37 results on '"Boffini, N"'
Search Results
2. AB0212 SECUKINUMAB IN PATIENTS WITH SPONDYLARTHRITIS AND A HISTORY OF MALIGNANCY: EXPERIENCE FROM A LARGE MONOCENTRIC COHORT
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Farina, N., primary, Tomelleri, A., additional, Boffini, N., additional, Cariddi, A., additional, Calvisi, S. L., additional, Baldissera, E., additional, Matucci-Cerinic, M., additional, and Dagna, L., additional
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- 2024
- Full Text
- View/download PDF
3. AB0201 RETENTION RATES OF DIFFERENT JANUS KINASES INHIBITORS IN RHEUMATOID ARTHRITIS: EXPERIENCE FROM A LARGE MONOCENTRIC COHORT
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Farina, N., primary, Tomelleri, A., additional, Boffini, N., additional, Cariddi, A., additional, Calvisi, S. L., additional, Viapiana, N., additional, Baldissera, E., additional, Matucci-Cerinic, M., additional, and Dagna, L., additional
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- 2024
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4. AB1103 UPADACITINIB REAL-LIFE EFFICACY AND SAFETY IN PSORIATIC ARTHRITIS: RESULTS AT 24 WEEKS OF A MULTICENTRIC ITALIAN STUDY (UP-REAL)
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Paci, V., primary, Luchetti, M. M., additional, Carletto, A., additional, Zabotti, A., additional, Luciano, N., additional, Ramonda, R., additional, Dagna, L., additional, Sandri, G., additional, Salvarani, C., additional, Chimenti, M. S., additional, Possemato, N., additional, Piccinelli, A., additional, Giovannini, I., additional, Striani, G., additional, Boffini, N., additional, Pantano, I., additional, Benfaremo, D., additional, Ciccia, F., additional, Selmi, C., additional, and Moroncini, G., additional
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- 2023
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- View/download PDF
5. GM-CSF blockade with mavrilimumab in severe COVID-19 pneumonia and systemic hyperinflammation: a single-centre, prospective cohort study
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De Luca G., Cavalli G., Campochiaro C., Della-Torre E., Angelillo P., Tomelleri A., Boffini N., Tentori S., Mette F., Farina N., Rovere-Querini P., Ruggeri A., D'Aliberti T., Scarpellini P., Landoni G., De Cobelli F., Paolini J. F., Zangrillo A., Tresoldi M., Trapnell B. C., Ciceri F., Dagna L., DE LUCA , GIACOMO, De Luca, G., Cavalli, G., Campochiaro, C., Della-Torre, E., Angelillo, P., Tomelleri, A., Boffini, N., Tentori, S., Mette, F., Farina, N., Rovere-Querini, P., Ruggeri, A., D'Aliberti, T., Scarpellini, P., Landoni, G., De Cobelli, F., Paolini, J. F., Zangrillo, A., Tresoldi, M., Trapnell, B. C., Ciceri, F., Dagna, L., and DE LUCA, Giacomo
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Mechanical ventilation ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Immunology ,medicine.disease ,Article ,Blockade ,Single centre ,Pneumonia ,Mavrilimumab ,Rheumatology ,Internal medicine ,medicine ,Immunology and Allergy ,Prospective cohort study ,Adverse effect ,business - Abstract
Summary Background Mortality in patients with COVID-19 pneumonia and systemic hyperinflammation is high. We aimed to examine whether mavrilimumab, an anti-granulocyte–macrophage colony-stimulating factor receptor-α monoclonal antibody, added to standard management, improves clinical outcomes in patients with COVID-19 pneumonia and systemic hyperinflammation. Methods This single-centre prospective cohort study included patients aged 18 years or older who were admitted to San Raffaele Hospital (Milan, Italy) with severe COVID-19 pneumonia, hypoxia, and systemic hyperinflammation. Patients received a single intravenous dose (6 mg/kg) of mavrilimumab added to standard care given by the hospital at the time. The control group consisted of contemporaneous patients with similar baseline characteristics who received standard care at the same hospital. The main outcome was time to clinical improvement (defined as improvement of two or more points on the seven-point ordinal scale of clinical status). Other outcomes included proportion of patients achieving clinical improvement, survival, mechanical ventilation-free survival, and time to fever resolution. Adverse events were monitored daily. Findings Between March 17 and April 15, 2020, 13 non-mechanically ventilated patients (median age 57 years [IQR 52–58], 12 [92%] men) received mavrilimumab and 26 patients (median age 60 [IQR 53–67], 17 [65%] men) in the control group received standard care. During the 28-day follow-up, no patients in the mavrilimumab group died, and seven (27%) patients in the control group died (p=0·086). At day 28, all patients in the mavrilimumab group and 17 (65%) patients in the control group showed clinical improvement (p=0·030), with earlier improvement in the mavrilimumab than in the control group (mean time to improvement 8 days [IQR 5 to 11] vs 19 days [11 to >28], p=0·0001). By day 28, one (8%) patient in the mavrilimumab group progressed to mechanical ventilation compared with nine (35%) patients in the control group who progressed to mechanical ventilation or died (p=0·14). By day 14, fever resolved in ten (91%) of 11 febrile patients in the mavrilimumab group, compared with 11 (61%) of 18 febrile patients in the control group (p=0·18); fever resolution was faster in mavrilimumab recipients versus controls (median time to resolution 1 day [IQR 1 to 2] vs 7 days [3 to >14], p=0·0093). Mavrilimumab was well tolerated, with no infusion reactions. Three (12%) patients in the control group developed infectious complications. Interpretation Mavrilimumab treatment was associated with improved clinical outcomes compared with standard care in non-mechanically ventilated patients with severe COVID-19 pneumonia and systemic hyperinflammation. Treatment was well tolerated. Confirmation of efficacy requires controlled testing. Funding IRCCS San Raffaele Scientific Institute.
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- 2020
6. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study
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Cavalli G, De Luca G, Campochiaro C, Della-Torre E, Ripa M, Canetti D, Oltolini C, Castiglioni B, Tassan Din C, Boffini N, Tomelleri A, Farina N, Ruggeri A, Rovere-Querini P, Di Lucca G, Martinenghi S, Scotti R, Tresoldi M, Ciceri F, Landoni G, Zangrillo A, Scarpellini P, Dagna L, DE LUCA , GIACOMO, Cavalli, G, De Luca, G, Campochiaro, C, Della-Torre, E, Ripa, M, Canetti, D, Oltolini, C, Castiglioni, B, Tassan Din, C, Boffini, N, Tomelleri, A, Farina, N, Ruggeri, A, Rovere-Querini, P, Di Lucca, G, Martinenghi, S, Scotti, R, Tresoldi, M, Ciceri, F, Landoni, G, Zangrillo, A, Scarpellini, P, Dagna, L, and DE LUCA, Giacomo
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Mechanical ventilation ,ARDS ,Anakinra ,medicine.medical_specialty ,education.field_of_study ,business.industry ,medicine.medical_treatment ,Standard treatment ,Immunology ,Population ,Retrospective cohort study ,medicine.disease ,Article ,Rheumatology ,Intensive care ,Internal medicine ,medicine ,Immunology and Allergy ,Respiratory function ,business ,education ,medicine.drug - Abstract
Summary Background Mortality of patients with coronavirus disease 2019 (COVID-19), acute respiratory distress syndrome (ARDS), and systemic inflammation is high. In areas of pandemic outbreak, the number of patients can exceed maximum capacity of intensive care units (ICUs), and, thus, these individuals often receive non-invasive ventilation outside of the ICU. Effective treatments for this population are needed urgently. Anakinra is a recombinant interleukin-1 receptor antagonist that might be beneficial in this patient population. Methods We conducted a retrospective cohort study at the San Raffaele Hospital in Milan, Italy. We included consecutive patients (aged ≥18 years) with COVID-19, moderate-to-severe ARDS, and hyperinflammation (defined as serum C-reactive protein ≥100 mg/L, ferritin ≥900 ng/mL, or both) who were managed with non-invasive ventilation outside of the ICU and who received standard treatment of 200 mg hydroxychloroquine twice a day orally and 400 mg lopinavir with 100 mg ritonavir twice a day orally. We compared survival, mechanical ventilation-free survival, changes in C-reactive protein, respiratory function, and clinical status in a cohort of patients who received additional treatment with anakinra (either 5 mg/kg twice a day intravenously [high dose] or 100 mg twice a day subcutaneously [low dose]) with a retrospective cohort of patients who did not receive anakinra (referred to as the standard treatment group). All outcomes were assessed at 21 days. This study is part of the COVID-19 Biobank study, which is registered with ClinicalTrials.gov , NCT04318366 . Findings Between March 17 and March 27, 2020, 29 patients received high-dose intravenous anakinra, non-invasive ventilation, and standard treatment. Between March 10 and March 17, 2020, 16 patients received non-invasive ventilation and standard treatment only and comprised the comparison group for this study. A further seven patients received low-dose subcutaneous anakinra in addition to non-invasive ventilation and standard treatment; however, anakinra treatment was interrupted after 7 days because of a paucity of effects on serum C-reactive protein and clinical status. At 21 days, treatment with high-dose anakinra was associated with reductions in serum C-reactive protein and progressive improvements in respiratory function in 21 (72%) of 29 patients; five (17%) patients were on mechanical ventilation and three (10%) died. In the standard treatment group, eight (50%) of 16 patients showed respiratory improvement at 21 days; one (6%) patient was on mechanical ventilation and seven (44%) died. At 21 days, survival was 90% in the high-dose anakinra group and 56% in the standard treatment group (p=0·009). Mechanical ventilation-free survival was 72% in the anakinra group versus 50% in the standard treatment group (p=0·15). Bacteraemia occurred in four (14%) of 29 patients receiving high-dose anakinra and two (13%) of 16 patients receiving standard treatment. Discontinuation of anakinra was not followed by inflammatory relapses. Interpretation In this retrospective cohort study of patients with COVID-19 and ARDS managed with non-invasive ventilation outside of the ICU, treatment with high-dose anakinra was safe and associated with clinical improvement in 72% of patients. Confirmation of efficacy will require controlled trials. Funding None.
