Michel Zummer

Université de Montréal, Montréal, Quebec, Canada

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Publications (58)263.11 Total impact

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):861.3-862. DOI:10.1136/annrheumdis-2015-eular.3538 · 10.38 Impact Factor
  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):498.2-498. DOI:10.1136/annrheumdis-2015-eular.2821 · 10.38 Impact Factor
  • 69th Annual Meeting of the Canadian-Rheumatology-Association (CRA); 07/2014
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    ABSTRACT: Background The prevalence of rheumatoid arthritis (RA) is 2-4 times higher in women compared to men. Furthermore, RA incidence in women increases from the age of menarche peaking around menopause, while it is rare in men younger than 45 years (1). Several studies have shown that treatment outcomes are worse in women (2). Objectives This analysis examined gender-specific differences with respect to disease parameters at initiation of the first anti-TNF agent for RA treatment in a Canadian routine clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. In this analysis, data were assessed from RA patients treated with golimumab subcutaneous as a first biologic who were enrolled between 2010 and 2012. Results 121 RA patients were included with mean (SD) disease duration of 9.3 (9.6) years. Eighty-nine patients (73.6%) were female. In the overall population, rheumatoid factor positivity was observed in 67% of patients and 17.5% were smokers, without any significant differences between genders. Patient reported disease parameters differed significantly between genders. Despite the younger age (56.6 vs. 62.0 years; P=0.051), female patients reported significantly higher pain (56.6 vs. 44.5 mm; P=0.045), patient global assessment (PtGA: 6.0 vs. 4.7 cm; P=0.034), tender joint count (10.2 vs. 6.8; P=0.022), and functional disability (HAQ-DI: 1.43 vs. 1.06; P=0.024). In addition, a statistical trend towards higher morning stiffness in female patients was observed (55.7 vs. 38.9; P=0.063). However, physician assessment of global disease activity (MDGA: 5.7 vs. 5.5; P=0.581), SJC (7.9 vs. 8.5; P=0.641), DAS28-ESR (5.3 vs. 4.7; P=0.086), CDAI (29.7 vs. 24.5; P=0.120) and SDAI (32.1 vs. 30.2; P=0.675) were statistically comparable between genders. Conclusions Objective measures (SJC, CRP/ESR), MDGA and composite outcomes were similar for male and female patients at golimumab initiation, with the exception of TJC being higher in women. Patient reported outcomes (PROs: pain, PtGA, HAQ-DI), however, were worse at baseline for female patients at biologic treatment initiation. These findings are similar to our previous research on patients initiating anti-TNF IV therapy (3). Overall, the results may suggest gender bias in the interpretation and use of PROs during the treatment decision making process in Canadian RA patients. References Disclosure of Interest D. Sholter: None declared, W. Bensen: None declared, D. Choquette: None declared, I. Fortin: None declared, R. Arendse: None declared, J. Kelsall: None declared, M. Sheriff: None declared, R. Faraawi: None declared, J. Rodrigues: None declared, M. Zummer: None declared, S. Dixit: None declared, M. Starr: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.3979
    69th Annual Meeting of the Canadian-Rheumatology-Association (CRA); 07/2014
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    ABSTRACT: Background Unlike rheumatoid arthritis (RA), the pattern of joint involvement in psoriatic arthritis (PsA) is usually asymmetric. Furthermore, PsA may demonstrate oligoarthritis or polyarthritis, while RA usually manifests in multiple joints. Objectives To describe the most commonly affected joints in patients with RA and PsA at baseline and after 6 months (mos) of treatment with infliximab (IFX) in a clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis, or PsA with IFX as first biologics or after having been treated with a biologic for <6 mos. RA patients treated between 2002-2012 and PsA patients treated with IFX between 2005-2012 were included. Based on the 28-joint involvement 7 groups were created: shoulder(s), elbow(s), metacarpophalangeal (MCP(s)), wrist(s), proximal interphalangeal (PIP(s)), knee(s), and thumb(s). The impact of treatment on joint swelling/tenderness was assessed with the McNemar test while the Chi-square test was used to compare the affected joints between disease groups. Results 832 RA patients (mean age: 55.8 yrs disease duration: 10.2 yrs) and 92 PsA patients (age: 48.7 yrs; disease duration: 6.8 yrs) were included. At baseline, mean DAS28, SJC28 and TJC28 in RA vs. PsA patients were 5.8 vs. 4.1 (P<0.001), 10.7 vs. 4.0 (P<0.001), and 12.6 vs. 5.9 (<0.001), respectively. Among RA patients, the joints most commonly swollen at baseline were MCPs (86.8% of patients), wrists (70.5%), and PIPs (53.2%). Knees, thumbs, elbows and shoulders were swollen in 42.3%, 33.7%, 30.5%, and 16.7% of patients, respectively (Figure 1A). With respect to tenderness, MCPs were tender in 83.8% of patients, wrists in 75.3%, shoulders in 57.8%, knees in 54.8%, PIPs in 55.3%, thumbs in 38.8%, and elbows in 41.0% (Figure 1B). Statistically significant differences were observed between RA and PsA patients both in the frequency of joint swelling/tenderness, which were lower in PsA, and the profile of affected joints. Among PsA patients, MCPs, wrists, and knees were the joints most commonly swollen, affected in 57.6%, 34.8%, and 31.5% of patients, respectively; MCPs, knees, and wrists were the joints most commonly tender (63.0%, 43.5%, and 42.4% of patients, respectively). Upon 6 mos of treatment, significant improvement in swelling/tenderness in all the most commonly affected joints in both RA and PsA patients was observed. The joints most resistant to treatment, still remaining affected at 6 mos, were MCPs in both patient groups. Conclusions Significant differences exist in both the frequency and the profile of swollen and tender joints in RA and PsA patients although both diseases shared the MCPs as the joint most commonly affected and most resistant to treatment. Treatment with IFX for 6 mos resulted in a significant reduction in the 28-swollen and tender joint counts in both RA and PsA patients. Disclosure of Interest A. Jovaisas: None declared, M. Starr: None declared, D. Choquette: None declared, M. Zummer: None declared, R. Arendse: None declared, D. Sholter: None declared, R. Faraawi: None declared, J. Rodrigues: None declared, S. Kapur: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen, A. Lehman Employee of: Janssen, S. Otawa Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2385
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):904-905. DOI:10.1136/annrheumdis-2014-eular.2385 · 10.38 Impact Factor
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    ABSTRACT: Background The efficacy of anti-TNF in the management of psoriatic arthritis (PsA) and rheumatoid arthritis (RA) has been demonstrated in numerous controlled clinical trials. Objectives The objective of this analysis was to assess in Canadian routine clinical practice the durability of treatment with infliximab (IFX) in PsA and RA and the determinants associated with sustainability of IFX. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. Patients with PsA or RA treated with IFX who were enrolled between 2002 (2005 for PsA patients) and 2012 were included in this analysis. Dose optimization was defined as an increase in the frequency and/or dosing of IFX. Kaplan Meier (KM) estimates and Cox proportional models were used in the analysis. Results A total of 92 PsA and 830 RA patients were included in the analysis. Mean (SD) age of the PsA and RA patient cohorts was 48.7 (9.9) and 55.8 (13.4) years, respectively, and mean (SD) duration since diagnosis was 6.8 (9.1) and 10.2 (10.1) years, respectively. Twenty seven (29.3%) PsA patients and 407 (49.0%) RA patients had discontinued treatment. Overall KM-based mean (SE) duration of treatment was 41.4 (3.6) months and 61.3 (2.2) months for PsA and RA patients, respectively. Longer treatment duration was associated with significantly greater improvements in pain (parameter estimate PsA: -0.21, P=0.020; RA: -0.27, P<0.001), patient global (PsA: -0.35, P<0.001; RA: -0.28, P<0.001) and HAQ-DI (PsA: -0.01, P<0.001; RA: -0.01, P<0.001). Significant associations with duration