Precise Measurements of Decay Parameters and CP Asymmetry with Entangled Λ-Λ[over ¯] Pairs

Based on 10 billion J/ψ events collected at the BESIII experiment, a search for CP violation in Λ decay is performed in the difference between CP-odd decay parameters α_{-} for Λ→pπ^{-} and α_{+} for Λ[over ¯]→p[over ¯]π^{+} by using the process e^{+}e^{-}→J/ψ→ΛΛ[over ¯]. With a five-dimensional fit to the full angular distributions of the daughter baryon, the most precise values for the decay parameters are determined to be α_{-}=0.7519±0.0036±0.0024 and α_{+}=-0.7559±0.0036±0.0030, respectively. The Λ and Λ[over ¯] averaged value of the decay parameter is extracted to be α_{avg}=0.7542±0.0010±0.0024 with unprecedented accuracy. The CP asymmetry A_{CP}=(α_{-}+α_{+})/(α_{-}-α_{+}) is determined to be -0.0025±0.0046±0.0012, which is one of the most precise measurements in the baryon sector. The reported results for the decay parameter will play an important role in the studies of the polarizations and CP violations for the strange, charmed and beauty baryons.

First Observation of the Direct Production of the χ_{c1} in e^{+}e^{-} Annihilation

We study the direct production of the J^{PC}=1^{++} charmonium state χ_{c1}(1P) in electron-positron annihilation by carrying out an energy scan around the mass of the χ_{c1}(1P). The data were collected with the BESIII detector at the BEPCII collider. An interference pattern between the signal process e^{+}e^{-}→χ_{c1}(1P)→γJ/ψ→γμ^{+}μ^{-} and the background processes e^{+}e^{-}→γ_{ISR}J/ψ→γ_{ISR}μ^{+}μ^{-} and e^{+}e^{-}→γ_{ISR}μ^{+}μ^{-} is observed by combining all the data samples. The χ_{c1}(1P) signal is observed with a significance of 5.1σ. This is the first observation of a C-even state directly produced in e^{+}e^{-} annihilation. The electronic width of the χ_{c1}(1P) resonance is determined to be Γ_{ee}=(0.12_{-0.08}^{+0.13})  eV, which is of the same order of magnitude as theoretical calculations.

Evidence for a Neutral Near-Threshold Structure in the K_{S}^{0} Recoil-Mass Spectra in e^{+}e^{-}→K_{S}^{0}D_{s}^{+}D^{*-} and e^{+}e^{-}→K_{S}^{0}D_{s}^{*+}D^{-}

We study the processes e^{+}e^{-}→K_{S}^{0}D_{s}^{+}D^{*-} and e^{+}e^{-}→K_{S}^{0}D_{s}^{*+}D^{-}, as well as their charge conjugated processes, at five center-of-mass energies between 4.628 and 4.699 GeV, using data samples corresponding to an integrated luminosity of 3.8  fb^{-1} collected by the BESIII detector at the BEPCII storage ring. Based on a partial reconstruction technique, we find evidence of a structure near the thresholds for D_{s}^{+}D^{*-} and D_{s}^{*+}D^{-} production in the K_{S}^{0} recoil-mass spectrum, which we refer to as the Z_{cs}(3985)^{0}. Fitting with a Breit-Wigner line shape, we find the mass of the structure to be (3992.2±1.7±1.6)  MeV/c^{2} and the width to be (7.7_{-3.8}^{+4.1}±4.3)  MeV, where the first uncertainties are statistical and the second are systematic. The significance of the Z_{cs}(3985)^{0} signal is found to be 4.6σ including both the statistical and systematic uncertainty. We report the Born cross section multiplied by the branching fraction at different energy points. The mass of the Z_{cs}(3985)^{0} is close to that of the Z_{cs}(3985)^{+}. Assuming SU(3) symmetry, the cross section of the neutral channel is consistent with that of the charged one. Hence, we conclude that the Z_{cs}(3985)^{0} is the isospin partner of the Z_{cs}(3985)^{+}.

[Agreement evaluation of the severity of oral epithelial dysplasia in oral leukoplakia]

Objective: To evaluate the inter-observer agreement of the severity of oral epithelial dysplasia in oral leukoplakia, providing a theoretical basis for the development of a more objective grading system. Methods: This study included 60 digital pathological slides of oral leukoplakia from Oral Medicine Department of West China Hospital of Stomatology, Sichuan University, and 239 tissue microarray images of oral leukoplakia from State Key Laboratory of Oral Diseases, Sichuan University, to evaluate the agreement of grading. Besides, 1 000 patches were generated from the 60 digital pathological slides and were divided into 500 small-sized patches (224 pixel×224 pixel) and 500 large-sized patches (1 024 pixel×1 024 pixel), to evaluate the agreement of feature detection. Gradings and feature detections were completed by three pathological experts from the oral pathology departments of two Grade 3, Class A stomatological hospitals in China. Kappa coefficient was used to quantify the inter-observer agreement among pathologists. Results: Minimal agreement was found in the grading of oral epithelial dysplasia among pathologists (Kappa=0.30 in the pathological slide group, Kappa=0.30 in the tissue microarray group). None agreement was found in feature detection within the small-sized patches group (median Kappa=0.14 for architectural features, median Kappa=0.18 for cytological features), and minimal agreement was found in feature detection within the large-sized patches group (median Kappa=0.25 for architectural features, median Kappa=0.25 for cytological features). Conclusions: Generally, the agreement of grading and feature detection of oral epithelial dysplasia in oral leukoplakia is poor. Development of a more objective grading system of oral epithelial dysplasia based on artificial intelligence may be helpful to improve the agreement.

Observation of Resonance Structures in e^{+}e^{-}→π^{+}π^{-}ψ_{2}(3823) and Mass Measurement of ψ_{2}(3823)

Using a data sample corresponding to an integrated luminosity of 11.3  fb^{-1} collected at center-of-mass energies from 4.23 to 4.70 GeV with the BESIII detector, we measure the product of the e^{+}e^{-}→π^{+}π^{-}ψ_{2}(3823) cross section and the branching fraction B[ψ_{2}(3823)→γχ_{c1}]. For the first time, resonance structure is observed in the cross section line shape of e^{+}e^{-}→π^{+}π^{-}ψ_{2}(3823) with significances exceeding 5σ. A fit to data with two coherent Breit-Wigner resonances modeling the sqrt[s]-dependent cross section yields M(R_{1})=4406.9±17.2±4.5  MeV/c^{2}, Γ(R_{1})=128.1±37.2±2.3  MeV, and M(R_{2})=4647.9±8.6±0.8  MeV/c^{2}, Γ(R_{2})=33.1±18.6±4.1  MeV. Though weakly disfavored by the data, a single resonance with M(R)=4417.5±26.2±3.5  MeV/c^{2}, Γ(R)=245±48±13  MeV is also possible to interpret data. This observation deepens our understanding of the nature of the vector charmoniumlike states. The mass of the ψ_{2}(3823) state is measured as (3823.12±0.43±0.13)  MeV/c^{2}, which is the most precise measurement to date.

The association of coffee consumption with the risk of osteoporosis and fractures: a systematic review and meta-analysis

To elucidate the association of coffee and bone health would help fracture risk reduction via dietary intervention. Although those who had higher coffee consumption were less likely to have osteoporosis, the associations between coffee consumption and fracture risk need further investigations with better study designs.

INTRODUCTION

The associations between coffee consumption and the risk of osteoporosis and fracture remain inconclusive. We aimed to better quantify these associations by conducting meta-analyses of observational studies.

METHODS

Relevant studies were systematically searched on PubMed, Web of Science, Cochrane library, and Embase Database up to November 25, 2021. The odds ratio (OR) or relative risk (RR) with 95% confidence intervals (CI) was pooled and a dose-response analysis was performed.

RESULTS

Four studies with 7114 participants for osteoporosis and thirteen studies with 391,956 participants for fracture incidence were included in the meta-analyses. High versus low coffee consumption was associated with a lower risk of osteoporosis [pooled OR (95% CI): 0.79 (0.65-0.92)], while it was non-significantly associated with fracture incidence [pooled OR (95% CI): 0.86 (0.67-1.05) at hip and 0.89 (0.42-1.36) at non-hip]. A non-linear association between the level of coffee consumption and hip fracture incidence was shown (P = 0.004). The pooled RR (95% CI) of hip fracture risk in those who consumed 1, 2-3, 4, and ≥ 9 cups of coffee per day was 0.92 (0.87-0.97), 0.89 (0.83-0.95), 0.91 (0.85-0.98), and 1.10 (0.76-1.59), respectively. The significance in the association between coffee consumption and the hip fracture incidence decreased in those studies that had larger sample size, higher quality, and more adjustments.

CONCLUSIONS

A dose-dependent relationship may exist between coffee consumption and hip fracture incidence. The effect of high versus low coffee consumption was influenced by study designs. Further studies with dedicated designs are needed to confirm the independent effects of coffee consumption on bone health.

Self-compression of stimulated Raman backscattering by a flying focus

The regime of self-compression has been proposed for plasma-based backward Raman amplification upon a flying focus. By using a pumping focus moving with a speed equal to the group velocity of stimulated Raman backscattering (SRBS), only a short part of SRBS which always synchronizes with the flying focus can be amplified. Therefore, instead of a short pulse, plasma noise or a long pulse can seed the BRA amplifiers. Here we demonstrate the regime by 2D particle-in-cell simulations, showing that the pump pulse is compressed from 26 ps to 116 fs, with an output amplitude comparable with the case of a well-synchronized short seed. As only one laser pulse is used in the simulation, the results present a significant path to simplify the Raman amplifiers.

Observation of a State X(2600) in the π^{+}π^{-}η' System in the Process J/ψ→γπ^{+}π^{-}η'

Based on (10087±44)×10^{6}  J/ψ events collected with the BESIII detector, the process J/ψ→γπ^{+}π^{-}η^{'} is studied using two largest decay channels of the η^{'} meson, η^{'}→γπ^{+}π^{-} and η^{'}→ηπ^{+}π^{-}, η→γγ. A new resonance, which we denote as the X(2600), is observed with a statistical significance larger than 20σ in the π^{+}π^{-}η^{'} invariant mass spectrum, and it has a connection to a structure around 1.5  GeV/c^{2} in the π^{+}π^{-} invariant mass spectrum. A simultaneous fit on the π^{+}π^{-}η^{'} and π^{+}π^{-} invariant mass spectra with the two η^{'} decay modes indicates that the mass and width of the X(2600) state are 2618.3±2.0_{-1.4}^{+16.3}  MeV/c^{2} and 195±5_{-17}^{+26}  MeV, where the first uncertainties are statistical, and the second systematic.

A novel mitochondria-targetable NIR fluorescent probe for monitoring intracellular hypobromous acid levels

The development of ultrasensitive in situ detection techniques for monitoring hypobromous acid (HBrO) levels in the biological systems is of great significance to reveal its complex pathological and physiological effects. A simple mitochondria-targetable hydrazine-based near-infrared (NIR) fluorescent probe (Mito-NIR) for detecting HBrO in the mitochondria of live cells is presented in this paper. Probe Mito-NIR displays the ultrafast (< 5 s) response for HBrO. It can detect HBrO with high sensitivity. Additionally, it shows high selectivity towards HBrO over other biologically important substances. Finally, it can monitor the changes of endogenous/exogenous HBrO levels in the mitochondria of live cells. A simple mitochondria-targetable NIR fluorescent probe with picomolar sensitivity for HBrO was developed to specifically track mitochondrial HBrO.

