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    A national, multicenter, retrospective study evaluating retention rate and efficacy of tocilizumab treatment in patients with active rheumatoid arthritis who had an inadequate response to csDMARDs and/or TNF inhibitors
    (Tubitak Scientific & Technological Research Council Turkey, 2023) Inanc, Guezide Nevsun; Terzioglu, Mustafa Ender; Karabulut, Yusuf; Yilmaz, Zevcet; Tarhan, Emine Figen; Enecik, Mehmet Emin; Sahin, Ali
    Background/aim: To describe the disease activity and retention rate in rheumatoid arthritis (RA) patients with inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and/or tumor necrosis factor inhibitors (TNFis) who were prescribed tocilizumab (TCZ) as first-line or second-line biologic treatment in real-world setting.Materials and methods: Data gathered from patients' files was used in a multicenter and retrospective context. Retention rates and the Disease Activity Score in 28 joints with CRP (DAS28-CRP) were evaluated at time points. The relationship of drug efficacy with factors such as smoking, obesity, and previous use of TNFis was also examined.Results: One hundred and twenty-four patients with a median (IQR) RA duration of 3.7 (7.4) years were included. Mean (SD) age was 52.9 (12.9) and 75% of the patients were female. TCZ retention rates in the 6th and 12th months were 94.1% and 86.6%, respectively. In all patients, DAS28-CRP level decreased significantly from baseline to Months 3 and 6. There was an increase in patients with remission and/or low disease activity and a decrease in patients with high disease activity at Month 3 and Month 6 (p < 0.001 for both). Disease activity was similar between subgroups based on body mass index, smoking status, and previous use of TNFis at any time point. Regres-sion analysis showed that absence of concomitant corticosteroid treatment independently was associated with remission/LDA achieve-ment at Month 6 [OR = 0.31, 95% CI (0.14- 0.72), p = 0.006], and Month 12 [OR = 0.35, 95% CI (0.13-0.94), p = 0.037]. Overall, 25 mild adverse events were reported.Conclusion: TCZ was found to be effective and safe in RA patients with IR to csDMARDs and/or TNFis. The drug retention rate was considered satisfactory with more than half of the patients continuing TCZ treatment at Month 12.
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    Patients' concerns regarding biological agents in rheumatology
    (Wiley, 2018) Pehlivan, Yavuz; Orucoglu, Nurdan; Pehlivan, Seda; Kimyon, Gezmis; Zengin, Orhan; Kucuk, Adem; Sahin, Ali
    ObjectiveThe potential side effects of biological agents may increase the anxiety levels of patients and influence not only their desire to use these therapies but also their concordance to treatment. This study aimed to determine the level and prevalence of drug-related concern in patients treated with biological agents and to acquire additional information regarding the related causes. Materials and MethodsA total of 1134 patients who were using biological agents for at least 3months with a diagnosis of rheumatic diseases were enrolled. General anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI). ResultsThe most common cause for drug-related concerns was the potential side effects of the drugs (59.5%). Among the potential side effects, cancer risk was the most common cause for concern (40.1%), followed by the risk of tuberculosis activation (30.7%). Anxiety levels were higher in patients who experienced side effects than in other patients, and this difference was statistically significant (P<0.05). STAI trait and state scores were moderately correlated with anxiety levels related to the drug (P<0.001). ConclusionAnxiety related to biological agents may significantly affect the patients' anxiety levels. Awareness regarding the patients' concerns and expectations related to the drug is important to ensure drug adherence and concordance to treatment.
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    Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio
    (Wiley, 2015) Uslu, Ali Ugur; Kucuk, Adem; Sahin, Ali; Ugan, Yunus; Yilmaz, Ramazan; Gungor, Tayfun; Bagcaci, Sinan
    AimRheumatoid arthritis (RA) is an inflammatory autoimmune disease with unknown etiology and systemic involvement. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are two new inflammatory markers used in the assessment of systemic inflammation. The aim here is to study NLR and PLR in patients with RA to investigate their relation with Disease Activity Score of 28 joints (DAS-28). MethodsThe study included 104 patients with RA and a control group of 51 age- and gender-matched healthy subjects. We divided the patients into two groups according to the DAS-28 score. Group 1 included patients with a score of lower than 2.6 by the DAS-28 (patients in remission) and Group 2 included patients with a score of 2.6 and higher (patients with active disease). ResultsNLR was 2.120.83 in the patient group and 1.58 +/- 0.57 in the control group. PLR was 136.50 +/- 53.52 in the patient group and 114.84 +/- 29.41 in the control group. There was a statistically significant difference in NLR and PLR between the patient and control groups (P0.0001 and P=0.001, respectively). Patients in Group 1 had an NLR of 1.84 +/- 0.61 and a PLR of 119.25 +/- 41.77. Patients in Group 2 had an NLR of 2.29 +/- 0.90 and a PLR of 147.28 +/- 56.96. There was a statistically significant difference in NLR and PLR between the two groups (P=0.003 and P=0.005 respectively). A correlation was observed between NLR and PLR by DAS-28 (r=0.345, P0.0001 and r=0.352, P0.0001, respectively). ConclusionsThe present study showed us that NLR and PLR were two new inflammatory markers which could be used to assess disease activity in patients with RA.