[Comparison of the mid- and long-term outcomes between natural orifice specimen extraction surgery and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer based on propensity score matching method]

Objective: To compare the mid- and long-term outcomes between natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer. Methods: A propensity score matching study was conducted. Patients with pathological diagnosis of rectal adenocarcinoma, preoperative imaging assessment of T1-3 and body mass index <28 kg/m(2) were included. Those who underwent local resection or abdominoperineal resection, had simultaneous multiple primary cancers, malignant intestinal obstruction or perforation, received neoadjuvant radiotherapy, and were unsuitable for laparoscopic surgery were excluded. From January 2017 to January 2019, 264 patients undergoing laparoscopic rectal cancer surgery at the Department of Colorectal Tumor Surgery, Shengjing Hospital of China Medical University were enrolled in this study, and divided into the NOSES group (52 cases) and the auxiliary incision group (212 cases). Propensity score matching method was used as 1:1 to match the initial data, and 46 pairs were finally obtained. SPSS 26.0 was used for data analysis, and 2-year disease-free survival, intraoperative and perioperative indicators were compared between the two groups. Results: The tumor short diameter in the NOSES group and the auxiliary incision group was (2.9±0.8) cm and (3.1±1.0) cm (t=0.842, P=0.402) respectively. Other baseline data were also comparable between the two groups(all P>0.05). There were no significant differences in operative time, intraoperative blood loss, length of hospital stay and postoperative complication rate between the two groups (all P>0.05). The time to first flatus [2 (1-6) days vs. 3 (1-6) days, Z=-3.035, P=0.002] and to liquid food intake [3 (1-6) days vs. 3 (2-7) days, Z=-2.587, P=0.010] after surgery in the NOSES group were earlier than those that in the auxiliary incision group. Compared with the auxiliary incision group, the postoperative pain score was lower [3 (2-5) vs. 4 (3-7), Z=-5.477, P<0.001], and the aesthetic score was higher [8 (6-9) vs. 7 (5-8), Z=-6.329, P<0.001] in the NOSES group. The distal resection margin in the NOSES group was longer than that in the auxiliary incised group [(3.7±1.2) cm vs. (2.9±1.4) cm, t=3.287, P<0.001]. There were no significant differences in proximal resection margin the number of harvested lymph nodes and positive rate of circumferential resection margin between the two groups (all P>0.05). The 2-year disease-free survival rate in the NOSES group and the auxiliary incision group was 93.5% and 89.1% respectively, and the difference was not statistically significant (P=0.466). Conclusions: NOSES has similar mid- and long-term outcomes to conventional laparoscopic surgery and the advantages of better cosmetic effect, less postoperative pain and faster recovery, which is more in line with the concept of minimally invasive and worthy of clinical promotion.

Long-term outcomes of lobectomy for papillary thyroid carcinoma with high-risk features

BACKGROUND

Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features.

METHODS

Consecutive patients with PTC and at least one high-risk feature treated in 2000-2012 were included in the study. High-risk features were defined as: primary tumour larger than 4 cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis.

RESULTS

Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P < 0.001). With a median follow-up of 93 months, multivariable analysis showed that the extent of surgery was not associated with DSS in the whole cohort (hazard ratio 1.36, 95 per cent c.i. 0.75 to 2.48; P = 0.310). After 1 : 1 case-control matching of 528 patients, no significant difference between lobectomy and total thyroidectomy groups was observed with respect to the 10-year DSS rate (94.3 versus 95.2 per cent respectively; P = 0.323) or 10-year recurrence-free survival rate (75.8 versus 79.2 per cent; P = 0.784).

CONCLUSION

Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.

P–194 Impact of cryopreservation duration on pregnancy outcomes of vitrified-warmed blastocysts transfer using an open-device system

Study question

Is there a negative effect of long-term cryopreservation upon pregnancy outcomes after transfer of vitrified-warmed blastocysts stored in an open-device system?

Summary answer

Prolonged cryopreservation of vitrified blastocysts up to 24 months increased the incidences of clinical pregnancy, ongoing pregnancy, and live birth, while decreased early miscarriage rate.

What is known already

Vitrification is adopted as the dominant approach for cryopreservation of human oocytes and embryos. However, little is known about the potential effect of prolonged storage after vitrification on the genomic integrity and metabolism of embryos. Several studies have sought to decipher the effect of cryopreservation duration on IVF pregnancy outcomes, but few were confined to vitrification and the results were inconsistent.

Study design, size, duration

This retrospective study included 6722 patients undergoing their first vitrified-warmed blastocyst transfer (VBT) cycles from January 2015 to June 2019 in a single fertility center in South China. The study was approved by the hospital’s Ethics Committee.

