SAT0438 REAL-WORLD TREATMENT PERSISTENCE WITH BIOLOGIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS AMONG GERMAN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Persistence rates of biologic disease modifying antirheumatic drugs (bDMARDs), which refer to the duration of time from initiation to discontinuation or switch of therapy, have been shown to vary considerably depending on the country, types of health centers, as well as the specific drug being investigated. Evidence on treatment persistence of psoriatic arthritis (PsA) patients in Germany is scarce.

Objectives:

Our aim was to study drug survival of bDMARDs in a German real-world cohort of adult biologic-naïve psoriatic arthritis patients.

Methods:

We utilized the German “Institut für angewandte Gesundheitsforschung Berlin” (InGef) research database consisting of about 4 million covered lives structured to represent the German population in terms of age and gender according to the Federal Office of Statistics (DESTATIS). Thereof, 2.9 million patients were continuously enrolled in the study period spanning from January 1st, 2013 and December 31st, 2018. For the analysis of persistence rates, the study population was identified based on the International Classification of Diseases, German Modification (ICD-10-GM) and claims records of biologic prescriptions based on ATC codes. Adult patients who had a diagnosis of psoriasis arthritis (L40.5 in combination with M07.0 or M07.1 or M07.2 or M07.3) in the inpatient or outpatient setting, and a claims record of biologic treatment licensed for psoriasis arthritis between January 1st, 2014 to December 31st, 2017 were included. Patients with Crohn’s disease (K50), ulcerative colitis (K51), ankylosing spondylitis (M45), and rheumatoid arthritis (M05-M07) were excluded. Biologic-naïve patients were identified as those who had no prior record of bDMARDs prescription during the 12 months before the index date (‘washout’). The index date was defined as the first claim for a biologic agent. Non-persistence occurred if a treatment gap exceeding the days of supply plus 60 days or a switch to a bDMARD other than the index therapy was observed. Days of supply were calculated based on the daily defined doses defined by the WHO for the respective bDMARDs. Kaplan-Meier curves were plotted to show the persistence of different biologics. The log-rank test was used to test for differences in the 1-year persistence rate.

Results:

Among 10,954 patients with a diagnosis of PsA, 348 biologic-naïve patients aged 18 years or above were identified. The one-year overall persistence rate was 57.5% for all bDMARD compounds. Reasons for non-persistence were switches to a different bDMARD agent in 15.8% of patients and 26.7% discontinued treatment. The highest persistence rate was observed for ustekinumab (81.3%), which was significantly higher than the respective rates for adalimumab (58.1%), certolizumab pegol (51.7%), etanercept (51.0%), or secukinumab (54.7%).

Conclusion:

Persistent rates for a real-world cohort of German PsA patients are modest with significant variations among different bDMARD therapies.

Disclosure of Interests:

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Kathrin Borchert Consultant of: Janssen-Cilag GmbH, Dominic Meise Consultant of: Janssen-Cilag GmbH, Jörg Mahlich Shareholder of: Janssen-Cilag GmbH, Employee of: Janssen-Cilag GmbH

Cisplatin and 5-fluorouracil with or without epidermal growth factor receptor inhibition panitumumab for patients with non-resectable, advanced or metastatic oesophageal squamous cell cancer: a prospective, open-label, randomised phase III AIO/EORTC trial (POWER)

BACKGROUND

Palliative chemotherapy of advanced oesophageal squamous cell cancer (ESCC) consists of cisplatin/5-fluorouracil (CF) to target epidermal growth factor receptor (EGFR) with panitumumab (P); chemotherapy enhanced overall survival (OS) in advanced colorectal or squamous cell head and neck cancers. With prospective serum and tumour biomarkers, we tested if P added to CF (CFP) improved OS in advanced ESCC.

PATIENTS AND METHODS

Eligible patients with confirmed ESCC that was not curatively resectable or did not qualify for definitive radiochemotherapy, were randomised 1 : 1 to receive CF [cisplatin (C) 100 mg/m² i.v., day 1; 5-fluorouracil (F) 1000 mg/m² i.v., days 1-4] or CF plus P (9 mg/kg, i.v., day 1, each q3-week cycle) until progressive disease or unacceptable toxicity. Safety was reviewed by the Data Safety Monitoring Board after 40, 70 and 100 patients who completed at least one cycle. After 53 enrolled patients, cisplatin was reduced from 100 mg/m² to 80 mg/m².

