Background This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death. Methods An observational longitudinal study was conducted during the first year of the SARS-CoV-2 pandemic (March 2020–March 2021). All pediatric patients attended at the rheumatology outpatient clinics of six tertiary referral hospitals in Madrid, Spain, with a diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic and clinical characteristics and treatment regimens. We ran a multivariable logistic regression model to assess associated factors for outcomes. Results The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients (38.96%) were asymptomatic, 41 (53.25%) had a mild-moderate COVID-19 and 6 patients (7.79%) required hospital admission. The median length of hospital admission was 5 (2–20) days, one patient required intensive care and there were no deaths. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was previous use of glucocorticoids (OR 3.51; p = 0.00). No statistically significant risk factors for symptomatic COVID-19 were found in the final model. Conclusion No differences in COVID-19 outcomes according to childhood-onset rheumatic disease types were found. Results suggest that associated comorbidities and treatment with glucocorticoids increase the risk of hospital admission.
Background:Patients with Rheumatoid Arthritis (RA) have been traditionally treated with other TNF inhibitors (TNFis) after the withdrawal of a first TNFi (cycling). However, due to the increase in the biological therapy options, changing to a biologic agent with different mechanism of action (switching) is an alternative choice. More studies are needed to clarify the role of both strategies in order to guide treatment decisions.Objectives:To analyze the survival of the second biological drug, TNFi or biologic with a different mechanism of action, in patients with RA non-responders to the first TNFi. To evaluate factors associated with the survival of the second-line therapy.Methods:A retrospective, longitudinal, observational study was performed, which included patients diagnosed of RA and treated with biological therapies between 2008 and 2017, who discontinue a first-line TNFi and started a second-line biological therapy. The demographic and clinical data were obtained from their medical records. Kaplan Meier and Log-rank survival analysis were performed, as well as Cox regression to identify related factors.Results:69 patients were identified, 14 men (20.3%) with a mean age at the beginning of the treatment of 52.68 ± 19.79 years. Demographic and clinical data are shown in the table. The main cause of withdrawal of the first TNFi was secondary failure (47.8%), followed by side effects (34.8%) and primary failure (13%). Cycling was performed in 34 patients (49.3%) and switching in 35 (50.7%). During the follow-up, the main causes of withdrawal of the second-line treatment were primary and secondary failure (10.1% in both cases). The survival analysis of the 42 patients who presented a primary or secondary failure to the first TNFi was stratified according to the cause of withdrawal of the second biological therapy. When cycling was chosen, the average treatment survival was 8.8 months (CI95%:4.8-12.8) whereas for the switching option it was 23 months (CI95%:5.4-40.5), being the differences statistically significant (p=0.049). Age was shown as a protective factor (HR=0.86, CI95%:0.76-98) and the positivity of Rheumatoid Factor (RF) as a risk factor (HR=4.76, CI95%:1.39-16.30) for the withdrawal of the second biological therapy. No differences were found in the withdrawal rate due to adverse effects among patients who performed switching or cycling (11.42% vs 5.88%, p=0.41). n= 69 (mean ± SD or%) Switching (n=35) Cycling (n=34) p-value Age (years)52.68 ± 12.7954.37 ± 12.4850.91 ± 13.070.354Gender Male 14 (20.3%)8 (22.9%)6 (17.6%)0.591 Female 55 (79.7%)27 (77.1%)28 (82.4%)BMI (kg/m2)25.42 ± 4.6224.99 ± 4.0325.98 ± 5.400.362First treatment duration (months)23.85 ± 22.7023.1 ± 20.524.7 ± 25.10.856Smokers18 (26.1%)9 (25.7%)9 (25.5%)0.943RF (+)56 (81.2%)31 (88.6%)25 (73.5%)0.227ACPA (+)61 (88.4%)32 (91.4%)29 (85.3%)0.189Erosions38 (55.1%)20 (57.1%)18 (52.9%)0.198Joint space narrowing44 (63.8%)22 (62.9%)22 (64.7%)0.569Rheumatoid nodules10 (14.5%)5 (14.3%)5 (14.7%)0.823Ocular manifestations7 (10.1%)4 (11.4%)3 (88%)0.9...