Participants/materials, setting, methods

A total of 6722 eligible patients were divided into five groups according to the storage duration after vitrification: Group I: 0–3 months; Group II: 3–6 months; Group III: 6–12 months; Group IV: 12–24 months; Group V: 24–36 months. The IVF pregnancy outcomes were compared between groups. Multivariate logistic regression was conducted to evaluate the independent effect of storage duration on pregnancy outcomes.

Main results and the role of chance

The odds of clinical pregnancy outcomes were similar from Group 1 to 4. However, the chance of clinical pregnancy (Group 1 as reference; Group 2: adjusted odds ratio (aOR)= 1.04, 95% CI 0.93–1.17; Group 3: aOR = 1.02, 95% CI 0.84–1.25; Group 4: aOR = 0.93, 95% CI 0.66–1.31; Group 5: aOR = 0.54, 95% CI 0.38–0.76) , ongoing pregnancy (Group 2: aOR=0.99, 95% CI 0.89–1.11; Group 3: aOR = 0.94, 95% CI 0.77–1.14; Group 4: aOR = 0.87, 95% CI 0.62–1.22; Group 5: aOR = 0.41, 95% CI 0.29–0.60), and live birth rate (Group 2: aOR=1.00, 95% CI 0.89–1.12; Group 3: aOR = 0.98, 95% CI 0.81–1.19; Group 4: aOR = 0.91, 95% CI 0.65–1.27; Group 5: aOR = 0.46, 95% CI 0.32–0.66) significantly decreased, while the early miscarriage rate (Group 2: aOR=1.11, 95% CI 0.92–1.35; Group 3: aOR =1.25, 95% CI 0.92–1.70; Group 4: aOR = 1.33, 95% CI 0.77–2.31; Group 5: aOR = 2.42, 95% CI 1.36–4.31) significantly increased as the storage duration increased up to 24–36 months.

Limitations, reasons for caution

The primary limitation of this study was its retrospective nature. Besides, as all these data come from a single IVF treatment center, the results should be confirmed by a larger multicenter study.

Wider implications of the findings: Our study provides more evidence about the negative impact of long-term storage of vitrified embryos on the clinical outcome. Clinicians should adapt FET strategies based on the embryo storage duration.

Trial registration number

Not applicable

Temperature-dependent dynamic structure factors for liquid water inferred from inelastic neutron scattering measurements

Temperature-dependent dynamic structure factors S(Q, ω) for liquid water have been calculated using a composite model, which is based on the decoupling approximation of the mean square displacement of the water molecules into diffusion and solid-like vibrational parts. The solid-like vibrational part S_vib(Q, ω) is calculated with the phonon expansion method established in the framework of the incoherent Gaussian approximation. The diffusion part S_diff(Q, ω) relies on the Egelstaff-Schofield translational diffusion model corrected for jump diffusions and rotational diffusions with the Singwi-Sjölander random model and Sears expansion, respectively. Systematics of the model parameters as a function of temperature were deduced from quasi-elastic neutron scattering data analysis reported in the literature and from molecular dynamics (MD) simulations relying on the TIP4P/2005f model. The resulting S(Q, ω) values are confronted by means of Monte Carlo simulations to inelastic neutron scattering data measured with IN4, IN5, and IN6 time-of-flight spectrometers of the Institut Laue-Langevin (ILL) (Grenoble, France). A modest range of temperatures (283-494 K) has been investigated with neutron wavelengths corresponding to incident neutron energies ranging from 0.57 to 67.6 meV. The neutron-weighted multiphonon spectra deduced from the ILL data indicate a slight overestimation by the MD simulations of the frequency shift and broadening of the librational band. The descriptive power of the composite model was suited for improving the comparison to experiments via Bayesian updating of prior model parameters inferred from MD simulations. The reported posterior temperature-dependent densities of state of hydrogen in H₂O would represent valuable insights for studying the collective coupling interactions in the water molecule between the inter- and intramolecular degrees of freedom.

POS0590 SAFETY AND EFFICACY OF BIOLOGICS IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS IN A REAL WORLD STUDY: USE OF INTRAVENOUS GOLIMUMAB AND INFLIXIMAB IN ADULTS WITH RHEUMATOID ARTHRITIS ≥65 YEARS OF AGE

Background:

AWARE is a real-world evidence-based (RWE) study evaluating the safety and efficacy of IV golimumab (GLM) and infliximab (IFX) in adults with RA.

Objectives:

Evaluate safety and efficacy of IV GLM and IFX in elderly AWARE participants.

