SAT0142 MATCHING ADJUSTED INDIRECT COMPARISON OF FILGOTINIB VS. TOFACITINIB IN MODERATE-TO-SEVERE ACTIVE RHEUMATOID ARTHRITIS PATIENTS WITH INADEQUATE RESPONSE TO METHOTREXATE

Background:

Filgotinib (FILG) is a JAK1 inhibitor that has been investigated in combination with methotrexate (MTX) for the treatment of moderate-to-severe rheumatoid arthritis (RA). To date, no head-to-head trial has compared the efficacy of FILG versus tofacitinib (TOFA).

Objectives:

To compare the efficacy of FILG 200 mg + MTX with TOFA 5 mg + MTX using matching adjusted indirect comparison (MAIC).

Methods:

MAIC technique uses individual patient data (IPD) from one trial and aggregate data from the other to enable comparison of outcomes after matching on baseline characteristics [1]. An anchored MAIC was conducted using IPD from the FINCH-1 trial of FILG 200 mg + MTX vs adalimumab (ADA) 40 mg + MTX and published data from ORAL STRATEGY [2] trial of TOFA 5 mg + MTX vs ADA 40 mg + MTX. Patients in the FINCH-1 trial were reweighted based on age, sex, race, tender joint count 28, swollen joint count 28, C-reactive protein and patient’s global assessment to match baseline characteristics of the comparator. After matching, Wald tests were used to test for significant differences in ACR 20/50/70 and clinical remission outcomes (SDAI≤3.3, CDAI≤2.8, DAS28(CRP)<2.6, Boolean) between FILG + MTX vs TOFA 5 mg + MTX relative to ADA 40 mg + MTX.

Results:

After matching, baseline characteristics were balanced across the trial populations [Table 1]. FILG 200 mg + MTX patients experienced significantly greater improvement in 12 week ACR50 and ACR70 outcomes compared to TOFA 5 mg + MTX with a mean difference in difference (DD) of 13.5% (p < .05) and 8.3% (p < .05) respectively, as well as numerical improvements on other ACR outcomes at 12, 24 and 52 weeks [Figure 1]. At 24 weeks, FILG 200 mg + MTX patients experienced significantly greater improvement in DAS28(CRP) clinical remission compared to TOFA 5 mg + MTX with DD of 10.1% (p < .05) [Figure 2] as well as numerical improvements on other efficacy outcomes. At 52 weeks, FILG 200 mg + MTX patients experienced significantly greater improvement in DAS28(CRP) clinical remission compared to TOFA 5 mg + MTX with DD of 13.2% (p < .05) [Figure 2] as well as numerical improvements on other efficacy outcomes.

Table 1.

Baseline Characteristics of FINCH-1 vs ORAL STRATEGY

CHARACTERISTICBEFORE MATCHINGAFTER MATCHINGORAL STRATEGYFILG 200 + MTX (N=475)ADA + MTX (N=325)FILG 200 + MTX (ESS=340)ADA + MTX (ESS=233)TOFA 5mg + MTX BID (N=376)ADA + MTX BID (N=386)Sex – Female, %79.8%81.8%83.0%83.0%83.0%83.0%Age (year), mean (SD)51.8 (12.8)53.3 (12.9)50.0 (13.4)50.7 (13.4)50.0 (13.4)50.7 (13.4)Race – White, %65.7%70.5%76.0%76.0%76.0%76.0%Tender Joint Count 28, mean (SD)15.0 (6.4)14.6 (6.3)15.6 (6.5)15.2 (6.7)15.6 (6.5)15.2 (6.7)Swollen Joint Count 28, mean (SD)11.2 (5.2)11.2 (5.0)11.8 (5.7)11.0 (5.4)11.8 (5.7)11.0 (5.4)C-Reactive Protein (mg/L), mean (SD)16.1 (21.0)14.6 (18.0)18.7 (21.9)16.7 (21.3)18.7 (21.9)16.7 (21.3)Patient global assessment baseline, mean (SD)67.1 (19.2)67.0 (19.1)61.7 (22.0)60.2 (23.5)61.7 (22.0)60.2 (23.5)

ESS = effective sample size; SD = standard deviation

Figure 1.

