Mahboob Rahman | University of Pennsylvania (original) (raw)

Papers by Mahboob Rahman

Research paper thumbnail of Inflammation and Arterial Stiffness in Chronic Kidney Disease: Findings From the CRIC Study

American journal of hypertension, 2017

Chronic kidney disease (CKD) and arterial stiffness are associated with increased cardiovascular ... more Chronic kidney disease (CKD) and arterial stiffness are associated with increased cardiovascular morbidity and mortality. Inflammation is proposed to have a role in the development of arterial stiffness, and CKD is recognized as a proinflammatory state. Arterial stiffness is increased in CKD, and cross-sectional data has suggested a link between increased inflammatory markers in CKD and higher measures of arterial stiffness. However, no large scale investigations have examined the impact of inflammation on the progression of arterial stiffness in CKD. We performed baseline assessments of 5 inflammatory markers in 3,939 participants from the chronic renal insufficiency cohort (CRIC), along with serial measurements of arterial stiffness at 0, 2, and 4 years of follow-up. A total of 2,933 participants completed each of the follow-up stiffness measures. In cross-sectional analysis at enrollment, significant associations with at least 2 measures of stiffness were observed for fibrinogen,...

Research paper thumbnail of Etanercept Provides Improved Quality of Life Regardless of the Presence of Psoriatric Arthritis in Moderate/Severe Psoriasis Subjects from Central and Eastern Europe, Latin America and Asia

Value in Health, 2013

A509 all 3 studies were analysed using latent growth models to generate intercepts and slopes of ... more A509 all 3 studies were analysed using latent growth models to generate intercepts and slopes of change across trials for each patient, irrespective of treatment. Slopes of change were correlated to examine how closely DLQI changes mirrored UAS7 changes. Results: Results indicated that both measures showed large improvements over the course of the trials: UAS7 and DLQI scores were high at the start of the study reflecting moderate-severe CSU/CIU (UAS7) and a very large effect on patient's life (DLQI). Correlations between changes in DLQI and changes in UAS7 by study end were 0.88, 0.85, and 0.88, indicating high correspondence between the two measures. ConClusions: These results suggest that collecting DLQI information in-clinic can provide an excellent indication of the weekly UAS7 score, and is more efficient for clinical practice routine in assessing CSU/CIU patients.

Research paper thumbnail of Etanercept in moderate rheumatoid arthritis: PRESERVE study results from central/eastern Europe, Latin America and Asia

International Journal of Clinical Rheumatology, 2014

Research paper thumbnail of AO2 the Association Between Therapeutic Persistence and Non-Pharmacy Cost Among Anti-Tumor Necrosis Factors (Anti-TNFS) in the Treatment of Rheumatoid Arthritis

Research paper thumbnail of PSS49 Health Care Utilization Increases in the Year Following a Diagnosis of Psoriasis

Value in Health, 2008

one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from the... more one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from their first prostaglandin dispensing. Rates were compared across the three prostaglandin analogs using chi-square tests. Statistical and descriptive analyses were performed using SAS 9.1. RESULTS: In total, 9402 patients were included, aged 70 (ϮSD = 12) years, 56% were female. The proportions of patients requiring adjunctive therapy were 31%, 42%, and 31% for bimatoprost, latanoprost and travoprost, respectively. A significantly higher proportion of adjunctive therapy was associated with latanoprost users (bimatoprost vs. latanoprost: Chi-square = 26.59, p < 0.001; travoprost vs. latanoprost: Chi-square = 19.82, p < 0.001). Bimatoprost and travoprost did not differ Chi-square = 0.01, p = 0.94). CONCLUSIONS: Approximately 40% of continuous prostaglandin users required adjunctive therapy in the first 12 months. The latanoprost cohort had the highest rate of adjunctive therapy. Higher rates of adjunctive therapy use may result in higher overall patient care costs.