Observation of J/ψ Electromagnetic Dalitz Decays to X(1835), X(2120), and X(2370)

Using a sample of about 10^{10}  J/ψ events collected at a center-of-mass energy sqrt[s]=3.097  GeV with the BESIII detector, the electromagnetic Dalitz decays J/ψ→e^{+}e^{-}π^{+}π^{-}η^{'}, with η^{'}→γπ^{+}π^{-} and η^{'}→π^{+}π^{-}η, have been studied. The decay J/ψ→e^{+}e^{-}X(1835) is observed with a significance of 15σ, and also an e^{+}e^{-} invariant-mass dependent transition form factor of J/ψ→e^{+}e^{-}X(1835) is presented for the first time. The intermediate states X(2120) and X(2370) are also observed in the π^{+}π^{-}η^{'} invariant-mass spectrum with significances of 5.3σ and 7.3σ. The corresponding product branching fractions for J/ψ→e^{+}e^{-}X, X→π^{+}π^{-}η^{'} [X=X(1835), X(2120), and X(2370)] are reported.

AB1442 A PREDICTIVE MODEL OF CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME: A RETROSPECTIVE COHORT STUDY

Background

Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening form of antiphospholipid syndrome (APS), with rarely occurrence but high mortality. Current classification diagnosis criteria require more than 3 organs involvement in 1-week time and pathological evidence in patient with persistent positive antiphospholipid antibodies (aPL), which could result the delaying diagnosis and treatment. A predictive model could help identify CAPS patients earlier and initiate early intervention.

Objectives

To develop a predictive model of CAPS in APS patients in a single-center prospective APS cohort.

Methods

Data of consecutive APS patients referred into Peking Union Medical College Hospital from May 2013 to October 2021 was collected. A binary logistic regression method was used to identify predictors of CAPS, coefficient B was assigned with score value in the development of prediction model, and risk-stratification was based on the calculated score using the predictive model. The performance of the model was assessed by Nagelkerke’s R2, Hosmer-Lemeshow test, Omnibus test, and area under the receiver operating characteristic curve (AUC).

Results

A total of 27 CAPS (11.9%) occurred in 226 APS patients. CAPS were more likely to occur in male secondary APS patients with history of arterial thrombosis. Precipitating factors (OR 108.961, 95% CI 23.299 to 509.572), thrombocytopenia (OR 14.765, 95% CI 3.088 to 70.612) and elevated serum creatine (OR 5.339, 95% CI 1.301 to 21.907) were selected by the binary logistic regression. The scores of precipitating factors, thrombocytopenia and elevated serum creatine were 5, 3 and 2. The risk scores were divided into high-risk (7-10) and low-risk (0-6), the risk for CAPS were 73.3% and 2.6%, with sensitivity of 81.5% and specificity of 96%. The Nagelkerke’s R2 (0.696), the Hosmer-Lemeshow test (χ2 =2.192, df=4, p=0.701) and the Omnibus test (χ2 =101.307, df=3, p=0.000) indicated the logistic regression model has a good fit. The AUC was 0.969 (95% CI 0.947 to 0.991, SE=0.011, p=0.000) indicated the model has good discrimination.

Conclusion

A predictive model of CAPS was developed with precipitating factors, thrombocytopenia, and elevated serum creatine. This model helps physicians identify CAPS in high-risk patients, could achieve early intervention and improve prognosis.

Table 1.

Characteristics and predicting factors of CAPS in PUMCH-APS cohort

CAPS（N=27）Non-CAPS（N=199）pOdds ratiopCoefficient ΒScoreGender（M）14(51.9)64(32.2)0.043Age (y)36.3±15.236.2±12.50.975Disease duration (m)49.7±77.753.9±72.30.777Secondary APS14(51.9)52(26.1)0.006APS diagnosisVenous thrombosis17(63.0)106(53.3)0.342Arterial thrombosis22(81.5)79(39.7)0.000Pregnancy morbidity5(18.5)68(34.2)0.103LA22(81.5)155(77.9)0.671aCL21(77.8)123(61.8)0.105a-β2GP123(85.2)155(77.9)0.384Precipitating factors24(88.9)19(9.5)0.000108.961(23.299-509.572)0.0004.6915WBC(×109/L)9.0±6.36.6±2.90.067HGB(g/L)82.7±20.4130±23.80.000Hemolytic anemia15(55.6)20(10.1)0.000PLT(×109/L)61.1±67.1132±84.00.000Thrombocytopenia24(88.9)80(40.2)0.00014.765(3.088-70.612)0.0012.6923Cr(μmol/L)224.5±225.874.4±28.40.002Elevated Cr15(55.6)34(17.1)0.0005.339(1.301-21.07)0.0201.6752LDH(U/L)476.4±227.0226.9±92.30.000 Elevated LDH25(92.6)54(27.1)0.000Proteinuria18(66.7)28(14.1)0.000Hematuria15(55.6)20(10.1)0.000Figure 1.

(A). Receiver Operating Characteristic (ROC) curve of the predictive model. Area under the receiver operating characteristic curve (AUC) was 0.969, the cut-off value of 7 were with sensitivity of 81.5% and specificity of 96%. (B). Calibration curve in internal validation.

Disclosure of Interests

None declared

AB0392 EFFICACY AND SAFETY OF UPADACITINIB IN A CHINESE SUBGROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS AND INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

Background

Upadacitinib (UPA) was effective in global Phase 3 trials in rheumatoid arthritis (RA) patients (pts) with inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

Objectives

To assess the efficacy and safety of UPA in csDMARD-IR pts with RA in Chinese subgroup from a Phase 3, randomized, double-blind, placebo (PBO)-controlled study (NCT02955212) 1.

Methods

Pts were randomized to 12 weeks of blinded treatment with UPA 15 mg once daily (QD) or PBO, in combination with csDMARDs. Primary and secondary endpoints were analyzed in a Chinese subgroup, including American College of Rheumatology criteria (ACR) responses, remission and low disease activity measures. Safety was analyzed for pts who received ≥1 dose of study drug.

Results

228 Chinese pts (67.5% of overall trial population) were randomized and took at least one dose of study drug. Baseline characteristics were generally balanced between UPA and PBO. 46% and 35.1% used methotrexate (MTX) alone as concomitant csDMARD in UPA and PBO group, respectively. 38.9% in UPA and 43.0% in PBO group used concomitant csDMARDs other than MTX and 15.0% and 21.9% respectively used a combination. At week 12, more Chinese pts receiving UPA achieved the primary endpoint of ACR20 compared with PBO (71.9% vs 31.6%, nominal p<0.001). UPA also showed greater improvements in all secondary endpoints vs PBO at Week 12 (Table 1), including ACR50 and ACR70, mean change in Disease Activity Score in 28 joints using C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form 36-item Health Survey-Physical Component Summary (SF-36 PCS), as well as proportion of pts achieving low disease activity based on DAS28-CRP ≤3.2 and Clinical Disease Activity Index (CDAI) ≤10, and clinical remission based on DAS28-CRP <2.6. Onset of response was rapid with more pts receiving UPA achieving ACR20 by Week 1 versus PBO (25.4% vs 5.3%, nominal p<0.001). Through Week 12 treatment-emergent adverse events (TEAEs) occurred in 57.9% of pts on UPA and 49.1% on PBO. The rate of pts with serious AEs (SAEs) was numerically higher with UPA than with PBO (6.1% vs 4.4%). TEAEs reported in ≥ 3% of subjects and with a higher rate on UPA vs. PBO were: upper respiratory tract infection, alanine aminotransferase increased, aspartate aminotransferase increased, hypertension, diarrhea, and leukopenia. Overall safety was consistent with the trial population1 and similar with the reported safety profile of the global clinical program2.

Table 1.

Summary of Efficacy Endpoint Results at Week 12 in Chinese Subgroup

Endpoint aUPA 15mg (N=114)PBO (N=114)Primary endpointACR20, %71.9***31.6Secondary endpointsΔ DAS28-CRP-2.42***-0.75Δ HAQ-DI-0.55***-0.11Δ SF-36 PCS7.63 b***2.94 cDAS28-CRP ≤3.2, %46.5***9.6DAS28-CRP <2.6, %28.1***1.8CDAI ≤10, %33.3***7.0ACR50, %39.5***7.0ACR70, %16.7***2.6ACR20 at Week 1, %25.4***5.3

***Nominal p<0.001 vs PBO

aNon-responder imputation for binary endpoints; ANCOVA with multiple imputation for DAS28(CRP) and HAQ-DI; mixed model repeated measures for other continuous endpoints. Δ: mean change from baseline

bN=106

cN=104

Conclusion

UPA demonstrated clinical and functional improvement in Chinese csDMARD-IR RA pts. The safety of UPA was comparable with the overall study population and with the safety seen in the global Phase 3 program.

References

[1]Zeng X, Zhao D, Radominski SC, et al. Int J Rheum Dis. 2021;24:1530–1539.

[2]Cohen SB, van Vollenhoven RF, Winthrop KL, et al. Ann Rheum Dis 2021;80:304–311.

Acknowledgements

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship.

Disclosure of Interests

Xiaofeng Zeng: None declared, Yi Liu: None declared, Jiankang Hu: None declared, Jingyang Li: None declared, Yongfu Wang: None declared, Dongbao Zhao: None declared, Lijun Wu: None declared, Zhengyu Xiao: None declared, ZHIJUN LI: None declared, Jian Xu: None declared, Sebastian Meerwein Shareholder of: may own AbbVie stock or options, Employee of: AbbVie employee, Yunxia Xie Shareholder of: may own AbbVie stock or options, Employee of: AbbVie employee, Peiwen Liang Employee of: AbbVie

POS0749 ANTI-Β2GPI-DOMAIN 1 ANTIBODIES STRATIFY HIGH RISK OF EXTRA-CRITERIA MANIFESTATIONS IN A LARGE PROSPECTIVE CHINESE COHORT OF ANTIPHOSPHOLIPID SYNDROME

Background

Anti-β2GPI-Domain 1 (β2GPI-D1) antibodies are potentially pathogenic in patients with antiphospholipid syndrome (APS), but their clinical associations and diagnostic value were unclear.

Objectives

To evaluate the clinical characteristics of APS patients with anti-β2GPI-D1 positivity, and its utility in diagnosing APS among SLE patients.

Methods

A total of 338 patients were included, of which 169 patients diagnosed with primary APS (PAPS group), 50 with APS secondary to SLE (SAPS group), 209 with SLE (SLE group). Serum anti-β2GPI-D1 IgG was measured using chemiluminescent immunoassay (Inova Company). Extra-criteria manifestations were analyzed, including thrombocytopenia, autoimmune hemolytic anemia, valvular lesions, APS nephropathy, and non-vascular neurological manifestations.

Results

Similar presence of anti-β2GPI-D1 IgG was seen among PAPS (32.80%) and SAPS (32.0%) patients, and 96.4% of those with positive anti-β2GPI-D1 IgG showed triple aPLs positivity. Anti-β2GPI-D1 IgG was significantly associated with recurrent thrombosis before APS diagnosis, microscopic thrombosis (p<0.05), but not with adverse pregnancy events (Figure 1). Notably, patients with extra-criteria manifestations, especially thrombocytopenia and APS nephropathy, showed significantly higher titers in anti-β2GPI-D1 IgG (p<0.05). After a median follow-up of twenty-five months, patients with anti-β2GPI-D1 IgG also showed a tendency of more extra-criteria events (3/55 vs 1/114, p=0.095), but not thrombotic events or adverse pregnancy events. Anti-β2GPI-D1 was positive among 8.13% of the SLE controls, and showed higher specificity (91.9%) in diagnosing SAPS among SLE patients as compared to classic aPLs.

Figure 1.

