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Cöster, Lars
Publications (10 of 13) Show all publications
Sjöwall, C. & Cöster, L. (2014). Belimumab may not prevent lupus nephritis in serologically active patientswith ongoing non-renal disease activity [Letter to the editor]. Scandinavian Journal of Rheumatology, 43(5), 428-430
Open this publication in new window or tab >>Belimumab may not prevent lupus nephritis in serologically active patientswith ongoing non-renal disease activity
2014 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 43, no 5, p. 428-430Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Informa Healthcare, 2014
National Category
Clinical Medicine Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:liu:diva-107239 (URN)10.3109/03009742.2014.887769 (DOI)000343002200016 ()2-s2.0-84921823191 (Scopus ID)
Available from: 2014-06-10 Created: 2014-06-10 Last updated: 2017-12-05
Kastbom, A., Cöster, L., Ärlestig, L., Chatzidionysiou, A., van Vollenhoven, R. F., Padyukov, L., . . . Saevarsdottir, S. (2012). Influence of FCGR3A genotype on the therapeutic response to rituximab in rheumatoid arthritis: an observational cohort study. BMJ Open, 2(5)
Open this publication in new window or tab >>Influence of FCGR3A genotype on the therapeutic response to rituximab in rheumatoid arthritis: an observational cohort study
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2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 5Article in journal (Refereed) Published
Abstract [en]

Objectives To determine whether a polymorphism in the Fcγ receptor type IIIA (FCGR3A-F158V), influencing immunoglobulin G binding affinity, relates to the therapeutic efficacy of rituximab in rheumatoid arthritis (RA) patients.

Design Observational cohort study.

Setting Three university hospital rheumatology units in Sweden.

Participants Patients with established RA (n=177; 145 females and 32 males) who started rituximab (Mabthera) as part of routine care.

Primary outcome measures Response to rituximab therapy in relation to FCGR3A genotype, including stratification for sex.

Results The frequency of responders differed significantly across FCGR3A genotypes (p=0.017 in a 3×2 contingency table). Heterozygous patients showed the highest response rate at 83%, as compared with patients carrying 158FF (68%) or 158VV (56%) (p=0.028 and 0.016, respectively). Among 158VV patients, response rates differed between male and female patients (p=0.036), but not among 158FF or 158VF patients (p=0.72 and 0.46, respectively).

Conclusions Therapeutic efficacy of rituximab in RA patients is influenced by FCGR3A genotype, with the highest response rates found among heterozygous patients. This may suggest that different rituximab mechanisms of action in RA are optimally balanced in FCGR3A-158VF patients. Similar to the previously described associations with RA susceptibility and disease course, the impact of 158VV on rituximab response may be influenced by sex.

Keyword
Rheumatology, Immunology, Therapeutics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87615 (URN)10.1136/bmjopen-2012-001524 (DOI)000315053900081 ()23002160 (PubMedID)
Available from: 2013-01-19 Created: 2013-01-19 Last updated: 2017-12-06
Simard, J. F., Arkema, E. V., Saxne, T., Baecklund, E., Cöster, L., Dackhammar, C., . . . Neovius, M. (2011). Ten years with biologics: to whom do data on effectiveness and safety apply?. RHEUMATOLOGY, 50(1), 204-213
Open this publication in new window or tab >>Ten years with biologics: to whom do data on effectiveness and safety apply?
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2011 (English)In: RHEUMATOLOGY, ISSN 1462-0324, Vol. 50, no 1, p. 204-213Article in journal (Refereed) Published
Abstract [en]

Methods. We identified all adult patients with RA (n = 9612), PsA (n = 1417) and other SpA (n = 1652) initiating a first biologic therapy between 1 January 1999 and 31 December 2008, registered in the Swedish Biologics Register (ARTIS), including information on demographics, disease characteristics and 1-year risk of first-line treatment discontinuation. Results. Over calendar time, measures of disease activity at start declined substantially for all indications, and diminished between first-, second- and third-line therapy starts. One-year risks of first-line therapy discontinuation increased. Switchers to anti-TNF and non-TNF biologics had different comorbidities. Despite andlt; 50% drug retention at 5 years, most patients remained exposed to some biologic. Conclusions. The trends in baseline characteristics and drug retention underscores that any effects of biologics, including comparison between different biologics, must be interpreted in light of the characteristics of the population treated. The observed differences further call for continued vigilance to properly evaluate the safety profiles of biologic treatments as they are currently used. Exposure to multiple biologics presents a challenge for attribution of long-term effects.