Research paper thumbnail of PSS48 Health Care Costs Increase in the Year Following a Diagnosis of Psoriasis

Value in Health, 2008

one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from the... more one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from their first prostaglandin dispensing. Rates were compared across the three prostaglandin analogs using chi-square tests. Statistical and descriptive analyses were performed using SAS 9.1. RESULTS: In total, 9402 patients were included, aged 70 (ϮSD = 12) years, 56% were female. The proportions of patients requiring adjunctive therapy were 31%, 42%, and 31% for bimatoprost, latanoprost and travoprost, respectively. A significantly higher proportion of adjunctive therapy was associated with latanoprost users (bimatoprost vs. latanoprost: Chi-square = 26.59, p < 0.001; travoprost vs. latanoprost: Chi-square = 19.82, p < 0.001). Bimatoprost and travoprost did not differ Chi-square = 0.01, p = 0.94). CONCLUSIONS: Approximately 40% of continuous prostaglandin users required adjunctive therapy in the first 12 months. The latanoprost cohort had the highest rate of adjunctive therapy. Higher rates of adjunctive therapy use may result in higher overall patient care costs.

Research paper thumbnail of PMS7 a 2-YEAR Evaluation of Infliximab's Effectiveness in the Treatment of Rheumatoid Arthritis in Actual Practice

Value in Health, 2009

after adjusting for age, gender, gout treatment, comorbidities, and medication use. RESULTS: We i... more after adjusting for age, gender, gout treatment, comorbidities, and medication use. RESULTS: We identifi ed 4821 AMI cases of which 1410 were women. The adjusted odds ratio (OR [95% CI]) of AMI among women with gout was 1.62 (1.21-2.16), higher than the adjusted OR for men (1.12 [0.99-1.26]; p-value for interaction 0.01). When we combined both women and men in our analyses, we found an overall adjusted OR of 1.15 (1.06-1.25). CONCLUSIONS: Using population-based data, we found a 62% increased risk for AMI among elderly women with gout, and a 15% increased risk for elderly gout patients overall. The association between hyperuricemia, a known precursor to gout, and cardiovascular disease provides a potential explanation for our fi ndings. Gender differences in serum uric acid levels and metabolism may further explain the difference in risks between women and men. Findings provide support for the aggressive management of cardiovascular risk factors in gout patients.

Research paper thumbnail of PAR18 a Five-Year Longitudinal Analysis Comparing Dose Changes for Patients with Rheumatoid Arthritis Taking Infliximab in a Medicare and in a Commercially Insured Population

Value in Health, 2007

time before switching were examined. Descriptive and Chi-Square statistical analyses were conduct... more time before switching were examined. Descriptive and Chi-Square statistical analyses were conducted to determine if differences existed among the three cohorts. RESULTS: A total of 1242 patients were analyzed: 490 (39.4%) infliximab plus MTX; 607 (48.9%) etanercept plus MTX; and 145 (11.7%) adalimumab plus MTX. Over two-thirds of the patients were female and the mean age was 50.0 years. The Charlson Co-morbidity Index and disease staging were similar among the three cohorts. During the 12 months follow-up, 39 patients (7.9%) in the infliximab plus MTX cohort switched compared to 72 patients (11.9%) in the etanercept group and 23 patients (15.9%) in the adalimumab group. Chi-Square analyses indicated the differences were statistically significant (p < 0.05) as compared to the infliximab plus MTX cohort. The infliximab group had an average time of 195.9 days before switching, compared to 183.1 days in the etanercept group, and 165.3 in the adalimumab group; this was not statistically significant. CONCLUSION: The rate of switching and time before switching are important measures of the effectiveness of RA treatment in real world practice. This study found that infliximab plus MTX is associated with a longer time before switching and a significantly lower switching rate, as compared to the other anti-TNFs. Further studies are needed to evaluate the impact of switching on clinical and economic outcomes.

