Patient-perspective and feasibility of home finger-prick testing to complement and facilitate large-scale research in rheumatology

BACKGROUND

During the COVID-19 pandemic, we developed a digital research platform to longitudinally investigate COVID-19-related outcomes in patients with rheumatic diseases and healthy controls. We used home finger-prick testing in order to collect serum samples remotely and increase the overall efficiency of the platform. The aim of the present study was to evaluate the success rate of the finger prick and patients' perspective towards the finger prick.

METHODS

Serum samples were collected up to five times during follow-up, either via a venepuncture at the research institute or a finger prick from participants' home. Participants were asked to complete a digital evaluation questionnaire of the finger prick after their attempts.

RESULTS

A total of 2135 patients and 899 controls performed at least one finger prick and were included in this study. The first finger prick was successfully done by 92% (95% CI: 90% to 93%) of patients, 94% (95% CI: 92% to 95%) of controls, 93% (95% CI: 92% to 94%) of all participants aged ≤70 years and 89% (95% CI: 86% to 92%) of all participants aged >70 years. Sex did not impact these success rates. Repeated failure occurred in 11/439 (0.8%) patients and 4/712 (0.6%) controls. Both patients and controls were less willing to perform a finger prick for individual healthcare compared with scientific research.

CONCLUSION

The vast majority of participants, among which elderly and patients with rheumatic diseases, were able to successfully draw the required amount of blood for serological analyses. This shows that finger-prick testing is suitable for a high-throughput implementation to monitor patients remotely.

Tocilizumab Dose Tapering Based on a Model-Based Algorithm is Feasible in Clinical Practice: A Short Communication

BACKGROUND

Tocilizumab in the treatment of rheumatoid arthritis (RA) is a potential candidate for concentration-guided tapering because the standard dose of tocilizumab results in a wide range of serum concentrations, usually above the presumed therapeutic window, and an exposure-response relationship has been described. However, no clinical trials have been published to date on this subject. Therefore, the objective of this study was to assess the feasibility of the tapering of intravenous (iv) tocilizumab with the use of a pharmacokinetic model-based algorithm in RA patients.

METHODS

A randomized controlled trial with a double-blind design and follow-up of 24 weeks was conducted. RA patients who received the standard of tocilizumab for at least the past 24 weeks, which is 8 mg/kg every 4 weeks, were included. Patients with a tocilizumab serum concentration above 5 mg/L at trough were randomized between concentration-guided dose tapering, referred to as therapeutic drug monitoring (TDM), or the standard 8 mg/kg dose. In the TDM group, the tocilizumab dose was tapered with a recently published model-based algorithm to achieve a target concentration of 4-6 mg/L after 20 weeks of dose tapering.

RESULTS

Twelve RA patients were included and 10 were randomized between the TDM and standard dose group. The study was feasible regarding the predefined feasibility criteria and patients had a positive attitude toward therapeutic drug monitoring. In the TDM group, the tocilizumab trough concentration within patients decreased on average by 24.5 ± 18.3 mg/L compared with a decrease of 2.8 ± 12 mg/L in the standard dose group. None of the patients in the TDM group reached the drug range of 4-6 mg/L. Instead, tocilizumab concentrations of 1.6 and 1.5 mg/L were found for the 2 patients who completed follow-up on the tapered dose. No differences in RA disease activity were observed between the 2 study groups.

CONCLUSIONS

This study was the first to show that it is feasible to apply a dose-reduction algorithm based on a pharmacokinetic model in clinical practice. However, the current algorithm needs to be optimized before it can be applied on a larger scale.

OP0178 COVID-19 BREAKTHROUGH INFECTIONS IN VACCINATED PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES AND CONTROLS – DATA FROM TWO PROSPECTIVE COHORT STUDIES

Background

Concerns have been raised regarding risks of COVID-19 breakthrough infections in vaccinated patients with immune-mediated inflammatory diseases (IMIDs) treated with immunosuppressants, but data on COVID-19 breakthrough infections in these patients are still scarce.

Objectives

The primary objective was to compare the incidence and severity of COVID-19 breakthrough infections with the SARS-CoV-2 delta variant between fully vaccinated IMID patients with immunosuppressants, and controls (IMID patients without immunosuppressants and healthy controls). The secondary objective was to explore determinants of breakthrough infections.