ACR20/50/70 relative to ADA 40 mg+ MTX of FILG 200 mg + MTX vs TOFA 5 mg + MTX * p < .05

Figure 2.

Clinical Remission outcomes relative to ADA 40 mg+ MTX of FILG 200 mg + MTX vs TOFA 5 mg + MTX * p < .05

Conclusion:

In this MAIC, compared to TOFA 5 mg + MTX, FILG 200 mg + MTX appears to produce improved efficacy outcomes (ACR20/50/70, DAS28(CRP), SDAI, CDAI and Boolean Remission) at weeks 12, 24 and 52.

References:

[1]Signorovitch JE, et al. “Matching-adjusted indirect comparisons: a new tool for timely comparative effectiveness research.” Value in Health 15.6 (2012): 940-947

[2]Fleischmann R, et al. “Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy).” The Lancet 390.10093 (2017): 457-468

Acknowledgments:

The study was funded by Gilead Sciences Inc

Disclosure of Interests:

Mahdi Gharaibeh Shareholder of: Gilead Sciences Inc, Employee of: Gilead Sciences, Amgen, Nate Smith Consultant of: Gilead Sciences Inc, Sushanth Jeyakumar Consultant of: Gilead Sciences, Ejim Mark Shareholder of: Gilead Sciences Inc, Employee of: Gilead Sciences, Novartis, Sanatan Shreay Shareholder of: Gilead Sciences, Employee of: Gilead Sciences

193 IMPROVED POST-THAW SURVIVAL OF BOVINE EMBRYOS PRODUCED IN SERUM-FREE IN VITRO PRODUCTION SYSTEM

Over a few decades the bovine in vitro embryo production (IVP) systems have been improving rapidly. Still, the goal to produce the same quality embryos in vitro as in vivo has not yet been reached. The FCS is usually added to media during IVP to provide growth factors and energy sources. Currently, serum-free culture systems are often preferred due to the lower risk of contamination and prevention of the development of large offspring syndrome. The aim of this study was to establish whether complete elimination of FCS from the bovine IVP system has an effect on blastocyst rates, embryo quality, and embryo survival rates after slow freezing. We replaced our conventional in vitro maturation (IVM) medium [tissue culture medium-199, 10% (v/v) FCS, 10 µg mL–1 epidermal growth factor (EGF), 1500 U mL–1 serum gonadotropin and chorionic gonadotropin (PG600), Na-pyruvate 0.5 mM, gentamycin sulfate 50 µg mL–1 and l-glutamine 1 mM] with SOF (SOFaaci) supplemented with 0.4% fatty acid-free BSA fraction V, 10 µg mL–1 EGF, and 1500 U mL–1 PG600. Matured cumulus-oocyte complexes (COC) from both experimental groups (total of 1145 from serum-free IVP and 687 from our conventional IVP system) were used for in vitro fertilisation and culture. Blastocyst rates were similar in the serum-free and our usual IVP protocol, 18 and 22%, respectively. Seventy-seven Grade 1 (according to IETS) Day 7 blastocysts from the serum-free IVP system and 80 Grade 1 Day 7 blastocysts from our conventional IVP system were frozen in 1.5 M ethylene glycol and 0.1 M sucrose containing cryopreservation medium. The post-thaw survival rates after 24 h of culture and evaluated as percentages of re-expanded embryos were 63.6% for the serum-free IVP and 46.3% for the conventional IVP system (P < 0.05, Z Test for 2 population proportions). These results indicate that it is possible to have a completely serum-free bovine IVP system and based on the slow freezing and thawing results the quality of serum-free IVP embryos might be better than of the embryos matured in our conventional maturation media. However, more experiments and increased sample sizes are needed to confirm the results. This study was supported by Project 3.2.0701.12–0036 of Archimedes Foundation, AP 2.4 of CCRMB, and institutional research funding (IUT 08–01) of the Estonian Ministry of Education and Research.

