Cystic fibrosis newborn screening in Switzerland - evaluation and scenarios for improvement after 11 years of follow-up

BACKGROUND

Newborn bloodspot screening (NBS) for cystic fibrosis (CF) is important for early diagnosis and treatment. However, screening can lead to false-positive results leading to unnecessary follow-up tests and distress. This study evaluated the 11-year performance of the Swiss CF-NBS programme, estimated optimal cut-offs for immunoreactive trypsinogen (IRT), and examined how simulated algorithms would change performance.

METHODS

The Swiss CF-NBS is based on an IRT-DNA algorithm with a second IRT (IRT-2) as safety net. We analysed data from 2011 to 2021, covering 959,006 IRT-1 analyses and 282 children with CF. We studied performance based on European Cystic Fibrosis Society (ECFS) standards including sensitivity, specificity, positive predictive value (PPV), false negative rate, and second heel-prick tests; identified optimal IRT cut-offs using receiver operating characteristics (ROC) curves; and calculated performance for simulated algorithms with different cut-offs for IRT-1, IRT-2, and safety net.

RESULTS

The Swiss CF-NBS showed excellent sensitivity (96 %, 10 false negative cases) but moderate PPV (25 %). Optimal IRT-1 and IRT-2 cut-offs were identified at 2.7 (>99th percentile) and 5.9 (>99.8th percentile) z-scores, respectively. Analysis of simulated algorithms showed that removing the safety net from the current algorithm could increase PPV to 30 % and eliminate >200 second heel-prick tests per year, while keeping sensitivity at 95 %.

CONCLUSION

The Swiss CF-NBS program performed well over 11 years but did not achieve the ECFS standards for PPV (≥30 %). Modifying or removing the safety net could improve PPV and reduce unnecessary follow-up tests while maintaining the ECFS standards for sensitivity.

Impact of Lymphopenia on Treatment Outcomes in Unresectable Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

The purpose of this study was to investigate associations between lymphopenia and radiotherapy (RT) parameters. Moreover, to investigate the prognostic role of lymphopenia, and treatment and patient-related factors. Definitive chemoradiation (CRT) with consolidative durvalumab offers the best chance for cure in patients with unresectable, locally advanced non-small cell lung cancer. However, treatment-related lymphopenia (TRL) may negatively impact outcomes.

MATERIALS/METHODS

Fifty-four patients treated with CRT and durvalumab from 2017 to 2021 at a single academic center were prospectively included. Absolute lymphocyte counts (ALC), absolute neutrophil counts (ANC), and neutrophil-to lymphocyte ratio (NLR) were analyzed before (TLR1), and after CRT (TRL2), before durvalumab initiation (TRL3), and 3 months after CRT (TRL4). Patients were prospectively enrolled in the study. Categorical variables were analyzed using Pearson's chi-squared or Fisher's Exact tests. Nonparametric continuous variables were analyzed using Wilcoxon Rank-Sum test. Association of continuous clinical and dosimetric variables with hematologic toxicity was performed with Spearman's correlation. Kaplan-Meier analysis and the log-rank test were used to assess the probability of PFS and OS Cox proportional hazard models were used to estimate the effect of covariates on disease control rate. Variables that were strongly associated in univariate Cox regression analyses were entered into a multivariable Cox model. All statistical tests were two-sided, and statistical significance was set at p < 0.05. All analyses were performed using STATA version 15.1.

RESULTS

The median follow-up was 28.4 months (m). N2-3 disease showed worse TRL2 compared to N0-1 (p = 0.013). Table 1 shows RT parameters related to TLR2. Median time to durvalumab initiation after CRT was 47 days. Patients who started durvalumab later than 42 days had a greater decrease in lymphocytes at the end of CRT compared to those who started earlier. (70.1 vs 58.8%, p = 0.025). Median overall survival (OS) and progression-free survival (PFS) were 39.4 and 22.4m, respectively. Disease control rate (DCR) with durvalumab consolidation was 70.8%. Patients with NLR >4 prior to durvalumab initiation achieved a lower DCR compared to those with a NLR ≤4 (85.7 vs 14.3%, p = 0.005).

CONCLUSION

CRT-related immunosuppression is associated with delayed durvalumab initiation and worse DCR. Larger PTV and higher lung and heart doses are associated with TRL. Median real-world OS and PFS are similar to those in the PACIFIC trial.

A Phase II Trial of Intraoperative Radiotherapy after Surgical Resection of Brain Metastases: Feasibility and Efficacy NCT04847284

PURPOSE/OBJECTIVE(S)

Intraoperative radiation therapy (IORT) is an alternative to local radiation therapy for brain metastases, reducing total treatment time, and improving patient comfort, but the most effective dose is unknown. The objective of this study is to evaluate the efficacy and safety of IORT in patients with surgical excision of brain metastases at a dose of 20 Gy.

MATERIALS/METHODS

This trial is a single-institution, open-label, prospective, non-randomized study for intraoperative radiotherapy immediately after resection of brain metastases. Registered in January 2021, currently ongoing, planned to enroll 25 patients with IK ≥70, brain damage newly diagnosed by MRI, without dural contact and at least 1 cm to the optic nerve, chiasm and brainstem. In the baseline visit, the General Cognitive State will be carried out: Minimum Mental State Exams. Specific cognitive study: 1- Processing speed (SYmbol digit modalities test), 2- Executive function (TMT, back and forward digit span test, phonological and semantic verbal fluency test, Stroop color-word test), 3- Verbal memory (FCSRT). Quality of life will be monitored by completing the EORTC QL-C30 and BN20 questionnaires. Intraoperative radiation therapy will be performed with a 50 kV low energy X-ray portable linear accelerator using spherical applicators ranging from 1.5 to 4 cm kV to deliver 20 Gy to the surface. During IORT a maximum dose (DMax) of 8 Gy will be allowed to the optic nerve/chiasm and brainstem structures. MRI will be performed 72 hours after IORT. Neurocognitive Test and MRI after 6 weeks and every 3 months. The primary endpoint will be local progression free survival (PFS). Secondary endpoints will be overall survival, time to save cancer therapy, cognitive performance and quality of life, as well as IORT-related neurotoxicity complications will be evaluated according to the scale of the CTACAE version 4. The analysis of the median local progression free survival, overall survival will be analyzed using the Kaplan-Meier curve (long range test). All results will be considered statistically significant with a p value < 0.05. The statistical analysis will be carried out with statistical software.

RESULTS

The trial is open and ongoing to recruitment; we have included 7 patients. The 85.7% were male, mean age was 61.4 years range (43-74). The 57.1% were lung cancer metastases. For now, no tumor recurrence or neurocognitive complications have been observed and then once you have the results ready, we will publish them.

CONCLUSION

The limited current literature on the use of IORT in brain metastases appears to show efficacy and safety, but the most effective dose is unknown as well as whether it is as effective as other radiotherapy alternatives. Our study is ongoing and needs to be completed and evaluated with more follow-up in order to reach definitive conclusions.

Diagnostic Utility of PSMA 18F-DCFPyL PET/TC in Occult Biochemical Recurrence of Prostate Carcinoma with PSA Values <2ng/ml More than Two Years of Experience

PURPOSE/OBJECTIVE(S)

To analyze the diagnostic capability of PET-PSMA in clinical practice in patients with occult biochemical recurrence of prostate carcinoma with PSA values less than 2ng/ml.

MATERIALS/METHODS

The first 116 patients who underwent PSMA 18F-DCFPyL PET/TC at the centers participating in the study for occult biochemical recurrence of prostatic neoplasia were selected. All patients had low PSA values (<2ng/ml). The studies were visually assessed by two experts in Nuclear Medicine, and classified dichotomously as positive or negative/inconclusive. The diagnostic capacity of the test was determined according to the PSA values, as well as the densities by groups. Descriptive statistical analysis was performed. The AUC was evaluated, determining the optimal cut-off point and its precision parameters.

RESULTS

The retrospective analysis showed that 66/116 patients (56.9%) were positive, with statistically significant differences in the medians of the positive group (AUC 0.77) and 50/116 (43.1%) patients were negative (AUC 0.42). The study of densities by group showed a marked clustering of the negative/ inconclusive studies in PSA values less than 0.5 ng/ml. Correlation was observed between the PSA values and the detection capability of the test (AUC: 0,74). The optimal cut-off point calculated was 0,55 which showed a sensitivity of 0,75 and specificity of 0,68.

CONCLUSION

PET-PSMA shows excellent diagnostic capability even in strictly selected patients with PSA values < 2ng/ml. Its indication with values < 0.5ng/mL should be assessed according to individual risk. In 56.9% of the patients in the study the positive result could influence changes in therapeutic strategy.

Change in Therapeutic Approach after PET/TC PSMA-18F DCFPyL in Occult Biochemical Recurrence of Prostate Carcinoma with Low PSA Values

PURPOSE/OBJECTIVE(S)

To analyze changes in therapeutic attitude after PET-PSMA. in patients with occult biochemical recurrence after primary treatment with low PSA values.

MATERIALS/METHODS

Retrospective study of patients diagnosed with prostate carcinoma who after primary treatment with curative intent present biochemical recurrence with low PSA values (<2ng/ml) and negative imaging tests (ultrasound, CT-Scan, MRI, GGO and/or PET-Choline). The assessment was performed by two expert nuclear physicians. All patients underwent a study with 300-350MBq PSMA-18F DCFPyL PET/TC, and after a follow-up of no less than six months we assessed whether there were changes in therapeutic attitude directly related to the results of the test. The clinical/therapeutic evaluation was performed by expert radiation oncologists. Descriptive statistical analysis was performed. RoC curves (sensitivity vs. 1-specificity) and the corresponding areas under the curve were calculated to assess the predictive power of the study.

RESULTS

PET-PSMA with complete follow-up was performed on 85 patients aged 48-78 years (mean age 69 years) with occult biochemical recurrence. Most patients were staged T2 (50.58%) - T3 (48.23%), cases N1 (10.58%), Gleason score ≥ 7 (96%) with mean PSA level 11.24 ng/ml at diagnosis. The mean nadir PSA values of 0.13 mg/dl following primary treatment with radical intent. In 48.2% of patients (41/85) had a positive PET-PSMA during follow-up, pre-study the median PSA levels were 0,62 ng/dl. There is a correlation between the PSA value and the ability to detect disease in the PET-PSMA study (AUC: 0,74). In 75% of patients with positive PET-PSMA (31/41) there were changes in the therapeutic approach. This proportion was significantly lower (25%) in those without pathological PET findings (11/44). In PET-PSMA-positive patients the therapeutic changes found were classified as indicating or changing the planning of salvage radiotherapy treatment and/or initiating systemic treatment with hormone therapy (median PSA levels after treatment changes were 0.08 ng/dl). In cases with negative PET-PSMA a watchful waiting attitude was adopted.

