Papers by Giovanni Lapadula
Scientific Abstracts
BackgroundAn increased number of elderly patients with rheumatoid arthritis (RA) has been observe... more BackgroundAn increased number of elderly patients with rheumatoid arthritis (RA) has been observed in the last years mainly due to the increase of life expectancy. In this group it is possible to include two different categories: patients with onset of RA in advanced age (60-65 years old), and patients with an early occurrence of RA aged with the disease.For all elderly patients many factors such as: comorbidities and polytherapy, extra-articular manifestations of RA, and the process of immune-senescence can increase frailty and difficulties for rheumatologist in management of RA. Although patients with late onset of RA frequently show more aggressive articular involvement and systemic manifestations, literature data suggest that rheumatologists tend to treat elderly patients less aggressively. Moreover, they delay treat to target approach with less frequent use of biologic drugs and prolonged use of steroids or NSAIDsThe improvement of knowledge about persistence of different drugs...
Scientific Abstracts
BackgroundIn the age of targeted-synthetic disease-modifying antirheumatic drugs (tsDMARDs), filg... more BackgroundIn the age of targeted-synthetic disease-modifying antirheumatic drugs (tsDMARDs), filgotinib represents the last JAK inhibitor available in Europe for rheumatoid arthritis (RA). Filgotinib is characterized by predominantly inhibition of JAK1 and its efficacy and safety have been highlighted by phase 2/3 studies, but no real-life data in RA are currently available.ObjectivesThe aim of this study was to evaluate the effectiveness and safety profile of filgotinib in real-life setting in RA patients included in Italian GISEA (Group for the Study of Early Arthritis) registry.MethodsFor this study, data from RA patients treated with filgotinib recorded in Italian GISEA registry were analysed. Disease activity scores and patients reported outcomes (PROs) were compared at baseline and six months follow-up using paired t-tests. The retention rate was estimated by the Kaplan-Meier method, while a cox regression model was used to search for possible factors influencing drug survival...
Journal of Clinical Medicine
While precision medicine is still a challenge in rheumatic disease, in recent years many advances... more While precision medicine is still a challenge in rheumatic disease, in recent years many advances have been made regarding pathogenesis, the treatment of inflammatory arthropathies, and their interaction. New insight into the role of inflammasome and synovial tissue macrophage subsets as predictors of drug response give hope for future tailored therapeutic strategies and a personalized medicine approach in inflammatory arthropathies. Here, we discuss the main pathogenetic mechanisms and therapeutic approaches towards precision medicine in rheumatoid arthritis from the 2022 International GISEA/OEG Symposium.
Mediators of Inflammation, 2018
Rheumatoid arthritis (RA) patients are at high risk of cardiovascular (CV) events, and the chroni... more Rheumatoid arthritis (RA) patients are at high risk of cardiovascular (CV) events, and the chronic inflammatory state may generate quantitative and qualitative changes in lipoprotein fractions. The anti-IL-6 receptor tocilizumab (TCZ), even if effective in inflammation and joint damage prevention, determined significant alterations to RA patients’ lipid levels in randomized controlled trials, but real-world data are lacking. We evaluated the changes in lipid fraction levels and disease activity in a longitudinal cohort of RA patients on long-term treatment with tocilizumab (TCZ) in a community setting. We retrospectively selected 40 naïve-biologic RA patients on treatment with intravenous TCZ compared to 20 RA patients on methotrexate treatment as the control group. Total cholesterol (Tot-Chol), low-density lipoproteins (LDL), high-density lipoprotein (HDL), and triglyceride (TG) levels were measured at the baseline and at 12, 24, and 52 weeks thereafter. At the same points, 28-join...