85 LOW-MOLECULAR-WEIGHT METABOLITES IN BOVINE IN VITRO PRODUCTION CULTURE MEDIA AS EMBRYO QUALITY MARKERS

The need for noninvasive embryo quality assessment techniques has increased as the in vitro production of cattle embryos has become more popular and necessary in the beef and milk production industries. In this study, we assessed the metabolomic profile of embryo culture media to determine whether it is possible to evaluate differences in low-molecular-weight metabolites in the culture media composition of morula stage embryos compared with embryos that develop to the blastocyst stage. Single bovine embryos were cultured in 60-µL SOF+0.4% BSA droplets under mineral oil. Twenty microliters of culture media was removed at Day 2, 5, and 8 post-fertilization. Cultured droplets without a zygote served as the control samples. A total of 42 samples were analysed using liquid chromatography-mass spectrometry (Q-Trap 3200, Ab Sciex, Framingham, MA, USA), followed by principal component analysis. Our preliminary results indicated significant differences (P < 0.00001) in 10 low-molecular-weight compounds between the groups. Three of those compounds (588, 589, and 702 Da) were represented in higher concentrations only in embryos that advanced into the blastocyst stage. These first results could allow the identification of embryos with improved viability and give better understanding of the development of pre-implantation embryo.This study was supported by CCRMB, Project ANIREP (3.2.0701.12–0036) and institutional grant IUT8–1.

A defined medium supports changes consistent with capacitation in stallion sperm, as evidenced by increases in protein tyrosine phosphorylation and high rates of acrosomal exocytosis

Efficient in vitro capacitation of stallion sperm has not yet been achieved, as suggested by low sperm penetration rates reported in in vitro fertilization (IVF) studies. Our objectives were to evaluate defined incubation conditions that would support changes consistent with capacitation in stallion sperm. Protein tyrosine phosphorylation events and the ability of sperm to undergo acrosomal exocytosis under various incubation conditions were used as end points for capacitation. Sperm incubated 4-6h in modified Whitten's (MW) with the addition of 25 mM NaHCO3 and 7 mg/mL BSA (capacitating medium) yielded high rates of protein tyrosine phosphorylation. Either HCO3(-) or BSA was required to support these changes, with the combination of both providing the most intense results. When a membrane-permeable form of cAMP and a phosphodiesterase inhibitor (IBMX) were added to MW in the absence of HCO3(-) and BSA, the tyrosine phosphorylation results obtained in our capacitating conditions could not be replicated, suggesting either effects apart from cAMP were responsible for tyrosine phosphorylation, or that stallion sperm might respond differently to these reagents as compared to sperm from other mammals. Sperm incubation in capacitating conditions was also associated with high percentages (P<or=0.001) of acrosomal exocytosis upon exposure to progesterone (44.6%) or calcium ionophore (51.6%), as compared to sperm incubated in medium devoid of BSA and NaHCO3. Our results were novel in that we report protein tyrosine phosphorylation in stallion sperm incubated in defined conditions, coupled with significant percentages of acrosome reacted sperm. The continuation of these studies might help to elucidate the conditions and pathways supporting sperm capacitation in the horse.

Is the self of the infant preserved in the adult?

What does a confrontation between philosophy and psychoanalysis look like? My task is a philosophical investigation of a psychoanalytic concept. Thus, I offer a conceptual analysis of a concept that is used both clinically and as a part of a metapsychology. The concept that I investigate in this article is regression. I work with the following two problems: What does a conceptual analysis of the phenomenon called "regression" look like? Regression can be regarded as an instrument that can give us knowledge about ourselves. What does this mean? I compare two ways of analyzing regression, an atomistic as well as an holistic approach. This comparison is made by way of a discussion of the conceptual analysis of the infant. Can we construct the inner life of the infant? How should we conceptualize the primitive? Using concepts like 'conceptual holism' and 'holism of attributes', I draw parallell conclusions about the construction of the infant's inner life and the analysis of the concept of regression.

