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  1. Article ; Online: [No title information]

    Besada, Emilio

    Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke

    2016  Volume 136, Issue 22, Page(s) 1875–1876

    Title translation Re: En pasient i 20-årene med icterus og smerter i ledd og muskler.
    Language Norwegian
    Publishing date 2016-12
    Publishing country Norway
    Document type Journal Article ; Comment
    ZDB-ID 603504-8
    ISSN 0807-7096 ; 0029-2001
    ISSN (online) 0807-7096
    ISSN 0029-2001
    DOI 10.4045/tidsskr.16.0972
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Risk Factors and Adverse Events Poorly Predict Infections and Hypogammaglobulinemia in Granulomatosis with Polyangiitis Patients Receiving Rituximab.

    Besada, Emilio

    Autoimmune diseases

    2016  Volume 2016, Page(s) 8095695

    Abstract: Background. 29 GPA patients from the Northern Norway vasculitis disease registry received rituximab (RTX) induction and maintenance. 24% and 31% had, respectively, severe and chronic infections while 45% had hypogammaglobulinemia and 28% discontinued RTX ...

    Abstract Background. 29 GPA patients from the Northern Norway vasculitis disease registry received rituximab (RTX) induction and maintenance. 24% and 31% had, respectively, severe and chronic infections while 45% had hypogammaglobulinemia and 28% discontinued RTX due to hypogammaglobulinemia. The aim of the study was to examine how known predictors and adverse events interacted with adverse events using structural statistical methods. Methods. Five predictors (age, cyclophosphamide, total Ig and CD4/CD8 ratio prior RTX, and type of RTX maintenance regimen) and 4 adverse events (severe and chronic infections, hypogammaglobulinemia, and RTX discontinuation) were modeled in principal component and redundancy analyses. Results. The 5 predictors explained 51% of the variance of the GPA cohort. Models including cyclophosphamide exposure and total Ig level predicted best adverse events. However total Ig level has low R squared. The 2 best combinations of adverse events explained 13% of the variance of the predictors and adverse events. Only chronic infections were associated with combination of all adverse events (P = 0.014). Hypogammaglobulinemia did not seem associated with the other adverse events. Conclusions. Traditional risk factors for infections and hypogammaglobulinemia seemed to poorly predict adverse events in our GPA cohort.
    Language English
    Publishing date 2016-01-18
    Publishing country United States
    Document type Journal Article
    ISSN 2090-0422
    ISSN 2090-0422
    DOI 10.1155/2016/8095695
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Low immunoglobulin levels increase the risk of severe hypogammaglobulinemia in granulomatosis with polyangiitis patients receiving rituximab.

    Besada, Emilio

    BMC musculoskeletal disorders

    2016  Volume 17, Page(s) 6

    Abstract: Background: Randomized controlled trials and retrospective studies in ANCA-associated vasculitis (AAV) concurred that rituximab (RTX) is effective to induce and maintain remission. Infections and hypogammaglobulinemia during RTX were usually infrequent ... ...

    Abstract Background: Randomized controlled trials and retrospective studies in ANCA-associated vasculitis (AAV) concurred that rituximab (RTX) is effective to induce and maintain remission. Infections and hypogammaglobulinemia during RTX were usually infrequent and uncomplicated. But in the Tromsø study cohort, 45% of patients with granulomatosis with polyangiitis (GPA) developed hypogammaglobulinemia during RTX maintenance leading to its discontinuation in 62%.
    Methods: To explain these differences in outcome when using RTX in AAV to maintain remission, we used statistical structural methods to compare the Tromsø study cohort with other published cohorts.
    Results: GPA patients' characteristics of the Tromsø study cohort were not so different compared with other cohorts. Rates of hypogammaglobulinemia and discontinuation of RTX seemed closely related to the cut-off used and to the levels of immunoglobulin (Ig) at baseline. Combination of low IgG serum levels at baseline (7.7 g/L) and low cut-off to define hypogammaglobulinemia in the Tromsø study cohort explained the high rate of hypogammaglobulinemia and discontinuation of RTX.
    Conclusions: Patients' characteristics in the Tromsø study cohort were not skewed, apart from IgG levels. Low IgG level at baseline seemed to contribute the most to hypogammaglobulinemia and its complications.
    MeSH term(s) Adult ; Agammaglobulinemia/blood ; Agammaglobulinemia/chemically induced ; Agammaglobulinemia/epidemiology ; Aged ; Antirheumatic Agents/adverse effects ; Biomarkers/blood ; Cohort Studies ; Female ; Granulomatosis with Polyangiitis/blood ; Granulomatosis with Polyangiitis/drug therapy ; Granulomatosis with Polyangiitis/epidemiology ; Humans ; Immunoglobulin G/blood ; Male ; Middle Aged ; Norway/epidemiology ; Risk Factors ; Rituximab/adverse effects ; Severity of Illness Index
    Chemical Substances Antirheumatic Agents ; Biomarkers ; Immunoglobulin G ; Rituximab (4F4X42SYQ6)
    Language English
    Publishing date 2016-01-06
    Publishing country England
    Document type Journal Article
    ISSN 1471-2474
    ISSN (online) 1471-2474
    DOI 10.1186/s12891-015-0860-3
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  4. Article ; Online: Comment on: tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice.