CONCLUSION

PET-PSMA is a powerful diagnostic tool that conditions significant changes in the therapeutic approach in those patients with occult biochemical recurrence with low PSA, changing the treatment in 75% of the cases when the study is positive.

Addressing mechanism bias in model-based impact forecasts of new tuberculosis vaccines

In tuberculosis (TB) vaccine development, multiple factors hinder the design and interpretation of the clinical trials used to estimate vaccine efficacy. The complex transmission chain of TB includes multiple routes to disease, making it hard to link the vaccine efficacy observed in a trial to specific protective mechanisms. Here, we present a Bayesian framework to evaluate the compatibility of different vaccine descriptions with clinical trial outcomes, unlocking impact forecasting from vaccines whose specific mechanisms of action are unknown. Applying our method to the analysis of the M72/AS01E vaccine trial -conducted on IGRA+ individuals- as a case study, we found that most plausible models for this vaccine needed to include protection against, at least, two over the three possible routes to active TB classically considered in the literature: namely, primary TB, latent TB reactivation and TB upon re-infection. Gathering new data regarding the impact of TB vaccines in various epidemiological settings would be instrumental to improve our model estimates of the underlying mechanisms.

Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study

BACKGROUND

Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale.

OBJECTIVE

We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients.

METHODS

Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression.

RESULTS

TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92).

LIMITATIONS

Inability to determine causation and limited generalizability.

CONCLUSION

TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.

Beliefs and counseling practices among dermatologists regarding sexual and other adverse effects of finasteride

Finasteride may cause low libido and erectile dysfunction and the product label of finasteride also includes post-marketing reactions of sexual dysfunction that continued after discontinuation of treatment, as well as male infertility and depression. The aim of this study was to evaluate the beliefs and counseling practices among dermatologists regarding adverse effects of finasteride. Anonymous paper surveys were personally distributed to 122 attendees at two annual major dermatology meetings. The participation rate was 82% with 47% women and 77% residents of the United States. 51% of respondents believed that finasteride could cause sexual side effects and 18% believed that it could cause persistent sexual side effects. Fewer than a quarter believed that finasteride could cause depression or lower sperm counts. When initiating finasteride, 69% of respondents counseled at least half of their patients about potential sexual side effects with 52% for persistent sexual side effects and 30% for depression. This study identifies the need for greater awareness of the potential adverse effects of finasteride and identifies opportunities for improvement in counseling practices that reflect finasteride's product labeling.

Prevalence of rosacea in transgender and gender-diverse populations: a retrospective cohort study

Hormones have been shown to affect the pathophysiology of rosacea, however, the prevalence of rosacea in transgender and gender diverse (TGD) patients on gender affirming hormone therapy (GAHT) has never been studied. Our retrospective cohort study showed a significantly decreased prevalence TGD patients on feminizing GAHT compared to cisgender men, women, and TGD not on GAHT. Our results suggest that estrogen and/or anti-androgenetic agents may play a protective role in the development or course of rosacea.

AB0462 CORRELATION BETWEEN SAXON TEST AND UNSTIMULATED SALIVARY FLOW RATE IN PATIENTS WITH SUSPECTED SJÖGREN´S SYNDROME

Background

Sjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, which alters their function producing dryness of the mouth, eyes and other mucous membranes. The method used to quantify glandular hypofunction is by whole saliva flow stimulated and unstimulated (UWSF) [1], which takes between 5 and 15 minutes (min). The Saxon test [2], is another tool with the same objective but requires less time: 2 minutes. In the literature, we only have found one study that compares the Saxon test with other diagnostic methods although it is developed in patients without SS [3].

Objectives

To compare the Saxon test and UWSF in a cohort of patients with suspected SS.

Methods

In a consecutive cohort of patients who attended the rheumatology department for suspected SS, UWSF was measured (mL/5 min) and the Saxon test (gr/2 min) was performed. The Index Reported by Patients with Sjögren’s Syndrome of the EULAR (ESSPRI) was collected too. This is a patient-reported index designed to assess the severity of patients’ symptoms (dryness, pain, somatic and mental fatigue) in SS through an average of single 0–10 numerical scale for each domain. To measure the UWSF, patients were asked to swallow their saliva before the start of the test and then to spit into a container for 5 min. The Saxon test was performed by calculating the difference in the weight of two pieces of sterile gauze that the patient chews for two minutes. An UWSF >0.25 mL/min, a Saxon test >2.75 g/2min and an ESSPRI<5 were considered normal. Spearman’s rank correlation coefficient (rs) was used to determine the correlation between both quantitative variables. The Chi-square test and the Gamma test were used in the comparisons between the groups (altered and normal) and the Mann-Whitney U in the comparisons of the quantitative variables based on the groups (altered and normal) previously defined. P values <0.05 were considered statistically significant.

Results

We enrolled 70 patients (63 women/7 men), with a mean age ± standard deviation of 54±13 years. The medians (Me) and interquartile ranges (IQR) obtained were 1.500 (0.6750 – 2.5000) mL/5min for the UWSF, 2.405 (1.6775-3.4925) g/2min for the Saxon test, 6.67 (3.67-7.67) for ESSPRI and 7.00 (4.00-8.00) for ESSPRI-dryness score.

A direct and significant correlation between the Saxon test and the UWSF (rs=0.325; P=0.006) was observed. Twenty-four patients (34.3%) presented an altered UWSF and forty-two patients (60%) had an altered Saxon test. When we analysed the intensity of the association between the different groups (altered/normal) of both variables, we observed a direct and significant association (Gamma value=0.583, P=0.010) between both tools.

We also detected differences in the Saxon test between patients with altered UWSF (Me: 1.89 gr/2min.; IQR: 1.47-2.68) and those with normal UWSF (Me: 2.78 gr/2 min.; IQR: 1.77-3, 75) (P=0.029). Similarly, we observed significant differences in UWSF values between patients with altered Saxon test (Me: 1.30 mL/5min IQR: 0.50-2.13) and those with a normal Saxon test (Me: 2.00 mL/5min IQR: 1.5-2.88) (P=0.008).

Regarding the ESSPRI, 42 (62,7%) patients presented an altered ESSPRI and 49 (73,1%) had an altered ESSPRI-dryness score. The group patients with ESSPRI-dryness score≥5 obtained significantly worse scores on the Saxon test (Me: 2.10 g/2min IQR: 1.58-3.07) and on the ESSPRI (Me:7.33 IQR:5.83-8.00) than the normal ESSPRI-dryness score group: Me:3.02 g/2min, IQR:2.20-3.84, on Saxon test (P=0.026); Me: 2.66 IQR:1, 00-4.08, on the ESSPRI (P=0.000).

Conclusion

In patients with suspected SS, there is a direct and significant correlation between the Saxon test and the UWSF. Therefore, the Saxon test could be useful in the initial assessment of oral gland dysfunction, to save time and/or to select patients who require performing the UWSF.

References

[1]Martínez Ceballos MA et al. Rev. Colomb Reumatol.2020; 27 (S2):90-101.

[2]Kohler PF & Winter ME. Arthr & Rheum. 1985;28(10):1128-32.

[3]Minagi HO et al. J Oral Rehabil.2020;47:1550-6.

Disclosure of Interests

None declared

AB1345 PREDICTIVE MODEL FOR THE DIAGNOSIS OF PSORIATIC ARTHRITIS IN DERMATOLOGY REFERRALS ACCORDING TO PURE-4 SCALE

Background

The rate of psoriatic arthritis progression is increased in those patients presenting with established disease greater than 2 years duration, so it is necessary to find tools that allow early diagnosis to prevent joint damage1. Prevalence of psoriatic arthritis varies according to the screening strategies used. The COMPAQ study compared four screening questionnaires for psoriatic arthritis (PEST, ToPAS, PASE and EARP), whose sensitivities ranged from 44 to 91%, with the EARP questionnaire showing the highest sensitivity2. A new, shorter questionnaire, PURE-4 scale, has been developed, with a sensitivity of 85.7%3.

Objectives

To evaluate the usefulness of PURE-4 scale in real clinical practice conditions to identify patients with psoriatic arthritis in patients with psoriasis referred from a dermatology department to a rheumatology department.

Methods

Retrospective descriptive study of patients diagnosed with psoriasis who have been referred from the Dermatology Department in the last 12 months for suspected joint domain according to PURE-4 scale used by this department. The following variables were collected: age, sex, obesity, dyslipidaemia, smoking, family history of psoriasis, form of psoriasis (plaque, palmoplantar, scalp, nail), previous treatment (topical, methotrexate, other, none), PASI index, compliance with CASPAR criteria, rheumatological diagnosis (psoriatic arthritis yes/no), PURE-4 score, morning stiffness in hands, Achilles enthesitis, inflammatory low back pain and need for anti-inflammatory drugs for joint pain in the last 3 months. Descriptive statistics was performed and Chi-square test was used to compare the diagnosis of psoriatic arthritis with PURE-4 values (at the response threshold ≥ 1 it has a sensitivity of 85.7% and a specificity of 83.6%).

Results

In the last 12 months the Dermatology Department of our hospital made 33 referrals for suspected psoriatic arthritis in patients diagnosed with psoriasis. Mean age was 46.4 ± 12.4 years, 51.5 % were men. Fifty-one percent of the patients had a BMI ≥25, 30.3% had dyslipidaemia and 45.5% were smokers; 10% of the patients had family history of psoriasis. The most prevalent form of psoriasis was plaque (18%) followed by nail (6%), palmoplantar (3%), scalp (3%) and droplet (3%) involvement; 51.5% of patients were on topical treatment, 9% on methotrexate and 39.4% on biologic treatments; mean PASI was 6.2 ± 7.5. Seventy-five percent of the referred patients did not meet CASPAR criteria; 33.3% were diagnosed with psoriatic arthritis by the rheumatologist. Of the 33 patients, 4 (12.1%) scored 0 points on PURE-4 scale; 21 (63.6%) scored 1 point; and 8 (24.3%) scored 2 points. Once assessed by a rheumatologist, 75.5% had no morning stiffness in the hands, 93.9% had no Achilles enthesitis and 87.9% had no inflammatory low back pain; only 24.2% of patients had required NSAIDs in the previous 3 months for joint pain. Finally, the diagnosis of psoriatic arthritis was analyzed against the PURE-4 cut-off point (Table 1).

Table 1.

Psoriatic arthritis diagnosis based on total score on PURE-4 scale

PURE-4 ScoreChi-squared testp value≧ 10.250.61= 10.100.74= 20.690.41

Conclusion

PURE-4 scale with a score ≥ 1 does not seem to improve the diagnosis of arthritis in psoriatic patients. It would be necessary to implement other questionnaires that are more complete, but at the same time affordable, when carried out during the dermatology consultation in order to increase the sensitivity to refer or not to the rheumatologist.