RESULTS

The trial was stopped early based on interim efficacy results triggered by the third safety analysis: median OS (mOS) favoured CF over CFP, regardless of cisplatin dose [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.06-2.98; P = 0.028]. In the final analysis, mOS was 10.2 versus 9.4 months for CF versus CFP, respectively (HR 1.17, 95% CI 0.79-1.75; P = 0.43). One hundred (70.4%) of 142 patients in the safety population died, 51 (51.0%) with CFP. Most deaths were related to disease progression [44/49 (90%) deaths in CF versus 34/51 (67%) deaths in CFP]; objective responses [27/73 (37.0%)] were identical. The most common serious adverse events were kidney injury [3 (4.3%) versus 7 (9.7%)], general health deterioration [5 (7.1%) versus 5 (6.9%)] and dysphagia [4 (5.7%) versus 4 (5.6%)] in CF versus CFP, respectively. There were three (4.3%) and 17 (23.6%) common terminology criteria for adverse events (CTCAE) grade 5 events in CF versus CFP, respectively. Low soluble (s)EGFR levels were associated with better progression-free survival; sEGFR was induced under CFP.

CONCLUSION

EGFR inhibition added to CF did not improve survival in unselected advanced ESCC patients. The results support further liquid biopsy studies.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01627379) and EudraCT (2010-020606-15).

A comprehensive analysis of the cellular and EBV-specific microRNAome in primary CNS PTLD identifies different patterns among EBV-associated tumors

Primary central nervous system (pCNS) posttransplant lymphoproliferative disorder (PTLD) is a complication of solid organ transplantation characterized by poor outcome. In contrast to systemic PTLD, Epstein-Barr virus (EBV)-association of pCNS PTLD is almost universal, yet viral and cellular data are limited. To identify differences in the pattern of EBV-association of pCNS and systemic PTLD, we analyzed the expression of latent and lytic EBV transcripts and the viral and cellular microRNAome in nine pCNS (eight EBV-associated) and in 16 systemic PTLD samples (eight EBV-associated). Notably although 15/16 EBV-associated samples exhibited a viral type III latency pattern, lytic transcripts were also strongly expressed. Members of the ebv-miR-BHRF1 and ebv-miR-BART clusters were expressed in virtually all EBV-associated PTLD samples. There were 28 cellular microRNAs differentially expressed between systemic and pCNS PTLD. pCNS PTLD expressed lower hsa-miR-199a-5p/3p and hsa-miR-143/145 (implicated in nuclear factor kappa beta and c-myc signaling) as compared to systemic PTLD. Unsupervised nonhierarchical clustering of the viral and cellular microRNAome distinguished non-EBV-associated from EBV-associated samples and identified a separate group of EBV-associated pCNS PTLD that displayed reduced levels of B cell lymphoma associated oncomiRs such as hsa-miR-155, -21, -221 and the hsa-miR-17-92 cluster. EBV has a major impact on viral and cellular microRNA expression in EBV-associated pCNS PTLD.

Mobilization of PBSC for allogeneic transplantation by the use of the G-CSF biosimilar XM02 in healthy donors

The human recombinant G-CSF filgrastim has been widely used for the mobilization of CD34⁺ stem cells of healthy donors (HD). In 2008, the G-CSF biosimilar XM02 (Ratiograstim, Tevagrastim and Biograstim) was approved by the European Medicines Agency (EMA) for the mobilization of PBSC. However, there is limited experience in the application of biosimilar G-CSF for the mobilization of PBSC especially in HD. Therefore, we investigated in two cohorts (n=22), the efficacy and safety of PBSC mobilization by either biosimilar G-CSF or reference G-CSF. We observed a similar yield of CD34⁺ stem cells as well as CD3⁺ T-cells and nucleated cells in both groups and a safe engraftment in all patients with similar reconstitution of hematopoiesis in all hosts. In summary, we found a comparable efficacy and safety of biosimilar G-CSF when compared with reference G-CSF.

Glutamine-enriched total parenteral nutrition in patients with inflammatory bowel disease

BACKGROUND

Studies in animal models of inflammatory bowel disease (IBD) suggest that supplementation of total parenteral nutrition with glutamine (gln), a conditionally essential amino acid in catabolic conditions, increases gln plasma concentrations, reduces intestinal damage, improves nitrogen balance and may improve the course of the disease. However, human data supporting this assumption are missing.

METHODS

A total of 24 consecutive patients with an acute exacerbation of IBD (19 Crohn's disease; five ulcerative colitis) and scheduled for total parenteral nutrition (TPN) (>7 days) were randomised. Parallel to a standardised anti-inflammatory therapy, the patients received either a TPN with 1.5 g/kg body weight of a standard amino acid or an isonitrogenic, isocaloric TPN with 1.2 g/kg body weight of a standard amino acid and 0.3 g/kg L-alanine-L-glutamine. Primary end points were gln plasma concentrations and intestinal permeability assessed by urinary lactulose and D-xylose ratio.