Background:Psoriatic arthritis (PsA) covers a wide spectrum of disease manifestations, including arthritis, enthesitis, dactylitis and axial spondylitis. This range of symptoms presents a challenge to the treating physician. Biologic disease-modifying antirheumatic drugs (bDMARDs) have proven effective through randomized clinical trials; and most international PsA guides include them as main option upon first-line treatment failure. However, studies regarding drug efficacy after bDMARD switching are scarce, lower response rates and drug survival on consecutive lines has been explored in previous research.Objectives:To assess bDMARDs survival after first-line failure in PsA patients treated in a third-level hospital and to determine baseline clinical and laboratory parameters associated with drug survival.Methods:We conducted a retrospective, single-centre study. 47 patients who received a second-line bDMARD were included, with diagnosis of PsA according to the criteria of an expert rheumatologist. All patients were studied according to a standard protocol. Data regarding bDMARD prescribed, baseline characteristics, axial or peripheral involvement and immunological profile (included both HLA-B27 and HLA-Cw6) were extracted. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at bDMARD start were included, as well. Kaplan-Meier, log-rank analyses and Cox regression models were applied.Results:Of 47 patients receiving a second bDMARD, 55,3% (26) were female and mean (S.D.) age was 40,6 (12,52) years. Median (interquartile range) disease duration was 10,1 (3,7-14,8) years. Prescribed drugs were Adalimumab (ADL) (36,2%, 17), Etanercept (ETN) (27,6%, 13), Infliximab (IFX) (6,4%, 3), Golimumab (GOL) (10,6%, 5), Certolizumab (CTZ) (4,3%, 2), Secukinumab (SCK) (8,5%, 4) and Apremilast (APR) (6,4%, 3). 42,3% cases suffered from axial involvement, rest of the sample (57,6%) presented a pure peripherical form of PsA. HLA-B27 and -Cw6 were assessed in 80,9% (38) and 68,1% (32), respectively; of whom, HLA-B27 carriers were 10,5% and HLA-Cw6 positive, 46,9%. Mean CRP level was 10,25 mg/L and mean ESR was 23,17 mm. Patients showed mean and median global drug retention of 44,57 (29,8-59,3) and 23 months. At 12-month visit, drug survival was 70%, 47% at 24 months, and 33% at 4 years from onset. Mean drug persistence by bDMARD prescribed was: ADL, 62,1 months; ETN, 51,9 months; IFX, 39 months; GOL, 22,8 months; CTZ, 9,5 months; SCK, 13,5 months; and APR, 16,3 months. Through log-rank analyses, differences in drug retention were investigated by several variables. Female sex (30,35m, 16,5-44,2 m.) was identified as statistically significant different than male patients (62,5m, 35,6-89,4m, p=0,021). Although not significant, other differences were remarkable: non-axial involvement, HLA-Cw6 negativity, HLA-B27 positivity and CRP level over 5 mg/L. No differences were found between altered and normal ESR patients.Conclusion:Second-line bDMARD survival is lower in female PsA patients, according to our data and previous bibliography. Despite our reduced sample and possible bias, non-axial involvement, absence of HLA-Cw6, presence of HLA-B27 and higher levels of CRP at biologic onset might be predictors of better drug persistence. Further investigations are required on this field.References:[1]Glintborg B et al. Clinical Response, Drug Survival, and Predictors Thereof Among 548 Patients With Psoriatic Arthritis Who Switched Tumor Necrosis Factor α Inhibitor Therapy. Results from the Danish Nationwide DANBIO Registry. Arthritis Rheum 2013:65(5):1213-23.[2]Stober C et al. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis. Rheumatology (Oxford) 2018:57(1):158-163.Table 1. Kaplan–Meier survival analysis of persistence according to sex.Table 2. Kaplan Meier survival analysis of persistence according to HLA-Cw6.Disclosure of Interests:None declared
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