Conclusion

Anti-β2GPI-D1 IgG had a stronger association with extra-criteria manifestations in APS patients compared to three classic APLs, which properly indicated its pathogenic role of microangiopathy.

Disclosure of Interests

None declared

POS0287 A PHASE III, RANDOMISED, DOUBLE-BLIND, ACTIVE-CONTROLLED CLINICAL TRIAL TO COMPARE BAT1806/BIIB800, A PROPOSED TOCILIZUMAB BIOSIMILAR, WITH TOCILIZUMAB REFERENCE PRODUCT IN SUBJECTS WITH MODERATE TO SEVERE RHEUMATOID ARTHRITIS WITH AN INADEQUATE RESPONSE TO METHOTREXATE THERAPY

Background

BAT1806/BIIB800 is a proposed biosimilar to reference tocilizumab (TCZ). A Phase III randomised, double-blind, active-controlled clinical trial was conducted as part of a biosimilar development programme.

Objectives

To evaluate the efficacy, pharmacokinetics (PK), safety and immunogenicity of BAT1806/BIIB800 in comparison with EU-sourced TCZ in subjects with moderate to severe rheumatoid arthritis with inadequate response to methotrexate (MTX).

Methods

The study was conducted at 55 centres in China and Europe, between June 2018 and January 2021. Eligible subjects were randomised in a 2:1:1 ratio to one of three treatment groups: (1) BAT1806/BIIB800 up to Week 48, (2) TCZ up to Week 48, or (3) TCZ up to Week 24, followed by BAT1806/BIIB800 from Week 24 to Week 48, administered intravenously every 4 weeks at a dose of 8mg/kg. The primary endpoint was the proportion of subjects achieving an ACR20 response at timepoints pre-specified to meet the requirements of different Regulatory Agencies: Week 12, for EMA; Week 24, for FDA and NMPA. Equivalence margins applied to differences in ACR20 response rates in the BAT1806/BIIB800 and TCZ treatment groups were pre-specified as follows: +/- 14.5% for EMA (95% confidence interval (CI)); -12.0%,15% for FDA (90% CI); +/- 13.6% for NMPA (95% CI). Secondary endpoints included pharmacokinetics, safety and immunogenicity.

The ICH E9(R1) estimands framework including intercurrent events (related or unrelated to the COVID19 pandemic) was implemented for the ACR20 evaluation. A logistic regression model including ‘region’ (China and Eastern Europe) and ‘previous biologic or targeted synthetic DMARD use’ (Yes/No) as captured in Interactive Web Response System as stratification factors was utilised to assess equivalence for the primary endpoint. The difference in response rates was estimated and corresponding confidence intervals were derived to assess equivalence for the primary endpoint. This abstract presents results up to Week 24.

Results

In total, 621 subjects were randomised to receive BAT1806/BIIB800 (N=312), TCZ (N=155), or TCZ followed by BAT1806/BIIB800 (N=154). The groups were comparable in terms of baseline demographics and disease characteristics, including age, gender, disease activity and disease duration. The estimated proportions of subjects achieving an ACR20 response in the BAT1806/BIIB800 vs. the TCZ groups, respectively, were 68.97% vs. 64.82% at Week 12 and 69.89% vs. 67.94% at Week 24. The estimated difference between ACR response rates was 4.15% (95% CI -3.63, 11.93) at week 12, and 1.94% (90% CI -4.04, 7.92; 95% CI -5.18, 9.07) at Week 24. The CIs for the estimated differences between the treatment groups were within the pre-defined equivalence margins (Figure 1). The treatment groups were comparable in terms of serum trough levels, incidence of TEAEs and ADA/NAb positivity (Table 1).

Table 1.

Safety and Immunogenicity up to Week 24, and Pharmacokinetics at Week 24

TCZ (N =309) n (%)BAT1806/BIIB800 (N=312) n (%)TEAE196 (63.4)201 (64.4)Related TEAE151 (48.9)148 (47.4)Serious TEAE13 (4.2)11 (3.5)Related Serious TEAE7 (2.3)2 (0.6)Fatal TEAE1 (0.3)3 (1.0)ADA positive a42 (13.6%)64 (20.5%)NAb positive a42 (13.6%)63 (20.2%)PK, n271276Serum trough level (ug/mL), mean (SD)15.4 (17.1)15.8 (12.3)Serum trough level (ug/mL), geometric mean (CV%)12.3 (140.3)12.9 (121.3)Below limit of quantification, n (%)43 (15.9)28 (10.1)

TEAE, treatment emergent adverse events

a subjects with ≥1 ADA/NAb positive results up to week 24

Conclusion

BAT1806/BIIB800 has demonstrated equivalent efficacy at Week 12 and Week 24 and a similar PK, safety and immunogenicity profile as reference tocilizumab up to Week 24.

Disclosure of Interests

Xiaomei Leng: None declared, Piotr Leszczynski: None declared, Sławomir Jeka: None declared, Shengyun Liu: None declared, Huaxiang Liu: None declared, Malgorzata Miakisz: None declared, Jieruo Gu: None declared, Lali Kilasonia Speakers bureau: Sandoz, Amgen, Takeda, Mykola Stanislavchuk Speakers bureau: Pfizer, Orion, Boehringer Ingelheim, Xiaolei Yang Shareholder of: Employee of the Bio-thera Solutions Ltd. with shares as a part of Stock incentive plan., Employee of: Employee of the Bio-thera Solutions Ltd., Yinbo Zhou Shareholder of: Employee of Bio-thera Solutions Ltd. with share as part of Stock incentive plan, Employee of: Employee of Bio-thera Solutions Ltd., Qingfeng Dong Shareholder of: Employee of Bio-thera Solutions Ltd. with shares as part of Stock incentive plan, Employee of: Employee of Bio-thera Solutions Ltd., Marian Mitroiu Shareholder of: Employee of Biogen and may hold stocks, Employee of: Employee of Biogen, Janet Addison Shareholder of: Employee of Biogen and holds stock in Biogen, Employee of: Employee of Biogen, Xiaofeng Zeng: None declared

POS1368 DIVERSITY OF HEMODYNAMIC TYPES IN CONNECTIVE TISSUE DISEASE ASSOCIATED PULMONARY HYPERTENSION: MORE THAN A SUBGROUP OF PULMONARY ARTERIAL HYPERTENSION

Background

Connective tissue disease (CTD) associated pulmonary hypertension (PH) is classified as a subgroup of WHO group 1 PH, also called pulmonary arterial hypertension (PAH). However, not all CTD-PH fit the hemodynamic definition of PAH. This study investigates the diversity of hemodynamical types of CTD-PH, their different clinical characteristics and outcomes.

Objectives

This study investigates the diversity of hemodynamical types of CTD-PH, their different clinical characteristics and outcomes.

Methods

We performed a retrospective cohort study. CTD-PH patients underwent right heart catheterization (RHC) were enrolled and divided into WHO group1 PH, WHO group 2 PH and high output PH (PVR<3WU and PAWP<15mmHg) according to hemodynamic features. Patients with obvious lung diseases, left heart disease and pulmonary embolism were excluded. Baseline characteristics, inflammatory markers, autoantibodies, cardiac function status, echocardiogram parameters, hemodynamics and survival rates were compared.

Results

207 CTD-PH patients were included, including 139 in WHO group 1 PH, 36 in WHO group 2 PH and 32 in high output PH. Incidence of anti-ribonucleoprotein antibody was lower in WHO Group 2 PH. High output PH is less severe, presenting lower NT-proBNP level, better WHO functional class, lower mPAP and PVR, higher cardiac output, and less cardiac remodeling. Among patients with elevated PAWP, combine pre& post-capillary PH had higher mPAP and larger right ventricle diameter. Association of mild to moderate interstitial lung disease didn’t show significant difference in disease characteristics. Short-term survival was significantly worse in WHO group 2 PH, yet 5-year survival rates didn’t differ between groups.

Conclusion

Pre-capillary PH is not the only hemodynamic type of CTD-PH. Different types of CTD-PH present different clinical phenotypes and outcome. Carefully phenotyping PH in CTD-PH patients is important.

Disclosure of Interests

None declared

AB0542 ANTIPHOSPHOLIPID ANTIBODY CARRIERS WITH THROMBOCYTOPENIA COULD BE AN INDEPENDENT PHENOTYPE OF PRIMARY ANTIPHOSPHOLIPID SYNDROME

Background

Among patients with immune thrombocytopenic (ITP), 10-20% of them were found with positive antiphospholipid antibodies (aPLs) but without typical clinical manifestations of antiphospholipid syndrome (APS), especially thrombotic events1.

Objectives

To compare the clinical characteristics and prognosis between aPLs carriers and patients with APS.

Methods

This is a single center prospective cohort study consecutively enrolling thrombocytopenic patients with continuous positive aPLs. Patients developing thrombotic events are classified as the APS group. The exclusion criteria are other underlying connective tissue diseases such as lupus and other causes that might manifest as thrombocytopenia, such as virus infection, hypersplenism, etc.

Results

This cohort included 47 thrombocytopenic patients with continuous positive aPLs and 55 with diagnosed primary APS. The proportion of thrombotic high risk demographic characteristics including smoking, hypertension, and higher level of homocysteine are higher in the APS group (p = 0.03, 0.04, 0.03, respectively). The prevalence of nephropathy was significantly higher in patients with diagnosed APS [0 vs 7 (12.7%), p =0.01]. Laboratory results and antibody profiles are presented in Table 1. The platelet count of aPLs carriers at admission was lower than APS patients [26×109/L (9×109/L, 46×109/L) vs 64×109/L (24×109/L, 89×109/L), p = 0.0002]. The proportion of positive anti-β2-glycoprotein I, anticardiolipin and lupus anticoagulant separately was similar, but triple aPLs positivity is more common in primary APS patients with thrombocytopenia [24 (51.1%) vs 40 (72.7%), p = 0.04]. There is no significant differences over the complement levels between the two groups [p = 0.2 for low complement 3 (C3), p = 0.8 for low C4]. Regarding the treatment response, the complete response (CR) rate is similar between aPLs carriers and primary APS patients with thrombocytopenia (p = 0.2). Nonetheless, the proportion of response, no response and relapse differed significantly between the two groups [13 (27.7%) vs 4 (7.3%), p < 0.0001; 5 (10.6%) vs 8 (14.5%), p < 0.0001; 5 (10.6%) vs 8 (14.5%), p < 0.0001, respectively]. In Kaplan-Meier analysis (Figure 1), primary APS patients had significantly more thrombotic events than aPLs carriers (p = 0.0006). aPLs carriers with thrombocytopenia share similar clinical manifestations with primary APS patients but hardly develop thrombotic events.

Figure 1.

Kaplan-Meier analysis of thrombotic events.

aPLs: antiphospholipid antibodies; PAPS: primary antiphospholipid syndrome.

Table 1.

Baseline characteristics of laboratory results and antibody profiles.

CharacteristicsaPLs carriers (n=47)Primary APS with thrombocytopenia (n=55)p-valueLaboratory results, median (Q1, Q3)Platelet count (×109/L)26 (9,46)64 (24, 89)0.0002*hsCRP (mg/L)1.39 (0.475, 2.845)1.08(0.41, 2.565)0.8ESR (mm/h)5.5 (2.75, 10.75)7.5 (5, 14.25)0.06LDH (U/L)221 (176, 252)228 (184.8, 282)0.3Low C3, n (%)3 (6.4)9 (16.4)0.2Low C4, n (%)5 (10.6)8 (14.5)0.8Antibody profiles, n (%)Positive aCL45 (95.7)33 (69.1)0.3Positive Anti-β2GP I38 (80.9)48 (87.3)0.5Positive LA35 (74.5)50 (90.9)0.05Triple positivity24 (51.1)40 (72.7)0.04*Positive Coombs,6 (12.8)10 (18.2)0.4

*p < 0.05, statistically significant. aPLs: antiphospholipid antibodies; APS: antisphopholipid syndrome; Q1/3: quantile 1/3; hsCRP: hypersensitive C-reactive protein; ESR: erythrocyte sedimentation rate; LDH: lactate dehydrogenase; C3/4: complement 3/4; aCL: anticardiolipin; GP: glycoprotein; LA: lupus anticoagulant.