Indian Journal of Rheumatology, 2019
Objective: Despite the well-established efficacy of methotrexate (MTX) in rheumatoid arthritis (R... more Objective: Despite the well-established efficacy of methotrexate (MTX) in rheumatoid arthritis (RA), monotherapy is not sufficient in almost half of patients. The aim of this registry-based study was to detect possible predictive factors for the early failure of MTX as a first-line treatment in early RA patients. Materials and Methods: Five-hundred and ninety RA patients beginning MTX as the first-line treatment were included. Persistence on therapy was re-evaluated after 12 months. Baseline features of disease were evaluated by means of univariate Cox regression, and parameters significantly associated to the outcome were included in multivariate model. Results: One hundred and forty-nine patients (25.3%) failed MTX during the 1 st year, for inefficacy in 43.6% and adverse events in 37.5% of cases, respectively. At univariate analysis, patients who discontinued or failed treatment showed lower mean age, higher prevalence of anti-citrullinated peptide antibodies (ACPAs), and higher number of tender/swollen joints. The dose of MTX was correlated with the efficacy and the tolerance of the drug. In particular, patients treated with 7.5 mg of MTX weekly showed a higher rate of discontinuation for inefficacy than adverse events, and the contrary was detected for higher doses. On multivariate analysis, age, ACPA, and number of tender joints were directly associated with MTX discontinuation or failure. Conclusions: More than 25% of RA patients treated with MTX as a first-line therapy failed treatment at 12 months. ACPA positivity, age, and number of tender joints were associated with early withdrawal of MTX in RA patients, while the dose of MTX was correlated to the efficacy and safety of the drug.
Patient Preference and Adherence, 2018
Objective: To estimate preferences in relevant treatment characteristics evaluated by different g... more Objective: To estimate preferences in relevant treatment characteristics evaluated by different groups involved in the management of patients with rheumatic diseases. Subjects and methods: We surveyed patients with rheumatic diseases, and rheumatologists, nurses, and pharmacists with experience in treatment with/provision of biologic drugs for these patients. Through a discrete choice experiment, participants evaluated 16 possible scenarios in which pairs of similarly efficacious treatments were described with six characteristics: 1) frequency of administration; 2) mode and place of administration; 3) manner, helpfulness, efficiency, and courtesy of health personnel; 4) frequency of reactions at the site of drug administration; 5) severity of generalized undesired/allergic reactions; and 6) additional cost. The direction and strength of preferences toward each characteristic level and the relative importance of each characteristic were estimated through a random-effects conditional logistic regression model. Results: In total, 513 patients, 110 rheumatologists, 51 nurses, and 46 pharmacists from 30 centers in Italy participated. Characteristics 3, 4, and 6 were the most important for every subgroup; 1 was least important for patients and rheumatologists, 2 was least important for pharmacists, and 2 and 5 were least important for nurses. For characteristic 2, pharmacists preferred subcutaneous self-injection with a syringe; nurses preferred assisted infusion at an infusion center close to the patient's home; patients and rheumatologists preferred subcutaneous self-injection with a pen. Conclusion: The different preferences for some characteristics shown by the different groups can play an important role, together with purely clinical aspects, in the choice and consequent benefit of treatments, contributing also to a more satisfactory use of resources.
Abstracts Accepted for Publication, 2019
Background: Race is linked to delays in healthcare. Black and Hispanic patients with osteoarthrit... more Background: Race is linked to delays in healthcare. Black and Hispanic patients with osteoarthritis have worse pain and function than Whites before arthroplasty. Whether Black and Hispanic patients with RA similarly delay care is unknown. Objectives: To assess whether Black and/or Hispanic (minority) RA patients have worse pain, function and disease activity at the time of arthroplasty. Methods: We used prospectively acquired data on RA patients between 10/2013 and 11/2018 prior to total knee arthroplasty (TKA) or total hip arthroplasty (THA). Pain, function, and disease activity were assessed using the visual analogue scale (VAS), the Multidimensional Health Assessment Questionnaire (MD HAQ), and the Disease Activity Score (DAS28). Race, ethnicity, education, income, insurance and medications were collected via self-report questionnaire. Multivariable linear and logistic models examined whether minority status predicted pain, function and disease activity. Results: 37 (23%) of the 164 patients were minorities (Table 1). MD HAQ and DAS28 were worse in minorities, only VAS was significant (p-value= 0.029). There was no significant difference in education. Unadjusted comparisons indicated no difference in pain, function, disease activity or medication use between groups. Insurance varied significantly between groups (p= <0.0001). In the multivariable analyses (Table 2), minority status was not significantly associated with worse function (MD HAQ) [p=0.26], disease activity (DAS28-ESR) [p=0.658], or VAS pain [p=0.18]. Increased age was significantly associated with better function (p=0.004). Conclusion: For Black and/or Hispanics with RA undergoing THA or TKA at a high-volume specialty hospital, minority status was not significantly associated with pain, disability or RA disease activity at the time of elective arthroplasty.