Methods:

AWARE, a prospective non-interventional study (88 US sites), enrolled patients (pts) initiating either IV GLM or IFX. Pt management was at the discretion of treating rheumatologists. In a post hoc analysis, pts were grouped by age (<65/≥65/≥75 yrs). Adverse events (AEs) were collected through the Week (W) 52 database lock (DBL; completed W52 or discontinued study) and at the end-of-study DBL (W104). The primary endpoint was proportion of pts with ≥1 infusion reaction through W52. Change from baseline in Clinical Disease Activity Index (CDAI) scores at Months 6 and 12 were secondary endpoints evaluated in bionaïve pts, including those with IFX dose escalation.

Results:

1270 pts were enrolled (685 IV GLM; 585 IFX). 1047 (82%) pts were female; mean age was 60 yrs (57% <65 yrs, 43% ≥65 yrs, and 7% ≥75 yrs). Mean disease durations were 9 yrs (IV GLM) and 7 yrs (IFX). Comorbidities were generally similar between IV GLM and IFX groups but more common among pts ≥65 vs <65 yrs. Through W52, 66% of IV GLM pts and 62% of IFX pts discontinued the study. Discontinuation due to lack of efficacy was generally similar across age groups within treatment groups, although somewhat higher for IV GLM (29%) vs IFX (19%). For both treatments, AEs and discontinuations due to AE through W52 were more common in pts ≥65 vs <65 yrs (Table 1). Consistent with general trends observed in elderly individuals,1 rates of serious AEs (SAEs) and serious infections increased with age for both IV GLM and IFX; however, increases were more notable in IFX- than IV GLM-treated pts ≥65 yrs. The incidence of serious infections was highest in pts ≥75 yrs for both treatments, although small sample size may limit data interpretation. No increase in opportunistic infections, including Varicella, was observed in pts ≥65 vs <65 yrs. Infusion reactions were more common in pts <65 yrs in both treatment groups, and more prevalent in IFX- than IV GLM-treated pts within each age group through W52. Generally similar safety results were seen between W52 and W104 for each treatment group (data not shown). Both IV GLM and IFX in bionaïve pts showed improvement in CDAI scores across age groups, which was maintained over time (Figure 1).

Table 1.

% of pts with ≥1 AE through W52 DBL

IV GLMIFX<65 yrs≥65 yrs≥75 yrs<65 yrs≥65 yrs≥75 yrsPatients, n3513349137021546Discontinued due to AE8.5%12.6%16.5%15.1%17.7%21.7%AE52.4%58.4%57.1%63.5%66.5%71.7%Most common AEs (≥5% of pts in either treatment group)Nausea3.7%3.3%3.3%8.4%6.0%2.2%Worsening of RA5.4%4.5%3.3%7.3%7.0%4.3%Upper respiratory tract infection5.7%5.1%4.4%6.2%5.6%2.2%Pruritis1.4%2.4%3.3%6.8%2.8%2.2%Sinusitis7.1%3.3%0%3.8%3.7%2.2%Urinary tract infection4.8%5.1%5.5%4.3%5.1%6.5%SAE7.7%16.8%20.9%9.7%18.6%26.1%Infection30.5%27.2%27.5%32.2%28.8%32.6%Serious infection3.7%6.3%7.7%3.5%7.9%15.2%Neoplasms benign, malignant and unspecified0.6%2.7%1.1%0.8%2.3%6.5%Latent tuberculosis0.3%0%00.3%0%0%Opportunistic infection1.4%1.8%4.4%1.9%1.4%4.3%Infusion reaction5.1%2.7%1.1%17.3%8.8%8.7%Death0.3%2.4%2.2%0%2.3%6.5%

Conclusion:

Elderly RA pts receiving IV GLM or IFX in this RWE study demonstrated similar safety and efficacy as reported in Phase 3 trials.2,3 The higher rates of AEs, discontinuations due to AE, and SAEs (mainly serious infections) observed in pts ≥65 yrs are in line with increased safety events seen in elderly vs younger individuals in the general population. Rates of AEs, SAEs, and infusion reactions were higher for IFX vs IV GLM. Infusion reactions were more common in pts <65 vs ≥65 yrs for both GLM and IFX, but more prevalent with IFX.

References:

[1]Castle SC. Clin Infect Dis 2000;31:578–85.

[2]Lipsky PE, et al. N Engl J Med 2000;343:1594-602.

[3]Weinblatt ME, et al. Ann Rheum Dis 2013;72:381-9.

