Adherence to Biologic Drugs Among Patients With Immune Mediated Inflammatory Diseases in Duhok Governorate

Kasim, Hala F.; Salih, Hishyar Mohammed; Eassa, Souzan

doi:10.31386/dmj.2020.14.1.7

Cited by 3 publications

(4 citation statements)

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“…During the 16-month research period, females constituted a significant majority of the RA patients recruited to the study (86.4%), which aligns with other studies globally [ 3 ] or locally in Iraq [ 28 , 29 ]. The no-therapy group of RA patients comprised only 14 (15.9%) of the total 88 RA patients.…”

Section: Discussionsupporting

confidence: 84%

“…The no-therapy group of RA patients comprised only 14 (15.9%) of the total 88 RA patients. The low presence of this group was expected, as it is hard to recruit RA patients who had not been treated previously since their well-being is dependent on the implementation of therapy among other factors that affect the progress of the illness [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Plasma Cholinesterase Activity in Patients With Rheumatoid Arthritis and Toxoplasmosis

Abdullah,

Eassa,

Mohammad

2023

Cureus

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Background and objectiveRheumatoid arthritis (RA) is a chronic autoimmune disease causing synovium inflammation and functional impairment. Toxoplasmosis is an intracellular zoonotic parasitic infection and a risk factor in immunosuppressed diseases including RA. The involvement of the cholinergic mechanism is not clear when both diseases exist in combination. This study aimed to examine plasma cholinesterase (ChE) activity in patients suffering from RA with concomitant toxoplasmosis, taking into account the enzyme susceptibility to in vitro inhibitory challenge with the organophosphate dichlorvos in RA patients. MethodsThis was a case-control study involving 88 RA patients and 61 healthy controls of both genders. The RA patients were allocated into three groups. The first group received no therapy (n=14), the second group received conventional anti-arthritis therapy (n=49), and the third group received conventional + biologic therapy (n=25). Plasma ChE activity was determined by an electrometric method. Plasma samples were screened for Toxoplasma gondii (T. gondii) infection, using ELISA T. gondii antibodies IgG and IgM. In vitro inhibition of plasma ChE activity was assessed by incubating the samples with dichlorvos at 0.25 and 0.5 μM. The time-dependent dichlorvos (0.25 μM)-induced plasma ChE inhibition and its kinetics were determined. ResultsThe RA patients comprised 76 (86.4%) females and 12 males (13.6%), whereas healthy controls included 22 (36.1%) females and 39 (63.9%) males. The rates of toxoplasmosis IgG positivity in controls and RA patients were 26.2% and 39.8%, respectively. Plasma ChE activity in patients with RA was significantly higher than that in the control group, by 16%. Plasma ChE values of RA patients with conventional therapy and conventional + biologic therapy were higher than that of the control group, by 18% and 27%, respectively. Odds and risk ratios of elevated plasma ChE activity (20%) in RA patients with therapy indicated that high plasma ChE activity among RA patients with therapy is a risk factor. The plasma ChE activity of T. gondii IgG-positive RA patients was not significantly different from that of the IgG-negative ones. Dichlorvos at 0.25 and 0.5 μM significantly inhibited in vitro plasma ChE activity in controls and RA patients. The rates of plasma ChE inhibition by dichlorvos were lower in the RA groups with conventional therapy in comparison with those in the control group (77% vs. 91%). Examining the dichlorvos time-dependent ChE inhibition kinetics, RA groups showed increases in the half-life of inhibition by 23.6% to 32.7% and the total inhibition time by 23.5% to 32.5%, together with decreases in the inhibition rate constant by 19% to 24.5%, an indication of reduced inhibition rate of plasma ChE activity compared to that of the control group. ConclusionsThe autoimmune nature of RA and its chronicity might have contributed to the increase in plasma ChE activity among the patients. This increase in enzyme activity could be a risk factor in RA patients undergoing conventi...

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Plasma Cholinesterase Activity in Patients With Rheumatoid Arthritis and Toxoplasmosis

Abdullah,

Eassa,

Mohammad

2023

Cureus

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“…9 A recent cross-sectional questionnaire-based study conducted at the Specialized Center of Rheumatic Disease and Medical Rehabilitation in Duhok, Iraq revealed the existence of high percentage (93.1%) of non-adherence patients to drugs prescribed by the center especially biological drugs which were mainly etanercept, infliximab or adalimumab. 12 This can be an important reason for the development of anti-drug antibodies in patients with episodic treatment. 13 The purpose of the present study was to detect serum antiinfliximab antibodies, together with the measurement of infliximab concentration in the serum of patients referred to Specialized Center of Rheumatic Disease and Medical Rehabilitation in Duhok, Iraq, even though they could not be on regular drug therapy and maintenance regimens.…”

Section: Introductionmentioning

confidence: 99%

“…13 The purpose of the present study was to detect serum antiinfliximab antibodies, together with the measurement of infliximab concentration in the serum of patients referred to Specialized Center of Rheumatic Disease and Medical Rehabilitation in Duhok, Iraq, even though they could not be on regular drug therapy and maintenance regimens. 12…”

Section: Introductionmentioning

confidence: 99%

Detection of Anti-Infliximab Antibodies and Identifying Factors affecting their Occurrence Using Elisa Method among Patients with Immune-Mediated Inflammatory Diseases

