BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies

Ding, Tina; Ledingham, Jo; Luqmani, Raashid; Westlake, Sarah; Hyrich, Kimme L; Lunt, Mark; Kiely, Patrick; Bukhari, Marwan; Abernethy, Rikki; Bosworth, Ailsa; Östör, A.; Gadsby, K.; McKenna, Frank; Finney, Diana; Dixey, Josh; Deighton, Chris

doi:10.1093/rheumatology/keq249a

Cited by 185 publications

(161 citation statements)

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“…Despite the clinical efficacy of anti-TNF therapies and a generally reassuring safety profile, some concerns remain regarding their long-term use due to the increased incidence of serious infections, tuberculosis (10,11), and potential malignancies (12). The cost of anti-TNF therapy is also an important consideration and leads to restrictions on prescribing in many countries (13).…”

Section: Introductionmentioning

confidence: 99%

Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

Marks

Holroyd

Dimitrov

et al. 2015

Arthritis Care & Research

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Objective. To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies. Methods. As part of a real-world approach, patients with RA receiving anti-TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (£2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti-TNF therapy dose by one-third. Results. Between January 2012 and February 2014, a total of 70 patients underwent anti-TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS £1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P 5 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P 5 0.038). Conclusion. Combined clinical and US assessment identifies individuals in remission who may be suitable for anti-TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.

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Section: Introductionmentioning

confidence: 99%

Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

Marks

Holroyd

Dimitrov

et al. 2015

Arthritis Care & Research

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show abstract

“…Or, l'association entre infection sévère et anti-TNF alpha n'est pas clairement établie. Pour le registre britannique [31], les patients sous anti-TNF alpha auraient un taux d'infections sévères plus élevé, le hasard-ratio ajusté pour les infections sévères était 20 % plus élevé dans la cohorte sous anti-TNF alpha par rapport au groupe sous nbDMARDs (adj HR : ). La méta-analyse de Leombruno et al [37] n'a pas non plus mis en évidence de différence significative entre les patients sous anti-TNF et les patients sous nbDMARDs.…”

Section: Discussionunclassified

“…La méta-analyse de Leombruno et al [37] n'a pas non plus mis en évidence de différence significative entre les patients sous anti-TNF et les patients sous nbDMARDs. Plusieurs études [31,38,39] ont conclu à une augmentation du risque infectieux au cours des six premiers mois de traitement, le temps que la maladie inflammatoire soit stabilisée. La PR représente un risque inhérent d'infection imputé au dysfonctionnement du système immunitaire.…”

Section: Discussionunclassified

Évaluation du rapport bénéfice-risque de la suspension des anti-TNF alpha en chirurgie orale

Pannérec

Catros

Fricain

2014

Med Buccale Chir Buccale

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“…In the context of hematological malignancies, there are reports of myeloma, as well as monoclonal gammopathy of undetermined significance (MGUS), progressing while receiving anti-TNF treatment 2 . The British Society for Rheumatology states that there is no conclusive evidence for an increase in risk of solid tumors or lymphoproliferative disease with anti-TNF therapies above what would be expected for the rest of the RA population 3 . Further, several studies have reported anti-TNF working against solid cancers 4,5 .…”

Section: To the Editormentioning

confidence: 99%

Prolonged Remission of Marginal Zone Lymphoma in a Patient with Rheumatoid Arthritis Treated with Anti-tumor Necrosis Factor Agents

Donaldson

Owen²,

McGonagle

2014

J Rheumatol

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BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies

Cited by 185 publications

References 1 publication

Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

Évaluation du rapport bénéfice-risque de la suspension des anti-TNF alpha en chirurgie orale

Prolonged Remission of Marginal Zone Lymphoma in a Patient with Rheumatoid Arthritis Treated with Anti-tumor Necrosis Factor Agents

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