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- 2020
7. Efficacy and safety of baricitinib in 446 patients with rheumatoid arthritis: A real-life multicentre study
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Guidelli, G, Viapiana, O, Luciano, N, De Santis, M, Boffini, N, Quartuccio, L, Birra, D, Conticini, E, Chimenti, M, Bazzani, C, Bruschi, E, Riva, M, Canziani, L, Bianchi, G, Pozzi, M, Limonta, M, Gorla, R, Perricone, R, Frediani, B, Moscato, P, De Vita, S, Dagna, L, Rossini, M, Selmi, C, Guidelli G. M., Viapiana O., Luciano N., De Santis M., Boffini N., Quartuccio L., Birra D., Conticini E., Chimenti M. S., Bazzani C., Bruschi E., Riva M., Canziani L. M., Bianchi G., Pozzi M. R., Limonta M., Gorla R., Perricone R., Frediani B., Moscato P., De Vita S., Dagna L., Rossini M., Selmi C., Guidelli, G, Viapiana, O, Luciano, N, De Santis, M, Boffini, N, Quartuccio, L, Birra, D, Conticini, E, Chimenti, M, Bazzani, C, Bruschi, E, Riva, M, Canziani, L, Bianchi, G, Pozzi, M, Limonta, M, Gorla, R, Perricone, R, Frediani, B, Moscato, P, De Vita, S, Dagna, L, Rossini, M, Selmi, C, Guidelli G. M., Viapiana O., Luciano N., De Santis M., Boffini N., Quartuccio L., Birra D., Conticini E., Chimenti M. S., Bazzani C., Bruschi E., Riva M., Canziani L. M., Bianchi G., Pozzi M. R., Limonta M., Gorla R., Perricone R., Frediani B., Moscato P., De Vita S., Dagna L., Rossini M., and Selmi C.
- Abstract
Objective Baricitinib, an oral Janus kinase (JAK) 1-2 inhibitor, is currently used along biologic DMARDs (bDMARDs) after the failure of methotrexate (MTX) in rheumatoid arthritis (RA). We investigated the efficacy and safety of baricitinib in real life. Methods We prospectively enrolled 446 RA patients treated with baricitinib from 11 Italian centres. Patients were evaluated at baseline and after 3, 6, and 12 months. They were arrayed based on previous treatments as bDMARD-naïve and bDMARD-insufficient responders (IR) after the failure or intolerance to bDMARDs. A sub-analysis differentiated the effects of methotrexate (MTX) and the use of oral glucocorticoids (OGC). Results Our cohort included 150 (34%) bDMARD-naïve and 296 (66%) bDMARD-IR patients, with 217 (49%) using baricitinib as monotherapy. Considering DAS-28-CRP as the primary outcome, at 3 and 6 months, 114/314 (36%) and 149/289 (51.6%) patients achieved remission, while those in low disease activity (LDA) were 62/314 (20%) and 46/289 (15.9%), respectively; finally at 12 months 81/126 (64%) were in remission and 21/126 (17%) in LDA. At all-timepoints up to 12 months, bDMARDs-naïve patients demonstrated a better clinical response, independently of MTX. A significant reduction in the OGC dose was observed at 3 and 12 months in all groups. The serum positivity for both rheumatoid factors (RF) and anti-citrullinated protein antibodies (ACPA) conferred a lower risk of stopping baricitinib due to inefficacy. Fifty-eight (13%) patients discontinued baricitinib due to adverse events, including thrombotic events and herpes zoster reactivation. Conclusion Real-life data confirm the efficacy and safety profiles of baricitinib in patients with RA and provide evidence that drug survival is higher in bDMARDs-naïve and seropositive patients.
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- 2021
8. Efficacy and safety of baricitinib in 446 patients with rheumatoid arthritis: a real-life multicentre study
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Giacomo Maria Guidelli, Viapiana, O., Luciano, N., Santis, M., Boffini, N., Quartuccio, L., Birra, D., Conticini, E., Chimenti, M. S., Bazzani, C., Bruschi, E., Riva, M., Canziani, L. M., Bianchi, G., Pozzi, M. R., Limonta, M., Gorla, R., Perricone, R., Frediani, B., Moscato, P., Vita, S., Dagna, L., Rossini, M., and Selmi, C.
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rheumatoid arthritis ,Sulfonamides ,Immunology ,Settore MED/16 ,baricitinib, dmards, rheumatoid arthritis ,Arthritis, Rheumatoid ,Methotrexate ,Treatment Outcome ,Rheumatology ,Purines ,Antirheumatic Agents ,baricitinib ,Azetidines ,Humans ,Pyrazoles ,Immunology and Allergy ,Drug Therapy, Combination ,dmards - Abstract
Baricitinib, an oral Janus kinase (JAK) 1-2 inhibitor, is currently used along biologic DMARDs (bDMARDs) after the failure of methotrexate (MTX) in rheumatoid arthritis (RA). We investigated the efficacy and safety of baricitinib in real life.We prospectively enrolled 446 RA patients treated with baricitinib from 11 Italian centres. Patients were evaluated at baseline and after 3, 6, and 12 months. They were arrayed based on previous treatments as bDMARD-naïve and bDMARD-insufficient responders (IR) after the failure or intolerance to bDMARDs. A sub-analysis differentiated the effects of methotrexate (MTX) and the use of oral glucocorticoids (OGC).Our cohort included 150 (34%) bDMARD-naïve and 296 (66%) bDMARD-IR patients, with 217 (49%) using baricitinib as monotherapy. Considering DAS-28-CRP as the primary outcome, at 3 and 6 months, 114/314 (36%) and 149/289 (51.6%) patients achieved remission, while those in low disease activity (LDA) were 62/314 (20%) and 46/289 (15.9%), respectively; finally at 12 months 81/126 (64%) were in remission and 21/126 (17%) in LDA. At all-timepoints up to 12 months, bDMARDs-naïve patients demonstrated a better clinical response, independently of MTX. A significant reduction in the OGC dose was observed at 3 and 12 months in all groups. The serum positivity for both rheumatoid factors (RF) and anti-citrullinated protein antibodies (ACPA) conferred a lower risk of stopping baricitinib due to inefficacy. Fifty-eight (13%) patients discontinued baricitinib due to adverse events, including thrombotic events and herpes zoster reactivation.Real-life data confirm the efficacy and safety profiles of baricitinib in patients with RA and provide evidence that drug survival is higher in bDMARDs-naïve and seropositive patients.
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- 2021
9. Publisher Correction: Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19 (Scientific Reports, (2020), 10, 1, (21291), 10.1038/s41598-020-78039-1)
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Spagnuolo V., Guffanti M., Galli L., Poli A., Querini P. R., Ripa M., Clementi M., Scarpellini P., Lazzarin A., Tresoldi M., Dagna L., Zangrillo A., Ciceri F., Castagna A., Andolina A., Redaelli M. B., Baldissera E., Bigai G., Bigoloni A., Boffini N., Borio G., Bossolasco S., Bruzzesi E., Calabro M. G., Calvisi S., Campochiaro C., Canetti D., Canti V., Castellani J., Castiglioni B., Cavalli G., Cavallo L., Cernuschi M., Chiurlo M., Cilla M., Cinel E., Cinque P., Conte C., Da Prat V., Danise A., De Lorenzo R., De Luca G., Dell'Acqua A., Dell'Acqua R., Della-Torre E., Torre L. D., Di Terlizzi G., Dumea I., Farolfi F., Ferrante M., Frangi C., Fumagalli L., Gallina G., Germinario B., Gianotti N., Hasson H., Lalla F., Landoni G., Lanzillotta M., Voti R. L., Mastrangelo A., Messina E., Moizo E., Montagna M., Monti G., Morsica G., Muccini C., Nozza S., Oltolini C., Pascali M., Patrizi A., Pieri M., Prestifilippo D., Ramirez G., Ranzenigo M., Sapienza J., Sartorelli S., Seghi F., Tambussi G., Din C. T., Tomelleri A., Turi S., Uberti-Foppa C., Vinci C., Spagnuolo, V., Guffanti, M., Galli, L., Poli, A., Querini, P. R., Ripa, M., Clementi, M., Scarpellini, P., Lazzarin, A., Tresoldi, M., Dagna, L., Zangrillo, A., Ciceri, F., Castagna, A., Andolina, A., Redaelli, M. B., Baldissera, E., Bigai, G., Bigoloni, A., Boffini, N., Borio, G., Bossolasco, S., Bruzzesi, E., Calabro, M. G., Calvisi, S., Campochiaro, C., Canetti, D., Canti, V., Castellani, J., Castiglioni, B., Cavalli, G., Cavallo, L., Cernuschi, M., Chiurlo, M., Cilla, M., Cinel, E., Cinque, P., Conte, C., Da Prat, V., Danise, A., De Lorenzo, R., De Luca, G., Dell'Acqua, A., Dell'Acqua, R., Della-Torre, E., Torre, L. D., Di Terlizzi, G., Dumea, I., Farolfi, F., Ferrante, M., Frangi, C., Fumagalli, L., Gallina, G., Germinario, B., Gianotti, N., Hasson, H., Lalla, F., Landoni, G., Lanzillotta, M., Voti, R. L., Mastrangelo, A., Messina, E., Moizo, E., Montagna, M., Monti, G., Morsica, G., Muccini, C., Nozza, S., Oltolini, C., Pascali, M., Patrizi, A., Pieri, M., Prestifilippo, D., Ramirez, G., Ranzenigo, M., Sapienza, J., Sartorelli, S., Seghi, F., Tambussi, G., Din, C. T., Tomelleri, A., Turi, S., Uberti-Foppa, C., and Vinci, C.
- Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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- 2021
10. Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19
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Spagnuolo, V., Guffanti, M., Galli, L., Poli, A., Querini, P. Rovere, Ripa, M., Clementi, M., Scarpellini, P., Lazzarin, A., Tresoldi, Moreno, Dagna, L., Zangrillo, A., Ciceri, F., Castagna, A., Andolina, A., Redaelli, M. Baiardo, Baldissera, E., Bigai, G., Bigoloni, A., Boffini, N., Borio, G., Bossolasco, S., Bruzzesi, E., Calabrò, M. G., Calvisi, S., Campochiaro, C., Canetti, D., Canti, V., Castellani, J., Castiglioni, B., Cavalli, G., Cavallo, L., Cernuschi, M., Chiurlo, M., Cilla, M., Cinel, E., Cinque, P., Conte, C., Da Prat, V., Danise, A., De Lorenzo, R., De Luca, G., Dell’Acqua, A., Dell’Acqua, R., Torre, E. Della, Torre, L. Della, Di Terlizzi, G., Dumea, I., Farolfi, F., Ferrante, M., Frangi, C., Fumagalli, L., Gallina, G., Germinario, B., Gianotti, Nicola, Hasson, H., Lalla, F., LANDONI, Giovanni, Lanzillotta, M., Voti, R. Li, Mastrangelo, A., Messina, E., Moizo, E., Montagna, M., Monti, G., Morsica, G., Muccini, C., Nozza, S., Oltolini, C., Pascali, M., Patrizi, A., Pieri, M., Prestifilippo, D., Ramirez, Giuseppe Alvise, Ranzenigo, M., Sapienza, J., Sartorelli, S., Seghi, F., Tambussi, G., Din, C. Tassan, Tomelleri, A., Turi, S., Uberti-Foppa, C., Vinci, C., COVID-BioB study group, Spagnuolo, V., Guffanti, M., Galli, L., Poli, A., Querini, P. R., Ripa, M., Clementi, M., Scarpellini, P., Lazzarin, A., Tresoldi, M., Dagna, L., Zangrillo, A., Ciceri, F., Castagna, A., Andolina, A., Redaelli, M. B., Baldissera, E., Bigai, G., Bigoloni, A., Boffini, N., Borio, G., Bossolasco, S., Bruzzesi, E., Calabro, M. G., Calvisi, S., Campochiaro, C., Canetti, D., Canti, V., Castellani, J., Castiglioni, B., Cavalli, G., Cavallo, L., Cernuschi, M., Chiurlo, M., Cilla, M., Cinel, E., Cinque, P., Conte, C., Da Prat, V., Danise, A., De Lorenzo, R., De Luca, G., Dell'Acqua, A., Dell'Acqua, R., Torre, E. D., Torre, L. D., Di Terlizzi, G., Dumea, I., Farolfi, F., Ferrante, M., Frangi, C., Fumagalli, L., Gallina, G., Germinario, B., Gianotti, N., Hasson, H., Lalla, F., Landoni, G., Lanzillotta, M., Voti, R. L., Mastrangelo, A., Messina, E., Moizo, E., Montagna, M., Monti, G., Morsica, G., Muccini, C., Nozza, S., Oltolini, C., Pascali, M., Patrizi, A., Pieri, M., Prestifilippo, D., Ramirez, G., Ranzenigo, M., Sapienza, J., Sartorelli, S., Seghi, F., Tambussi, G., Din, C. T., Tomelleri, A., Turi, S., Uberti-Foppa, C., and Vinci, C.
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Male ,medicine.medical_specialty ,Time Factors ,Coronavirus disease 2019 (COVID-19) ,Lymphocyte ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Corticosteroid treatment ,Severe disease ,Diseases ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Adrenal Cortex Hormones ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Pandemics ,Aged ,Retrospective Studies ,Multidisciplinary ,business.industry ,Proportional hazards model ,Age Factors ,COVID-19 ,Retrospective cohort study ,Middle Aged ,Viral Load ,Publisher Correction ,COVID-19 Drug Treatment ,Hospitalization ,Treatment Outcome ,Infectious diseases ,Viral infection ,medicine.anatomical_structure ,Italy ,Female ,business - Abstract
The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p 2/FiO2 > 200 mmHg, and a lymphocyte count at admission > 1.0 × 109/L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids.
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- 2020
11. Efficacy and safety of tocilizumab in severe COVID-19 patients: a single-centre retrospective cohort study
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Campochiaro C., Della-Torre E., Cavalli G., De Luca G., Ripa M., Boffini N., Tomelleri A., Baldissera E., Rovere-Querini P., Ruggeri A., Monti G., De Cobelli F., Zangrillo A., Tresoldi M., Castagna A., Dagna L (TOCI-RAF Study Group), Landoni G, DELLA TORRE , EMANUEL, Campochiaro, C., Della-Torre, E., Cavalli, G., De Luca, G., Ripa, M., Boffini, N., Tomelleri, A., Baldissera, E., Rovere-Querini, P., Ruggeri, A., Monti, G., De Cobelli, F., Zangrillo, A., Tresoldi, M., Castagna, A., Dagna, L (TOCI-RAF Study Group), Landoni, G, and DELLA TORRE, Emanuel
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Multivariate analysis ,Coronavirus disease 2019 (COVID-19) ,Efficacy ,Pneumonia, Viral ,macromolecular substances ,030204 cardiovascular system & hematology ,Antibodies, Monoclonal, Humanized ,Antiviral Agents ,Article ,Betacoronavirus ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Tocilizumab ,Medical microbiology ,Internal medicine ,Intensive care ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,skin and connective tissue diseases ,Pandemics ,Aged ,Retrospective Studies ,business.industry ,Interleukin-6 ,Standard treatment ,Oxygen Inhalation Therapy ,COVID-19 ,Retrospective cohort study ,Middle Aged ,Receptors, Interleukin-6 ,Coronavirus ,Outcome and Process Assessment, Health Care ,chemistry ,Italy ,Cohort ,Female ,Safety ,Coronavirus Infections ,Respiratory Insufficiency ,business - Abstract
Highlight • This is the first study comparing tocilizumab to standard of care in severe COVID-19 • Tocilizumab in severe COVID-19 patients did influence 28-day clinical outcomes • Tocilizumab safety was safisfactory except for ICU-admitted patients, Background : Tocilizumab (TCZ), a humanized monoclonal antibody targeting the interleukin-6 (IL-6) receptor, has been proposed for the treatment of COVID-19 patients; however, limited data are available on the safety and efficacy. Methods : We performed a retrospective study on severe COVID-19 patients with hyper-inflammatory features admitted outside intensive care units (ICUs). Patients treated with intravenous TCZ in addition to standard of care were compared to patients treated with standard of care alone. Safety and efficacy were assessed over a 28-day follow-up. Results : 65 patients were included, 32 were of whose treated with TCZ. At baseline, all patients were on high-flow supplemental oxygen and most (78% of TCZ patients and 61% of standard treatment patients) were on non-invasive ventilation. During the 28-day follow-up, 69% of TCZ patients experienced a clinical improvement compared to 61% of standard treatment patients (p = 0.61). Mortality was 15% in the tocilizumab group and 33% in standard treatment group (p = 0.15). In TCZ group, at multivariate analysis, older age was a predictor of death, whereas higher baseline PaO2:FiO2 was a predictor of clinical improvement at day 28. The rate of infection and pulmonary thrombosis was similar between the two groups. Conclusions : At day 28, clinical improvement and mortality were not statistically significant different between tocilizumab and standard treatment patients in our cohort. Bacterial or fungal infections were recorded in 13% of tocilizumab patients and in 12% of standard treatment patients. Confirmation of efficacy and safety will require ongoing controlled trials.
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- 2020
12. Colchicine as a new therapeutic option for antithyroid arthritis syndrome
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Mancuso G., Boffini N., Dagna L., Della-Torre E., Mancuso, G., Boffini, N., Dagna, L., and Della-Torre, E.
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Adult ,medicine.medical_specialty ,Methimazole ,business.industry ,Arthritis ,MEDLINE ,Syndrome ,medicine.disease ,Dermatology ,chemistry.chemical_compound ,Rheumatology ,chemistry ,Antithyroid Agents ,Colchicine ,Medicine ,Humans ,Pharmacology (medical) ,Female ,business - Published
- 2020
13. OP0223 DEVELOPMENT AND PRELIMINARY VALIDATION OF ULTRASONOGRAPHIC DISEASE ACTIVITY AND DAMAGE SCORES IN PSORIATIC ARTHRITIS PATIENTS: RESULTS FROM THE UPSTREAM (ULTRASOUND IN PSORIATIC ARTHRITIS TREATMENT) STUDY
- Author
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Zabotti, A., primary, Piga, M., additional, Zanetti, A., additional, Canzoni, M., additional, Boffini, N., additional, Picerno, V., additional, Zanframundo, G., additional, Silvagni, E., additional, Giovannini, I., additional, Raffeiner, B., additional, Scolieri, P., additional, Mancini, P., additional, Parisi, S., additional, Bortoluzzi, A., additional, Sakellariou, G., additional, De Lucia, O., additional, Tinazzi, I., additional, Figus, F., additional, Idolazzi, L., additional, Lorenzin, M., additional, Callegher, S. Z., additional, Cauli, A., additional, Carrara, G., additional, Scirè, C. A., additional, and Iagnocco, A., additional
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- 2021
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14. Ultrasonography in psoriatic arthritis: Which sites should we scan?