Disclosure of Interests:

Joy Schechtman: None declared, Aaron Broadwell Speakers bureau: Amgen, AbbVie, Eli Lilly, Horizon, Janssen, Mallinckrodt, Novartis, Pfizer, Radius, Sanofi/Regeneron, and UCB, Consultant of: AbbVie, Amgen, Aurinia, Celegene, Eli Lilly, Janssen, Novartis, Pfizer, and Sandoz, Shelly Kafka Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Shawn Black Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Stephen Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Wayne Langholff Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Sergio Schwartzman Shareholder of: Amgen, Boston Scientific, Gilead, Medtronic, and Pfizer, Speakers bureau: AbbVie, Janssen, Eli Lily, Novartis, Pfizer, Regeneron, Sanofi, and UCB, Consultant of: AbbVie, Gilead, Eli Lilly, Janssen, Myriad, Novartis, Regeneron, Samsung, Sanofi, and UCB

Comprehensive evaluation of the learning curve to achieve satisfactory adenoma detection rate

BACKGROUND AND AIM

The number of colonoscopies required to reach satisfactory adenoma detection rate (ADR) is not well established. The aim of this study was to identify the appropriate number of procedures required to attain satisfactory ADR for those well-trained endoscopists who have a cecal intubation rate (CIR) ≥ 90% and start to perform colonoscopy independently.

METHODS

All endoscopists with compelete independent colonoscopy data during career in our database were enrolled. The number of procedures required to achieve ADR ≥ 20% was identified by cumulative summation (Cusum), learning curve Cusum (LC-Cusum), and moving average method. Mixed effect logistic regression model was developed to determine the relationship between endoscopist as well as patient-related factors and adenoma detection.

RESULTS

A total of 24 943 procedures and 14 endoscopists were enrolled. By Cusum analysis, the interest point was at 207 procedures. By LC-Cusum analysis, 71% (10/14) and 86% (12/14) of endoscopists had attained satisfactory ADR after 200 and 300 procedures, respectively. By moving average method, endoscopists reached a mean ADR of 20% at 216 and 261 procedures over blocks of 50 and 100 procedures, respectively. The total number of procedures, number of daily procedures, patient age and gender, bowel preparation, sedation, and diverticulosis were significantly associated with adenoma detection.

CONCLUSIONS

This is the first study to investigate the learning curve of ADR for those well-trained endoscopists who have a CIR ≥ 90% and start to perform colonoscopy independently. Two hundred procedures might be an optimal number required to reach an ADR ≥ 20%.

POS0607 PROMIS ASSESSMENT OF RESPONSE TO TREATMENT WITH GOLIMUMAB IV OR INFLIXIMAB IN RHEUMATOID ARTHRITIS PATIENTS: RESULTS FROM THE PHASE-4 AWARE STUDY

Background:

AWARE is a phase-4 observational study designed to provide real-world assessment of Golimumab (GLM) IV & infliximab (IFX) in patients (pts) with rheumatoid arthritis (RA).

Objectives:

To assess patient-reported aspects of social, mental, & physical health through the 8th infusion (≈1 year of treatment) using Patient Reported Outcomes Measurement Information System (PROMIS), a validated, disease-agnostic set of health assessment instruments.

Methods:

AWARE enrolled 1270 RA pts initiating treatment with GLM/IFX. The 52 week analysis set included pts with ≥1-year treatment or those discontinued and, while enrolled, completed PROMIS-29 or PROMIS short form (SF) questionnaires. PROMIS instruments were administered at baseline & prior to infusions 2, 5, & 8. The raw score was converted into a standardized T-score with a mean of 50 and SD of 10.

Results:

At baseline, treatment groups were balanced on demographics & medical characteristics. Most pts were white (87.0% GLM, 86.2% IFX) & female (83.4% GLM, 82.4% IFX). Mean ages were 58.5 ±12.96 years for GLM & 59.6 ±13.24 years for IFX. Overall, 35.3% GLM & 42.9% IFX pts were bio-naïve. The proportion of GLM & IFX pts with prior exposure to 1 or 2 biologics was similar; however, 20.1% GLM pts vs 10.8% IFX pts had exposure to ≥3 biologics. Methotrexate use was similar between GLM (76.4%) & IFX pts (75.0%). Based on mean PROMIS T-scores at baseline (Table 1), Fatigue, Pain Interference, & Physical Function domains approached or exceeded 1 SD worse than those of general US population. Through the 8th infusion, GLM- & IFX-treated pts achieved meaningful improvement based on mean changes from baseline in most PROMIS-29 domains & respective SFs with no significant difference between GLM and IFX. The percentage of GLM or IFX pts with improvements of ≥3, ≥5, or ≥10 units change in T-scores increased from infusion 2 through infusion 8.

Conclusion:

RA pts treated with GLM or IFX achieved comparable improvements across PROMIS-assessed social, mental, & physical health. PROMIS-29 was able to detect change to subsequent anti-tumor necrosis factor-α therapies.

Table 1.

