Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis

Cantini, Fabrizio; Niccoli, Laura; Nannini, Carlotta; Cassarà, Emanuele; Kaloudi, Olga; Favalli, Ennio Giulio; Becciolini, Andrea; Biggioggero, Martina; Benucci, Maurizio; Gobbi, Francesca Li; Grossi, Valentina; Infantino, María; Meacci, Francesca; Manfredi, Mariangela; Guiducci, Serena; Bellando-Randone, Silvia; Matucci‐Cerinic, Marco; Foti, Rosario; Gangi, M. Di; Mosca, Marta; Tani, Chiara; Palmieri, Fabrizio; Goletti, Delia

doi:10.1016/j.semarthrit.2015.10.001

Cited by 49 publications

(39 citation statements)

References 203 publications

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“…The beneficial effect of targeting pro-inflammatory cytokines is testified to by the clinical efficacy of monoclonal antibodies in biological drugs working against TNF-α, IL-6 or IL-1β in RA patients, whilst in AS and PsA, along with TNF-α, IL-12/23 and IL-17 axis is involved [38,39]. In this regard, two more human monoclonal antibodies have been approved for the treatment of PsA (ustekinumab, directed against IL-12/23) and secukinumab (directed against IL-17A) and the latter has also been approved for the AS treatment.…”

Section: Discussionmentioning

confidence: 99%

Role and Function of A2A and A3 Adenosine Receptors in Patients with Ankylosing Spondylitis, Psoriatic Arthritis and Rheumatoid Arthritis

Ravani

Vincenzi

Bortoluzzi

et al. 2017

IJMS

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Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are chronic inflammatory rheumatic diseases that affect joints, causing debilitating pain and disability. Adenosine receptors (ARs) play a key role in the mechanism of inflammation, and the activation of A2A and A3AR subtypes is often associated with a reduction of the inflammatory status. The aim of this study was to investigate the involvement of ARs in patients suffering from early-RA (ERA), RA, AS and PsA. Messenger RNA (mRNA) analysis and saturation binding experiments indicated an upregulation of A2A and A3ARs in lymphocytes obtained from patients when compared with healthy subjects. A2A and A3AR agonists inhibited nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) activation and reduced inflammatory cytokines release, such as tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6. Moreover, A2A and A3AR activation mediated a reduction of metalloproteinases (MMP)-1 and MMP-3. The effect of the agonists was abrogated by selective antagonists demonstrating the direct involvement of these receptor subtypes. Taken together, these data confirmed the involvement of ARs in chronic autoimmune rheumatic diseases highlighting the possibility to exploit A2A and A3ARs as therapeutic targets, with the aim to limit the inflammatory responses usually associated with RA, AS and PsA.

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Section: Discussionmentioning

confidence: 99%

Role and Function of A2A and A3 Adenosine Receptors in Patients with Ankylosing Spondylitis, Psoriatic Arthritis and Rheumatoid Arthritis

Ravani

Vincenzi

Bortoluzzi

et al. 2017

IJMS

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“…Our study demonstrated that in real life, ABA represents the drug of choice in case of underlying infectious risk, such as pre-treatment LTBI positive screening. A recent Italian multidisciplinary expert panel named Tailored BIOlogic therapy (ITABIO), aiming at defining an evidence-based decisional statements for the first-line-tailored biologic therapy in patients with rheumatic diseases, also concluded that LTBI positivity should drive the choice towards ABA, TCZ, or ETA [12]. Knowing the pathophysiologic role of TNF in controlling and confining mycobacteria infections [28], the choice of a different MoA whenever possible might not seem unexpected.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, in clinical practice, several other factors may be advocated as drivers of the choice of a specific agent such as comorbidities, host-related risk factors for infections, cardiovascular risk, the patient's compliance and preference for a specific route of administration, predictive biomarkers such as seropositivity for rheumatoid factor (RF) and/or anti-citrullinated protein antibodies (ACPA), and, eventually, also costeffectiveness [12]. These factors are not always adequately supported by evidence-based medicine (EBM) but are perceived as very relevant by experts in the field and supported by sciencebased medicine (SBM).…”

