Antibodies toward infliximab are associated with low infliximab concentration at treatment initiation and poor infliximab maintenance in rheumatic diseases

International audienceINTRODUCTION: A proportion of patients receiving infliximab have antibodies toward infliximab (ATI), which are associated with increased risk of infusion reaction and reduced response to treatment. We studied the association of infliximab concentration at treatment initiation and development of ATI as well as the association of the presence of ATI and maintenance of infliximab. METHODS: All patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) receiving infliximab beginning in December 2005 were retrospectively followed until January 2009 or until infliximab discontinuation. Trough serum infliximab and ATI concentrations were measured at each visit. The patients were separated into two groups: ATI(pos) if ATI were detected at least once during the follow-up period and ATI(neg) otherwise. Repeated measures analysis of variance was used to study the association of infliximab concentration at treatment initiation and the development of ATI. Maintenance of infliximab in the two groups was studied by using Kaplan-Meier curves. RESULTS: We included 108 patients: 17 with RA and 91 with SpA. ATI were detected in 21 patients (19%). The median time to ATI detection after initiation of infliximab was 3.7 months (1.7 to 26.0 months). For both RA and SpA patients, trough infliximab concentration during the initiation period was significantly lower for ATI(pos) than ATI(neg) patients. RA patients showed maintenance of infliximab at a median of 19.5 months (5.0 to 31.0 months) and 12.0 months (2.0 to 24.0 months) for ATI(neg) and ATI(pos) groups, respectively (P = 0.08). SpA patients showed infliximab maintenance at a median of 16.0 months (3.0 to 34.0 months) and 9.5 months (3.0 to 39.0 months) for ATI(neg) and ATI(pos) groups, respectively (P = 0.20). Among SpA patients, those who were being treated concomitantly with methotrexate had a lower risk of developing ATI than patients not taking methotrexate (0 of 14 patients (0%) vs. 25 of 77 patients (32%); P = 0.03). CONCLUSIONS: High concentrations of infliximab during treatment initiation reduce the development of ATI, and the absence of ATI may be associated with prolonged maintenance of infliximab. Thus, trough serum infliximab concentration should be monitored early in patients with rheumatic diseases

Etude transversale de la relation concentration-effet de l'infliximab au cours des rhumatismes inflammatoires

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

L'Ostéoporose (prise en charge et rôle du pharmacien à l'officine)

L'ostéoporose est une maladie osseuse chronique. Elle est définie par l'Organisation Mondiale de la Santé comme une maladie du squelette, entraînant une diminution de la résistance osseuse et exposant à un risque accru de fracture. Environ une femme sur trois et un homme sur cinq, seront touchés par la maladie au cours de leur vie. Du fait de cette prévalence importante et des conséquences graves des fractures ostéoporotiques (morbidité, mortalité, diminution de la qualité de vie...), l'ostéoporose fait partie des grands problèmes de santé publique auxquels nous devons faire face. Elle a pourtant été longtemps négligée par le passé, puisqu'elle été considérée comme une conséquence inévitable du vieillissement. Nous savons maintenant qu'il n'en est rien ! Les dix dernières années ont été l'occasion de changements importants dans la prise en charge. Le diagnostic évolue maintenant vers une évaluation globale du risque fracturaire du patient, en tenant compte de ses facteurs de risque. De plus, nous avons pu assister à l'apparition d'un grand nombre de nouvelles solutions en matière de thérapeutique. Les biphosphonates à administration plus espacées sont en tête de liste, mais de nouvelles molécules intéressantes sont maintenant disponibles. Des traitements efficaces sont désormais disponibles. Désormais, il faudra améliorer la prise en charge qui est encore loin d'être idéale. Chaque professionnel de santé doit se mobiliser et parmi ceux-ci, le pharmacien d'officine a son rôle à jouer. De part sa proximité avec le patient et son expertise du médicament, il peut permettre d'améliorer la prise en charge, et doit maintenant s'impliquer d'avantage dans ce sens !TOURS-BU Sciences Pharmacie (372612104) / SudocSudocFranceF