[Epignathus: prenatal diagnosis by sonography and magnetic resonance imaging]

Prenatal diagnosis of a teratoma of the oral cavity (epignathus) is presented using ultrasonography and magnetic resonance imaging as complementary techniques. Chromosome analysis from amniotic fluid revealed an inverted duplication of chromosome 1 that was confined to the tumour, whereas the constitutional karyotype was normal. The development of polyhydramnios, presumably reflecting impaired fetal swallowing, led to premature rupture of membranes and spontaneous delivery at 23 + 4 weeks of pregnancy. The premature neonate succumbed to acute respiratory distress secondary to airway obstruction by the tumour, and died immediately after birth.

Correlation of DNA adducts in blood mononuclear cells with tobacco carcinogen-induced damage in human lung

The formation of carcinogen-DNA adducts within the respiratory epithelium is thought to be a critical factor in the induction of lung cancer from tobacco smoke. A reliable surrogate measure of carcinogen damage to the lung would be of great value in molecular epidemiological studies of cancer risk. The validity of measurements of DNA adducts formed from hydrophobic aromatic hydrocarbons in peripheral blood mononuclear cells (MNCs) was investigated by comparing the levels of aromatic DNA adducts detected in lung tissue from 31 lung cancer patients with those detected in MNCs from the same individuals using the 32P-postlabeling assay. The associations of smoking history and intake of dietary antioxidants with adduct levels also were assessed. Tissue-specific, as well as common DNA adducts were detected in lung and blood; total MNC adduct levels were highly correlated with total lung adducts. After smoking cessation, adduct levels appeared to decay in both tissues at similar rates. Multivariate analyses (Poisson regression modeling) indicated that dietary antioxidant intake (carotenoids, vitamin A, and retinol) modified the levels of aromatic DNA adducts in both the lungs and blood. Of all models tested, the optimal one for predicting lung adduct levels included the measure of blood MNC adduct levels only. Therefore, blood MNCs are a valid surrogate tissue for estimating the burden of DNA adducts in respiratory tissue in molecular epidemiological studies.

Mutations in the p53 gene in lung cancer are associated with cigarette smoking and asbestos exposure

It has been proposed that the patterns of mutations in the p53 tumor suppressor gene will provide clues to the mechanisms of cancer occurrence. Cigarette smoking is known to be the greatest risk factor for lung cancer. Epidemiological evidence has also implicated radon and asbestos as exposures that significantly increase this disease risk; asbestos exposure synergistically enhances the lung cancer risk of smokers. Previous studies of the mutational spectra of the p53 gene in lung cancer have shown cigarette smoke and radon exposure to be associated with the induction of particular lesions or classes of lesions. We have investigated the p53 gene in surgically resectable lung cancers in 85 patients from the Massachusetts General Hospital. We found 25 (29%) patients to have somatic p53 mutations in their tumors. The patients with p53 mutations who were current smokers were significantly older (75.1 versus 59.8 years; P < 0.01 and had smoked for significantly more years (56.8 versus 41.2 years; P < 0.01) than had those without p53 changes. Consistent with other reports, we observed a large number (40%) of G:C to T:A transversion mutations, noting that their occurrence increased with increasing cumulative exposure to cigarette smoke. Interestingly, we also found that p53 mutations occurred significantly more frequently in patients with a history of occupational exposure to asbestos [3 of 60 (5%) for patients without p53 mutations versus 5 of 25 (20%) of those with p53 mutations; P < 0.05].(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanism of the localization of manganese (III) mesotetra(4-sulfonatophenyl)porphine in mice bearing L1210 tumors

In accordance with earlier work the manganese (III) derivative of meso-tetra(4-sulfonatophenyl)porphine (TPPS4) is found to accumulate in the tumors of L1210-bearing mice. The tumor/liver ratio of porphyrin extends from 1.5 to 3.6 over a range of dose and time periods. The subcellular distribution of porphyrin in L1210 tumor and liver, and the tissue distribution (cellular, stroma, soluble) in L1210 tumor indicates that the porphyrin tends to be located predominantly in soluble and stromal fractions. These data are interpreted in terms of the physiology and composition of neoplastic tissue to formalize a mechanism for the localization of Mn(III)TPPS4 in L1210 tumor and a general working hypothesis for the localization of porphyrins in neoplastic tissue. The in vivo stability of Mn(III)TPPS4 is also addressed and is found to be demetallated to a degree of approximately 1% in liver and kidney.