Research paper thumbnail of PAR17 a Comparision of Therapeutic Persistence Among Anti-Tumor Necrosis Factors (Anti-TNFS) in the Treatment of Rheumatoid Arthritis

Value in Health, 2007

time before switching were examined. Descriptive and Chi-Square statistical analyses were conduct... more time before switching were examined. Descriptive and Chi-Square statistical analyses were conducted to determine if differences existed among the three cohorts. RESULTS: A total of 1242 patients were analyzed: 490 (39.4%) infliximab plus MTX; 607 (48.9%) etanercept plus MTX; and 145 (11.7%) adalimumab plus MTX. Over two-thirds of the patients were female and the mean age was 50.0 years. The Charlson Co-morbidity Index and disease staging were similar among the three cohorts. During the 12 months follow-up, 39 patients (7.9%) in the infliximab plus MTX cohort switched compared to 72 patients (11.9%) in the etanercept group and 23 patients (15.9%) in the adalimumab group. Chi-Square analyses indicated the differences were statistically significant (p < 0.05) as compared to the infliximab plus MTX cohort. The infliximab group had an average time of 195.9 days before switching, compared to 183.1 days in the etanercept group, and 165.3 in the adalimumab group; this was not statistically significant. CONCLUSION: The rate of switching and time before switching are important measures of the effectiveness of RA treatment in real world practice. This study found that infliximab plus MTX is associated with a longer time before switching and a significantly lower switching rate, as compared to the other anti-TNFs. Further studies are needed to evaluate the impact of switching on clinical and economic outcomes.

Research paper thumbnail of PSK4 Cost Comparison Between Two Anti-Tumor Necrosis Factor (Anti-TNF) Therapies in Patients with Psoriasis Using Average Sales Price

Research paper thumbnail of Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Rheumatology, 2011

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumo... more Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX.

Research paper thumbnail of Improvement in hemoglobin levels in patients with ankylosing spondylitis treated with infliximab

Arthritis Care & Research, 2009

ObjectiveAnemia is a common complication in patients with inflammatory diseases such as ankylosin... more ObjectiveAnemia is a common complication in patients with inflammatory diseases such as ankylosing spondylitis (AS). This post hoc analysis of a large, randomized, placebo‐controlled trial examined the effect of infliximab on hemoglobin levels, physical function, and fatigue in patients with AS.MethodsPatients received infliximab 5 mg/kg (n = 188) or placebo (n = 68) at weeks 0, 2, 6, 12, and 18. Hemoglobin, interleukin‐6 (IL‐6), and C‐reactive protein (CRP) levels, fatigue (visual analog scale [VAS]), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]), and disease activity were evaluated at baseline and week 24. Anemia was defined as a hemoglobin level <12 gm/dl for women and <13 gm/dl for men.ResultsAt baseline, 11 placebo group patients (16.2%) and 37 infliximab group patients (19.7%) had anemia. Of these, more infliximab‐treated patients achieved normal hemoglobin levels at week 24 compared with patients receiving placebo (70.3% versus 27.3%; P = 0.01...

Research paper thumbnail of Department of Rheumatology

Assessment b y MRI of infl ammation and damage in rheumatoid arthritis patients with methotrexate... more Assessment b y MRI of infl ammation and damage in rheumatoid arthritis patients with methotrexate inadequate response receiving golimumab: results of the GO-FORWARD trial

Research paper thumbnail of PAR6 a Comparison of Health Care Costs in Patients with Psoriatic Arthritis (Psa) Who Received Etanercept (Eta), Eta Plus Methotrexate (MTX), Infliximab (Inf), or Inf Plus MTX

Research paper thumbnail of Identifying Preliminary Domains to Detect and Measure Rheumatoid Arthritis Flares: Report of the OMERACT 10 RA Flare Workshop

The Journal of Rheumatology, 2011

Background.While disease flares in rheumatoid arthritis (RA) are a recognized aspect of the disea... more Background.While disease flares in rheumatoid arthritis (RA) are a recognized aspect of the disease process, there is limited formative research to describe them.Methods.The Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Definition Working Group is conducting an international research project to understand the specific characteristics and impact of episodic disease worsening, or “flare,” so that outcome measures can be developed or modified to reflect this uncommonly measured, but very real and sometimes disabling RA disease feature. Patient research partners provided critical insights into the multidimensional nature of flare. The perspectives of patients and healthcare and research professionals are being integrated to ensure that any outcome measurement to detect flares fulfills the first OMERACT criteria of Truth. Through an iterative data-driven Delphi process, a preliminary list of key domains has been identified to evaluate flare.Results.At OMERACT 10, co...