of treatment in PsA patients were observed for disease duration (HR=1.04), previous biologic (HR=2.10), baseline TJC28 (HR=1.10), baseline PASI (HR=0.86) and concomitant use of traditional DMARD(s) (HR=0.16) or NSAID(s) (HR=0.38). For RA patients, IFX dose optimization (HR=0.72) and concomitant use of steroids (HR=1.78) were identified as significant predictors of treatment durability. Conclusions The results of this observational study have shown a high durability of treatment with IFX for patients with PsA or RA in a real-world setting. Concomitant medication use significantly impacts treatment durability. Furthermore, longer disease duration, higher TJC, less severe skin disease at initiation and previous biologic use in PsA, and absence of IFX dose optimization in RA, may be associated with reduced treatment durability. Disclosure of Interest J. Kelsall: None declared, A. Jovaisas: None declared, P. Rahman: None declared, D. Sholter: None declared, M. Starr: None declared, W. Bensen: None declared, M. Sheriff: None declared, W. Olszynski: None declared, M. Zummer: None declared, R. Faraawi: None declared, A. Chow: None declared, S. Kapur: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.4013
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):1150-1151. DOI:10.1136/annrheumdis-2014-eular.4013 · 10.38 Impact Factor
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    ABSTRACT: Background DAS28 is an important outcome for clinical research and practice assisting with therapeutic decisions. The main contributors to DAS28 are joint tenderness and acute-phase reactants. A simulation analysis showed that, due to its logarithmic transformation in the DAS28 formula, the ESR contribution is greater in the lower than in the higher DAS28 range. Objectives This analysis assessed the relative contribution of individual DAS28 components and examined its clinimetric properties in rheumatoid arthritis (RA) patients treated with infliximab in a Canadian real-world setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with infliximab or golimumab as first biologics or after treatment with a biologic for <6 months (M). RA patients treated with infliximab between 2002-2012 and with ≤60M of follow-up were included. The association between treatment duration and parameter improvement was assessed using linear regression. Slope correlation was assessed with the Pearson's correlation coefficient. Results 832 patients evaluated over 4,002 visits were included. Longer treatment duration was associated with significant (P<0.001) improvements in DAS28, TJC28, SJC28, PtGA, ESR, and CRP. Correlation analysis of the rate of change over time showed a high correlation (0.7-0.9) of DAS28 with TJC28, SJC28, and PtGA but low correlation with ESR (r=0.418) and CRP (r=0.411). Overall, the relative contribution of TJC28, SJC28, PtGA, and ESR in DAS28-ESR was 22%, 9%, 12%, and 57%, respectively. For DAS28-CRP, the relative TJC28, SJC28, PtGA, and CRP contributions were 25%, 10%, 12%, and 20%. Over 60M of treatment, the mean relative contribution of TJC28 (M0:31%, M60:17%), SJC28 (M0:15%, M60:5%), and PtGA (M0:15%, M60:9%) significantly (P<0.001) decreased whereas the weight of ESR contribution increased (M0:39%, M60:69%). Similar results were obtained with DAS28-CRP although the CRP contribution was lower compared to ESR. Increased DAS28-ESR was associated with higher relative contributions (per unit of DAS28-ESR increase) of TJC28 [parameter estimate (B) =5.3], SJC28 (B=2.1), and PtGA (B=0.7) but lower ESR contribution (B=-8.1). Similarly, increased DAS28-CRP was associated with lower relative CRP contribution (B=-2.0). Conclusions This analysis shows that TJC28 and acute-phase reactants have a greater weight than SJC28 and PtGA within DAS28. Furthermore, the relative contribution of acute-phase reactants is greater with lower DAS28, due to their logarithmic nature. These findings suggest that biologic variability and variability in laboratory techniques may have significant impact on classifying remission or DAS28 changes among patients with low DAS28 and on therapeutic plan changes. Disclosure of Interest D. Choquette: None declared, D. Sholter: None declared, I. Fortin: None declared, M. Starr: None declared, C. Thorne: None declared, M. Baker: None declared, R. Arendse: None declared, P. Baer: None declared, M. Zummer: None declared, J. Rodrigues: None declared, M. Sheriff: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen, A. Lehman Employee of: Janssen, S. Otawa Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2379