Conclusion

In the absence of other high risk factor for thrombosis, Thrombocytopenia could be an independent and long-lasting clinical phenotype for aPLs carriers.

References

[1]Bidot CJ, Jy W, Horstman LL, Ahn ER, Yaniz M, Ahn YS. Antiphospholipid antibodies (APLA) in immune thrombocytopenic purpura (ITP) and antiphospholipid syndrome (APS). Am J Hematol. Jun 2006;81(6):391-6.

Disclosure of Interests

None declared

POS0306 EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS WITH ACTIVE ANKYLOSING SPONDYLITIS REFRACTORY TO BIOLOGIC THERAPY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED PHASE 3 TRIAL

Background

Upadacitinib (UPA) was shown to be safe and effective through 2 years in patients (pts) with active ankylosing spondylitis (AS) naïve to biologic disease-modifying antirheumatic drugs (bDMARDs) in the pivotal phase 2/3 SELECT-AXIS 1 trial.1,2

Objectives

To assess the efficacy and safety of UPA in pts with active AS with an inadequate response (IR) to bDMARDs.

Methods

SELECT-AXIS 2 (NCT04169373) was conducted under a master protocol and includes two separate studies (one for AS bDMARD-IR and one for non-radiographic axial spondyloarthritis [nr-axSpA]). The AS bDMARD-IR study is a randomized, double-blind, placebo (PBO)-controlled, phase 3 trial that enrolled adults ≥18 years with AS who met modified New York criteria, had BASDAI and pt’s assessment of total back pain scores ≥4 (numeric rating scale 0–10) at study entry, and had an IR to one or two bDMARDs (TNF inhibitor or IL-17 inhibitor). Pts were randomized 1:1 to receive oral UPA 15 mg once daily (QD) or PBO during the 14-week (wk) double-blind treatment period. The primary endpoint was ASAS40 response at wk 14. Multiplicity-controlled secondary endpoints evaluated at wk 14 were improvements from baseline in disease activity (ASDAS [CRP], ASDAS ID [<1.3], ASDAS LDA [<2.1], BASDAI50, ASAS20, and ASAS PR), pain (total and nocturnal back pain), function (BASFI), objective measure of inflammation (SPARCC MRI score of the spine), spinal mobility (BASMI), enthesitis (MASES), and quality of life (ASQoL and ASAS HI). Non-responder imputation incorporating multiple imputation (NRI-MI) was used to handle intercurrent events and missing data for binary endpoints. Cochran-Mantel-Haenszel (CMH) test and mixed-effect model for repeated measures (MMRM) were used for analyzing binary and continuous endpoints, respectively. Treatment-emergent adverse events (TEAEs) assessed through wk 14 are reported for pts who had ≥1 dose of study drug.

Results

All 420 randomized pts with active AS received assigned treatment (UPA 15 mg, n=211; PBO, n=209); 409 (97%) received study drug through wk 14. Baseline demographic and disease characteristics were generally similar between treatment groups and reflective of an active AS bDMARD-IR population (74% male; mean age 42.4 years; mean disease duration 7.7 years; 83% HLA-B27 positive; mean BASDAI 6.8). Significantly more pts achieved the primary endpoint of ASAS40 response at wk 14 with UPA vs PBO (45% vs 18%; P<0.0001; Figure 1); UPA showed onset of effect in ASAS40 as early as wk 4 (nominal P≤0.05). All multiplicity-controlled secondary endpoints met statistical significance for UPA vs PBO at wk 14 across multiple clinical domains of AS (P<0.0001; Figure 1). The rate of TEAEs was similar between treatment groups through wk 14 (UPA, 41%; PBO, 37%). TEAEs led to discontinuation in 3 (1.4%) pts treated with PBO and none with UPA. Serious infections occurred with UPA (2.4%) but not with PBO and included 4 events of COVID-19 and 1 event of uveitis. Additional events of uveitis were reported in 3 (1.4%) pts treated with PBO. Inflammatory bowel disease (IBD) occurred in 1 (0.5%) pt on UPA and none on PBO. No malignancy, major adverse cardiovascular events, venous thromboembolic events, or death were reported with UPA; 1 event of malignancy was observed with PBO.

Conclusion

UPA 15 mg QD was significantly more effective than PBO over 14 wks of treatment in pts with active AS and IR to bDMARDs. No new safety risks were identified with UPA compared with its known safety profile.3,4 These findings are consistent with and complementary to those of SELECT-AXIS 1 (bDMARD-naïve AS population),1,2 and support the use of UPA in pts with active AS, including those who had a previous IR to bDMARD therapy.

References

[1]van der Heijde D, et al. Arthritis Rheumatol. 2021;73(suppl 10).

[2]van der Heijde D, et al. Lancet. 2019;394(10214):2108–2117.

[3]Cohen SB, et al. ARD. 2021;80:304–311.

[4]Burmester G, et al. Rheumatol Ther. 2021;1–19.

Acknowledgements

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Julia Zolotarjova, MSc, MWC, of AbbVie.

Disclosure of Interests

Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, and UCB, Employee of: Director of Imaging Rheumatology BV, Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, and Werfen, Grant/research support from: AbbVie, Novartis, Joachim Sieper Speakers bureau: AbbVie, Janssen, Merck, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Merck, and Pfizer, Atul Deodhar Consultant of: AbbVie, Amgen, Aurinia, BMS, Celgene, GSK, Janssen, Lilly, MoonLake, Novartis, Pfizer, and UCB., Grant/research support from: AbbVie, GSK, Lilly, Novartis, Pfizer, and UCB, Robert Inman Consultant of: AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, and Sandoz, Grant/research support from: AbbVie, Amgen, and Janssen, Hideto Kameda Speakers bureau: AbbVie, Asahi-Kasei, BMS, Chugai, Eisai, Janssen, Lilly, Mitsubishi-Tanabe, Novartis, and Pfizer, Consultant of: AbbVie, Janssen, Lilly, Novartis, Sanofi, and UCB, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer Ingelheim, Chugai, Eisai, and Mitsubishi-Tanabe, Xiaofeng Zeng: None declared, Yunxia Sui Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Xianwei Bu Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Aileen Pangan Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Peter Wung Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, In-Ho Song Shareholder of: May own AbbVie stock or options, Employee of: AbbVie

AB0339 EFFICACY, PHARMACOKINETICS AND SAFETY BETWEEN CT-P13 AND CHINA-APPROVED INFLIXIMAB: 54 WEEK RESULT FROM A PHASE III RANDOMIZED CONTROLLED TRIAL IN CHINESE PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS

Background

CT-P13 is an approved biosimilar to EU-approved and US-licensed Infliximab (INX) for the indications of rheumatoid arthritis (RA), adult and paediatric Crohn’s disease, adult and paediatric ulcerative colitis, ankylosing spondylitis, psoriatic arthritis and psoriasis.

Objectives

The purpose of this study was to demonstrate equivalence of efficacy and compare PK and safety profiles of CT-P13 and China-approved INX.

Methods

In this randomized, double blinded, multicenter, parallel-group, phase III study, patients with active RA who had been responding inadequately to methotrexate for at least 3 months, were randomized to receive either CT-P13 or China-approved INX. Patients were treated with doses of 3 mg/kg at Weeks 0, 2, 6, then every 8 weeks up to Week 54. Prior to dosing at Week 30, patients randomized to China-approved INX underwent a second randomization either to continue China-approved INX or to switch to CT-P13 at Week 30. Results of patients who underwent transition to CT-P13 were included in the China-approved INX group. The primary efficacy endpoint was change in DAS28 (CRP) from baseline to Week 14, which was analyzed using an analysis of covariance. Equivalence was determined if the 90% CI for the estimate of treatment difference was entirely contained within the predefined equivalence margin of -0.6 to 0.6.

Results

270 patients were randomly assigned to 2 treatment groups in a 1:1 ratio (136 and 134 patients in the CT-P13 and China-approved INX groups, respectively) and 184 patients completed the study. The least square mean change (standard error) of DAS28 (CRP) from baseline to Week 14, -1.566 [0.1419] and -1.547 [0.1491], was similar between the CT-P13 and China-approved INX groups, respectively. The 90% CI for the estimate of treatment difference (-0.29, 0.25) was contained within the predefined equivalence margin, which demonstrated therapeutic equivalence between the groups. The mean actual values for DAS28 (CRP) decreased from baseline to Week 54 and were similar between the groups (Figure 1). Additional efficacy endpoints, including ACR responses (ACR20 at Week 14; 60.6%, 54.8% and at Week 54; 65.1%, 60.6% in the CT-P13 and China-approved INX groups, respectively), EULAR responses, CDAI, and SDAI, were similar between the groups, even after switching at Week 30. During the study, mean serum INX concentrations were similar between the groups. Between Weeks 14 and 22, mean (percent coefficient of variation) AUCτ were 11156333.615 (44.796) ng·h/mL and 11462884.280 (51.057) ng·h/mL, and Cmax,ss were 66577.2 (31.4) ng/mL and 66356.1 (21.0) ng/mL in the CT-P13 and China-approved INX groups, respectively, which were similar between the groups. Most treatment-emergent AEs were grade 1 or 2 in intensity. One malignancy was reported in the CT-P13 group and no deaths were reported. The proportions of patients with anti-drug antibodies were similar between the groups, even after switching at Week 30. The overall safety profile of CT-P13 was comparable to that of China-approved INX and no new safety issues were observed (Table 1).

Table 1.

Summary of Safety Results

Number of patients (%)CT-P13 (N=136)China-approved Infliximab (N=133)Treatment-emergent AEsTotal115 (84.6%)107 (80.5%)Related97 (71.3%)86 (64.7%)Treatment-emergent serious AEsTotal17 (12.5%)12 (9.0%)Related10 (7.4%)6 (4.5%)Infusion related reaction/ hypersensitivity/anaphylactic reactionsTotal(=Related)20 (14.7%)19 (14.3%)InfectionsTotal45 (33.1%)43 (32.3%)Related36 (26.5%)40 (30.1%)

Note: Summary is presented for the safety population who received at least 1 dose (full or partial) of study drug.

Conclusion

The study demonstrated that efficacy of CT-P13 is equivalent to that of China-approved INX. Also, the PK and safety profiles of CT-P13 were comparable to those of China-approved INX. No loss of efficacy or difference in safety or immunogenicity was observed after switching from China-approved INX to CT-P13 at Week 30.

