialdehyde (MDA) levels. RESULTS: The levels of TNF-α, TREM, and MDA in serum and kidney samples were significantly higher in rats from sepsis group than in rats from control group (p < 0.05). Group 3 showed a significant reduction in serum levels of TNF-α, CRP, and TREM as compared with Group 2 (p < 0.05). Serum TNF-α, CRP, TREM, and MDA levels and kidney TNF-α and TREM levels were significantly lower in Group 4 than in Group 2 (p < 0.05). Serum TNF-α and TREM levels in Group 4 were significantly lower than those in Group 3, and histopathological scores were significantly lower in Group 3 and Group 4 than in Group 2 (p < 0.05). Histopathological scores of Group 4 were significantly lower than those of Group 3 (p < 0.05). CONCLUSIONS: Etanercept, a TNF-α inhibitor, may ameliorate sepsis-induced oxidative stress, inflammation, and histopathological damage.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Etanercepte/administração & dosagem , Inflamação/prevenção & controle , Rim/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Sepse/patologia , Fator de Necrose Tumoral alfa/sangue , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Modelos Animais de Doenças , Etanercepte/farmacologia , Inflamação/patologia , Injeções Intraperitoneais , Ratos , Ratos Sprague-Dawley , Sepse/sangue
3.
Medicine (Baltimore) ; 99(3): e16635, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011430

RESUMO

OBJECTIVE: This study aimed to explore the cost-effectiveness of etanercept plus methotrexate (ETN+MTX) compared to triple disease-modifying anti-rheumatic drugs (DMARDs) in treating Chinese rheumatoid arthritis (RA) patients. METHODS: The 134 Chinese RA patients who were about to initiate ETN+MTX or triple DMARDs therapy based on treat-to-target strategy were consecutively recruited and categorized into ETN+MTX group (N = 49) or triple DMARDs group (N = 85). Treatment efficacy was assessed at month 3 (M3)/M6/M9/M12 after initiation of treatment. Also, 1-year treatment cost was evaluated, and cost-effectiveness analysis and sensitivity analysis were conducted. RESULTS: RA patients in ETN+MTX group exhibited similar disease activity and quality of life at each time point while elevated 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) change (M0-M12) and low disease activity rate compared with triple DMARDs group. For 1-year treatment cost, ETN+MTX required increased drug cost, decreased other medical cost, and finally elevated total cost compared with triple DMARDs. Meanwhile, compared to triple DMARDs, ETN+MTX produced an additional quality-adjusted life year (QALY) of 0.015, resulting in an incremental cost-effectiveness ratio (ICER) of ¥2,939,506.7 per QALY that was 53.1 folds of gross domestic product (GDP) per capita in China. More interestingly, sensitivity analysis revealed that the ETN price had to be reduced at least by 71.3% before ETN+MTX became cost-effectiveness compared to triple DMARDs. CONCLUSION: ETN+MTX is less cost-effective in treating Chinese RA patients compared with triple DMARDs.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Etanercepte/uso terapêutico , Metotrexato/uso terapêutico , Adulto , Idoso , Antirreumáticos/administração & dosagem , Antirreumáticos/economia , Sedimentação Sanguínea , China , Análise Custo-Benefício , Quimioterapia Combinada , Etanercepte/administração & dosagem , Etanercepte/economia , Feminino , Gastos em Saúde , Humanos , Masculino , Metotrexato/administração & dosagem , Metotrexato/economia , Pessoa de Meia-Idade , Qualidade de Vida , Indução de Remissão , Índice de Gravidade de Doença
4.
Expert Opin Drug Saf ; 19(1): 93-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31615274

