Real-World Persistence and Treatment Patterns in Patients with Psoriatic Arthritis Treated with Anti-IL17 Therapy in Spain: The PerfIL-17 Study

INTRODUCTION

Given the growing interest and use of interleukin-17 inhibitors (anti-IL17) for the treatment of psoriatic arthritis (PsA), an observational study has been conducted to characterize the patient profile, treatment patterns, and persistence of ixekizumab or secukinumab in patients with PsA receiving them as first anti-IL17.

METHODS

This is a multicenter retrospective study, conducted at eight Spanish hospitals where data from adult patients with PsA were collected from electronic medical records. Three cohorts of patients, initiating treatment with an anti-IL17 [secukinumab 150 mg (SECU150), secukinumab 300 mg (SECU300), or ixekizumab (IXE)] between January 2019 and March 2021, were included. Demographic and clinical patient characteristics, treatment patterns, and persistence were analyzed descriptively. Continuous data were presented as mean [standard deviation (SD)] and categorical variables as frequencies with percentages. Persistence rates at 3, 6, and 12 months were calculated.

RESULTS

A total of 221 patients with PsA were included in the study [SECU150, 103 (46.6%); SECU300, 38 (17.2%); and IXE, 80 (36.2%)]. Treatment patterns differed by clinical characteristics: SECU150 was initiated more frequently in patients with moderate PsA and less peripheral joint involvement, while patients on SECU300 included those with a higher rate of enthesitis and active skin psoriasis, and patients on IXE showed a longer time since PsA diagnosis, more frequent comorbidities, joint involvement, and diagnosed skin psoriasis. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) were previously administered in 88.2% of patients and biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) were administered in 72.9%. The mean number of previous b/tsDMARDs was 2.4 (SD 1.5) in the IXE cohort, 1.7 (SD 0.9) in the SECU300 cohort, and 1.6 (SD 1.0) for those in the SECU150 cohort. The global persistence on all anti-IL17 was 97.2%, 88.4%, and 81.0% at 3, 6, and 12 months, respectively. The most frequent reason for discontinuation across the three cohorts was lack of effectiveness (16.7%; 37/221).

CONCLUSIONS

Most of the patients with PsA treated with anti-IL17 in Spain had moderate to severe disease activity, high peripheral joint and skin involvement, and had received previous b/tsDMARDs. More than 80% of patients with a 1-year follow-up persisted on anti-IL17, with the highest rate observed in the IXE cohort, followed by the SECU150 then SECU300 cohorts.

Early development of electrophysiological activity: Contribution of periodic and aperiodic components of the EEG signal

Brain function rapidly changes in the first 2 years of life. In the last decades, resting-state EEG has been widely used to explore those changes. Previous studies have focused on the relative power of the signal in established frequency bands (i.e., theta, alpha, and beta). However, EEG power is a mixture of a 1/f-like background power (aperiodic) in combination with narrow peaks that appear over that curve (periodic activity, e.g., alpha peak). Therefore, it is possible that relative power captures both, aperiodic and periodic brain activity, contributing to changes in electrophysiological activity observed in infancy. For this reason, we explored the early developmental trajectory of the relative power in theta, alpha, and beta frequency bands from infancy to toddlerhood and compared it with changes in periodic activity in a longitudinal study with three waves at age 6, 9, and 16 to 18 months. Finally, we tested the contribution of periodic activity and aperiodic components of the EEG to age changes in relative power. We found that relative power and periodic activity trajectories differed in this period in all the frequency bands but alpha. Furthermore, aperiodic EEG activity flattened between 6 and 18 months. More importantly, only alpha relative power was exclusively related to periodic activity, whereas aperiodic components of the signal significantly contributed to the relative power of activity in theta and beta bands. Thus, relative power in these frequencies is influenced by developmental changes of the aperiodic activity, which should be considered for future studies.

