W e present a case of recurrent auricular chondritis, which developed after two injections of a luteinising hormone-releasing hormone (LH-RH) analogue buserelin combined with oral treatment of a pure antiandrogen bicalutamide (Casodex). The patient was treated successfully with a continuous moderate dose of corticosteroids together with azathioprine and methotrexate. Complete repair of the deformed ear followed 7 months after starting the treatment.Relapsing polychondritis (RP) is a chronic autoimmune cartilaginous inflammation. Auricular chondritis is a presenting sign in over 85% of patients, in which patients' ears become red, swollen, and tender. We observed a painless form of recurrent auricular chondritis complicated by severe cartilage damage. CASE REPORTA 69 year old man had a history of old myocardial infarction and prostatic adenocarcinoma (Gleason score VI, stage T2B NO MO). He underwent two injections of an LH-RH analogue buserelin (Suprefact Depot, Aventis Pharma), combined with a pure antiandrogen bicalutamide (Casodex; AstraZeneca).Five months after starting treatment he presented with a painless redness and swelling of his right ear, which spared the lobe. This inflammation, showing inflammatory mononuclear infiltrate, progressed to include dropping and deformity of the upper part of the ear, and resolved spontaneously after 3 months (figs 1A and 2). The patient was then referred to the rheumatologist.Besides the dropped pinna, no systemic manifestations were found on physical examination and the patient's neurological status was unremarkable, including normal pain perception. Retinal screening showed no vasculitic changes. Routine laboratory investigation was normal except for raised inflammatory markers: erythrocyte sedimentation rate and C reactive protein. Serum immunoelectrophoresis, antinuclear antibodies, antineutrophil cytoplasmic antibodies, rheumatoid factor, prostate-specific antigen were normal. Viral serology, tuberculin test, and Venereal Disease research Laboratory test were negative. Ultrasound of large vessels and echocardiography were normal. A chest x ray examination and computed tomography (CT), abdominal CT, and bone scan were unremarkable.Owing to serious coronary disease, the lack of active auricular inflammation and systemic disease, and because buserelin treatment had been stopped, it was decided to observe the patient without treatment. However, painless auricular chondritis of the opposite side occurred 3 months later, supporting an initial suspicion of relapsing polychondritis. Prednisone 40 mg/day and azathioprine 100 mg/day were given. Corticosteroids were tapered to 20 mg/day for 1 month after reduction of inflammation in the opposite ear. Azathioprine treatment was stopped when the liver enzyme level was significantly raised after 2 months of treatment. A daily dose of prednisone 20 mg/day was continued, and oral methotrexate 7.5 mg/week was started after the liver function returned to normal. Partial repair of the auricular cartilage was noted 2 months later and f...
ObjectivesThe aim of this study was to analyse efficacy, safety and cost savings of switching from infliximab originator (IFXor) to the biosimilar (BS) CT-P13 in single centre.MethodsEligible patients were those older than 18 years old with the diagnosis of rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriatic arthritis (PsA) on treatment (Tx) with IFXor for at least 6 months and with stable disease activity. In December 2016 all eligible patients were proposed to switch to CT-P13. At the day of the last Tx with IFXor, informed consent, data and blood samples were collected. On the next Tx day, CT-P13 was administered after standard evaluation of efficacy and safety. Efficacy was measured considering change from baseline in Disease Activity Score in 28 joints (DAS28) for RA and PsA and in Ankylosing Spondylitis Disease Activity Score (ASDAS) for SpA. Disease worsening was considered when an increase of 1.2 from baseline in DAS28 or an increase of 1.1 in ASDAS occurred. A cost analysis was done based on the purchasing prices of the 2 drugs at our centre.ResultsIn a 12 months period switch to CT-P13 was performed in 60 patients for non-medical reasons. Disease activity (DA) was stable over the observation period and similar to the values observed with IFXor. Median follow-up time was 261 days during which disease worsening occurred in 3 (5%) patients. 1 patient had a minor adverse event (oedema of the lip). These 4 (6.7%) patients stopped the BS. One returned to IFXor and the other 3 switched to another drug. The switch to CT-P13 represented a 26.4% reduction of costs in the use of IFX Tx in these patients.Abstract AB1231 – Table 1Numbers are medians unless otherwise stated.Total (n=60)SpA (n=36; 60%)RA (n=16; 27%) PA (n=8; 13%) Age (years)53 (48–64)50 (41–59)59 (52–70)56 (48–64)Gender (n,% male)39 (65%)30 (83%)2 (13%)7 (88%)Disease duration (years)17 (10–23)16 (10–22)18 (13–24)16 (10–22)Patients on methotrexate41 (68%)20 (33%)15 (25%)6 (10%)Patients with previous biologic therapy4 (6.7%)1 (2.8%)3 (18.8%)0 (0%)Time on IFX originator before switch (years)7.9 (6.5–11.9)7.7 (6.4–12.3)8.4 (6.7–12.4)7.6 (6.7–9.6)Time on CT-P13 since switch (months)9 (7–11)9 (7–11)10 (9–10)9 (4–10Abstract AB1231 – Table 2Variables median from baseline to 9 months after switch to CT-P13. ESR – Erythrocyte Sedimentation Rate; CRP – C-Reactive Protein; PtGA – Patient global assessment of DA; PhGA – Physician global assessment of DA.Baseline3 Months after switch6 Months after switch9 Months after switchVariation from baseline to 9 Months after switch ESR (mm/h)15 (10–21)17 (9–29)15 (9–24)15 (9–24)0CRP (mg/dL)0.18 (0.80–0.57)0.17 (0.06–0.50)0.19 (0.10–0.46)0.25 (0.10–0.72) 0.07PtGA (0–100)30 (20–50)20 (30–50)30 (3–50)30 (15–50)0PhGA (0–100)20 (10–30)20 (10–30)20 (0–30)20 (10–30)0Abstract AB1231 – Figure 1ConclusionsThe switch in routine care of a group of RA, SpA and PsA patients from IFXor to CT-P13 did not affect efficacy and safety and reduced costs in 26.4%.Reference[1 ] Bente Glintborg, et al. A nationwide non-medical switch fro...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.