References

[1]Gladman DD et al. Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis 2011;70(12):2152-2154.

[2]Mishra S et al. Comparison of four validated psoriatic arthritis screening tools in diagnosing psoriatic arthritis in patients with psoriasis (COMPAQ Study). Br J Dermatol 2017;176(3):765-770.

[3]Audureau E et al. Psoriatic arthritis screening by the dermatologist: development and first validation of the ‘PURE-4 scale’. J Eur Acad Dermatol Venereol 2018;32(11):1950-1953.

Disclosure of Interests

None declared

AB0430 EFFECTIVENESS OF RITUXIMAB TREATMENT IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME

Background

The therapeutic management of Sjögren’s Syndrome remains challenging in clinical practice. Randomized clinical trials with rituximab (RTX) fail to submit primary outcomes; nevertheless, some case series show improvement with this treatment.

Objectives

To evaluate the effectiveness of therapy with RTX in patients with primary Sjögren’s Syndrome (pSS).

Methods

A retrospective chart review was conducted among patients with pSS who fulfilled 2002 AECG and 2016 ACR/EULAR criteria and had received RTX in the last 6 years. Patients with Sjögren’s Syndrome associated with other autoimmune diseases were not included. Clinical, serological and radiological variables were analyzed (prior and 6 months after RTX therapy). A descriptive statistical analysis was performed.

Results

18 patients were analyzed, 72.2% women, with a mean age of 60.9 years (36-83) and a mean duration of disease of 9.7 years (2-28).

Reasons for treatment initiation were pulmonary involvement (n=5), renal involvement (n=4), arthritis (n=3), severe ocular/oral dryness (n=3), recurrent mumps (n=2) and autoimmune hepatitis with lymphadenopathy (n=1).

Initial regimen was 2 doses of 1 g each administered 15 days apart. In 8 patients the dose was reduced in subsequent cycles to a single dose of 1 g or 500 mg. The mean number of cycles received was 3.2 (1 - 12).

In 7 patients its administration persists as maintenance treatment every 6 months. In 5 patients, treatment was suspended because of clinical improvement/stability; in 2 it was stopped due to adverse effects (one for psychosis and the other for infusion reaction).; in 1 patient it was discontinued due to lack of efficacy in dryness; in 1 patient with pulmonary involvement, it was replaced by mycophenolate due to COVID-19 pandemic and clinical stability; in 1 patient it was suspended due to initiation of radiotherapy for epidermoid carcinoma of the scalp and 1 died of large cell neuroendocrine carcinoma.

RTX was effective in 5 (100%) patients with pulmonary involvement (clinical, radiological and functional stability and/or improvement); in 4 (100%) patients with renal involvement (clinical and analytical improvement); in 3 (100%) patients with arthritis complete improvement was obtained; in 2 (100%) patients with recurrent mumps relapse was avoided; in 1 (100%) patient with autoimmune hepatitis and lymphadenopathy clinical and radiological improvement was obtained. Of the three patients with dryness: 1 experienced subjective clinical improvement, 1 reported improvement coinciding with the use of therapeutic contact lenses and 1 improved only at the beginning.

Subjective improvement in asthenia was observed in 4 patients.

Complement levels normalized in 4 of 5 patients with hypocomplementemia as well as in 4 of 4 with increased B2-microglobulin; 3 of 6 patients with hypergammaglobulinemia normalized IgG value. No changes were observed in the four patients who were rheumatoid factor positive.

6 of 6 patients receiving corticosteroid treatment, reduced the dose by half and 1 achieved corticoid withdrawal.

Conclusion

The observed data suggest that RTX may be useful in selected patients with pSS. Further research is needed to determine its efficacy.

References

[1]Chen YH, Wang XY, Jin X, Yang Z, Xu J. Rituximab Therapy for Primary Sjögren’s Syndrome. Front Pharmacol. 2021 Sep 2;12:731122

[2]Ramos-Casals M, Brito-Zerón P, Bombardieri S, Bootsma H, De Vita S, Dörner T, et al. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Ann Rheum Dis. 2020 Jan;79(1):3-18

[3]Mavragani CP, Moutsopoulos HM. Sjögren’s syndrome: Old and new therapeutic targets. J Autoimmun. 2020 Jun;110:102364

[4]Mariette X, Criswell LA. Primary Sjögren’s Syndrome. N Engl J Med. 2018 Mar 8;378(10):931-939

Disclosure of Interests

None declared

AB0802 PREVALENCE OF NONALCOHOLIC FATTY LIVER DISEASE IN RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS, AND PSORIATIC ARTHRITIS

Background

Non-alcoholic fatty liver disease (NAFLD), the most common cause of liver disease, has a prevalence of about 25% in the general population. It increases mortality and comorbidity in patients with immune-mediated inflammatory diseases.

Objectives

The main objective is to estimate the prevalence of NAFLD in three of the most common rheumatologic pathologies: rheumatoid arthritis (RA), axial spondyloarthritis (SpA-ax) and psoriatic arthritis (PsA). As a secondary objective, the possibility of finding associated risk factors in this group of subjects that may imply a higher risk of developing NAFLD is proposed.

Methods

We conducted a prospective single center observational study which included patients diagnosed with RA, EspA-ax, and PsA attended in the Rheumatology department of a tertiary hospital from January to April 2021. Anthropometric parameters, history related to cardiovascular risk factors and disease activity at the time of the visit were collected. Additionally, blood tests and transitional elastography were performed in all patients and the presence of NAFLD was assessed by the fatty liver index (FLI) scale. Different variables were considered to study their association with NAFLD.

Results

90 patients were included: 28 diagnosed with RA, 36 with EspA-ax and 26 with PAs. 41.1% were male (age range: 27-79 years). Patients with previous liver disease were excluded from the study. 22 (27.2%) patients had NAFLD measured by FLI ≥ 60. No significant differences in prevalence of hepatic steatosis were found between the 3 groups, although values were higher in patients with PsA.

The variables that were significantly associated with the development of NAFLD in our cohort were: body mass index (BMI), abdominal perimeter, blood glucose level, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), HDL, TG, GGT, ferritin and uric acid levels. The rest of the variables studied did not show statistically significant differences (Table 1).

Table 1.NO STEATOSIS (FLI<60)n=59STEATOSIS (FLI>60)n=22MeanStandard deviationMeanStandard deviationpBMI24,523,0030,292,77< 0,001Abdominal perimeter86,3410,01106,828,55< 0,001Age52,9312,8757,598,240,1185Glucose78,648,3790,6419,690,0002Insulin8,8310,1212,406,660,1302HOMA1,752,022,761,700,0500HbA1c5,350,455,690,640,0096Total cholesterol190,9829,46201,4138,530,1977HDL64,8817,6655,5911,550,0249LDL110,4428,45120,0036,210,2163TG81,1232,42128,5055,52< 0,001GPT25,8330,7337,1819,820,1116GOT27,2023,4926,8210,690,9413GGT20,8017,6649,9538,46< 0,001Creatinin0,750,190,840,180,0583Uric acid4,781,305,911,140,0007Ferritina121,75111,30208,00140,170,0050PCR2,894,552,672,330,8307

Conclusion

Hepatic steatosis was present in 27.2% of patients vs 25% estimated prevalence in the general population. Identification of risk factors involved would allow better control of the comorbidities associated with NAFLD.

The fact that the prevalence found in our sample population is so close to that of the general population, may be related to a good inflammatory control of the underlying disease.

Further prospective studies with larger sample sizes are needed to find additional predictive factors for the development of NAFLD in this group of diseases.

References

[1]Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A. y Tiribelli, C. (2006). The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterology, 6: 33.

[2]Brenner, C., Galluzzi, L., Kepp, O. y Kroemer, G. (2013). Decoding cell death signals in liver inflammation. Journal of Hepatology, 59(3): 583-594.

[3]Byrne, C.D. y Targher, G. (2015). NAFLD: a multisystem disease. Journal of Hepatology, 62(1 Suppl): 47

[4]Miele, L., Vallone, S., Cefalo, C., La Torre, G., Di Stasi, C., Vecchio, F.M., et al. (2009). Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. Journal of Hepatology, 51(4): 778-786.

Disclosure of Interests

None declared

POS1548-HPR USEFULNESS OF AN ELECTRONIC CONSULTATION SYSTEM BETWEEN PRIMARY CARE HEALTH CENTERS AND RHEUMATOLOGY DEPARTMENT OF A TERTIARY HOSPITAL

Background

The EPISER study is the first Spanish epidemiological study that has confirmed the great burden of rheumatic diseases in the general population: they consume a large quantity of health resources (doctor visits, medical products) and imply a high social impact in terms of work absenteeism. Rheumatic diseases represent almost 30% of Primary Care medical consultations in Spain1,2. Electronic consultation could be an alternative response to the increase of this demand, both to make an early diagnosis and derivation and to improve communication with Primary Care physicians3,4.

Objectives

To analyze the demand of Primary Care and its resolution through the electronic consultation system of the Rheumatology Department of a tertiary hospital.

Methods

Retrospective descriptive study of the data collected in the request and information system (Sistema de Peticiones Electrónicas, SIPE) that supports electronic consultation between primary care physicians of the health area and the Rheumatology Department of a tertiary hospital, between July 2020 and May 2021.The following variables were collected: age, sex, reason for consultation, response time in days and destination (primary care/outpatient follow-up). Descriptive statistics were used to present the results.

Results

The last 500 consecutive electronic consultations registered in the system, referring to 496 patients, were collected. Mean age was 59.5±17.7 years; 74.2% women. Mean response time was 2 days, median response time 1 day and range 0-45. The reasons for consultation (see Graph 1) were: osteoporosis assessment 55 (11%), treatment adjustment 50 (10%), appointment request 49 (9.8%), loss to follow-up 43 (8.6%), local-regional pathology assessment 39 (7.8%), infiltration request 28 (5, 6%), suspected rheumatoid arthritis 19 (3.8%), flare 18 (3.6%), suspected polymyalgia rheumatica or giant cell arteritis 16 (3.2%), COVID vaccine consultation 14 (2.8%), Raynaud’s phenomenon 13 (2.6%), monoarthritis assessment 12 (2.4%), assessment of polyarthritis 11 (2.2%), adverse effects of treatment 11 (2.2%), suspected spondyloarthritis 11 (2.2%), suspected psoriatic arthritis 8 (1, 6%), generalized pain 7 (1.4%), suspected Sjögren’s syndrome 5 (1%), suspected systemic lupus erythematosus 1 (0.2%), suspected other systemic autoimmune diseases 9 (1.8%), others 81 (16.2%). Fifty-seven and four % (287) of the patients required an appointment at the Rheumatology outpatient clinic and in 42.6% of the patients (213) the electronic consultation was successful, so it was not necessary to refer the patient to the hospital.

