In some cases, people have a medical condition that doesn’t respond well to treatments. The journey to finding an effective treatment can be long and difficult. But for patients with chronic inflammatory conditions like rheumatoid or psoriatic arthritis, or ankylosing spondylitis, a treatment called Simponi could greatly benefit them. Simponi (golimumab), a tumor necrosis factor (TNF) inhibitor, is effective for patients with chronic inflammatory conditions who have previously been treated by other TNF inhibitors. Find the full study in Rheumatology and Therapy.
Chronic Inflammatory Conditions
Ankylosing Spondylitis (AS)
Ankylosing spondylitis (AS) is a type of spondyloarthropathy, a group of conditions impacted up to 13 out of 1,000 U.S. citizens. If you want to understand AS, you can just break down the name! Ankylosing refers to when vertebrae fuse together, while spondylitis refers to joint inflammation in the pelvis and base of the spine. So people with AS experience chronic spinal inflammation which sometimes spreads to the hips, knees, or shoulders.
Doctors aren’t quite sure what causes AS, but it is believed to be a combination of genetic and environmental factors. In some (but not all) cases, HLA-B , IL1A, ERAP1, and IL23R gene mutations are linked to AS. Symptoms generally occur in early adulthood and include:
- Uveitis (eye inflammation) and eye pain – occurs in 40% of patients with AS
- Vision loss
- Light sensitivity
- Reduced flexibility
- Changes in posture
- Joint pain and stiffness
- Inflamed tendons
Learn more about ankylosing spondylitis here.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is a chronic inflammatory disorder causing joint inflammation, bone erosion, and joint deformity. RA is difficult to predict as it varies so much between patients. In some cases, it progresses slowly; in others, it progresses rapidly. Furthermore, in some patients, RA never gets worse at all. For those with a more progressive condition, they may experience periods of remission. Females are more likely to experience RA, and risk increases with age. RA is difficult to detect early, as it mimics other conditions.
- Joint and muscle pain, stiffness, inflammation, and weakness
- Poor grip strength
- Difficulty walking or climbing stairs
- Skin redness or lumps
- Inflamed fingers
- Pins-and-needles sensations
- Dry mouth
- Physical deformities
Learn more about rheumatoid arthritis here.
Psoriatic Arthritis (PsA)
Psoriatic arthritis (PsA) is an inflammatory arthritis that occurs in patients with psoriasis. About 40% of patients have a family history of either arthritis or psoriasis, suggesting a genetic cause. However, the condition may also result from infections. PsA leads to joint damage and psoriatic plaques (red skin patches with silver scales). Symptoms include:
- Joint and tendon swelling, pain, and stiffness
- Reduced range of motion
- Morning stiffness
- Swollen toes and fingers
- Pitted, dented nails or other changes (separation from nail bed)
- Eye pain and redness
Learn more about psoriatic arthritis here.
Simponi, developed by Janssen, is a tumor necrosis factor (TNF) inhibitor. Tumor necrosis factor is a pro-inflammatory cytokine that plays a role in cell survival, proliferation, and death. However, excess levels of TNF lead to inflammation. Thus, TNF-inhibitors reduce inflammation by blocking the effects of TNF. TNF-inhibitors are considered to be biological disease-modifying anti-rheumatic drugs (DMARDs).
According to data, Simponi is most effective when given to patients as a first treatment. However, the drug is still effective when given to patients whose conditions were not effectively treated by other therapies, including other TNF-inhibitors. Researchers determined this by studying the results of the GO-NICE clinical trial:
- The 1,454 participants received 50mg Simponi injections once per month for a 2-year period.
- 33% (480 patients) had ankylosing spondylitis. Most were also positive for the biomarker HLA-B27, which signals inflammatory spinal and joint-based arthritis.
- 32.5% (473 patients) had rheumatoid arthritis.
- 34.5% (501 patients) had psoriatic arthritis.
- To determine its efficacy, researchers used the Bath Ankylosing Spondylitis Disease Activity Index, 28-Joint Disease Activity Score, and Psoriatic Arthritis Response Criteria Index. Participant disease activity was monitored and assessed every 3 months.
Next, researchers divided the participants into 3 groups based on prior treatments: 0, 1, or 2+. Prior treatments included Humira, Enbrel, and infliximab. For ankylosing spondylitis, 61% (292 patients) received Simponi as their first ever treatment. 27% (130 patients) received it as their second treatment. 12% (58 patients) previously received 2 or more TNF-inhibitors prior to Simponi.
After 2 years, patients reduced disease activity scores by 2-3 points. In patients with AS, RA, and PsA, Simponi was most effective as a first-line treatment (i.e. in patients who had never been treated before). Patients experienced reduced fatigue, less pain, better physical function, and a higher quality of life. As a result, Simponi is believed to be effective in treating these conditions.
Read the source article here.