RESUMO

Objectives: The objective of this study was to calculate adherence, persistence and 10-year switches in patients with PsA, by comparing adalimumab and etanercept in real life.Methods: The authors conducted a retrospective, observational, pharmacological and non-interventional study taking into consideration the dispensations of the study drugs at the Hospital Pharmacy, from 1 January 2007 to 31 December 2018. In the study, the authors considered adalimumab and etanercept. The authors calculated adherence to treatment through the relationship between received daily dose (RDD) and prescribed daily dose (PDD), and calculated persistence to treatment as the difference in days between the first and last dispensation.Results: The authors enrolled 113 patients, 60 treated with adalimumab and 53 with etanercept. Adherence levels were 0.83 for adalimumab and 0.84 for etanercept. Switches occurred in 42% of adalimumab and in 47% of etanercept prescriptions.Conclusion: In the treatment of PsA, persistence and switches are a problem for patients who cannot follow a consistent therapy over time, for clinicians who have to manage therapy suspension and changes, and for the National Health System that must procure and pay for a high number of drugs without information on their real value in terms of efficacy and safety of use.


Assuntos
Adalimumab/administração & dosagem , Artrite Psoriásica/tratamento farmacológico , Etanercepte/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Acta Dermatovenerol Alp Pannonica Adriat ; 28(4): 183-184, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31855274

RESUMO

Etanercept is an anti-tumor necrosis factor ɑ (anti-TNFɑ) drug used for treating immunomediated inflammatory diseases. It is least associated with hepatitis B virus (HBV) reactivation. We present a 71-year-old man with psoriasis refractory to phototherapy and acitretin, which led to etanercept monotherapy. Before anti-TNFɑ treatment, past contact with HBV was elicited; antibodies to HBc and HBs were positive whereas HBsAg was negative. Seven years after treatment initiation, while the patient was completely asymptomatic, a transaminase elevation was found and a reactivation of HBV was documented, with a high viral load of the virus. He started entecavir therapy and, after a 14-month follow-up, the viral load is still detectable at a low level, as well as HBsAg. We emphasize the late and asymptomatic reactivation of HBV associated with soluble anti-TNFɑ monotherapy. This case reinforces the importance of current recommendations for periodic monitoring of viral load and HBV markers in all patients that have had prior contact with HBV (positive anti-HBc), with or without indication for treatment of HBV (HBsAg and HBV-DNA negative).


Assuntos
Etanercepte/administração & dosagem , Etanercepte/farmacologia , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/fisiologia , Imunossupressores/farmacologia , Ativação Viral/efeitos dos fármacos , Idoso , Etanercepte/efeitos adversos , Hepatite B/induzido quimicamente , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Masculino , Psoríase/tratamento farmacológico , Fatores de Tempo
6.
Expert Opin Drug Saf ; 18(8): 733-744, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173698

RESUMO

Objectives: To examine agreement between the FDA Adverse Event Reporting System (FAERS) and observational studies in common infections for tumor necrosis factor inhibitors (TNFi's). Methods: Using MedDRA® preferred terms, all infection cases in FAERS with each TNFi were retrieved using EvidexTM. Observational studies reporting TNFi-related infections were identified from PubMed (OS-PM) and ClinicalTrials.gov (OS-CT). Infections with a reporting rate of ≥2% (based on percentage of total number of infections) from each data source were compiled. Fleiss's kappa and Cohen's kappa (κ) were calculated to determine agreement across all three sources and between each two sources. Results: A total of 163,789 FAERS infection cases, 53 OS-PM studies and 52 OS-CT studies were identified. The Fleiss' kappa that comparing all 3 data sources demonstrated lack of agreement. Significant moderate agreements were found between FAERS and OS-CT for etanercept and adalimumab, respectively (κ = 0.53, p = 0.02; κ = 0.56, p = 0.02), but no agreements (κ < 0) when comparing FAERS vs. OS-PM or OS-CT vs. OS-PM. Conclusion: For common TNFi-related infections, passive (FAERS) and active (observational studies) pharmacovigilance results are similar between FAERS vs. OS-CT for etanercept and adalimumab but dissimilar across the 3 sources. Our findings suggest incorporating both active and passive pharmacovigilance methods in post-marketing drug safety assessment.