Mean (SD) Change from Baseline PROMIS-29 Domain and Short Form T-Scores: 52 Week Analysis Set

GLMIFXLSM difference (95% CI)*Anxiety (4-item)N=6N=570Baseline53.4 (10.13)54.6 (10.53)Change from baseline at infusion 8N=223 -2.6 (8.10)N=286-3.7 (7.86)-0.29 (-1.54, 0.97)Depression (4-item)BaselineN=67451.9 (9.83)N=57452.5 (10.21)Change from baseline at infusion 8N=225-2.1 (7.56)N=287-2.3 (7.89)0.49 (-0.72, 1.70)Fatigue (4-item)BaselineN=67158.4 (9.91)N=57459.4 (9.99)Change from baseline at infusion 8N=225-3.4 (8.72)N=281-3.1 (7.77)0.69 (-0.64, 2.03)Short form Fatigue 7aBaselineN=68159.1 (8.51)N=57659.7 (8.25)Change from baseline at infusion 8N=228-3.2 (7.40)N=287-2.4 (6.35)1.01 (-0.11, 2.14)Pain interference (4-item)BaselineN=67963.0 (7.56)N=57463.9 (7.80)Change from baseline at infusion 8N=227-4.2 (8.23)N=284-3.1 (7.77)1.84 (0.55, 3.13)Short form Pain interference 6bBaselineN=68061.9 (7.45)N=57662.8 (7.54)Change from baseline at infusion 8N=228-3.8 (7.88)N=287-3.2 (6.67)1.31 (0.15, 2.48)Physical function (4-item)BaselineN=67838.2 (6.79)N=57138.0 (6.90)Change from baseline at infusion 8N=2242.2 (5.64)N=2831.9 (5.85)-0.76 (-1.73, 0.21)Sleep disturbance (4-item)BaselineN=67154.6 (8.72)N=569N=55.5 (8.61)Change from baseline at infusion 8N=221-1.4 (7.45)N=281-1.7 (7.61)0.23 (-0.96, 1.42)Social participation (4-item)BaselineN=67343.7 (8.40)N=57442.9 (8.77)Change from baseline at infusion 8N=2253.2 (8.15)N=2833.4 (7.48)-0.10 (-1.36, 1.16)

*Least squares mean (LSM) difference & confidence interval (CI) are based on analysis of covariance controlling for baseline PROMIS score using inverse probability of treatment weighted propensity score.

Disclosure of Interests:

Clifton Bingham Consultant of: AbbVie, BMS, Eli Lilly, Gilead, Janssen, Pfizer, Regeneron/Sanofi, Grant/research support from: Bristol-Myers Squibb, Shelly Kafka Employee of: Janssen Research & Development, LLC, Shawn Black Employee of: Janssen Research & Development, LLC, Stephen Xu Employee of: Janssen Research & Development, LLC, Wayne Langholff Employee of: Janssen Research & Development, LLC, Jeffrey Curtis Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB

AB0525 GUSELKUMAB TREATMENT SHOWS RAPID ONSET OF EFFECT ON COMPONENTS OF AMERICAN COLLEGE OF RHEUMATOLOGY RESPONSE CRITERIA: RESULTS OF 2 RANDOMIZED PHASE 3 TRIALS

Background:

Guselkumab (GUS), an anti-interleukin-23p19-subunit monoclonal antibody, demonstrated efficacy vs placebo (PBO) in achieving American College of Rheumatology 20% improvement (ACR20) response in patients (pts) with active psoriatic arthritis (PsA) in two phase 3 trials, DISCOVER-1 & 2.1,2

Objectives:

To assess the differential treatment effects of GUS across individual components of ACR response in PsA pts participating in the DISCOVER-1 & 2 trials.

Methods:

In DISCOVER-1 & 2, 1120 pts were randomized & treated with GUS 100 mg every 4 weeks (Q4W; N=373); GUS 100 mg at Week (W)0 and W4, then Q8W (N=375); or matching PBO (N=372). Pts were evaluated by independent joint assessors at study visits. ACR20 response is defined as ≥20% improvement from baseline in both tender joint count (0-68 [TJC68]) and swollen joint count (0-66 [SJC66]) and ≥20% improvement from baseline in ≥3 of 5 assessments: Patient Assessment of Pain [Pt Pain], Patient Assessment of Global Disease Activity (arthritis) [PtGA], Physician Assessment of Global Disease Activity [PGA], Patient assessment of physical function as measured by Disability Index of the Health Assessment Questionnaire (HAQ-DI), and C-reactive protein (CRP). For each ACR component, achievement of ≥20% improvement from baseline was assessed over time through W24 for the combined (Q4W+Q8W) GUS groups, and median time to onset of treatment effect was determined with Kaplan-Meier curves by randomized group.

