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Drug Design, Development and Therapy 2017The steadily increasing knowledge regarding pathogenetic mechanisms in autoimmune rheumatic diseases has paved the way to different therapeutic approaches. In... (Review)
Review
The steadily increasing knowledge regarding pathogenetic mechanisms in autoimmune rheumatic diseases has paved the way to different therapeutic approaches. In particular, the market entry of biologics has dramatically modified the natural history of rheumatic chronic inflammatory diseases with a meaningful impact on patients' quality of life. Among the wide spectrum of available biological treatments, rituximab (RTX), first used in the treatment of non-Hodgkin's lymphoma, was later approved for rheumatoid arthritis and anti-neutrophil cytoplasmic antibodies-associated vasculitis. Nowadays, in rheumatology, RTX is also used with off-label indications in patients with systemic sclerosis, Sjögren's syndrome and systemic lupus erythematosus. RTX is a monoclonal antibody directed to CD20 molecules expressed on the surfaces of pre-B and mature B lymphocytes. It acts by causing apoptosis of these cells with antibody- and complement-dependent cytotoxicity. As inflammatory responses to cell-associated immune complexes are key elements in the pathogenesis of several autoimmune rheumatic diseases, such an approach might be effective in these patients. In fact, RTX, by promoting the rapid and long-term depletion of circulating and lymphoid tissue-associated B cells, leads to a lower recruitment of these effector cells at sites of immune complex deposition, thus reducing inflammation and tissue damage. RTX is of the most interest to rheumatologists as it represents an important additional therapeutic approach. Thus, the advent in clinical practice of approved RTX biosimilars, such as CT-P10, may be of help in improving treatment access as well as in reducing costs.
Topics: Animals; Antigens, CD20; Antirheumatic Agents; Autoimmune Diseases; Biosimilar Pharmaceuticals; Humans; Quality of Life; Rheumatic Diseases; Rituximab
PubMed: 29042750
DOI: 10.2147/DDDT.S139248 -
Annals of the Rheumatic Diseases Mar 2005Non-steroidal anti-inflammatory drugs (NSAIDs) and traditional disease modifying antirheumatic drugs (DMARDs) are widely used in the treatment of psoriatic arthritis... (Review)
Review
Non-steroidal anti-inflammatory drugs (NSAIDs) and traditional disease modifying antirheumatic drugs (DMARDs) are widely used in the treatment of psoriatic arthritis (PsA), but this is based more upon clinical experience than adequate evidence from clinical trials. This report summarises the results from available trials highlighting evidence of efficacy and deficiencies with respect to effect on joints and to a lesser degree cutaneous disease. The available published data on efficacy of NSAIDs, glucocorticoids, antimalarials, sulfasalazine, gold, methotrexate, azathioprine, and ciclosporin are detailed, as well as new data on leflunomide and other novel agents. The conclusions of this review are that evidence supports marginal efficacy of sulfasalazine and perhaps gold in the treatment of peripheral psoriatic arthropathy, and methotrexate and ciclosporin are effective for treating the skin disease although evidence for improvement of the arthropathy is empirical at best. New trials with standardised and validated outcome measures are required to better assess efficacy. Evaluating newer agents, against and in combination with traditional DMARDS, may further clarify the latter's role in the future management of this condition.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Arthritis, Psoriatic; Glucocorticoids; Humans; Treatment Outcome
PubMed: 15708943
DOI: 10.1136/ard.2004.030783 -
Bulletin of the Hospital For Joint... 2013Methotrexate has become the "anchor drug" for rheumatoid arthritis (RA), taken by many more patients than any other disease modifying anti-rheumatic drug (DMARD) or... (Review)
Review
Methotrexate has become the "anchor drug" for rheumatoid arthritis (RA), taken by many more patients than any other disease modifying anti-rheumatic drug (DMARD) or biological agent. Methotrexate has greater efficacy and effectiveness than any other non-biologic DMARD, and greater tolerability and safety than other DMARDs. The efficacy of methotrexate is comparable to biologic agents in parallel clinical trials of DMARD-naïve patients. Adequate responses to methotrexate monotherapy or combinations with other non-biologic DMARDs are seen in about two- thirds of patients with RA in usual care. The most efficacious treatments for RA reported in the rheumatology literature are seen in strategy trials with methotrexate as the anchor drug, without any biologic agent. Interpretation of significantly lower radiographic progression between methotrexate and biologic agents in clinical trials is over- stated regarding clinic consequences. The admonition to patients to refrain entirely from consumption of alcohol while taking methotrexate may be unnecessary. Accurate information concerning methotrexate as the anchor drug for RA should lead to better understanding of optimal use and better to patient outcomes in usual clinical care.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Biological Products; Drug Therapy, Combination; Humans; Methotrexate; Time Factors; Treatment Outcome
PubMed: 24219036
DOI: No ID Found -
CMAJ : Canadian Medical Association... Feb 2017
Topics: Antirheumatic Agents; Humans; Hydroxychloroquine; Hypopigmentation; Lupus Erythematosus, Systemic; Male; Middle Aged
PubMed: 26903361
DOI: 10.1503/cmaj.150622 -
Reumatologia Clinica 2018To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.
OBJECTIVE
To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.
METHODS
A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).
RESULTS
Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text.