Research paper thumbnail of Correction: The impact of anti-drug antibodies on drug concentrations and clinical outcomes in rheumatoid arthritis patients treated with adalimumab, etanercept, or infliximab: Results from a multinational, real-world clinical practice, non-interventional study

Research paper thumbnail of High levels of antipeptidoglycan antibodies in PsA and other seronegative arthritides

High levels of antipeptidoglycan antibodies in PsA and other seronegative arthritides

The Journal of Rheumatology

Bacterial cell wall peptidoglycan, the arthritogenic factor in adjuvant induced arthritis, may al... more Bacterial cell wall peptidoglycan, the arthritogenic factor in adjuvant induced arthritis, may also be involved in the etiology of some human rheumatic diseases. Patients with some seronegative rheumatic diseases like ankylosing spondylitis and Reiter&amp;amp;#39;s syndrome have elevated antibody titers to peptidoglycan. Using an ELISA with soluble peptidoglycan, we examined the sera of 110 patients with psoriatic arthritis, psoriasis without arthritis and a variety of other joint diseases. Antibody titers were significantly higher (p less than 0.001) among the 22 patients with psoriatic arthritis than the 16 patients with psoriasis without arthritis. Patients with other seronegative arthritides also had higher levels of antipeptidoglycan antibodies than patients with rheumatoid (seropositive) arthritis, osteoarthritis and crystal induced arthritis. Our results furnish additional support for the suggestion for a bacterial role in the pathogenesis of psoriatic and some other seronegative arthritides.

Research paper thumbnail of PSK6 Impact of Psoriasis Disease on Annual Total Health Care Costs and Resource Utilization Among Medicaid Recipients

Value in Health, 2007

Human Genital warts (GW) are common and increasing in sexually active people. Ninety percent of G... more Human Genital warts (GW) are common and increasing in sexually active people. Ninety percent of GW are due to Human Papillomavirus (HPV) types 6 and 11. Current treatments can be long, painful, sometimes fail, and relapses are frequent. The objective of this study was to assess treatment patterns and costs associated with the treatment of GW in Italy. Such estimation is important to assess the cost-effectiveness of Gardasil®, the quadrivalent HPV vaccine (types 6, 11, 16 & 18). METHODS: A national retrospective observational study was designed to involve 40 investigators in public gynaecological, dermatological, and sexually transmitted disease centres, enrolling 360 patients aged 14-64 years, with newly diagnosed or recurrent GW. Investigators documented medical resource utilisation and absence from work for the treatment of GW and related complications in 2005 (physician visits, diagnostic tests, medications, office-based treatments, hospitalisations, days off work). Annual direct medical costs per patient were estimated along with productivity losses from the societal perspective. RESULTS: A total of 28 investigators enrolled 341 patients (189 men and 152 women); 8 patients were admitted directly to day-hospital and 333 (97.7%) had at least one investigator visit (on average 3.4 visits); 267 outpatient cases (80.2%) underwent at least one office-based procedure. 124 patients (36.4%) were prescribed a self-applied therapy. 39 cases (11.4%) were admitted to day-hospital. 47 patients (13.8%) reported a medical complication related to GW treatment. Mean annual direct medical costs per patient were €242 for men and €332 for women. Mean costs per patient including productivity losses were €325 and €464 for men and women, respectively. CONCLUSION: This study is the first to identify therapeutic patterns and costs of GW in Italy. Treatment costs are in line with recent European estimates, whereas a wider use of office-based procedures instead of self-applied therapies was found.

