To be remembered: B cell memory response against SARS-CoV-2 and its variants in vaccinated and unvaccinated individuals

COVID-19 disease has plagued the world economy and affected the overall well-being and life of most of the people. Natural infection as well as vaccination leads to the development of an immune response against the pathogen. This involves the production of antibodies, which can neutralize the virus during future challenges. In addition, the development of cellular immune memory with memory B and T cells provides long-lasting protection. The longevity of the immune response has been a subject of intensive research in this field. The extent of immunity conferred by different forms of vaccination or natural infections remained debatable for long. Hence, understanding the effectiveness of these responses among different groups of people can assist government organizations in making informed policy decisions. In this article, based on the publicly available data, we have reviewed the memory response generated by some of the vaccines against SARS-CoV-2 and its variants, particularly B cell memory in different groups of individuals.

AB1050 CHARACTERISTICS OF PATIENTS WITH COINCIDENT GOUT AND ADVANCED CHRONIC KIDNEY DISEASE

Background

Patients with chronic kidney disease (CKD) are at increased risk for developing gout1 and vice versa.2 Those with both gout and CKD present distinct challenges for patients and physicians because of the high prevalence of other comorbidities and restrictions on gout medication use, including non-steroidal anti-inflammatories3,4 and some oral urate-lowering therapies (ULTs).5 This unique patient population has not been well characterized using real-world data.

Objectives

This retrospective chart review study of patients with coincident gout and CKD was conducted to better understand patient characteristics and treatment patterns of this population. This study is unique in that patient data were obtained from nephrologists, allowing a glimpse of how they view gout and its management.

Methods

111 nephrologists provided de-identified medical record data of their most-recently seen advanced (stage 3─5) CKD patients. Patients met study criteria for gout if any of the following were true: gout listed as a comorbidity, ULT use, or visible tophi or gout flares documented. A patient’s gout was determined to be uncontrolled if they had serum uric acid >6 mg/dL in addition to ≥1 visible tophus, ≥2 gout flares in the past year, or gouty arthritis (≥1 tender or swollen joint). Characteristics of this unique population were examined, along with gout management patterns. Differences between patients with controlled and uncontrolled gout were also investigated using data from patients’ most recent evaluation.

Results

173 patients with stages 3-5 CKD and who met study criteria for gout were included. Mean age was 58.3±18.1 years and BMI averaged 32.0 ± 11.8 kg/m2. A higher than expected proportion of patients were female (47%). The most common comorbidities were hypertension (85%), diabetes mellitus (47%), anemia of CKD (42%), CKD-mineral bone disorder (41%), ischemic heart disease (23%), and congestive heart failure (21%). Mean CKD duration was 4.1 ± 5.5 years, mean estimated glomerular filtration rate (eGFR) at most recent visit was 32.3 ± 13.9 ml/min/1.73 m2, and 62% were using a ULT. 23 patients (13%) had uncontrolled gout (48% female, 63.1 ± 16.4 years, mean eGFR 32.0 ± 14.6 ml/min/1.73 m2), all of whom had been prescribed a ULT. Compared with controlled gout patients, uncontrolled patients had higher rates of pulmonary hypertension (14% vs. 4%), gout-related chronic pain in the 12-months prior to data collection (63% vs. 42%), and joint involvement (joint swelling, tenderness, flexibility loss, and/or damage/lesions on x-ray; 26% vs. 9%). Colchicine was also used more frequently in uncontrolled gout patients (26% vs. 7%).

Conclusion

The coincident gout with advanced CKD population described here shows unique differences from the general gout population, including a high proportion of females (47%). Given that women have a lower likelihood of developing gout at the same serum uric acid level,6 this finding was particularly surprising (general gout population: 67% male7). Importantly, nearly 40% of included patients were not utilizing a ULT, leaving them susceptible to developing the painful and debilitating sequalae of uncontrolled gout. Additionally, 41% of the study population had a CKD-related mineral bone disorder, indicating that patients with coincident gout and CKD may have bones that are more vulnerable to gout-related bone damage. Our study confirms a high prevalence of gout and its associated comorbidities in patients with advanced CKD and suggests another nephrology education opportunity to highlight the potential benefits of gout monitoring, earlier intervention, and management.

References

[1]Safiri S, et al. Arthritis Rheumatol 2020;72:1916-27.