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Zabotti, A, Piga, M, Canzoni, M, Sakellariou, G, Iagnocco, A, Scire, C, Adinolfi, A, Azzolin, I, Bandinelli, F, Batticciotto, A, Boffini, N, Bortoluzzi, A, Carrara, G, Cavatorta, F, Cagnotto, G, Caprioli, M, Colaci, M, De Lucia, O, Delle Sedie, A, Denaro, V, Di Matteo, A, Di Sabatino, V, Epis, O, Hoxha, A, Farina, I, Germano, G, Filippou, G, Filippucci, E, Focherini, M, Gabba, A, Idolazzi, L, La Paglia, G, Luccioli, F, Macchioni, P, Magnani, M, Massarotti, M, Mastaglio, C, Navarini, L, Parisi, S, Diamanti, A, Picerno, V, Piras, M, Porta, F, Possemato, N, Prevete, I, Raffeiner, B, Ramonda, R, Ravagnani, V, Rossi, D, Rossi, S, Scolieri, P, Santoboni, G, Scioscia, C, Terenzi, R, Tinazzi, I, Toscano, C, Venditti, C, Volpe, A, Vukatana, G, Zanframundo, G, Zabotti A., Piga M., Canzoni M., Sakellariou G., Iagnocco A., Scire C. A., Adinolfi A., Azzolin I., Bandinelli F., Batticciotto A., Boffini N., Bortoluzzi A., Carrara G., Cavatorta F. P., Cagnotto G., Caprioli M., Colaci M., De Lucia O., Delle Sedie A., Denaro V., Di Matteo A., Di Sabatino V., Epis O. M., Hoxha A., Farina I., Germano G., Filippou G., Filippucci E., Focherini M. C., Gabba A., Idolazzi L., La Paglia G. M. C., Luccioli F., Macchioni P., Magnani M., Massarotti M., Mastaglio C., Navarini L., Parisi S., Diamanti A. P., Picerno V., Piras M., Porta F., Possemato N., Prevete I., Raffeiner B., Ramonda R., Ravagnani V., Rossi D., Rossi S., Scolieri P., Santoboni G., Scioscia C., Terenzi R., Tinazzi I., Toscano C., Venditti C., Volpe A., Vukatana G., Zanframundo G., Zabotti, A, Piga, M, Canzoni, M, Sakellariou, G, Iagnocco, A, Scire, C, Adinolfi, A, Azzolin, I, Bandinelli, F, Batticciotto, A, Boffini, N, Bortoluzzi, A, Carrara, G, Cavatorta, F, Cagnotto, G, Caprioli, M, Colaci, M, De Lucia, O, Delle Sedie, A, Denaro, V, Di Matteo, A, Di Sabatino, V, Epis, O, Hoxha, A, Farina, I, Germano, G, Filippou, G, Filippucci, E, Focherini, M, Gabba, A, Idolazzi, L, La Paglia, G, Luccioli, F, Macchioni, P, Magnani, M, Massarotti, M, Mastaglio, C, Navarini, L, Parisi, S, Diamanti, A, Picerno, V, Piras, M, Porta, F, Possemato, N, Prevete, I, Raffeiner, B, Ramonda, R, Ravagnani, V, Rossi, D, Rossi, S, Scolieri, P, Santoboni, G, Scioscia, C, Terenzi, R, Tinazzi, I, Toscano, C, Venditti, C, Volpe, A, Vukatana, G, Zanframundo, G, Zabotti A., Piga M., Canzoni M., Sakellariou G., Iagnocco A., Scire C. A., Adinolfi A., Azzolin I., Bandinelli F., Batticciotto A., Boffini N., Bortoluzzi A., Carrara G., Cavatorta F. P., Cagnotto G., Caprioli M., Colaci M., De Lucia O., Delle Sedie A., Denaro V., Di Matteo A., Di Sabatino V., Epis O. M., Hoxha A., Farina I., Germano G., Filippou G., Filippucci E., Focherini M. C., Gabba A., Idolazzi L., La Paglia G. M. C., Luccioli F., Macchioni P., Magnani M., Massarotti M., Mastaglio C., Navarini L., Parisi S., Diamanti A. P., Picerno V., Piras M., Porta F., Possemato N., Prevete I., Raffeiner B., Ramonda R., Ravagnani V., Rossi D., Rossi S., Scolieri P., Santoboni G., Scioscia C., Terenzi R., Tinazzi I., Toscano C., Venditti C., Volpe A., Vukatana G., and Zanframundo G.
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- 2018
15. CO0001 MAVRILIMUMAB IMPROVES OUTCOMES IN SEVERE COVID-19 PNEUMONIA AND SYSTEMIC HYPER-INFLAMMATION
- Author
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De Luca, G., primary, Cavalli, G., additional, Campochiaro, C., additional, Della Torre, E., additional, Angelillo, P., additional, Tomelleri, A., additional, Boffini, N., additional, Tentori, S., additional, Mette, F., additional, Rovere-Querini, P., additional, Ruggeri, A., additional, D’aliberti, T., additional, Scarpelllini, P., additional, Landoni, G., additional, De Cobelli, F., additional, Paolini, J. F., additional, Zangrillo, A., additional, Tresoldi, M., additional, Trapnell, B. C., additional, Ciceri, F., additional, and Dagna, L., additional
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- 2020
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16. AB0336 IMPACT OF SUBJECTIVE INTOLERANCE TO METHOTREXATE ON THE QUALITY OF LIFE OF PATIENTS WITH RHEUMATOID ARTHRITIS: SIDE EFFECTS AND AVOIDANCE COPING STRATEGIES THROUGH SELF-ADMINISTRATION IN THE EVENING OR DURING THE WEEKEND
- Author
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Cavalli, G., primary, Biggioggero, M., additional, Cariddi, A., additional, De Luca, G., additional, Agape, E., additional, Boffini, N., additional, Baldissera, E., additional, Dagna, L., additional, and Favalli, E. G., additional
- Published
- 2020
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17. Ultrasonography in psoriatic arthritis: which sites should we scan?
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Zabotti A., Piga M., Canzoni M., Sakellariou G., Iagnocco A., Scire C. A., Adinolfi A., Azzolin I., Bandinelli F., Batticciotto A., Boffini N., Bortoluzzi A., Carrara G., Cavatorta F. P., Cagnotto G., Caprioli M., Colaci M., De Lucia O., Delle Sedie A., Denaro V., Di Matteo A., Di Sabatino V., Epis O. M., Hoxha A., Farina I., Germano G., Filippou G., Filippucci E., Focherini M. C., Gabba A., Idolazzi L., La Paglia G. M. C., Luccioli F., Macchioni P., Magnani M., Massarotti M., Mastaglio C., Navarini L., Parisi S., Diamanti A. P., Picerno V., Piras M., Porta F., Possemato N., Prevete I., Raffeiner B., Ramonda R., Ravagnani V., Rossi D., Rossi S., Scolieri P., Santoboni G., Scioscia C., Terenzi R., Tinazzi I., Toscano C., Venditti C., Volpe A., Vukatana G., Zanframundo G., Zabotti, A, Piga, M, Canzoni, M, Sakellariou, G, Iagnocco, A, Scire, C, Adinolfi, A, Azzolin, I, Bandinelli, F, Batticciotto, A, Boffini, N, Bortoluzzi, A, Carrara, G, Cavatorta, F, Cagnotto, G, Caprioli, M, Colaci, M, De Lucia, O, Delle Sedie, A, Denaro, V, Di Matteo, A, Di Sabatino, V, Epis, O, Hoxha, A, Farina, I, Germano, G, Filippou, G, Filippucci, E, Focherini, M, Gabba, A, Idolazzi, L, La Paglia, G, Luccioli, F, Macchioni, P, Magnani, M, Massarotti, M, Mastaglio, C, Navarini, L, Parisi, S, Diamanti, A, Picerno, V, Piras, M, Porta, F, Possemato, N, Prevete, I, Raffeiner, B, Ramonda, R, Ravagnani, V, Rossi, D, Rossi, S, Scolieri, P, Santoboni, G, Scioscia, C, Terenzi, R, Tinazzi, I, Toscano, C, Venditti, C, Volpe, A, Vukatana, G, and Zanframundo, G
- Subjects
Genetics and Molecular Biology (all) ,medicine.medical_specialty ,Immunology ,Arthritis ,Physical examination ,outcomes research ,psoriatic arthritis ,ultrasonography ,rheumatology ,immunology and allergy ,immunology ,biochemistry ,genetics and molecular biology (all) ,Disease ,Biochemistry ,Sensitivity and Specificity ,General Biochemistry, Genetics and Molecular Biology ,Rheumatology ,Immunology and Allergy ,Biochemistry, Genetics and Molecular Biology (all) ,NO ,Tendons ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Prospective cohort study ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,business.industry ,outcomes research, psoriatic arthritis, ultrasonography ,Arthritis, Psoriatic ,Bursa, Synovial ,medicine.disease ,Joints ,Observational study ,Differential diagnosis ,business - Abstract
In psoriatic arthritis (PsA), ultrasonography (US) plays a growing role in the differential diagnosis and in monitoring treatment response.1 PsA is a heterogeneous disease with different domains and peculiar sites involved.2 Therefore, a dedicated US composite score is needed to monitor disease activity and to identify structural damage progression. A recently published Systematic Literature Review (SLR) identified only two US scores specifically developed for PsA (ie, 5TPD and PsA-Son) and, although these had a good sensitivity to detect inflammation and a good feasibility, they have not been validated in other series.1 3 4 Recently, the Study Group for US of the Italian Society of Rheumatology promoted the Ultrasound in PSoriatic Arthritis TREAtMent (UPSTREAM) study (registered at ClinicalTrial.gov, NCT03330769). UPSTREAM is a multicentre observational prospective cohort study and it represents the first …
- Published
- 2018
18. UPADACITINIB REAL-LIFE EFFICACY AND SAFETY IN PSORIATIC ARTHRITIS: RESULTS AT 24 WEEKS OF A MULTICENTRIC ITALIAN STUDY (UP-REAL).