Assuntos
Fatores Imunológicos/efeitos adversos , Farmacovigilância , Vigilância de Produtos Comercializados/métodos , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Doenças Autoimunes/tratamento farmacológico , Etanercepte/administração & dosagem , Etanercepte/efeitos adversos , Humanos , Fatores Imunológicos/administração & dosagem , Vigilância de Produtos Comercializados/estatística & dados numéricos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Estados Unidos , United States Food and Drug Administration
7.
PLoS One ; 14(5): e0216746, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31145730

RESUMO

OBJECTIVES: To compare drug survival in patients with axial spondyloarthritis treated with different TNF inhibitors in standard dosage. METHODS: Patients fulfilling the Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis in the Swiss Clinical Quality Management cohort were included in this study if a first TNF inhibitor on standard dosage was started after recruitment and if a baseline visit was available. Drug maintenance up to drug discontinuation or dose escalation was compared between TNF inhibitors with multiple adjusted Cox proportional hazards models and multiple imputation for missing baseline covariate data. RESULTS: A total of 966 patients were included (adalimumab 344, etanercept 237, golimumab 214, infliximab 171). Patients on certolizumab (n = 18) were excluded. Patients starting golimumab had lower disease activity as well as better physical function and quality of life in comparison to patients starting another drug. A higher proportion of patients starting infliximab had a history of extra-articular manifestations. Drug dosage was more often escalated during follow-up in patients treated with infliximab than with subcutaneously administered agents. However, no significant differences in time up to drug discontinuation or dose escalation were observed in multiple adjusted analyses if treatment was initiated after 2009, when all 4 TNF inhibitors were available: hazard ratio for infliximab versus etanercept 1.16 (95% confidence interval 0.80; 1.67), p = 0.44, for golimumab versus etanercept 0.80 (0.58; 1.10), p = 0.17 and for adalimumab versus etanercept 0.93 (0.69; 1.26), p = 0.66. CONCLUSION: In axial spondyloarthritis, drug survival with standard doses of different TNF inhibitors is comparable.


Assuntos
Adalimumab/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Etanercepte/administração & dosagem , Infliximab/administração & dosagem , Espondilartrite/tratamento farmacológico , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Antirreumáticos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , /administração & dosagem
8.
Clin Rheumatol ; 38(8): 2227-2231, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062254

RESUMO

To determine the influence of breastfeeding duration in the clinical activity of low-income juvenile idiopathic arthritis (JIA). Ninety-one JIA patients followed in Fortaleza-CE, Brazil, were cross-sectionally evaluated from May 2015 to April 2016. Breastfeeding duration was obtained by interviewing mothers. Mean age was 14.6 ± 5.2 years with 10.31 ± 3.7 years of disease duration. Polyarticular category predominated, with 39 (42.8%) patients, followed by 23 (25.3%) oligoarticular and 17 (18.7%) enthesitis-related. Forty-seven (61.8%) were receiving methotrexate isolated or combined to leflunomide, which was used by 12 (15.4%); 30 (32.9%) were on biologic DMARD with 16 (53.3%) etanercept, 8 (26.7%) adalimumab, 3 (10%) tocilizumab, and 1 (3.3%) each on infliximab, abatacept, and canakinumab. Mean(SD) CHAQ and JADAS27 were 0.37 ± 0.36 and 5.03 ± 6.1, respectively and 22 (24%) had permanent joint deformities. No family declared monthly income over US$900.00 and 32 (37.2%) earned less than US$300.00. Eighty-three (91%) were ever breastfed; over two-thirds were breastfed for more than 3 months. Those breastfed for more than 6 months had less joint deformities and a tendency to lower JADAS27 and CHAQ scores using minimally adjusted general linear or logistic models, as appropriate. Parental smoking or literacy and family income did not differ regarding breastfeeding time. This is a low-income JIA cohort with the highest breastfeeding prevalence ever reported. Breastfeeding over 6 months was associated with less disease activity.Key Point• Long-term breastfeeding benefits juvenile idiopathic arthritis.