Methods

In this study we pooled data collected from two large ongoing prospective multi-center cohort studies (Target to-B! [T2B!] study and ARC study). Clinical data were collected between February and December 2021, using digital questionnaires, standardized electronic case record forms and medical files. Post-vaccination serum samples were analyzed for anti-RBD antibodies (T2B! study only) and anti-nucleocapsid antibodies to identify asymptomatic breakthrough infections (ARC study only). Logistic regression analyses were used to assess associations with the incidence of breakthrough infections. Multivariable models were adjusted for age, sex, cardiovascular disease, chronic pulmonary disease, obesity and vaccine type.

Results

We included 3207 IMID patients with immunosuppressants and 1810 controls (985 IMID patients without immunosuppressants and 825 healthy controls). The incidence of COVID-19 breakthrough infections was comparable between patients with immunosuppressants (5%) and controls (5%). The absence of SARS-CoV-2 IgG antibodies after COVID-19 vaccination was independently associated with an increased incidence of breakthrough infections (P 0.044). The proportion of asymptomatic COVID-19 breakthrough cases that were additionally identified serologically in the ARC cohort was comparable between IMID patients with immunosuppressants and controls; 66 (10%) of 695 patients vs. 64 (10%) of 647 controls. Hospitalization was required in 8 (5%) of 149 IMID patients with immunosuppressants and 5 (6%) of 86 controls with a COVID-19 breakthrough infection. Hospitalized cases were generally older, and had more comorbidities compared with non-hospitalized cases (Table 1). Hospitalization rates were significantly higher among IMID patients treated with anti-CD20 therapy compared to IMID patients using any other immunosuppressant (3 [23%] of 13 patients vs. 5 [4%] of 128 patients, P 0.041; Table 1).

Table 1.

Determinants of the severity of COVID-19 breakthrough infections.

Ambulatory care (n = 222)Hospitalized (n = 13)Group - no. (%)IMID patients with immunosuppressants141(64)8(62)IMID patients without immunosuppressants49(22)3(23)Healthy controls32(14)2(15)Patient characteristicsAge, years – mean (SD)51(14)60(11)Female sex – no. (%)143(64)4(31)Comorbidities – no. (%)Cardiovascular disease17(8)5(39)Chronic pulmonary disease17(8)4(31)Diabetes15(7)3(23)Obesity34(15)5(39)Immunosuppressants– no. (%)Methotrexate36(16)2(15)TNF inhibitor48(22)2(15)Anti-CD20 therapy13(6)3(23)Mycophenolate mofetil3(1)0(0)S1P modulator5(2)0(0)Other immunosuppressants70(32)3(23)

Conclusion

The incidence of COVID-19 breakthrough infections in IMID patients with immunosuppressants was comparable to controls, and infections were mostly mild. Anti-CD20 therapy might increase patients’ susceptibility to severe COVID-19 breakthrough infections, but traditional risk factors also continue to have a critical contribution to the disease course of COVID-19. Therefore, we argue that most patients with IMIDs should not necessarily be seen as a risk group for severe COVID-19, and that integrating other risk factors should become standard practice when discussing treatment options, COVID-19 vaccination, and adherence to infection prevention measures with patients.

Disclosure of Interests

None declared

POS1520-HPR RHEUMATOLOGY PATIENTS TREATED WITH A bDMARD PERSPECTIVE TOWARDS THERAPEUTIC DRUG MONITORING

Background

Therapeutic Drug Monitoring (TDM) is a tool to determine the optimal dose of a drug for individual patients using measurement of blood concentrations and, optionally, anti-drug antibodies (ADA). In the field of rheumatology interest in applying TDM is increasing. A recent study by Syversen et al., the NOR-DRUM B trail, supports TDM as a treatment strategy. This study showed that treatment with proactive TDM was more effective then treatment without TDM. Applying TDM creates a more personalized treatment for individual patients, therefore it is relevant to understand the patients perspective towards TDM.

Objectives

To study the perspective of rheumatology patients treated with a bDMARD in a personalized fashion using TDM.