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Paci, V., Luchetti, M. M., Carletto, A., Zabotti, A., Luciano, N., Ramonda, R., Dagna, L., Sandri, G., Salvarani, C., Chimenti, M. S., Possemato, N., Piccinelli, A., Giovannini, I., Striani, G., Boffini, N., Pantano, I., Benfaremo, D., Ciccia, F., Selmi, C., and Moroncini, G.
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- 2023
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19. Early disease control by low-dose prednisone comedication may affect the quality of remission in patients with early rheumatoid arthritis
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Todoerti, M, Scirè, C, Boffini, N, Bugatti, S, Montecucco, C, Caporali, R, Todoerti, Monica, Scirè, Carlo Alberto, Boffini, Nicola, Bugatti, Serena, Montecucco, Carlomaurizio, Caporali, Roberto, Todoerti, M, Scirè, C, Boffini, N, Bugatti, S, Montecucco, C, Caporali, R, Todoerti, Monica, Scirè, Carlo Alberto, Boffini, Nicola, Bugatti, Serena, Montecucco, Carlomaurizio, and Caporali, Roberto
- Abstract
In order to identify rate and stability of remission induced by low-dose prednisone comedication in early rheumatoid arthritis (RA), we evaluated patients with early RA (<1 year) who were randomized to receive (P) or not (non-P) low-dose prednisone in association with step-up disease-modifying antirheumatic drug therapy over 2 years. Prevalence and duration of clinical remission were evaluated in the first and second year. Each treatment group included 105 patients; no significant differences were found at baseline. During the first year, P patients achieved higher rates of clinical remission with a time-averaged odds ratio (OR) of 1.965 (CI 95% 1.214-3.182, P= 0.006). Moreover, they showed a higher probability of sustained remission during the second year (OR 4.480, CI 95% 1.354-14.817, P= 0.014). In conclusion, we found as in early RA low-dose prednisone comedication is associated with higher rate of clinical remission, earlier disease activity control and more stable remission over time.
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- 2010
20. AB0796 Clinical picture of anti-jo-1 positive anti-synthetase syndrome at presentation and during follow-up
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Scorletti, E., primary, Cavagna, L., additional, Caporali, R., additional, Fusetti, C., additional, Boffini, N., additional, and Montecucco, C., additional
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- 2013
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21. Interleukin-6 blockade with sarilumab in severe COVID-19 pneumonia with systemic hyperinflammation: an open-label cohort study
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Emanuel, Della-Torre, Corrado, Campochiaro, Giulio, Cavalli, Giacomo, De Luca, Angela, Napolitano, Salvatore, La Marca, Nicola, Boffini, Valentina, Da Prat, Gaetano, Di Terlizzi, Marco, Lanzillotta, Patrizia, Rovere Querini, Annalisa, Ruggeri, Giovanni, Landoni, Moreno, Tresoldi, Fabio, Ciceri, ALberto, Zangrillo, Francesco, De Cobelli, Lorenzo, Dagna, Alberto, Zangrillo, Della-Torre, E., Campochiaro, C., Cavalli, G., De Luca, G., Napolitano, A., La Marca, S., Boffini, N., Da Prat, V., Di Terlizzi, G., Lanzillotta, M., Rovere Querini, P., Ruggeri, A., Landoni, G., Tresoldi, M., Ciceri, F., Zangrillo, A., De Cobelli, F., and Dagna, L.
- Subjects
Male ,Time Factors ,Epidemiology ,Bacteremia ,Azithromycin ,Severity of Illness Index ,Lopinavir ,Cohort Studies ,therapeutics ,Immunology and Allergy ,Enzyme Inhibitors ,Lung ,anti-inflammatory agents, non-steroidal ,biology ,Coinfection ,Interleukin ,Middle Aged ,Anti-Bacterial Agents ,Drug Combinations ,C-Reactive Protein ,Treatment Outcome ,Italy ,Administration, Intravenous ,Female ,Coronavirus Infections ,Hydroxychloroquine ,Cohort study ,medicine.medical_specialty ,Pneumonia, Viral ,Immunology ,Antibodies, Monoclonal, Humanized ,Antiviral Agents ,General Biochemistry, Genetics and Molecular Biology ,Betacoronavirus ,Rheumatology ,Internal medicine ,Severity of illness ,medicine ,Humans ,Interleukin 6 ,Pandemics ,Proportional Hazards Models ,Noninvasive Ventilation ,Ritonavir ,Interleukin-6 ,SARS-CoV-2 ,Proportional hazards model ,business.industry ,Oxygen Inhalation Therapy ,COVID-19 ,medicine.disease ,Receptors, Interleukin-6 ,COVID-19 Drug Treatment ,Blockade ,Sarilumab ,Pneumonia ,inflammation ,biology.protein ,Tomography, X-Ray Computed ,business - Abstract
ObjectivesTo assess the safety and efficacy of interleukin (IL)−6 blockade with sarilumab in patients with severe COVID-19 pneumonia and systemic hyperinflammation.MethodsWe conducted an open-label study of sarilumab in severe COVID-19 pneumonia (PaO2/FiO2 ResultsTwenty-eight patients were treated with sarilumab and 28 contemporary patients receiving standard of care alone were used as controls. At day 28 of follow-up, 61% of patients treated with sarilumab experienced clinical improvement and 7% died. These findings were not significantly different from the comparison group (clinical improvement 64%, mortality 18%; p=NS). Baseline PaO2/FiO2 ratio >100 mm Hg and lung consolidation ConclusionsAt day 28, overall clinical improvement and mortality in patients with severe COVID-19 were not significantly different between sarilumab and standard of care. Sarilumab was associated with faster recovery in a subset of patients showing minor lung consolidation at baseline.
- Published
- 2020
22. MAVRILIMUMAB IMPROVES OUTCOMES IN SEVERE COVID-19 PNEUMONIA AND SYSTEMIC HYPERINFLAMMATION
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G. De Luca, G. Cavalli, C. Campochiaro, DELLA TORRE E, P. Angelillo, A. Tomelleri, N. Boffini, S. Tentori, F. Mette, P. Rovere-Querini, A. Ruggeri, T. D’aliberti, P. Scarpelllini, G. Landoni, F. De Cobelli, J. F. Paolini, A. Zangrillo, M. Tresoldi, B. C. Trapnell, F. Ciceri, L. Dagna, De Luca, G., Cavalli, G., Campochiaro, C., DELLA TORRE, E, Angelillo, P., Tomelleri, A., Boffini, N., Tentori, S., Mette, F., Rovere-Querini, P., Ruggeri, A., D’Aliberti, T., Scarpelllini, P., Landoni, G., De Cobelli, F., Paolini, J. F., Zangrillo, A., Tresoldi, M., Trapnell, B. C., Ciceri, F., and Dagna, L.
- Published
- 2020
23. Early disease control by low-dose prednisone comedication may affect the quality of remission in patients with early rheumatoid arthritis
- Author
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Todoerti, Monica, Scirè, Carlo Alberto, Boffini, Nicola, Bugatti, Serena, Montecucco, Carlomaurizio, Caporali, Roberto, Todoerti, M, Scirè, C, Boffini, N, Bugatti, S, Montecucco, C, and Caporali, R
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Male ,Time Factors ,NO ,Follow-Up Studie ,Dose-Response Relationship ,Glucocorticoid ,Drug Therapy ,Surveys and Questionnaires ,Rheumatoid ,Odds Ratio ,Humans ,Surveys and Questionnaire ,Glucocorticoids ,Arthritis ,Remission Induction ,Antirheumatic Agent ,Middle Aged ,Antirheumatic Agents ,Arthritis, Rheumatoid ,Dose-Response Relationship, Drug ,Drug Therapy, Combination ,Female ,Follow-Up Studies ,Methotrexate ,Prednisone ,Combination ,Drug ,Arthriti ,Human - Abstract
In order to identify rate and stability of remission induced by low-dose prednisone comedication in early rheumatoid arthritis (RA), we evaluated patients with early RA (
- Published
- 2010
24. Secukinumab is not associated with cancer recurrence or progression in patients with spondyloarthritis and history of neoplastic disease.
