1887
Volume 2009, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: The currently available TNF blocking agents include ifliximab, etanercept and adalimumab. They are approved for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis in the United States and Europe. Also TNF blockers are used currently in other rheumatic and non-rheumatic disease.

Objective: Primary objective: To evaluate our practice of using TNF blockers in the outpatient rheumatology clinics at Hamad Medical Corporation in Qatar, to evaluate the response rate to TNF blockers, and the rate of switching from one TNF blockers to another.

Secondary objective: to assess rate of serious infection and TB.

Methods: The study involved a retrospective chart review of 82 patients in rheumatology outpatient clinic since the introduction of TNF-Blockers at Hamad Medical Corporation in 2002 till December of2005.

Results: Twenty two patients out of 82 received Infliximab (26.8%), 51 patients received etanercept (62.1%) and 22 patients received adalimumab (26.8%) including switchers and non switchers. Response rate was 82% to initial TNF blocker in RA, and almost 100% in Psoriatic arthritis and ankylosing spondylitis. Reason of switching was either due to no response or side effects. No significant serious adverse events in our cohort and no TB reactivation.

Conclusion: Our data are comparable with the international guidelines; regarding the use of TNF blockers in rheumatic disease.also they reflect the daily practice in the rheumatology outpatient clinic in Qatar.

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2009-05-01
2024-11-09
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References