Methods

Adult rheumatology patients from the Amsterdam Rheumatology and immunology Center who participate in the COVID-19 prospective cohort study (Nederlands Trial Register, trial ID NL8513) received a digital questionnaire which comprised, in addition to demographic items, of three TDM topics: familiarity, attitude and risk assessment.

Results

Participants were selected based on the following criteria: treatment with a bDMARD and a fully completed questionnaire (n=888). Table 1 shows characteristics of study population.

Table 1.

Characteristics of study population

Total N= 888Age, yr Mean (SD)55(13)Gender, female - N (%)575(65)Diagnosis* - N (%)RA511(58)PSA172(19)AS203(23)Axial and peripheral SpA21(3)Other17(2)bDMARD** - N (%)Adalimumab242(27)Etanercept352(40)Other297(33)

* Some patients reported more than one diagnosis

** Three patients reported more than one bDMARD

Sixty-six percent (n=582) of the participants had never heard of the concept ‘personalized dosing, using TDM’. After explaining the concept 60% (n=535) of the participants answered they have a positive attitude towards the concept (Figure 1). Participants with a positive attitude received a follow-up question. They were asked which of the following related aspects: individual dosing, costs, safety and other, they thought was most relevant regarding the concept. Multiple answers were possible. Ninety-four percent (n=502) reported as the main reason for having a positive attitude, that the treatment can be personally adjusted. The second and third reasons, respectively, were safety 43% (n=230) and costs 27% (n=142) of the treatment.

Figure 1.

Attitude towards concept of TDM against being familiar with concept of TDM

Five percent (n=43) of the participants had a negative attitude towards the concept. Main reasons were; previous experience with unsuccessful dose reduction and unwillingness to change current treatment due to the fact that several previous treatments were ineffective.

Participants were also asked what amount of risk they are willing to take when presented with five different situations; worsening rheumatologically symptoms: e.g. pain and swelling, increased fatigability, necessary treatment with prednisone, switching to another bDMARD or more frequent visits to rheumatologist. Majority of the patients reported for each of the five situations, respectively: 37% (n=330), 40% (n=359), 51% (n=453), 48% (n= 426) and 29% (n=262) that they would only be willing to take a negligible risk, < 0.1%.

Conclusion

Majority of participants was not familiar with the concept of personalized dosing using TDM. However, the majority had a positive attitude towards the concept. The main reason for a positive attitude is that the treatment can be personally adjusted. On the other hand, patients who are currently being treated with a bDMARD were only willing to take a negligible risk when it comes to their own treatment.

References

[1]Syversen, S. W., Jorgensen, K. K., Goll, G. L., Brun, M. K., Sandanger, O., Bjorlykke, K. H., Haavardsholm, E. A. (2021). Effect of Therapeutic Drug Monitoring vs Standard Therapy During Maintenance Infliximab Therapy on Disease Control in Patients With Immune-Mediated Inflammatory Diseases: A Randomized Clinical Trial. JAMA, 326(23), 2375-2384. doi:10.1001/jama.2021.21316

Disclosure of Interests

Maureen Leeuw: None declared, Sadaf Atiqi: None declared, Fenna de Vries: None declared, Laura Boekel: None declared, Femke Hooijberg: None declared, Michael Nurmohamed Speakers bureau: Abbvie, Jansen, Celgene, Consultant of: Abbvie, Grant/research support from: Abbvie, Amgen, Pfizer, Galapagos, BMS, Gert-Jan Wolbink: None declared, Charlotte Krieckaert: None declared

Breakthrough SARS-CoV-2 infections with the delta (B.1.617.2) variant in vaccinated patients with immune-mediated inflammatory diseases using immunosuppressants: a substudy of two prospective cohort studies

Background

Concerns have been raised regarding the risks of SARS-CoV-2 breakthrough infections in vaccinated patients with immune-mediated inflammatory diseases treated with immunosuppressants, but clinical data on breakthrough infections are still scarce. The primary objective of this study was to compare the incidence and severity of SARS-CoV-2 breakthrough infections between patients with immune-mediated inflammatory diseases using immunosuppressants, and controls (patients with immune-mediated inflammatory diseases not taking immunosuppressants and healthy controls) who had received full COVID-19 vaccinations. The secondary objective was to explore determinants of breakthrough infections of the delta (B.1.617.2) variant of SARS-CoV-2, including humoral immune responses after vaccination.

