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- Elhai, M, et al.
(författare)
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Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study
- 2019
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Ingår i: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 78:7, s. 979-987
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Tidskriftsartikel (refereegranskat)abstract
- To assess the safety and efficacy of rituximab in systemic sclerosis (SSc) in clinical practice.MethodsWe performed a prospective study including patients with SSc from the European Scleroderma Trials and Research (EUSTAR) network treated with rituximab and matched with untreated patients with SSc. The main outcomes measures were adverse events, skin fibrosis improvement, lung fibrosis worsening and steroids use among propensity score-matched patients treated or not with rituximab.Results254 patients were treated with rituximab, in 58% for lung and in 32% for skin involvement. After a median follow-up of 2 years, about 70% of the patients had no side effect. Comparison of treated patients with 9575 propensity-score matched patients showed that patients treated with rituximab were more likely to have skin fibrosis improvement (22.7 vs 14.03 events per 100 person-years; OR: 2.79 [1.47–5.32]; p=0.002). Treated patients did not have significantly different rates of decrease in forced vital capacity (FVC)>10% (OR: 1.03 [0.55–1.94]; p=0.93) nor in carbon monoxide diffusing capacity (DLCO) decrease. Patients having received rituximab were more prone to stop or decrease steroids (OR: 2.34 [1.56–3.53], p<0.0001). Patients treated concomitantly with mycophenolate mofetil had a trend for better outcomes as compared with patients receiving rituximab alone (delta FVC: 5.22 [0.83–9.62]; p=0.019 as compared with controls vs 3 [0.66–5.35]; p=0.012).ConclusionRituximab use was associated with a good safety profile in this large SSc-cohort. Significant change was observed on skin fibrosis, but not on lung. However, the limitation is the observational design. The potential stabilisation of lung fibrosis by rituximab has to be addressed by a randomised trial.
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| 2. |
- Katsaounou, Paraskevi, et al.
(författare)
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Smoking and severe persistent asthma
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Smoking has detrimental effects on different clinical aspects of asthma, like accelerated decline in lung function, diminished symptom control, worse quality of life(QoL) and impaired therapeutic response. Fighting for Breath, a survey conducted by EFA(2005) showed that a worrying number of uncontrolled asthmatic patients(pts) indicated exposure to passive smoking as possible reason for poor QoL. After a decade, we conducted Still Fighting for Breath(GfK on behalf of Novartis upon EFA's invitation), an online survey in 1333 pts with severe persistent asthma(SPA) to assess the impact of SPA on pts’ daily life(fig1). Though law banning smoking in public spaces is implemented, still a high proportion of pts(88%) reported disruption in activities of daily living with 38% presenting poor perception of their disease control(disconnect b/w Pts perception and GINA assessment). Asthmatics identified exposure to smoking as trigger for exacerbations, with 63% of them(68% of caregivers) avoiding smoky premises. Percentage of smokers with SPA was higher than the general population in some of the countries. Current smokers with asthma were significantly more frequently diagnosed with anxiety(47%) and depression (41%) than never-smokers(40% and 27%, resp.) and ex-smokers(42% and 28%, resp.)(z-test, Α = 0.05). Thus, there is a need for improved management and support(smoking cessation, treatment, assessment of perception and psychological conditions) of asthmatic smokers with SPA.
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