Research paper thumbnail of Lipoprotein(a) and risk of myocardial infarction

Lipoprotein(a) and risk of myocardial infarction

Jama-journal of The American Medical Association, 1994

Research paper thumbnail of Lipoprotein(a) and risk of myocardial infarction

Lipoprotein(a) and risk of myocardial infarction

Jama-journal of The American Medical Association, 1994

Research paper thumbnail of Inflammation and Arterial Stiffness in Chronic Kidney Disease: Findings From the CRIC Study

American journal of hypertension, 2017

Chronic kidney disease (CKD) and arterial stiffness are associated with increased cardiovascular ... more Chronic kidney disease (CKD) and arterial stiffness are associated with increased cardiovascular morbidity and mortality. Inflammation is proposed to have a role in the development of arterial stiffness, and CKD is recognized as a proinflammatory state. Arterial stiffness is increased in CKD, and cross-sectional data has suggested a link between increased inflammatory markers in CKD and higher measures of arterial stiffness. However, no large scale investigations have examined the impact of inflammation on the progression of arterial stiffness in CKD. We performed baseline assessments of 5 inflammatory markers in 3,939 participants from the chronic renal insufficiency cohort (CRIC), along with serial measurements of arterial stiffness at 0, 2, and 4 years of follow-up. A total of 2,933 participants completed each of the follow-up stiffness measures. In cross-sectional analysis at enrollment, significant associations with at least 2 measures of stiffness were observed for fibrinogen,...

Research paper thumbnail of Etanercept Provides Improved Quality of Life Regardless of the Presence of Psoriatric Arthritis in Moderate/Severe Psoriasis Subjects from Central and Eastern Europe, Latin America and Asia

Value in Health, 2013

A509 all 3 studies were analysed using latent growth models to generate intercepts and slopes of ... more A509 all 3 studies were analysed using latent growth models to generate intercepts and slopes of change across trials for each patient, irrespective of treatment. Slopes of change were correlated to examine how closely DLQI changes mirrored UAS7 changes. Results: Results indicated that both measures showed large improvements over the course of the trials: UAS7 and DLQI scores were high at the start of the study reflecting moderate-severe CSU/CIU (UAS7) and a very large effect on patient's life (DLQI). Correlations between changes in DLQI and changes in UAS7 by study end were 0.88, 0.85, and 0.88, indicating high correspondence between the two measures. ConClusions: These results suggest that collecting DLQI information in-clinic can provide an excellent indication of the weekly UAS7 score, and is more efficient for clinical practice routine in assessing CSU/CIU patients.

Research paper thumbnail of Etanercept in moderate rheumatoid arthritis: PRESERVE study results from central/eastern Europe, Latin America and Asia

International Journal of Clinical Rheumatology, 2014

Research paper thumbnail of AO2 the Association Between Therapeutic Persistence and Non-Pharmacy Cost Among Anti-Tumor Necrosis Factors (Anti-TNFS) in the Treatment of Rheumatoid Arthritis

Research paper thumbnail of PSS49 Health Care Utilization Increases in the Year Following a Diagnosis of Psoriasis

Value in Health, 2008

one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from the... more one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from their first prostaglandin dispensing. Rates were compared across the three prostaglandin analogs using chi-square tests. Statistical and descriptive analyses were performed using SAS 9.1. RESULTS: In total, 9402 patients were included, aged 70 (ϮSD = 12) years, 56% were female. The proportions of patients requiring adjunctive therapy were 31%, 42%, and 31% for bimatoprost, latanoprost and travoprost, respectively. A significantly higher proportion of adjunctive therapy was associated with latanoprost users (bimatoprost vs. latanoprost: Chi-square = 26.59, p < 0.001; travoprost vs. latanoprost: Chi-square = 19.82, p < 0.001). Bimatoprost and travoprost did not differ Chi-square = 0.01, p = 0.94). CONCLUSIONS: Approximately 40% of continuous prostaglandin users required adjunctive therapy in the first 12 months. The latanoprost cohort had the highest rate of adjunctive therapy. Higher rates of adjunctive therapy use may result in higher overall patient care costs.

