Showing papers by "Inmaculada de la Torre published in 2015"
TL;DR: The results suggest that the presence of Doppler-detected synovitis may predict BT tapering failure in RA patients in sustained clinical remission.
Abstract: Objective To investigate the predictive value of synovitis detected by Doppler US in relation to failed tapering of biologic therapy (BT) in RA patients in sustained clinical remission. Methods A total of 77 RA patients (52 women, 25 men) in sustained clinical remission, treated with a stable dosage of BT were prospectively recruited. BT was tapered according to an agreed strategy implemented in clinical practice (i.e. increasing the interval between doses for s.c. BT and reducing the dose for i.v. BT). BT tapering failure was assessed at 6 and 12 months. Doppler US investigation of 42 joints for the presence and grade (0-3) of B-mode synovial hypertrophy and synovial power Doppler signal (i.e. Doppler synovitis) was performed at baseline by a rheumatologist blinded to clinical and laboratory data. Hand and foot radiographs were obtained at baseline and at 12-month follow-up. Results Of the 77 patients, 46 (59.7%) were on s.c. BT and 31 (40.3%) on i.v. BT. At 12 months, 35 patients (45.5%) presented BT tapering failure, 23 of them (29.9% of all patients) in the first 6 months of BT tapering. In logistic regression analysis, the baseline DAS28 and the global score of Doppler synovitis were identified as independent predictors of BT tapering failure at 12 and 6 months. The presence of Doppler synovitis was the strongest predictor for BT tapering failure. No patient showed radiographic progression. Conclusion Our results suggest that the presence of Doppler-detected synovitis may predict BT tapering failure in RA patients in sustained clinical remission.
93 citations
TL;DR: Whether quantitative or qualitative assay data prove more accurate in the assessment of infliximab levels in AS patients is investigated to find out whether therapeutic drug ranges can be established.
Abstract: There are various immunosorbent assays which can be used to determine infliximab (IFX) levels. Results vary between assays complicating reliability in everyday clinical practice. The aim of this study was to determine whether quantitative or qualitative assay data prove more accurate in the assessment of infliximab levels in AS patients. We analyzed 40 serum samples, taken prior to infusion, from AS patients who had been undergoing IFX therapy as a first-line of biological treatment for more than a year. IFX levels and IFX–anti-drug antibodies (ADA) were measured using two different ELISA assays [Promonitor® IFX R1 and R2 (version 1), Promonitor® IFX and anti-IFX (version 2) (Progenika Biopharma, Spain)] strictly following the manufacturer’s guidelines. Cohen’s unweighted kappa and the intraclass correlation coefficient determined qualitative and quantitative agreement for serum levels in version 1 and version 2. Bland–Altman plots were drawn to compare both assays. The comparison of data measuring IFX levels for version 1 and version 2 resulted in questionable quantitative agreement (ICC 0.659; 95 % CI 0.317–0.830) and moderate qualitative agreement (κ 0.607; 95 % CI 0.387–0.879) owing to systematically higher values in version 2 than version 1. Version 2 consistently detected higher levels of infliximab, particularly when analyzed in a quantitative context. Further research is needed to synchronize cutoff levels between essays and diseases so therapeutic drug ranges can be established.
7 citations
TL;DR: Golimumab seems to be effective and safe in refractory uveitis related to SpA and the side-effects observed were not severe.
Abstract: Objectives To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA) Methods Multicenter study of uveitis related to SpA that had been refractory to at least one immunosuppressive drug. The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness in cases of macular edema. Results Nine patients (9 men) (11 affected eyes) with a mean age ± SD of 42.1±5.25 years (range 32-48) were evaluated. The pattern of ocular involvement was anterior uveitis (n=5) and anterior+intermediate (n=4). According to the course, uveitis was acute (n=1), chronic (n=4) or recurrent (n=4). Besides oral steroids and before GLM onset they had received: intraocular corticosteroids (n=2), immunosupressive conventional drugs: MTX (n=7), AZA (3), SZP (4) and LFN (n=1) and biologic therapy: IFX ev 5mg/kg/6-8 week (n=3), ETN sc 50 mg/week (n=3), and ADA 40mg/2 week (n=2). GLM was started because of lack of efficacy of the previous treatments, at the standard dose of 50 mg/sc/month as a monotherapy (n=5) or combined (n=4) with MTX (n=2), AZA (n=1) and LFN (n=1). Significant improvement of anterior chamber cells was observed (baseline: median 1 [IQR 0-3]), and (0 [0-1]) (p=0.01) and (0 [0-0]) (p=0.01) at 2 weeks and 6 months, respectively. The mean visual acuity also improved from a mean of 0.75±0.24 at baseline to 0.77±0.26 (p=0.1) and 0.85±0.27 (p=0.1) at 3 and 6 months, respectively, and the macular thickness (OCT) from a mean of 280±30 to 263±16 microns at 6 months. Corticosteroids were also tapered from a mean dose of prednisone at baseline of 31±20 mg/day to 27±18 and 14±11 mg/day at 2 weeks and 6 months respectively. After a mean follow-up of 13±7 months, 7 of 9 patients were on remission and the side-effects observed were not severe (injection site erythema in 1 case). Conclusions Golimumab seems to be effective and safe in refractory uveitis related to SpA. Disclosure of Interest None declared
1 citations