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Farina N, Tomelleri A, Boffini N, Cariddi A, Calvisi S, Baldissera E, Matucci-Cerinic M, and Dagna L
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- Humans, Female, Male, Retrospective Studies, Middle Aged, Adult, Aged, Neoplasms drug therapy, Neoplasm Recurrence, Local drug therapy, Antibodies, Monoclonal, Humanized therapeutic use, Antibodies, Monoclonal, Humanized adverse effects, Spondylarthritis drug therapy, Disease Progression
- Abstract
Secukinumab is a monoclonal antibody directed against interleukin-17 approved for the treatment of psoriasis and spondyloarthritis. The favorable oncological profile of secukinumab in patients with a history of malignancy has been shown in patients with psoriasis. However, systematic data to this regard have not been published yet for patients with spondyloarthritis. The objective of the present study was to evaluate the oncological safety of secukinumab in patients affected by this group of diseases. We performed a retrospective study in which we identified from our cohort patients with spondyloarthritis treated with secukinumab and with a history of malignancy. These patients' baseline demographic, treatment, rheumatological, and oncological data were collected. The neoplastic outcome (i.e., cancer recurrence or progression) after secukinumab start was then analyzed. Our study included 22 patients with spondyloarthritis. The most frequently reported oncological diagnosis was breast cancer (9 [41%] patients). Secukinumab was started after a median of 24 months following cancer diagnosis. At this time point, all but three patients were in oncological remission. No case of cancer relapse or progression was recorded over a median follow-up of 30 months. In the largest cohort reported to date to this regard, secukinumab was not associated with oncological recurrence or progression in patients with spondyloarthritis with a history of malignancy. Secukinumab may, therefore, represent a safe option in this clinical scenario., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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25. The impact of 2023 EMA recommendations on patients treated with JAK inhibitors: real-life experience from a prospective monocentric cohort.
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Tomelleri A, Benanti G, Cariddi A, Calvisi SL, Baldissera E, Boffini N, Matucci-Cerinic M, and Dagna L
- Subjects
- Humans, Prospective Studies, Janus Kinases, Janus Kinase Inhibitors therapeutic use, Arthritis, Rheumatoid
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- 2024
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26. Upadacitinib effectiveness and factors associated with minimal disease activity achievement in patients with psoriatic arthritis: preliminary data of a real-life multicenter study.
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Luchetti Gentiloni MM, Paci V, Carletto A, Zabotti A, Ramonda R, Chimenti MS, Dagna L, Luciano N, Piccinelli A, Giovannini I, Striani G, Boffini N, Sandri G, Possemato N, Pantano I, Benfaremo D, Salvarani C, Ciccia F, Selmi C, and Moroncini G
- Subjects
- Humans, Male, Treatment Outcome, Preliminary Data, Severity of Illness Index, Arthritis, Psoriatic drug therapy, Antirheumatic Agents therapeutic use
- Abstract
Background: Upadacitinib (UPA) is a selective JAK inhibitor recently approved for the treatment of psoriatic arthritis (PsA). In this post-approval study, we aimed to evaluate the effectiveness and safety of UPA over 24 weeks and identify clinical predictors of response, in a multicentric cohort of patients affected by PsA., Methods: One hundred and twenty-six patients with PsA treated with UPA were enrolled in 10 Italian centres. UPA effectiveness outcomes, such as the proportion of patients with MDA status, DAPSA remission, and low disease activity, ASDAS-CRP inactive and low disease activity, and change from baseline in DAPSA and ASDAS-CRP scores, were evaluated every 12 weeks until week 24. The proportion of DAPSA minor, moderate, and major improvement, and ASDAS clinically important improvement (CII) and major improvement (MI) were considered as well. All treatment-related adverse events were collected during the observation period. Clinical predictors of MDA response at week 24 were evaluated through multivariate analysis., Results: At baseline, 124/126 (98%) and 54/126 (43%) patients showed peripheral and axial involvement, respectively; 110 (87%) patients were intolerant or resistant to biologic DMARDs. At 24 weeks, MDA status, DAPSA remission, and ASDAS-CRP inactive disease were achieved in 47%, 23%, and 48% of patients, respectively. Minor, moderate, and major DAPSA improvement was observed in 67%, 39%, and 23%, respectively; while 65% and 35% achieved ASDAS-CRP CII and MI, respectively. The mean change from baseline was 15.9 ± 13.5 (p < 0.001) for DAPSA and 1.21 ± 0.97 (p < 0.001) for ASDAS-CRP. Thirteen patients (10%) discontinued UPA due to a lack of efficacy or non-serious adverse events. No serious adverse events were observed. Male gender (OR 2.54, 95% CI 1.03-6.25 p = 0.043), being naïve to biological DMARDs (OR 4.13, 95% CI 1.34-12.71, p = 0.013) and elevated baseline CRP (OR 2.49, 95% CI 1.02-6.12, p = 0.046) were associated with MDA response at week 24., Conclusions: This is one of the first real-life studies supporting the effectiveness of UPA and its safety profile in PsA patients. Furthermore, the study identifies predictors of MDA response to UPA treatment at 6 months., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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27. Safety of Janus Kinase Inhibitors: A Real-World Multicenter Retrospective Cohort Study.
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Lanzillotta M, Boffini N, Barone E, Cincinelli G, Gerardi MC, Luciano N, Manara M, Ughi N, Epis OM, Selmi C, Caporali RF, and Dagna L
- Abstract
Objective: Oral Janus kinase inhibitors (JAKis) represent an effective strategy for rheumatoid arthritis (RA) treatment. A previous study supported that tofacitinib (TOF) is associated with higher incidence of cardiovascular (CV) and neoplastic events compared to tumor necrosis factor inhibitors. Given the apparent discrepancy between these data and real-world experience, we aimed to investigate the safety and efficacy of the available JAKis in a multicenter cohort., Methods: We retrospectively evaluated patients with RA who ever received 1 JAKi (TOF, baricitinib [BAR], upadactinib [UPA], filgotinib [FIL]) from 4 tertiary care centers in Milan, Italy. Outcomes related to JAKi safety were recorded, particularly major CV events as well as adverse events of special interest (AESIs), which included serious infections, opportunistic infections, venous thromboembolism, herpes zoster infections, liver injury, malignancies, and deaths; retention rates were also calculated. Further analyses included patients fulfilling the risk factors suggested to influence TOF safety., Results: Six hundred eighty-five patients were included and received BAR (48%), TOF (31%), UPA (14%), or FIL (7%) as first-line innovative treatment prior to a biologic. Of a total of 1137 patient-years of observation, we recorded 1 stroke and 123 (18%) AESIs, including 3 deaths, all a result of severe infections. Among patients with a higher CV risk, we observed a higher frequency of AESIs (23%)., Conclusion: Our real-world data confirm that JAKis are effective and carry a low risk of AESIs, especially in patients who do not display CV risk factors at baseline. Our study could not identify differences between JAKis. Different safety profiles should be defined in larger prospective cohorts.
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- 2023
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28. Efficacy and safety of baricitinib in 446 patients with rheumatoid arthritis: a real-life multicentre study.
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Guidelli GM, Viapiana O, Luciano N, De Santis M, Boffini N, Quartuccio L, Birra D, Conticini E, Chimenti MS, Bazzani C, Bruschi E, Riva M, Canziani LM, Bianchi G, Pozzi MR, Limonta M, Gorla R, Perricone R, Frediani B, Moscato P, De Vita S, Dagna L, Rossini M, and Selmi C
- Subjects
- Drug Therapy, Combination, Humans, Methotrexate adverse effects, Purines, Pyrazoles, Sulfonamides adverse effects, Treatment Outcome, Antirheumatic Agents adverse effects, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid drug therapy, Azetidines adverse effects
- Abstract
Objectives: Baricitinib, an oral Janus kinase (JAK) 1-2 inhibitor, is currently used along biologic DMARDs (bDMARDs) after the failure of methotrexate (MTX) in rheumatoid arthritis (RA). We investigated the efficacy and safety of baricitinib in real life., Methods: We prospectively enrolled 446 RA patients treated with baricitinib from 11 Italian centres. Patients were evaluated at baseline and after 3, 6, and 12 months. They were arrayed based on previous treatments as bDMARD-naïve and bDMARD-insufficient responders (IR) after the failure or intolerance to bDMARDs. A sub-analysis differentiated the effects of methotrexate (MTX) and the use of oral glucocorticoids (OGC)., Results: Our cohort included 150 (34%) bDMARD-naïve and 296 (66%) bDMARD-IR patients, with 217 (49%) using baricitinib as monotherapy. Considering DAS-28-CRP as the primary outcome, at 3 and 6 months, 114/314 (36%) and 149/289 (51.6%) patients achieved remission, while those in low disease activity (LDA) were 62/314 (20%) and 46/289 (15.9%), respectively; finally at 12 months 81/126 (64%) were in remission and 21/126 (17%) in LDA. At all-timepoints up to 12 months, bDMARDs-naïve patients demonstrated a better clinical response, independently of MTX. A significant reduction in the OGC dose was observed at 3 and 12 months in all groups. The serum positivity for both rheumatoid factors (RF) and anti-citrullinated protein antibodies (ACPA) conferred a lower risk of stopping baricitinib due to inefficacy. Fifty-eight (13%) patients discontinued baricitinib due to adverse events, including thrombotic events and herpes zoster reactivation., Conclusions: Real-life data confirm the efficacy and safety profiles of baricitinib in patients with RA and provide evidence that drug survival is higher in bDMARDs-naïve and seropositive patients.
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- 2021
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29. Respiratory Impairment Predicts Response to IL-1 and IL-6 Blockade in COVID-19 Patients With Severe Pneumonia and Hyper-Inflammation.