Research paper thumbnail of PSS48 Health Care Costs Increase in the Year Following a Diagnosis of Psoriasis

Value in Health, 2008

one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from the... more one intermittent dispensing of any IOPLA other than PAs in the 12-month follow-up period from their first prostaglandin dispensing. Rates were compared across the three prostaglandin analogs using chi-square tests. Statistical and descriptive analyses were performed using SAS 9.1. RESULTS: In total, 9402 patients were included, aged 70 (ϮSD = 12) years, 56% were female. The proportions of patients requiring adjunctive therapy were 31%, 42%, and 31% for bimatoprost, latanoprost and travoprost, respectively. A significantly higher proportion of adjunctive therapy was associated with latanoprost users (bimatoprost vs. latanoprost: Chi-square = 26.59, p < 0.001; travoprost vs. latanoprost: Chi-square = 19.82, p < 0.001). Bimatoprost and travoprost did not differ Chi-square = 0.01, p = 0.94). CONCLUSIONS: Approximately 40% of continuous prostaglandin users required adjunctive therapy in the first 12 months. The latanoprost cohort had the highest rate of adjunctive therapy. Higher rates of adjunctive therapy use may result in higher overall patient care costs.

Research paper thumbnail of PMS7 a 2-YEAR Evaluation of Infliximab's Effectiveness in the Treatment of Rheumatoid Arthritis in Actual Practice

Value in Health, 2009

after adjusting for age, gender, gout treatment, comorbidities, and medication use. RESULTS: We i... more after adjusting for age, gender, gout treatment, comorbidities, and medication use. RESULTS: We identifi ed 4821 AMI cases of which 1410 were women. The adjusted odds ratio (OR [95% CI]) of AMI among women with gout was 1.62 (1.21-2.16), higher than the adjusted OR for men (1.12 [0.99-1.26]; p-value for interaction 0.01). When we combined both women and men in our analyses, we found an overall adjusted OR of 1.15 (1.06-1.25). CONCLUSIONS: Using population-based data, we found a 62% increased risk for AMI among elderly women with gout, and a 15% increased risk for elderly gout patients overall. The association between hyperuricemia, a known precursor to gout, and cardiovascular disease provides a potential explanation for our fi ndings. Gender differences in serum uric acid levels and metabolism may further explain the difference in risks between women and men. Findings provide support for the aggressive management of cardiovascular risk factors in gout patients.

Research paper thumbnail of PAR18 a Five-Year Longitudinal Analysis Comparing Dose Changes for Patients with Rheumatoid Arthritis Taking Infliximab in a Medicare and in a Commercially Insured Population

Value in Health, 2007

time before switching were examined. Descriptive and Chi-Square statistical analyses were conduct... more time before switching were examined. Descriptive and Chi-Square statistical analyses were conducted to determine if differences existed among the three cohorts. RESULTS: A total of 1242 patients were analyzed: 490 (39.4%) infliximab plus MTX; 607 (48.9%) etanercept plus MTX; and 145 (11.7%) adalimumab plus MTX. Over two-thirds of the patients were female and the mean age was 50.0 years. The Charlson Co-morbidity Index and disease staging were similar among the three cohorts. During the 12 months follow-up, 39 patients (7.9%) in the infliximab plus MTX cohort switched compared to 72 patients (11.9%) in the etanercept group and 23 patients (15.9%) in the adalimumab group. Chi-Square analyses indicated the differences were statistically significant (p < 0.05) as compared to the infliximab plus MTX cohort. The infliximab group had an average time of 195.9 days before switching, compared to 183.1 days in the etanercept group, and 165.3 in the adalimumab group; this was not statistically significant. CONCLUSION: The rate of switching and time before switching are important measures of the effectiveness of RA treatment in real world practice. This study found that infliximab plus MTX is associated with a longer time before switching and a significantly lower switching rate, as compared to the other anti-TNFs. Further studies are needed to evaluate the impact of switching on clinical and economic outcomes.

