The treatment journey for patients with axial spondyloarthritis in North Africa and the Middle East: From diagnosis to management

Zorkany, Bassel El; Ali, Yousef; Namas, Rajaie; Bedaiwi, Mohamed; Husain, Waleed; Ahmed, Haytham Mohamed; Zoghbi, Nelly Ziade

doi:10.1111/1756-185x.13961

Cited by 7 publications

(4 citation statements)

References 35 publications

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“…As for the diagnosis, despite the lower background prevalence in some populations, HLA-B27 is characterized by high specificity and a high positive likelihood ratio, which makes it highly valuable for axSpA diagnosis, particularly when found positive [8]. In countries where the HLA-B27 testing might be less cost-effective such as in North Africa and the Middle East, rheumatologists may rely mostly on clinical features and confirmatory imaging to make the diagnosis of SpA [48]. However, in the European White population, HLA-B27 has a high positive likelihood ratio of 9.0 for the diagnosis of axSpA [49].…”

Section: Human Leucocyte Antigen-b27 and Spondyloarthritis Classifica...mentioning

confidence: 99%

Human leucocyte antigen-B27 testing in clinical practice: a global perspective

Ziadé

2023

Current Opinion in Rheumatology

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Purpose of reviewThe association between human leucocyte antigen (HLA)-B27 and spondyloarthritis (SpA) was described half a century ago. New insights about pathophysiologic pathways and their role in bone formation were reported in recent years and will be discussed in this review. Recent findingsThere is a considerable variation in the association between HLA-B27 and SpA across the globe, with the strongest association reported in populations of Northern European and Asian descent and the lowest in the Middle East and Africa. Other genes are also involved in disease susceptibility, highlighting the importance of newly proposed weighted genetic scores to support the diagnosis. On the global level, the interaction between genetic background and gut dysbiosis seems critical for disease predisposition. As for the individual patient, the presence of HLA-B27 can have a significant influence on SpA diagnosis and disease phenotype. More importantly, new studies suggested a role for HLA-B27 in radiographic damage in the sacroiliac joints and the progression of bone formation in the spine. SummaryFindings in recent years have enhanced our understanding of the role of HLA-B27 in the pathophysiology and in disease-related bone formation in SpA, which may pave the way for new therapeutic targets.

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Section: Human Leucocyte Antigen-b27 and Spondyloarthritis Classifica...mentioning

confidence: 99%

Human leucocyte antigen-B27 testing in clinical practice: a global perspective

Ziadé

2023

Current Opinion in Rheumatology

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“…105,106 In some parts of the MENA region, the availability of bDMARDs is still limited; besides, the high cost of bDMARDs represents a financial restriction for their use in some MENA countries. 107 Moreover, the availability of well-trained rheumatologists may affect the country's profile in using bDMARDs. 94 Thus, the currently published literature demonstrates significant variations in the rate of utilization of bDMARDs amongst SpA patients, which reflect substantial variations in the factors that affect biologics use across different MENA countries.…”

Section: Dovepressmentioning

confidence: 99%

The Impact of Spondyloarthritis on Health-Related Quality of Life and Healthcare Resource Utilization in Saudi Arabia: A Narrative Review and Directions for Future Research

Al Rayes,

Salah,

Hamad

et al. 2023

OARRR

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Spondylarthritis (SpA) is an umbrella term that encompasses a wide range of rheumatological disorders. Several studies demonstrated that SpA is associated with increased healthcare resource utilization (HCRU) and a lower health-related quality of life (HRQoL). This review aimed to summarize the current literature regarding the multidimensional impact of SpA on HRQoL and HCRU in Saudi Arabia and explore the correlation of the extent of severity of SpA with HRQoL and HCRU. Although the prevalence of SpA varies across different populations and is correlated with HLA-B27 prevalence, the magnitude of SpA in the Saudi population has not been extensively evaluated. Few studies have investigated the impact of SpA on HRQoL and HCRU in Saudi Arabia and the Middle East. There is a need to study the cost-effectiveness of various SpA treatment strategies, including biologic disease-modifying anti-rheumatic drugs (bDMARDs), to prioritize healthcare spending in the Saudi healthcare system. Data on SpA in Saudi Arabia and the Middle East region are mainly based on expert views, with few population-based studies compared to other regions. Therefore, there is an imperative need to develop high-quality, national-level epidemiological studies that assess the following: (1) more accurate estimates of the current prevalence of SpA in Saudi Arabia, including the prevalence of axial SpA and psoriatic arthritis; (2) the phenotypes/clinical characteristics of SpA, including disease severity and extra-articular involvement; (3) the impact of SpA on the HRQoL of the patients and the factors that can predict the extent of impaired HRQoL in such population, which can represent the first step in developing psychological interventions that should be personalized to this patient population; (4) the impact of implementing formal assessment of disease activity on the management of the patients and, subsequently, their HRQoL; and (5) the HCRU and costs for patients with SpA, and how treatment patterns can affect this cost.