Conclusion

Forty-two and six percent of the queries were resolved thanks to the electronic consultation system in an average of two days, otherwise that patients would have been referred to specialized care. The main reasons for consultation were osteoporosis assessment and clarification of doubts about the treatment of patients who were already being followed up by the Rheumatology Department.

References

[1]Carmona L, Ballina J, Gabriel R, Laffon A. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis 2001 -11;60(11):1040-1045.

[2]Seoane-Mato D, Martínez Dubois C, Moreno Martínez MJ, Sánchez-Piedra C, Bustabad-Reyes S. Frequency of medical visits due to osteoarticular problems of the adult general population in Spain. EPISER2016 Study. Gac Sanit 2020 Sep - Oct;34(5):514-517.

[3]Tejera Segura B, Bustabad S. A New Form of Communication Between Rheumatology and Primary Care: The Virtual Consultation. Reumatol Clin 2016 /01/01;12(1):11-14.

[4]Pego-Reigosa JM, Peña-Gil C, Rodríguez-Lorenzo D, Altabás-González I, Pérez-Gómez N, Guzmán-Castro JH, et al. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Serv Res 2022 -01-12;22(1):60.

Disclosure of Interests

None declared

POS0903 ASSOCIATION STUDY BETWEEN ANTI-TIF 1γ ANTIBODY AND DEVELOPMENT OF NEOPLASIA IN THREE TERTIARY HOSPITALS

Background

Anti-transcriptional intermediary factor 1γ (anti-TIF 1γ) antibody is robustly linked with cancer-associated dermatomyositis (DM) in adults, but its specificity varies widely between series. TIF 1γ can act either as a tumor promoter or suppressor and may behave as an autoantigen.

Objectives

Investigate the association between anti-TIF 1γ antibody positivity and development of neoplasia.

Methods

A retrospective chart review was conducted among patients with positive anti-TIF 1γ antibodies detected by immunoblot from March 2019 to December 2021 in three tertiary hospitals. Demographic variables, creatine kinase (CK) values, other autoantibodies, associated autoimmune diseases (AIDs) and existence or not of a cancer diagnosis were analyzed. To rule out malignancy, patients had to present a PET-CT scan without pathological findings or a chest CT scan, a gynecological study and a digestive study without alterations. A descriptive statistical analysis was performed.

Results

29 patients with anti-TIF 1γ antibodies were analyzed, 82.7% women, with a mean age of 61 years (31-96 years).

The reason for requesting this antibody was: clinical features suggestive of DM in 10 patients (34.5%), muscle weakness in 9 (31%), interstitial lung disease (ILD) in 5 (17.2%), persistent CK elevation in 3 (10.3%), constitutional syndrome in 1 (3.5%) and antiphospholipid syndrome in 1 patient (3.5%). The mean time from symptoms onset to the detection of anti-TIF 1γ was 14 months (0-60 months).

10 patients (34.5%) had a diagnosis of DM; 4 patients (13.8%) systemic lupus erythematosus (SLE); one (3.5%) had a SLE/DM overlap syndrome; one patient (3.5%) subacute cutaneous lupus; one (3.5%) was diagnosed with diffuse systemic sclerosis; one patient (3.5%) limited systemic sclerosis; one patient (3.5%) antiphospholipid syndrome; one patient (3.5%) HLA-B27+ spondyloarthritis and 9 patients (31%) had no associated AIS.

5 patients (17.2%) showed ILD with different patterns: UIP (n=2), NSIP (n=2) and COP (n=1). Only 9 patients (31%) had elevated CK levels at the time of antibody determination.

10 patients (34.5%) were diagnosed with cancer: lung adenocarcinoma (n=2), small cell lung carcinoma (n=2), breast carcinoma (n=2), hepatocarcinoma (n=1), cervical cancer (n=1), ovarian carcinoma (n=1) and gallbladder adenocarcinoma (n=1). Of those, 7 patients (70%) had elevated CK levels and 6 (60%) had a diagnosis of DM. None of the patients diagnosed with cancer had ILD.

In 4 patients (40%), the diagnosis of cancer was simultaneous with the diagnosis of anti-TIF 1γ antibodies; in 4 (40%), the diagnosis of the tumor preceded the finding of the antibodies; in the other 2 (20%), the finding of the antibodies preceded that of the tumor. 30-month survival after cancer diagnosis was 10%.

In 17 patients (58.6%) no malignancy has been found so far in the annual cancer screening. In two patients (6.9%) no cancer screening was performed.

Conclusion

In our study, 60% of patients with DM and anti-TIF 1γ presented neoplasia, a prevalence similar to that established in other series (60-80%). Furthermore, 21% of patients with antibodies and without DM were diagnosed with cancer, suggesting that anti-TIF 1γ antibodies could also be associated with neoplasia in patients without DM. Patients with ILD did not present cancer, supporting the observation of previous studies in which the presence of ILD is a marker of low risk for neoplasia in patients with DM. HyperCKemia might predict the association with neoplasia in patients with anti-TIF 1γ antibodies.

References

[1]De Vooght J, Vulsteke JB, De Haes P, Bossuyt X, Lories R, De Langhe E. Anti-TIF1-γ autoantibodies: warning lights of a tumour autoantigen. Rheumatology. 2020 Mar 1;59(3):469-477

[2]Shimizu K, Kobayashi T, Kano M, Hamaguchi Y, Takehara K, Matsushita T. Anti-transcriptional intermediary factor 1-γ antibody as a biomarker in patients with dermatomyositis. J Dermatol. 2020 Jan;47(1):64-68

[3]Masiak A, Kulczycka J, Czuszyńska Z, Zdrojewski Z. Clinical characteristics of patients with anti-TIF1-γ antibodies. Reumatologia. 2016;54(1):14-8

Disclosure of Interests

None declared

AB0572 USEFULNESS OF MINOR SALIVARY GLAND BIOPSY IN THE DIAGNOSIS OF PATIENTS WITH SUSPECTED PRIMARY SJÖGREN’S SYNDROME

Background

The classification system for Sjögren’s syndrome (SS) proposed by the American-European Consensus Group (AECG) and the revised diagrams proposed by the American College of Rheumatology (ACR) include an altered minor salivary gland biopsy (MSGB) or positive antiRo, among other findings. Thus, an altered MSGB is a particularly important finding in patients with autoantibody-negative. A retrospective cohort study showed that a positive biopsy result led to a definitive diagnosis in 80% of patients1.

Objectives

To assess the usefulness of MSGB in the diagnosis of SS in anti-SSA/SSB (Ro/La) negative patients.

Methods

Retrospective descriptive study in patients with suspected SS in which MSGB were collected according to standard clinical practice over a consecutive period (from September 2020 to May 2021) in the Rheumatology Department of a tertiary hospital.

Patients were grouped according to the reason for requesting the biopsy: 1) Dry eye/oral syndrome (DEOS), 2) DEOS + altered Saxon/Schirmer, 3) DEOS + positive antinuclear antibodies (ANA+), 4) DEOS + (ANA+) + other serological alterations (hypergammaglobulinaemia, rheumatoid factor (RF), hypocomplementemia), 5) DEOS + extraglandular manifestations (EG) + (ANA+) +/- other serological alterations. The following variables were collected: age, sex, dry eye/oral syndrome, Raynaud’s phenomenon, EG manifestations (arthritis, autoimmune hepatitis, primary biliary cirrhosis, interstitial lung disease, pleuropericarditis, autoimmune chronic nephropathy suspected or tubulointerstitial nephritis and/or neurological manifestations), ANA, hypergammaglobulinaemia, RF, hypocomplementemia, Saxon and Schirmer tests and histological result of MSGB according to its Focus Score (FS); MSGB was considered altered when FS was ≥1. Descriptive analysis was performed (means and frequencies); Chi-square test was used to compare the reasons for requesting MSGB between patients with altered and unaltered results and to compare whether any of the groups (Groups 2-5) were more frequently associated with an altered MSGB compared to patients presenting only with dry syndrome (Group 1).

Results

Seventy-eight MSGB were collected. Mean age of patients was 55 years; 90% were women. ANA were present in 17% of patients with altered MSGB. DEOS was the suspected manifestation in 83% of patients, 13% had Raynaud’s phenomenon and 47% had some EG manifestation. MSGB was compatible with a diagnosis of SS (according to 2002/2016 classification criteria) in 28% of anti-SSA/SSB negative patients. Patients with dry syndrome and positive ANA (Group 3) were significantly associated with MSGB altered (Table 1).

Table 1.

Comparative table of patterns inidicated in the reasons for requesting a MSGB. *Not significant (NS).

Reason for request (%)MSGB alteredMSGB unalteredpp vs drynessDEOS (50)19460.65DEOS + Saxon/Schirmer (38)15340.47NSDEOS + ANA (30)11270.67NSDEOS + ANA + others (8)640.410.05DEOS + EG + ANA (14)9150.69NS

Conclusion

MSGB was compatible with a diagnosis of SS in 28% of anti-SSA/SSB negative patients. The data suggest that patients presenting with objectified dryness with Saxon and/or Schirmer test, as well as those with extraglandular manifestations and ANA+ and/or other serological alterations, are more likely to have a compatible with SS result on MSGB. Studies with larger numbers of patients are needed.

References

[1]Wicheta S, Van der Groen T, Faquin WC, August M. Minor Salivary Gland Biopsy-An Important Contributor to the Diagnosis of Sjögren Syndrome. J Oral Maxillofac Surg 2017 -12;75(12):2573-2578.

Disclosure of Interests

None declared

AB1396 MULTICENTER QUALITATIVE STUDY ON THE EXPERIENCE OF USE OF BIOLOGIC AND TARGETED SYNTHETIC DISEASE-MODIFYING DRUGS IN PATIENTS WITH RHEUMATIC DISEASES. WHAT DO OUR PATIENTS THINK?

Background

The development of targeted biologic (bDMARDs) and targeted synthetic disease-modifying drugs (tsDMARDS) has made a substantial change in the control of our patients, and has allowed an increasing number of patients to achieve clinical remission.

Objectives

To gain understanding of patients’ experiences of starting treatment with b/tsDMARDs, and explore their attitudes in order to improve the doctor-patient relationship, adherence to treatment, compliance, and knowledge about the experience of using b/tsDMARDs.

Methods

A qualitative study was carried out. A consecutive sample of 130 patients attended in the rheumatology units of four Madrid hospitals, from August 29th, 2021 to January 21st, 2022 completed a questionnaire that consisted of 31 questions, a subsequent qualitative analysis of discourse and content through focus groups with patients was carried out. Descriptive statistical analysis was performed. Chi-squared tests were applied to explore the dependency relationship between the different qualitative variables.