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):880-881. DOI:10.1136/annrheumdis-2014-eular.2379 · 10.38 Impact Factor
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    ABSTRACT: Background A definition of minimal disease activity (MDA) in PsA was derived from the opinion of 60 PsA experts including fulfillment of ≥5 of the 7 following criteria: tender joint count (TJC) ≤1, swollen joint count (SJC) ≤1, PASI ≤1 or body surface area ≤3%, pain (VAS) ≤15, patient global disease activity (PtGA) (VAS) ≤20, HAQ ≤0.5, and tender entheseal points ≤1 (1). Objectives To describe the rate of MDA achievement over time and to assess the association between MDA achievement and DAS28 remission in PsA patients treated with anti-TNF in a routine clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis (RA), ankylosing spondylitis (AS), or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for <6 months. Data from PsA patients treated with infliximab (enrolled in 2005-2013) or golimumab (enrolled in 2010-2013) who had available MDA information at baseline, 6 months, and/or 12 months were included. Improvement in patient parameters over time was assessed for statistical significance with the paired-samples t-test. Agreement between MDA and remission as defined by the DAS28 (<2.6) criteria was assessed with the sensitivity, specificity, as well as the positive (PPV) and negative (NPV) predictive value. Results A total of 123 PsA patients with mean (SD) age of 50.5 (10.5) yrs and mean (SD) duration since diagnosis of 6.1 (7.3) yrs were included in this analysis, providing information from 340 assessments. At the time of enrollment in the registry, mean (SD) patient parameters were: DAS28 =4.2 (1.5), PASI =2.7 (4.8), SJC28 =4.1 (3.5), TJC28 =6.1 (5.6), morning stiffness =45.4 (43.0) min, health assessment questionnaire (HAQ-DI) =1.09 (0.65), physician global assessment of disease activity (MDGA) =5.3 (2.1), patient global assessment of disease activity (PtGA) =49.3 (27.3) mm, and pain =46.5 (25.2) mm. By 6 mos of treatment, statistically significant (P<0.05) improvements were observed in all clinical and patient outcome parameters studied, which were sustained or further enhanced over 12 months of treatment. The proportion of patients with MDA significantly increased from 12.3% at baseline to 45.0% after 6 months of treatment (P<0.001), and 41.9% at 12 mos (P=0.021). Similarly, DAS28 remission was observed in 15.9%, 47.8% and 45.1% of patients at baseline, 6 mos, and 12 mos, respectively. Using DAS28 as reference standard, sensitivity was 69.8%, specificity 93.0%, NPV 88.2%, and PPV 80.4%. Conclusions MDA has high discriminatory power for remission as defined by the DAS28 criteria, while being more rigorous than DAS28. Furthermore, treatment with anti-TNF is effective in inducing MDA in 45% of patients as early as 6 mos from treatment initiation. References Disclosure of Interest P. Rahman: None declared, S. Shaikh: None declared, M. Starr: None declared, W. Bensen: None declared, D. Choquette: None declared, W. Olszynski: None declared, M. Sheriff: None declared, M. Zummer: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, A. Lehman Employee of: Janssen, S. Otawa Employee of: Janssen, F. Nantel Employee of: Janssen, V. Letourneau Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2382
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):1056-1056. DOI:10.1136/annrheumdis-2014-eular.2382 · 10.38 Impact Factor