Place, publisher, year, edition, pages
Oxford University Press, 2011
Keyword
Biologics, Rheumatoid arthritis, Anti-tumour necrosis factor, Psoriatic arthritis, Spondylarthritides
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-64235 (URN)10.1093/rheumatology/keq326 (DOI)000285193500028 ()
Available from: 2011-01-17 Created: 2011-01-17 Last updated: 2011-01-17
Turesson, C., Cöster, L. & Lysholm, J. (2010). RHEUMATOID ARTHRITIS: INSIGHTS, STRATEGIES AND EXPECTATIONS?SWEDISH RESULTS OF THE RAISE PATIENT NEEDS SURVEY in SCANDINAVIAN JOURNAL OF RHEUMATOLOGY, vol 39, issue , pp 23-23. In: SCANDINAVIAN JOURNAL OF RHEUMATOLOGY (pp. 23-23). Informa Healthcare, 39
Open this publication in new window or tab >>RHEUMATOID ARTHRITIS: INSIGHTS, STRATEGIES AND EXPECTATIONS?SWEDISH RESULTS OF THE RAISE PATIENT NEEDS SURVEY in SCANDINAVIAN JOURNAL OF RHEUMATOLOGY, vol 39, issue , pp 23-23
2010 (English)In: SCANDINAVIAN JOURNAL OF RHEUMATOLOGY, Informa Healthcare , 2010, Vol. 39, p. 23-23Conference paper, Published paper (Refereed)
Abstract [en]

n/a

Place, publisher, year, edition, pages
Informa Healthcare, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-59489 (URN)000281471700039 ()
Available from: 2010-09-17 Created: 2010-09-17 Last updated: 2010-09-17
van Vollenhoven, R., Ernestam, S., Geborek, P., Petersson, I., Cöster, L., Waltbrand, E., . . . Bratt, J. (2009). Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial. The Lancet, 374(9688), 459-466
Open this publication in new window or tab >>Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial
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2009 (English)In: The Lancet, ISSN 0140-6736, Vol. 374, no 9688, p. 459-466Article in journal (Refereed) Published
Abstract [en]

Background: New treatment strategies for early rheumatoid arthritis are evolving rapidly. We aimed to compare addition of conventional disease-modifying antirheumatic drugs (sulfasalazine and hydroxychloroquine) with addition of a tumour necrosis factor antagonist (infliximab) to methotrexate in patients with early rheumatoid arthritis. Methods: We undertook a randomised trial in 15 rheumatology units in Sweden. We enrolled patients with early rheumatoid arthritis (symptom duration less than1 year) and administered methotrexate (up to 20 mg per week). After 3-4 months, those who had not achieved low disease activity but who could tolerate methotrexate were randomly allocated by computer addition of either sulfasalazine and hydroxychloroquine or infliximab. Primary outcome was achievement of a good response according to European League Against Rheumatism (EULAR) criteria at 12 months. Patients were followed up to 24 months; here, we present findings at 12 months. Analysis was by intention to treat and we used non-responder imputation. The Swefot (Swedish Pharmacotherapy) study is registered in the WHO database at the Karolinska University Hospital, number CT20080004. Findings: 487 patients were initially enrolled. Of 258 who had not achieved low disease activity with methotrexate, 130 were allocated sulfasalazine and hydroxychloroquine and 128 were assigned infliximab. 32 of 130 (25%) patients allocated sulfasalazine and hydroxychloroquine achieved the primary outcome compared with 50 of 128 (39%) assigned infliximab (risk ratio 1·59 [95% CI 1·10-2·30], p=0·0160). Adverse events were balanced fairly well between the two groups and accorded with known adverse events of the drugs used. No deaths occurred in either group. Interpretation: In patients with early rheumatoid arthritis in whom methotrexate treatment failed, addition of a tumour necrosis factor antagonist to methotrexate monotherapy is clinically superior to addition of conventional disease-modifying antirheumatic drugs. Funding: Swedish Rheumatism Association, Schering-Plough.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-21256 (URN)10.1016/S0140-6736(09)60944-2 (DOI)
Available from: 2009-09-30 Created: 2009-09-30 Last updated: 2009-09-30
Askling, J., Baecklund, E., Granath, F., Geborek, P., Fored, M., Backlin, C., . . . Feltelius, N. (2009). Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register. Annals of the Rheumatic Diseases, 68(5), 648-653
Open this publication in new window or tab >>Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register
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2009 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, no 5, p. 648-653Article in journal (Refereed) Published
Abstract [en]

Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis ( RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern.

Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n = 67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 ( n = 6604) were identified. A general population comparator ( n = 471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these individuals.

Results: Among the 6604 anti-TNF-treated RA patients, 26 malignant lymphomas were observed during 26 981 person-years of follow-up, which corresponded to a relative risk (RR) of 1.35 (95% CI 0.82 to 2.11) versus anti-TNF-naive RA patients ( 336 lymphomas during 365 026 person-years) and 2.72 ( 95% CI 1.82 to 4.08) versus the general population comparator ( 1568 lymphomas during 3 355 849 person-years). RA patients starting anti-TNF therapy in 1998-2001 accounted for the entire increase in lymphoma risk versus the two comparators. By contrast, RR did not vary significantly by time since start of first treatment or with the accumulated duration of treatment, nor with the type of anti-TNF agent.

