Drug retention of 7 biologics and tofacitinib in biologics-naïve and biologics-switched patients with rheumatoid arthritis: The ANSWER cohort study

Background: This multi-center, retrospective study aimed to clarify retention rates and reasons for discontinuation of 7 biological disease-modifying antirheumatic drugs (bDMARDs) and tofacitinib (TOF), one of the janus kinase inhibitors, in bDMARDs-naïve and bDMARDs-switched patients with rheumatoid arthritis (RA). Methods: This study assessed 3897 patients and 4415 treatment courses with bDMARDs and TOF from 2001 to 2019 (2737 bDMARDs-naïve courses and 1678 bDMARDs-switched courses [59.5% of switched courses were their second agent], female 82.3%, baseline age 57.4 years, disease duration 8.5 years; rheumatoid factor positivity 78.4%; Disease Activity Score in 28 joints using erythrocyte sedimentation rate 4.3; concomitant prednisolone [PSL] dose 6.1 mg/day [usage 42.4%], and methotrexate [MTX] dose 8.5 mg/week [usage 60.9%]). Treatment courses included abatacept (ABT; n = 663), adalimumab (ADA; n = 536), certolizumab pegol (CZP; n = 226), etanercept (ETN; n = 856), golimumab (GLM; n = 458), infliximab (IFX; n = 724), tocilizumab (TCZ; n = 851), and TOF (n = 101/only bDMARDs-switched cases). Drug discontinuation reasons (categorized into lack of effectiveness, toxic adverse events, non-toxic reasons, or remission) and rates were estimated at 36 months using Gray's test and statistically evaluated after adjusted by potential clinical confounders (age, sex, disease duration, concomitant PSL and MTX usage, starting date, and number of switched bDMARDs) using the Fine-Gray model. Results: Cumulative incidence of drug discontinuation for each reason was as follows: lack of effectiveness in the bDMARDs-naïve group (from 13.7% [ABT] to 26.9% [CZP]; P < 0.001 between agents) and the bDMARDs-switched group (from 18.9% [TCZ] to 46.1% [CZP]; P < 0.001 between agents); toxic adverse events in the bDMARDs-naïve group (from 4.6% [ABT] to 11.2% [ETN]; P < 0.001 between agents) and the bDMARDs-switched group (from 5.0% [ETN] to 15.7% [TOF]; P = 0.004 between agents); and remission in the bDMARDs-naïve group (from 2.9% [ETN] to 10.0% [IFX]; P < 0.001 between agents) and the bDMARDs-switched group (from 1.1% [CZP] to 3.3% [GLM]; P = 0.9 between agents). Conclusions: Remarkable differences were observed in drug retention of 7 bDMARDs and TOF between bDMARDs-naïve and bDMARDs-switched cases.Ebina K., Hirano T., Maeda Y., et al. Drug retention of 7 biologics and tofacitinib in biologics-naïve and biologics-switched patients with rheumatoid arthritis: The ANSWER cohort study. Arthritis Research and Therapy 22, 142 (2020); https://doi.org/10.1186/s13075-020-02232-w

Association of the low e’ and high E/e’ with long-term outcomes in patients with normal ejection fraction

Objective We aimed to evaluate the association of the severity of left ventricular (LV) diastolic dysfunction with long-term outcomes in patients with normal ejection fraction. Design Retrospective study. Setting A single centre in Japan. Participants We included 3576 patients who underwent both scheduled transthoracic echocardiography and ECG between 1 January and 31 December 2013, in a hospital-based population after excluding valvular diseases or low ejection fraction (14 (with relaxation disorder and high LV end-diastolic pressure, n=646). Primary and secondary outcome measures The primary outcome measure was a composite of all-cause death and major adverse cardiac events (MACE). The secondary outcome measure were all-cause death and MACE, separately. Results The cumulative 3-year incidences of the primary outcome measures were significantly higher in the e′14 group (23.4%) than those for the e′≥7 group (13.0%; p14 related to e′14 was associated with the long-term prognosis in patients with normal ejection fraction in an incremental fashion

Gender differences of low-dose aspirin-associated gastroduodenal ulcer in Japanese patients

AIM: To clarify the gender differences about the clinical features and risk factors of low-dose aspirin (LDA) (81-100 mg daily)-associated peptic ulcer in Japanese patients

Carcinoembryonic antigen and carbohydrate antigen 19-9 are prognostic predictors of colorectal cancer with unresectable liver metastasis

No evidence currently exists to demonstrate the prognostic value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in patients with unresectable colorectal cancer liver metastases (CRLM). Therefore, we retrospectively investigated the correlation between serum CEA and CA19-9 levels and overall survival in patients with unresectable CRLM. The study involved 40 patients who were diagnosed with unresectable CRLM between March 2000 and August 2010 at Jikei University Hospital, Japan. We retrospectively investigated the correlation between patient characteristics, including serum CEA and CA19-9 levels, and overall survival using univariate and multivariate analyses. In the univariate analysis, the absence of primary tumor resection (p=0.0161), the absence of systemic chemotherapy (p=0.0119), serum CEA ≥100 ng/ml (p=0.0148) and CA19-9 ≥100 U/ml (p<0.0001) were significant predictors of poor survival. In the multivariate analysis, the absence of systemic chemotherapy (p=0.0356), serum CEA ≥100 ng/ml (p=0.0079) and CA19-9 ≥100 U/ml (p=0.0002) were independent predictors. Serum CEA and CA19-9 levels are therefore independent prognostic predictors of survival in patients with unresectable CRLM