Spinal somatosensory evoked potentials in juvenile diabetes

Spinal somatosensory evoked potentials to stimulation of the peroneal nerves in the popliteal fossa were recorded from 46 insulin-dependent neurologically normal patients with juvenile diabetes. Conduction velocities of these potentials were determined over proximal peroneal nerve, cauda equina, and spinal cord and were compared with those obtained from 46 age-matched control subjects. Mean values for overall spinal conduction velocity (L3-C7 spines) and conduction velocity over rostral spinal cord (T6-C7 spines) and peroneal nerve-cauda equina (stimulus to L3 spine) were lower in the diabetic group (p less than 0.001). Peripheral nerve conduction velocity alone was slow in 5 patients, and spinal conduction velocity was slow in 8; in 2 patients both peripheral and spinal velocities were slow. This study suggests that in addition to impairment of peripheral nerve function, patients with juvenile diabetes without clinical evidence of neurological involvement can have a defect in spinal afferent transmission.

Intercalative and nonintercalative binding of large cationic porphyrin ligands to polynucleotides

The interactions of two positional isomers and one analogue of meso-tetra (4-N-methylpyridyl) porphine, with the synthetic polynucleotides poly[d(A-T)] . poly[d(A-T)] and poly[d(G-C)] . poly[d(G-C)] have been investigated by circular dichroism. All four porphyrins were found to bind to the polynucleotides as shown by the induction of circular dichroism in their Soret bands. Furthermore, the sign of the induced ellipticity reflects selective occupation of binding sites by the porphyrin ligands. The conformational lability of poly[d(A-T)] X poly[d(A-T)] was found to be appreciable as micromolar amounts of meso-substituted 4-N-methylpyridyl, 3-N-methylpyridyl, and p-N-trimethylanilinium porphines induced a CD spectrum similar but not identical to that of DNA in the Z-form, i.e. a negative band at 280 nm and a positive band at 259 nm. The effect of porphyrin binding to poly[d(G-C)] X poly[d(G-C)] was less pronounced and dissimilar to that seen in the AT polymer.

Deficiency of androgen receptors in male pseudohermaphroditism

A diagnosis of androgen receptor deficiency was made in a male with ambiguous genitalia during the neonatal period. Since the neonate had a small hypospadiac phallus with laboratory evidence of a receptor deficiency and clinical unresponsiveness to high levels of androgen, it was decided to assign a female gender. Bilateral orchiectomy and phallic recession were performed.

Growth retardation in fetal alcohol syndrome. Unresponsiveness to growth-promoting hormones

The relationships between growth retardation and metabolic and hormonal parameters were studied in 7 children with fetal alcohol syndrome (FAS). Fasting blood concentrations of TSH, T4, T3, FSH and LH were normal. Plasma prolactin concentrations after chlorpromazine stimulation were normal. 3 children had abnormal oral glucose tolerance tests with increased plasma insulin response. Peak plasma growth hormone responses to insulin-induced hypoglycemia were elevated in 5 patients. Fasting bioassayable serum somatomedin activity, determined in 6 patients, was elevated in 3 patients and normal in 3 patients. Administration of hGH to 3 patients with FAS had little effect upon nitrogen retention and did not increase plasma insulin concentrations, although serum somatomedin activity sharply increased in 1 patient evaluated for somatomedin response. The data indicate that the growth defect in FAS is not due to deficiency of growth-promoting hormones, but rather to peripheral unresponsiveness.