Conclusion: Overall and as used in routine care against RA, TNF antagonists are not associated with any major further increase in the already elevated lymphoma occurrence in RA. Changes in the selection of patients for treatment may influence the observed risk.

Place, publisher, year, edition, pages
London, UK: B M J Publishing Group, 2009
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:liu:diva-18039 (URN)10.1136/ard.2007.085852 (DOI)000265168500007 ()18467516 (PubMedID)
Available from: 2009-05-04 Created: 2009-05-04 Last updated: 2017-12-13Bibliographically approved
Askling, J., van Vollenhoven, R. F., Granath, F., Raaschou, P., Fored, C. M., Baecklund, E., . . . Klareskog, L. (2009). Cancer Risk in Patients With Rheumatoid Arthritis Treated With Anti-Tumor Necrosis Factor alpha Therapies Does the Risk Change With the Time Since Start of Treatment?. Arthritis and Rheumatism, 60(11), 3180-3189
Open this publication in new window or tab >>Cancer Risk in Patients With Rheumatoid Arthritis Treated With Anti-Tumor Necrosis Factor alpha Therapies Does the Risk Change With the Time Since Start of Treatment?
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2009 (English)In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 60, no 11, p. 3180-3189Article in journal (Refereed) Published
Abstract [en]

Objective. To determine the short-term and medium-term risks of cancer in patients receiving antitumor necrosis factor alpha (anti-TNF alpha) therapies that have proven effective in the treatment of chronic inflammatory conditions. Methods. By linking together data from the Swedish Biologics Register, Swedish registers of RA, and the Swedish Cancer Register, we identified and analyzed for cancer occurrence a national cohort of 6,366 patients with RA who first started anti-TNF therapy between January 1999 and July 2006. As comparators, we used a national biologics-naive RA cohort (n = 61,160), a cohort of RA patients newly starting methotrexate (n = 5,989), a cohort of RA patients newly starting disease-modifying antirheumatic drug combination therapy (n = 1,838), and the general population of Sweden. Relative risks (RRs) were estimated using Cox regression analyses, examining overall RR as well as RR by time since the first start of anti-TNF therapy, by the duration of active anti-TNF therapy, and by the anti-TNF agent received. Results. During 25,693 person-years of followup in 6,366 patients newly starting anti-TNF, 240 first cancers occurred, yielding an RR of 1.00 (95% confidence interval 0.86-1.15) versus the biologics-naive RA cohort, and similar RRs versus the other 2 RA comparators. RRs did not increase with increasing time since the start of anti-TNF therapy, nor with the cumulative duration of active anti-TNF therapy. During the first year following the first treatment start, but not thereafter, dissimilar cancer risks for adalimumab, etanercept, and infliximab were observed. Conclusion. During the first 6 years after the start of anti-TNF therapy in routine care, no overall elevation of cancer risk and no increase with followup time were observed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2009
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-52389 (URN)10.1002/art.24941 (DOI)000271781400005 ()19877027 (PubMedID)
Available from: 2009-12-18 Created: 2009-12-18 Last updated: 2017-12-12Bibliographically approved
Cöster, L., Kendall, S., Gerdle, B., Henriksson, C., Henriksson, K.-G. & Bengtsson, A. (2008). Chronic widespread musculoskeletal pain - A comparison of those who meet criteria for fibromyalgia and those who do not. European Journal of Pain, 12(5), 600-610
Open this publication in new window or tab >>Chronic widespread musculoskeletal pain - A comparison of those who meet criteria for fibromyalgia and those who do not
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2008 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 5, p. 600-610Article in journal (Refereed) Published
Abstract [en]

Fibromyalgia is currently classified as chronic widespread pain with widespread allodynia to pressure pain. There are few data describing pain characteristics, quality of life, consequences for daily living, and psychosocial status in patients who meet the classification criteria for fibromyalgia proposed by the American College of Rheumatology compared with patients with chronic widespread pain but not widespread allodynia. This study used a randomly selected sample from the general population. A postal questionnaire and a pain mannequin were sent to 9952 people. The response rate was 76.7%. The pain drawings showed that 345 people had widespread pain, that is, they noted pain in all four extremities and axially. Clinical examination, which included a manual tender point examination, was performed in 125 subjects. These people answered commonly used questionnaires on pain, quality of life, coping strategies, depression, and anxiety. Compared with chronic widespread pain without widespread allodynia, fibromyalgia was associated with more severe symptoms/consequences for daily life and higher pain severity. Similar coping strategies were found. Chronic widespread pain without widespread allodynia to pressure pain was found in 4.5% in the population and fibromyalgia in 2.5%. © 2007 European Federation of Chapters of the International Association for the Study of Pain.