Disclosure of Interests

Jonathan Kay Consultant of: Boehringer Ingelheim GmbH; Pfizer Inc.; Samsung Bioepis; Sandoz Inc., Grant/research support from: Pfizer Inc. (paid to UMass Chan Medical School), Xiaofeng Zeng Grant/research support from: Celltrion, Inc, Lin Chen Grant/research support from: Celltrion, Inc, Kaijiang Tang Grant/research support from: Celltrion, Inc, guixiu shi Grant/research support from: Celltrion, Inc, Lin Liu Grant/research support from: Celltrion, Inc, Lijun Wu Grant/research support from: Celltrion, Inc, Yi Liu Grant/research support from: Celltrion, Inc, Jiankang Hu Grant/research support from: Celltrion, Inc, Shengyun Liu Grant/research support from: Celltrion, Inc, Zheng Yi Grant/research support from: Celltrion, Inc, Sung Hyun Kim Employee of: Celltrion, Inc, YunJu Bae Employee of: Celltrion, Inc, JeeHye Suh Employee of: Celltrion, Inc, Seungjin Rhee Employee of: Celltrion, Inc, SeulGi Lee Employee of: Celltrion, Inc, Chankyoung Hwang Employee of: Celltrion, Inc

OP0145 VALIDATION OF 3 PREDICTION MODELS FOR THROMBOSIS IN ANTIPHOSPHOLIPID SYNDROME PATIENTS BASED ON A PROSPECTIVE COHORT

Background

Antiphospholipid syndrome (APS) is a rare and complicated acquired autoimmune thrombophilia characterized by arterial/venous thrombosis and/or recurrent pregnancy loss. Thrombosis is the first cause of death of APS patients. However, there has been no generally acknowledged model to predict thrombosis. Only adjusted global APS score (aGAPSS) was developed for prediction but based on a cross-sectional study1. Additionally, the predictive ability of Padua score and Caprini score has not been validated in APS patients.

Objectives

Aim to validate the ability of aGAPSS, Padua score and Caprini score to predict thrombosis in APS patients basing on a prospective cohort.

Methods

Consecutive APS patients who fulfilled the 2006 Sydney Revised Classification Criteria for APS, referred to Peking Union Medical College Hospital were included. Clinical data, aGAPSS, Padua score, and Caprini score at the time of diagnosis were collected. Patients with less than 1-year follow-up were excluded. Harrell c-index and calibration curve were used to validate the prediction models.

Results

A total of 302 patients were enrolled in this study. The mean age was 32±12 years old, and 202 (66.9%) were female (Table 1). Patients were followed up for a median of 36 months. During the follow-up period, there were 62 thrombotic events, with 40 (13.25%) venous and 22 (7.28%) arterial thrombosis. The 1-, 3-, and 5-year thrombosis risks were 8.9%, 16.9%, and 21.3% respectively (Figure 1A). The Harrell c-indexes for predicting thrombosis of aGAPSS, Padua score, and Caprini score were 0.56 (95% confidence interval [CI], 0.52-0.60), 0.58 (95% CI, 0.54-0.62), and 0.61 (95%CI, 0.57-0.65) respectively. The model predicting venous thrombosis with the best discrimination was Padua score whose Harrell c-index was 0.64 (95% CI, 0.60-0.68), and the model predicting arterial thrombosis with the best discrimination was Caprini score whose Harrell c-index was 0.62 (95%CI, 0.56-0.68). The calibration curves illustrated that the calibration for predicting thrombosis within 3 years after diagnosis of all the 3 models was poor (Figure 1B-D).

Table 1.

Demographic characteristics and clinical manifestations at baseline

N=302N=302Age, mean±SD32±12Clinical manifestationsFemale, n (%)202 (66.9)Venous thrombosis, n (%)156 (51.7)Disease duration (months), median (Q1, Q3)11.50 (3.00, 44.00)Deep venous thrombosis, n (%)112 (37.1)Secondary to SLE, n (%)73 (24.2)Pulmonary embolism, n (%)70 (23.2)Smoking history, n (%)63 (20.9)Visceral venous thrombosis, n (%)12 (4.0)Hypertension, n (%)59 (19.5)Cranial venous sinus thrombosis, n (%)13 (4.3)Hyperlipidemia, n (%)151 (50.0)Arterial thrombosis, n (%)113 (37.4)BMI, mean±SD23.96±3.89Stroke/TIA, n (%)62 (20.5)LA positive, n (%)241 (79.8)Myocardial infarction, n (%)14 (4.6)aCL positive, n (%)208 (68.9)Arterial thrombosis of lower extremities, n (%)22 (7.3)aβ2GPI positive, n (%)242 (80.1)Visceral arterial thrombosis, n (%)18 (6.0)Triple aPL positive, n (%)165 (54.6)Thrombocytopenia, n (%)118 (39.1)Obstetric manifestations, n (%)N=202Valvular lesions, n (%)24 (7.9)Pregnancy morbidity103 (51.0)Early miscarriages (<10 weeks)13 (6.4)Fetal death (>= 10 weeks)68 (33.7)Preeclampsia, eclampsia and placental dysfunction36 (17.8)Figure 1.

The Kaplan-Meier curve and the calibration curve of 3 prediction models within 3 years after diagnosis. A: The Kaplan-Meier curve of venous, arterial and both venous and arterial thrombosis. B: The calibration curves for venous thrombosis. C: The calibration curves for arterial thrombosis. D: The calibration curves for both venous and arterial thrombosis.

Conclusion

The ability of aGAPSS, Padua score and Caprini score to predict thrombosis in APS patients is relatively poor. Construction of a new prediction model specifically for APS patients is required to help with early prevention and treatment.

References

[1]Sciascia, S., et al., GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology (Oxford), 2013. 52(8): p. 1397-403.

Disclosure of Interests

None declared

Menopausal hormone therapy: what are the problems in the perception of Chinese physicians?

OBJECTIVE

This study aimed to investigate Chinese physicians' perception and attitudes toward menopausal hormone therapy (MHT).

METHODS

This nationwide online survey was conducted in China. Physicians registered in the WeChat groups of the Gynecological Endocrinology Committee of China's Maternal and Child Health Care Association received a message invitation to complete this anonymous online survey from April 2020 to July 2020. Physicians' knowledge of and attitudes toward MHT were surveyed.

RESULTS

In total, 4672 questionnaires were submitted; only completed questionnaires could be submitted. The message was sent to 6021 doctors, so the response rate was 77.6%. Overall, 77.9-92.9% of physicians knew the common indications and contraindications to MHT. Additionally, 90.6%, 85.4%, 80.7% and 37.5% of physicians thought that MHT would increase the risk of venous thrombosis, breast cancer, endometrial cancer and weight gain, respectively. In total, 58.1% of the physicians mistakenly believed that a sex hormone test was one of the necessary examinations to reassess MHT prescription during follow-up visits. We found that 68.5% of physicians would consider using MHT themselves or recommend MHT to their partners in the future, and 11.4% were currently using MHT.

CONCLUSIONS

Most Chinese physicians have basic knowledge of MHT. Their misunderstandings about MHT mainly centered on the risks of endometrial cancer, weight gain and the necessary examinations during follow-up visits. These misunderstandings need to be clarified in future professional training programs.

Observation of the Singly Cabibbo Suppressed Decay Λ_{c}^{+}→nπ^{+}

The singly Cabibbo-suppressed decay Λ_{c}^{+}→nπ^{+} is observed for the first time with a statistical significance of 7.3σ by using 3.9  fb^{-1} of e^{+}e^{-} collision data collected at center-of-mass energies between 4.612 and 4.699 GeV with the BESIII detector at BEPCII. The branching fraction of Λ_{c}^{+}→nπ^{+} is measured to be (6.6±1.2_{stat}±0.4_{syst})×10^{-4}. By taking the upper limit of branching fractions of Λ_{c}^{+}→pπ^{0} from the Belle experiment, the ratio of branching fractions between Λ_{c}^{+}→nπ^{+} and Λ_{c}^{+}→pπ^{0} is calculated to be larger than 7.2 at the 90% confidence level, which disagrees with most predictions of the available phenomenological models. In addition, the branching fractions of the Cabibbo-favored decays Λ_{c}^{+}→Λπ^{+} and Λ_{c}^{+}→Σ^{0}π^{+} are measured to be (1.31±0.08_{stat}±0.05_{syst})×10^{-2} and (1.22±0.08_{stat}±0.07_{syst})×10^{-2}, respectively, which are consistent with previous results.

Serum 25-hydroxyvitamin D might be negatively associated with hyperuricemia in U.S. adults: an analysis of the National Health and Nutrition Examination Survey 2007-2014

PURPOSE

The results of previous studies on the relationship between serum 25-hydroxyvitamin D [25(OH)D] and hyperuricemia are controversial. We hypothesized that serum 25(OH)D concentrations of U.S. adults would negatively correlate with the risk of hyperuricemia.

METHOD

Data came from the National Health and Nutrition Examination Survey 2007-2014 were used, after excluding those who met at least one of the exclusion criteria, a total of 9096 male individuals and 9500 female individuals aged 18 years or older were included. Binary logistic regression analysis and restricted cubic spline with fully adjusted confounding factors were applied to evaluate the association between serum 25(OH)D and hyperuricemia. We further performed stratified analysis and sensitivity analysis to minimize the influence of gender, metabolic syndrome, obesity and renal dysfunction on the above association.

RESULTS

We found a negative correlation between serum 25(OH)D and hyperuricemia. In the binary logistic regression analysis, compared with the highest serum 25(OH)D quartile [Q4: 25(OH)D > 77.10 nmol/L] group, the odds ratios (95% confidence intervals) in the lowest quartile [Q1: 25(OH)D ≤ 43.20 nmol/L] was 1.46 (1.22-1.75) in the fully adjusted model. Restricted cubic spline analysis showed L-shaped and non-linear relationships between 25(OH)D and hyperuricemia. In sensitivity analysis, after restricting to participants without significant renal dysfunction and obesity, the above association remained significant. After restricting to participants who were diagnosed as metabolic syndrome, above association remained significant in the fully adjusted model. In stratified analysis by gender, the association remained significant among males and females.

CONCLUSIONS

Serum 25(OH)D might be inversely associated with hyperuricemia in general U.S. adults. From our study, for people with unexplained hyperuricemia, screening for serum Vitamin D concentration might be necessary.

Development and validation of an individualized nomogram for predicting the high-volume (> 5) central lymph node metastasis in papillary thyroid microcarcinoma

PURPOSE

Papillary thyroid microcarcinoma (PTMC) frequently presents a favorable clinical outcome, while aggressive invasiveness can also be found in some of this population. Identifying the risk clinical factors of high-volume (> 5) central lymph node metastasis (CLNM) in PTMC patients could help oncologists make a better-individualized clinical decision.

METHODS

We retrospectively reviewed the clinical characteristics of adult patients with PTC in the Surveillance, Epidemiology, and End Results (SEER) database between Jan 2010 and Dec 2015 and in one medical center affiliated to Chongqing Medical University between Jan 2018 and Oct 2020. Univariate and multivariate logistic regression analyses were used to determine the risk factors for high volume of CLNM in PTMC patients.

RESULTS

The male gender (OR = 2.02, 95% CI 1.46-2.81), larger tumor size (> 5 mm, OR = 1.64, 95% CI 1.13-2.38), multifocality (OR = 1.87, 95% CI 1.40-2.51), and extrathyroidal invasion (OR = 3.67; 95% CI 2.64-5.10) were independent risk factors in promoting high-volume of CLNM in PTMC patients. By contrast, elderly age (≥ 55 years) at diagnosis (OR = 0.57, 95% CI 0.40-0.81) and PTMC-follicular variate (OR = 0.60, 95% CI 0.42-0.87) were determined as the protective factors. Based on these indicators, a nomogram was further constructed with a good concordance index (C-index) of 0.702, supported by an external validating cohort with a promising C-index of 0.811.

CONCLUSION

A nomogram was successfully established and validated with six clinical indicators. This model could help surgeons to make a better-individualized clinical decision on the management of PTMC patients, especially in terms of whether prophylactic central lymph node dissection and postoperative radiotherapy should be warranted.