Results:

Median time to response for all components except SJC66 occurred earlier with GUS than PBO. Time to onset of ACR20 treatment effect is shown in Figure 1. CRP data show 56% of GUS-treated pts had diminution of systemic inflammation by W4 (Table 1). Reduction in systemic inflammation was accompanied or rapidly followed by GUS-related improvement in both PtGA and PGA (median W4-8). Although SJC66/TJC68 data showed similar patterns, there was also a high PBO response (data not shown). Consistent with early reductions in systemic inflammation, 48-61% of GUS-treated pts had ≥20% improvement in TJC68/SJC66/PGA at W4 (Table 1), and 45-48% had ≥20% improvement in HAQ-DI, PtGA, and Pt Pain by W8. By W24, >80% of GUS-treated pts had ≥20% improvement in SJC66/TJC68/PGA, followed by 63-64% with this degree of improvement in PtGA, CRP, and Pt Pain, and 57% for HAQ-DI.

Conclusion:

GUS demonstrated ACR20 improvements with separation from PBO in ACR components as early as W4, which is consistent with reduced inflammation by GUS and prior serological studies.3 At early study time points, both pts and physicians were able to discern improvements in signs and symptoms of arthritis that rapidly followed reductions in systemic inflammation (CRP). The predominant drivers of ACR20 response rates at W24 in GUS pts were SJC66/TJC68/PGA.

References:

[1]Deodhar A et al. Lancet. 2020;395:1115-25

[2]Mease P et al. Lancet. 2020;395:1126-36

[3]Siebert S et al. EULAR 2020. Presentation OP0229

Table 1.W4W8W12W16W20W24ACR20203950566061HAQ-DI score364552545657SJC66617484868788TJC68486575798081PGA506774788181PtGA354858596264Pt Pain324855586163CRP566062636464Figure 1

Disclosure of Interests:

Peter Nash Consultant of: AbbVie, Bristol Myers Squibb, Boehringer, Celgene, Gilead, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sandoz, Sun, Grant/research support from: AbbVie, Bristol Myers Squibb, Boehringer, Celgene, Gilead, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sandoz, Sun, Iain McInnes Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Janssen, Eli Lilly, Gilead, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, and UCB, Wen-Chan Tsai Consultant of: AbbVie, Eli Lilly, Janssen, Pfizer, and Novartis, Ying Ying Leung Consultant of: Abbvie, Eli Lilly, Janssen, and Novartis, Lai-Shan Tam Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Lilly, Pfizer, and Sanofi, Grant/research support from: Amgen, Boehringer Ingelheim, Janssen, GSK, Novartis, and Pfizer, Daniel Furtner Employee of: Janssen, a division of Johnson & Johnson Pte. Ltd., May Shawi Employee of: Janssen Research and Development, LLC, Stephen Xu Employee of: Janssen Research and Development LLC, Shihong Sheng Employee of: Janssen Research and Development, LLC, Alexa Kollmeier Employee of: Janssen Research and Development, LLC, Atul Deodhar Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, and UCB.

POS0902 EFFICACY AND SAFETY OF INTRAVENOUS GOLIMUMAB IN ANKYLOSING SPONDYLITIS PATIENTS WITH EARLY VS LATE DISEASE THROUGH WEEK 52 OF GO-ALIVE STUDY

Background:

The GO-ALIVE study assessed efficacy and safety of intravenous golimumab (IV GLM) in patients (pts) with ankylosing spondylitis (AS).1,2

Objectives:

In this post hoc analysis, we assessed IV GLM efficacy and safety in AS pts with early disease (ED) vs late disease (LD) based on pt-reported duration of inflammatory back pain (IBP).

Methods:

In this Phase 3, double-blind, placebo (PBO)-controlled trial, pts with active AS were randomized (1:1) to receive IV GLM 2 mg/kg at Week (W) 0, W4, then Q8W or PBO at W0, W4, and W12 with crossover to IV GLM at W16, W20, then Q8W through 52. The primary endpoint was achievement of SpondyloArthritis International Society 20% improvement response (ASAS 20) at W16. In this post hoc analysis, 208 pts were grouped into quartiles based on self-reported duration of IBP symptoms. Efficacy and safety in 60 pts with ED (1st quartile) were compared with 52 pts with LD (4th quartile).

Results:

For the overall study population, mean duration of IBP symptoms was 10.9 yr and mean time since diagnosis was 5.5 yr. For ED pts, the mean duration of IBP symptoms ranged from 2.3 yr (IV GLM) to 2.6 yr (PBO), and for LD pts ranged from 23.5 yr (IV GLM) to 24.4 yr (PBO). At W16, ASAS 20 was achieved by 72% IV GLM vs 32% PBO pts with ED and by 67% IV GLM vs 21% PBO pts with LD. Pts with ED had numerically better response than those with LD in Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and across more stringent endpoints, including ASAS 40, Bath Ankylosing Spondylitis Disease Activity Index 50% improvement (BASDAI 50), and Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease and major improvement (Table 1). Response rates at W16 among IV GLM-treated pts were generally consistent through 1 year in both ED and LD subgroups; also in ED and LD subgroups, pts crossing over to IV GLM at W16 demonstrated response at W52 consistent with pts who started IV GLM at W0. At W16, improvements in enthesitis score were similar for pts with ED (mean change -2.9 for IV GLM vs 0.1 for PBO) and LD (mean change -2.5 for IV GLM vs 0.6 for PBO); improvements were maintained at W52 for ED and LD pts. Treatment-emergent adverse events and serious adverse events through 1 year were 46% and 3% for pts with ED compared with 61% and 2% for pts with LD, respectively.