Section: Introductionmentioning

confidence: 99%

Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry

et al. 2017

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According to international recommendations, the selection of the biologic disease modifying anti-rheumatic drug (bDMARD) for rheumatoid arthritis (RA) is mainly left to the clinician's preference. We analyzed the real-life factors influencing the first-line choice or the switching strategy, focusing on the prescription of abatacept (ABA) or tocilizumab (TCZ) compared to TNFα inhibitors (TNFi). Patients enrolled in the Lombardy Rheumatology Network (LORHEN) Registry after January 1, 2010, when all considered bDMARD agents were available, were included. The population was divided into Bfirst-^and Bsecond-line^bDMARD. We included 1910 patients (first line n = 1264, second line n = 646). Age was higher in ABA or TCZ vs TNFi treated patients (p < 0.0001). Positive latent tuberculosis screening was associated with first-line ABA (p = 0.002). Methotrexate (MTX) combination therapy was lower in the TCZ group (p = 0.02). The type (dyslipidemia, hypertension, pulmonary disease) and the number of comorbidities influenced the choice towards ABA (p = 0.01). Multinomial logistic regression demonstrated that a second-line treatment, higher age, dyslipidemia, pulmonary disease, other comorbidities, and extraarticular RA manifestations were associated with ABA compared to TNFi. TCZ was associated with a second-line treatment, higher age, and more severe disease activity. Stopping the first bDMARD due to adverse events (AE) influenced the choice towards ABA. In real life, higher age and comorbidities influence the choice towards ABA and TCZ compared to TNFi. ABA was preferred in case of suspension of previous treatments due to AE. After failing a first-line TNFi, swapping to a different mechanism of action is more common.

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“…Also, indications that most of the CIDs share the same effector mechanisms and pathways of inflammation can be exemplified by the observation that specific therapeutic approaches in one specific CID can often be used in another CID as well. Examples are the use of anti-TNFα treatment in rheumatoid arthritis, psoriasis, and IBD (26–28) and targeting the IL-12/IL-23 pathway in various other CIDs (29). We can conclude that, despite the presentation of different clinical symptoms and involvement of different organs, distinct CIDs share common immune mechanisms.…”

Section: Common Pathways In Cidsmentioning

confidence: 99%

Embracing Complexity beyond Systems Medicine: A New Approach to Chronic Immune Disorders

Velde

Bezema²,

Kampen

et al. 2016

Front. Immunol.

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In order to combat chronic immune disorders (CIDs), it is an absolute necessity to understand the bigger picture, one that goes beyond insights at a one-disease, molecular, cellular, and static level. To unravel this bigger picture we advocate an integral, cross-disciplinary approach capable of embracing the complexity of the field. This paper discusses the current knowledge on common pathways in CIDs including general psychosocial and lifestyle factors associated with immune functioning. We demonstrate the lack of more in-depth psychosocial and lifestyle factors in current research cohorts and most importantly the need for an all-encompassing analysis of these factors. The second part of the paper discusses the challenges of understanding immune system dynamics and effectively integrating all key perspectives on immune functioning, including the patient’s perspective itself. This paper suggests the use of techniques from complex systems science in describing and simulating healthy or deviating behavior of the immune system in its biopsychosocial surroundings. The patient’s perspective data are suggested to be generated by using specific narrative techniques. We conclude that to gain more insight into the behavior of the whole system and to acquire new ways of combatting CIDs, we need to construct and apply new techniques in the field of computational and complexity science, to an even wider variety of dynamic data than used in today’s systems medicine.

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Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis

Cited by 49 publications

References 203 publications

Role and Function of A2A and A3 Adenosine Receptors in Patients with Ankylosing Spondylitis, Psoriatic Arthritis and Rheumatoid Arthritis

Role and Function of A2A and A3 Adenosine Receptors in Patients with Ankylosing Spondylitis, Psoriatic Arthritis and Rheumatoid Arthritis

Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry

Embracing Complexity beyond Systems Medicine: A New Approach to Chronic Immune Disorders

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