Poor assessment of bone mineral density after a forearm fracture in women aged 50 years or older: Data from a French health insurance database

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Insuffisance de la mesure de densitométrie osseuse après fracture de l'avant-bras chez les femmes âgées de 50 ans ou plus : utilisation des bases de données de l'assurance maladie de la Région Centre Val de Loire

National audience[No abstract available

Trough infliximab concentration may predict long-term maintenance of infliximab in ankylosing spondylitis

International audienc

Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: a systematic review

Import JabRef | WosArea Orthopedics; RheumatologyInternational audienceAim: To perform a systematic review of the literature on the concurrent validity, predictive validity and responsiveness of radiographic metric measurement of femoro-acetabular joint space width (JSW) in hip osteoarthritis (OA). Methods: Eligibility criteria: studies reporting any data on (1) JSW on X-rays in hip OA patients and (2) concurrent validity (correlations with clinical symptoms), predictive validity (correlations with future symptomatic state, joint space loss or joint replacement), and/or responsiveness (JSW change over time evaluated using the standardized response mean (SRM)). Search strategy: Medline PUBMED and Embase databases. Statistical analysis: Random-effects models were constructed to obtain pooled SRMs. Results: Of 448 articles, 79 met the abstract inclusion criteria and were read for further screening. Of these, 15 reported measures of validity and 11 reported measures of responsiveness. Concurrent validity: Five studies suggested an association between JSW and symptoms in the general population. Two evaluated the correlations between JSW and symptoms in hip OA patients, with conflicting results. Five demonstrated that JSW is predictive of future hip joint replacement. Responsiveness was moderate (SRM = 0.66; 95% confidential interval (95%CI): 0.41, 0.91), but tended to be lower in randomized clinical trials than in cohort studies (0.35 vs 0.83), using an intention to treat rather than a completer analysis (0.30 vs 0.80), and using manual rather than computer-based measurement (0.47 vs 1.12). Conclusion: There is evidence of a weak association between JSW and symptoms, of predictive validity for subsequent joint replacement, and of moderate responsiveness of metric measurement of JSW. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved

Trough infliximab concentration may predict long-term maintenance of infliximab in ankylosing spondylitis

International audienc

Therapeutic Drug Monitoring of Infliximab in Spondyloarthritis: An Observational Open-Label Study

International audienceBackground: Infliximab is a chimeric monoclonal antibody that binds to human tumor necrosis factor alpha and which is approved for refractory spondyloarthritis (SpA). Individual adjustment of infliximab dosage may help to improve the therapeutic response in SpA. We investigated whether a knowledge of infliximab serum concentration modifies physician decision and improves the control of disease activity in SpA. Methods: Thirty-two patients routinely treated with infliximab were included in an observational open-label study. On visit 1 (V1), according to disease activity, a preliminary therapeutic decision was selected among 4 therapeutic options (ie, decrease, increase, maintain the dosage of infliximab, or switch over for another treatment), and a blood sample was collected to measure infliximab trough serum concentration. The final therapeutic decision, based on both disease activity and infliximab serum concentration assessed at V1, was applied at the following infusion (V2). Clinical and biological evaluations were performed at V3 and V4 and compared with those at V1. Results: The measurement of infliximab trough concentration modified the therapeutic decision for 10 patients (31%). For both patients with increased or decreased infliximab dosage at V2, median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was similar at V3 or V4 as compared with that at V1. However, a trend for an inverse relationship between infliximab serum concentrations and BASDAI was observed. Conclusions: Knowledge of infliximab trough concentration modified the therapeutic decision for SpA patients with predominantly axial symptoms but did not improve the control of disease activity as estimated by the BASDAI

Infliximab concentration is predictive of control of disease activity and maintenance of treatment in rheumatoid arthritis.

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