Results

One hundred and thirty questionnaires were collected (see general characteristics in the Table 1).

Table 1.

Baseline demographics.

Sex, n (%)96 female (73.85%), 34 male (26.15%)Age, years, mean (SD)51,62±12.31 yearsEthnicity/race, n(%)74.6% White or Caucasian22.3% Hispanic or Latino2.3% Asiatic0.8% Black or African AmericanDiagnosis, (%)42.4% rheumatoid arthritis25.3% axial spondyloarthritis10% psoriatic arthritis6.9% connective tissue diseases15.4 % otherTime since diagnosis (years), mean (SD)14,7 years (+/-11,43)Time since initiation of treatment with b/tsDMARDs (years), mean (SD)5,84 years (+/-4,28)

Most of the patients (68.46%) felt hope when they were informed that they were going to start treatment with b/tsDMARDs, 26.9% relief, 22.3% happiness and 27.7% fear and concern. 76% of the patients received information about why the treatment was modified, the advantages of b/tsDMARDs (60%), their mechanism of action (48.5%) and the precautions to be aware of (38.5 %). Fifty-two percent of the respondents searched for additional information on their own, with the most used sources being from internet search engines (34.2%), the corresponding drug insert (22.8%) and the page of the Spanish Society of Rheumatology (23.7%).

60% of the respondents were informed about the possible risks associated with the treatment, 49.4% reported being more concerned when they contracted an infection. Most of the patients were recommended to receive influenza (81.5%) and pneumococcal (69.2%) vaccination, of which 74.6% and 54.6% received those respectively. A statistically significant dependence was observed between the recommendation of the vaccine and vaccination, since most (91,5%) of those who received the recommendation were vaccinated (p<0.001). Most of the respondents kept their scheduled appointments (87.3%) and never forgot to take their medication (37.04%).

51% of the patients reported that with b/tsDMARDs they had experienced “considerable improvement”, 38.5% indicated that “their life has changed”, 10% reported little or no improvement. It was observed that men reported a maximum degree of improvement with a significantly higher frequency than women (77% vs 37% respectively), OR 5.79 (p <0.009, IC 95% 1.42, 23.67). To the question “In which aspects have you noticed the greatest changes?” the respondents answered: reduction in outbreaks of the disease (67%), emotional improvement (38.6%) and regaining work activity (31.8%).

Conclusion

In our setting, education programs inform patients adequately, but it seems necessary to make a greater emphasis on therapeutic compliance, providing more safety information, and compliance to recommended vaccinations.

References

[1]Arkell P, et al. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication—“it could give me two heads and I’d still try it!” BMC Musculoskelet Disord. 2013;10:165. doi: 10.1186/1471-2474-14-165

Disclosure of Interests

None declared

Drugs targeting epithelial-to-mesenchymal transition molecules for treatment of lichen planopilaris

Primary Cicatricial or scarring alopecia (PCA) is a diverse group of hair disorders that cause permanent destruction of the pilosebaceous unit, resulting in disappearance of the follicular ostia. Lichen Planopilaris (LPP) is a subtype of primary lymphocytic cicatricial alopecia and there urgent need to identify novel molecules that successfully target specific pathogenic pathways in LPP to inhibit and reverse disease progression. Recent studies into LPP pathogenesis have discovered that follicular stem cells undergo epithelial-to-mesenchymal transition (EMT). We sought to identify drugs that target molecules involved in EMT to repurpose these drugs for treatment of LPP. We identified 8 molecules and 15 drugs that target these EMT molecules. Only 4 of these drugs, pioglitazone, tofacitinib, barcitinib, and apremilast, have been reported in individual cases or case series of patients with LPP, and controlled studies are missing. We describe each drug and mechanism of action target EMT in detail in this review article. Although studies have demonstrated the efficacy of EMT inhibitors in anti-cancer therapy, there are no studies using EMT-attenuating drugs for the treatment of LPP. The treatment molecules discussed provide a new platform for clinical studies and controlled trials in LPP.

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

AIMS

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

METHODS AND RESULTS

1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

CONCLUSION

Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.

Interaction Control and Bright Solitons in Coherently Coupled Bose-Einstein Condensates

We demonstrate fast control of the interatomic interactions in a Bose-Einstein condensate by coherently coupling two atomic states with intra- and interstate scattering lengths of opposite signs. We measure the elastic and inelastic scattering properties of the system and find good agreement with a theoretical model describing the interactions between dressed states. In the attractive regime, we observe the formation of bright solitons formed by dressed-state atoms. Finally, we study the response of the system to an interaction quench from repulsive to attractive values, and observe how the resulting modulational instability develops into a bright soliton train.

Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Versus Dolutegravir/Abacavir/Lamivudine in Antiretroviral-Naive Adults (SYMTRI): A Multicenter Randomized Open-Label Study (PReEC/RIS-57)

Background

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) is the reference for combination therapy based on protease inhibitors due to its efficacy, tolerability, and convenience. Head-to-head randomized comparisons between D/C/F/TAF and combination therapy based on integrase inhibitors in antiretroviral-naive patients are lacking.

Methods

Adult (>18 years old) human immunodeficiency virus-infected antiretroviral-naive patients (HLA-B∗5701 negative and hepatitis B virus negative), with viral load (VL) ≥500 c/mL, were centrally randomized to initiate D/C/F/TAF or dolutegravir/abacavir/lamivudine (DTG/3TC/ABC) after stratifying by VL and CD4 count. Clinical and analytical assessments were performed at weeks 0, 4, 12, 24, and 48. The primary endpoint was VL <50 c/mL at week 48 in the intention-to-treat (ITT)-exposed population (US Food and Drug Administration snapshot analysis, 10% noninferiority margin).

Results

Between September 2018 and 2019, 316 patients were randomized and 306 patients were included in the ITT-exposed analysis (151 D/C/F/TAF and 155 DTG/3TC/ABC). Almost all (94%) participants were male and their median age was 35 years. Forty percent had a baseline VL >100 000 copies/mL, and 13% had <200 CD4 cells/μL. Median weight was 73 kg and median body mass index was 24 kg/m². At 48 weeks, 79% (D/C/F/TAF) versus 82% (DTG/3TC/ABC) had VL <50 c/mL (difference, −2.4%; 95% confidence interval [CI], −11.3 to 6.6). Eight percent versus four percent experienced virologic failure but no resistance-associated mutations emerged. Four percent versus six percent had drug discontinuation due to adverse events. In the per-protocol analysis, 94% versus 96% of patients had VL <50 c/mL (difference, −2%; 95% CI, −8.1 to 3.5). There were no differences in CD4 cell count or weight changes.

Conclusions

We could not demonstrate the noninferiority of D/C/F/TAF relative to DTG/ABC/3TC as initial antiretroviral therapy, although both regimens were similarly well tolerated.

Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation

Purpose

To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes.

Materials and methods

Eighty patients treated with an Intrabeam^® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits.

Results

Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group.

Conclusion

IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

Primary resistance to integrase strand transfer inhibitors in Spain using ultrasensitive HIV-1 genotyping

BACKGROUND

Transmission of resistance mutations to integrase strand transfer inhibitors (INSTIs) in HIV-infected patients may compromise the efficacy of first-line antiretroviral regimens currently recommended worldwide. Continued surveillance of transmitted drug resistance (TDR) is thus warranted.

OBJECTIVES

We evaluated the rates and effects on virological outcomes of TDR in a 96 week prospective multicentre cohort study of ART-naive HIV-1-infected subjects initiating INSTI-based ART in Spain between April 2015 and December 2016.

METHODS

Pre-ART plasma samples were genotyped for integrase, protease and reverse transcriptase resistance using Sanger population sequencing or MiSeq™ using a ≥ 20% mutant sensitivity cut-off. Those present at 1%-19% of the virus population were considered to be low-frequency variants.

RESULTS

From a total of 214 available samples, 173 (80.8%), 210 (98.1%) and 214 (100.0%) were successfully amplified for integrase, reverse transcriptase and protease genes, respectively. Using a Sanger-like cut-off, the overall prevalence of any TDR, INSTI-, NRTI-, NNRTI- and protease inhibitor (PI)-associated mutations was 13.1%, 1.7%, 3.8%, 7.1% and 0.9%, respectively. Only three (1.7%) subjects had INSTI TDR (R263K, E138K and G163R), while minority variants with integrase TDR were detected in 9.6% of subjects. There were no virological failures during 96 weeks of follow-up in subjects harbouring TDR as majority variants.

CONCLUSIONS

Transmitted INSTI resistance remains rare in Spain and, to date, is not associated with virological failure to first-line INSTI-based regimens.

Effects of radiation on toxicity, complications, revision surgery and aesthetic outcomes in breast reconstruction: An argument about timing and techniques

BACKGROUND

Radiotherapy (RT) combined with breast reconstruction can reduce the risk of cancer recurrence and increase the survival rate. However, this approach seems to worsen aesthetic outcomes and increase complication rates. The impact of breast reconstruction timing and techniques on clinical outcomes, however, remains unclear. For this reason, we aimed to perform a more comprehensive analysis of a series of patients undergoing RT and breast reconstruction.

METHODS

Patients were divided into 4 groups according to the timing of reconstruction (before RT and after RT) and surgical technique (heterologous reconstruction and autologous reconstruction (AR)). The median time between RT and reconstruction, number of revision surgeries, incidence of complications, toxicity, aesthetics and associated clinical risk factors were used to assess the clinical outcomes. An objective system of skin toxicity evaluation was performed.

RESULTS

Ninety-five patients were included in this study. No significant differences in the median time between RT and reconstruction, incidence of complications, toxicity or aesthetics were noted between different timings or techniques of reconstruction. Patients undergoing AR needed more revision surgeries to complete reconstruction. However, the total number of surgical procedures was similar between the groups. In a comparison between the treated and untreated breasts by an objective system, RT produced an increase in erythema and pigmentation and a decrease in elasticity in the treated breast (p<0.05 for all parameters). On multivariate analysis, smoking was a significant predictor associated with complications.

CONCLUSIONS

Combined breast reconstruction and RT seem to be successful regardless of the order of treatment or the type of reconstruction.

POS0996 SIX-YEAR RESULTS FROM THE ESPERANZA COHORT: EVALUATION OF CLINICAL FEATURES, DISEASE ACTIVITY MEASURES AND TREATMENT ASPECTS IN AXIAL AND PERIPHERAL EARLY SPONDYLOARTHRITIS

Background:

Esperanza was a multicenter national health program developed to facilitate an early diagnosis of patients with Spondyloarthritis (SpA) in Spain.

Objectives:

To compare the clinical evolution of patients with axial SpA (axSpA) and peripheral SpA (pSpA) included in this program.