FRIDAY, 15 JUNE 2018, 2018
To understand if changes in patient reported outcomes (PROs) differ among patients with 1°or 2°TN... more To understand if changes in patient reported outcomes (PROs) differ among patients with 1°or 2°TNFi failure. Methods: In TARGET (NCT10709758), patients with intolerance or an inadequate response to TNFi were randomised to placebo or sarilumab 150 mg or 200 mg plus csDMARD. For patients with an inadequate response to TNFi (92% of the sample), 1°or 2°failure was investigator-determined at enrollment. The following PROs were assessed at Week 0 (treatment initiation) and Week 24: HAQ-DI, patient global assessment of disease visual analogue scale (VAS), pain VAS, SF-36, morning stiffness VAS, EQ-5D, and Rheumatoid Arthritis Impact of Disease (RAID) scale. All scales produce global (total) scores, except the SF-36 which has eight domains and two summary scores (physical and mental component scores [PCS and MCS]) and the EQ-5D which has a single index utility score and a global health VAS. The PRO change from baseline was analysed through mixed model repeated measures with treatment, region, number of prior TNFis, baseline of the PRO analysed, visit, treatment-by-visit interaction, 1°and 2°subgroup, treatment-by-subgroup interaction, and treatment-by-visit-by-subgroup interaction. Post-hoc analysis of the sarilumab 200 mg data are reported here as this is the recommended dose of sarilumab. Results: In this post-hoc analysis, 174 of 181 patients in the placebo group and 167 of 184 in the sarilumab 200 mg group were classified as TNFi 1°or 2°failures (the remaining patients were classed as intolerant or other and not included in this analysis); 75 and 64 were 1°and 99 and 103 were 2°treatment failures in the placebo and the sarilumab 200 mg groups, respectively. At Week 24, changes in all PROs were numerically similar in the 1°or 2°TNFi failures for both the sarilumab 200 mg and placebo groups (table 1). Furthermore, treatment-by-subgroup interaction testing did not show a statistically significant interaction of TNFi failure status and PRO outcome (all interaction P-values>0.05). Treatment emergent adverse events occurred in 65.6% of sarilumab 200 mg patients in the 1°failure group and 63.1% in the 2°failure group and were consistent with safety data reported previously.
Saturday, 16 JUNE 2018, 2018
Table 1. Mean (SE) PAAP score, a SF-36v2Q7 score b and SF-36v2 BP c at baseline through M6(FAS) i... more Table 1. Mean (SE) PAAP score, a SF-36v2Q7 score b and SF-36v2 BP c at baseline through M6(FAS) in RA and PsA csDMARD-IR or TNFi-IR population, and SF-36v2Q7 score, b and SF-36v2 BP c at baseline and W12 (FAS) in the AS population Conclusions: Treatment with tofacitinib is associated with a rapid improvement and sustained reduction of pain in pts with RA and PsA who are csDMARD-IR or TNFi-IR, and in pts with AS.