Persistence and Use of Ixekizumab in Patients with Psoriatic Arthritis in Real-World Practice in Spain. The PRO-STIP Study

INTRODUCTION

Ixekizumab (IXE) is an IgG4-type monoclonal antibody targeting IL-17A indicated alone or in combination with methotrexate, for the treatment of active psoriatic arthritis (PsA) in adult patients with insufficient response or with intolerance to one or more disease-modifying anti-rheumatic drug (DMARD) therapy. The PRO-STIP study aimed to describe persistence, patient characteristics, treatment patterns, and effectiveness in patients with PsA receiving IXE in a real-world clinical setting in Spain.

METHODS

This was an observational, multicentric, retrospective, longitudinal study in adult PsA patients who started IXE between January 2019 and December 2020, with at least 24 weeks of follow-up. A descriptive analysis of patient characteristics and treatment patterns was performed. The primary objective, treatment persistence, was estimated by Kaplan-Meier survival curve. Effectiveness was evaluated by Disease Activity in Psoriatic Arthritis (DAPSA) scores at baseline and at 12 and 24 weeks.

RESULTS

Eighty-nine patients met the selection criteria (55.1% women and mean age 51.5 years). The median time from PsA diagnosis to starting IXE was 7.7 years (IQR 3.4-14.6). Prior to IXE, 95.5% patients had been treated with at least one biologic or targeted synthetic DMARD (b/tsDMARD). The observed persistence rates were 95.5%, 84.3% and 68.5% at 24, 48, and 104 weeks, respectively. The median persistence was not reached in the study period (mean persistence, 86.9 [95% CI 80.6-93.2] weeks). Twenty-eight (31.5%) patients discontinued IXE, 19 patients (21.3%) due to loss of effectiveness and two patients (2.2%) due to adverse events. In patients receiving treatment and with available effectiveness assessment (n = 24), DAPSA decreased significantly from baseline 23.7 (95% CI 19.5-27.9) to 14.8 (95% CI 10.5-19.2) at 12 weeks (p = 0.005) and 14.3 (95% CI 11.1-17.4) at 24 weeks (p = 0.004).

CONCLUSIONS

PsA patients treated with IXE in a real-world setting show high treatment persistence through 104 weeks and improvements in disease activity after treatment initiation. This suggests that IXE could be an effective treatment for patients with PsA.

RETROSPECTIVELY REGISTERED

Date of registration: 25th May 2021.

Predicting Effortful Control at 3 Years of Age from Measures of Attention and Home Environment in Infancy: A Machine Learning Approach

Effortful control (EC) is a dimension of temperament that encompass individual differences in self-regulation and the control of reactivity. Much research suggests that EC has a strong foundation on the development of executive attention, but increasing evidence also shows a significant contribution of the rearing environment to individual differences in EC. The aim of the current study was to predict the development of EC at 36 months of age from early attentional and environmental measures taken in infancy using a machine learning approach. A sample of 78 infants participated in a longitudinal study running three waves of data collection at 6, 9, and 36 months of age. Attentional tasks were administered at 6 months of age, with two additional measures (i.e., one attentional measure and another self-restraint measure) being collected at 9 months of age. Parents reported household environment variables during wave 1, and their child's EC at 36 months. A machine-learning algorithm was implemented to identify children with low EC scores at 36 months of age. An "attention only" model showed greater predictive sensitivity than the "environmental only" model. However, a model including both attentional and environmental variables was able to classify the groups (Low-EC vs. Average-to-High EC) with 100% accuracy. Sensitivity analyses indicate that socio-economic variables together with attention control processes at 6 months, and self-restraint capacity at 9 months, are the most important predictors of EC. Results suggest a foundational role of executive attention processes in the development of EC in complex interactions with household environments and provide a new tool to identify early markers of socio-emotional regulation development.