Methods:

Patients from the Esperanza cohort fulfilling ASAS criteria for axSpA or pSpA and completed the 6-year follow-up were included. Patients were classified according to the predominant symptom. In case of having axSpA and pSpA, they were classified as axSpA. Clinical features, disease activity and treatment aspects at baseline and 6-year visit were evaluated.

Results:

From 775 patients recruited at baseline, 6-year follow-up data from 178 (83.5%) fulfilling ASAS criteria at the final visit were available: 133 (74.7%) for axSpA and 45 for pSpA (25.3%). 118 (66.3%) were males (50.6% with axSpA and 62.2%, pSpA, p=0.4). Patients with axSpA had more frequently positive HLA-B27 (90.5%) vs. (9.5%), p<0.001. Follow-up clinical features are shown in Table 1. At the final visit, both axSpA and pSpA presented an improvement in clinical symptoms, disease activity (CRP, BASDAI, ASDAS and VAS-pt) and quality of life (ASQoL). A worsening of mobility (BASMI) was observed in both groups. The prevalence of uveitis, psoriasis and inflammatory bowel disease (IBD) at baseline was 10.7%, 18% and 5.6%, respectively. At the 6-year visit, the cumulative prevalence (CP) was 14% for uveitis (16.5% in axSpA and 6.7% in pSpA), 22.5% for psoriasis (12.8% in axSpA and 51.1% in pSpA) and 7.9% for IBD (5.3% in axSpA and 15.6% in pSpA). Most of the patients were prescribed NSAIDS at baseline and more patients maintained this treatment at the 6-year visit in axSpA compared with pSpA (96.9% vs 87.5%, p=0.02). At the final visit, a higher percentage with pSpA received csDMARDs in comparison with axSpA (81% vs. 35.7%, p<0.001). Sixty (44.4%) patients received biologic therapy at the final visit and no differences were observed in their prescription: 43% in axSpA and 48.6% in pSpA(p=0.6).

Conclusion:

The early diagnosis of recent-onset SpA achieves a significant improvement in clinical features, disease activity and quality of life in patients with axSpA and pSpA after 6 years of follow-up. Although previous publications revealed a low radiographic progression in this cohort1, the worsening of BASMI must aware clinicians of possible evolutive structural damage.

Reference:

[1]Fernández-Carballido et al. RMD Open. 2020 Sep;6(2):e001345

Acknowledgements:

The Spanish Foundation of Rheumatology received funding from Pfizer (formerly Wyeth) to develop the Esperanza Program. Later, the Program has been supported by restricted grants from the Instituto de Salud Carlos III and Fondos FEDER (FIS PI13/02034 and PI17/01840) and AbbVie.

Disclosure of Interests:

Carolina Tornero: None declared, Victoria Navarro-Compán: None declared, Beatriz Joven-Ibáñez: None declared, RAQUEL ALMODOVAR: None declared, Xavier Juanola-Roura: None declared, Cristina Fernández-Carballido: None declared, Juan Carlos Quevedo-Abeledo: None declared, Jose Rosas: None declared, Azucena Hernández: None declared, Carlos A. Montilla-Morales: None declared, Jose Ramón Maneiro: None declared, A. Juan-Mas: None declared, Jose Antonio Pinto Tasende: None declared, Mireia Moreno: None declared, Jesus Sanz: None declared, Teresa Ruiz Jimeno: None declared, Manuel Moreno: None declared, María Lourdes Ladehesa Pineda: None declared, Eugenio de Miguel Speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi., Paid instructor for: Janssen, Novartis, Roche, Consultant of: AbbVie, Novartis, Pfizer, Galapagos, Grant/research support from: Abbvie, Novartis, Pfizer.

POS1218 SAFETY AND EFFICACY OF ANAKINRA IN SEVERE SARS-COV2 INFECTION (COVID19) AT A TERTIARY HOSPITAL

Background:

SARS-CoV-2 virus is a novel coronavirus that causes COVID-19 disease, which in its most severe form produces life-threatening atypical pneumonia and ARDS. Coronaviruses induce dysregulation of the immune system resulting in a cytokine storm syndrome with activation of the macrophage mediated mainly by IL-1 and IL-6. Although there is no specific treatment to date, researchers have explored novel approaches through targeting both IL-6 and IL-1. Anakinra is a recombinant human IL-1 receptor antagonist that prevents IL-1β and IL-1α binding and therefore blocks signal transduction. Its high bioavailability, rapid action, relatively short half-life and good safety profile make it a promising drug.

Objectives:

Analyse the experience of administering Anakinra for severe forms of COVID19 in patients hospitalised at a tertiary hospital.

Methods:

Retrospective single-center study in which all patients admitted for COVID-19 and treated with Anakinra from April 1st to the end of the 1st wave (July 2020) were included. Medical records were reviewed to collect demographic, clinical and lab test data, using Brescia-COVID respiratory severity scale, SaFi, CRP, Ferritin, LDH and lymphocytes. Variables were assessed at baseline, 72h and 7 days after treatment initiation. Descriptive statistical analysis was performed, including a sub-analysis of patients who received anakinra as the only biological treatment.

Results:

54 patients were included, of which 37 male (68.5%) with a median age of 69.5 years (36-94). Comorbidities were lung disease 14 pts (25.9%), cardiovascular disease 39 pts (72.2%), Diabetes Mellitus 11 pts (20.4%), kidney disease and rheumatic disease each in 6 pts (11.1%), and immunosuppression 13 pts (24.1%). Each patient received a mean of 4.85 doses of anakinra (± 3.96). Other therapies included low-dose steroids (70.3%); high-dose steroids: 1mg/kg (87%), bolus (24%), Tocilizumab (57.4%), Infliximab (24.1%), Lopinavir/Ritonavir (48%), Hydroxychloroquine (94.4%), and Azithromycin (79.6%). Mortality was 22% overall, 75% due to COVID19, 8.3% due to infectious complications and 16.7% due to non-infectious complications. In the group receiving Anakinra as only biological drug, mortality accounted for 17.9% of patients, 75% due to COVID19 and 25% to non-infectious complications. No adverse effects related to anakinra were observed.

General group (n=54)Group receiving anakinra as only biological drug (n=23)PBaselineAfter 72hAfter 7dBaselineAfter 72hAfter 7dBrescia-COVID1.65 (0.95)1.63 (1.13)1.73 (1.19)1.09 (0.8)0.91 (0.88)1.09 (0.8)Mean(SD)Values:Values:Values:Values:Values:Values:NS0: 11.1%0: 16.7%0: 7.9 %0: 26.1%0: 39.1%0: 8.7 %1: 31.5%1: 27.8%1: 52.6%1: 47.8%1: 34.8%1: 82.6%2: 42.6%2: 38.9%2: 18.4%2: 21.7%2: 21.7%2: 8.7%3: 53.7%3: 7.4%3: 7.9%3:4.34%3: 4.34%3: 0%4: 3.7%4: 9.3%4: 13.2%4: 0%4: 0%4: 0%SaFi222.60 (115.2)240.51 (117.6)250.95 (102.6)306.35 (124.7)316.04 (129.8)300.36 (135.4)NSMean (SD)Values:Values:Values:Values:Values:Values:>300:>300:>300:>300:>300:>300:25.9%24.5 %34.2 %56,52%52.2 %45.46 %201-299201-299:201-299:201-299:201-299:201-299:: 14.8%26.4%34.2%17.39%21.7%27.27%<201:<201:<201:<201:<201:<201:59.3%49%31.6%26.1%26.1%27.27%Lymphocytes, 10^3/microLMean (SD)1.07 (1.5)5.16 (3.05)1.15 (2.49)0.88 (0.56)1.25 (0.79)1.15. (2.4)NSFerritine,ng/mlMean (SD)1098.4 (944.8)1080.23 (873.9)1069.19 (989.42)1112.76 (621.80)903.25 (385.49)704.14 (261.86)NSC-reactive protein, mg/LMean (SD)38.78 (37.58)21.46 (20.17)7 (6)50 (6.38)34.67 (23.3)19.96 (28.92)NSLDH, U/LMean (SD)387.64 (163.1)394.98 (209.32)374.26 (157.63)326.38 (111.66)308 (116.59)355 (151.96)NSRespiratory improvement*N/A20.37%51.85%N/A30.43%69.5%.007Lab test improvement**N/A51.85%77.78%N/A60.87%78.2%NS

* SaFi normalised or increased 100 mmHg or more

** Improvement of 2 or more analytic variables

Conclusion:

Anakinra in severe SARS-CoV-2 infection offers respiratory improvement and partial lab tests improvement. No adverse effects were observed.

Acknowledgements:

We wish to acknowledge Puerta de Hierro Majadahonda COVID19 task force and all the patients and staff affected by the pandemic.

Disclosure of Interests:

None declared

AB0503 DISEASE CONTROL IN ANKYLOSING SPONDYLITIS PATIENTS WITH PERIPHERAL ARTHRITIS IN REAL CLINICAL PRACTICE IN SPAIN: MiDAS STUDY RESULTS

Background:

MIDAS study assessed disease activity in patients (pts) with ankylosing spondylitis (AS) treated in clinical practice in Spain.

Objectives:

This subanalysis compared disease activity status between AS pts with and without peripheral arthritis (PA).

Methods:

Observational, non-interventional, cross-sectional, multicenter study. Pts ≥18 years with ≥6 months diagnosis, fulfilling ASAS and modified New York criteria; undergoing treatment ≥3 months. Disease activity was measured by BASDAI and ASDAS-CRP. The number of painful and swollen joints was recorded in AS pts according to the OMERACT recommendations.1

Results:

313 AS pts included: 251 (80.2%) without PA and 62 (19.8%) with PA (Table 1). The most frequently involved painful joints in pts with PA were knees (29.0%) and hips (25.8%), while the swollen ones were proximal interphalangeal joints of the hands (17.7%), knees (9.7%) and wrists (8.1%). According to BASDAI (Figure 1A), pts with PA showed a higher score 4.2 (2.4) and a lower percentage 58.1% had disease activity controlled (BASDAI<4) than total AS pts (3.1 [2.2] and 64.5%, respectively) and pts without PA (2.8 [2.1] and 70.1%, respectively). According to ASDAS-CRP (Figure 1B), mean (SD) score was 1.9 (1.1) for AS pts, 2.4 (1.1) for pts with PA and 1.8 (1.1) for pts without PA, while 29.4% AS pts, 14.5% pts with PA and 33.1% pts without PA had inactive disease (ASDAS-PCR<1.3). By combining both indices (ASDAS-CRP and BASDAI), 51.8% AS pts showed adequate control (inactive disease/remission) of disease activity, 29.0% of pts with PA and 57.4% of pts without PA.

Table 1.