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Della-Torre E, Lanzillotta M, Campochiaro C, Cavalli G, De Luca G, Tomelleri A, Boffini N, De Lorenzo R, Ruggeri A, Rovere-Querini P, Castagna A, Landoni G, Tresoldi M, Ciceri F, Zangrillo A, and Dagna L
- Subjects
- Aged, Disease-Free Survival, Female, Follow-Up Studies, Humans, Interleukin-1 immunology, Interleukin-6 immunology, Male, Middle Aged, Severity of Illness Index, Survival Rate, Antibodies, Monoclonal, Humanized administration & dosage, COVID-19 immunology, COVID-19 mortality, Interleukin 1 Receptor Antagonist Protein administration & dosage, Interleukin-1 antagonists & inhibitors, Interleukin-6 antagonists & inhibitors, SARS-CoV-2 immunology, COVID-19 Drug Treatment
- Abstract
Background: Restraining maladaptive inflammation is considered a rationale strategy to treat severe coronavirus disease-19 (COVID-19) but available studies with selective inhibitors of pro-inflammatory cytokines have not provided unequivocal evidence of survival advantage. Late administration is commonly regarded as a major cause of treatment failure but the optimal timing for anti-cytokine therapy initiation in COVID-19 patients has never been clearly established., Objectives: To identify a window of therapeutic opportunity for maximizing the efficacy of interleukin (IL)-1 and IL-6 blockade in COVID-19., Methods: Survival at the longest available follow-up was assessed in severe hyper-inflamed COVID-19 patients treated with anakinra, tocilizumab, sarilumab, or standard of care, stratified according to respiratory impairment at the time of treatment initiation., Results: 107 patients treated with biologics and 103 contemporary patients treated with standard of care were studied. After a median of 106 days of follow-up (range 3-186), treatment with biologics was associated with a significantly higher survival rate compared to standard therapy when initiated in patients with a PaO
2 /FiO2 ≥ 100 mmHg (p < 0.001). Anakinra reduced mortality also in patients with PaO2 /FiO2 < 100 mmHg (p = 0.04)., Conclusions: IL-1 and IL-6 blocking therapies are more likely to provide survival advantage in hyper-inflamed COVID-19 patients when initiated before the establishment of severe respiratory failure., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Della-Torre, Lanzillotta, Campochiaro, Cavalli, De Luca, Tomelleri, Boffini, De Lorenzo, Ruggeri, Rovere-Querini, Castagna, Landoni, Tresoldi, Ciceri, Zangrillo and Dagna.)- Published
- 2021
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30. Interleukin-1 and interleukin-6 inhibition compared with standard management in patients with COVID-19 and hyperinflammation: a cohort study.
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Cavalli G, Larcher A, Tomelleri A, Campochiaro C, Della-Torre E, De Luca G, Farina N, Boffini N, Ruggeri A, Poli A, Scarpellini P, Rovere-Querini P, Tresoldi M, Salonia A, Montorsi F, Landoni G, Castagna A, Ciceri F, Zangrillo A, and Dagna L
- Abstract
Background: Patients with severe COVID-19 develop a life-threatening hyperinflammatory response to the virus. Interleukin (IL)-1 or IL-6 inhibitors have been used to treat this patient population, but the comparative effectiveness of these different strategies remains undetermined. We aimed to compare IL-1 and IL-6 inhibition in patients admitted to hospital with COVID-19, respiratory insufficiency, and hyperinflammation., Methods: This cohort study included patients admitted to San Raffaele Hospital (Milan, Italy) with COVID-19, respiratory insufficiency, defined as a ratio of the partial pressure of oxygen to the fraction of inspired oxygen of 300 mm Hg or less, and hyperinflammation, defined as serum C-reactive protein concentration of 100 mg/L or more or ferritin concentration of 900 ng/mL or more. The primary endpoint was survival, and the secondary endpoint was a composite of death or mechanical ventilation (adverse clinical outcome). Multivariable Cox regression analysis was used to compare clinical outcomes of patients receiving IL-1 inhibition (anakinra) or IL-6 inhibition (tocilizumab or sarilumab) with those of patients who did not receive interleukin inhibitors, after accounting for baseline differences. All patients received standard care. Interaction tests were used to assess the probability of survival according to C-reactive protein or lactate dehydrogenase concentrations., Findings: Of 392 patients included between Feb 25 and May 20, 2020, 275 did not receive interleukin inhibitors, 62 received the IL-1 inhibitor anakinra, and 55 received an IL-6 inhibitor (29 received tocilizumab and 26 received sarilumab). In the multivariable analysis, compared with patients who did not receive interleukin inhibitors, patients treated with IL-1 inhibition had a significantly reduced mortality risk (hazard ratio [HR] 0·450, 95% CI 0·204-0·990, p=0·047), but those treated with IL-6 inhibition did not (0·900, 0·412-1·966; p=0·79). In the multivariable analysis, there was no difference in adverse clinical outcome risk in patients treated with IL-1 inhibition (HR 0·866, 95% CI 0·482-1·553; p=0·63) or IL-6 inhibition (0·882, 0·452-1·722; p=0·71) relative to patients who did not receive interleukin inhibitors. For increasing C-reactive protein concentrations, patients treated with IL-6 inhibition had a significantly reduced risk of mortality (HR 0·990, 95% CI 0·981-0·999; p=0·031) and adverse clinical outcome (0·987, 0·979-0·995; p=0·0021) compared with patients who did not receive interleukin inhibitors. For decreasing concentrations of serum lactate dehydrogenase, patients treated with an IL-1 inhibitor and patients treated with IL-6 inhibitors had a reduced risk of mortality; increasing concentrations of lactate dehydrogenase in patients receiving either interleukin inhibitor were associated with an increased risk of mortality (HR 1·009, 95% CI 1·003-1·014, p=0·0011 for IL-1 inhibitors and 1·006, 1·001-1·011, p=0·028 for IL-6 inhibitors) and adverse clinical outcome (1·006, 1·002-1·010, p=0·0031 for IL-1 inhibitors and 1·005, 1·001-1·010, p=0·016 for IL-6 inhibitors) compared with patients who did not receive interleukin inhibitors., Interpretation: IL-1 inhibition, but not IL-6 inhibition, was associated with a significant reduction of mortality in patients admitted to hospital with COVID-19, respiratory insufficiency, and hyperinflammation. IL-6 inhibition was effective in a subgroup of patients with markedly high C-reactive protein concentrations, whereas both IL-1 and IL-6 inhibition were effective in patients with low lactate dehydrogenase concentrations., Funding: None., (© 2021 Elsevier Ltd. All rights reserved.)
- Published
- 2021
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31. Interleukin-6 blockade with sarilumab in severe COVID-19 pneumonia with systemic hyperinflammation: an open-label cohort study.
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Della-Torre E, Campochiaro C, Cavalli G, De Luca G, Napolitano A, La Marca S, Boffini N, Da Prat V, Di Terlizzi G, Lanzillotta M, Rovere Querini P, Ruggeri A, Landoni G, Tresoldi M, Ciceri F, Zangrillo A, De Cobelli F, and Dagna L
- Subjects
- Administration, Intravenous, Anti-Bacterial Agents therapeutic use, Antiviral Agents therapeutic use, Azithromycin therapeutic use, Bacteremia epidemiology, Betacoronavirus, COVID-19, Cohort Studies, Coinfection epidemiology, Coronavirus Infections diagnostic imaging, Coronavirus Infections immunology, Coronavirus Infections mortality, Drug Combinations, Enzyme Inhibitors therapeutic use, Female, Humans, Hydroxychloroquine therapeutic use, Italy, Lopinavir therapeutic use, Lung diagnostic imaging, Male, Middle Aged, Noninvasive Ventilation, Oxygen Inhalation Therapy, Pandemics, Pneumonia, Viral diagnostic imaging, Pneumonia, Viral immunology, Pneumonia, Viral mortality, Proportional Hazards Models, Receptors, Interleukin-6 antagonists & inhibitors, Ritonavir therapeutic use, SARS-CoV-2, Severity of Illness Index, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, COVID-19 Drug Treatment, Antibodies, Monoclonal, Humanized therapeutic use, C-Reactive Protein immunology, Coronavirus Infections drug therapy, Inflammation immunology, Interleukin-6 immunology, Pneumonia, Viral drug therapy
- Abstract
Objectives: To assess the safety and efficacy of interleukin (IL)-6 blockade with sarilumab in patients with severe COVID-19 pneumonia and systemic hyperinflammation., Methods: We conducted an open-label study of sarilumab in severe COVID-19 pneumonia (PaO
2 /FiO2 <300 mm Hg) with hyperinflammation (elevated inflammatory markers and serum IL-6 levels). Sarilumab 400 mg was administered intravenously in addition to standard of care and results were compared with contemporary matched patients treated with standard of care alone. Clinical improvement, mortality, safety and predictors of response were assessed at 28 days., Results: Twenty-eight patients were treated with sarilumab and 28 contemporary patients receiving standard of care alone were used as controls. At day 28 of follow-up, 61% of patients treated with sarilumab experienced clinical improvement and 7% died. These findings were not significantly different from the comparison group (clinical improvement 64%, mortality 18%; p=NS). Baseline PaO2 /FiO2 ratio >100 mm Hg and lung consolidation <17% at CT scan predicted clinical improvement in patients treated with sarilumab. Median time to clinical improvement in patients with lung consolidation <17% was shorter after sarilumab (10 days) than after standard treatment (24 days; p=0.01). The rate of infection and pulmonary thrombosis was similar between the two groups., Conclusions: At day 28, overall clinical improvement and mortality in patients with severe COVID-19 were not significantly different between sarilumab and standard of care. Sarilumab was associated with faster recovery in a subset of patients showing minor lung consolidation at baseline., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2020
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32. Colchicine as a new therapeutic option for antithyroid arthritis syndrome.