Research paper thumbnail of PAR17 a Comparision of Therapeutic Persistence Among Anti-Tumor Necrosis Factors (Anti-TNFS) in the Treatment of Rheumatoid Arthritis

Value in Health, 2007

time before switching were examined. Descriptive and Chi-Square statistical analyses were conduct... more time before switching were examined. Descriptive and Chi-Square statistical analyses were conducted to determine if differences existed among the three cohorts. RESULTS: A total of 1242 patients were analyzed: 490 (39.4%) infliximab plus MTX; 607 (48.9%) etanercept plus MTX; and 145 (11.7%) adalimumab plus MTX. Over two-thirds of the patients were female and the mean age was 50.0 years. The Charlson Co-morbidity Index and disease staging were similar among the three cohorts. During the 12 months follow-up, 39 patients (7.9%) in the infliximab plus MTX cohort switched compared to 72 patients (11.9%) in the etanercept group and 23 patients (15.9%) in the adalimumab group. Chi-Square analyses indicated the differences were statistically significant (p < 0.05) as compared to the infliximab plus MTX cohort. The infliximab group had an average time of 195.9 days before switching, compared to 183.1 days in the etanercept group, and 165.3 in the adalimumab group; this was not statistically significant. CONCLUSION: The rate of switching and time before switching are important measures of the effectiveness of RA treatment in real world practice. This study found that infliximab plus MTX is associated with a longer time before switching and a significantly lower switching rate, as compared to the other anti-TNFs. Further studies are needed to evaluate the impact of switching on clinical and economic outcomes.

Research paper thumbnail of PSK4 Cost Comparison Between Two Anti-Tumor Necrosis Factor (Anti-TNF) Therapies in Patients with Psoriasis Using Average Sales Price

Research paper thumbnail of Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Rheumatology, 2011

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumo... more Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX.

Research paper thumbnail of Improvement in hemoglobin levels in patients with ankylosing spondylitis treated with infliximab

Arthritis Care & Research, 2009

ObjectiveAnemia is a common complication in patients with inflammatory diseases such as ankylosin... more ObjectiveAnemia is a common complication in patients with inflammatory diseases such as ankylosing spondylitis (AS). This post hoc analysis of a large, randomized, placebo‐controlled trial examined the effect of infliximab on hemoglobin levels, physical function, and fatigue in patients with AS.MethodsPatients received infliximab 5 mg/kg (n = 188) or placebo (n = 68) at weeks 0, 2, 6, 12, and 18. Hemoglobin, interleukin‐6 (IL‐6), and C‐reactive protein (CRP) levels, fatigue (visual analog scale [VAS]), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]), and disease activity were evaluated at baseline and week 24. Anemia was defined as a hemoglobin level <12 gm/dl for women and <13 gm/dl for men.ResultsAt baseline, 11 placebo group patients (16.2%) and 37 infliximab group patients (19.7%) had anemia. Of these, more infliximab‐treated patients achieved normal hemoglobin levels at week 24 compared with patients receiving placebo (70.3% versus 27.3%; P = 0.01...

Research paper thumbnail of Department of Rheumatology

Assessment b y MRI of infl ammation and damage in rheumatoid arthritis patients with methotrexate... more Assessment b y MRI of infl ammation and damage in rheumatoid arthritis patients with methotrexate inadequate response receiving golimumab: results of the GO-FORWARD trial

Research paper thumbnail of PAR6 a Comparison of Health Care Costs in Patients with Psoriatic Arthritis (Psa) Who Received Etanercept (Eta), Eta Plus Methotrexate (MTX), Infliximab (Inf), or Inf Plus MTX

Research paper thumbnail of Identifying Preliminary Domains to Detect and Measure Rheumatoid Arthritis Flares: Report of the OMERACT 10 RA Flare Workshop

The Journal of Rheumatology, 2011

Background.While disease flares in rheumatoid arthritis (RA) are a recognized aspect of the disea... more Background.While disease flares in rheumatoid arthritis (RA) are a recognized aspect of the disease process, there is limited formative research to describe them.Methods.The Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Definition Working Group is conducting an international research project to understand the specific characteristics and impact of episodic disease worsening, or “flare,” so that outcome measures can be developed or modified to reflect this uncommonly measured, but very real and sometimes disabling RA disease feature. Patient research partners provided critical insights into the multidimensional nature of flare. The perspectives of patients and healthcare and research professionals are being integrated to ensure that any outcome measurement to detect flares fulfills the first OMERACT criteria of Truth. Through an iterative data-driven Delphi process, a preliminary list of key domains has been identified to evaluate flare.Results.At OMERACT 10, co...