    Besada, Emilio

    Rheumatology (Oxford, England)

    2015  Volume 54, Issue 4, Page(s) 751

    MeSH term(s) Antibodies, Monoclonal, Humanized/therapeutic use ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/drug therapy ; Female ; Glucocorticoids/therapeutic use ; Humans ; Male ; Prednisone/therapeutic use
    Chemical Substances Antibodies, Monoclonal, Humanized ; Antirheumatic Agents ; Glucocorticoids ; tocilizumab (I031V2H011) ; Prednisone (VB0R961HZT)
    Language English
    Publishing date 2015-04
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 1464822-2
    ISSN 1462-0332 ; 1462-0324
    ISSN (online) 1462-0332
    ISSN 1462-0324
    DOI 10.1093/rheumatology/keu467
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Risk Factors and Adverse Events Poorly Predict Infections and Hypogammaglobulinemia in Granulomatosis with Polyangiitis Patients Receiving Rituximab

    Emilio Besada

    Autoimmune Diseases, Vol

    2016  Volume 2016

    Abstract: Background. 29 GPA patients from the Northern Norway vasculitis disease registry received rituximab (RTX) induction and maintenance. 24% and 31% had, respectively, severe and chronic infections while 45% had hypogammaglobulinemia and 28% discontinued RTX ...

    Abstract Background. 29 GPA patients from the Northern Norway vasculitis disease registry received rituximab (RTX) induction and maintenance. 24% and 31% had, respectively, severe and chronic infections while 45% had hypogammaglobulinemia and 28% discontinued RTX due to hypogammaglobulinemia. The aim of the study was to examine how known predictors and adverse events interacted with adverse events using structural statistical methods. Methods. Five predictors (age, cyclophosphamide, total Ig and CD4/CD8 ratio prior RTX, and type of RTX maintenance regimen) and 4 adverse events (severe and chronic infections, hypogammaglobulinemia, and RTX discontinuation) were modeled in principal component and redundancy analyses. Results. The 5 predictors explained 51% of the variance of the GPA cohort. Models including cyclophosphamide exposure and total Ig level predicted best adverse events. However total Ig level has low R squared. The 2 best combinations of adverse events explained 13% of the variance of the predictors and adverse events. Only chronic infections were associated with combination of all adverse events (P=0.014). Hypogammaglobulinemia did not seem associated with the other adverse events. Conclusions. Traditional risk factors for infections and hypogammaglobulinemia seemed to poorly predict adverse events in our GPA cohort.
    Keywords Internal medicine ; RC31-1245 ; Immunologic diseases. Allergy ; RC581-607
    Subject code 610
    Language English
    Publishing date 2016-01-01T00:00:00Z
    Publisher Hindawi Publishing Corporation
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Is there an interactive effect of immunoglobulin levels and CD4+ cell counts during rituximab treatment? Comment on the article by Mélet et al.

    Besada, Emilio

    Arthritis & rheumatology (Hoboken, N.J.)

    2014  Volume 66, Issue 4, Page(s) 1053–1054

    MeSH term(s) Antibodies, Monoclonal, Murine-Derived/pharmacology ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/immunology ; CD4-Positive T-Lymphocytes/drug effects ; CD8-Positive T-Lymphocytes/drug effects ; Female ; Humans ; Male
    Chemical Substances Antibodies, Monoclonal, Murine-Derived
    Language English
    Publishing date 2014-04
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 2756371-6
    ISSN 2326-5205 ; 2326-5191
    ISSN (online) 2326-5205
    ISSN 2326-5191
    DOI 10.1002/art.38358
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Potential patient benefit of a subcutaneous formulation of tocilizumab for the treatment of rheumatoid arthritis: a critical review.

    Besada, Emilio

    Patient preference and adherence

    2014  Volume 8, Page(s) 1051–1059

    Abstract: Treatment of rheumatoid arthritis (RA) was revolutionized during the last decade with the development of new biologic disease-modifying anti-rheumatic drugs (DMARDs) enabling the targeting of immune cells and cytokines other than tumor necrosis factor ( ... ...

