OP0122 COMPARATIVE EFFECTIVENESS OF JAKI VERSUS BDMARDS; A NATIONWIDE STUDY IN RA

Background:

The Janus kinase inhibitors (JAKi) have been increasingly used for the treatment of rheumatoid arthritis (RA) in Sweden, with baricitinib representing ~80% of prescriptions. Evidence regarding the comparative effectiveness of JAKis versus biologics (bDMARDs), and in particular non- tumour-necrosis-factor inhibitor (TNFi) bDMARDs, in real-life is limited.

Objectives:

To compare RA patients treated with bDMARDs and JAKi in Sweden, in terms of: (1) patient characteristics at treatment start; (2) proportions of patients remaining on therapy, and response rates, at 12 months.

Methods:

RA patients starting treatment in 2017 and 2018 with either a TNFi, rituximab, abatacept, interleukin 6 inhibitors (IL6i) or a JAKi as different lines of treatment were identified in the Swedish Rheumatology Quality Register. One patient could contribute with more than one treatment episode.

Treatment response at 12 months was measured as EULAR good response, HAQ improvement >0.2 units, DAS28 and CDAI remission, and as 0 tender and swollen joint counts (28JC). Patients were classified as non-responders if they stopped treatment before evaluation due to safety or inefficacy. Responses for patients who stopped treatment due to pregnancy or death and patients on treatment but with missing response were imputed using multiple imputation.

Proportions of responders and differences in proportions between treatment groups, adjusted using inverse probability of treatment weighting, were estimated using linear regression with robust standard errors.

Results:

JAKi were often used after bDMARDs, and less frequently prescribed in combination with methotrexate. Measured comorbidities were less frequent among JAKi initiators than among non-TNFi biologic initiators, but RA activity was similar (Table).

Table 1.

Patient characteristics at treatment initiation

CharacteristicMedian (IQR) or N (%)AbataceptIL6iRituximabTNFiJAKiTreatment Starts6945346923497905Age63 (53-71)59 (48-70)65 (54-73)59 (47-68)60 (51-70)Female543 (78)441 (83)519 (75)2739 (78)759 (84)RA duration (years)13 (5-21)10 (5-18)12 (6-22)9 (3-17)13 (7-22)Rheum. factor535 (79)385 (73)588 (87)2405 (70)686 (77)DAS284.8 (3.9-5.6)4.9 (4.0-5.7)4.7 (3.8-5.5)4.4 (3.4-5.3)4.7 (3.9-5.7)HAQ1.3 (0.8-1.6)1.3 (0.8-1.8)1.3 (0.8-1.8)1.0 (0.5-1.4)1.3 (0.8-1.8)Tender joints5 (2-9)6 (3-10)5 (2-9)4 (2-8)6 (2-10)Swollen joints4 (2-6)4 (2-7)4 (2-7)3 (1-6)4 (2-7)ts/bDMARD line3 (2-4)3 (2-4)2 (1-4)1 (1-2)4 (2-6)At least one prev. TNFi539 (78)442 (83)457 (66)1448 (41)770 (85)At least one prev. non-TNFi271 (39)220 (41)243 (35)441 (13)584 (65)Methotrexate co-treatment264 (50)172 (40)286 (53)1708 (62)296 (40)Glucocorticoids co-treatment247 (47)186 (43)275 (51)1126 (41)389 (53)Cancer*90 (2.8)64 (2.3)363 (7.7)410 (1.8)20 (2.2)Cardio-vascular dis.*245 (7.5)123 (4.4)322 (6.8)749 (3.4)41 (4.4)Chronic respiratory dis.*303 (9.3)140 (5.0)473 (10.0)721 (3.2)50 (5.4)Diabetes*324 (9.9)216 (7.7)456 (9.7)1479 (6.7)69 (7.5)

* any diagnosis within 5 years before start Adjusted differences in proportion with each response outcome

In a crude comparison, 65% (61%-68%) of JAKi, 62% (59%-66%) of abatacept, 58% (53%-62%) of IL6i, 80% (77%-83%) of rituximab and 68% (67%-70%) of TNFi initiators remained on treatment at 12 months after start. Also, JAKi showed lower overall responder proportions than TNFi, rituximab and IL6i.

After adjustment for demographic and socio-economic factors, RA disease activity, previous use of ts/bDMARDs, co-medication with glucocorticoids and methotrexate and comorbidities at baseline, no significant differences in responder proportions between JAKi and bDMARDs remained (Figure). Furthermore, the adjusted proportions of patients on treatment were higher for JAKi and rituximab than for the other bDMARDs.

Conclusion:

This preliminary analysis of patients treated in clinical practice found no statistically significant difference in effectiveness between JAKi and bDMARDs.

Disclosure of Interests:

Andrei Barbulescu: None declared, Johan Askling Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB. These entities have entered into agreements with Karolinska Institutet with JA as principal investigator, mainly in the context of safety monitoring of biologics via the ARTIS national safety monitoring system, Katerina Chatzidionysiou Speakers bureau: Eli Lilly, Abbvie and Pfizer, Consultant of: Eli Lilly, Abbvie and Pfizer, Helena Forsblad-d’Elia: None declared, Alf Kastbom Employee of: Sanofi, Ulf Lindström: None declared, Carl Turesson Speakers bureau: Abbvie, Bristol-Myers Squibb, Medac, Pfizer, Roche, Consultant of: Roche, Grant/research support from: Bristol-Myers Squibb, Thomas Frisell: None declared

Rare Earth Elements Removal from Water Using Natural Polymers

Adsorption of rare earth metals, Eu (III) and Nd (III) was investigated on a new environmental friendly material, thiourea functionalized cellulose. Before usage, the synthesized material was characterized by Fourrier Transform Infrared spectroscopy and energy dispersive X-ray analysis. The influence of adsorption parameters (adsorbent dosage, time, temperature and initial metal concentration) on adsorption capacity was investigated. Experimental data were fitted by using the pseudo-first-order and pseudo-second-order kinetic models. Simultaneously thermodynamic and equilibrium studies have been carried out using Langmuir, Freundlich and Sips isotherm. Maximum adsorption capacities were reached in 30 minutes at 298 K having the value of 27 mg/g for Eu (III) and 73 mg/g for Nd (III).

