Factors associated with discontinuation of biologics in patients with inflammatory arthritis in remission: data from the BIOBADASER registry.

BACKGROUND: The objectives of this study were to assess the discontinuation of biologic therapy in patients who achieve remission and identify predictors of discontinuation of biologics in patients with inflammatory arthritis in remission. METHODS: An observational retrospective study from the BIOBADASER registry comprising adult patients diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) and receiving 1 or 2 biological disease-modifying drugs (bDMARDs) between October 1999 and April 2021. Patients were followed yearly after initiation of therapy or until discontinuation of treatment. Reasons for discontinuation were collected. Patients who discontinued bDMARDs because of remission as defined by the attending clinician were studied. Predictors of discontinuation were explored using multivariable regression models. RESULTS: The study population comprised 3,366 patients taking 1 or 2 bDMARDs. Biologics were discontinued owing to remission by 80 patients (2.4%): 30 with RA (1.7%), 18 with AS (2.4%), and 32 with PsA (3.9%). The factors associated with a higher probability of discontinuation on remission were shorter disease duration (OR: 0.95; 95% CI: 0.91-0.99), no concomitant use of classic DMARDs (OR: 0.56; 95% CI: 0.34-0.92), and shorter usage of the previous bDMARD (before the decision to discontinue biological therapy) (OR: 1.01; 95% CI: 1.01-1.02); in contrast, smoking status (OR: 2.48; 95% CI: 1.21-5.08) was associated with a lower probability. In patients with RA, positive ACPA was associated with a lower probability of discontinuation (OR: 0.11; 95% CI: 0.02-0.53). CONCLUSIONS: Discontinuation of bDMARDs in patients who achieve remission is uncommon in routine clinical care. Smoking and positive ACPA in RA patients were associated with a lower probability of treatment discontinuation because of clinical remission.

Niveles de fármacos anti-TNFα en pacientes con artritis reumatoide y espondiloartritis / Anti-TNFα Drug Levels in Patients with Rheumatoid Arthritis and Spondyloarthritis

Antecedentes y objetivos: El conocimiento de los niveles de fármacos anti-TNFα puede modificar el tratamiento en pacientes con artritis reumatoide (AR) y espondiloartritis (EspA). Objetivos: Comparar los niveles de anti-TNFα en los pacientes con AR vs. EspA, en diferentes situaciones clínicas. Materiales y métodos: Se realizó un estudio retrospectivo, observacional donde se midieron los niveles de anti-TNFα y la presencia de anticuerpos antifármacos en pacientes seleccionados consecutivamente, utilizando la técnica de ELISA. Resultados: Se estudiaron 53, 73 y 78 pacientes en tratamiento con infliximab, adalimumab y etanercept, respectivamente. Los niveles medios de fármaco en pacientes con dosis estándar fueron: infliximab 2,2μg/ml (1,4-5,2), adalimumab 4,9μg/ml (0,8-8,9) y etanercept 3,1μg/ml (2,3-4,4). No se encontraron diferencias en los niveles fármacos según la actividad de la enfermedad, sin embargo, hubo diferencias en los niveles de etanercept e infliximab según el uso de fármacos modificadores de la enfermedad sintéticos (FAMEsc). Conclusiones: Los niveles de fármacos anti-TNFα se verán modificados por el tratamiento con FAMEsc.(AU)

Background and objectives: Knowledge of the levels of anti-TNFα drugs can modify treatment in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).ObjectivesTo compare the levels of anti-TNFα in patients with RA vs SpA, in different clinical situations. Materials and methods: A retrospective, observational study was conducted. Levels of anti-TNFα and the presence of anti-drug antibodies were measured in consecutively selected patients, using the ELISA technique. Results: Fifty-three, 73 and 78 patients treated with infliximab, adalimumab and etanercept were studied, respectively. The median drug levels in patients using standard doses were infliximab 2.2μg/ml (1.4-5.2), adalimumab 4.9μg/ml (0.8-8.9) and etanercept 3.1μg/ml (2.3-4.4). There were no differences in drug levels according to disease activity but we found differences in etanercept and infliximab levels according to DMARD use. Conclusions: Levels of anti-TNFα drugs will change with DMARD treatment.(AU)

Anti-TNFα drug levels in patients with rheumatoid arthritis and spondyloarthritis.