Methods

In this substudy, we pooled data collected in two large ongoing prospective multicentre cohort studies conducted in the Netherlands (Target to-B! [T2B!] study and Amsterdam Rheumatology Center COVID [ARC-COVID] study). Both studies recruited adult patients (age ≥18 years) with immune-mediated inflammatory diseases and healthy controls. We sourced clinical data from standardised electronic case record forms, digital questionnaires, and medical files. We only included individuals who were vaccinated against SARS-CoV-2. For T2B!, participants were recruited between Feb 2 and Aug 1, 2021, and for ARC-COVID, participants were recruited between April 26, 2020, and March 1, 2021. In this study we assessed data on breakthrough infections collected between July 1 and Dec 15, 2021, a period in which the delta SARS-CoV-2 variant was the dominant variant in the Netherlands. We defined a SARS-CoV-2 breakthrough infection as a PCR-confirmed or antigen test-confirmed SARS-CoV-2 infection that occurred at least 14 days after vaccination. All breakthrough infections during this period were assumed to be due to the delta variant due to its dominance during the study period. We analysed post-vaccination serum samples for anti-receptor binding domain (RBD) antibodies to assess the humoral vaccination response (T2B! study only) and anti-nucleocapsid antibodies to identify asymptomatic breakthrough infections (ARC-COVID study only). We used multivariable logistic regression analyses to explore potential clinical and humoral determinants associated with the odds of breakthrough infections. The T2B! study is registered with the Dutch Trial Register, Trial ID NL8900, and the ARC-COVID study is registered with Dutch Trial Register, trial ID NL8513.

Findings

We included 3207 patients with immune-mediated inflammatory diseases who receive immunosuppressants, and 1807 controls (985 patients with immune-mediated inflammatory disease not on immunosuppressants and 822 healthy controls). Among patients receiving immunosuppressants, mean age was 53 years (SD 14), 2042 (64%) of 3207 were female and 1165 (36%) were male; among patients not receiving immunosuppressants, mean age was 54 years (SD 14), 598 (61%) of 985 were female and 387 (39%) were male; and among healthy controls, mean age was 57 years (SD 13), 549 (67%) of 822 were female and 273 (33%) were male. The cumulative incidence of PCR-test or antigen-test confirmed SARS-CoV-2 breakthrough infections was similar in patients on immunosuppressants (148 of 3207; 4·6% [95% CI 3·9–5·4]), patients not on immunosuppressants (52 of 985; 5·3% [95% CI 4·0–6·9]), and healthy controls (33 of 822; 4·0% [95% CI 2·8–5·6]). There was no difference in the odds of breakthrough infection for patients with immune-mediate inflammatory disease on immunosuppressants versus combined controls (ie, patients not on immunosuppressants and healthy controls; adjusted odds ratio 0·88 [95% CI 0·66–1·18]). Seroconversion after vaccination (odds ratio 0·58 [95% CI 0·34–0·98]; T2B! cohort only) and SARS-CoV-2 infection before vaccination (0·34 [0·18–0·56]) were associated with a lower odds of breakthrough infections.

Interpretation

The incidence and severity of SARS-CoV-2 breakthrough infections in patients with immune-mediated inflammatory diseases on immunosuppressants was similar to that in controls. However, caution might still be warranted for those on anti-CD20 therapy and those with traditional risk factors.

Funding

ZonMw (the Netherlands Organization for Health Research and Development) and Reade foundation.

POS0659 LONG-TERM DYNAMICS OF ANTIBODY RESPONSE TO ADALIMUMAB DETECTED WITH A DRUG TOLERANT ASSAY

Background

Immunogenicity of adalimumab (ADL) has been the subject of extensive research, with the primary focus on its incidence, antibody titers and effects on clinical outcome. However, the temporal evolution of antibodies, i.e. dynamic and variation in titers, time point of emergent and persistence or transience of the response, remains under elucidated. To investigate this further, it is essential to collect samples at regular intervals and over a longer period of time. Also, a drug tolerant assay should be used to conquer with the phenomenon of drug interference (1).