Modeling the carbon monoxide dissipation in Timisoara, Romania

Modeling the evolution of pollutants' concentration is important for predicting their impact on the human health and implementing measures for a sustainable development and environmental protection. Since the carbon dioxide (CO) is one of the main pollutants that affect the urban environment, the present study aimed at building a model for the evolution of the mean daily and monthly concentration in Timisoara, Romania. We found a non-linear direct dependence of CO concentration on the temperature and humidity and an inverse proportional relationship with the wind speed. The models have been linearized and validated by statistical tests. The extreme values distributions have also been detected, and comparisons of the data with the admissible values are provided.

Mathematical modeling of sulfur dioxide concentration in the western part of Romania

Nowadays air pollution is a major issue, due to its effect on the human health and environment. Therefore, in this article, we analyze the evolution of sulfur dioxide (SO₂) concentration for eight months (November 2015-June 2016) at three monitoring stations in Timisoara, Romania. The results indicate that the legal limits have been exceeded only a few times and the pollutants' distribution is strongly influenced by the relative atmospheric calm in the County. We also propose a new model for the SO₂ dissipation, which takes into account the individual data series, as well as the specific atmospheric conditions.

Taste of medicinal plants: A potential tool in predicting ethnopharmacological activities?

ETHNOPHARMACOLOGICAL RELEVANCE

Taste (rasa) is traditionally valued in Ayurveda as an important ethnopharmacological category, and reported to correlate with certain therapeutic activities (karman). The present paper endeavors to provide for the first time a type of mapping of ayurvedic ethnopharmacological space by the integration of medicinal plant taste-activity relationship (TA) data, originating from several traditional sources.

MATERIAL AND METHODS

The present TA database included 183 ayurvedic medicinal plants, with their traditional description of taste and ethnophamacological actions (EPA). 111 plants had a unique taste, and 72 plants a combination of several tastes, consisting of one principal taste, and other 2-4 secondary tastes. 121 ethnopharmacological actions were considered. Potential global or individual associations between rasa and karman were statistically analyzed.

RESULTS

We found a statistically significant global correspondence between the predominant plant taste and the ethnopharmacological activities (Chi-square test, p<0.05), and the following individual associations (Fisher exact test, p<0.05, positive association if lnOR >0, negative association if lnOR <0): bitter- 11 positive associations (lnOR 0.940 to 3.544) and 8 negative associations (lnOR -0.997 to -3.101), sweet- 14 positive associations (lnOR 0.839 to 3.132) and 20 negative associations (lnOR -0.962 to -3.270), pungent- 23 positive associations (lnOR 0.835 to 4.126) and 11 negative associations (lnOR -1.255 to -3.147), astringent- 7 positive associations (lnOR 1.099 to 3.813) and 7 negative associations (lnOR -1.076 to -2.631), sour- 7 positive associations (lnOR 1.128 to 4.664) and 1 negative association (lnOR -2.244). Among the 109 statistically significant associations, 24 were not traditionally mentioned, and only 4 were in opposition with the traditional ayurvedic sources.

DISCUSSIONS

The present study confirms the traditional relationship rasa-karman and demonstrates that statistical models can be used to predict EPAs of medicinal plants depending on their taste. Integration of the ayurvedic concept of taste into ethnopharmacological research might reveal new facets of plant therapeutic potentials and provide a framework for developing a probabilistic approach to drug discovery that can be exploited to increase bioprospecting research efficacy.

Musculoskeletal Ultrasound in Early Rheumatoid Arthritis - Correlations with Disease Activity Score

PURPOSE

to assess synovial inflammation using musculoskeletal ultrasonography, in a cohort of patients with early rheumatoid arthritis, and establish the correlations with disease activity score.

MATERIAL AND METHODS

We enrolled 29 patients diagnosed with early RA, according to ACR-EULAR 2010 classification criteria, in Rheumatology Clinic, Emergency County Hospital Craiova, between September 2013-August 2014. We performed clinical evaluation, assessed laboratory tests and performed US for all the patients. Musculoskeletal ultrasonography was performed using an ESAOTE MyLab 25 ultrasound, by the same examiner, with multi-frequency linear array transducers (7-12Mh). The presence of synovitis was assessed both in grey scale (GSUS) and power-Doppler (PDUS), according to OMERACT-EULAR consent.

RESULTS

Assessment of synovial inflammatory activity by ultrasound examination, using both grey scale and PDUS, has shown active synovitis in all patients, with a mean number of joints with active synovitis of 5. Evaluating the grade, using PDUS, we found grade 1 in all patients, 2 in 14 and grade 3 in 3 patients. Inflammatory markers correlated significant with both GSUS and PDUS. Analysis of correlation between GSUS examination parameters and disease activity score, found a positive, moderate inter-relation, results found also for PD score.

CONCLUSION

our results sustain the role of US for detecting inflammatory activity in early RA patients, and, in addition with clinical and biological assessment, represents a sensitive, reliable and reproducible method, easily approached, that should be included in our routine evaluation.