Assuntos
Artrite Juvenil/prevenção & controle , Aleitamento Materno , Abatacepte/administração & dosagem , Adalimumab/administração & dosagem , Adolescente , Anticorpos Monoclonais Humanizados/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite Juvenil/epidemiologia , Produtos Biológicos/administração & dosagem , Brasil/epidemiologia , Criança , Estudos Transversais , Etanercepte/administração & dosagem , Feminino , Humanos , Infliximab/administração & dosagem , Leflunomida/administração & dosagem , Masculino , Metotrexato/administração & dosagem , Mães , Pobreza , Adulto Jovem
9.
Rev Assoc Med Bras (1992) ; 65(4): 493-508, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31066801

RESUMO

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Etanercepte/administração & dosagem , Fatores Imunológicos/administração & dosagem , Psoríase/tratamento farmacológico , Anticorpos Monoclonais/efeitos adversos , Brasil , Tomada de Decisão Clínica , Etanercepte/efeitos adversos , Humanos , Fatores Imunológicos/efeitos adversos , Psoríase/patologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
10.
Ann Dermatol Venereol ; 146(5): 363-371, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31047699

RESUMO

BACKGROUND: The purpose of this study was to explore the correlation of anxiety and depression with therapeutic response to etanercept in psoriasis patients. PATIENTS AND METHODS: One hundred and thirty-three patients with moderate-to-severe plaque psoriasis undergoing etanercept treatment were consecutively enrolled in this prospective cohort study, with all patients receiving etanercept treatment for 6 months. Psoriasis Area and Severity Index (PASI) score was evaluated at baseline (M0) and at month 1 (M1), M3 and M6 after treatment, and PASI 75/90 responses were calculated. The Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score and the HADS-Depression (HADS-D) score were used to evaluate patients' anxiety and depression at M0, M1, M3 and M6. Sustained anxiety/depression were defined as HADS-A/D score≥8points both at M0 and M1. RESULTS: Female gender and higher PASI score were associated with high risk of anxiety, while female gender, higher PASI score and longer disease duration were correlated with increased depression risk. After 6 months of etanercept treatment, 65.4% and 36.1% patients achieved PASI 75 and PASI 90 responses respectively, and both HADS-A and HADS-D scores were decreased. Most importantly, no correlation of baseline anxiety and depression with PASI 75 or PASI 90 response after 6 months of treatment was noted, while sustained depression, though not sustained anxiety, was observed to be correlated with decreased PASI 75 and PASI 90 responses. CONCLUSIONS: Etanercept reduces anxiety and depression in psoriasis patients, and sustained depression correlates with reduced therapeutic response to etanercept.


Assuntos
Ansiedade/diagnóstico , Depressão/diagnóstico , Etanercepte/uso terapêutico , Psoríase/tratamento farmacológico , Psoríase/psicologia , Ansiedade/etiologia , Depressão/etiologia , Etanercepte/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
11.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31048415

