medwireNews: Findings from 2 studies published successful Rheumatology suggest that angiotensin receptor blocker (ARB) usage whitethorn beryllium associated with an accrued hazard for processing elephantine compartment arteritis (GCA), and that interferon (IFN)-γ whitethorn warrant further probe arsenic a hazard biomarker.
For the archetypal study, Sarah Mackie (University of Leeds, UK) and squad investigated the incidence of GCA successful implicit a cardinal radical initiating attraction with antihypertensive drugs successful UK superior attraction betwixt 1995 and 2019. A full of 957 individuals developed GCA during 5 years of follow-up.
In a weighted investigation accounting for perchance confounding factors, the researchers recovered that radical connected ARBs (n=74,390) had a important 55% higher hazard for GCA than those taking angiotensin-converting enzyme (ACE) inhibitors (n=73,902), with incidence rates of 2.73 versus 1.76 per 10,000 patient–years. Rates of GCA were comparable among radical initiating different antihypertensives (n=75,712) and those connected ACE inhibitors, however.
A akin signifier of results was seen for polymyalgia rheumatica (PMR). The hazard was a important 15% higher with ARBs than ACE inhibitors, whereas it was comparable for different antihypertensive agents and ACE inhibitors.
These findings suggest that “[n]on-ARB drugs whitethorn beryllium preferable erstwhile choosing antihypertensives (or different indications for ACE [inhibitors] and ARB) successful patients with accrued hazard of GCA and/or PMR, specified arsenic older patients with a idiosyncratic oregon household past of autoimmunity,” constitute Mackie and colleagues.
They emphasize, however, that “the precedence should ever beryllium effectual attraction of hypertension with whichever cause is suitable for that patient.”
The 2nd study, from Karin Wadström (Lund University, Malmö, Sweden) and co-authors, investigated whether biomarkers of inflammation were associated with the improvement of GCA among 30,447 people who were included successful the Malmö Diet Cancer Study successful 1991–1996.
A full of 94 people developed incidental GCA aft a median of 11.9 years. In an investigation of 8 biomarkers that were preselected for evaluation, the researchers identified IFN-γ arsenic a imaginable biomarker for GCA development.
They accidental that IFN-γ levels measured successful the humor astatine baseline were importantly higher among radical who developed GCA comparative to 97 matched controls, astatine 7.27 versus 7.07 units, giving an likelihood ratio (OR) of 1.52 per modular deviation increase.
When patients were categorized into 4 groups according to clip from baseline to GCA diagnosis, the strongest relation betwixt IFN-γ levels and GCA hazard was seen successful those with samples taken nearer to the clip of diagnosis. The OR was a important 2.37 for those sampled 0.3–8.5 years prediagnosis (quartile 1), and was nary longer statistically important successful those with a longer interval.
None of the different preselected biomarkers were importantly associated with the improvement of GCA overall, but CXCL-10 levels were importantly higher successful radical from quartile 1 who did versus did not make GCA, arsenic were CXCL-11 levels successful quartile 2 (8.5–11.9 years anterior to diagnosis).
The squad says that each of these findings mislaid statistical value aft accommodation for aggregate testing, but “the information that respective biomarkers are progressive successful the aforesaid inflammatory pathways summation the likelihood that they bespeak important biologic mechanisms.”
Wadström et al besides carried retired a hypothesis-generating probe utilizing main constituent investigation to measure a wider scope of biomarkers. This revealed a fig of proteins that were importantly associated with GCA hazard erstwhile analyzed per modular deviation, including IFN-γ, CXCL-10, and CXCL-11 arsenic successful the prespecified analysis, arsenic good arsenic others including stem compartment factor, interleukin-2 and -10RB, CXCL9, and monocyte chemotactic macromolecule 3.
Taken together, the “[r]esults of the existent survey bespeak that immoderate of the processes successful the pathogenesis of GCA whitethorn statesman years earlier objective onset,” constitute the researchers.
They item the request for validation studies to trial whether their findings are generalizable to different populations.
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Rheumatology 2022; doi:10.1093/rheumatology/keac599
Rheumatology 2022; doi:10.1093/rheumatology/keac581
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