Wednesday, June 28, 2017

Abatacept switching from IV to SC and back at the 2017 EULAR Annual Meeting in Madrid

I had already looked at abatacept at the 2017 EULAR Annual Meeting in Madrid [1,2]. Now I have found another issue concerning abatacept. It is about r the ACTION (AbataCepTIn rOutiNe clinical practice) study, which is an observational study, which our employer doesn’t allow us to participate. Let’s have a closer look at the study.

R. Alten and colleagues presented [3]: „ LESS THAN 5% OF REAL-LIFE PATIENTS WHO SWITCH FROM IV TO SC ABATACEPT IN REAL-WORLD CLINICAL PRACTICE SUBSEQUENTLY SWITCH BACK TO THE IV FORMULATION”. Conclusions: “Less than 5% of pts who switched formulation from IV to SC abatacept in real-world clinical practice re-switched to the IV formulation, suggesting that switching has no adverse clinical impact. A change in formulation was mainly due to pt wish, reflecting their involvement in decision-making.”

That is strange indeed. The data reflects real world and not study reality. But I have made the opposite observation. When SC formulation became available, we switched patients from IV to SC and only a few stayed on SC – the very few ones with problematic veins, who suffered multiple IV punctures each time. Another observation at our center: patients, who started SC hardly ever switched to IV. There’s quite a lot of room for interpretation. Maybe patients in an observational study still reflect more a study cohort than real world patients.

Links and References:
[3] DOI: 10.1136/annrheumdis-2017-eular.1379


Etanercept Switching Patterns at the 2017 EULAR Annual Meeting in Madrid

There had been a study on Etanercept Switching Patterns at the 2017 EULAR Annual Meeting in Madrid. I’ve already looked at studies addressing biosimilars at the 2017 EULAR Annual Meeting [1,2]. But there is this interesting study on patients, who had been placed on etanercept biosimilar and switched back to the originator drug.

R. Alten and colleagues presented [3]: “PRELIMINARY REAL WORLD DATA ON SWITCHING PATTERNS BETWEEN ETANERCEPT, ITS RECENTLY MARKETED BIOSIMILAR COUNTERPART AND ITS COMPETITOR ADALIMUMAB, USING SWEDISH PRESCRIPTION REGISTRY”. The study is on Swedish patients, as in Sweden the switch to biosimilars has been implemented much earlier than for instance in Germany. 7% of the patients switched back to originator etanercept after an average of 43 days. Interestingly 6% of patients switched back to from etanercept biosimilar to their original drug adalimumab after an average of 57 days. “Despite the change from a brand biologic to the biosimilar is very likely made for economic reasons, the reasons for switching back to the innovator are not clear and may imply patients’ preference or clinical reasons.”

The impact of biologics is strange. To change from originator etanercept to etanercept biosimilar is understandable, but changing to adalimumab. Yet, we have to investigate the reasons for switching back to the original biologics. It is unclear if this stimulates anti-drug antibodies.

Links and References:
[3] DOI: 10.1136/annrheumdis-2017-eular.3585


Haiku Dimming Daylight

The dimming daylight
Cut meadow in straw yellow
Bats come out to hunt

Sunny Sunday
Cyclists at competition
Blackberries are ripe

Hear the moon
Look at the pizza box
Empty like the night

Green ivy climbing
Until the first floor trimming
Void stare from within

High-end restaurant
With a zen garden below
Just how to get out?

Morning sun
Dyeing the wheat field golden
Little warbler flying

Before Moulin Rouge
Long queue down the boulevard
Missing out on spring

Nugget Head
Vanishing lighthouse
Lights turn on


Tuesday, June 27, 2017

Haiku in Mainichi Shinbun (毎日新聞)

I've just had the pleasure to review past year's haiku in the Manichi Shinbun (毎日新聞), a Japanese newspaper. I have been delighted to see two of my haiku appearing there.
The second haiku is about a scene on the German autobahn. One can see the airport hotel with the toucan. Now and then you can see geese. Also today in the morning a saw some geese, but a couple of kilometers away from the hotel. Yes, hotel is an awkward word. Depicting another scene, but with a better word, the haiku could look like this:

Passing the tavern
With the gay coloured toucan
Three geese high up


Deer Antler Velvet in Rheumatoid Arthritis

Someone asked: what is deer antler velvet, how does it work? I ask: does it work at all?
An article in National Geographic News answers the question “What Is It?” like this: “Deer antler velvet is essentially a growth hormone called "insulin-like growth factor 1," or IGF-1.” [1] I could lean back now quoting S. Suzuki’s study as he and his colleagues looked at inhibition of IGF-1 in rheumatoid arthritis.

S. Suzuki and colleagues published [2]: “Inhibition of the insulin-like growth factor system is a potential therapy for rheumatoid arthritis.”  The authors concluded: “These results indicate that aberrant IGF-I and IGFBP-3 production plays a role in abnormal osteoclastic activation and angiogenesis in RA. This work supports future clinical exploration of anti-IGF-IR mAb in drug repositioning as a new treatment for RA.”
So, the inhibition of IGF-1 could be a future treatment. So what about deer antler velvet? Does it harm in rheumatoid arthritis?

WebMD lists other names [3]: Andouiller de Cerf, Antler Velvet, Bois de Cerf, Bois de Cerf Rouge, Bois de Chevreuil, Bois de Velours, Bois de Wapiti, Cervus elaphus, Cervus nippon, Cornu Cervi Parvum, Deer Antler, Deer Antler Velvet, Elk Antler, Elk Antler Velvet etc. pp. And: “Deer velvet contains multiple substances including the female sex hormones estrone and estradiol.”

M. Allen and colleagues published two studies (in 2002 and 2008) and I will show you the results of the more recent study [4]: “A randomized clinical trial of elk velvet antler in rheumatoid arthritis”. The authors examined the effects of elk velvet antler on joint pain and swelling, patient/physician global assessment of disease activity, functional ability, quality of life, blood levels of C-reactive protein, and adverse events in 168 rheumatoid arthritis patients experiencing residual symptoms after standard treatment. “There were no significant differences between groups on any measures.” The authors concluded: “Overall, elk velvet antler does not effectively manage residual symptoms in patients with rheumatoid arthritis.”

A. Gilbey and colleagues published a meta-analysis [5]: “Health benefits of deer and elk velvet antler supplements: a systematic review of randomised controlled studies”. The authors found two studies concerning rheumatoid arthritis, most probably the studies by M. Allen. They concluded: “Claims made for velvet antler supplements do not appear to be based upon rigorous research from human trials, although for osteoarthritis the findings may have some promise.” May have some promise in osteoarthritis isn’t enough.

Let’s have a quick look at the risks of IGF-1 [6]: “Convincing experimental data suggest that the GH/IGF-1 axis plays an important role in cancer development and behaviour. Epidemiological studies have supported an association with cancer, but not with tumour induction per se, although this is a distinction that is important mechanistically but not clinically.”

Does Deer Antler Velvet work in rheumatoid arthritis? No! There hasn’t been any evidence in a randomized controlled trial! Moreover IGF-1 is risky. I wouldn’t counsel my patients to take any of the above mentioned deer antler products.