Influence of the environment on the early development of attentional control

The control of visual attention is key to learning and has a foundational role in the development of self-regulated behavior. Basic attention control skills emerge early in life and show a protracted development along childhood. Prior research suggests that attentional development is influenced by environmental factors in early and late childhood. Although, much less information is available about the impact of the early environment on emerging endogenous attention skills during infancy. In the current study we aimed to test the impact of parental socioeconomic status (SES) and home environment (chaos) in the emerging control of orienting in a sample of typically-developing infants. A group of 142 (73 female) 6-month-old infants were longitudinally tested at 6, 9 (n = 122; 60 female) and 16-18 (n = 91; 50 female) months of age using the gap-overlap paradigm. Median saccade latency (mdSL) and disengagement failure (DF) were computed as dependent variables for both overlap and gap conditions. Also, composite scores for a Disengagement Cost Index (DCI) and Disengagement Failure Index (DFI) were computed considering mdSL and DF of each condition, respectively. Families reported SES and chaos in the first and last follow-up sessions. Using Linear Mixed Models with Maximum Likelihood estimation (ML) we found a longitudinal decrease in mdSL in the gap but not in the overlap condition, while DF decreased with age independently of the experimental condition. Concerning early environmental factors, an SES index, parental occupation and chaos at 6 months were found to show a negative correlation with DFI at 16-18 months, although in the former case it was only marginally significant. Hierarchical regression models implementing ML showed that both SES and chaos at 6 months significantly predicted a lower DFI at 16-18 months. Results show a longitudinal progression of endogenous orienting between infancy and toddlerhood. With age, an increased endogenous control of orienting is displayed in contexts where visual disengagement is facilitated. Visual orienting involving attention disengagement in contexts of visual competition do not show changes with age. Moreover, these attentional mechanisms of endogenous control seem to be modulated by early experiences of the individual with the environment.

Attention: The grounds of self-regulated cognition

Everyone knows what paying attention is, yet not everybody knows what this means in cognitive and brain function terms. The attentive state can be defined as a state of optimal activation that allows selecting the sources of information and courses of action in order to optimize our interaction with the environment in accordance with either the saliency of the stimulation or internal goals and intentions. In this article we argue that paying attention consists in tuning the mind with the environment in a conscious and controlled mode in order to enable the strategic and flexible adaptation of responses in accordance with internal motivations and goals. We discuss the anatomy and neural mechanisms involved in attention functions and present a brief overview of the neurocognitive development of this seminal cognitive function on the grounds of self-regulated behavior. This article is categorized under: Psychology > Attention (BEAB) Brain Function and Dysfunction (BEAC) Cognitive Development (BAAD).

Predicting behavioral and brain markers of inhibitory control at preschool age from early measures of executive attention

Background

Inhibitory control (IC) is the ability to prevent prepotent responses when inappropriate. Longitudinal research on IC development has mainly focused on early childhood and adolescence, while research on IC development in the first years of life is still scarce. To address this gap in the literature, we explored the association between executive attention (EA) and elementary forms of IC in infancy and toddlerhood, with individual differences in IC later at 5 years of age.

Method

We conducted a five-wave longitudinal study in which children's EA and IC (n = 96) were tested at the age of 9 and 16 months and 2, 3, and 5 years. Children performed various age-appropriate EA and IC tasks in each wave, measuring inhibition of attention, endogenous control of attention, inhibition of the response, and conflict inhibition. At 5 years of age, IC was measured with a Go/No-go task while recording event-related potentials. After correlation analyses, structural equation model analyses were performed to predict IC at 5 years of age from EA and early IC measures.

Results

The results revealed that EA at 9 months predicted IC measures at 2 years of age. Likewise, measures of IC at 2 years predicted performance on the Go/No-go task at behavioral and neural levels. No direct association was found between EA at 9 months and IC at 5 years of age. We further observed that some EA and IC measures were not associated across time.