Objectives

To evaluate the temporal evolution and to distinguish dynamic patterns of antibody response. Secondly, to assess the clinical impact and factors influencing these dynamic patterns.

Methods

ADA and adalimumab concentration were measured in sera of 511 consecutive ADL treated rheumatoid arthritis patients. Serum samples were drawn at week 0, 4, 16, 28, 52, 78 and 104. ADA were measured with a drug tolerant assay (Acid dissociation RadioImmunoAssay). Logistic regression analysis was carried out. Benjamini-Hochberg was used to correct for multiple testing.

Results

Baseline characteristics are depicted in Table 1. Fifty-nine percent of patients (n=300) developed ADA. Based on visual observations patients were clustered in 9 groups, taking the next features in to account (Figure 1); the presence or absence of ADA, the height of ADA titers (higher or lower than 100AU/mL), emergent (early vs. late; cutoff week 28) and its persistence. Based on these features 397 (77%) patients were assigned to one of the groups. Due to missing data at crucial time points the remainder of patients were excluded. In the ‘High early’ and High early LTF’ group was the rate of MTX use (adjusted odds ratio (AOR) 0.033 [95%CI 0.01-0.09] P<0.0001 respectively 0.79 [95%CI 0.03-0.22] P <0.0001), adalimumab concentration above 5mg/L (AOR 0.022[95%CI 0.01-0.08] P<0.001 respectively 0.026 [95%CI 0.01-0.09] P<0.001) and low disease activity (DAS28 <3.2) at week 52 (AOR 0.191[95%CI 0.07-0.56] P<0.002 respectively 0.102 [95%CI 0.03-0.31] P<0.001) significantly lower, compared to the negative group. Furthermore, the failure rate was in both groups significantly higher (AOR 9.19 [95%CI 3.7-22.87] P<0.0001 respectively 23.94 [95%CI 8.13-70.53] P<0.0001). In contrast to forgoing studies, our data does not show any differences in clinical outcomes between groups with persistent and transient ADA response.

Table 1.

Baseline characteristics

Totaal N=511Follow-upMedian weeks (IQR)78 (28-104)DemographicsAge mean SD53,7; ± 12,5Female No (%)409 (79.8)Disease statusDisease duration years median (IQR)6,7 (3-13)IgM rheumatoid factor + (%)327 (68.2)Anti-citrullinated protein antibody + (%)315 (73.2)Erosive (%)296 (61.6)DAS28-score mean SD4.5 ± 1.5MedicationMethotrexate use no (%)378 (73)

Conclusion

The majority of patients have an immune response to ADL. Based on ADA concentration, time point of emergence and its persistence, certain patterns of ADA response can be distinguished. Only high ADA concentration at early time points, causing low ADL concentration, are associated with unfavorable clinical effects. All the remaining distinctive patterns does not have any association with clinical outcomes. This suggests a regulated immune response in the majority of patients.

References

[1]Atiqi S, Hooijberg F, Loeff FC, Rispens T, Wolbink GJ. Immunogenicity of TNF-Inhibitors. Front Immunol. 2020 Feb 26;11:312. doi:10.3389/fimmu.2020.00312. PMID: 32174918; PMCID: PMC7055461

Disclosure of Interests

Sadaf Atiqi: None declared, Maureen Leeuw: None declared, Femke Hooijberg: None declared, Laura Boekel: None declared, Floris Loeff: None declared, Karien Bloem: None declared, Charlotte Krieckaert: None declared, Annick de Vries: None declared, Michael Nurmohamed Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Roche, and Sanofi, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, MSD, Mundipharma, Novartis, Pfizer, Roche, and Sanof, Theo Rispens Speakers bureau: AbbVie, Pfizer, and Regeneron, Grant/research support from: Genmab, Gert-Jan Wolbink Speakers bureau: UCB, Pfizer, AbbVie, Biogen and BMS, Grant/research support from: Pfeizer (paid to institution)

Antibody development and disease severity of COVID-19 in non-immunised patients with rheumatic immune-mediated inflammatory diseases: data from a prospective cohort study

Background

Research on the disease severity of COVID-19 in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) has been inconclusive, and long-term prospective data on the development of SARS-CoV-2 antibodies in these patients are lacking.