Saturday, 16 JUNE 2018, 2018
Background: Therapeutic drug monitoring is used to guide treatment in patients treated with TNF-a... more Background: Therapeutic drug monitoring is used to guide treatment in patients treated with TNF-a inhibitors. Current bridging ELISA (bELISA), mostly used in routine analysis, cannot detect anti-drug antibodies (ADA) in immune complexes and differentiate between neutralizing and non-neutralizing ADA. Reporter Gene Assay (RGA), which detects only neutralizing ADA, is both costly and labourintensive. Therefore, alternative assays are warranted to obviate these limitations. Objectives: To develop an in-house competitive ELISA (cELISA) for detection of neutralizing ADA, to compare results between four different assays for ADA detection and to propose an algorithm to assist clinicians in personalized therapeutic drug monitoring of Infliximab (IFX) and Adalimumab (ADL). Methods: Samples from 105 patients on IFX or ADL therapy (n IFX =61, n ADL =44) from the Departments of Rheumatology and Gastroenterology, University Medical Centre Ljubljana, with undetectable drug levels, were tested with in-house cEL-ISA, in-house bELISA, in-house bELISA with acetic acid dissociation (acid bELISA (1)) and RGA. cELISA was developed following the principles of RGA, briefly, diluted samples were pre-incubated with a fixed amount of IFX or ADL, linked to horseradish peroxidase. After incubation on a TNF-a plate, the reaction was detected using TMB substrate. Within and between-run imprecisions for cEL-ISA were determined. Correlation coefficient and agreement between results from different assays were calculated. Results: Within and between-run imprecisions in cELISA met the validation criteria (<20%). We found high correlation between cELISA and RGA (anti-IFX r=0.932 (p<0.0001) and anti-ADL r=0.948 (p<0.0001)) and 100% agreement between results. cELISA also correlated with bELISA (anti-IFX r=0.663 (p=0.0002) and anti-ADL r=0.896 (p<0.0001)). Agreement between bELISA and cELISA was 79% for anti-IFX and 82% for anti-ADL samples. The more sensitive cELISA and functional RGA detect 13% (8/61) more positive samples in anti-IFX group and 18% (8/44) more samples in anti-ADL group. Acid bELISA found 3% (2/61) more positive samples in anti-IFX group and 14% (6/44) of samples in the anti-ADL group. In total, 16% (10/61) more samples in anti-IFX and 30% (13/44) more samples in anti-ADL group were confirmed having ADA. Based on our results we propose a sequential algorithm, which enables reliable, affordable and increased detection of ADA (figure 1).
Spondyloarthritis – treatment, 2018
BASFI, BASMI and ASDAS were found to be similar in both groups. Median BAS-DAI scores at first TN... more BASFI, BASMI and ASDAS were found to be similar in both groups. Median BAS-DAI scores at first TNFi initiation were higher in patients with nr-axSpA than in patients with AS (58.65±18.21, 51.06±18.91, p=0.030). Cumulative drug survival rates did not show significant difference among INF (at 59. months:18,5%), ADA (at 71. months: 39,5%) and ETN (at 51. months: 24,2%) in nr-axSpA group (p=0,699) (figure 1). Similarly, drug survival rates at 78, 77, 78. months for 3 anti-TNF drugs had shown no difference in AS patients (INF (at 78. months: 38,1%), ADA (at 77. months: 52,4%), ETN (at 78. months: 39,0%)) (p=0,151) (Figure 2). Cumulative survival rates in AS patients (at 78. months:42,2%) were found to be significantly higher than that (at 71. months:28,2%) in nr-axSpA patients (p<0,001) (Figure 3). Abstract AB0835-Figure 1. Drug survival rates anti-TNF in nr-axSpA. Abstract AB0835-Figure 2. Drug survival rate by anti-TNF in AS. Abstract AB0835-Figure 3. Overall drug survival on first anti-TNF in nr-axSpA and AS patients. Conclusions: In contrast to the literature that revealed similar short term survival rates for anti-TNF drugs in patients with AS and nr-axSPA, we found higher survival rates in patients with AS compared to patients with nr-axSpa in this long-term observational study.A limitation of the study may be the low number of nr-axSpa patients using anti-TNF, related to the requirements of social insurance system.