Rice OsClo5, a caleosin protein, negatively regulates cold tolerance through the jasmonate signalling pathway

Caleosin is a lipid droplet-binding protein involved in maintenance of the lipid droplet structure and in signal transduction. However, the role of caleosin proteins in stress resistance is limited. Here, we report data for a rice caleosin protein gene, OsClo5, involved in cold stress tolerance via influence and regulation of the JA signalling pathway. Overexpression lines and RNAi lines of OsClo5 were subjected to cold stress and recovery to measure electrolyte leakage and survival rate. Changes were also detected in the genome-wide transcriptome of OsClo5 overexpressed plants. OsClo5 is located mainly in lipid droplets and expressed in all tissues tested. Its expression was upregulated by various stress conditions when subjected to cold treatment. Overexpression of OsClo5 decreased cold tolerance, and RNAi lines of OsClo5 had higher survival than WT seedlings. OsClo5 inhibited one jasmonate biosynthetic gene and several jasmonate ZIM domain (JAZ) genes, which were upregulated in response to cold stress. OsClo5 is a constitutively expressed caleosin protein that regulates plant cold resistance through inhibition of jasmonate signalling and JA synthesis.

Modulation of gut microbiota and hypoglycemic/hypolipidemic activity of flavonoids from the fruits of Lycium barbarum on high-fat diet/streptozotocin-induced type 2 diabetic mice

Lycium barbarum has been used as a traditional medicinal and edible plant in China. The fruits of L. barbarum, rich in flavonoids with large exploration potentiality, are associated with antioxidant...

Treatment and outcome in deficiency of adenosine deaminase 2: a literature review

OBJECTIVES

Deficiency of adenosine deaminase 2 (DADA2) is a rare disease with varying phenotypes and disease outcomes. We aimed to summarize the treatments of DADA2 and to explore the factors associated with disease outcome.

MATERIAL AND METHODS

A systemic literature review of DADA2 was conducted. Cases were included if they had documented detailed genotypes, phenotypes, treatment protocols and outcomes. Patients were categorized into uncontrolled and controlled groups. Factors associated with disease outcome were analyzed with logistic regression models.

RESULTS

A total of 242 DADA2 patients with treatment protocols and responses were included, 17 of whom required no treatment. The general effective rate of TNFi was 78.6% (103/131). Hematological abnormalities and increased acute phase reactants are independently associated with TNFi effectiveness, OR=0.21 (95%CI 0.07-0.661, p=0.007) and 9.62 (95%CI 2.31-40.00, p=0.002), respectively. Among those 225 patients requiring active treatment, 157 (69.8%) patients were in the controlled group, and 68(30.2%) in the uncontrolled group. Neither age of disease onset nor genotype was associated with disease outcome. Increased acute phase reactants (APRs), constitutional symptoms, neurological symptoms, and treatment with TNF inhibitors (TNFi) were independently associated with disease control, while recurrent infections and severe vascular events were the main causes of mortality (10/21 and 6/21, respectively).

CONCLUSIONS

In patients requiring treatment, symptoms of systemic inflammation and vasculitis and TNFi treatment are associated with disease control; while recurrent infections and severe vascular events should be treated intensively as they are the main causes of death. Hematological abnormalities should be monitored as it would decrease TNFi effectiveness.

Rhodol-derived turn-on fluorescent probe for copper ions with high selectivity and sensitivity

A new rhodol-derived fluorescent probe 1 with picolinate as the recognition receptor was designed and simply synthesized using a one-step reaction. With the concentration of added Cu²⁺ increases, it gradually turns pink, so the effect of naked eye detection can be achieved. The detection limit of probe 1 for Cu²⁺ is 42 nM, and the linear detection range was 0-2 μM. The experimental results showed that 1 was a fluorescent probe with high selectivity, good water solubility, and high sensitivity to Cu²⁺ . Probe 1 was successfully applied in cell imaging experiments and can detect the concentration of Cu²⁺ in water samples. All these indicate that probe 1 has the potential to be applied to the detection of Cu²⁺ concentration in the real environment.

AB0260 LONG-TERM EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS FROM CHINA, BRAZIL, AND SOUTH KOREA WITH RHEUMATOID ARTHRITIS AND AN INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS: RESULTS AT 64 WEEKS

Background:

Upadacitinib (UPA), an oral Janus kinase inhibitor, in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), showed significant improvements in clinical and functional measures compared with placebo (PBO) up to 12 weeks (wks), in patients (pts) from China, Brazil, and South Korea with rheumatoid arthritis (RA) and prior inadequate response to csDMARDs (csDMARD-IR).1

Objectives:

To assess the efficacy and safety of UPA up to 64 wks (long-term extension; LTE) in csDMARD-IR pts with RA from China, Brazil, and South Korea.

Methods:

Pts were randomized to 12 wks of blinded treatment with UPA 15 mg once daily (QD) or PBO, in combination with csDMARDs. From Wk 12 onward, pts could continue to receive open-label UPA 15 mg QD. Efficacy endpoints were analyzed by original randomized treatment group sequences over 64 wks and included American College of Rheumatology (ACR) responses, and key remission and low disease activity measures. Non-responder imputation was used to handle missing data for binary endpoints. Treatment-emergent adverse events (TEAEs) per 100 patient-years (PY) were summarized for pts receiving ≥1 dose of UPA from baseline through to Wk 64.

Results:

Of 338 randomized pts who received ≥1 dose of study drug, 310 (91.7%) entered the LTE and 275 (81.4%) completed 64 wks of treatment. Among those initially randomized to UPA, the proportion of pts achieving 20%/50%/70% improvement in ACR criteria, and key remission and low disease activity measures increased over 64 wks of treatment (Figure 1). Improvements from baseline in the Health Assessment Questionnaire-Disability Index and pts’ assessment of pain were observed over 64 wks of UPA treatment (data not shown). By Wk 64, efficacy results for pts who switched from PBO to UPA at Wk 12 followed a similar trajectory to those originally randomized to UPA.

The observed rate of serious infections was 8.1 events/100 PY. Herpes zoster events were mostly non-serious, involving only 1 or 2 dermatomes. Most cases of hepatic disorders were Grade 1 or 2 hepatic transaminase elevations. There was 1 case of venous thromboembolic event (VTE; concurrent pulmonary embolism and deep vein thrombosis [DVT] in a patient with a history of DVT) and 3 cases of malignancy. Adjudicated major adverse cardiovascular events (Table 1) occurred in 2 pts (1 with non-fatal myocardial infarction and 1 with non-fatal stroke) who had underlying risk factors for cardiovascular disease. There were no deaths, active tuberculosis, or renal dysfunction.

Conclusion:

UPA 15 mg was effective in treating the signs and symptoms of RA and in improving physical function over 64 wks with no new safety signals1 in csDMARD-IR pts with RA from China, Brazil, and South Korea.

References:

[1]Zeng A, et al. Ann Rheum Dis 2020;79(Suppl 1):1016 [abstract SAT0160]

Table 1.

TEAEs at Wk 64

Event (E/100 PY)UPA 15 mg(n=322; PY=334.5)Any AE421.5 (399.8–444.1) Serious AE19.1 (14.7–24.4) AE leading to discontinuation of study drug9.0 (6.1–12.8) Deathsa0AEs of special interest Serious infection8.1 (5.3–11.7) Opportunistic infection0.9 (0.2–2.6) Herpes zoster9.0 (6.1–12.8) Hepatic disorder42.2 (35.5–49.7) Gastrointestinal perforation (adjudicated)0.3 (0.0–1.7) Any malignancy (excluding NMSC)0.6 (0.1–2.2) NMSC0.3 (0.0–1.7) MACE (adjudicated)b0.6 (0.1–2.2) VTE (adjudicated)c0.3 (0.0–1.7) Anemia11.1 (7.8–15.2) Neutropenia11.7 (8.3–15.9) Lymphopenia7.8 (5.1–11.4) CPK elevation11.1 (7.8–15.2)

aIncluding non-treatment-emergent deaths. bDefined as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. cIncluding DVT and pulmonary embolism.

AE, adverse event; CPK, creatine phosphokinase; E, events; MACE, major adverse cardiovascular event; NMSC, non-melanoma skin cancer

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Yanna Song, PhD, of AbbVie provided statistical support. Medical writing support was provided by Laura Chalmers, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Xiaofeng Zeng: None declared, Dongbao Zhao: None declared, Sebastiao Radominski: None declared, MAURO KEISERMAN: None declared, Chang-Keun Lee: None declared, Naomi Martin Employee of: AbbVie employee and may own stock or options, Sebastian Meerwein Employee of: AbbVie employee and may own stock or options, Yunxia Sui Employee of: AbbVie employee and may own stock or options, Won Park: None declared

POS0754 DEVELOPMENT OF A RISK PREDICTION MODEL FOR VENOUS THROMBOEMBOLISM IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: THE SLE-VTE SCORE

Background:

Patients with systemic lupus erythematosus (SLE) have a substantially increased risk of venous thromboembolism (VTE). An individual VTE risk assessment is important to ensure that all patients are assessed and given adequate thromboprophylaxis.

Objectives:

We conducted this study to develop a risk score for VTE in patients with SLE.

Methods:

Patients with SLE who participated in the Chinese SLE Treatment and Research group were enrolled in this study. Patient baseline information and clinical laboratory indicators were obtained, and VTE events were recorded every 3-6 months during follow-up visits. The risk prediction model was created and internally validated using the bootstrap methods, and a scoring system was established (Figure 1).

Figure 1.

Flow chart of study design.

Results:

Out of 4,502 patients included in this study, 135 had a VTE event. After univariate analysis and Lasso regression, the following 11 variables were identified and included in the risk prediction model: male sex, age, BMI ≥25 kg/m2, hyperlipidemia, hypoalbuminemia, hsCRP>3 mg/L, renal involvement, nervous system involvement, anti-β2-glycoprotein I antibody positivity, lupus anticoagulant positivity, and no use of hydroxychloroquine. The AUC for the SLE-VTE score (Table 1) was 0.947 (95% CI, 0.9249-0.9694). The SLE-VTE score’s sensitivity and specificity with the optimal cutoff value of 13 were 0.919 and 0.881, respectively. The SLE-VTE score was superior to the GAPSS system in predicting the risk of VTE in patients with SLE (AUC= 0.947 vs. 0.680, P< 0.001; integrated discrimination improvement (IDI)= 0.6652, P< 0.001; net reclassification improvement (NRI)= 0.6652, P< 0.001).

Table 1.

Final multivariable analysis for venous thromboembolism risk in patients with SLE

β coefficientsOdds ratio* (95% CI)P-valuePoints in scoring systemMale0.6211.86(0.953-3.503)0.0612Age at study entry(≥50)0.8372.308(1.339-3.915)0.0023BMI02(kg/m20.7922.209(1.333-3.627)0.0023Hyperlipemia0.8382.313(1.246-4.166)0.0063Hypoalbuminemia2.1638.697(5.185-14.794)< 0.0017hsCRP>3 mg/L1.4524.272(2.618-6.968)< 0.0015Anti β2GPI1.0132.754(1.543-4.853)0.0013LA1.5594.752(2.799-8.072)< 0.0015Nervous system2.38210.832(6.163-18.998)< 0.0018Lupus nephritis0.8352.305(1.414-3.756)0.0013No use of hydroxychloroquine1.7715.876(3.722-9.401)< 0.0016

BMI: body mass index; hsCRP: Hypersensitive c-reactive protein; ACL: anticardiolipin, antiβ2GPI: anti-β2-glycoprotein I, LA: lupus anticoagulantm;

Values in bold are statistically significant at p <0.05.

Conclusion:

Various factors are related to the occurrence of VTE in patients with SLE. The proposed SLE-VTE risk score can accurately predict the risk of VTE and help identify SLE patients with a high risk of VTE who may benefit from thromboprophylaxis.

