Effectiveness and drug survival of TNF-inhibitors in the treatment of psoriatic arthritis : A prospective cohort study

Background and objectives: Tumor necrosis factor (TNF)-inhibitors are used to treat psoriatic arthritis (PsA), but only a limited number of observational studies on this subject have been published thus far. The aim of this research was to analyze the effectiveness and drug survival of TNF-inhibitors in the treatment of PsA. Methods: PsA patients identified from the National Register for Biologic Treatment in Finland (ROB-FIN) starting their first, second, or third TNF-inhibitor treatment between 2004 and 2014 were included. Effectiveness was measured using ACR and EULAR response criteria and modeled using ordinal logistic regression. Treatment persistence was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards model. Results: The study comprised 765 patients and 990 TNF-inhibitor treatment courses. EULAR moderate treatment responses at 6 months were achieved by 68% and 37% of the users of the first and the second or the third biologic, respectively. The probabilities of discontinuing the treatment within 12 and 24 months were 20% and 28%, respectively. Adjusted treatment responses to all TNF-inhibitors were similar; however, co-therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) was not associated with better effectiveness. Adalimumab [hazard ratio (HR) = 0.62; 95% confidence interval (CD: 0.44-0.88] was superior to infliximab in drug survival while etanercept (HR = 0.77, 95% CI: 0.55-1.1) and golimumab (HR = 0.75, 95% CI: 0.46-1.2) did not differ from it. Co-medication with csDMARDs did not statistically improve drug survival. Conclusion: All available TNF-inhibitors showed similar treatment responses with or without csDMARDs. Adalimumab was associated with better drug survival when compared to infliximab. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

Generation of self-reactive, shared T-cell receptor ? chains in the human thymus

The T-cell receptor (TCR) repertoire is generated in a semistochastic process of gene recombination and pairing of TCR? to TCR? chains with the estimated total TCR diversity of >108. Despite this high diversity, similar or identical TCR chains are found to recur in immune responses. Here, we analyzed the thymic generation of TCR sequences previously associated with recognition of self- and nonself-antigens, represented by sequences associated with autoimmune diabetes and HIV, respectively. Unexpectedly, in the CD4+ compartment TCR? chains associated with the recognition of self-antigens were generated in significantly higher numbers than TCR? chains associated with the recognition of nonself-antigens. The analysis of the circulating repertoire further showed that these chains are not lost in negative selection nor predominantly converted to the regulatory T-cell lineage. The high abundance of self-reactive TCR? chains in multiple individuals suggests that the human thymus has a predilection to generate self-reactive TCR? chains independently of the HLA-type and that the individual risk of autoimmunity may be modulated by the TCR? repertoire associated with these chains.Peer reviewe

Characterization and Electrochemical Properties of Oxygenated Amorphous Carbon (a-C) Films

Amorphous carbon (a-C) films with varying oxygen content were deposited by closed-field unbalanced magnetron sputtering with the aim to understand the effect of oxygen on the structural and physical properties of the films and subsequently correlate these changes with electrochemical properties. The a-C films were characterized by transmission electron microscopy, helium-ion microscopy, atomic force microscopy, Raman spectroscopy, X-ray photoelectron spectroscopy and time-of-flight elastic recoil detection analysis. The electrochemical properties were studied by electrochemical impedance spectroscopy and cyclic voltammetry with several redox systems (Ru(NH3)62+/3+, Fe(CN)64−/3−, dopamine and ascorbic acid). The results indicated that the carbon films are amorphous with an ID/IG ratio near 2.6. The oxygen content of the films seemed to saturate at around 11 at. %, whereas the amount of surface oxygen functional groups increased steadily with increasing oxygen inflow during deposition. O/C ratio increased from 0.09 to 0.19. A significant increase in film resistivity was observed with increasing oxygen content. Lightly oxygenated a-C films showed a low charge transfer resistance (Rct) and reversible electron transfer for Ru(NH3)62+/3+ whereas both Rct and ΔEp increased considerably for heavily oxygenated films. The inner sphere redox systems were significantly affected by the surface oxygen functional groups with dopamine and ascorbic acid showing a linear increase in ΔEp and Epa, respectively, with increasing oxygen content. Fe(CN)64−/3− did not show a clear trend but was still clearly affected by the increase in oxygen content. The double layer capacitance was about 1 μF/cm2 for all the oxygenated a-C films.peerReviewe

Association of rheumatoid arthritis disease activity and antibodies to periodontal bacteria with serum lipoprotein profile in drug naive patients

Abstract Objective: We investigated lipid concentrations, particle sizes and antibodies binding to periodontal bacteria Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis and to malondialdehyde-acetaldehyde (MAA) modified low-density lipoprotein in immunoglobulin (Ig) class A, G and M among patients with newly diagnosed rheumatoid arthritis (RA) in a population-based cohort. Methods: Concentrations and sizes of lipoprotein particles analysed by proton nuclear magnetic resonance spectroscopy and antibody levels to MAA modified low-density lipoprotein were studied at baseline and after one-year of follow-up. Serum Ig A and G class antibodies to periodontal bacteria were determined at baseline. Results: Sixty-three patients were divided into tertiles according to disease activity by disease activity score with 28 joint count and erythrocyte sedimentation rate (ESR) (<3.9, 3.9–4.7, >4.7). Small low-density lipoprotein concentration was lowest in the tertile with the highest disease activity. In high-density lipoprotein, the concentrations of total, medium and small particles decreased with disease activity. The particle size in low-density lipoprotein associated with disease activity and the presence of antibodies to P. gingivalis. Ig G and M antibodies to MAA modified low-density lipoprotein correlated with disease activity. Inflammation associated changes faded by one year. Conclusions: Drug naive RA patients had proatherogenic changes in lipid profiles, but they were reversible, when inflammation diminished

Immunological effects of low-dose cyclophosphamide in cancer patients treated with oncolytic adenovirus

Patients with advanced solid tumors refractory to and progressing after conventional therapies were treated with three different regimens of low-dose cyclophosphamide (CP) in combination with oncolytic adenovirus. CP was given with oral metronomic dosing (50 mg/day, N = 21), intravenously (single 1,000 mg dose, N = 7) or both (N = 7). Virus was injected intratumorally. Controls (N = 8) received virus without CP. Treatments were well tolerated and safe regardless of schedule. Antibody formation and virus replication were not affected by CP. Metronomic CP (oral and oral + intravenous schedules) decreased regulatory T cells (T(regs)) without compromising induction of antitumor or antiviral T-cell responses. Oncolytic adenovirus given together with metronomic CP increased cytotoxic T cells and induced Th1 type immunity on a systemic level in most patients. All CP regimens resulted in higher rates of disease control than virus only (all P < 0.0001) and the best progression-free (PFS) and overall survival (OS) was seen in the oral + intravenous group. One year PFS and OS were 53 and 42% (P = 0.0016 and P < 0.02 versus virus only), respectively, both which are unusually high for chemotherapy refractory patients. We conclude that low-dose CP results in immunological effects appealing for oncolytic virotherapy. While these first-in-human data suggest good safety, intriguing efficacy and extended survival, the results should be confirmed in a randomized trial