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    ABSTRACT: Background Patient (PtGA) and physician (MDGA) assessment of global disease activity have been used as outcome measures individually or as part of composite scores in the measurement of rheumatoid arthritis (RA) disease severity and the evaluation of treatment effectiveness. However, discordance between the two is common1. The question arising is which global measure is a more valid predictor of disease remission. Objectives The aim of the analysis was to compare PtGA and MDGA with respect to their association with remission based on DAS-28, SDAI and CDAI, using a sequential cross-sectional analysis. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with infliximab (IFX) or golimumab as first biologics or after having been treated with a biologic for <6 months. Eligible patients for this study included RA patients treated with IFX who were enrolled between 2002 and 2012 with available information on 6-, 12-, or 18-month remission. Logistic regression analysis with the parametric Wald statistic was used to compare the independent association of MDGA and PtGA with remission at 6, 12 and 18 months. The WALD statistic assesses the extent of contribution of an individual predictor to an outcome of interest and can be used to compare the contribution of different predictors. Results A total of 657 patients were included with mean (SD) age of 56.2 (13.5) years and disease duration of 10.1 (10.0) years. Significant (P<0.001) associations were observed between both PtGA and MDGA and achievement of remission at the corresponding assessments regardless of remission type. For DAS28 remission, the Wald statistic at 6, 12 and 18 months for MDGA vs. PtGA was 26.9 vs. 39.2, 12.7 vs. 35.9, and 19.8 vs. 22.5, respectively. For SDAI remission the MDGA and PtGA Wald statistics were 27.7 vs. 24.5, 27.8 vs. 28.5, and 32.4 vs. 23.4, respectively, at 6, 12 and 18 months. For CDAI remission, the Wald statistic for MDGA vs. PtGA at these time points was 34.8 vs. 26.9, 38.1 vs. 37.2, and 39.5 vs. 27.1. Similar results were obtained for predicting low disease activity. Conclusions The results of this analysis show that PtGA is a better predictor of DAS28 disease remission compared to MDGA. This could be explained by the fact that DAS28 includes PtGA and not MDGA. However, for CDAI and SDAI, physicians were better in predicting remission although the superiority of the MDGA was not consistent over time. References Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4276
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):398-398. DOI:10.1136/annrheumdis-2014-eular.4276 · 10.38 Impact Factor
  • Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A211-A211. DOI:10.1136/annrheumdis-2013-eular.670 · 10.38 Impact Factor
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    ABSTRACT: Objectives Hospitalization is a major factor in health care costs and a surrogate for worse outcomes in chronic disease. The aim of this study was to determine the frequency of hospitalization secondary to lupus flare, the causes of hospitalization, and to determine risk factors for hospitalization in patients with systemic lupus erythematosus (SLE).Methods Data were collected as part of the 1000 Canadian Faces of Lupus, a prospective cohort study, where annual major lupus flares including hospitalizations were recorded over a 3-year period.ResultsOf 665 patients with available hospitalization histories, 68 reported hospitalization related to a SLE flare over 3 years of follow-up. The average annual hospitalization rate was 7.6% (range 6.6-8.9%). The most common reasons for hospitalization were: hematologic (22.1%), serositis (20.6%), musculoskeletal (MSK) (16.2%), and renal (14.7%). Univariate risk factors for lupus hospitalization included (OR [95% CI]; p < 0.05): juvenile-onset lupus (2.2 [1.1-4.7]), number of ACR SLE criteria (1.4 [1.1-1.7], baseline body mass index (BMI) (1.1 [1.0-1.1]), psychosis (3.4 [1.2-9.9]), aboriginal race (3.2 [1.5-6.7]), anti-Smith (2.6 [1.2-5.4]), erythrocyte sedimentation rate >25 mm/hr (1.9 [1.1-3.4]), proteinuria >0.5 g/d (4.2 [1.9-9.3], and SLAM-2 score (1.1 [1.0-1.2]). After multivariate regression only BMI, number of ACR criteria, and psychosis were associated with hospitalization for lupus flare.Conclusions The mean annual rate of hospitalization attributed to lupus was lower than expected. Hematologic, serositis, MSK and renal were the most common reasons. In a regression model elevated BMI, more ACR criteria and psychosis were associated with hospitalization.