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“…The prevalence of PsA has been reported to be 0.01% in the Middle East and North Africa [ 8 ]. The global prevalence of AxSpA has been estimated to be 0.3–1.4% [ 9 ], with a prevalence of 0.11% in the Middle East [ 10 ]. However, the true epidemiology of inflammatory rheumatic diseases needs to be better evaluated in the Gulf region by improving the reporting of diseases and establishing data and patient registries [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Consensus-Based Overarching Principles and Recommendations on the Use of Biosimilars in the Treatment of Inflammatory Arthritis in the Gulf Region

Alnaqbi,

Al Adhoubi,

Aldallal

et al. 2024

BioDrugs

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Background Though biologic agents have significantly improved the treatment of inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis), high costs, stringent regulations, strict reimbursement criteria, and existing patents have limited patient access to treatments. While being highly similar in quality, safety, and efficacy to biologic reference products, biosimilars can reduce the financial burden and prevent underutilization of medication. Objective The objective of this initiative was to develop an evidence-based consensus of overarching principles and recommendations aimed at standardizing the use of biosimilars in treating inflammatory arthritis in the Gulf region. Methods A task force of practicing rheumatologists, a clinical pharmacist, a health economist, patients, regulators, and payors from across the Gulf region developed recommendations and overarching principles based on the outputs of a systematic literature review conducted to address Patient-Intervention-Comparison-Outcome (PICO) questions specific to key challenges regarding the use of biosimilars for the treatment of inflammatory arthritis in the region. As the data before 2017 have been previously reviewed in another publication, the current review focused on data published between January 2017 and August 2022 (PROSPERO ID CRD42022364002). Consensus on each statement required a level of agreement of 70% or greater. Results Consensus was reached for five overarching principles and nine recommendations by the task force. The principles emphasize the importance of improving the awareness, understanding, and perception of biosimilars, as well as the need for regulated regional real-world data generation and protocols to make biosimilars a viable and affordable treatment option for all patients. The consensus recommendations advocate the need for shared treatment decisions between rheumatologists and patients when considering biosimilars. They further recommend that confirmation of a biosimilar’s efficacy and safety in a single indication is sufficient for extrapolation to other diseases for which the reference product has been approved. Finally, there is a need for pharmacovigilance and national health policies governing the adoption and prescription of biosimilars in clinical practice across the region. Conclusions These are the first consensus recommendations for the Gulf region based on a systematic literature review and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines, integrating clinical evidence with clinical expertise to optimize decision making for the use of biosimilars in patients with inflammatory arthritis. They were formulated based on predominantly international data because of the limited regional data and therefore can be generalized to serve as recommendations for healthcare professionals in other parts of the world. ...

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The treatment journey for patients with axial spondyloarthritis in North Africa and the Middle East: From diagnosis to management

Cited by 7 publications

References 35 publications

Human leucocyte antigen-B27 testing in clinical practice: a global perspective

Human leucocyte antigen-B27 testing in clinical practice: a global perspective

The Impact of Spondyloarthritis on Health-Related Quality of Life and Healthcare Resource Utilization in Saudi Arabia: A Narrative Review and Directions for Future Research

Consensus-Based Overarching Principles and Recommendations on the Use of Biosimilars in the Treatment of Inflammatory Arthritis in the Gulf Region

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