Serum drug levels of biologic agents in the management of rheumatoid arthritis and spondyloarthritis: a systematic review

Martín-López, María; Carmona, Loreto; Balsa, A.; Calvo‐Alén, Jaime; Sanmartí, Raimón; Tornero, Jesús; Rosas, José

doi:10.1007/s00296-018-4022-4

Cited by 15 publications

(5 citation statements)

References 35 publications

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“…Because many currently available drugs induce side effects, patient compliance is very poor. Although the use of biological agents for RA has increased in recent years, it is expensive, and this has greatly limited the application of biological agents for RA 18–21. In the USA, the annual direct medical cost of each patient is about $13,500, and the indirect cost is between $1,000 and $33,000 22…”

Section: Discussionmentioning

confidence: 99%

Curcumin alleviates rheumatoid arthritis-induced inflammation and synovial hyperplasia by targeting mTOR pathway in rats

Dai¹,

Zhou²,

Xu³

et al. 2018

DDDT

120

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PurposeRheumatoid arthritis (RA) is a chronic, progressive autoimmune disease characterized by aggressive and symmetric polyarthritis. Mammalian target of rapamycin (mTOR) was reported to be a new target for RA therapy and its inhibitor rapamycin can significantly reduce the invasive force of fibroblast-like synoviocytes. Here, we determined the effect of curcumin to alleviate inflammation and synovial hyperplasia for the therapy of RA.Materials and methodsCollagen-induced arthritis (CIA) was developed in Wistar rats and used as a model resembling RA in humans. Rats were treated with curcumin (200 mg/kg) and the mTOR inhibitor rapamycin (2.5 mg/kg) daily for 3 weeks. Effects of the treatment on local joint, peripheral blood, and synovial hyperplasia in the pathogenesis of CIA were analyzed.ResultsCurcumin and rapamycin significantly inhibited the redness and swelling of ankles and joints in RA rats. Curcumin inhibited the CIA-induced mTOR pathway and the RA-induced infiltration of inflammatory cells into the synovium. Curcumin and rapamycin treatment inhibited the increased levels of proinflammatory cytokines including IL-1β, TNF-α, MMP-1, and MMP-3 in CIA rats.ConclusionOur findings show that curcumin alleviates CIA-induced inflammation, synovial hyperplasia, and the other main features involved in the pathogenesis of CIA via the mTOR pathway. These results provide evidence for the anti-arthritic properties of curcumin and corroborate its potential use for the treatment of RA.

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Section: Discussionmentioning

confidence: 99%

Curcumin alleviates rheumatoid arthritis-induced inflammation and synovial hyperplasia by targeting mTOR pathway in rats

Dai¹,

Zhou²,

Xu³

et al. 2018

DDDT

120

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“…In this sense, the use of infliximab presents the higher potential of immunogenicity, with the development of antidrug antibodies (ADA), as compared with the remaining anti-TNF agents. The anti-drug antibodies (ADA) are associated with decrease of clinical response and increasing incidence of reactions to infusion as well as to reactions at the application site [22,23]. Besides this, lower adhesion to treatment with infliximab has been demonstrated in other immunomediated diseases when compared with other anti-TNF agents [24], which could be explained by its higher potential for adverse reactions, mainly infusional ones and in the application site, and by its administration path [18,[22][23][24]; patients with rheumatic diseases might present preference for subcutaneous administration instead of intravenously and for home administration instead of hospital [24].…”

Section: Discussionmentioning

confidence: 99%

“…The anti-drug antibodies (ADA) are associated with decrease of clinical response and increasing incidence of reactions to infusion as well as to reactions at the application site [22,23]. Besides this, lower adhesion to treatment with infliximab has been demonstrated in other immunomediated diseases when compared with other anti-TNF agents [24], which could be explained by its higher potential for adverse reactions, mainly infusional ones and in the application site, and by its administration path [18,[22][23][24]; patients with rheumatic diseases might present preference for subcutaneous administration instead of intravenously and for home administration instead of hospital [24]. However, this result should be interpreted with caution as infliximab has shown better persistence in particular subsets, such as in oligoarticular-PsA [26].…”