Methods

Adult patients with rheumatic IMIDs from the Amsterdam Rheumatology and Immunology Center, Amsterdam were invited to participate. All patients were asked to recruit their own sex-matched and age-matched control subject. Clinical data were collected via online questionnaires (at baseline, and after 1–4 and 5–9 months of follow-up). Serum samples were collected twice and analysed for the presence of SARS-CoV-2-specific antibodies. Subsequently, IgG titres were quantified in samples with a positive test result.

Findings

In total, 3080 consecutive patients and 1102 controls with comparable age and sex distribution were included for analyses. Patients were more frequently hospitalised compared with controls when infected with SARS-CoV-2; 7% vs 0.7% (adjusted OR: 7.33, 95% CI: 0.96 to 55.77). Only treatment with B-cell targeting therapy was independently associated with an increased risk of COVID-19-related hospitalisation (adjusted OR: 14.62, 95% CI: 2.31 to 92.39). IgG antibody titres were higher in hospitalised compared with non-hospitalised patients, and slowly declined with time in similar patterns for patients in all treatment subgroups and controls.

Interpretation

We observed that patients with rheumatic IMIDs, especially those treated with B-cell targeting therapy, were more likely to be hospitalised when infected with SARS-CoV-2. Treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs other than B-cell targeting agents is unlikely to have negative effects on the development of long-lasting humoral immunity against SARS-CoV-2.

POS0524 CARDIOVASCULAR DISEASE RISK IN INFLAMMATORY ARTHRITIS PATIENTS STILL SUBSTANTIALLY ELEVATED IN 2020

Background:

Patients with inflammatory rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are at a higher risk for developing cardiovascular diseases (CVD) than the general population. This increased risk is partly due to a higher incidence of traditional cardiovascular (CV) risk factors, such as hypertension and dyslipidemia, and partly due to the underlying systemic inflammation. During the past two decades, the burden of the systemic inflammation has been reduced by more efficacious anti-inflammatory treatment, which somewhat attenuated the increased CV risk of rheumatic patients. However, it remains important to monitor the effects of these new treatment strategies on the prevalence of CVD in patients with a rheumatic disease in systematically controlled cohorts.

Objectives:

The aim of the current report was to evaluate whether the CV risk of patients with inflammatory rheumatic diseases still differs from the general population, despite advances In anti-rheumatic treatment strategies.

Methods:

In March 2020, all adult patients with an inflammatory rheumatic disease from the Amsterdam Rheumatology and Immunology Center, location “Reade” were systematically asked to participate in a prospective cohort study. The primary aim of this study was to monitor the impact of the COVID-19 pandemic on patients with inflammatory rheumatic diseases compared to age and sex matched healthy controls. Between April 26, 2020 and May 27, 2020, participants completed the first online questionnaire of the study. Amongst others, information on demographic data, including CV comorbidities and risk factors, and medication use was collected. The baseline characteristics and prevalence of CVD were compared between RA, PsA or AS and healthy controls.

Results:

In total, 1455 consecutive patients with an inflammatory rheumatic disease (979 RA patients, 261 PsA patients and 215 AS patients), and 414 healthy controls completed the first questionnaire, as shown in table 1. CV comorbidities were more frequently reported in RA, PsA and AS patients compared to healthy controls; 107 (11%), 28 (11%) and 22 (10%) compared to 30 (7%), respectively.

Table 1.

Biological DMARD usage in RA, PsA and AS patients

Patient characteristicsAll patients (n=1455)RA (n=979)PsA (N=261)AS (n=215)Controls (n=414)Mean age - yr55 ± 1358 ± 1255 ± 1348 ± 1353 ± 13Female sex - no (%)934 (64)728 (74)119 (46)87 (41)298 (72)BMI (IQR)25 (23-28)25 (22-28)26 (24-30)25 (22-28)24 (22-27)Smoking - no (%)178 (12)126 (13)17 (7)35 (16)34 (8)Cardiovascular disease – no (%)157 (11)107 (11)28 (11)22 (10)30 (7)Rheumatic medication - no (%)csDMARDs877 (60)712 (73)148 (57)17 (8)N.A.Oral glucocorticoids161 (11)139 (14)17 (7)5 (2)2 (0.4)TNF inhibitor563 (39)336 (34)121 (46)106 (49)N.A.IL-6 inhibitor19 (1)19 (2)00N.A.IL-17 inhibitor17 (1)2 (0.2)7 (3)8 (4)N.A.

