Whitney Palmer

Healthcare. Politics. Family.

TNFis Pose No Cancer Risk for Spondyloarthritis Patients

Published on the May 19, 2016, Rheumatology Network website

By Whitney L.J. Howell

Patients with spondyloarthritis can confidently undergo treatment with tumor necrosis factor ⍺ inhibitors (TNFi) without fear of increasing their overall risk of cancer, a new study finds. Existing safety data is scarce, and cancer risks aren’t clearly understood.

According to a May 4 Annals of the Rheumatic Diseases  (ARD)  study from the Karolinska Institute in Sweden, patients who use TNFi to treat spondyloarthritis (SpA) have an equivalent overall cancer risk as those who have never received TNFi. There is also no increased risk for six site-specific cancers: prostate, lung, colorectal, breast, malignant lymphoma and melanoma.

Traditionally, TNFi is a standard part of treatment for chronic inflammatory disease, including rheumatological arthritis, SpA , ankylosing spondylitis (AS). psoriatic arthritis (PsA) and undifferentiatied spondyloarthritis (SpA UNS). The study aimed to evaluate the role TNFi plays in increasing cancer risk and how it could vary across inflammatory diseases by age, sex, lifestyle and previous treatments.

“Apart from the immediate clinical importance considering the increasing use of TNFi in SpA, the study of cancer risk in these patients may provide new insights different from RA cohorts,” researchers wrote. “Patients with SpA are younger, often male, have different lifestyles, frequently use biological DMARDs as monotherapy and have no intrinsic associations with, for example, malignant lymphoma.”

Researchers gathered data from the Swedish Anti-Rheumatic Therapy in Sweden (ARTIS) and Danish Biologic (DANBIO) registers. They included information on 8,703 SpA patients (ARTIS=5,448; DANBIO=3,255) who used TNFi treatments for the first time between 2001 and 2011. They also gathered data on 28,164 SpA patients who never used TNFi for the Swedish National Patient and Population Registers. In addition, 131,687 patients from the general population were included for comparison.

Based on their results, out of 1, 188 cancers among those SpA patients never used TNFi, the relative risk (RR) of cancer overall was 1.1 (95% CI 1.0 to 1.2). The 147 cancers among SpA TNFi users showed an RR of 0.8 versus TNFi-naïve patients (95% CI 0.7 to 1.0). The results were similar to AS and PsA when analyzed separately. Site-specific RRS were: prostate, 0.5 (95% CI 0.3 to 0.8), lung, 0.6 (95% CI 0.3 to 1.3), colorectal, 1.0 (95% CI 0.5 to 2.0), breast, 1.3 (95% CI 0.9 to 2.0), lymphoma, 0.8 (95% CI 0.4 to 1.8), and melanoma, 1.4 (95% CI 0.7 to 2.6).

Although the study represents the largest assessment of cancer risk after TNFi therapy in patients with SpA to date, there were some limitations to the study, such as the time span which may not have been long enough to detect effects of TNFi therapy that may occur years after exposure.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/tnfis-pose-no-cancer-risk-spondyloarthritis-patients

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May 19, 2016 Posted by | Healthcare | , , , | Leave a comment

Early Treatment for Early RA Leads to Better Outcomes

Published on the May 16, 2016, Rheumatology Network website

By Whitney L.J. Howell

Patients with early-active rheumatoid arthritis who receive initial or temporary combination therapies can experience faster clinical improvements than those who don’t, a new study found. These targeted treatments also determine long-term outcomes.

Existing research shows treat-to-target therapy works for rheumatoid arthritis patients, but little evidence exists that highlights the long-term impact of continued targeted treatment. The new study evaluated the long-term outcomes in early-active rheumatoid arthritis patients after 10 years of targeted treatments using four different strategies.

The April 2016 Annals of Internal Medicine study found drug-free remissions — with prevention of functional deterioration and clinically-relevant radiographic damage — and normalized survival are realistic outcomes for rheumatoid arthritis patients.

In the randomized-trial, 508 early-active rheumatoid arthritis patients received a combination of four different strategies: (1) sequential monotherapy, (2) step-up combination therapy, (3) initial combination therapy with prednisone, or (4) infliximab. All strategies were followed by targeted treatments that aimed at low disease activity.

The endpoints were functional ability (measured by the Health Assessment Questionnaire (HAQ) score) and radiographic progression (Sharp-Van Heijde score). Survival in the study was compared with the general population using the standardized mortality ratio.

According to study results, 195 patients – 38 percent of the participating population – dropped out of the study. Twenty-eight percent were from strategy 4 compared to 40 percent to 45 percent in strategies 1 and 3, respectively.

At year 10, 53 percent and 14 percent were in remission and drug-free remission, respectively, without experiencing any differences among strategies. During the same time, mean HAQ scores were 0.69, 0.72, 0.64, and 0.58 in strategies 1 through 4, respectively.

Sharp van-der Heijde estimates during follow-up were 11, 8, 8, and 6 for strategies 1 through 4, respectively. Standardized morality ratio was 1.16 (95% CI, 0.92 to 1.46) based on 72 observed and 62 expected deaths. There were similar survival rates among all four strategies (P=0.81).

To see the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/early-treatment-early-ra-leads-better-outcomes

 

May 19, 2016 Posted by | Healthcare | , , , | Leave a comment

Arhalofenate an “Ideal Candidate for Gout”

Published on the May 16, 2016, Rheumatology Network website

By Whitney L.J. Howell

For patients with gout, new evidence suggests arhalofenate can be used to safely prevent flare-ups, as well as reduce serum levels.

A Phase IIb study published in the April 7 issue of Nature Reviews Rheumatology demonstrated the dual mode of action of arhalofenate has a significant advantage over other urate-lowering therapies that can prompt an initial increase in flare-up risk. That spike occurs due to mobilization of stored urate and shrinkage of intra-articular urate crystals, causing phagocytosis and an inflammatory response.

Overall, researchers said, gout is an overlooked and poorly-managed disease, and these new findings could alter treatment.

In a 12-week, double-blind study, 239 participants were randomly assigned to four different treatment protocols: once-daily arhalofenate 600 mg or 800 mg, allopurinol 300 mg, allopurinol 600 mg plus colchicine 0.6 mg, or a placebo. Participants must have experienced more than three gout flare-ups during the previous year, could not have taken colchicine or urate-lowering therapy, and had baseline serum uric acid levels between 7.5 mg/dl and 12.0 mg/dl.

“All of a sudden, we were killing two birds with one stone,” said corresponding study author Pol Boudes, M.D. “IL-1ß is the cytokine that is key to triggering gout flare. The demonstration (in mice) that arholafenate was acting as a brake on local release of IL-1ß following an inflammatory challenge with urate crystals was very relevant to making this drug an ideal candidate for gout.”

According to study results, flare incidence was significantly lower in the high-dose arhalofenate group (0.66) than in the allopurinol-only group (1.24, P=0.0056) or the placebo group (1.13, P=0.0049). It was similar to the allopurinol plus colchicine group (0.40, P=0.091). The arhalofenate 600 mg group experienced a non-significant 16 percent reduction in flare incidence versus allopurinol.

The next step, researchers said, is a Phase III study to determine if the combination treatment could significantly improvement gout management.

To read the article at its original location: http://www.rheumatologynetwork.com/gout/arhalofenate-%E2%80%9Cideal-candidate-gout%E2%80%9D

May 19, 2016 Posted by | Healthcare | , , , | Leave a comment

   

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