American Journal of Case Reports, 2017
Unusual clinical course Background: Medication-related osteonecrosis of the jaw (MRONJ) is a seve... more Unusual clinical course Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, occurring in patients undergoing treatments with antiresorptive or antiangiogenic agents, such as bisphosphonates, denosumab, or bevacizumab, for different oncologic and non-oncologic diseases. The aim of this study was to report a case of MRONJ in a patient taking infliximab, an anti-TNF-a antibody used to treat Crohn's disease, rheumatoid arthritis, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis. Case Report: A 49-year-old female patient affected by Crohn's disease, who had been undergoing 250 mg intravenous infliximab every six weeks for 12 years, with no history of antiresorptive or antiangiogenic agent administration, came to our attention for post-surgical MRONJ, associated with a wide cutaneous necrotic area of her anterior mandible. Following antibiotic cycles, the patient underwent surgical treatment with wide bone resection and debridement of necrotic tissues; after prolonged follow-up (16 months), the patient completely healed without signs of recurrence. Conclusions: Prevention of MRONJ by dental checkup before and during treatments with antiresorptive treatments (bisphosphonates or denosumab) is a well-established procedure. Although further studies are required to confirm the role of infliximab in MRONJ, based on the results of this study, we propose that patients who are going to be treated with infliximab should also undergo dental checkup before starting therapy, to possibly avoid MRONJ onset.
The Israel Medical Association journal : IMAJ, 2018
Clinical research is needed to identify patients with axial spondyloarthritis (axSpA) who are mor... more Clinical research is needed to identify patients with axial spondyloarthritis (axSpA) who are more likely to be responsive to interleukin (IL)-17 inhibition. To evaluate short-term efficacy of secukinumab in the management of axSpA. Twenty-one patients (7 males, 14 females) with axSpA were consecutively treated with secukinumab. Laboratory and clinical assessments were based on erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Data were recorded at baseline and at a 3 month follow-up visit. The study was comprised of 21 patients. Both BASDAI and ASDAS-CRP showed a statistically significant reduction between the baseline and the 3 month visit (P < 0.0001 and P = 0.0005, respectively). During the laboratory assessment, ESR showed a significant decrease (P = 0.008) while CRP improvement did not reach statistical significance (P = 0.213). No statis...
Reumatismo, 2016
The aim of this study was to assess circulating levels of reactive oxygen metabolites (ROMs) as a... more The aim of this study was to assess circulating levels of reactive oxygen metabolites (ROMs) as a marker of oxidative stress in rheumatoid arthritis (RA) patients during an anti-tumor necrosis factor alpha (TNF-α) treatment. We enrolled 40 patients with RA (36 females; age 53±13 yrs) treated with different subcutaneously administered TNF-α inhibitors. The oxidative status was determined on the basis of plasma samples taken before, at 24 and 52 weeks of the anti-TNF-α treatment. Hydroperoxide levels were measured using the d-ROMs test, a useful clinically proven oxidative stress marker. During the anti-TNF-α therapy, we observed a significant reduction in serum ROMs levels in RA patients from 33.2±10 mg H2O2/L at baseline to 29.5±7 and 29.3±9 mg H2O2/L, at 24 and 52 weeks, respectively (p<0.05). We also identified a significant correlation between the oxidative stress status and the disease activity score on 28 joints/C-reactive protein and health assessment questionnaire disabili...