Baseline demographic and clinical characteristics of the AS pts

AS(n=313)AS without PA(n=251)AS with PA(n=62)Age (years), mean (SD)50.4 (12.0)50.1 (11.9)51.5 (12.5)Sex (male), n (%)237 (75.7%)193 (76.9%)44 (71.0%)Time since diagnosis (years), mean (SD)15.5 (11.6)15.4 (11.4)16.0 (12.6)Time from onset of symptoms to diagnosis (years), mean (SD)5.0 (7.2)4.9 (7.1)5.6 (7.6)Presence of HLA-B*27+, n (%)245 (78.5%)197 (78.8%)48 (77.4%)Family history of AS, n (%)66 (21.1%)55 (21.9%)11 (17.7%)Family history of psoriasis, n (%)43 (13.7%)34 (13.5%)9 (14.5%)Pts previously treated with bDMARD, n (%)99 (31.6%)79 (31.5%)20 (32.3%)Swollen joint count (0-66), mean (SD)0.1 (0.9)0.0 (0.0)0.7 (1.9)Painful joint count (0-68), mean (SD)0.6 (2.4)0.0 (0.0)3.0 (4.7)CRP levels (mg/l), mean (SD)5.1 (8.2)4.7 (7.6)6.7 (10.3)Active disease, n (%)* BASDAI ≥4111 (35.5%)26 (41.9%)75 (29.9%) ASDAS-CRP ≥2.1133 (42.4%)93 (37.1%)40 (64.5%) BASFI, mean (SD)3.4 (2.7)3.1 (2.6)4.5 (2.8) MASES index, mean (SD)0.2 (0.8)0.2 (0.7)0.4 (1.2) SPARCC index, mean (SD)0.4 (1.1)0.3 (1.0)0.6 (1.4) Pts perceived disease control (PASS), n (%)270 (86.3%)221 (88.0%)49 (79.0%) ASAS-HI, mean (SD)5.8 (4.4)5.4 (4.2)7.6 (4.6)

*Refers to the percentage of pts with active disease according to BASDAI≥4 and ASDAS-CRP ≥2.1.

Figure 1.

Disease status according to peripheral joints involvement A)Disease control according to BASDAI B)Disease activity according to ASDAS-CRP

Conclusion:

Patients of the MiDAS study with peripheral disease showed higher disease activity and worse physical function, suggesting a severe and complex phenotype more than the one of the AS pts without PA.

References:

[1]J Rheumatol 1993;20:526-91.

AS, ankylosing spondylitis; ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score- C-reactive protein; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; PA, peripheral arthritis.

Acknowledgements:

We thank to MIDAS group investigators and patients included in the study.

Disclosure of Interests:

Xavier Juanola Speakers bureau: Novartis, Abbvie, Pfizer, Lilly, Consultant of: Novartis, Lilly, Abbvie, Cristina Fernández-Carballido Speakers bureau: I have received lectures fees from Abbvie, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB., Consultant of: I have worked as a paid consultant for Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB., Alejandro Muñoz Jimenez.: None declared., Jesus Sanz Speakers bureau: Abbvie, Janssen-Cilag, Novartis, Lilly, Consultant of: Abbvie, Janssen-Cilag, Novartis, Lilly, Amgen, Grant/research support from: Abbvie, ANA URRUTICOECHEA-ARANA Speakers bureau: Abbvie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Consultant of: Abbvie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Patricia Moya Speakers bureau: Abbvie, Novartis and UCB, Consultant of: Roche, Joaquin Maria Belzunegui Otano Speakers bureau: Lilly, Amgen, Novartis, Abbvie, Janssen., Cristina Sanabra Employee of: Novartis employee, Carlos Sastré Employee of: Novartis employee.

Long-term results of a randomized partial irradiation trial compared to whole breast irradiation in the early stage and low-risk breast cancer patients after conservative surgery

PURPOSE

To report long-term results of a randomized trial comparing accelerated partial breast irradiation (APBI) to whole-breast irradiation (WBI) in terms of efficacy, toxicity, and cosmesis.

METHODS AND MATERIALS

WBI group was treated with 3D conformal external irradiation, 2 Gy daily/fraction, 5 fractions/week, to a total dose of 50 Gy. APBI group was treated with 3D conformal external irradiation 3.75 Gy/fraction, twice a day, 5 fractions/week, to a total dose of 37.5 Gy in the APBI group. Patients were followed up every 6 months up to 5 years and yearly thereafter. During follow-up visits, the clinician evaluated chronic toxicity and scored cosmetic results with a four-scale system.

RESULTS

After a median follow-up of 10.3 years, 43 patients in each group (84%) are alive without disease. One patient died after disease progression in the APBI arm, and there was no death in the WBI arm. The rest of the patients died from another disease different than breast cancer, similarly between groups. There was greater fibrosis in the APBI group (9 patients grade 1 and one grade 2) compared to WBI (3 patients grade 1 and one grade 2); p = 0.18. Regarding cosmesis, in APBI group, 19 and 21 (43.2 and 47%) patients had excellent or good results, similar to the WBI group with 18 patients (40.9%) in each cosmesis outcome. The WBI group did not have any patient with poor cosmesis but the APBI had 3 (6.8%; p = 0.24).

CONCLUSION

After a follow-up of 10 years, there were no differences in efficacy between the 2 treatment arms. Despite slight greater toxicity in the APBI group, the cosmesis was similar and satisfactory in both groups.

New three-dimensional volumetric ultrasound probe for accurate quantification of atherosclerotic plaque volume

Background

Atherosclerosis burden is directly related with the development of clinical cardiovascular events. Recent ESC guidelines endorse carotid and/or femoral plaque burden assessment as a complement for conventional cardiovascular risk evaluation. Compared with previous 3D probes, new 3D-matrix transducers for vascular ultrasound imaging are designed to improve functionality and image quality for an accurate study of atherosclerosis burden.

Purpose

We aimed to validate a commercially available 3D-matrix transducer for plaque volume measurement in early disease stages (small plaques) when accurate plaque detection and quantification is challenging, and intermediate-advanced (medium-large size) plaques in carotid and femoral arteries.

Methods

We performed an ex vivo study using carotid and femoral arterial specimens from a pig model of early atherosclerosis in which actual 3D vascular ultrasound (3DVUS) volume measurements obtained using the new 3D-matrix transducer (XL14–3) were correlated against gold-standard histological measurements. Moreover, we performed a clinical experiment in a subset of intermediate-high risk patients from the “Athero-Brain: Head to Heart (H2H)” study with patent carotid and femoral atherosclerosis for comparing plaque volume evaluated by the new XL14–3 3D-matrix transducer, based on “electronic” 3D-sweep technology, with that measured by previously validated VL13–5 “mechanical” 3D-sweep transducer that uses a mechanically steered linear-array.

Results

In the ex vivo setting, we evaluated 11 atherosclerotic plaques (6 carotid and 5 femoral plaques, mean plaque volume 16.5±22.5 mm3 ranging in size from 1 to 56 mm3), finding a strong correlation between 3DVUS measures and the histological gold-standard with an intraclass correlation coefficient (ICC) of 0.994 (95% CI [0.976; 0.998]). In the clinical setting, we measured 25 plaques (14 carotid and 11 femoral plaques; mean plaque volume 273.4±216.5 mm3 ranging in size from 10 to 859 mm3) from 8 patients (mean age 75±5 years old, 45% men) finding again a strong correlation between 3DVUS electronic-based and mechanical-based volume measurements (ICC=0.996 95% CI [0.991; 0.998]). Correlation and Bland-Altman plots for the measurements of both experiments are displayed in the figure and showed good agreement (Slope close to 1 in the Passing Bablock analysis) with small or lower than clinically relevant differences between measurements.

Conclusions

3DVUS using new matrix technology accurately measures plaque volumes of early (small-size) to intermediate-advanced plaques located in superficial arteries like carotid and femoral arteries.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Carlos III Institute through an Integrated Excellence Project Grant

Weekly radiotherapy in elderly breast cancer patients: a comparison between two hypofractionation schedules

PURPOSE

Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations.

MATERIALS AND METHODS

47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups.

RESULTS

After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters.

CONCLUSION

Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation.

AB0726 CHOROIDAL THICKNESS IS A BIOMARKER AND CAN PREDICT THE RESPONSE TO TREATMENT IN ANKYLOSING SPONDYLITIS

Background:

Choroidal thickness (CT) has been proposed and evaluated as a potential marker of systemic inflammation associated with inflammatory diseases as Ankylosing spondylitis (AS). Patients with active AS have a thicker choroid than healthy subjects, regardless of eye inflammation. The evolution of choroid after treatment is poorly known.

Objectives:

This study evaluates the CT of patients with severe AS disease activity before and after six months of biological therapy.

Methods:

This prospective multicenter study evaluates the CT in 44 patients with high AS disease activity, naïve for biological treatment, and no history of eye inflammation before and after six months of biological therapy, aged from 18 to 65 years. The correlations between the CT and C-reactive protein (CRP) with the disease activity indices and scales as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), night pain and Patient Global Assessment (PGA) were calculated at baseline and after six months of biological therapy. The concordance between the CT and CRP was determined. Finally, we assessed potential predictors of response to treatment. Clinically important improvement was defined as a decrease in ASDAS score ≥ 1.1 points.

Results:

Globally, 44 eyes of 44 patients aged between 18-65 years were included in the study, 12 (27%) women. The biological treatments prescribed were: Adalimumab 13 (29.5%), Certolizumab 9 (20.5%), Secukinumab 10 (20%), Etanercept 8 (18%), Infliximab 3 (6.8%), and Golimumab 1 (2.2%).

Mean CT values were significantly higher at baseline than after six months of treatment (baseline 355.28±80.46 µm; 6 months, 341.26±81.06 µm) (p<0.001).

CT decreased both in patients on biological treatment without effect in eye (Secukinumab and Etanecept; p=0.024) and in patients on treatment with effect in eye (other; p=0.005). Also, CRP, BASDAI, night pain and PGA decreased after six months of treatment ((p<0.001, p<0.001, p<0.001, p<0.001). We found a 95% concordance between CT and CRP at baseline and 6 months.

Multivariable analysis showed that clinically important improvement was associated with higher CT and age as independent factors (OR 0.97, CI95% 0.91-0.93; p=0.009, and OR 0.81, CI95% 0.7-0.95; p=0.005). Clinically important improvement was associated with basal CT >374 µm (sensitivity 78 %, [CI 95% 60-90], specificity 78% [CI 95% 52-92], area under the curve of ROC, 0.70, likelihood ratio 3.6).

Conclusion:

CT decreased significantly after six months of biological treatment. CT and CPR had a 95% concordance. A high CT is associated with risk of failure to biological treatment. CT can be considered as a useful biomarker of inflammation and predictor of response to treatment in AS.