    Abstract Treatment of rheumatoid arthritis (RA) was revolutionized during the last decade with the development of new biologic disease-modifying anti-rheumatic drugs (DMARDs) enabling the targeting of immune cells and cytokines other than tumor necrosis factor (TNF). Subcutaneous formulations of the newer biologic DMARDs facilitate not only patients' emancipation from the hospital, but reduce both societal and medical costs. Intravenous tocilizumab (TCZ) in RA has an efficacy and safety profile similar to anti-TNF in both the short and long-term. However, TCZ can be administered in monotherapy without loss of efficacy when patients do not tolerate methotrexate or synthetic DMARDs. TCZ is consistently found superior to methotrexate and possibly superior to adalimumab in monotherapy in randomized controlled trials. Subcutaneous administration of TCZ is as effective and safe as its intravenous administration in RA patients during the first year of treatment. Similar to intravenous TCZ, patients' weight and possibly previous use of anti-TNF influence the efficacy of subcutaneous TCZ. Additionally, combination with synthetic DMARDs seems to expose RA patients to more adverse events independently of its administration route. Pharmacokinetics of different administration routes could potentially lead to differences in efficacy, adverse events, and auto-immunogenicity. The concentration of free TCZ before new TCZ dose (C trough) is higher in the subcutaneous route, while the maximal concentration of free TCZ is higher in the intravenous route. The subcutaneous dosages of TCZ 162 mg every week, and every 2 weeks in RA patients with low body weight (<60 kg) work well. Nevertheless, dosage and intervals of subcutaneous TCZ administration could be adjusted during the course of treatment since 80% of non-Japanese RA patients with usually higher body weight achieved similar efficacy with the low TCZ dosage in combination with a synthetic DMARD. Patients want effective, easy-to-administer therapy with sustained prolonged efficacy without the need of polypharmacy and with minimal to no side effects. Subcutaneous TCZ in RA patients in monotherapy seems to live up to patients' expectations.
    Language English
    Publishing date 2014-08-01
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 2455848-5
    ISSN 1177-889X
    ISSN 1177-889X
    DOI 10.2147/PPA.S34958
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  8. Article ; Online: Routine pneumocystis pneumonia prophylaxis in patients treated with rituximab?

    Besada, Emilio

    Chest

    2013  Volume 144, Issue 1, Page(s) 359–360

    MeSH term(s) Antibodies, Monoclonal, Murine-Derived/adverse effects ; Antineoplastic Agents/adverse effects ; Female ; Humans ; Male ; Opportunistic Infections/chemically induced ; Opportunistic Infections/epidemiology ; Pneumonia, Pneumocystis/chemically induced ; Pneumonia, Pneumocystis/epidemiology ; Rituximab
    Chemical Substances Antibodies, Monoclonal, Murine-Derived ; Antineoplastic Agents ; Rituximab (4F4X42SYQ6)
    Language English
    Publishing date 2013-07
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1378/chest.13-0530
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Rituximab og nøytropeni.

    Besada, Emilio

    Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke

    2012  Volume 132, Issue 20, Page(s) 2259; author reply 2259

    Title translation Rituximab and neutropenia.
    MeSH term(s) Antibodies, Monoclonal, Murine-Derived/adverse effects ; Arthritis, Rheumatoid/drug therapy ; Humans ; Immunosuppressive Agents/adverse effects ; Infection/chemically induced ; Tumor Necrosis Factor-alpha/antagonists & inhibitors
    Chemical Substances Antibodies, Monoclonal, Murine-Derived ; Immunosuppressive Agents ; Tumor Necrosis Factor-alpha
    Language Norwegian
    Publishing date 2012-10-30
    Publishing country Norway
    Document type Comment ; Letter
    ZDB-ID 603504-8
    ISSN 0807-7096 ; 0029-2001
    ISSN (online) 0807-7096
    ISSN 0029-2001
    DOI 10.4045/tidsskr.12.1147
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Alternative explanations for development of late-onset neutropenia in rituximab-treated rheumatic disease patients: comment on the article by Tesfa et al.

    Besada, Emilio

    Arthritis and rheumatism

    2012  Volume 64, Issue 2, Page(s) 596–7; author reply 597

    MeSH term(s) Antibodies, Monoclonal, Murine-Derived/adverse effects ; Antirheumatic Agents/adverse effects ; B-Lymphocytes ; Humans ; Neutropenia/chemically induced ; Rheumatic Diseases/drug therapy
    Chemical Substances Antibodies, Monoclonal, Murine-Derived ; Antirheumatic Agents
    Language English
    Publishing date 2012-02
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 127294-9
    ISSN 1529-0131 ; 0004-3591 ; 2326-5191
    ISSN (online) 1529-0131
    ISSN 0004-3591 ; 2326-5191
    DOI 10.1002/art.33428
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