Publications by authors named "Guillermo Carvajal-Alegria"
Antibody gene transfer offers a promising solution to the high cost and frequent administration of monoclonal antibodies (mAbs), enabling the body to produce its own drugs economically and sustainably. This review addresses the challenges faced by antibody therapies, including economic and environmental impacts, as well as patient-related issues such as efficacy and tolerance. We propose that direct protein production, or autologous production, via plasmid DNA (pDNA) injection may address some of these challenges.
View Article and Find Full Text PDFObjective: The SEMAPHORE trial evaluated the efficacy and safety of tocilizumab (TCZ) treatment in patients with glucocorticoid (GC)-dependent polymyalgia rheumatica (PMR). TCZ reduced GC dose and disease activity at week 24. This study aimed to assess relapse rates after stopping TCZ treatment in patients achieving remission at week 24.
View Article and Find Full Text PDFObjectives: Insight into the immunopathology of polymyalgia rheumatica (PMR) is scarce and mainly derived from peripheral blood studies. The limited data available point towards macrophages as potential key players in PMR. This study aimed to identify the factors driving proinflammatory macrophage development and their functions in the immunopathology of PMR.
View Article and Find Full Text PDFBackground: Moderate doses of glucocorticoids result in improvements in nearly all patients with polymyalgia rheumatica, but related adverse events are common in older individuals. We aimed to evaluate whether treatment with baricitinib (a Janus kinase 1/2 inhibitor) results in disease control without the use of oral glucocorticoids in people with recent-onset polymyalgia rheumatica.
Methods: We conducted a randomised, double-blind, placebo-controlled, parallel-group trial at six expert centres in France.
Objectives: Salivary gland ultrasound (SGUS) has an interest in primary Sjögren's disease (pSD) for diagnosis, but the evolution of parenchymal lesions over time is unknown. The objective of this study was to assess the severity of ultrasound abnormalities in relation to pSD duration from the time of buccal dryness onset.
Methods: In this cross-sectional international multicentre study, patients with pSD according to the 2002 or 2016 ACR/EULAR classification criteria were included.
Article Synopsis
- The purpose of this project was to update the 2016 recommendations regarding the management of immunosuppressants or biologics in patients with giant cell arteritis (GCA).
- A task force of 18 physicians developed 26 validated recommendations after thorough discussion and a >85% consensus process.
- Key recommendations include using subcutaneous tocilizumab (TCZ) as a first-line treatment when glucocorticoid-sparing is needed, initiating TCZ at diagnosis for patients with specific high-risk conditions, and considering TCZ or methotrexate if glucocorticoid discontinuation is not feasible after 12 months.
French protocol for the diagnosis and management of giant cell arteritis.
Rev Med Interne
January 2025
Article Synopsis
- Giant cell arteritis (GCA) primarily affects women over 50, causing symptoms like headaches and jaw pain, and can lead to severe complications like vision loss due to eye involvement.
- Diagnosis relies on advanced imaging techniques such as FDG-PET and CT scans, while the temporal artery biopsy is considered the gold standard.
- Urgent treatment with high doses of corticosteroids is critical to prevent vision loss, and long-term management is necessary to monitor for recurrence and potential cardiovascular issues.
Article Synopsis
- The French Society of Rheumatology updated its recommendations for managing rheumatoid arthritis (RA) based on the latest EULAR guidelines, involving a wide range of experts and patient representatives.
- The guidelines stress the importance of shared decision-making and comprehensive management for individuals with RA or those at risk, focusing on both drug and non-drug therapies.
- Additional emphasis is on the diagnosis and treatment of RA-related interstitial lung disease (RA-ILD), highlighting the need for collaboration between rheumatologists and pulmonologists for effective management.
Article Synopsis
- A web-based ecological momentary assessment (EMA) tool was developed to monitor symptoms in patients with Sjögren's disease (SjD), focusing on daily variability in symptoms over three months.
- The study involved 45 participants, primarily women, who recorded their symptoms through the WebApp, allowing comparisons with traditional paper questionnaires.
- Results showed a high level of user satisfaction (SUS score of 90) and effective symptom tracking, confirming the tool's usefulness for accurately capturing daily experiences of SjD patients.
Introduction: The therapeutic arsenal for psoriatic arthritis (PsA) is gradually being expanded, but the use of these targeted treatments must be optimal. Our objective was to guide the choice of targeted therapy to use as first-line treatment in a patient with PsA in whom methotrexate (MTX) has failed.
Methods: We searched for literature data in PubMed with the appropriate keywords for the six points of our argument: (1) the tolerance of MTX; (2) the efficacy of targeted therapies combined with MTX vs monotherapy; (3) immunogenicity of anti-tumor necrosis alpha (TNFα) monoclonal antibodies (mAbs); (4) immunogenicity of anti-interleukin (IL)-17, anti-IL-12/23, and anti-IL-23 mAbs; (5) the therapeutic maintenance of anti-TNFα mAbs when combined or not with MTX; (6) the therapeutic maintenance of anti-IL-17 vs anti-TNFα mAbs as first-line targeted therapy.
Introduction: The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for polymyalgia rheumatic (PMR) and giant cell arteritis (GCA), in the coming years.
Methods: We conducted a systematic review of 17 national and international clinical trial databases for all disease-modifying anti-rheumatic drugs (DMARDs) for PMR and GCA that are already marketed, in clinical development or withdrawn. The search was performed on January 2024, with the keywords "polymyalgia rheumatica" and "giant cell arteritis".