RESUMO

OBJECTIVES: Patients with Kawasaki disease can develop life-altering coronary arterial abnormalities, particularly in those resistant to intravenous immunoglobulin (IVIg) therapy. We tested the tumor necrosis factor α receptor antagonist etanercept for reducing both IVIg resistance and coronary artery (CA) disease progression. METHODS: In a double-blind multicenter trial, patients with Kawasaki disease received either etanercept (0.8 mg/kg; n = 100) or placebo (n = 101) subcutaneously starting immediately after IVIg infusion. IVIg resistance was the primary outcome with prespecified subgroup analyses according to age, sex, and race. Secondary outcomes included echocardiographic CA measures within subgroups defined by coronary dilation (z score >2.5) at baseline. We used generalized estimating equations to analyze z score change and a prespecified algorithm for change in absolute diameters. RESULTS: IVIg resistance occurred in 22% (placebo) and 13% (etanercept) of patients (P = .10). Etanercept reduced IVIg resistance in patients >1 year of age (P = .03). In the entire population, 46 (23%) had a coronary z score >2.5 at baseline. Etanercept reduced coronary z score change in those with and without baseline dilation (P = .04 and P = .001); no improvement occurred in the analogous placebo groups. Etanercept (n = 22) reduced dilation progression compared with placebo (n = 24) by algorithm in those with baseline dilation (P = .03). No difference in the safety profile occurred between etanercept and placebo. CONCLUSIONS: Etanercept showed no significant benefit in IVIg resistance in the entire population. However, preplanned analyses showed benefit in patients >1 year. Importantly, etanercept appeared to ameliorate CA dilation, particularly in patients with baseline abnormalities.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Etanercepte/administração & dosagem , Imunoglobulinas Intravenosas/administração & dosagem , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Doença Aguda , Pré-Escolar , Método Duplo-Cego , Resistência a Medicamentos/efeitos dos fármacos , Resistência a Medicamentos/fisiologia , Quimioterapia Combinada , Feminino , Humanos , Lactente , Masculino
12.
Scand J Rheumatol ; 48(4): 266-270, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31012365

RESUMO

Objectives: Inadequate response to adalimumab can be caused by insufficient blockade of the target tumour necrosis factor (TNF) at low serum concentrations. In such cases, patients may respond to another TNF inhibitor. We investigated whether the serum adalimumab concentration is related to the efficacy of a second TNF inhibitor, etanercept, in rheumatoid arthritis (RA). Methods: Patients with RA starting etanercept treatment were prospectively observed in the Reade Rheumatology Registry. In patients previously on adalimumab, serum concentrations were determined before treatment discontinuation. According to this concentration, three subgroups were formed: < 0.5 µg/mL, 0.5-5.0 µg/mL, and ≥ 5.0 µg/mL. The European League Against Rheumatism (EULAR) good/moderate response rate after 52 weeks of etanercept was compared between the switcher subgroups and biologic-naive patients. Results: In total, 449 consecutive patients were included, of whom 69 switched from adalimumab (15%) and 380 were biologic naive (85%). EULAR good or moderate response was achieved by 74% of the biologic-naive patients and by 72%, 50%, and 52% of switchers with adalimumab concentration < 0.5 µg/mL, 0.5-5.0 µg/mL, and ≥ 5.0 µg/mL, respectively (p = 0.15). Patients with an adalimumab concentration ≥ 0.5 µg/mL were significantly less likely to achieve EULAR good/moderate response on etanercept compared to biologic-naive patients, whereas patients with a concentration < 0.5 µg/mL did not significantly differ from patients starting etanercept without prior biologic treatment. Conclusion: RA patients with an inadequate response to adalimumab, in the presence of sufficient drug concentrations, benefit less from switching to another TNF inhibitor, etanercept.


Assuntos
Adalimumab , Artrite Reumatoide , Substituição de Medicamentos/métodos , Etanercepte , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Adalimumab/sangue , Adulto , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Antirreumáticos/sangue , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Monitoramento de Medicamentos/métodos , Etanercepte/administração & dosagem , Etanercepte/efeitos adversos , Etanercepte/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Seleção de Pacientes , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento
13.
Dermatol Online J ; 25(2)2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30865417

RESUMO

Acrodermatitis continua of Hallopeau, first described in 1890, is an uncommon variant of pustular psoriasis. It presents as a sterile pustular eruption of the tips of fingers and toes. The condition has a chronic, relapsing course and is often resistant to many anti-psoriatic therapies. In the following case, we present our experience of etanercept use in a 61-year-old man. Although initial therapy with high-dose etanercept achieved a rapid, sustained response and remission, the lesions relapsed a few months into a lower, maintenance dosage. This result prompted the use a second biotherapeutic agent ustekinumab, which resulted in complete remission, but required a higher dosage than recommended with reduced dosing intervals.