Kasim¹,

Eassa²,

Salih³

2021

Indian Journal of Forensic Medicine & Toxicology

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Background: Biological disease-modifying anti-rheumatic drugs such as infliximab are often associated with the development of anti-drug antibodies. Such a problem should be monitored in patients on these drugs. The purpose of the present study was to detect anti-infliximab antibodies and identifying factors affecting their occurrence, together with measuring infliximab concentration in the serum of patients with immune-mediated inflammatory diseases. Methods:A cross-sectional study was conducted between December 2018 to October 2019 at the Specialized Center of Rheumatic Diseases and Medical Rehabilitation in Duhok, Iraq. The included patients were of both genders, aged between 20-70 years, diagnosed with any type of immune-mediated inflammatory diseases for at least one year and had been taking infliximab with or without conventional drugs for at least 3 months. Disease activity scales specific to each disease condition were used. Anti-infliximab antibodies and infliximab concentrations in the serum were measured by using the sandwich ELISA method. Results: Anti-infliximab antibodies were detected in 19/31 (61.3%) of patients treated with infliximab, and 25/31 (80.6%) of them had an unsatisfactory infliximab concentration in the serum (< 3 μg/mL). Short duration (< 10 years) of the disease was significantly associated (p < 0.05) with positive anti-infliximab antibodies. A non-significant association (p > 0.05) was reported between the occurrence of anti-infliximab antibodies and other examined factors. High percentages of patients (57.9%) with positive anti-infliximab antibodies had moderate to high disease activity. Unsatisfactory infliximab concentration was found in 73.7% of these patients. The non-users of methotrexate and other conventional synthetic disease-modifying anti-rheumatic drugs comprised 78.9% and 68.4% of patients who had antibodies to infliximab, respectively. Conclusions: Anti-infliximab antibodies were positive in more than half of the examined patients, and most of them had unsatisfactory infliximab serum concentrations. Further efforts are needed to provide biological drugs regularly, using at least one of the conventional synthetic disease-modifying anti-rheumatic drugs to reduce the development of anti-infliximab antibodies. Regular measurement of anti-drug antibodies and biological drugs concentrations are essential to earn the goal of therapy.

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Immunological Profiles, Oxidative Stress Biomarkers and Plasma Cholinesterase Activities in Patients with Immune-Mediated Inflammatory Diseases Treated in a Clinic in Duhok, Iraq

Abdullah,

Mohammad,

Eassa

2024

Acta Medica Bulgarica

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Aim The purpose of the present study was to measure the levels of selected plasma biochemical variables among cases of immune-mediated inflammatory diseases (IMIDs), other than rheumatoid arthritis, treated in a clinic in the city of Duhok, Iraq, since such information is scarce in the region. Materials and Methods A case-control study on IMIDs patients treated in a clinic in Duhok, Iraq, was performed from February 2022 to June 2023. A total of 29 patients of both genders with IMIDs and 61 healthy controls were recruited at the Duhok Center for Rheumatic Diseases and Medical Rehabilitation, Duhok, Iraq. The laboratory tests conducted on plasma samples from IMIDs patients and healthy controls included measurements of interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, malondialdehyde (MDA), total antioxidant status (TAS) and cholinesterase (ChE) activity. Results No significant differences were found in gender distribution, age, and body mass index between the IMIDs patients and healthy controls. The majority of patients (69%) received conventional therapy combined with biologic agents, whereas the remaining patients (31%) received only conventional medications. The IMIDs identified among the 29 patients were Behcet’s disease (27.6%), ankylosing spondylitis (24.1%), inflammatory bowel diseases (24.1%), psoriatic arthritis (10.3%), systemic lupus erythematosus (6.9%) and psoriasis (6.9%). Conventional therapy used was mostly azathioprine (44.8%) and methotrexate (17.2%), whereas biological therapy included mostly etanercept (27.6%) and adalimumab (24.1%). The values of CRP, IL-6 and TNF-Į among the IMIDs patients were not significantly different from those of the controls. The oxidative stress biomarker MDA was elevated in IMID patients (2.93 ± 1.106 —mol/L vs. 2.52 ± 0.478) at a p value of 0.064 (though not significant). The TAS level (1.21 ± 0.422 mmol Trolox Equiv./L vs. 1.00 ± 0.338, p = 0.022) and plasma ChE activity (1.18 ± 0.50 ¨ pH/20 min vs. 0.83 ± 0.30, p = 0.001) were significantly higher in IMIDs patients compared to controls. Conclusions The data suggest that oxidative stress and changes in plasma ChE activity might be a part of the pathophysiological alterations among IMIDs patients. Therapeutic drug monitoring and its clinical outcome as well as response of IMIDs patients to anti-ChE agents are worth of further in depth exploration and pursuing. They are essential for better diagnosis, treatment, and management of IMIDs.

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Adherence to Biologic Drugs Among Patients With Immune Mediated Inflammatory Diseases in Duhok Governorate

Cited by 3 publications

References 11 publications

Plasma Cholinesterase Activity in Patients With Rheumatoid Arthritis and Toxoplasmosis

Plasma Cholinesterase Activity in Patients With Rheumatoid Arthritis and Toxoplasmosis

Detection of Anti-Infliximab Antibodies and Identifying Factors affecting their Occurrence Using Elisa Method among Patients with Immune-Mediated Inflammatory Diseases

Immunological Profiles, Oxidative Stress Biomarkers and Plasma Cholinesterase Activities in Patients with Immune-Mediated Inflammatory Diseases Treated in a Clinic in Duhok, Iraq

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