    Lupus 09/2013; 22(13). DOI:10.1177/0961203313505689 · 2.48 Impact Factor
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    ABSTRACT: OBJECTIVE: To examine the association between smoking and cutaneous involvement in SLE. METHODS: We analyzed data from a multicenter Canadian SLE cohort. Muco-cutaneous involvement was recorded at most recent visit, using the SLEDAI-2K (rash, alopecia, oral ulcers), the SLICC/ACR Damage Index (SDI; alopecia, extensive scarring and skin ulceration) and the ACR criteria (malar rash, discoïd rash, photosensitivity, mucosal involvement). Multivariate logistic regression models were used to estimate independent association between muco-cutaneous involvement and cigarette smoking, age, sex, lupus duration, medications, and laboratory data. RESULTS: In our cohort of 1346 patients, 91.0% were female, with mean age 47.1 years (standard deviation, SD 14.3) and mean disease duration of 13.2 years (SD 10.0). A total of 41.2% reported ever smoking, 14.0% were current smokers and 27.1% were past smokers. Active cutaneous manifestations occurred in 28.4%; cutaneous damage occurred in 15.4%. Regarding ACR criteria, malar rash was noted in 59.5%, discoid rash in 16.9%, and photosensitivity in 55.7%. In multivariate analysis, current smoking was associated with active SLE rash (OR 1.63; 95% CI 1.07-2.48). Having ever smoked was associated with the ACR criteria discoid rash (2.36; 1.69-3.29) and photosensitivity (1.47; 1.11-1.95), and with the total cutaneous ACR score (1.50; 1.22-1.85). We did not detect associations between previous smoking and active cutaneous manifestations. No association was found between smoking and cutaneous damage or mucosal ulcers. No interaction was seen between smoking and antimalarials. CONCLUSION: Current smoking is associated with active SLE rash, and ever smoking with cutaneous ACR criteria. This provides additional motivation for smoking cessation in SLE. © 2013 by the American College of Rheumatology.
    08/2013; 65(8). DOI:10.1002/acr.21966
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    ABSTRACT: OBJECTIVE: To update estimates of cancer risk in SLE relative to the general population. METHODS: A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. RESULTS: Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23). CONCLUSION: These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.
    Journal of Autoimmunity 02/2013; 42. DOI:10.1016/j.jaut.2012.12.009 · 7.02 Impact Factor
  • Guillaume Chausse · Dafna Gladman · Michel Zummer
    67th Annual Meeting of the Canadian-Rheumatology-Association (CRA); 08/2012
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    ABSTRACT: We aimed to determine disease severity and treatment of patients with psoriatic arthritis (PsA) in rheumatology practices in Canada through the PsA Assessment in Rheumatology (PAIR) study. Rheumatologists who were members of the Canadian Rheumatology Association were asked to complete a form for each patient addressing demographic questions, history, clinical examination, and patient-reported outcomes. Results were compared with a cohort seen in a PsA clinic during the same period. From across Canada, 22 rheumatologists from 5 provinces submitted information about 233 consecutive patients with PsA [145 men (62.2%), 88 women (37.8%), mean age 53.2 yrs (±12.7), 88.4% disease duration>2 yrs]. A majority (80.7%) fulfilled ClASsification for Psoriatic ARthritis (CASPAR) criteria, and 30% had taken no disease-modifying antirheumatic drugs. Clinical joint damage was documented in 60% of the patients, active skin disease in 70%, and nail lesions in 32%. Only 22% were rated as having moderate to high disease activity, while 52% were rated as low disease activity and 26% were deemed in remission. The decision was based on joint counts, patient global assessment, physician global assessment, and acute-phase reactants. Twenty-seven percent of the patients were to have their medications changed based on the current visit, the majority for inadequate response to medications. Patients in the PAIR cohort had more inflamed joints but similar damage to those in the PsA clinic. Patients with PsA seen in regular rheumatology practice fulfill CASPAR criteria, have active disease, and more than half have joint damage. The majority have low activity or are in remission.