Table 1. Baseline characteristics. Values are displayed as mean ± standard deviation (SD), median with interquartile range (IQR) or frequencies with percentages (%). RA = rheumatoid arthritis, PsA = psoriatic arthritis, AS = ankylosing spondylitis, BMI = body mass index, TNF = anti-tumor necrosis factor, IL = interleukin.

Conclusion:

We demonstrated that the prevalence of CVD is approximately 1.5 times higher in patients with rheumatic diseases compared to healthy controls (11% vs. 7%, respectively). This corresponds with previous research, although the reported prevalence of CVD in PsA and AS patients is even higher compared to prior studies. This suggests that the CVD risk of patients with rheumatic diseases is still elevated in 2020 compared to the general population, despite the improved management of rheumatic disease activity. Therefore, adequate and timely treatment of CV risk factors remains relevant, not only in patients with RA, but in patients other rheumatic diseases as well.

References:

[1]Hooijberg F et al. (2020) Patients with rheumatic diseases adhere to COVID-19 isolation measures more strictly than the general population. The Lancet rheumatology 2(10), 583-585.

Disclosure of Interests:

None declared

The long-term effect of prenatal progesterone treatment on child development, behaviour and health: a systematic review

BACKGROUND

Progesterone is widely used in prenatal care. However, long-term effects of prenatal progesterone treatment on child development are unclear.

OBJECTIVES

To evaluate long-term outcomes in children after prenatal progesterone treatment.

SEARCH STRATEGY

MEDLINE, Embase and Cochrane Central Register of Controlled Trials from inception to 24 May 2020.

SELECTION CRITERIA

Randomised controlled trials (RCTs) reporting outcomes in children born to women who received progesterone treatment (compared with placebo or another intervention) during any trimester in pregnancy.

DATA COLLECTION AND ANALYSIS

Two authors independently selected and extracted data. We used the Cochrane Risk of Bias tool for randomised trials and Quality In Prognosis Studies.

MAIN RESULTS

Of 388 papers, we included seven articles based on five RCTs, comprising 4222 measurements of children aged 6 months to 8 years. All studies compared progesterone to placebo in second and/or third trimester for the prevention of preterm birth. Meta-analysis (two studies, n = 890 children) showed no difference in neurodevelopment as assessed by the Bayley-III Cognitive Composite score at 2 years between children exposed to progesterone versus placebo (Standardised Mean Difference -0.04, 95% Confidence Interval -0.26 to 0.19), I2  = 22%. Heterogeneity prohibited additional meta-analyses. Other long-term outcomes showed no differences.

CONCLUSIONS

Our systematic review comprising a multitude of developmental measurements with a broad age range did not find evidence of benefit or harm in offspring prenatally exposed to progesterone treatment for the prevention of preterm birth. We identified an urgent need for follow-up studies of prenatal progesterone administration in early pregnancy and effects in offspring beyond early childhood.

TWEETABLE ABSTRACT

Progesterone to prevent preterm birth: no effect on child development. Outcomes after first trimester progesterone are unclear.

Salivary markers of stress system activation and social withdrawal in humans

Introduction

Social withdrawal is an early and common feature of psychiatric disorders. Hypothalamic-pituitary-adrenal (HPA)-axis activation through increased salivary cortisol (sC) and sympathetic activation through increased salivary alpha-amylase (sAA) may play a role.

Objectives

We aimed to study whether the link between increased sC and sAA on the one hand and depression on the other hand is mediated by social withdrawal.

Methods

In this cross-sectional, observational study, sC and sAA measures were measured in seven saliva samples in 843 participants (231 psychiatric patients and 612 healthy controls). Social withdrawal was assessed through the Brief Symptom Inventory (BSI)-, the Short Form 36-, and the Dutch Dimensional Assessment of Personality Pathology social withdrawal subscales, and analyzed using linear regression and mediation analyses. On average, participants were 44.0 years old (SD=12.8; 64.1% female).