References:

[1]Ramirez GA, Efthymiou M, Isenberg DA, Cohen H. Under crossfire: thromboembolic risk in systemic lupus erythematosus. Rheumatology. 2018;58:940-952.

[2]Chung WS, Lin CL, Chang SN, Lu CC, Kao CH. Systemic lupus erythematosus increases the risks of deep vein thrombosis and pulmonary embolism: a nationwide cohort study. J Thromb Haemost. 2014;12:452-458.

[3]Liew NC, Alemany GV, Angchaisuksiri P, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. Int Angiol. 2017;36:1.

[4]Savino S, Giovanni S, Veronica M, Dario R, Khamashta MA, Laura BM. GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology. 2013:8.

[5]Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603.

[6]Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Nguyen NT, Stamos MJ. A Nationwide Analysis of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Colon and Rectal Surgery. J Gastrointest Surg. 2014;18:2169-2177.

Disclosure of Interests:

None declared

OP0290 CLINICAL CHARACTERISTICS AND PROGNOSIS OF ANTIPHOSPHOLIPID SYNDROME PATIENTS BASED ON CLUSTER ANALYSIS: A 10-YEAR COHORT STUDY

Background:

APS is an autoimmune disease characterized by persistent antiphospholipid antibodies (aPLs) positivity, leading to thrombotic events or pregnancy morbidity. High-risk aPLs profiles included positive lupus anticoagulant (LA) and multiple aPLs positivity1. Association was also found between aPLs and a variety of manifestations beyond thrombosis, referred to “non-criteria manifestations” (i.e. thrombocytopenia, hemolytic anemia, heart valve disease and aPL-related nephropathy)2, of which the role in APS risk stratification is poorly understood. The manifestation spectrum of APS is wide, ranging from asymptomatic aPLs positivity to life-threatening catastrophic APS, and patients other than confirmed APS also need proper management. Therefore, a risk stratification integrating demographic data, aPL-related manifestations, aPLs profiles, coexisting cardiovascular risk factors and SLE is needed for management guidance and prognosis assessment.

Objectives:

Using cluster analysis, to identify phenotypes among aPL-positive patients and assess the prognosis of each phenotype.

Methods:

This is a single-center, prospective cohort study of aPL-positive patients who presented to Peking Union Medical College Hospital from 2004 to 2020. Demographic characteristics, aPL-related manifestations, cardiovascular risk factors, antibodies profile and follow-up data were recorded. The primary end point was defined as a combination of newly onset arterial thrombosis (AT) or deep venous thrombosis (DVT), major bleeding events, non-criteria manifestations and all-cause death. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of patients and variables separately. Multiple comparison and Kaplan-Meier survival analysis were performed among clusters.

Results:

Four clusters among 383 patients (70.2% female; mean age 37.7 years) were identified (Figure 1A). Cluster 1 (n=138): female patients with SLE, non-criteria manifestations, triple aPLs positivity, high AT rate and moderate DVT rate. Cluster 2 (n=112): male patients with obesity, smoking history, hypertension, hyperhomocysteinemia, triple aPLs positivity and the highest rate of AT and DVT. Cluster 3 (n=83): female patients with the highest pregnancy morbidity rate and the lowest thrombosis rate. Cluster 4 (n=50): 62% male patients with isolated LA positivity, high AT rate and moderate DVT rate. Four clusters of variables were also identified (Figure 1A). From Kaplan-Meier survival analysis, 1-, 5- and 10-year event-free survival rates were 92.6%, 79.8% and 66.8%, respectively. Cluster 3 showed lowest incidence of primary endpoint (Figure 1B), while Cluster 1 and 2 showed higher newly-onset AT risk compared with other clusters (P=0.028 for 2 vs 3 and P=0.049 for 2 vs 4).

Figure 1.

Conclusion:

We identified 4 clinical phenotypes of aPL-positive patients. APS secondary to SLE was always aggregated with non-criteria manifestations. Clinicians should be alert to the possibility of SLE in aPL-positive patients with coexisting non-criteria manifestations, for whom immunosuppressive therapy besides anticoagulation may be necessary. Cluster 4 represented patients with isolated LA positivity and shared similar prognosis with secondary APS and male patients, which confirmed that LA represented a high-risk antibody spectrum. Additionally, cardiovascular risk factors (i.e. male, smoking history and obesity) played an important role in thrombosis events, and led to poor prognosis. Therefore, more attention should be paid to male patients, and the screening and management of cardiovascular risk factors should not be ignored.

References:

[1]Tektonidou MG, Andreoli L, Limper M et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019;78:1296–304.

[2]Miyakis S, Lockshin MD, Atsumi T et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306.

Disclosure of Interests:

None declared.

AB0197 EFFICACY AND SAFETY OF HLX01 COMBINED WITH METHOTREXATE IN CHINESE PATIENTS WITH MODERATELY TO SEVERELY ACTIVE RHEUMATOID ARTHRITIS WHO HAD INADEQUATE RESPONSES TO METHOTREXATE: RESULTS OF A RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 3 STUDY

Background:

Rituximab is an effective therapy for rheumatoid arthritis (RA) patients with inadequate responses to methotrexate (MTX)1, 2. However, it has not been registered or approved in China for the treatment of RA by far. HLX01, an approved rituximab biosimilar (demonstrated in Chinese patients with diffuse large B-cell lymphoma)3, is thus evaluated in this study for the benefits of Chinese RA patients.

Objectives:

This study aimed to evaluate the efficacy and safety of HLX01 plus MTX versus placebo plus MTX in Chinese patients with active RA who had inadequate responses to MTX.

Methods:

This was a randomised, double-blind, placebo-controlled phase 3 study conducted in China (NCT03522415). Eligible patients were randomised 2:1 to receive intravenous infusion of 2×1000 mg HLX01 or placebo on day 1 and day 15. Patients with inadequate responses at week 16 and 20 were allowed to receive rescue treatments. Patients were retreated with or switched to receive (if initially assigned to placebo) 2×1000 mg rituximab at the first day of week 24 and 26. The primary endpoint of this study was the American College of Rheumatology criteria (ACR) 20 response at week 24. Secondary efficacy endpoints were evaluated at week 12, 24, 36 and 48. The safety, pharmacokinetics, pharmacodynamics and immunogenicity of HLX01 were observed and analyzed throughout the study.

Results:

Between May 28, 2018 and Sep 11, 2020, a total of 275 patients (ITT set) were randomised and 263 patients without major protocol deviations were included in per-protocol set (PPS). At week 24, HLX01 showed statistically superior efficacy (p <0.001) to placebo (ACR20: 60.7% vs 35.9% in ITT set, 60.3% vs 37.1% in PPS). Secondary efficacy endpoints were also significantly improved in HLX01 group compared with placebo (Table 1). The overall incidence of serious treatment emergent adverse events (TEAEs), adverse drug reactions (ADRs), and TEAEs leading to drug discontinuation were similar among treatment groups, with the most common TEAE been upper respiratory tract infection before (18.1% vs 18.5%) or after (13.0% vs 12.3%) week 24. Serum concentrations, immunogenicity and pharmacodynamics were similar between HLX01 and placebo groups.

Table 1.

Results of secondary efficacy endpoints at week 12, 24, 36 and 48 in ITT set.

DurationSecondary efficacy endpointsACR20 (%)ACR50 (%)ACR70 (%)DAS28-CRP(mean)HAQ-DI(mean)HLX01PlaceboHLX01PlaceboHLX01PlaceboHLX01PlaceboHLX01PlaceboBaseline5.495.431.401.45Week 1248.132.621.910.94.45.43.894.471.021.22Week 2460.735.936.618.515.312.03.394.370.871.22Week 3660.148.946.431.532.217.42.883.510.710.97Week 4873.862.055.240.239.927.22.823.510.721.03

Conclusion:

Comparing with placebo plus MTX, HLX01 plus MTX showed significantly improved clinical outcomes and comparable safety profiles in Chinese patients with moderately to severely active RA who had inadequate responses to MTX, demonstrating HLX01 in combination with MTX as a well-tolerated, safe and efficient treatment option.

References:

[1]Emery P, Deodhar A, Rigby WF, et al. Efficacy and safety of different doses and retreatment of rituximab: a randomised, placebo-controlled trial in patients who are biological naive with active rheumatoid arthritis and an inadequate response to methotrexate (Study Evaluating Rituximab’s Efficacy in MTX iNadequate rEsponders (SERENE)). Ann Rheum Dis. Sep 2010;69(9):1629-35. doi:10.1136/ard.2009.119933.

[2]Rubbert-Roth A, Tak PP, Zerbini C, et al. Efficacy and safety of various repeat treatment dosing regimens of rituximab in patients with active rheumatoid arthritis: results of a Phase III randomized study (MIRROR). Rheumatology (Oxford). Sep 2010;49(9):1683-93. doi:10.1093/rheumatology/keq116.

[3]Shi Y, Song Y, Qin Y, et al. A phase 3 study of rituximab biosimilar HLX01 in patients with diffuse large B-cell lymphoma. J Hematol Oncol. Apr 16 2020;13(1):38. doi:10.1186/s13045-020-00871-9.

Acknowledgements:

The authors would like to thank participants in this study and their families. They would also like to acknowledge other investigators and staff at all clinical sites and the members of the Independent Data Monitoring Committee.

Disclosure of Interests:

None declared

POS0775 APLS-ASSOCIATED RETINAL VASCULOPATHY AS A PRESENTATION OF THROMBOTIC MICROANGIOPATHY

Background:

Persistent antiphospholipid antibodies (aPL) positivity was a recognized risk factor for thrombotic events, obstetric morbidity and a variety of manifestations beyond thrombosis. The presence of some non-criteria manifestations including thrombocytopenia, hemolytic anemia, and APS nephropathy should prompt consideration for thrombotic microangiopathy (TMA).1 Patients with APS can also present with a variety of ocular and neuro-ophthalmic manifestations, such as retinal artery/vein occlusion, retinal arteritis, optic neuritis and ischemic optic neuropathy, with underlying mechanisms remained elusive. Retinal vasculopathy including retinal artery occlusion (RAO) or retinal vein occlusion (RVO) was recently found occurred more frequently in APS patients with thrombocytopenia2, suggested other possible mechanisms besides thromboembolism.

Objectives:

To explore risk factors and possible mechanisms of retinal vasculopathy among APS patients.

Methods:

In this single-center case-control study among APS patients, we evaluated patients who fulfilled 2006 Sapporo APS Classification Criteria3 with or without retinal vasculopathy during 2018-2020 at Peking Union Medical College Hospital. Demographic data, aPL-related manifestations, cardiovascular risk factors and antibodies profile were compared and a logistical regression model was built. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of variables.

Results:

A total of 310 APS patients (67.4% female, mean age 38.1 years) were included, of whom 18 patients were diagnosed with retinal vasculopathy (9 with RVO and 9 with RAO). No significant differences was found among most demographic characteristics, clinical manifestations, or antibody profile. However, APS-related heart valve disease (OR 13.66, 95% confidence interval [CI] 4.55-40.98), APS nephropathy (OR 12.77, 95% CI 4.04-40.35), thrombocytopenia (OR 2.63, 95% CI 1.01-6.89) and high serum IgM (OR 3.67, 95% CI 1.30-10.40) were predictive of retinal vasculopathy (Figure 1 A). APS-related heart valve disease and nephropathy were also found statistical significant in multivariate logistical regression (Figure 1 B). They and other non-criteria manfestations were aggregated with retinal vasculopathy from cluster analysis of variables (Figure 1 C).

Conclusion:

Patients with APS-related heart valve disease and nephropathy suffered a higher risk of retinal vasculopathy including RAO and RVO. The underlying mechanisms of aPLs-associated retinal vasculopathy may involve TMA, leading to a poor prognosis and therapeutic changes.