References:

[1]Karkucak M, Kalkisim A, Kola M, et al. SAT0408 anti Tnf-α therapy provides beneficial effects on choroidal thickness increase in patients with active ankylosing spondylitis: a possible mechanism of infliximab effectiveness in suppressing uveitis attacks.Ann Rheum Dis. 2016;75:817.

Disclosure of Interests:

None declared

SAT0386 USEFULNESS OF THE FECAL CALPROTECTIN AS SCREENING TOOL FOR INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH SPONDYLOARTHRITIS AND NO DIGESTIVE SYMPTOMS

Background:

Fecal calprotectin (FC) is a biomarker of bowel inflammation widely spread in diagnosis and follow-up of inflammatory bowel disease (IBD). It is classically estimated that 5% of patients with axial spondyloarthritis (SpA) also have IBD; coexistence of both conditions has definite impact in clinical decisions. Proactive detection of both diseases should be advisable, though appropriate screening tools are still lacking.

Objectives:

To evaluate the usefulness of FC for the diagnosis of IBD in patients diagnosed with SpA with no clinical suggestive manifestations or previous diagnosis of IBD.

Methods:

Patients from a Rheumatology clinic diagnosed with SpA who met ASAS criteria and did not present digestive symptoms suggestive of IBD were consecutively included. Demographics, clinical and analytical data of SpA (uveitis, HLA B27, acute phase reactants) at the time of inclusion, and treatment history were collected. Patients with a positive FC (> 50 mg/Kg) underwent ileocolonoscopy with biopsies of colon and terminal ileum. Patients who were recommended to avoid NSAIDs 2-4 weeks before stool collection and endoscopy.

Patients with no endoscopic findings underwent a second determination of fecal calprotectine. If persisted positive, capsule endoscopy was performed to evaluate small intestine.

Results:

98 patients included; 47% male, mean age 46.1 (20-74) years. BASDAI 3.6 ± 2.5. HLA B27 positive in 78% of patients, high ESR in 31.6%, high CRP in 9.2%. FC positive in 49 patients (50%): mean 147 mg/kg (range 0-3038).

47 underwent ileocolonoscopy: In 13 cases (26.5%), endoscopic findings were suggestive of IBD (7 Crohn’s disease and 1 ulcerative colitis). Microscopic inflammation was found in 2 additional cases. Among those 34 patients with normal ileocolonoscopy, 16 patients refused further investigations; among the remining 18 patients, a second FC was positive in 16. Capsule endoscopy showed findings suggestive of small intestine IBD in 6 additional patients.

In patients with high FC levels,those with high CRP and ESR were more likely to have IBD(29% v 16% and 29% v 12% respectively). Patients with a history ofuveitis(18% vs 12%) orpsoriasis(33% v 16%) also had a higher prevalence of IBD, although none of those differences reached statistical significance.

FC was higher insmokers(72%v 44%; p=0.03). There were no significant differences regarding HLA B27. No statistically significant differences were found in FC between patients with high FC who were diagnosed with IBD and those who were not.

Conclusion:

In our study, patients with SpA and no clinical feature suggestive of IBD who showed FC> 50 mg/kg had high prevalence of IBD, which could indicate theusefulness of FC as screening tool for IBD in patients with SpA.

Patients with SpA and other immune-mediated condition or elevated CRP, seem to be more likely to have subclinical IBD.

Disclosure of Interests:

None declared

Dorsolateral prefrontal N-acetyl-aspartate concentration in male patients with chronic schizophrenia and with chronic bipolar disorder

Objectives

A study of N-acetyl-aspartate (NAA) can provide data of interest about cortical alterations in psychotic illnesses. Although a decreased NAA level in the cerebral cortex is a replicated finding in chronic schizophrenia, the data are less consistent for bipolar disease. On the other hand, it is likely that NAA values in schizophrenia may differ in men and women.

Methods

We used proton magnetic resonance spectroscopy (1H MRS) to examine NAA levels in the prefrontal cortex in two groups of male patients, one with schizophrenia (n = 11) and the other with bipolar disorder (n = 13) of similar duration, and compared them to a sample of healthy control males (n = 10). Additionally, we compared the degree of structural deviations from normal volumes of gray matter (GM) and cerebrospinal fluid (CSF) in the dorsolateral prefrontal cortex.

Results

Compared to controls, schizophrenia and bipolar patients presented decreased NAA to creatine ratios, while only the schizophrenia group showed an increase in CSF in the dorsolateral prefrontal region. There were no differences in choline to creatine ratios among the groups.

Conclusions

These data suggest that the decrease in NAA in the prefrontal region may be similar in schizophrenia and bipolar disorder, at least in the chronic state. However, cortical CSF may be markedly increased in schizophrenia patients.

Potential of topological descriptors to model the retention of polychlorinated biphenyls in different gas chromatography stationary phases, including ionic liquid-based columns

The aim of this study was to develop a statistical model based on a set of intuitive topological descriptors that will help to determine the influence of the polychlorinated biphenyls (PCBs) structural features on the chromatographic behavior of these analytes in a variety of gas chromatographic stationary phases, including the highly polar ionic liquid (IL)-based SLB-IL76 and SLB-IL60 columns. The model was developed using the stepwise multiple linear regression method, and constructed through several levels of increasing complexity to make evident the relative influence of the selected descriptors. The proposed model was easy to implement and provided similar satisfactory results irrespective of the dependent variables used (i.e., retention index or retention time) or the chromatographic conditions applied (i.e., pseudo-isotherm and programmed temperature) for IL-based phases. The model also allowed the correct prediction of the elution order of selected PCBs in these and other less polar phases evaluated (i.e., SW-10, DB-17, ZB-5 and HT-8). To our knowledge, this is the first models based on topological descriptors described in the literature that provided a satisfactory fitting of the PCB behavior in IL-based phases. Our results indicated that the mechanism governing the chromatographic separation of PCBs in these highly polar columns showed significant differences compared with those observed in other less polar stationary phases.

Cord blood transplantation is associated with good outcomes in secondary Acute Myeloid Leukaemia in first remission

BACKGROUND

We conducted a retrospective survey within the European Society for Blood and Marrow Transplantation (EBMT) registry to assess the outcomes of cord blood transplantation (CBT) in secondary acute myeloid leukaemia (sAML).

METHODS

Inclusion criteria consisted of ≥18 years of age, sAML, first CBT between 2002 and 2016, and either first complete remission (CR) or active disease at CBT.

RESULTS

One hundred forty-six patients met the study inclusion criteria. Status at transplantation was first CR (n = 97), primary refractory sAML (n = 30) or relapsed (n = 19) sAML. Neutrophil engraftment was achieved in 118 patients while the remaining 25 patients (17%) failed to engraft. This includes 13% of patients transplanted in first CR versus 30% of those transplanted with active disease (P = 0.008). Two-year incidences of relapse were 25% in first CR patients versus 36% in those with advanced disease (P = 0.06) while 2-year incidences of nonrelapse mortality were 35% and 49% (P = 0.03), respectively. At 2-year overall survival, leukaemia-free survival and graft-versus-host disease (GVHD)-free relapse-free survival were 42% vs. 19% (P < 0.001), 40% vs. 16% (P < 0.001), and 26% vs. 12% (P = 0.002) in first CR patients versus those with advanced disease, respectively.

CONCLUSIONS

We report here the first study of CBT in a large cohort of sAML patients. Main observation was that CBT rescued approximately 40% of patients with sAML in first CR.

EXPERIMENTAL EVALUATION OF NEUTRON SHIELDING MATERIALS

A new proposed design of neutron shielding material-based on the commercial material Borotron UH050 with an addition of Al(OH)3-is evaluated in order to determine if its neutron and gamma shielding properties match those of a reference material, NS4FR. Neutron and gamma dosimetry measurements are performed, as well as neutron spectrometry measurements and Monte Carlo simulations. Negligible differences are found between the materials for neutron shielding, while significant differences are found for gamma shielding. The effect of Al(OH)3 addition to Borotron UH050 is to reduce neutron shielding properties while increasing gamma shielding properties. The resulting material is as efficient as NS4FR for neutron shielding but less efficient for gamma shielding-thicknesses 20% higher are required to match gamma shielding properties of NS4FR. Monte Carlo models of the materials are validated based on the performed measurements of neutron spectra and neutron and gamma ambient dose equivalent.

Bright Soliton to Quantum Droplet Transition in a Mixture of Bose-Einstein Condensates

Attractive Bose-Einstein condensates can host two types of macroscopic self-bound states: bright solitons and quantum droplets. Here, we investigate the connection between them with a Bose-Bose mixture confined in an optical waveguide. We show theoretically that, depending on atom number and interaction strength, solitons and droplets can be smoothly connected or remain distinct states coexisting only in a bistable region. We measure their spin composition, extract their density for a broad range of parameters, and map out the boundary of the region separating solitons from droplets.

Occurrence of graft-versus-host disease increases mortality after umbilical cord blood transplantation for acute myeloid leukaemia: a report from Eurocord and the ALWP of the EBMT

BACKGROUND

The efficacy of umbilical cord blood transplantation (UCBT) as treatment for acute myeloid leukaemia (AML) relies on immune-mediated graft-versus-leukaemia effects. Previous studies have suggested a strong association between graft-versus-host disease (GVHD) occurrence and graft-versus-leukaemia effects after allogeneic hematopoietic cell transplantation.

METHODS

Here, we evaluated the kinetics of relapse rate in correlation with GVHD occurrence after UCBT. The kinetics of relapse rate over time in correlation to GVHD occurrence were assessed by calculating the relapse rate per patient-year within sequential 90-day intervals. The impact of GVHD on relapse and mortality was further studied in multivariate Cox models handling GVHD as a time-dependent covariate.

RESULTS

The study included data from 1068 patients given single (n = 567) or double (n = 501) UCBT. The proportion of patients with grade II, III and IV acute GVHD was 20%, 7% and 4%, respectively. At 2 years, the cumulative incidence of chronic GVHD was 42%, the cumulative incidence of relapse was 32%, and overall survival was 32% as well. Relapse rates declined gradually over time during the first 30 months after transplantation. There was a possible suggestion that grade II-IV acute (HR = 0.8, P = 0.1) and chronic (HR = 0.65, P = 0.1) GVHD decreased relapse risk. However, grade II-IV acute GVHD significantly increased early (the first 18 months after UCBT) mortality (HR = 1.3, P = 0.02), whilst chronic GVHD increased each early (HR = 2.7, P < 0.001) and late (HR = 4.9, P < 0.001) mortality after UCBT.

CONCLUSIONS

The occurrence of grade II-IV acute or chronic GVHD each increases overall mortality after UCBT for AML mitigating the possible graft-versus-leukemia effect of GVHD.