Results

Basal and diurnal sAA were unrelated to any social withdrawal scale and depression. Certain sC measures were positively associated with the BSI social withdrawal subscale (i.e., area under the curve with respect to the increase, beta=0.082, p=0.02; evening sC value: beta=0.110, p=0.003; and mean sC value: beta=0.097; p=0.01). We found limited support for statistical mediation by social withdrawal (measured using a composite social withdrawal score) on the relationship between evening sC and depression.

Conclusions

Thus, although we found no support for a role of basal and diurnal sAA in social withdrawal, HPA-axis activation may partly aggravate social withdrawal in depressive disorders.

Development of a SARS-CoV-2 Total Antibody Assay and the Dynamics of Antibody Response over Time in Hospitalized and Nonhospitalized Patients with COVID-19

Severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infections often cause only mild disease that may evoke relatively low Ab titers compared with patients admitted to hospitals. Generally, total Ab bridging assays combine good sensitivity with high specificity. Therefore, we developed sensitive total Ab bridging assays for detection of SARS-CoV-2 Abs to the receptor-binding domain (RBD) and nucleocapsid protein in addition to conventional isotype-specific assays. Ab kinetics was assessed in PCR-confirmed, hospitalized coronavirus disease 2019 (COVID-19) patients (n = 41) and three populations of patients with COVID-19 symptoms not requiring hospital admission: PCR-confirmed convalescent plasmapheresis donors (n = 182), PCR-confirmed hospital care workers (n = 47), and a group of longitudinally sampled symptomatic individuals highly suspect of COVID-19 (n = 14). In nonhospitalized patients, the Ab response to RBD is weaker but follows similar kinetics, as has been observed in hospitalized patients. Across populations, the RBD bridging assay identified most patients correctly as seropositive. In 11/14 of the COVID-19-suspect cases, seroconversion in the RBD bridging assay could be demonstrated before day 12; nucleocapsid protein Abs emerged less consistently. Furthermore, we demonstrated the feasibility of finger-prick sampling for Ab detection against SARS-CoV-2 using these assays. In conclusion, the developed bridging assays reliably detect SARS-CoV-2 Abs in hospitalized and nonhospitalized patients and are therefore well suited to conduct seroprevalence studies.

The fidelity of treatment delivery can be assessed in treatment outcome studies: a successful illustration from behavioral medicine

OBJECTIVES

Treatment outcome studies ought to assess the fidelity of their treatments, including treatment delivery, but practical guidelines and examples for this are lacking. Based on general recommendations in available literature, this study proposes and illustrates the design and application of a Method of Assessing Treatment Delivery (MATD) in a behavioral medicine trial comparing two treatments for chronic low back pain.

STUDY DESIGN AND SETTING

In designing MATD, two experts identified several feasible treatment elements. Agreement between the experts in classifying these elements into five categories (essential and unique, essential but not unique, unique but not essential, compatible, prohibited) was assessed. In applying MATD, treatment recordings were evaluated by two independent raters, who coded the (non)-occurrence of MATD elements and who categorized each session as belonging to one of the two treatments.

RESULTS

MATDs content validity was supported by adequate agreement between the experts' classifications of the treatment elements. MATDs interrater reliability was good.

CONCLUSION

Comprehensive illustrations of designing and applying MATD may encourage the verification of treatment delivery as a partial reflection of treatment fidelity in forthcoming treatment outcome studies.

Fear of movement/injury in the general population: factor structure and psychometric properties of an adapted version of the Tampa Scale for Kinesiophobia

In recent years, several studies have pointed out the importance of pain-related fear in the development and maintenance of chronic pain. An important instrument for measuring pain-related fear in the context of low back pain is the Tampa Scale for Kinesiophobia (TSK). Recently, a version of this questionnaire has been developed for administration among the general population (TSK-G). To determine the factor structure of the TSK-G, data from a random sample of the Dutch general population were studied separately for people who had had back complaints in the previous year, and people who had been without back complaints. For both groups the TSK-G appeared to consist of one, internally consistent, factor of 12 items. The one-factor TSK-G also appeared valid after comparison with scores on measures of catastrophizing and general health status.