Assuntos
Acrodermatite/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Etanercepte/uso terapêutico , Psoríase/tratamento farmacológico , Ustekinumab/uso terapêutico , Acrodermatite/etiologia , Produtos Biológicos/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Etanercepte/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/complicações , Recidiva , Ustekinumab/administração & dosagem
14.
Actas Dermosifiliogr ; 110(7): 546-553, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30851873

RESUMO

BACKGROUND AND OBJECTIVES: Psoriasis is a chronic inflammatory skin disease with an estimated prevalence in Spain of 2.3% of the population. Approximately 30% of patients have moderate-to-severe forms. Treatment with biologic agents is proving to be a step forward in the management of the disease, although these treatments are very expensive. The objective of this study was to determine the efficiency, in terms of cost per number needed to treat (NNT), of the biologic drugs available in Spain for the treatment of moderate to severe plaque psoriasis. METHODS: NNT data were obtained from a network meta-analysis that included all randomized clinical trials of biologic drugs sold in Spain. The cost of each treatment was calculated based on the approved dosage for the first year of treatment, as indicated in the Summary of Product Characteristics. These data were used to calculate the cost per NNT of the drugs for various PASI scores (75, 90, and 100). A sensitivity analysis was performed taking into consideration only the PASI-response measurement time (after 10, 12, or 16 weeks, depending on the drug). RESULTS: The order of efficiency, from most to least efficient, in the case of a PASI 75 response was ixekizumab > ustekinumab 45mg > ustekinumab 90mg > secukinumab > infliximab > etanercept > adalimumab. The order for PASI 90 was ixekizumab >secukinumab >ustekinumab 45mg > ustekinumab 90mg > infliximab > adalimumab > etanercept. The order for PASI 100 was ixekizumab > secukinumab > infliximab > ustekinumab 90mg > ustekinumab 45mg > adalimumab > etanercept. The sensitivity analysis showed some changes in the order, depending on the response-assessment period. CONCLUSIONS: The findings show a link between the efficacy of the biologic therapies available in Spain for the treatment of moderate-to-severe plaque psoriasis and their efficiency. Ixekizumab had the lowest cost per NNT for all PASI-response scores (75, 90, and 100) during the first year of treatment.


Assuntos
Custos de Medicamentos , Números Necessários para Tratar , Psoríase/tratamento farmacológico , Adalimumab/administração & dosagem , Adalimumab/economia , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/economia , Etanercepte/administração & dosagem , Etanercepte/economia , Humanos , Infliximab/administração & dosagem , Infliximab/economia , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Espanha , Resultado do Tratamento , Ustekinumab/administração & dosagem , Ustekinumab/economia
15.
Rev Fac Cien Med Univ Nac Cordoba ; 76(1): 59-62, 2019 03 06.
Artigo em Espanhol | MEDLINE | ID: mdl-30882344

RESUMO

Introduction: There are numerous reports of patients with rheumatoid arthritis (RA) who became pregnant while on treatment with etanercept. In spite of being formally contraindicated during pregnancy and lactation its discontinuation in cases of women with severe RA is no longer recommended since an increase in congenital malformations nor perinatal complications has not been reported. There are few data on the success or failure of pregnancies achieved by assisted fertilization in patients with RA treated with etanercept. Methods: Two cases of severe RA under etanercept treatment and assisted fertilization are described. Results: After 4 failed attempts both patients became pregnant. They finally arrived at term without obstetric or perinatal complications. No congenital malformations nor infectious complications of the newborns occurred. Conclusion: The risk-benefit profile of etanercept in severe RA patients has been changing with postmarketing surveillance. If there is clinical indication, the benefit of not stopping etanercept during assited fertilization and pregnancy should be .evaluated.