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Mancuso G, Boffini N, Dagna L, and Della-Torre E
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- Adult, Arthritis chemically induced, Female, Humans, Syndrome, Antithyroid Agents adverse effects, Arthritis drug therapy, Colchicine therapeutic use, Methimazole adverse effects
- Published
- 2020
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33. Efficacy and safety of apremilast for Behçet's syndrome: a real-life single-centre Italian experience.
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De Luca G, Cariddi A, Campochiaro C, Vanni D, Boffini N, Tomelleri A, Cavalli G, and Dagna L
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- Adult, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Behcet Syndrome complications, Behcet Syndrome epidemiology, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Male, Oral Ulcer drug therapy, Oral Ulcer epidemiology, Oral Ulcer etiology, Prospective Studies, Recurrence, Thalidomide administration & dosage, Time Factors, Treatment Outcome, Behcet Syndrome drug therapy, Mouth Mucosa pathology, Quality of Life, Thalidomide analogs & derivatives
- Abstract
Objectives: To evaluate the efficacy and safety of apremilast in treating oral ulcers (OUs), the cardinal and high-disabling feature of Behçet's disease (BD)., Methods: Twelve consecutive patients affected by BD with recurrent/relapsing OUs resistant and/or intolerant to conventional therapy were enrolled and prospectively followed. The primary endpoint was the number of OUs at week 12. Secondary endpoints were modification from baseline to week 12 in Behçet's Syndrome Activity Score (BSAS), Behçet's Disease Current Activity Form (BDCAF) score, Behçet's Disease Quality of Life (BDQOL) scale and pain of OUs, as measured by a visual analogue scale (VAS). All adverse events (AEs) were recorded during follow-up. Non-parametric tests (Wilcoxon rank test) were used and a P-value <0.05 was considered statistically significant., Results: After 12 weeks of apremilast, there was a significant reduction in the number of OUs [0.58 (s.d. 0.67) vs 3.33 (s.d. 1.45) at baseline, P = 0.02] that was paralleled by improvement in disease activity: BSAS was 16.8 (s.d. 9.1) [from 45.9 (s.d. 19.6) at baseline] (P = 0.02), BDCAF score was 0.72 (s.d. 0.65) [vs 2.45 (s.d. 1.0) at baseline] (P = 0.04) and the VAS score for pain decreased to 23.3 (s.d. 13.7) [vs 67.9 (s.d. 17.2) at baseline] (P = 0.02). Consistently, an improvement of BDQOL was assessed (P = 0.02). Clinical improvement led to complete steroid discontinuation in six patients and a tapering of the prednisone dose in two patients (P = 0.016). Colchicine was discontinued in six of nine patients (P = 0.031). AEs related to apremilast occurred in four patients (mainly due to gastrointestinal AEs), leading to drug discontinuation in all of them., Conclusion: Our preliminary real-world data support the use of apremilast as an effective therapeutic strategy against BD-related recurrent OUs resistant or intolerant to first-line therapy., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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34. Spinal non-Hodgkin's lymphoma mimicking a flare of disease in a patient with ankylosing spondylitis treated with anti-TNF agents: case report and review of the literature.
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Monti S, Boffini N, Lucioni M, Paulli M, Montecucco C, and Caporali R
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- B-Lymphocytes pathology, Diagnosis, Differential, Humans, Low Back Pain etiology, Lymphoma, B-Cell pathology, Magnetic Resonance Imaging, Male, Middle Aged, Randomized Controlled Trials as Topic, Lumbar Vertebrae pathology, Lymphoma, B-Cell diagnosis, Sacroiliac Joint pathology, Spondylitis, Ankylosing drug therapy, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
We report the case of a 52-year-old man with long-standing HLAB27-positive ankylosing spondylitis treated with anti-tumour necrosis factor (TNF) alpha therapy who was admitted to our rheumatology department complaining of increasing lumbar and buttock pain radiating to the posterior thigh, associated with numbness in the leg, gait disturbance and low-grade fever. The clinical picture was initially interpreted as a flare of disease but was not responsive to treatment. A contrast-enhanced spinal MRI was performed with evidence of a diffuse signal abnormality involving the sacroiliac joints and the spine, with evidence of spondylodiscitis of L5 and with a lesion causing L5-S1 root compression and infiltrating the iliopsoas muscle. These findings confirmed the possibility of a reactivation of disease associated with an infectious process. The most frequent causes of infectious spondylodiscitis were excluded, and a biopsy was then performed. Histological analysis revealed a high-grade B-cell non-Hodgkin's lymphoma of the spine. This case highlights how a differential diagnosis of low back pain with neurological symptoms can be particularly troublesome in ankylosing spondylitis and that continuous vigilance is warranted in patients treated with long-term immunosuppressive therapies.
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- 2016
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35. The multifaceted aspects of interstitial lung disease in rheumatoid arthritis.
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Cavagna L, Monti S, Grosso V, Boffini N, Scorletti E, Crepaldi G, and Caporali R
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- Female, Genetic Predisposition to Disease, Humans, Male, Risk Factors, Smoking adverse effects, Smoking genetics, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid drug therapy, Arthritis, Rheumatoid genetics, Arthritis, Rheumatoid metabolism, Arthritis, Rheumatoid physiopathology, Lung Diseases, Interstitial drug therapy, Lung Diseases, Interstitial etiology, Lung Diseases, Interstitial genetics, Lung Diseases, Interstitial metabolism, Lung Diseases, Interstitial physiopathology
- Abstract
Interstitial lung disease (ILD) is a relevant extra-articular manifestation of rheumatoid arthritis (RA) that may occur either in early stages or as a complication of long-standing disease. RA related ILD (RA-ILD) significantly influences the quoad vitam prognosis of these patients. Several histopathological patterns of RA-ILD have been described: usual interstitial pneumonia (UIP) is the most frequent one, followed by nonspecific interstitial pneumonia (NSIP); other patterns are less commonly observed. Several factors have been associated with an increased risk of developing RA-ILD. The genetic background plays a fundamental but not sufficient role; smoking is an independent predictor of ILD, and a correlation with the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies has also been reported. Moreover, both exnovo occurrence and progression of ILD have been related to drug therapies that are commonly prescribed in RA, such as methotrexate, leflunomide, anti-TNF alpha agents, and rituximab. A greater understanding of the disease process is necessary in order to improve the therapeutic approach to ILD and RA itself and to reduce the burden of this severe extra-articular manifestation.
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- 2013
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36. Atherosclerosis and rheumatoid arthritis: more than a simple association.
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Cavagna L, Boffini N, Cagnotto G, Inverardi F, Grosso V, and Caporali R
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- Arthritis, Rheumatoid genetics, Atherosclerosis genetics, Cardiovascular Diseases genetics, Cytokines metabolism, Humans, Arthritis, Rheumatoid metabolism, Atherosclerosis metabolism, Cardiovascular Diseases metabolism
- Abstract
In the last decades a large amount of evidence linked rheumatoid arthritis (RA) to atherosclerosis. In fact, RA patients have an increased risk of cardiovascular events that is not fully explained by other classic cardiovascular risk factors. RA and atherosclerosis may share several common pathomechanisms and inflammation undoubtedly plays a primary role. The proinflammatory cytokines such as tumor necrosis factor alpha and interleukin-6, involved in the pathogenesis of RA, are also independently predictive of subsequent cardiovascular disease (CVD). In RA, inflammation alters HDL constituents and the concentration of LDL and HDL, thus facilitating atherosclerosis and CVD events. On the other hand, also the increase of oxidative processes, frequently observed in RA, induces atherosclerosis. Interestingly, some genetic polymorphisms associated with RA occurrence enhance atherosclerosis, however, other polymorphisms associated with RA susceptibility do not increase CVD risk. Several other mechanisms may influence atherosclerotic processes in RA. Moreover, atherosclerosis may be directly mediated also by underlying autoimmune processes, and indirectly by the occurrence of metabolic syndrome and impaired physical activity. Finally, the effects of RA therapies on cardiovascular system in general and on atherosclerosis in particular are really wide and different. However, the starting point of every RA treatment is that disease control, or better remission, is the best way we have for the reduction of CVD occurrence.
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- 2012
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37. Early disease control by low-dose prednisone comedication may affect the quality of remission in patients with early rheumatoid arthritis.
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Todoerti M, Scirè CA, Boffini N, Bugatti S, Montecucco C, and Caporali R
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- Dose-Response Relationship, Drug, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Male, Middle Aged, Odds Ratio, Remission Induction methods, Surveys and Questionnaires, Time Factors, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid drug therapy, Glucocorticoids therapeutic use, Methotrexate therapeutic use, Prednisone therapeutic use
- Abstract
In order to identify rate and stability of remission induced by low-dose prednisone comedication in early rheumatoid arthritis (RA), we evaluated patients with early RA (<1 year) who were randomized to receive (P) or not (non-P) low-dose prednisone in association with step-up disease-modifying antirheumatic drug therapy over 2 years. Prevalence and duration of clinical remission were evaluated in the first and second year. Each treatment group included 105 patients; no significant differences were found at baseline. During the first year, P patients achieved higher rates of clinical remission with a time-averaged odds ratio (OR) of 1.965 (CI 95% 1.214-3.182, P= 0.006). Moreover, they showed a higher probability of sustained remission during the second year (OR 4.480, CI 95% 1.354-14.817, P= 0.014). In conclusion, we found as in early RA low-dose prednisone comedication is associated with higher rate of clinical remission, earlier disease activity control and more stable remission over time.
- Published
- 2010
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