Section: Discussionmentioning

confidence: 99%

Medication Persistence for Psoriatic Arthritis in a Brazilian Real-World Setting

et al. 2019

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Aim: To evaluate the persistence of biological (TNF inhibitor [anti-TNF]) and synthetic (conventional synthetic disease-modifying antirheumatic drugs [csDMARDs]) antirheumatic agents for psoriatic arthritis and their associated factors. Methods: A historical cohort was developed. Persistence and associated factors were evaluated at 6 and 12 months. Results: A total of 161 patients were included. The anti-TNF treatment presented higher persistence as compared with csDMARDs at 6 (83.4 vs 50.8%; p < 0.05) and 12 months (66.4 vs 35.6%; p < 0.05). From anti-TNFs, adalimumab and etanercept presented similar persistence, along with leflunomide and methotrexate among the csDMARDs. The factors associated with non-persistence with regard to anti-TNF agents were female sex and use of infliximab. Conclusion: Anti-TNF agents are important therapeutic alternatives and present lower rates of discontinuation as compared with csDMARDs.

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“…This is supported by a recent study by Pedersen et al who showed that therapeutic drug monitoring of TNF inhibitors leads to better clinical response and cost management in the treatment of patients with rheumatic diseases [ 52 ]. A recent review concluded that measuring drug levels and ADAb in RA and SpA patients with biologic treatment might be useful both in case of poor response and longer clinical remission [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of subcutaneous TNF inhibitors and its clinical significance in real-life setting in patients with spondyloarthritis

et al. 2021

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Key messages Considerable proportion of patients with SpA have been immunized to the subcutaneous anti-TNF drug they are using. Concomitant use of MTX protects from immunization, whereas SASP does not. Patients with SpA using subcutaneous anti-TNF drugs can benefit from monitoring of the drug trough levels. Abstract Immunization to biological drugs can lead to decreased efficacy and increased risk of adverse effects. The objective of this cross-sectional study was to assess the extent and significance of immunization to subcutaneous tumor necrosis factor (TNF) inhibitors in axial spondyloarthritis (axSpA) patients in real-life setting. A serum sample was taken 1–2 days before the next drug injection. Drug trough concentrations, anti-drug antibodies (ADAb) and TNF-blocking capacity were measured in 273 patients with axSpA using subcutaneous anti-TNF drugs. The clinical activity of SpA was assessed using the Bath AS Disease Activity Index (BASDAI) and the Maastricht AS Entheses Score (MASES). ADAb were found in 11% of the 273 patients: in 21/99 (21%) of patients who used adalimumab, in 0/83 (0%) of those who used etanercept, in 2/79 (3%) of those who used golimumab and in 6/12 (50%) of those who used certolizumab pegol. Use of methotrexate reduced the risk of formation of ADAb, whereas sulfasalazine did not. Presence of ADAb resulted in decreased drug concentration and reduced TNF-blocking capacity. However, low levels of ADAb had no effect on TNF-blocking capacity and did not correlate with disease activity. The drug trough levels were below the consensus target level in 36% of the patients. High BMI correlated with low drug trough concentration. Patients with low drug trough levels had higher disease activity. The presence of anti-drug antibodies was associated with reduced drug trough levels, and the patients with low drug trough levels had higher disease activity. The drug trough levels were below target level in significant proportion of patients and, thus, measuring the drug concentration and ADAb could help to optimize the treatment in SpA patients.

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Serum drug levels of biologic agents in the management of rheumatoid arthritis and spondyloarthritis: a systematic review

Cited by 15 publications

References 35 publications

Curcumin alleviates rheumatoid arthritis-induced inflammation and synovial hyperplasia by targeting mTOR pathway in rats

Curcumin alleviates rheumatoid arthritis-induced inflammation and synovial hyperplasia by targeting mTOR pathway in rats

Medication Persistence for Psoriatic Arthritis in a Brazilian Real-World Setting

Immunogenicity of subcutaneous TNF inhibitors and its clinical significance in real-life setting in patients with spondyloarthritis

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