  1. Grom AA, Murry KJ, Luyrink L, Emery M, Passo MH, Glass DN, et al., Ptterns of expression of turner necrosis alpha, turner necrosis beta,and their receptors in synovial of patients with juvenile rheumatoid arthritis and juvenile spondyloarthropthy. Arhtitis and Rheum. 1996; 39::17031710.
    [Google Scholar]
  2. Braun A, Takemura S, Vallejio AN, Goronzy JJ, Weyend CM. Lymphotoxin B-mediated stimulation of synoviocytes in rheumatoid arthritis. Arhtritis and Rheum. 2004; 50::21402150.
    [Google Scholar]
  3. Scallon B, Cai A, Solowski N, Rosenberg A, Song XY, Shealy D, et al., Binding and functional comparison of tow types of tumor necrosis factor antagonist. J Pharmacol Exp Ther. 2002; 301::418426.
    [Google Scholar]
  4. Catrina Aljrollmo C, AF Klint E, Engsrtrom M, Lampa J, Hermansson Y, et al., Evidence that anti-tumor necrosis factor therapy with both etanercept and Infliximab induces apoptosis in macrophages,but not lymphocytes,in rheumatoid arthritis joints;etended report. Arhtritis and Rheum. 2005; 52::6172.
    [Google Scholar]
  5. Van den Brande JM, Bratt H, van den Brink GR, Versteege HH, Bauer CA, Hoedemaeker I, et al., Infliximab but not etanercept induces apoptosis in lamina propriaT-lymphocytes from patients with chrons disease. Gastroentrology. 2003; 124::17741784.
    [Google Scholar]
  6. Nestorov I. Clinical pharmacokinetics of tumor necrosis factor antagonists. J Rheumatol Suppl. 2005; 74::1318.
    [Google Scholar]
  7. Anderson PJ. Tumor necrosis factor inhibitors;clinical implication of their different immunogenicity profiles. Semin arthritis Rheum. 2005; 34:5 suppl 1:1922.
    [Google Scholar]
  8. Maini RN, Breedveld FC, Kalden JR, Smolen JS, Davis D, Macfarlene JD, et al., Theraputic efficacy of multiple intravenous infusion of anti-tumor necrosis factor alpha monoclonal antibody combined with low dose methotrexate in rheumatoid arthritis. Arthritis and Rheum. 1998; 41::15521563.
    [Google Scholar]
  9. Miani R, St.Clair EW, Breedveld F, Furst D, Kalden J, weisman M, for the ATTRACT study group , et al., Infliximab (Chimeric anti-tumor necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patient reciving concomitant methotrexate:arandomised phase 111 trial. Lancet. 1999; 354::19321939.
    [Google Scholar]
  10. Klareskog L, van der heijde D, de Jager JP, Gough A, Kalden J, Malaise M, et al., Theraputic effect of the combination etanercept and methotrexate compared with each treatment alone in patient with rheumatoid arthritis; double-blind randomized controlled trial. Lancet. 2004; 363::675681.
    [Google Scholar]
  11. Moreland LW, Schiff MH, Baumgartner SW, Jindall EA, Fleischmann RM, Bulpit KJ, et al., Atrial of etanercept therapy in rheumatoid arthritis; arandomised controlled trial. Ann Internal Medicine. 1999; 130:478486.
    [Google Scholar]
  12. Weinblatt ME, Kremer JM, Bankhurst AD, Bulpitt KJ, Fleschmann RM, Fox RI, et al., A trial of etanercept,a recombinant tumor necrosis factor receptor Fc fusion protein,in patients with rheumatoid arthritis reciving methotrexate. N Engl J Med. 1999; 340::253259.
    [Google Scholar]
  13. Wienblatt ME, Key stone EC, Furst DE, Moreland LW, Weismann MH, Birbara CA, et al., Adalimumab,afully human anti-tumor necrosis factor alpha monoclonal antibody for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate,the ARAMADA trial. Arthrits and rheumatism. 2003; 48::3545.
    [Google Scholar]
  14. Van den Bosch F, Kruithof E, Baeten D, et al., Randomised double-blinded comparison of chimereric monoclonal antibody to tumor necrosis alpha (Infliximab) versus placebo in active spondyloarthropathy. Arthritis Rheum. 2002; 46::755765.
    [Google Scholar]
  15. Gorman JD, Sack KE, Davis JC. Treatment of ankyolsing apondylitis by inhibition of tumor necrosis alpha. N Engl J Med. 2002; 346::13491356.
    [Google Scholar]
  16. Leonardi CL, Powers JL, Matheson RT, et al., (Etanercept Psoriasis Study Group). Etanercept as monotherapy in patient with psoriasis. N Engl J Med. 2003;:3492014-22.
    [Google Scholar]
  17. Mease P. Tumour necrosis factor(TNF) in psoriatic arthritis;pathoophysiology and treatment with TNF inhibitors. Ann Rheum Dis. 2002; 61::298308.
    [Google Scholar]
  18. Braun J, Siper J. Biological therapies in the spondyloarthritides-the current state,review. Rheumatology. 2004; 43::10721084.
    [Google Scholar]
  19. Broeq O, Plubel Y, Breuil V, Grisot C, Flory P, Mousnier A, et al., Etanercept -infliximab swiched in rheumatoid arthritis 14 out of 131 pateints treated with anti-TNF alpha. Press Med. 2002; 31::18361839, In French.
    [Google Scholar]
  20. Gomez-Puerta JA, Sanma RTI, Rodriquez-Cross JR, Canete JD. Etanercept is effective in patients with rheumatoid arthritis with no response to Infliximab therapy. Ann Rheum Dis. 2004; 63::896.
    [Google Scholar]
  21. Van vollenhoven R, Harju A, Brannrmark S, Klareskog L. Treatment with Infliximab when etanercept has failed or vice versa: data from STURE registry showing that swiching tumor necrosis factor alpha blockers can make a sense. Ann Rheum Dis. 2003; 62::11951198.
    [Google Scholar]
  22. Yazici Y, Erkan D. Do etanercept -naive patient with rheumatoid arhtrits respond better to Infliximab than patients for whom etanercept has failed? Ann Rheum Dis. 2004; 63::607608.
    [Google Scholar]
  23. Nikas SN, Voulgari AN, Almanos Y, Papadopoulos CG, Venetsanopoulou A, Georgidis AN, et al., Efficacy of swiching from Infliximab to adalimumab: a comparative controlled study. Ann Rheum Dis. 2006; 65::257260.
    [Google Scholar]
  24. Haraoui B, Keyston EC, Thorn JC, Pope JE, Chen I, Asare CG, et al., clinical outcome of patients with rheumatoid arthritis after swiching from Infliximab to etanercept. J Rheum. 2004; 31::23562359.
    [Google Scholar]
  25. Hansen KE, Hildebrand JP, Genovese MC, Cush JJ, Ptel S, Cooly DA, et al., The efficacy of swiching from etanercept to Infliximab in patients with rheumatoid arthritis. J Rheum. 2004; 31::10981102.
    [Google Scholar]
  26. Wick MC, Ernestam S, Lindblad S, Bratt J, Klareskog L, van Vollenhoven RF. Adalimumab (Humira) restore clinical response in patients with secondary loss of efficacy from Infliximab (ramicade) or etanercept (Enbrel): results from STURE registry at Karolinska University Hospital. Scan J Rheum. 2005; 34::353358.
    [Google Scholar]
  27. Favalli EG, Arreghini M, Arnoldi C, Panni B, Marchesoni A, Tosi S, et al., Anti-tuomr necrosis factor alpha swiching in rheumatoid arthritis and juvenile chronic arthritis. Arthritis and Rheum. 2004; 51:30.
    [Google Scholar]
  28. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al., Tuberculosis associated with Infliximab, a tumor necrosis factor alpha -nutralizing agent. N Engl J Med. 2001; 345::10981104.
    [Google Scholar]
  29. Mohan AK, Cote TR, Block JA, Manadan AM, Siegel JN, Braun MM. Tuberculosis following the use of Etanercept, a tumor necrosis factor inhibitor. Clin Infect Dis. 2004; 39::295299.
    [Google Scholar]
  30. Garadam MA, Kyeston EC, Menzies R, Manners S, Skamene E, Long R, et al., Anti-tumor necrosis factor agents and tuberculosis risk: mechanism of action and clinical management. Lancet Infect Dis. 2003; 3::148155.
    [Google Scholar]
  31. Furst DE, Cush J, Kaufmann S, Sigel J, Kurth R. Preliminary guidelines for diagnosing and treating tuberculosis in patients with rheumatoid arthritis in immunosuppressive trials or being treated with biological agents. Ann Rheum Dis. 2002; 61::6263.
    [Google Scholar]
  32. Munoz-Fernandez S, Hidalgo V, Frenandez-Melon J, Schlincker A, Martina-Mola E. Effect ofinflximab on threatening panuveitis in Behcets disease. Lancet. 2001; 358::1644.
    [Google Scholar]
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