[2]Feig DI. Curr Opin Nephrol Hypertens 2009; 18: 526–530.

[3]Stamp LK, et al. Nat Rev Rheumatol. 2021; 17(10): 633–641.

[4]Wallace SL, et al. J Rheumatol 1991; 18(2): 264-9.

[5]Abdelatif AA and Elkhalili N. Am J Ther 2014; 21: 523-34.

[6]Bhole V, et al. Arthritis Rheum 2010;62:1069-76.

[7]Francis-Sedlak M, et al. Rheumatol Ther 2021;8:183-97.

Disclosure of Interests

Leonard Stern Speakers bureau: Horizon Therapeutics, Consultant of: Horizon Therapeutics, Richard Johnson Shareholder of: Colorado Research Partners LLC and XORTX Therapeutics, Speakers bureau: Horizon Therapeutics, Consultant of: Horizon Therapeutics, Payam Shakouri Speakers bureau: Horizon Therapeutics and Relypsa, Consultant of: Horizon Therapeutics, Amod Athavale Grant/research support from: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brad Marder Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Sreedhar Mandayam Shareholder of: Medingenii Capital LLC and Prosalus Capital LLC, Speakers bureau: Otsuka and Alexion, Consultant of: US Renal Care and Aurinia, Grant/research support from: Travere, Norvartis, Omeros, Roche, Vertex, Equillium, Goldfinch Bio, and Pfizer

Prevalence of asthma and associated factors among schoolchildren in rural South India

OBJECTIVES

1) To estimate the prevalence of asthma among secondary school children in a rural area in Karnataka, South India, and 2) to identify risk factors associated with asthma among asthma patients.

MATERIALS AND METHODS

A cross-sectional study was undertaken among 588 secondary school children in a rural area in South India. A locally adapted version of the questionnaire used in an asthma prevalence study in Iowa, USA, was administered.

RESULTS

The prevalence of asthma in the study group was 4.9%. In a multivariate model, significant association was found with sex (male predominance) and exposure to dust in the house. Place of residence, farm dwelling, household pets (cats or dogs), smokers in the family, type of cooking fuel used and the use of firewood without chimneys did not show any significant association.

CONCLUSION

In the present study, the prevalence of questionnaire-diagnosed asthma in the study group was 4.9%. Of the total number of schoolchildren with asthma, 17 (58.6%) were detected who had not been diagnosed previously. One third of the children with asthma had visited emergency departments in the last 12 months, indicative of poor asthma control. Another third suffered limitation of activity at home and or at school, which could indicate poor quality of life.

A clinical trial of the efficacy and safety of montelukast as monotherapy in patients with chronic stable bronchial asthma

This study is aimed to evaluate the efficacy and safety of montelukast, as monotherapy, in the treatment of chronic stable bronchial asthma in adults. This was a multicentre, open label, non-comparative, prospective, 4-week study. Eligible patients discontinued all anti-inflammatory medication (steroids, chromoglycate sodium) 2 weeks prior to starting therapy with montelukast (10 mg daily). The primary efficacy criteria were improvements in forced expiratory volume in one second (FEV1), peak exploratory flow rate (PEFR) after 4 weeks of therapy. Secondary efficacy criteria were improvement in the patients' symptoms (assessed on an ordinal scale), decrease in discomfort levels (scored on a scale of 0-100), change in peripheral eosinophil counts, decrease in total daily dose of inhaled beta2 agonist (salbutamol). A total of 148 patients, mean age (+/- SD) 40.21 +/- 13.70 years, were enrolled into the study. At the end of the study there were significant improvements in FEV1 and PEFR (29% and 28% increase respectively from baseline values, p<0.000001). The mean total daily dose of inhaled salbutamol decreased significantly from prestudy values of 461 +/- 332 microg/day to 161 +/- 207 microg/day (p<0.000001). The mean eosinophil counts fell from 5.80 +/- 4.90% (+/- SD) to 4.84 +/- 4.42% (+/- SD) (p=0.02). Symptom scores improved significantly as did subjective assessment of discomfort. A total of 29 (19.6%) adverse events were reported, all of which were of mild to moderate intensity. Monotherapy with montelukast significantly improved parameters of asthma control. It was well tolerated with no reports of serious or severe adverse events.