Keyword
Activities of Daily Living Adaptation, Psychological Adult Aged Anxiety/epidemiology Chronic Disease Creatine Kinase, MM Form/blood Depression/epidemiology Diagnosis, Differential Female Fibromyalgia/classification/*diagnosis/psychology Humans Male Middle
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43334 (URN)10.1016/j.ejpain.2007.10.001 (DOI)73539 (Local ID)73539 (Archive number)73539 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Gerdle, B., Björk, J., Cöster, L., Henriksson, K.-G., Henriksson, C. & Bengtsson, A. (2008). Prevalence of widespread pain and associations with work status: A population study. BMC Musculoskeletal Disorders, 9
Open this publication in new window or tab >>Prevalence of widespread pain and associations with work status: A population study
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2008 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 9Article in journal (Refereed) Published
Abstract [en]

Background. This population study based on a representative sample from a Swedish county investigates the prevalence, duration, and determinants of widespread pain (WSP) in the population using two constructs and estimates how WSP affects work status. In addition, this study investigates the prevalence of widespread pain and its relationship to pain intensity, gender, age, income, work status, citizenship, civil status, urban residence, and health care seeking. Methods. A cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, 18-74 years) in a county (Östergötland) in the southern Sweden. The questionnaire was mailed and followed by two postal reminders when necessary. Results. The participation rate was 76.7% (n = 7637), the non-participants were on the average younger, earned less money, and male. Women had higher prevalences of pain in 10 different predetermined anatomical regions. WSP was generally chronic (90-94%) and depending on definition of WSP the prevalence varied between 4.8-7.4% in the population. Women had significantly higher prevalence of WSP than men and the age effect appeared to be stronger in women than in men. WSP was a significant negative factor - together with age 50-64 years, low annual income, and non-Nordic citizen - for work status in the community and in the group with chronic pain. Chronic pain but not the spreading of pain was related to health care seeking in the population. Conclusion. This study confirms earlier studies that report high prevalences of widespread pain in the population and especially among females and with increasing age. Widespread pain is associated with prominent effects on work status. © 2008 Gerdle et al, licensee BioMed Central Ltd.

Keyword
Adolescent Adult Aged Chronic Disease Cross-Sectional Studies Demography Employment/*statistics & numerical data Female Humans Male Middle Aged Occupational Diseases Pain/diagnosis/*epidemiology/physiopathology *Population Surveillance Prevalence Question
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43153 (URN)10.1186/1471-2474-9-102 (DOI)72100 (Local ID)72100 (Archive number)72100 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Askling, J., Fored, C., Brandt, L., Baecklund, E., Bertilsson, L., Feltelius, N., . . . Klareskog, L. (2007). Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists. Annals of the Rheumatic Diseases, 66(10), 1339-1344
Open this publication in new window or tab >>Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists
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2007 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 66, no 10, p. 1339-1344Article in journal (Refereed) Published
Abstract [en]

Objectives: The degree to which treatment with tumour necrosis factor (TNF) antagonists may be associated with increased risks for serious infections is unclear. An observational cohort study was performed using prospectively collected data from the Swedish Biologics Register (ARTIS) and other national Swedish registers. Methods: First, in the ARTIS, all 4167 rheumatoid arthritis (RA) patients starting TNF antagonist treatment between 1999 and 2003 were identified. Secondly, in the Swedish Inpatient Register, all individuals hospitalised for any reason and who also carried a diagnosis of RA, between 1964 and 2003 (n = 44 946 of whom 2692 also occurred in ARTIS), were identified. Thirdly, in the Swedish Inpatient Register, all hospitalisations listing an infection between 1999 and 2003 were identified. By cross-referencing these three data sets, RRs for hospitalisation with infection associated with TNF antagonist treatment were calculated within the cohort of 44 946 RA patients, using Cox regression taking sex, age, geography, co-morbidity and use of inpatient care into account. Results: Among the 4167 patients treated with TNF antagonists, 367 hospitalisations with infections occurred during 7776 person-years. Within the cohort of 44 496 RA patients, the RR for infection associated with TNF antagonists was 1.43 (95% Cl 1.18 to 1.73) during the first year of treatment, 1.15 (95% Cl 0.88 to 1.51) during the second year of treatment, and 0.82 (95% Cl 0.62 to 1.08) for subjects remaining on their first TNF antagonist treatment after 2 years. Conclusion: Treatment with TNF antagonists may be associated with a small to moderate increase in risk of hospitalisation with infection, which disappears with increasing treatment duration.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-39547 (URN)10.1136/ard.2006.062760 (DOI)49646 (Local ID)49646 (Archive number)49646 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
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