Research paper thumbnail of Correction: The impact of anti-drug antibodies on drug concentrations and clinical outcomes in rheumatoid arthritis patients treated with adalimumab, etanercept, or infliximab: Results from a multinational, real-world clinical practice, non-interventional study

Research paper thumbnail of High levels of antipeptidoglycan antibodies in PsA and other seronegative arthritides

High levels of antipeptidoglycan antibodies in PsA and other seronegative arthritides

The Journal of Rheumatology

Bacterial cell wall peptidoglycan, the arthritogenic factor in adjuvant induced arthritis, may al... more Bacterial cell wall peptidoglycan, the arthritogenic factor in adjuvant induced arthritis, may also be involved in the etiology of some human rheumatic diseases. Patients with some seronegative rheumatic diseases like ankylosing spondylitis and Reiter&amp;amp;#39;s syndrome have elevated antibody titers to peptidoglycan. Using an ELISA with soluble peptidoglycan, we examined the sera of 110 patients with psoriatic arthritis, psoriasis without arthritis and a variety of other joint diseases. Antibody titers were significantly higher (p less than 0.001) among the 22 patients with psoriatic arthritis than the 16 patients with psoriasis without arthritis. Patients with other seronegative arthritides also had higher levels of antipeptidoglycan antibodies than patients with rheumatoid (seropositive) arthritis, osteoarthritis and crystal induced arthritis. Our results furnish additional support for the suggestion for a bacterial role in the pathogenesis of psoriatic and some other seronegative arthritides.

Research paper thumbnail of PSK6 Impact of Psoriasis Disease on Annual Total Health Care Costs and Resource Utilization Among Medicaid Recipients

Value in Health, 2007

Human Genital warts (GW) are common and increasing in sexually active people. Ninety percent of G... more Human Genital warts (GW) are common and increasing in sexually active people. Ninety percent of GW are due to Human Papillomavirus (HPV) types 6 and 11. Current treatments can be long, painful, sometimes fail, and relapses are frequent. The objective of this study was to assess treatment patterns and costs associated with the treatment of GW in Italy. Such estimation is important to assess the cost-effectiveness of Gardasil®, the quadrivalent HPV vaccine (types 6, 11, 16 & 18). METHODS: A national retrospective observational study was designed to involve 40 investigators in public gynaecological, dermatological, and sexually transmitted disease centres, enrolling 360 patients aged 14-64 years, with newly diagnosed or recurrent GW. Investigators documented medical resource utilisation and absence from work for the treatment of GW and related complications in 2005 (physician visits, diagnostic tests, medications, office-based treatments, hospitalisations, days off work). Annual direct medical costs per patient were estimated along with productivity losses from the societal perspective. RESULTS: A total of 28 investigators enrolled 341 patients (189 men and 152 women); 8 patients were admitted directly to day-hospital and 333 (97.7%) had at least one investigator visit (on average 3.4 visits); 267 outpatient cases (80.2%) underwent at least one office-based procedure. 124 patients (36.4%) were prescribed a self-applied therapy. 39 cases (11.4%) were admitted to day-hospital. 47 patients (13.8%) reported a medical complication related to GW treatment. Mean annual direct medical costs per patient were €242 for men and €332 for women. Mean costs per patient including productivity losses were €325 and €464 for men and women, respectively. CONCLUSION: This study is the first to identify therapeutic patterns and costs of GW in Italy. Treatment costs are in line with recent European estimates, whereas a wider use of office-based procedures instead of self-applied therapies was found.

Research paper thumbnail of Lipoprotein(a) and risk of myocardial infarction

Lipoprotein(a) and risk of myocardial infarction

Jama-journal of The American Medical Association, 1994

Research paper thumbnail of Lipoprotein(a) and risk of myocardial infarction

Lipoprotein(a) and risk of myocardial infarction

Jama-journal of The American Medical Association, 1994