References:

[1]Kotzen ES, Roy S, Jain K. Antiphospholipid Syndrome Nephropathy and Other Thrombotic Microangiopathies Among Patients With Systemic Lupus Erythematosus. Adv Chronic Kidney Dis. 2019 Sep;26(5):376-386.

[2]Ermakova NA, Alekberova ZS, Reshetniak TM, Kalashnikova LA, Kosheleva NM. [Retinal vascular lesions in systemic lupus erythematosus and secondary antiphospholipid syndrome]. Vestn Oftalmol. 2005 Sep-Oct;121(5):31-6.

[3]Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306.

Figure 1. A) Forest plot of univariate analysis; B) Forest plot of multivariate logistic regression; C) Cluster analysis of variables.

Disclosure of Interests:

None declared

[Mechanism of hepatocyte mitochondrial NDUFA13 deficiency-induced liver fibrogenesis: the role of abnormal hepatic stellate cell activation]

OBJECTIVE

To investigate the role of hepatocyte mitochondrial NDUFA13 loss in the liver fibrogenesis in mice and explore the possible mechanisms.

OBJECTIVE

We used liver-specific NDUFA13 heterozygous knockout mouse models (NDUFA13^fl/-; Alb-Cre) established previously by intercrossing NDUFA13^fl/fl and Alb-Cre mice, with their littermate control NDUFA13^fl/fl mice as the control (n=8). The mice were euthanized at the age of 4 weeks and 2 years, and the liver tissues were collected for HE and Masson staining to observe the pathological changes and fibrosis phenotypes. Western blotting was performed to detect the expression of NDUFA13 protein in the liver tissues, and the infiltration of F4/80⁺ macrophages and the expressions of TGF-β1, TNF-α and IL-1β were analyzed by immunofluorescence assay. The expression levels of α-SMA, matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteases 1 (TIMP-1), collagen-Ⅰ and collagen-Ⅲ were assayed by immunohistochemistry.

OBJECTIVE

HE and Masson staining showed obvious inflammatory infiltration but no significant fibrosis in the liver tissues of 4-week-old NDUFA13^fl/- mice, but severe liver damage with massive fibrosis was observed in 2-year-old NDUFA13^fl/- mice. NDUFA13 expression in 2-year-old NDUFA13^fl/- mice markedly decreased compared with that in the control NDUFA13^fl/fl mice as shown by Western blotting (P < 0.05). Immunohistochemistry showed obvious infiltration of F4/80⁺ macrophages in the liver tissue with a large amount of TGF-β1 production (P < 0.05) and TNF-α and IL-1β secretions in NDUFA13^fl/- mice (P < 0.05). NDUFA13 knockout obviously promoted α-SMA expression (P < 0.05) and collagen-Ⅰ and collagen-Ⅲ deposition (P < 0.05) while significantly decreased MMP-9 and increased TIMP-1 expression in the liver (P < 0.05).

OBJECTIVE

Hepatocytes-specific NDUFA13 deficiency can trigger spontaneous and chronic liver fibrosis phenotypes in mice probably in association with abnormal activation of hepatic stellate cells induced by macrophages and inflammatory factors.

microRNA-21 ameliorates the impairment of autophagy in palatal wound healing

Fibroblast injury and autophagy dysfunction have been shown to contribute to the persistence of oral wounds. Recently, microRNAs have emerged as vital regulators and fine tuners of various pathophysiological cellular processes that influence the wound healing process. This study explored the biological function and regulatory mechanism of miRNA-21 (miR-21) in the healing of oral wounds by interfering with autophagy. Healthy gingival cells derived from wild-type (WT) and from miR-21KO mice were characterized by immunocytofluorescence, and changes in wound healing were subsequently assessed using an in vitro scratch wound healing assay. The roles of critical proteins required for autophagy, autophagy related 5 (ATG5) and Bcl-2 interacting coiled-coil protein 1 (Beclin1) were evaluated by immunohistochemistry. Human gingival fibroblasts (HGFs) were transfected with a miR-21 mimic and a miR-negative control, and the relative expression of miR-21, ATG5, Beclin1 and LC3-I/II was characterized by qRT-PCR and Western blot. Pathological changes were observed in a palatal wound healing model using WT and miR-21KO mice. Immunohistochemistry was used to examine extracellular matrix (ECM) proteins and autophagy markers. Cell migration was delayed in gingiva-derived mesenchymal stem cells (GMSCs) from miR-21KO mice compared with WT mice. The expression of ATG5 and Beclin1 was significantly up-regulated in miR-21KO gingiva. Transfection of a miR-21 mimic into HGFs inhibited autophagy and up-regulated miR-21 expression. Knockdown of miR-21 suppressed the expression of fibronectin and CTGF, enhanced the autophagy effect of fibroblasts, suggesting that autophagy is involved in miR-21 regulated palatal wound healing. Taken together, these results suggest that miR-21 promotes oral wound healing by increasing ECM production through the inhibition of autophagy and facilitates clinical management of wound healing.

ORAOV1-B Promotes OSCC Metastasis via the NF-κB-TNFα Loop

Metastasis, a powerful prognostic indicator of oral squamous cell carcinoma (OSCC), is chiefly responsible for poor cancer outcomes. Despite an increasing number of studies examining the mechanisms underlying poor outcomes, the development of potent strategies is hindered by insufficient characterization of the crucial regulators. Long noncoding RNAs (lncRNAs) have recently been gaining interest as significant modulators of OSCC metastasis; however, the detailed mechanisms underlying lncRNA-mediated OSCC metastasis remain relatively uncharacterized. Here, we identified a novel alternative splice variant of oral cancer overexpressed 1 (ORAOV1), named as ORAOV1-B, which was subsequently validated as an lncRNA and correlated with OSCC lymph node metastasis; significantly increased invasion and migration were observed in ORAOV1-B-overexpressing OSCC cells. RNA pulldown and mass spectrometry identified Hsp90 as a direct target of ORAOV1-B, and cDNA microarrays suggested TNFα as a potential downstream target of ORAOV1-B. ORAOV1-B was shown to directly bind to and stabilize Hsp90, which maintains the function of client proteins, receptor-interaction protein, and IκB kinase beta, thus activating the NF-κB pathway and inducing TNFα. Additionally, TNFα reciprocally enhanced p-NF-κB-p65 and the downstream epithelial-mesenchymal transition. ORAOV1-B effects were reversed by a TNFα inhibitor, demonstrating that TNFα is essential for ORAOV1-B-regulated metastatic ability. Consistent epithelial-mesenchymal transition in the ORAOV1-B group was demonstrated via an orthotopic model. In the metastatic model, ORAOV1-B significantly contributed to OSCC-related lung metastasis. In summary, the novel splice variant ORAOV1-B is an lncRNA, which significantly potentiates OSCC invasion and metastasis by binding to Hsp90 and activating the NF-κB-TNFα loop. These findings demonstrate the versatile role of ORAOV1 family members and the significance of genes located within 11q13 in promoting OSCC. ORAOV1-B might serve as an attractive OSCC metastasis intervention target.

MiR-302b Suppresses Tumor Metastasis by Targeting Frizzled 6 in OSCC

Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of malignant epithelial tumors of the oral and maxillofacial region. OSCC has high rate of metastasis and poor prognosis. Tobacco and/or alcohol consumption and human papillomavirus infection are relatively exact susceptibility factors for OSCC, but the specific process of oral mucosal carcinogenesis and progression is very complicated. microRNA-302b (miR-302b) could regulate various characteristics of many tumor cells, such as proliferation and apoptosis, but its role and mechanism in OSCC have not been reported. This research aims to study the effect of miR-302b on the invasion and migration ability of OSCC and the mechanism by which it functions as well as to identify new prognostic indicators and therapeutic targets for OSCC patients. Functional studies showed that the miR-302b level was negatively correlated with the invasion and migration ability of OSCC. The studies also showed that the overexpression of miR-302b could attenuate the invasion and migration ability of OSCC cells and reduce lymphangiogenesis and the lung metastasis rate of OSCC cells in a mouse model. Mechanistic studies were performed by quantitative polymerase chain reactions, luciferase assays, and RNA pull-down experiments. The results verified that frizzled class receptor 6 (FZD6) is a target gene of miR-302b in OSCC that could promote cell invasion and migration. Clinical studies demonstrate that the protein expression level of FZD6 was higher in OSCC and metastatic lymph nodes than in normal oral mucosa epithelium. Taken together, these data showed that miR-302b could inhibit the invasion and migration ability of OSCC cells by targeting and downregulating FZD6, thereby inhibiting OSCC metastasis. As a new target gene of miR-302b, FZD6 has the potential to become a prognostic and therapeutic target for OSCC patients.

[Progress in research of allergen detection methods]

Allergic diseases have continued to increase year by year causing serious physical and mental injury to patients, families and individuals. This increase has been driven by conventional environmental and nutritional changes but is also created by the continual introduction of food additives into the diet and novel interior decoration materials into the living space. The causes of allergic diseases are complex and diverse, and the medical laboratory often is not be able to identify the allergic trigger; this creates a difficult environment to identify the appropriate clinical treatment for disease prevention and control. Physicians must be able to identify these triggers to help patients avoid the underlying allergenic cause of their disease. This can only be done by actively knowing a patient's medical history, identifying the clinical manifestations of hypersensitivity and utilizing confirmatory testing as an important clinical tool in identifying the allergic source.

Clinical Frailty Scale and Biomarkers for Assessing Frailty in Elder Inpatients in China

OBJECTIVE

This study aimed to assess the feasibility of the Clinical Frailty Scale (CFS) and clinical biomarkers in assessing the frailty in elder inpatients in China.

DESIGN

The study was a cross-sectional study.

SETTING AND PARTICIPANTS

The study included 642 elder inpatients (295 females and 347 males) aged ≥65 years, from the Department of Geriatrics of Zhejiang Hospital between January 2018 and December 2019.

MEASUREMENTS

All participants underwent a comprehensive geriatric assessment and blood tests. Univariate and multivariate logistic regression was used to analyze the association between risk factors and frailty.

RESULTS

The average age of the participants was 82.72±8.06 years (range: 65-95 years) and the prevalence of frailty was 39.1% according to the CFS. Frail participants showed significantly lower short physical performance battery (SPPB), basic activities of daily living (ADL) and instrumental activities of daily living (IADL) scores (all p<0.001), and lower hemoglobin, total protein and albumin levels (all P<0.05) than nonfrail participants. Frail participants had higher CRP, D-dimer and fibrinogen levels than nonfrail participants (all p<0.05). Univariate logistic regression analysis showed a significant association between frailty and age, comorbidity, polypharmacy, fall history, SPPB, ADL, and IADL scores, D-dimer, fibrinogen, hemoglobin, total protein and albumin levels (all P<0.05). Multivariate logistic regression analysis indicated that age (odds ratio (OR), 95% confidence interval (CI)= 1.151(1.042-1.272), P=0.006), SPPB scores (OR, 95% CI=0.901(0.601-1.350), P<0.001), and D-dimer (OR, 95% CI=4.857(2.182-6.983), P<0.001), fibrinogen (OR, 95% CI=2.665(0.977-4.254), P<0.001), hemoglobin (OR, 95% CI=0.837(0.725-0.963), P= 0.044), and albumin (OR, 95% CI=0.860 (0.776-1.188), P<0.001) levels were independently associated with frailty in all participants.

CONCLUSION

Frailty in elder inpatients in China is characterized by older age, a lower SPPB scores, higher D-dimer and fibrinogen levels and lower hemoglobin and albumin levels. Functional decline and malnutrition may be the targets of frailty interventions.