Conclusion

As we expected, EA skills in infancy and toddlerhood were related to better performance of children on IC tasks, toghether with a more mature inhibition-related brain functioning. Altogether, the results indicate that IC in early childhood could be predicted from EA and IC at 9 months and 2 years of age and suggest that the early emergence of IC relies on the development of particular EA and basic IC skills. However, some discontinuities in the longitudinal development of IC are observed in the first 5 years of life. These findings provide further support for the hierarchical model of IC development.

Development of visual attention control in early childhood: Associations with temperament and home environment

Endogenous visual attention orienting is early available from infancy. It shows a steady development during the preschool period towards monitoring and managing executive attention to optimize the interplay between environmental contingencies and internal goals. The current study aims at understanding this transition from basic forms of endogenous control of visual orienting towards the engagement of executive attention, as well as their association with individual differences in temperament and home environment. A total of 150 children between 2 and 4 years of age were evaluated in a Visual Sequence Learning task, measuring visual anticipations in easy (context-free) and complex (context-dependent) stimuli transitions. Results showed age to be a predictor of a reduction in exogenous attention, as well as increased abilities to attempt to anticipate and to correctly anticipate in complex transitions. Home chaos predicted more complex correct anticipations, suggesting that the exposure to more unpredictable environments could benefit learning in context-dependent settings. Finally, temperamental surgency was found to be positively related to sustained attention in the task. Results are informative of age differences in visual attention control during toddlerhood and early childhood, and their association with temperament and home environment.

POS1415 A MACHINE LEARNING ANALYSIS OF FACTORS PREDICTING ORGAN DAMAGE PROGRESSION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS USING THE SPANISH SOCIETY OF RHEUMATOLOGY LUPUS REGISTRY (RELESSER)

Background

Evidence shows that around half of the patients with systemic lupus erythematosus (SLE) develop irreversible organ damage due to the disease itself or to other factors (e.g., steroid treatment). It is essential to have a comprehensive understanding of factors that predict organ damage progression to identify at-risk patients and inform clinical decision making.

Objectives

To develop an algorithm, using machine learning (ML) methodology, that predicts organ damage progression in SLE patients.

Methods

The Spanish Society of Rheumatology Lupus Registry (RELESSER) with patient records from 45 Rheumatology Units across Spain was used. RELESSER data were collected from 2011 to 2021 and captured demographic and comprehensive clinical information. In this analysis, a sample of 2,676 patients was used. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to measure organ damage progression between 2015 (start of the prospective data collection in RELESSER) and 2020.To predict the risk of an increase in the SDI, 102 variables were identified as potential predictors. A ML model (gradient boosting trees) was developed and validated by a simple logistic regression (LG) model. The area under the receiver operating characteristic curve (AUCROC) was used to quantify the improvement over random chance (an AUCROC of 0.5). Shapley Additive Explanation (SHAP) values were used in the ML model to identify predictors and their contribution to damage progression.

Results

Of all patients, 13% experienced organ damage progression, with 2-year patient follow-up. The ML algorithm was better at identifying these patients (AUCROC 0.68) than the LG model (AUCROC 0.63) (Figure 1). ML model performance can be contextualized using a random sample of 100 SLE patients of whom 13 suffered organ damage progression, the model would successfully identify 12. However, 66 additional patients would be incorrectly identified (True Positive 90%; False Positive 79%). The top 5 predictors of damage progression, across all patients, were patient age >49 years,

Figure 1.

ROC AUC plot

Creatinine > 0.9 mg/dl, cardiovascular-related disease complications (> 3 complications), low hematocrit level recorded recently (<41.9 months ago), and triglycerides > 81.5 mg/dl. At the patient level, the 5 patients with the highest predicted risk had strong predictors of progression, with key predictors being patient age at study entry >49 years, age at diagnosis >40 years, cardiovascular-related disease complications, and increased creatinine >0.9 mg/dl. The 5 patients with the lowest predicted risk had strong predictors of no change with key predictors being not having a low hematocrit level recorded recently, triglycerides <81.5 mg/dl and patient age at study entry <49 years.