Poster Presentations, 2017
Background: Antidrug antibodies (ADAb) seem to be associated with a loss of response in immune-me... more Background: Antidrug antibodies (ADAb) seem to be associated with a loss of response in immune-mediated inflammatory diseases (1) and in psoriatic arthritis (2). Objectives: To assess the effect of ADAb on clinical response in patients with spondyloarthritis (SpA) treated with anti-TNF drugs. Methods: We conducted a systematic literature review of controlled trials and observational studies assessing the effect of ADAb on response to anti-TNF drugs (Adalimumab (ADL), Certolizumab (CTZ), Etanercept (ETA), Golimumab (GOL) and Infliximab (INF)) in patients with axial or peripheral SpA. Databases analysed were PubMed, the Cochrane library, and ACR/EULAR meeting abstracts, until January 2017. A meta-analysis was performed using the inverse variance approach and statistical heterogeneity was assessed with the Cochran Q-test and I 2 values. A statistical threshold of 5% was considered as significant. Results: Over 1,387 publications screened, 7 studies were selected for metaanalysis (3-9). These studies were observational studies (n=6) or controlled trial (n=1); involved patients with axial or peripheral SpA (n=6) or psoriatic arthritis (n=1); included treatments with ADL (n=4), ETA (n=1), INF and INF biosimilar (n=2), or various anti-TNF drugs (n=1). ADAb rates varied between anti-TNF drugs: 0% for ETA, 13.6-31.4% for ADL, 0-28.9% for INF. Patients with ADAb were less often responders than patients without ADAb in 6 studies, more often responders in one study, while the risk ratio (RR) for response was not assessable in one study due to the absence of ADAb. The weighted pooled RR (95% CI) for response to anti-TNF drugs was 0.73 (0.54-0.98) in ADAb+ in comparison with ADAb-patients (p=0.04) (see figure). There were trends towards more infusion reactions and lower serum drug levels in patients with ADAb (data not shown). Conclusions: According to the results of this meta-analysis, ADAb positivity is associated with a lower rate of response to anti-TNF agents in patients with SpA. References: [1] The immunogenicity of anti-TNF therapy in immune-mediated inflammatory diseases: a systematic review of the literature with a meta-analysis, Garcês.S and al, ARD 2014; 72:1947-1955. [2] The comparative immunogenicity of biologic therapy and it's clinical releavance in psoriatic arthritis: a systematic review of the literature, Balsa.
Abstracts Accepted for Publication, 2017
with two recommended DMARDS Grade IV: single use of DMARDS including MTX less than 5mg. Results: ... more with two recommended DMARDS Grade IV: single use of DMARDS including MTX less than 5mg. Results: There was no relationship between titers of Anti-CCP Ab and titers of RF. We found significant statistical correlation between anti-CCP antibody titers and inflammatory markers such as CRP and MMP-3. There was significant statistical correlation between CRP and MMP-3. In terms of treatment intensity, strong intensity group showed high titer of anti-CCP Ab and CRP. Titer of RF and MMP-3 level did not have any relationship with the treatment intensity. In cases treated with biologics, anti-CCP Ab and CRP were significantly higher compared to non-biologic case group. In 80% of cases treated with biologics titer of anti-CCP was more than 200 units. However, non-biologic treatment was continued in more than 50% of cases with anti-CCP Ab higher than 200 units. Conclusions: Even though we treated cases based on the severity of the symptoms of the patient and response in laboratory data, high anti-CCP Ab titers and CRP at the base line were most associated with the treatment intensity after 1 year. The results of our study suggest that the titer of anti-CCP Ab can be better a predictor of the treatment intensity than MMP-3 and RF.
Clinical Therapeutics, 2017
We provide a review of current knowledge on comparability between biosimilars and originator biol... more We provide a review of current knowledge on comparability between biosimilars and originator biologics in view of the continuous evolution occurring in this highly dynamic area. Methods: English-language literature indexed in MEDLINE was explored, without time limits, to July 31, 2016, using the terms biosimilar, biotechnologic drug, biologic drug, monoclonal antibody, fusion protein, and anti-tumor necrosis factor. The reference lists of identified articles were examined carefully for additional pertinent publications. Findings: Biological medicines are much more structurally complex and extremely sensitive to manufacturing conditions and therefore more difficult to characterize and produce than small molecule drugs. Even minor changes in manufacturing may lead to significant variations of the cellular systems used for biological production, as well as to differences in the structure, stability, or other quality aspects of the end product, all of which have the potential to affect tolerability and/or efficacy and increase the risk of immune responses. Owing to these issues, specific regulatory guidance on biosimilars is continuously evolving, and there is some disagreement on which studies need to be implemented to approve a biosimilar. According to current literature, the following points on biosimilars deserve consideration: biosimilar development is characterized by global harmonization, although several not fully answered questions remain regarding extrapolation of indications, switching or interchangeability, and tolerability; in patients with rheumatic diseases, the tolerability and efficacy of biosimilars in clinical practice remain to be established; several medical and patient associations have published position papers on biosimilars requesting that safety, efficacy, and traceability be carefully considered; longterm postmarketing studies should be implemented to allow physicians to gain confidence in biosimilars. Implications: On the basis of current knowledge, and taking into consideration both regulatory rules and medical society positions, it can be concluded that, although cost savings are highly desirable, the approval process for biosimilars needs to place tolerability and efficacy, supported by scientifically sound evidence, as the highest priority. Moreover, physicians must retain full authority regarding the decision about which biopharmaceutical to use for treating patients.