BACKGROUND AND OBJECTIVES: Knowledge of the levels of anti-TNFa drugs can modify treatment in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). OBJECTIVES: To compare the levels of anti-TNFa in patients with RA vs SpA, in different clinical situations. MATERIALS AND METHODS: A retrospective, observational study was conducted. Levels of anti-TNFa and the presence of anti-drug antibodies were measured in consecutively selected patients, using the ELISA technique. RESULTS: Fifty-three, 73 and 78 patients treated with infliximab, adalimumab and etanercept were studied, respectively. The median drug levels in patients using standard doses were infliximab 2.2 µg/mL (1.4-5.2), adalimumab 4.9 µg/mL (0.8-8.9) and etanercept 3.1 µg/mL (2.3-4.4). There were no differences in drug levels according to disease activity but we found differences in etanercept and infliximab levels according to DMARD use. CONCLUSIONS: Levels of anti-TNFa drugs will change with DMARD treatment.

Anti-TNFα Drug Levels in Patients with Rheumatoid Arthritis and Spondyloarthritis. / Niveles de fármacos anti-TNFα en pacientes con artritis reumatoide y espondiloartritis.

BACKGROUND AND OBJECTIVES: Knowledge of the levels of anti-TNFα drugs can modify treatment in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). OBJECTIVES: To compare the levels of anti-TNFα in patients with RA vs SpA, in different clinical situations. MATERIALS AND METHODS: A retrospective, observational study was conducted. Levels of anti-TNFα and the presence of anti-drug antibodies were measured in consecutively selected patients, using the ELISA technique. RESULTS: Fifty-three, 73 and 78 patients treated with infliximab, adalimumab and etanercept were studied, respectively. The median drug levels in patients using standard doses were infliximab 2.2µg/ml (1.4-5.2), adalimumab 4.9µg/ml (0.8-8.9) and etanercept 3.1µg/ml (2.3-4.4). There were no differences in drug levels according to disease activity but we found differences in etanercept and infliximab levels according to DMARD use. CONCLUSIONS: Levels of anti-TNFα drugs will change with DMARD treatment.

Artritis reumatoide, un nuevo enfoque del riesgo cardiovascular / Rheumatoid arthritis, a new focus on cardiovascular risk

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Artritis reumatoide: ¿cómo usar los fármacos en el embarazo y la lactancia? / Rheumatoid arthritis: How to use drugs during pregnancy and lactation?

La artritis reumatoide es una enfermedad que tiene una alta prevalencia en mujeres en edad fértil. Se realiza una revisión de las características de la barrera placentaria, el paso de medicamentos a través de ella y del uso de fármacos durante el embarazo: los que son potencialmente seguros, los fármacos que sólo pueden ser usados si la vida materna se ve comprometida, los fármacos que están contraindicados y aquéllos con información insuficiente sobre seguridad y que por tanto deben ser evitados, en este último grupo se ubican los fármacos biológicos. También se realiza una revisión acerca del uso de fármacos durante la lactancia, periodo en el cual es frecuente un rebrote de la artritis reumatoide (AU)

Rheumatoid arthritis is a disease that is highly prevalent in women of childbearing age. A review is done about the characteristics of the placental barrier, the passage of drugs through it and the use of drugs during pregnancy: those which are potentially safe drugs, those drugs that can only be used if there is a life threatening condition for the mother, drugs that are contraindicated and those with insufficient data on safety and therefore should be avoided, the latter group comprises biological drugs. Also a review is done about the use of drugs during lactation, a period that a flare of rheumatoid arthritis can occur (AU)

[Rheumatoid arthritis: how to use drugs during pregnancy and lactation?]. / Artritis reumatoide: cómo usar los fármacos en el embarazo y la lactancia?

Rheumatoid arthritis is a disease that is highly prevalent in women of childbearing age. A review is done about the characteristics of the placental barrier, the passage of drugs through it and the use of drugs during pregnancy: those which are potentially safe drugs, those drugs that can only be used if there is a life threatening condition for the mother, drugs that are contraindicated and those with insufficient data on safety and therefore should be avoided, the latter group comprises biological drugs. Also a review is done about the use of drugs during lactation, a period that a flare of rheumatoid arthritis can occur.

[Sensitivity and specificity of metabolic syndrome criteria for insulin resistance diagnosis in Spanish population]. / Sensibilidad y especificidad de los criterios del síndrome metabólico para el diagnóstico de insulinorresistencia en la población española.