    The Journal of Rheumatology 08/2012; 39(9):1850-3. DOI:10.3899/jrheum.120282 · 3.17 Impact Factor
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    ABSTRACT: The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part II, focusing on specific safety aspects of treatment with traditional and biologic DMARD in patients with RA, is reported here. Key questions were identified a priori based on results of a national needs-assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and was supplemented with a "grey literature" search including relevant public health guidelines. Systematic reviews of postmarketing surveillance and RA registry studies were performed to update included guideline literature reviews as appropriate. Guideline quality was independently assessed by 2 reviewers. Guideline characteristics, recommendations, and supporting evidence from observational studies and randomized trials were synthesized into evidence tables. The working group voted on recommendations using a modified Delphi technique. Thirteen recommendations addressing perioperative care, screening for latent tuberculosis infection prior to the initiation of biologic DMARD, optimal vaccination practices, and treatment of RA patients with active or a history of malignancy were developed for rheumatologists, other primary prescribers of RA drug therapies, and RA patients. These recommendations were developed based on a synthesis of international RA and public health guidelines, supporting evidence, and expert consensus in the context of the Canadian health system. They are intended to help promote best practices and improve healthcare delivery for persons with RA.
    The Journal of Rheumatology 06/2012; 39(8):1583-602. DOI:10.3899/jrheum.120165 · 3.17 Impact Factor
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    ABSTRACT: The (ever) prevalence of neuropsychiatric systemic lupus erythematosus (NPSLE) can vary widely depending on the definition used. We determined the prevalence of NPSLE in 1000 Faces of Lupus, a large multicenter Canadian cohort. Adults enrolled at 10 sites who satisfied the American College of Rheumatology (ACR) classification for systemic lupus erythematosus (SLE) were included. NPSLE was defined as (i) NPSLE by ACR classification criteria (seizures or psychosis), (ii) ACR, SLEDAI (seizure, psychosis, organic brain syndrome, cranial nerve disorder, headache, and cerebrovascular accident (CVA)), SLAM (CVA, seizure, cortical dysfunction, and headache), and SLICC (cognitive impairment, psychosis, seizures, CVA, cranial or peripheral neuropathy, and transverse myelitis) with and (iii) without minor nonspecific NPSLE manifestations (including mild depression, mild cognitive impairment, and electromyogram-negative neuropathies), and (iv) by ACR and SLEDAI neuropsychiatric (NP) indexes alone. Factors associated with NPSLE were explored using regression models. Cohort size was 1253, with mean disease 12 ± 10 years, mean age 41 ± 16 years, and 86% female. Subgroup size was dependent on the specific definition of NPSLE. Prevalence of NPSLE was 6.4% in group (i), n = 1253 (n = 80); 38.6% in group (ii), n = 681(n = 263); 28.7% in group (iii), n = 586 (n = 168); and 10.2% in group (iv), n = 1125 (n = 115). In univariate analysis, Aboriginals had a nearly 2-fold increase in frequency of NPSLE in all groups. Education level and income were not associated with NPSLE (P = 0.32 and 0.03, respectively). As well, number of ACR criteria, SLAM, age at diagnosis, disease duration, and gender were not associated with NPSLE. Anti-Ro was significantly associated in groups (i) and (iv) and antiphospholipid antibodies (aPL) were increased in groups (i), (ii), and (iii); however, this lost significance when thromboembolic events were excluded from SLICC, SLEDAI, and SLAM indexes. In group (iv), absence of anti-Sm was significant. In multivariate analysis, anti-Ro and aPL (i) and anti-Ro+ and lack of anti-Sm (iv) were significant. NPSLE was not increased in those with +anti-DNA, La, or ribonucleoprotein (RNP), lupus anticoagulant (LAC), or anticardiolipin (aCL) antibody. The prevalence and factors associated with NPSLE varied depending on the definition used, was highest in Aboriginals, and may be higher if +anti-Ro or aPL are present. SLAM and SLICC include mild subjective disease manifestations, which contributed to a 10% higher prevalence of NPSLE compared to a more strict definition. NPSLE may be less in this database than other publications as its overall prevalence may be decreasing, or because of selection bias inherent to those who enter an observational cohort. NPSLE was associated with aPL and often anti-Ro and varied by ethnicity.