Objective: To develop recommendations for the routine management of patients with polymyalgia rheumatica (PMR).
Methods: Following standard procedures, a systematic review of the literature by five supervised junior rheumatologists, based on the questions selected by the steering committee (5 senior rheumatologists), was used as the basis for working meetings, followed by a one-day plenary meeting with the working group (15 members), leading to the development of the wording and determination of the strength of the recommendations and the level of agreement of the experts.
Results: Five general principles and 19 recommendations were drawn up.
Article Synopsis
- The study focused on evaluating the correlation and concordance between different activity score indices for Polymyalgia Rheumatica (PMR), particularly including the C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS).
- Data were analyzed from the SEMAPHORE trial, comparing the efficacy of tocilizumab to placebo in PMR patients while measuring various PMR-ASs at multiple visits.
- Results showed an excellent correlation between the activity scores, indicating that in trials with drugs affecting CRP levels, these derived scores can be reliably used.
Introduction: Major salivary gland ultrasonography (SGUS) demonstrated its good metric properties as an outcome measure for diagnosing primary Sjögren's disease (SD). The objective was to assess SGUS reliability among sonographers with different levels of experience, using web training.
Methods: Sonographers from expert centers participated in the reliability exercise.
Background: Medium-dose glucocorticoids can improve symptoms in nearly all patients with polymyalgia rheumatica. According to its good safety profile, abatacept could be used instead of glucocorticoids in early polymyalgia rheumatica. We aimed to determine whether the efficacy of abatacept is sufficient to justify larger studies in early polymyalgia rheumatica.
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- Research on giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) has gained importance recently, as physicians encounter challenges in diagnosing and treating these conditions, necessitating the search for helpful biomarkers.
- The review highlights various clinical situations where biomarkers can aid in diagnosis, predict relapses or complications, monitor disease activity, and guide treatment decisions for GCA and PMR.
- It discusses the broad range of biomarkers studied, including common markers like C-reactive protein and more specific inflammatory indicators, while stressing the need for consistency and careful evaluation in research on GCA and PMR biomarkers.
Background: Janus kinase inhibitors (JAKis) is a new therapeutic class in autoimmune and inflammatory diseases. Four molecules are approved in rheumatoid arthritis (RA) in Europe. Recently, questions have raised about adverse events.
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- Anterior atlanto-axial subluxation (AAS) is a condition that can develop in rheumatoid arthritis (RA) patients and can lead to severe neurological problems; this study aimed to find the prevalence and predictors of AAS after 12 years in early polyarthritis patients.
- The research followed 323 patients enrolled in the ESPOIR cohort, finding that only 4.6% had AAS, with specific factors like IgA RFs at baseline and CRP/RFs after 10 years being associated with the condition.
- Despite some associations found, the rarity of severe AAS cases suggests that these findings may not have significant clinical importance for predicting the condition's occurrence.
Article Synopsis
- This study investigated the effectiveness of tocilizumab, an IL-6 antagonist, for treating glucocorticoid-dependent polymyalgia rheumatica, a condition with limited treatment options.
- Conducted as a double-blind, placebo-controlled trial, 101 patients participated over roughly three years, comparing the effects of tocilizumab and placebo alongside a standardized reduction of prednisone.
- Results showed that 67.3% of participants receiving tocilizumab met the primary efficacy goal, compared to 31.4% in the placebo group, indicating a significant difference in disease activity reduction.
Article Synopsis
- The study aimed to evaluate the usefulness of repeated minor salivary gland biopsies (MSGB) in diagnosing Sjögren's syndrome (SS) in patients suspected of having the condition.
- Out of 93 patients analyzed, the first MSGB was positive in 23 cases, showing that those with positive results had more serious symptoms and relevant antibodies.
- The results indicated a low agreement between the two biopsies, and while a second MSGB did lead to diagnostic changes for a few patients, this was mainly when their clinical symptoms had significantly progressed.
Objectives: Many study groups have developed scores to reflect disease activity. The result of this fragmented process is a multitude of disease activity scores, even for a single disease. We aimed to identify and standardise disease activity scores in rheumatologyMETHODS: We conducted a literature review on disease activity criteria using both a manual approach and in-house computer software (BIBOT) that applies natural language processing to automatically identify and interpret important words in abstracts published in English between 1.
View Article and Find Full Text PDFObjectives: To assess, in patients with recent-onset arthritis, whether a self-reported familial occurrence of rheumatoid arthritis (RA) is associated with a clinical presentation of the disease, final diagnosis, long-term outcome and treatment decisions.
Methods: The study was conducted from data of patients included between 2002 and 2005 in the early arthritis ESPOIR cohort. Patients were recruited on the basis of having at least two swollen joints for >6 weeks and <6 months, no other diagnosis than RA and no previous exposure to glucocorticoids or disease-modifying antirheumatic drugs (DMARDs).
Objectives: To determine whether acetabular dysplasia is associated with hip pain at physical examination among adults with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA).
Methods: This cross-sectional ancillary study was conducted on the prospective DESIR cohort, which enrolled patients aged 18-50 years who had recent-onset IBP. Two readers used antero-posterior pelvic radiographs to assess the Tönnis angle, acetabular angle (AA), lateral centre-edge angle (LCEA), and femoral head extrusion index (FHEI).