BACKGROUND AND OBJECTIVE: Metabolic syndrome (MS) is an abdominal obesity and insulin resistance (IR)-related syndrome associated with a high cardiovascular risk. Recently, the International Diabetes Federation (IDF) has proposed a modification of the Adult Treatment Panel III (ATP III) diagnostic criteria. However, the sensitivity of these new criteria has not been established. The aim of the present study was to define the sensitivity and specificity of the different criteria used for the diagnosis of the MS in our population. SUBJECTS AND METHOD: We studied in 177 healthy subjects, 68 men and 109 women, the body mass index, waist circumference (WC), blood pressure, glucose, insulin, lipids and apolipoproteins A1 and B. The HOMA index was used as an IR indicator. IR was considered with an HOMA index > or = 3.8. RESULTS: Subjects with IR showed higher age, systolic blood pressure, triglycerides and apo B, and lower HDL cholesterol. A WC > or = 102 cm in men and > or = 88 cm in women (ATP III criteria) had a low sensitivity for IR (29.4% and 44.7% respectively), with high specificity (81% and 90%). A WC > or = 94 cm in men and > or = 80 cm in women (IDF criteria) showed good sensitivity (73.5% and 73.7% respectively) but less specificity (57.1% and 53.3%). The IDF criteria showed better sensitivity than ATP III, without substantial change in the specificity for the different HOMA cut-off points. CONCLUSIONS: ATP III criteria had low sensitivity in our population. The new criteria (WC > or = 94 cm in men and > or = 80 cm in women, and blood glucose > or = 100 mg/dL) improve three-fold the diagnostic sensitivity and, therefore, seems to be more useful for detecting IR in our country.

Sensibilidad y especificidad de los criterios del síndrome metabólico para el diagnóstico de insulinorresistencia en la población española / Sensitivity and specificity of metabolic syndrome criteria for insulin resistance diagnosis in Spanish population

Fundamento y objetivo: El síndrome metabólico (SM) es un trastorno relacionado con obesidad abdominal e insulinorresistencia (IR) y con un elevado riesgo cardiovascular. Recientemente, la International Diabetes Federation (IDF) ha propuesto una modificación de los criterios diagnósticos tradicionales del SM del Adult Treatment Panel III (ATP III). Sin embargo, la sensibilidad de estos nuevos criterios no se ha establecido. Los objetivos del estudio fueron definir sensibilidad y especificidad de los diferentes criterios del SM en nuestra población. Sujetos y método: Se estudió en 177 voluntarios adultos sanos (68 varones y 109 mujeres): el índice de masa corporal (IMC), el perímetro de cintura (PC), la presión arterial y los valores de glucosa, insulina, lípidos y apolipoproteínas (apo) A1 y B. Como indicador de IR se utilizó el índice HOMA, considerando IR un índice HOMA >= 3,8. Resultados: Los sujetos con IR tuvieron mayores edad, IMC, presión arterial sistólica, triglicéridos y apoB y menos colesterol unido a lipoproteínas de alta densidad (cHDL). Un PC >= 102 cm en varones y >= 88 cm en mujeres (criterio ATP III) mostró baja sensibilidad para IR (el 29,4 y el 44,7% respectivamente), con alta especificidad (el 81 y el 90%). Un PC >= 94 cm en varones y >= 80 cm en mujeres (criterio IDF) mostró buena sensibilidad (el 73,5 y el 73,7% respectivamente), pero menor especificidad (el 57,1 y el 53,3%). Los criterios IDF mostraron mejor sensibilidad que los ATP III, sin empeorar sustancialmente la especificidad, para el punto de corte de HOMA. Conclusiones: Los criterios del ATP III tienen baja sensibilidad en nuestra población. Los nuevos criterios, PC >= 94 cm en varones y >= 80 cm en mujeres y glucemia >= 100 mg/dl, mejoran 3 veces la sensibilidad diagnóstica de IR y, por tanto, parecen ser más útiles para detectar IR en nuestro medio

