المؤلفون: Bekele, Delamo I.¹ (AUTHOR) bekele.delamo@mayo.edu, Cheng, Elizabeth² (AUTHOR), Reimold, Andreas³ (AUTHOR), Geier, Christian⁴ (AUTHOR), Ganuthula, Kavya² (AUTHOR), Walsh, Jessica A.⁵ (AUTHOR), Clegg, Daniel O.⁵ (AUTHOR), Dubreuil, Maureen⁶ (AUTHOR), Kaushik, Prashant⁷ (AUTHOR), Ng, Bernard⁸ (AUTHOR), Chang, Elizabeth⁹ (AUTHOR), Duong, Ryan² (AUTHOR), Park, Jina¹⁰ (AUTHOR), Kerr, Gail S.¹¹ (AUTHOR) Gail.Kerr@va.gov

المصدر: Rheumatology International. Nov2022, Vol. 42 Issue 11, p1925-1937. 13p.

مصطلحات موضوعية: *TUMOR necrosis factors, *SPONDYLOARTHROPATHIES, *INFLAMMATORY bowel diseases, *PERIPHERAL vascular diseases, *DISEASE remission

مستخلص: Although tumor necrosis factor inhibitors (TNFi) have favorably altered the treatment landscape for patients with axial spondyloarthritis (axSpA), there is limited data regarding TNFi persistence and reasons for discontinuation. This is an observational time-to-event study utilizing data collected for a prospective multiple-disease registry of US Veterans with axSpA treated with TNFi therapies and recruited over a 10 year period. Clinical, serological, and comorbid parameters were collected. Corporate Data Warehouse Pharmacy files provided courses of the 5 TNFi agents, and response to treatment was documented. Individual TNFi persistence was established utilizing univariate and multivariate Cox proportional models, and reasons for discontinuation were obtained by physician chart review. Two-hundred and fifty-five axSpA patients received 731 TNFi courses. A majority of patients (84.3%) had TNFi persistence at 12 months; 63.5% and 47.1% at 24 and 36 months, respectively. Compared to adalimumab, infliximab demonstrated greater persistence, certolizumab the least. Age, smoking status, BMI, comorbidity burden, inflammatory markers and HLA-B27 did not predict TNFi persistence or discontinuation. Stroke and peripheral arterial disease increased the probability of TNFi discontinuation. Secondary non-response (SNR) was the most common reason for discontinuation (46% of all courses); non-adherence (6%) and clinical remission (2%) were uncommon. Pain score at enrollment, myocardial infarction, African American race and inflammatory bowel disease (IBD) predicted TNFi response. While initial persistence of TNFi treatment was high, a large proportion of the patients discontinued initial TNFi therapy by 3 years, primarily due to loss of efficacy. While further research identifying potential predictors of TNFi discontinuation in axSpA is warranted, access to alternate disease-modifying therapies is needed. [ABSTRACT FROM AUTHOR]

المؤلفون: Bekele, Delamo I.¹ (AUTHOR) Bekele.delamo@mayo.edu, Warrington, Kenneth J.¹ (AUTHOR), Koster, Matthew J.¹ (AUTHOR)

المصدر: Rheumatology International. 2021, Vol. 41 Issue 2, p487-492. 6p.

مصطلحات موضوعية: *INFLAMMATORY bowel diseases, *GIANT cell arteritis, *CROHN'S disease, *DISEASE relapse, *ULCERATIVE colitis

مستخلص: To describe the clinical characteristics, management, and outcome of a series of patients with giant cell arteritis (GCA) and inflammatory bowel disease (IBD). Patients with both GCA and IBD evaluated between 1/1/1996 and 12/30/2018 were retrospectively identified. Clinical characteristics, laboratory parameters, radiologic features, histopathology, management and outcomes were abstracted. A systematic literature review identifying patients with IBD and GCA was performed via a Medline and EMBASE search from inception through December 31 2019. Six patients were identified with GCA and IBD (66% male). Five (83%) had ulcerative colitis (UC) and one had Crohn's disease (CD). Diagnosis of IBD preceded GCA in four patients with an average interval of 30 years (range 14–42). Average time to IBD diagnosis in those with prior GCA diagnosis was 1.5 years. During mean follow-up of 4.3 years, GCA relapse was infrequent with only one patient with relapse observed. Systematic literature review identified six additional patients with confirmed coexistence of GCA and IBD. Similar to the current series, male sex was more common and ulcerative colitis was the predominant IBD phenotype. The current study reports findings from the largest single-institution case-series of co-existent GCA and IBD. In contrast to Takayasu arteritis with co-existent IBD, which displays a predilection for female sex and Crohn's disease phenotype, both the current study and review of literature demonstrate a stronger association of GCA with male sex and ulcerative colitis. Further studies addressing a potential pathophysiologic connection between GCA and IBD are suggested. [ABSTRACT FROM AUTHOR]