Conclusion:

While IV GLM provided clinically meaningful improvements in signs and symptoms of AS in pts regardless of disease duration, response generally appeared numerically better in pts with ED than in pts with LD. This supports the principle of prompt diagnosis and early treatment.

References:

[1]Deodhar A, et al. J Rheumatol. 2018;45:341-348.

[2]Reveille J, et al. J Rheumatol. 2019;46:1277-1283.

Table 1.

Efficacy Outcomes

EDLDWeek 16Week 52Week 16Week 52PBO(n=25)IV GLM(n=35)PBO→IV GLM(n=25)IV GLM(n=35)PBO(n=28)IV GLM(n=24)PBO→IV GLM(n=28)IV GLM(n=24)ASAS 2032%71%68%71%21%67%68%63%ASAS 4012%46%56%60%4%42%57%42%BASDAI 5012%40%64%60%7%33%57%42%ASDAS inactive disease (score <1.3)4%17%44%37%0%8%14%4%ASDAS major improvement (decrease ≥2.0)n=244%57%n=2454%51%0%n=2348%46%n=2330%ASDAS clinically important improvement (decrease ≥1.1)n=2429%77%n=2475%77%18%n=2391%61%n=2365%Mean change from baseline (SD) in BASFIn=23-0.4 (2.0)-2.3 (2.1)n=23-2.7 (2.7)-2.8 (2.6)n=27-0.3 (1.8)n=24-2.2 (1.7)n=27-2.4 (2.2)n=23-2.3 (1.7)Mean change from baseline (SD) in BASMIn=23-0.3 (0.7)-0.4 (0.7)n=23-0.6 (0.7)-0.3 (0.5)n=270.01 (0.5)n=21-0.3 (0.6)n=27-0.4 (0.7)n=20-0.3 (0.7)Mean change from baseline (SD) in enthesitis scoren=230.1 (3.6)-2.9 (2.9)n=23-2.0 (4.4)-3.2 (2.5)n=27-0.6 (3.4)n=21-2.5 (3.0)n=27-2.5 (3.1)n=20-3.5 (5.9)

SD=standard deviation

Disclosure of Interests:

Atul Deodhar Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, and UCB, Shelly Kafka Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Kim Hung Lo Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Lilianne Kim Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Stephen Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, John D Reveille Consultant of: Eli Lilly and UCB, Grant/research support from: Eli Lilly and Janssen

AB0524 EFFICACY OF GUSELKUMAB ACROSS BASDAI COMPONENTS IN TREATING AXIAL-RELATED SYMPTOMS OF PSORIATIC ARTHRITIS: RESULTS FROM TWO PHASE 3, RANDOMIZED, PLACEBO-CONTROLLED STUDIES

Background:

The monoclonal antibody guselkumab (GUS; anti- IL-23p19-subunit) is approved to treat psoriatic arthritis (PsA). Post hoc analyses of DISCOVER-1&2 suggested that GUS may be effective in improving symptoms of axial manifestation of PsA.

Objectives:

Evaluate the efficacy of GUS across components of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in improving symptoms of axial manifestations of active PsA patients (pts) using data from Phase 3, randomized, placebo (PBO)-controlled studies.

Methods:

DISCOVER-1&2 enrolled pts with active PsA; pts were randomized to subcutaneous injections of guselkumab 100 mg every 4 weeks (Q4W) or at Wk0, 4, and Q8W, or PBO. These post hoc analyses included pts who were identified by the investigator as having axial symptoms and sacroiliitis (prior X-ray or MRI or screening X-ray). BASDAI scores were assessed at Wks 0, 8, 16, 24, and 52. Mean BASDAI component scores through Wk52 are reported by treatment group. Pooled data from the two studies are reported. Mean BASDAI component scores are reported using observed data; total BASDAI scores with missing components were set to missing. The proportion of pts achieving ≥50% improvement in BASDAI (BASDAI 50) was also determined; pts with missing data or who met the treatment failure criteria (discontinued study agent or used prohibited medications) were considered nonresponders at all subsequent timepoints.

