Objective To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD). Methods This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect. Results We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5–10) to 5 (2.5–7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2). Conclusion ABA may be an effective and safe treatment for patients with RA-ILD.
Background:Different Jakinibs (JAKi) have shown efficacy in rheumatoid arthritis (RA) but in an important proportion of patients, insufficient response leads to therapy withdrawal. The different JAKi show variable selectivity for the four Jak isoforms (Jak1,2,3 y Tyk2) but there are no clinical trials analyzing the response to a JAKi after the suspension of another JAKi and therefore, observational data may be useful in this regard.Objectives:To describe efficacy and safety of the second JAKi in patients with suspension of the first due to failure or side effects.Methods:Spanish observational multicentric study. Data were retrospectively obtained from medical records of 28 patients with RA sequentially treated with baricitinib o tofacitinib in any order.Results:We identified 28 patients with RA treated with baricitinib and tofacitinib. Patient´s characteristics are summarized in Table 1. Half of the patients received tofacitinib first, and the other half baricitinib as the first JAKi. Mean survival for the first JAKi was 7,6 ± 6,1 months. The reason for withdrawal was inefficacy in 17 cases (61%) and adverse effects in 11 (39%). Mean follow-up after starting on the second JAKi was 9,6 ± 5,6 [3-19] months. Disease activity data along follow-up are depicted in Table 2. Survival on the second JAKi was 82% at 3, 76% at 6, and 62% at 12 months when 13 of the 21 patients maintained the therapy. In all 8 patients who discontinued the second JAKi, the reason was inefficacy. The treatment suspension rate was similar among patients discontinuing the first JAKi for inefficacy (n=5, 29,4%) or for adverse effects (n=3; 27,3%).Table 1.Baseline Charateristics.N 28Clinical characteristicsFemale24 (86%)Age*61.2 ± 13.2ACPA (+)19 (67,9%)Erosions13 (46,4%)Extra-articular manifestations8 (28,6%)TJC*10,8 ± 5,4SJC *7,4 ± 4,6DAS28-CPR*5,4 ± 0,91 High disease activity71,5% Moderate disease activity23,8% Low disease activity4,7%Previous treatmentbDMARD24 (86%)N° of previous bDMARDs *3,9±2,2 iTNF75% No-iTNF67,9%(*) Mean ± SDTabla 2.Treatment results during the follow-up period.Baseline (n 28)3 m (n 28)6 m (n 25)12 m (n 21)TJC10,8±5,43,8±3,34,23±2,51,9±1,5SJC7,2±4,61,8±1,71,7±20,7±1CPR mg/dL1±0,60,54±0,480,64±0,90,33±0,24DAS28CPR5,4±0,913,29±0,973,15±1,22,15±0,6Prednisone mg7,2±4,26,8±3,55,3±2,53,1±2,1Conclusion:Our data show that therapy with a second JAKi is a safe and efficacious option after discontinuation of the first JAKi due to either inefficacy or side effects. The response rate to the second JAKi is similar in patients with inefficacy or side effects which suggests that failure to the first does not reduce the chance of response to the second.Acknowledgments:M. Retuerto was recipient of a training grant from Sociedad Española de Reumatología (SER).Disclosure of Interests:None declared
ObjectiveClinicians often face the challenge of providing effective and safe therapy for pregnant women with uveitis. Certolizumab pegol (CZP) differs from other anti-TNFα agents due to its limited placental transfer. In this study we assessed the efficacy of CZP in pregnant women with uveitis. We also provided information on outcomes of pregnant women and neonates exposed to CZP. MethodsWe carried out a multicentre study of women with uveitis who received CZP during pregnancy and their neonates.The main visual outcomes were visual acuity (VA), intraocular inflammation and corticosteroid-sparing effect. Pregnancy outcomes, maternal and neonatal infections and congenital malformations were also assessed. ResultsWe studied 14 women (23 affected eyes); mean age of 34.3±5.5 years. The underlying diseases were spondyloarthritis (n=7), idiopathic (n=2), and Vogt-Koyanagi-Harada, rheumatoid arthritis, juvenile idiopathic arthritis, punctate inner choroidopathy and Behçet's disease (1 each). The patterns of ocular involvement were anterior (n=10), posterior (n=2), intermediate (n=1), panuveitis (n=1). Cystoid macular oedema was present in one patient (1 eye). Uveitis was bilateral in nine cases and chronic in seven patients. CZP was started before getting pregnant in ten patients and after conceiving in four. All patients achieved or maintained ocular remission throughout pregnancy. Fifteen healthy infants were born. Only one woman presented a mild infection during pregnancy. Neither infections nor malformations were observed in neonates after a follow-up of 6 months. Six infants were breastfed and all of them received scheduled vaccinations without complications. ConclusionCertolizumab pegol is effective and safe in women with uveitis during pregnancy.
Objective Although there are different tools to evaluate axial spondyloarthritis (axSpA), they are hardly used in clinical routine due to time constraints. The Routine Assessment of Patient Index Data 3 (RAPID3) is a composite measure feasible to be used as a sole metric in busy clinics. We aimed to test its measurement properties in patients with axial SpA in a real clinical setting. Methods Cross-sectional study that included 131 consecutive patients with axial SpA. The convergent (Spearman's rho) and discriminant (ROC curve analysis) validity of RAPID3 were tested against several axSpA-specific measures (BASDAI, ASDAS, BASFI, mSASSS). A multivariate model was built to detect disease factors associated with RAPID3 remission (values ≤3). Results The study included 82 men and 49 women, median age of 55 years (IQR: 46-61), and median disease duration of 11 years (IQR: 6-24). Mean RAPID3 was 9.45 ± 6.7. The BASDAI showed moderate correlation with ASDAS (rho: 0.66, p < 0.0001), but higher with BASFI (rho: 0.78, p < 0.0001) and RAPID3 (rho: 0.75, p < 0.0001). The ASDAS had moderate correlations with BASFI, BASDAI, and RAPID3 (ranges from 0.66 to 0.68, p < 0.0001). Higher correlations were found between BASFI and BASDAI (rho: 0.78, p < 0.0001) and BASFI-RAPID3 (rho: 0.73, p < 0.0001). The m-SASSS did not show any correlation with any of the afore-mentioned composite measures. Kappa agreement between RAPID3 remission and other SpA remission criteria was moderate (k: 0.46-0.56). The RAPID3 thresholds to define remission ranged from values ≤2 to ≤ 6 with areas under the ROC curves between 0.86 and 0.91. Female sex (OR 0.34, 95%CI: 0.12- 0.90, p= 0.031) and NSAIDs intake (OR 0.26, 95%CI: 0.10-0.66, p= 0.005) were independently associated with lower odds of achieving RAPID3 remission. Conclusion RAPID3 demonstrated construct validity in this cross-sectional study. This index can be useful for a more comprehensive assessment of axSpA in busy clinical settings.
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