CONCLUSIONS
The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Biological Availability; Clinical Decision-Making; Dose-Response Relationship, Drug; Drug Administration Routes; Evidence-Based Medicine; Humans; Medication Adherence; Methotrexate; Patient Education as Topic; Practice Guidelines as Topic; Quality of Life; Randomized Controlled Trials as Topic; Rheumatic Diseases; Self Administration
PubMed: 28082032
DOI: 10.1016/j.reuma.2016.12.001 -
The European Respiratory Journal Apr 2002Sulphasalazine prescribing is on the increase. Pulmonary toxicity and blood dyscrasias are rare side-effects. Numerous case reports have been published implicating... (Review)
Review
Sulphasalazine prescribing is on the increase. Pulmonary toxicity and blood dyscrasias are rare side-effects. Numerous case reports have been published implicating sulphasalazine in pulmonary toxicity. The authors searched the literature for cases of sulphasalazine induced lung toxicity and the 50 cases identified are discussed here. All published case reports/letters referring to sulphasalazine and lung toxicity were studied. The search terms "sulphasalazine" and "sulfasalazine" were combined with the terms "lung", "pulmonary disease", "pneumonitis" and "pleuritis" using Medline and PubMed databases. Typical presentation of sulphasalazine-induced lung disease was with new onset dyspnoea and infiltrates on chest radiography. Common symptoms were cough and fever. Crepitations on auscultation and peripheral eosinophilia were noted in half of the cases. Sputum production, allergy history, rash, chest pain and weight loss were inconsistent findings. Pulmonary pathology was variable, the commonest being eosinophilic pneumonia with peripheral eosinophilia and interstitial inflammation with or without fibrosis. Fatal reports were infrequent. Most patients were managed by drug withdrawal with 40% prescribed corticosteroids. In conclusion, sulphasalazine lung disease should be distinguished from interstitial lung disease due to underlying primary disease. Despite the increase in sulphasalazine prescribing, pulmonary toxicity remains rare. The majority of patients with suspected sulphasalazine-induced lung disease improved within weeks of drug withdrawal and the need for corticosteroids is debatable.
Topics: Antirheumatic Agents; Colitis, Ulcerative; Female; Humans; Inflammatory Bowel Diseases; Lung Diseases; Male; Middle Aged; Sulfasalazine
PubMed: 11999006
DOI: 10.1183/09031936.02.00267402 -
Clinical and Experimental Rheumatology 2016The Corrona US national registry collects data concerning patient status from both the rheumatologist and patient at routine clinical encounters. Corrona has functioning... (Review)
Review
The Corrona US national registry collects data concerning patient status from both the rheumatologist and patient at routine clinical encounters. Corrona has functioning disease registries in rheumatoid arthritis, psoriatic arthritis, spondyloarthropathies, psoriasis and inflammatory bowel disease. Corrona merges data concerning long-term effectiveness and safety, as well as comparative and cost effectiveness of agents to treat these autoimmune diseases.
Topics: Antirheumatic Agents; Autoimmune Diseases; Biological Products; Cost-Benefit Analysis; Drug Costs; Humans; Registries; Rheumatic Diseases; Rheumatology; Time Factors; Treatment Outcome; United States
PubMed: 27762197
DOI: No ID Found -
The Journal of the American Osteopathic... May 1996Musculoskeletal problems account for the majority of initial complaints attended to by primary care physicians. It is likely that a child who eventually has juvenile... (Review)
Review
Musculoskeletal problems account for the majority of initial complaints attended to by primary care physicians. It is likely that a child who eventually has juvenile rheumatoid arthritis diagnosed will initially be evaluated by a family physician or a pediatrician. Primary care physicians will play an increasingly important role in management of juvenile rheumatoid arthritis, as the availability of specialists in many communities is limited, and access to them may be further limited by managed care initiatives. This article offers a brief review of the definition and classification of juvenile rheumatoid arthritis and introduces a diagnostic algorithm to provide a simplified approach toward evaluating children with arthritis. Treatment and outcomes are summarized in text and graphic formats.
Topics: Age of Onset; Antirheumatic Agents; Arthritis, Juvenile; Child; Child, Preschool; Diagnosis, Differential; Drug Therapy, Combination; Humans; Musculoskeletal Diseases; Prognosis
PubMed: 8936447
DOI: 10.7556/jaoa.1996.96.5.298 -
British Journal of Clinical Pharmacology Oct 2019Methotrexate at low doses (5-25 mg/week) is first-line therapy for rheumatoid arthritis. However, there is inter- and intrapatient variability in response, with... (Review)
Review
Methotrexate at low doses (5-25 mg/week) is first-line therapy for rheumatoid arthritis. However, there is inter- and intrapatient variability in response, with contribution of variability in concentrations of active polyglutamate metabolites, associated with clinical efficacy and toxicity. Prescribing remains heterogeneous across population groups, disease states and regimens. This review examines current knowledge of dose-response of oral methotrexate in the setting of rheumatoid arthritis, and how this could help inform dosage regimens.
Topics: Administration, Oral; Antirheumatic Agents; Arthritis, Rheumatoid; Dose-Response Relationship, Drug; Humans; Methotrexate; Polyglutamic Acid; Practice Patterns, Physicians'
PubMed: 31276602
DOI: 10.1111/bcp.14057 -
RMD Open Mar 2021We summarised four pivotal Randomised Controlled Trials (RCTs) with antirheumatic drugs on the secondary prevention of cardiovascular events. The favourable effects of... (Review)
Review
We summarised four pivotal Randomised Controlled Trials (RCTs) with antirheumatic drugs on the secondary prevention of cardiovascular events. The favourable effects of canakinumab and colchicine confirm (low-grade) inflammation as an independent risk factor for cardiovascular events. While colchicine might be the first drug in the clinic, we expect that this is only the first in a future series of anti-inflammatory drugs used in secondary prevention of cardiovascular events.
Topics: Anti-Inflammatory Agents; Antirheumatic Agents; Cardiovascular Diseases; Colchicine; Humans; Inflammation
PubMed: 33727219
DOI: 10.1136/rmdopen-2020-001560