Results:

These analyses included 312 pts from DISCOVER-1&2 (103 GUS Q4W, 91 GUS Q8W, 118 PBO); mean total BASDAI scores at Wk0 were 6.4, 6.5, and 6.6, respectively. Demographics and mean baseline BASDAI component scores (ie, fatigue, spinal pain, joint pain, enthesitis, qualitative morning stiffness, and quantitative morning stiffness) were similar across treatment groups (Table 1). In comparison with the total study population, this subgroup of pts had a higher mean C-reactive protein level at baseline and a higher proportion of pts with enthesitis and included a slightly higher proportion of males. Mean scores for all six BASDAI components, including spinal pain, decreased through Wk24 in GUS-treated pts, with separation from PBO observed as early as Wk8; improvements were maintained at Wk52. At Wk24, BASDAI 50 response rates were higher in the Q4W and Q8W groups vs PBO (38% and 40% vs 19%).1 At WK52, mean BASDAI component scores for PBO pts who crossed over to GUS Q4W at Wk24 were similar to those for pts who were randomized to GUS.2 A similar trend was observed for BASDAI50 response.

Conclusion:

Among PsA pts with axial symptoms and sacroiliitis (via investigator-confirmed imaging) in the DISCOVER-1&2 trials, GUS treatment resulted in lower mean scores for all six BASDAI components compared with PBO as early as Wk 8 and through Wk24, with mean scores maintained at Wk52.

References:

[1]Helliwell P, et al. Ann Rheum Dis. 2020; 79; Suppl 1.

[2]Mease PJ, et al. Arthritis Rheumatol. 2020; 72 (suppl 10).

Table 1.

Baseline demographic and disease characteristics for patients who were identified by physicians as having symptoms consistent with spondylitis and had sacroiliitis confirmed via prior radiograph/MRI or screening radiograph

GUS Q4WGUS Q8WPlaceboPatients, n10391118Male, n (%)68 (66)54 (59)69 (59)Age, years44.9 ± 11.845.0 ± 10.745.3 ± 11.0BASDAIPatients, n9584110Score6.4 ± 1.76.5 ± 1.86.6 ± 1.5BASDAI ComponentsFatigue6.4 ± 2.06.7 ± 1.96.5 ± 1.9Spinal pain6.6 ± 2.16.5 ± 2.36.7 ± 2.0Joint pain6.3 ± 1.96.5 ± 2.26.8 ± 1.7Enthesitis6.3 ± 2.16.4 ± 2.26.3 ± 2.2Qualitative morning stiffness6.8 ± 2.16.7 ± 2.57.0 ± 2.0Quantitative morning stiffness6.2 ± 2.95.7 ± 2.96.1 ± 2.8

Data are mean ± standard deviation unless otherwise noted.

BASDAI, Bath ankylosing spondylitis disease activity index

Disclosure of Interests:

Frank Behrens Speakers bureau: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Genzyme, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Genzyme, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: Celgene, Chugai, Janssen, Pfizer, and Roche, Philip J Mease Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, SUN, and UCB, Philip Helliwell Consultant of: Galapagos, Janssen, Novartis, Grant/research support from: AbbVie, Janssen, Pfizer, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Global Services, Wim Noel Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, Soumya D Chakravarty Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, Xie L Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, Stephen Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, Yanli Wang Employee of: IQVIA providing statistical support (funded by Janssen), Xenofon Baraliakos Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB.

Responses of growth, photosynthesis and related physiological characteristics in leaves of Acer ginnala Maxim. to increasing air temperature and/or elevated O3

Regional warming and atmospheric ozone (O₃ ) pollution are two of the most important environmental issues, and commonly coexist in many areas. Both factors have an intense impact on plants. However, little information is available on the combined and interactive effects of air warming and elevated O₃ concentrations on physiological characteristics of plants. To explore this issue, we studied variations in growth, photosynthesis and physiological characteristics of leaves of Acer ginnala seedlings exposed to control (ambient temperature and O₃ ), increasing air temperature (ambient temperature + 2 °C), elevated O₃ (ambient O₃ concentration + 40 ppb) and a combination of the two abiotic factors at different phenological stages by using open-top chambers. The results showed that increasing air temperature had no significant effect on growth, but increased photosynthesis and antioxidant enzyme activity at the leaf unfolding and defoliation stages. In contrast, elevated O₃ decreased growth and photosynthesis and caused oxidative stress injury in A. ginnala leaves at each phenological stage. The combination of increasing air temperature and elevated O3 improved growth and net photosynthetic rates of tested plants and alleviated the oxidative stress compared to O₃ alone. Our findings demonstrated that moderate warming was beneficial to A. ginnala at leaf unfolding and defoliation stages, and alleviated the adverse effects of O₃ stress on growth, photosynthesis and the antioxidant system. These results will provide a theoretical reference and scientific basis for the adaptation and response of A. ginnala under regional air warming and atmospheric O₃ pollution.