Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies

Thomas, Konstantinos; Vassilopoulos, Dimitrios

doi:10.31138/mjr.31.1.129

Cited by 23 publications

(22 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Rheumatoid arthritis (RA) is the most common inflammatory arthritis [ 1 ] that can cause damage to the joints. It can also present with extra-articular manifestations, affecting other major organs [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

et al. 2020

View full text Add to dashboard Cite

During the coronavirus disease-2019 (COVID-19) pandemic there were several barriers to treatment access and medication adherence in rheumatoid arthritis (RA) patients. There is no information regarding the RA patient health status in Egypt during the COVID-19. Thus,the aim of this work was to study the impact of the pandemic on RA patients through a patient-reported questionnaire and to determine the influence of gender, geographic regions. This multi-centre study initiated by the Egyptian College of Rheumatology (ECR) was conducted on 1037 RA patients attending rheumatology clinics from 10 governorates. The questionnaire provided covered socio-demographic data, health/disease status, information/knowledge about COVID-19 and medical/family history of the infection. Patients mean age was 44.2 ± 12.3 years;855 females and 182 males; 539(52%) from rural and 497(48%) from urban areas. 41.8% reported a striking difficulty to obtain hydroxychloroquine during the pandemic. The majority (70%) considered maintaining a regular visit to the rheumatologist in addition to remote contact mainly by phone (44.4%) or via WhatsApp (33.1%), in particular among male and urban patients. Urban patients were more likely to be infected by COVID-19 (12.9% vs 6.2%; p < 0.0001) than rural. Northern cities had more patients with suspected COVID-19 (13.9% vs 6.1%; p < 0.0001); was significantly associated with more disease flares (30.8% vs 5.8%) with subsequent change in the RA treatment (20.9% vs 6.4%; p < 0.0001). Patients with RA faced remarkable difficulty to obtain their medications with subsequent change in their disease status. The challenges of the pandemic have hastened changes in the way we deliver health care. Electronic supplementary material The online version of this article (10.1007/s00296-020-04736-9) contains supplementary material, which is available to authorized users.

show abstract

Section: Introductionmentioning

confidence: 99%

“…It can also present with extra-articular manifestations, affecting other major organs [ 2 ]. Infections are the most important comorbidities associated with increased morbidity and mortality [ 1 ]. Despite the tremendous improvement that brought to its management, RA patients still confronting many challenges.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A significant body of evidence has been mounted over the years regarding the safety of chronic JAKi therapy in patients with rheumatic diseases. Janus kinase inhibitors seem to have similar risk with tumor necrosis factor-α inhibitors for serious infections, with the exception of higher risk for herpes zoster [ 22 ] and with a safety signal of higher risk for VTE with tofacitinib after weeks to months of exposure and in the presence of additional risk factors [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Effectiveness and Safety of Baricitinib as Adjunctive to Standard-of-Care Treatment in Hospitalized Patients With Severe Coronavirus Disease 2019

Tziolos

Karofylakis

Grigoropoulos

et al. 2021

Open Forum Infectious Diseases

Self Cite

View full text Add to dashboard Cite

Background Therapeutic options for hospitalized patients with severe coronavirus disease 2019 (sCOVID-19) are limited. Preliminary data have shown promising results with baricitinib, but real-life experience is lacking. We assessed the safety and effectiveness of add-on baricitinib to standard-of-care (SOC) including dexamethasone in hospitalized patients with sCOVID-19. Methods This study is a 2-center, observational, retrospective cohort study of patients with sCOVID-19, comparing outcomes and serious events between patients treated with SOC versus those treated with SOC and baricitinib combination. Results We included 369 patients with sCOVID-19 (males 66.1%; mean age 65.2 years; median symptom duration 6 days). The SOC was administered in 47.7% and combination in 52.3%. Patients treated with the combination reached the composite outcome (intensive care unit [ICU] admission or death) less frequently compared with SOC (22.3% vs 36.9%, P = .002). Mortality rate was lower with the combination in the total cohort (14.7% vs 26.6%, P = .005), and ICU admission was lower in patients with severe acute respiratory distress syndrome (29.7% vs 44.8%, P = .03). By multivariable analysis, age (odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.36–2.44, per 10-year increase), partial pressure of oxygen/fraction of inspired oxygen ratio (OR = 0.60, 95% CI = .52–0.68, per 10 units increase), and use of high-flow nasal cannula (OR = 0.34; 95% CI, .16–0.74) were associated with the composite outcome, whereas baricitinib use was marginally not associated with the composite outcome (OR = 0.52; 95% CI, .26–1.03). However, baricitinib use was found to be significant after inverse-probability weighted regression (OR = 0.93; 95% CI, .87–0.99). No difference in serious events was noted between treatment groups. Conclusions In real-life settings, addition of baricitinib to SOC in patients hospitalized with sCOVID-19 is associated with decreased mortality without concerning safety signals.

show abstract

“…Tofacitinib has the largest safety database of the JAKi, since it was the first medication in the class to be licensed [ 24 ]. Findings from a US registry of RA patients (n = 21,832) reported higher rates of serious infection in patients prescribed tofacitinib combination therapy with disease-modifying antirheumatic drugs (DMARDs) 3.67(95%CI: 2.21–5.75) versus 2.01 events per 100PY (95% CI: 1.65–2.42) for DMARD therapy alone.…”

Section: Serious Infection Riskmentioning

confidence: 99%

The infection risks of JAK inhibition

Adas

Alveyn

Cook

et al. 2021

Expert Review of Clinical Immunology

View full text Add to dashboard Cite

Introduction Janus Kinase inhibitors (JAKi) have shown to be highly effective in the treatment of immune-mediated inflammatory diseases. As with all immunomodulatory therapies, careful assessment of any treatment-associated infection risk is essential to inform clinical decision-making. Areas covered We summarize current literature on infection rates among the licensed JAKi using published phase II/III trial results, post-licensing and registry data. Expert opinion licensed JAKi show increased risk of infection across the class compared to placebo, most commonly affecting respiratory and urinary tracts, nasopharynx and skin. This risk is dose-dependent. Risks are similar at licensed JAKi doses to that seen with biologic therapies. The risk is compounded by other risk factors for infection, such as age and steroid co-prescription. Herpes zoster reactivation is more common with JAKi compared to other targeted immune modulation, making screening for varicella exposure and vaccination in appropriate cohorts an advisable strategy. Crucially, these small risk increases must be balanced against the known harms (including infection) of uncontrolled autoimmune disease. JAKi are a safe and potentially transformative treatment when used for appropriately selected patients.

show abstract

Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies

Cited by 23 publications

References 74 publications

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

Real-Life Effectiveness and Safety of Baricitinib as Adjunctive to Standard-of-Care Treatment in Hospitalized Patients With Severe Coronavirus Disease 2019

The infection risks of JAK inhibition

Contact Info

Product

Resources

About