International Journal of Immunopathology and Pharmacology, 2014
Tumour necrosis factor (TNF) plays an important role in the pathogenesis of immune-mediated infla... more Tumour necrosis factor (TNF) plays an important role in the pathogenesis of immune-mediated inflammatory diseases (IMIDs). TNF inhibition results in down-regulation of abnormal and progressive inflammatory processes, resulting in rapid and sustained clinical remission, improved quality of life and prevention of target organ damage. Adalimumab is the first fully human monoclonal antibody directed against TNF. In this article, we review the role and cost effectiveness of adalimumab in the treatment of IMIDs in adults and children. The efficacy and tolerability of adalimumab has been demonstrated in patients with a wide range of inflammatory conditions, leading to regulatory approval in rheumatoid arthritis (RA), psoriatic arthritis (PsA), plaque psoriasis, inflammatory bowel diseases (Crohn's disease, ulcerative colitis, paediatric Crohn's disease, and intestinal Behçet's disease), ankylosing spondylitis (AS), axial spondyloarthritis (SpA) and juvenile idiopathic arthritis...
Reumatismo, 2014
The aim of the study was to review from the present literature the intra-articular (IA) use of th... more The aim of the study was to review from the present literature the intra-articular (IA) use of the TNF-blocking drugs. A total of 28 papers about this topic were found through a search in PubMed; the first publication's date was July 2003. These studies include a total of 214 patients affected by 12 different joint diseases that reported a total of 1046 intra-articular therapies carried out in 10 different joint sites. Infliximab and etanercept were the most widely used medications. The safety of this treatment clearly emerges from our analysis, while more difficult was the evaluation of its efficacy. Nevertheless we deduced an ideal patient profile that may better respond to the IA anti-TNF treatment.
Reumatismo, 2011
L' uvea è, in virtù della sua ricca vascolarizzazione, la tonaca oculare più frequentemente sede ... more L' uvea è, in virtù della sua ricca vascolarizzazione, la tonaca oculare più frequentemente sede di processi flogistici, distinti in uveiti anteriori (iridocicliti) e posteriori (corioretiniti). Le uveiti costituiscono la più importante causa di perdita della funzione visiva (1), e questo si verifica, se pur con meccanismi differenti, sia per le iridocicliti che per le corioretiniti, non necessariamente per l'acuzie del singolo episodio, ma perché spesso, nonostante la terapia, esse assumono un decorso croni-co-recidivante con complicanze e/o esiti che compromettono il visus (2). Nell'era antibiotica, dominate le uveiti infettive, sono le forme idiopatiche o, meglio, quelle a patogenesi immune le più frequenti ed aggressive, laddove i comuni presidi terapeutici (midriatici e steroidi per via topica e generale, immunosoppressori per via generale) non sempre sono risolutivi. Uveiti immunomediate possono verificarsi isolatamente (oftalmite simpatica, ad es.) oppure nell'ambito di malattie sistemiche, ad es. in corso di Spondiloartriti sieronegative HLA-B27 (SpA), Artriti croniche giovanili (ACG), M. di Behcet (MB), Artropatia psoriasica (AP), come pure nel M. di Crohn e nella Sarcoidosi. Una delle maggiori difficoltà dell'approccio terapeutico delle uveiti è senz'altro la scarsa conoscenza della loro patogenesi molecolare, cioè di quali mediatori cellulari e/o umorali siano determinanti nel causare l'infiltrato leucocitario e l'essudato, ele-LAVORO ORIGINALE
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Papers by Giovanni Lapadula