RESULTS

Gln plasma levels did not differ significantly in either group throughout the study. Intestinal permeability did not change within 7 days either with or without gln supplementation (Delta-lactulose/xylose ratio: 0.01+/-0.05 (gln+) vs 0.02+/-0.1 (gln-)). The observed changes in inflammatory and nutritional parameters, and also disease activity, length of TPN and hospital stay, were independent of glutamine substitution. Five (41%) patients in the gln+ group and three (25%) patients in the gln- group needed surgical intervention.

CONCLUSION

Although limited by the sample size, these results do not support the hypothesis that glutamine substitution has an obvious biochemical or clinical benefit in patients with active IBD scheduled for total parenteral nutrition.

Evaluation of long-term efficacy and safety of transdermal fentanyl in the treatment of chronic noncancer pain

The objective of this international, multicenter, open-label trial was to assess the efficacy and safety of up to 12 months of therapy with transdermal therapeutic system (TTS) fentanyl in patients (n = 532) with chronic noncancer pain. The trial was completed by 301 (57%) of the patients. The main outcome measures were pain control assessment, global treatment satisfaction, patient preference for TTS fentanyl, and quality of life. The mean dose of transdermal fentanyl (TDF) increased from 48 to 90 microg/h during a period of 12 months. During treatment, on average 67% of patients within the efficacy analysis group (n = 524) reported very good, good, or moderate pain control. Global satisfaction (very good or good) was also stable at 42%. The majority (86%) of patients reported a preference for TDF over their previous treatment (P < .001, binomial test). Short Form 36 quality-of-life scores improved from baseline for bodily pain. The most frequent treatment-related adverse events were nausea (31%), constipation (19%), and somnolence (18%). With regard to opioid-specific adverse events (respiratory depression [< 1%], adrenal insufficiency [< 1%], drug abuse/dependence [1%], and opioid withdrawal syndrome [3%]), these were extremely rare and, with the exception of opioid withdrawal syndrome, none was considered definitively related to the treatment. Long-term treatment with TDF provided a stable degree of pain control in the majority of patients with moderate to severe chronic noncancer pain. It was preferred by the majority of patients compared with their previous opioid medication. Overall, long-term treatment with TDF was generally well tolerated, particularly in view of the low incidence of potentially serious side effects such as drug abuse/dependence and respiratory depression. However, at present, it is important that patients receiving TDF should still be subject to careful assessment and monitoring.

Evaluation of a novel mononuclear cell isolation procedure for serological HLA typing

Despite recent advances in DNA-based genotyping, the microcytotoxicity test is still broadly used for the determination of human leukocyte class I antigens in patients as well as organ donors and also for the detection of HLA antibodies. Excellent purity and viability of peripheral blood mononuclear cells (PBMC) are essential for reliable HLA typing results. Background staining and cell loss can contribute to impaired typing results or even cause misinterpretations. A novel isolation procedure using cell preparation tubes (CPT) with prefilled Ficoll was compared with the standard Ficoll gradient. We determined the recovery, purity, and viability of the PBMC after several periods of storage. Finally, the isolated cells were used for HLA class I typing, and background reactivities were scored. By using the CPT method, the recovery of PBMC was significantly higher than recovery with the standard technique (P </= 0.001). Contamination by granulocytes increased considerably during the storage time for the standard protocol, whereas purity remained stable when CPT were used (P </= 0.001). With both methods, lymphocyte viability declined markedly over time. We found significantly more dead cells by using the CPT methods. Due to high background scores, HLA typing was impossible after 48 h. The isolation of PBMC by the CPT method resulted in a higher yield and improved purity compared to those obtained with the standard gradient technique. The decreasing viability after 48 h limits the use of both methods for HLA typing and HLA antibody screening.

The development of chromatic and achromatic contrast sensitivity in infancy as tested with the sweep VEP

Swept-contrast visual evoked potential (VEP) techniques were used to measure the development of contrast sensitivity functions (CSFs) for achromatic and red/green isoluminant chromatic gratings. Subjects were infants of 8, 14, 20 and 32 weeks of age, and adults. Stimuli were 20 deg, 0.3-4 cyc/deg sinusoidal gratings, counterphased at 6 Hz and modulated through white. Achromatic and chromatic CSFs for all ages could be fit simultaneously with a double exponential equation of a common, lowpass shape. Both achromatic and chromatic CSFs exhibited developmental shifts in both sensitivity and spatial scale. From 8 weeks to adulthood, sensitivity increased by 0.64 log units for achromatic gratings and by 0.91 log units for chromatic gratings, yielding an 0.27 log unit larger sensitivity change for chromatic than for achromatic stimuli. Spatial scale shifts were closely similar across achromatic and chromatic CSFs, and were consistent with the factor of about four predicted on the basis of changes in foveal receptor packing density and eye size. The question of uniform vs differential loss of sensitivity for chromatic vs achromatic stimuli at fixed spatial frequencies is discussed.