Assuntos
Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Etanercepte/administração & dosagem , Fertilização In Vitro , Complicações na Gravidez/tratamento farmacológico , Resultado da Gravidez , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Índice de Gravidade de Doença
16.
Medicine (Baltimore) ; 98(11): e14620, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882628

RESUMO

The purpose of this study was to investigate the correlation of bone marrow edema (BME) in sacroiliac joint (SIJ) with clinical characteristics and clinical response, and whether the quick decrease of BME could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis (AS) patients.Ninety active AS patients underwent etanercept treatment for 6 months were enrolled consecutively and classified into standard dose group (n = 37) and dose tapering group (n = 53). BME in SIJ and clinical response were assessed by SPARCC criteria and ASAS 40 response criteria, respectively. "Quick decrease of BME in SIJ" was defined as the decrease of SPARCC score≥50% from M0 to M1.BME in SIJ was positively correlated with pain VAS score, BASDAI score, CRP, IL-1ß, IL-17, and TNF-α levels. ASAS 40 response rate at M6 was lower in dose tapering group than standard dose group, while higher in patients with a quick decrease of BME in SIJ than other patients. Besides, the ASAS 40 response rate in dose tapering group was similar to standard dose group in patients with a quick decrease of BME in SIJ but was lower than standard dose group in patients without a quick decrease of BME in SIJ at M6.A quick decrease of BME in SIJ predicts better treatment response to etanercept, and it might be served as a novel marker for dose tapering initiation of etanercept in AS patients.


Assuntos
Antirreumáticos/administração & dosagem , Doenças da Medula Óssea/etiologia , Edema/etiologia , Etanercepte/administração & dosagem , Espondilite Anquilosante/complicações , Espondilite Anquilosante/tratamento farmacológico , Adulto , Biomarcadores , Doenças da Medula Óssea/diagnóstico por imagem , Proteína C-Reativa/metabolismo , Edema/diagnóstico por imagem , Feminino , Humanos , Interleucina-17/sangue , Interleucina-1beta/sangue , Imagem por Ressonância Magnética , Masculino , Dor Musculoesquelética/etiologia , Medição da Dor , Articulação Sacroilíaca , Índice de Gravidade de Doença , Espondilite Anquilosante/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto Jovem
17.
Am J Clin Dermatol ; 20(2): 295-306, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924030

RESUMO

Tildrakizumab (tildrakizumab-asmn in the USA) [Ilumetri®; Ilumya™] is a humanized monoclonal antibody (mAb) that selectively targets the p19 subunit of interleukin (IL)-23, thereby inhibiting the IL-23/IL-17 axis, the signalling pathway primarily implicated in the immunopathogenesis of psoriasis. Administered subcutaneously, it is approved for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy (e.g. in the EU and Australia) and those who are candidates for systemic therapy or phototherapy (in the USA). In the pivotal phase III reSURFACE 1 and 2 trials, tildrakizumab was superior to placebo and efficacious compared with etanercept, in terms of the proportion of patients achieving a response [≥ 75% improvement from baseline in Psoriasis Area and Severity index score (PASI 75) and a Physician's Global Assessment score of 0/1] at week 12. Response rates peaked at week 22 and the vast majority of patients achieving PASI 75 at week 28 maintained this response after a total of 3 years of treatment in the reSURFACE trials and their ongoing open-label extension studies. In addition, patients with a partial or no response to etanercept at week 28 benefitted from switching to the highest approved dose of tildrakizumab in the reSURFACE 2 trial and its ongoing extension. Treatment with tildrakizumab improved health-related quality of life and was generally well tolerated, both in the short- and longer-term. Tildrakizumab thus expands the range of useful therapeutic options for patients with moderate-to-severe plaque psoriasis, particularly those with an inadequate response to phototherapy and conventional systemic agents.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Psoríase/tratamento farmacológico , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais Humanizados , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/farmacologia , Etanercepte/administração & dosagem , Humanos , Psoríase/patologia , Qualidade de Vida , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
18.
Expert Opin Drug Saf ; 18(3): 219-229, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30704314

