The use of biological disease-modifying antirheumatic drugs for inflammatory arthritis in Korea: results of a Korean Expert Consensus

Park, Eun Jung; Kim, Hyungjin; Jung, Seung Min; Sung, Yoon Kyoung; Baek, Han Joo; Lee, Sang Hoon

doi:10.3904/kjim.2019.411

Cited by 24 publications

(27 citation statements)

References 168 publications

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“… 3 , 6 – 9 National reimbursement policies or financial constraints might partly contribute to inter-country variation. 6 , 7 , 10 However, given the nature of slowly progressing disease, there have been few examinations of the anti-inflammatory effect of cDMARDs on the axial skeleton over a long observation period among large patient samples. Additionally, no studies have evaluated the impact of cDMARDs on radiographic progression using validated outcome measures in patients with AS.…”

Section: Introductionmentioning

confidence: 99%

Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

Lee

Koo

Nam

et al. 2020

Therapeutic Advances in Musculoskeletal

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Objectives: The clinical benefit of conventional disease-modifying antirheumatic drugs (cDMARDs) for treating ankylosing spondylitis (AS) is generally limited to improvements in peripheral arthritis. However, cDMARDs could be conditionally considered as alternatives to established drugs for improving axial manifestations in exceptional circumstances. However, there are few studies of the impact of cDMARDs on radiographic progression outcomes. Therefore, we investigated the effectiveness of cDMARDs on radiographic progression in AS. Methods: Among 1280 AS patients at a single hospital from 2000 to 2018, 301 who had been treated with sulfasalazine (SSZ) or methotrexate (MTX) were enrolled. For each patient, the entire follow-up period was split into 1-year intervals. Each interval was classified as either an “on-cDMARD” interval, which was a period of treatment with SSZ alone, MTX alone, or a combination of SSZ and MTX, or an “off-cDMARD” interval, which was a period without cDMARD treatment. Radiographic progression was scored using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). The relationship between cDMARD use and radiographic progression within the intervals, defined as the rate of mSASSS progression, was investigated using linear models with adjustment for potential confounding covariates and for clustering among observations from the same patient. Results: The 732 on-cDMARD intervals and 1027 off-cDMARD intervals were obtained from enrolled patients. In multivariable regression analysis, there was no significant association between cDMARDs and the rate of mSASSS progression (β = −0.081, p = 0.418). The mean adjusted mSASSS change per year was 0.610 from on-cDMARD intervals and 0.691 from off-cDMARD intervals. Conclusion: Treatment with cDMARDs may not reduce radiographic progression in AS patients.

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Section: Introductionmentioning

confidence: 99%

Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

Lee

Koo

Nam

et al. 2020

Therapeutic Advances in Musculoskeletal

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“…If the disease activity of patients with RA is not well-controlled by csDMARDs, bDMARDs are usually administered. 3 25 28 29 35 However, they have several potential adverse effects, such as increasing the risk of infection, including reactivation of tuberculosis and exacerbation of hepatitis B virus (HBV) and hepatitis C virus (HCV). 36 37 Because of concerns regarding cancer, these drugs require caution when patients have a history of malignancy.…”

Section: Resultsmentioning

confidence: 99%

Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus

et al. 2021

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Background There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. Methods Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. Results Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities, including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. Conclusion These QIs can be used to assess and improve the quality of health care for patients with RA.

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“…In patients with RA, when primary drugs are ineffective, patients can be switched to drugs with a different mechanism of action. 77 – 79 Moreover, several studies have attempted to identify biomarkers in patients with RA that could predict treatment outcomes and therefore could guide physicians in their decision to prescribe the most suitable biologics. 80 In addition to TNFi, biologics that have been used for a long time in AS and various IL-17 inhibitors have been released as new therapeutic drugs.…”

Section: Finding the Best Biologics For Patients With Nr-axspamentioning

confidence: 99%

The role of ixekizumab in non-radiographic axial spondyloarthritis

Koo

Kim

2021

Therapeutic Advances in Musculoskeletal

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Among patients with axial spondyloarthritis (axSpA), non-radiographic axial spondyloarthritis (nr-axSpA) is distinguished from ankylosing spondylitis (AS) by a lack of obvious radiographic changes in the sacroiliac joint. Tumor necrosis factor inhibitor (TNFi) has been used as a highly effective treatment in patients with AS and has shown good efficacy and safety in clinical trials in patients with nr-axSpA. As the pathophysiological mechanism for axSpA has started to become better recognized, various drugs other than TNFi, all of which are related to the interleukin-17 (IL-17) axis, are being evaluated in patients with axSpA. IL-17 inhibitors, such as secukinumab and ixekizumab, are effective drugs for patients with AS. A recent clinical trial reported that ixekizumab, a monoclonal antibody against IL-17A, was also effective in patients with nr-axSpA. In a COAST-X study, ixekizumab was superior to a placebo for improving signs and symptoms in patients with nr-axSpA at weeks 16 and 52. The adverse events were no different from those found in previous ixekizumab studies, and no new safety signals were identified. However, when considering several IL-17 inhibitors, it is necessary to obtain sufficient data to identify the exacerbation of extra-articular manifestation. In terms of effectiveness and safety, ixekizumab may be an appropriate alternative to TNFi in nr-axSpA patients.

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The use of biological disease-modifying antirheumatic drugs for inflammatory arthritis in Korea: results of a Korean Expert Consensus

Cited by 24 publications

References 168 publications

Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus

The role of ixekizumab in non-radiographic axial spondyloarthritis

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