Background and objective: Metabolic syndrome (MS) is an abdominal obesity and insulin resistance (IR)-related syndrome associated with a high cardiovascular risk. Recently, the International Diabetes Federation (IDF) has proposed a modification of the Adult Treatment Panel III (ATP III) diagnostic criteria. However, the sensitivity of these new criteria has not been established. The aim of the present study was to define the sensitivity and specificity of the different criteria used for the diagnosis of the MS in our population. Subjects and method: We studied in 177 healthy subjects, 68 men and 109 women, the body mass index, waist circumference (WC), blood pressure, glucose, insulin, lipids and apolipoproteins A1 and B. The HOMA index was used as an IR indicator. IR was considered with an HOMA index >= 3.8. Results: Subjects with IR showed higher age, systolic blood pressure, triglycerides and apo B, and lower HDL cholesterol. A WC >= 102 cm in men and >= 88 cm in women (ATP III criteria) had a low sensitivity for IR (29.4% and 44.7% respectively), with high specificity (81% and 90%). A WC >= 94 cm in men and >= 80 cm in women (IDF criteria) showed good sensitivity (73.5% and 73.7% respectively) but less specificity (57.1% and 53.3%). The IDF criteria showed better sensitivity than ATP III, without substantial change in the specificity for the different HOMA cut-off points. Conclusions: ATP III criteria had low sensitivity in our population. The new criteria (WC >= 94 cm in men and >= 80 cm in women, and blood glucose >= 100 mg/dL) improve three-fold the diagnostic sensitivity and, therefore, seems to be more useful for detecting IR in our country

Genetic variation in the hepatic lipase gene is associated with combined hyperlipidemia, plasma lipid concentrations, and lipid-lowering drug response.

BACKGROUND: Combined hyperlipidemia (CHL) is a very frequent dyslipidemia, being lipid-lowering drugs often necessary in its management. Some genetic loci have been associated with CHL, and modulation of lipid-lowering treatment by genetic polymorphisms has been reported. We have investigated whether common polymorphisms in the hepatic lipase gene (LIPC) influence the baseline lipid concentration and the response to atorvastatin or bezafibrate in patients with CHL. METHODS: Two genetic polymorphisms in LIPC (-514C-->T and +651A-->G) were determined by polymerase chain reaction and restriction analysis in 118 subjects of the ATOMIX (Atorvastatin in Mixed dyslipidemia) study who were randomized to treatment with either atorvastatin or bezafibrate and in 114 normolipidemic controls. RESULTS: The -514T allele frequency was higher in the ATOMIX group (0.297) than in the control group (0.193) (P = .01). The -514T allele carriers in the control group showed higher high-density lipoprotein cholesterol (HDL-C) concentrations than the -514C homozygotes, 50.8 +/- 1.86 versus 45.9 +/- 1.40 mg/dL (P = .02). The +651G carriers in the ATOMIX group showed lower total cholesterol and low-density lipoprotein cholesterol than the +651A homozygotes, 274 +/- 3.72 and 181 +/- 3.50 mg/dL versus 289 +/- 4.0 and 194 +/- 3.76 mg/dL, respectively (P < .01). Homozygotes for the -514C allele on bezafibrate treatment had greater decrease in triglycerides and greater increase in HDL-C than -514T allele carriers after 12 months of bezafibrate treatment, -39.4% and +35.8% versus -25.5% and +20.4%, respectively (P = .080 and P = .007, respectively). CONCLUSIONS: A higher frequency of the -514T allele of LIPC suggests a role of this locus in the pathogenesis of CHL. The -514T allele is associated with higher HDL-C concentration in normolipidemic population. The -514C-->T polymorphism modulates the lipid-lowering response to bezafibrate, with a better effect in homozygous CC subjects.

Ultrasonography for the evaluation of visceral fat and the metabolic syndrome.

Association between abdominal obesity and cardiovascular disease has been related with visceral adiposity, through the predisposition of developing type 2 diabetes mellitus and metabolic syndrome (MS). Sonography is a simple and reliable method to measure both subcutaneous and visceral fat. To analyze the relationship of anthropometric measurements with abdominal adiposity measured by sonography and to analyze the utility of sonography in the prediction of insulin resistance (IR) and the other components of MS. Visceral fat measurements by sonography correlated better with components of MS than did subcutaneous fat measurements. Preperitoneal circumference (PC) was strongly correlated with all components of MS and with IR expressed as a homeostasis model assessment (HOMA) index for IR. PC was better than waist circumference (WC) in predicting triglyceride levels, apolipoprotein B levels, and HOMA index, but WC was better than PC in predicting high-density lipoprotein cholesterol levels. The area under the receiver operating characteristic curve was 0.699 for PC and 0.684 for WC, in subjects with body mass index 25 kg/m2 or greater (P=.024 and .015, respectively). PC and WC showed good correlation with HOMA index (Spearman correlation coefficient=0.306, P<.001 and .206, P<.001, respectively). Abdominal visceral fat is better correlated with MS than subcutaneous fat; sonography is a useful method to evaluate the abdominal fat; PC is the best sonography parameter correlated with components of MS, and in overweight and obese subjects, PC is better than WC at predicting components of the MS.