RESUMO

INTRODUCTION: TNF-α inhibitors can be administered either as monotherapy or in combination with other anti-inflammatory drugs or DMARDs in the treatment of chronic immune-mediated diseases. AREAS COVERED: Patients receiving TNF-α inhibitors are at high risk of infections. An update is made on the risk of infection in patients receiving TNF-α inhibitors and the strategies for mitigating against the development of these serious adverse events. EXPERT OPINION: Infliximab than etanercept appears to be responsible for the increased risk of infections. Re-activation of latent tuberculosis infection and the overall risk of opportunistic infections should be considered before beginning a course of TNF-α inhibitors. A careful medical history, Mantoux test/quantiferon-TB Gold In-tube Test and chest-X-ray should always be performed before starting TNF-α inhibitors. Particular attention should be paid to risk factors for Pneumocystis jirovecii infection. Hepatitis B and C virological follow-up should be considered during TNF-α inhibitors treatment. Finally, appropriate vaccinations for influenza, S. pneumoniae, and HBV should be administered to decrease the risk of infection, and patients who are at high risk of herpes zoster reactivation would benefit from a second vaccination in adulthood.


Assuntos
Doenças do Sistema Imunitário/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Animais , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Etanercepte/administração & dosagem , Etanercepte/efeitos adversos , Humanos , Doenças do Sistema Imunitário/imunologia , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Infliximab/administração & dosagem , Infliximab/efeitos adversos , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/etiologia , Fatores de Risco
19.
Clin Rheumatol ; 38(6): 1595-1604, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30746581

RESUMO

OBJECTIVES: Hip arthritis plays a critical role in the prognosis of ankylosing spondylitis (AS). Dose reduction of tumor necrosis factor inhibitors preserves general improvement of AS, so this study attempted to examine the equivalence between Yisaipu® tapering and conventional therapy for hip arthritis in AS patients, using clinical parameters and magnetic resonance image (MRI). METHODS: AS patients received this etanercept-biosimilar injections (50 mg/week) in the first 12 weeks. Participants in the tapering group were treated with this reagent 50 mg every other week from week 13 to week 24, while the control group kept undergoing full-dose therapy. Clinical and laboratory parameters were assessed at baseline, week 12 and week 24. MRI examination of hip was performed at baseline and week 24. RESULTS: One hundred and thirty-six patients were enrolled, and 80 of them were in the tapering group. Linear mixed model revealed that main effects of tapering group with control group as reference in disease activity parameters were insignificant (p > 0.05). Main effects of baseline with week 24 as reference were significant (p < 0.05), but main effects of week 12 with week 24 as reference were not (p > 0.05). Prevalence of acute inflammatory change in MRI significantly decreased in the tapering group (76.88% vs 20.00%, p < 0.05) and control group (76.79% vs 19.64%, p < 0.05). Influence of both treatments on acute inflammatory change was equivalent (p > 0.05). CONCLUSION: Efficacy of Yisaipu® tapering treatment is comparable to the full-dose therapy for hip arthritis in AS patients. Both treatments maintain remission of hip arthritis after patients achieved low disease activity.


Assuntos
Etanercepte/administração & dosagem , Quadril/diagnóstico por imagem , Imagem por Ressonância Magnética , Espondilite Anquilosante/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/administração & dosagem , Medicamentos Biossimilares/administração & dosagem , Proteína C-Reativa/metabolismo , Feminino , Humanos , Modelos Lineares , Masculino , Receptores do Fator de Necrose Tumoral/metabolismo , Estudos Retrospectivos , Espondilite Anquilosante/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Adulto Jovem
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