    Seminars in arthritis and rheumatism 05/2012; 42(2):179-85. DOI:10.1016/j.semarthrit.2012.03.011 · 3.63 Impact Factor
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    ABSTRACT: The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part 1 is reported here. The CRA Therapeutics Committee assembled a national working group of RA clinical experts, researchers, patient consumers, and a general practitioner. Treatment questions were developed a priori based on results of a national needs assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and the grey literature. Guideline quality was assessed by 2 independent reviewers, and guideline characteristics, recommendations, and supporting evidence from observational studies and randomized controlled trials were synthesized into evidence tables. The full working group reviewed the evidence tables and developed recommendations using a modified Delphi technique. Five overarching principles and 26 recommendations addressing general RA management strategies and treatment with glucocorticoids and traditional and biologic DMARD were developed for rheumatologists, other primary prescribers of RA drug therapies, and patients with RA. These recommendations were developed based on a synthesis of international guidelines, supporting evidence, and expert consensus considering the Canadian healthcare context with the intention of promoting best practices and improving healthcare delivery for persons with RA.
    The Journal of Rheumatology 09/2011; 39(8):1559-82. DOI:10.3899/jrheum.110207 · 3.17 Impact Factor
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    ABSTRACT: Current clinical trial designs for pharmacologic interventions in rheumatoid arthritis (RA) do not reflect the innovations in RA diagnosis, treatment, and care in countries where new drugs are most often used. The objective of this project was to recommend revised entry criteria and other study design features for RA clinical trials. Recommendations were developed using a modified nominal group consensus method. Canadian Rheumatology Research Consortium (CRRC) members were polled to rank the greatest challenges to clinical trial recruitment in their practices. Initial recommendations were developed by an expert panel of rheumatology trialists and other experts. A scoping study methodology was then used to examine the evidence available to support or refute each initial recommendation. The potential influence of CRRC recommendations on primary outcomes in future trials was examined. Recommendations were finalized using a consensus process. Recommendations for clinical trial inclusion criteria addressed measures of disease activity [Disease Activity Score 28 using erythrocyte sedimentation rate (DAS28-ESR) > 3.2 PLUS ≥ 3 tender joints using 28-joint count (TJC28) PLUS ≥ 3 swollen joint (SJC28) OR C-reactive protein (CRP) or ESR > upper limit of normal PLUS ≥ 3 TJC28 PLUS ≥ 3 SJC28], functional classification, disease classification and duration, and concomitant RA treatments. Additional recommendations regarding study design addressed rescue strategies and longterm extension. There is an urgent need to modify clinical trial inclusion criteria and other study design features to better reflect the current characteristics of people living with RA in the countries where the new drugs will be used.
    The Journal of Rheumatology 07/2011; 38(10):2095-104. DOI:10.3899/jrheum.110188 · 3.17 Impact Factor
  • 2nd Mexican-Canadian Congress of Rheumatology/39th Mexican Congress of; 06/2011

Publication Stats

1k Citations
263.11 Total Impact Points

Institutions

  • 2009–2014
    • Université de Montréal
      Montréal, Quebec, Canada
  • 2005–2014
    • Hôpital Maisonneuve-Rosemont
      Montréal, Quebec, Canada
  • 2011
    • Memorial University of Newfoundland
      Saint John's, Newfoundland and Labrador, Canada
  • 2008
    • University of Pittsburgh
      • Division of Rheumatology and Clinical Immunology
      Pittsburgh, Pennsylvania, United States
  • 2006
    • McGill University Health Centre
      • Epidemiology Clinic
      Montréal, Quebec, Canada
  • 1993
    • Credit Valley Hospital
      Mississauga, Ontario, Canada