Conclusion

We developed a machine learning model, using an exhaustive set of variables in RELESSER which successfully predicted short-term organ damage progression in SLE patients, and outperformed a standard regression model. If the model were to be used as a clinical tool, only light-touch interventions should be carried out due to high false positive rate. Further model optimizations, including exposing the model to longer follow-up data and testing it in non-Spanish patients is needed.

Disclosure of Interests

Jose M Pego-Reigosa Speakers bureau: Eli Lilly, GSK, Consultant of: AstraZeneca, GSK, MSD, Eli Lilly, Grant/research support from: The RELESSER registry was funded by grants from GSK, UCB, Roche and Novartis, WALID FAKHOURI Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Silvia Díaz-Cerezo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Aidan Cooper Consultant of: Salaried employee of IQVIA while conducting the analyses for this study, Anne-Marie Saunders Consultant of: Salaried employee of IQVIA while conducting the analyses for this study, Grace Segall Consultant of: Salaried employee of IQVIA throughout conceptualization, design and execution of analysis for this study, Employee of: Eli Lilly and Company throughout finalization of analysis and abstract development for this study, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Sebastian Moyano Employee of: Eli Lilly and Company, Iñigo Rua-Figueroa Grant/research support from: The RELESSER registry was funded by grants from GSK, UCB, Roche and Novartis

POS1199 IS PSORIATIC ARTHRITIS A RISK FACTOR FOR SEVERE COVID -19 INFECTION? DATA FROM THE ARGENTINIAN REGISTRY SAR-COVID

Background

Comorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained.

Objectives

To describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confirmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA).

Methods

Cross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR / EULAR 2010 criteria), who had confirmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID)1 was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher’s test, Student’s test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed.

Results

A total of 129 PsA patients and 808 with RA were included. Clinical characteristics are shown in Table 1. Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. The frequency of NIAID≥5 was comparable between groups (PsA 19.5% vs RA 20.1%; p=0.976). (Figure 1).

Table 1.

Characteristics of patients with PsA and RA who presented COVID-19 in the SAR-COVID registry.

Psoriatic arthritis (n=129)Rheumatoid arthritis (n=808)P valueTotal (n=937)Age (years), mean (SD)51.7 (12.7)53.1 (12.9)0.23952.9 (12.9)Female72 (55.8)684 (84.7)<0.001756 (80.7)Comorbidities65 (50.4)355 (43.9)0.203420 (44.8) Obesity (BMI ≥30)19 (15.2)102 (13.4)0.692121 (13.7) Morbid obesity (BMI ≥40)1 (0.8)10 (1.3)111 (1.25) Hypertension35 (28.5)205 (26.8)0.783240 (27.0) Diabetes16 (13.0)67 (8.8)0.18883 (9.39) Dyslipidemia24 (19.5)102 (13.5)0.106126 (14.4) Cardiovascular or cerebrovascular disease5 (11.4)32 (3.9)0.03337 (4.2)Two or more comorbidities55 (42.6)219 (27.1)<0.001274 (29.2)Current smoking4 (3.6)60 (8.4)0.7964 (7.7)High disease activity0 (0)29 (3.8)0.02729 (3.23)Glucocorticoids treatment5 (20.0)95 (60.1)<0.001100 (54.6)Conventional DMARDs47 (36.4)443 (54.8)<0.001490 (52.3)Biologic DMARDs60 (46.5)193 (23.9)<0.001253 (27.0)JAK inhibitors4 (3.10)72 (8.9)0.03876 (8.1)Full recovery of COVID-19105 (84.0)644 (81.7)0.127749 (82.0)COVID-19 complications16 (12.5)68 (8.7)0.22784 (9.2)Death due to COVID-191 (0.8)34 (4.3)0.07435 (3.8)

Notes=values n (%) unless otherwise indicated; BMI: Body Mass Index; DMARDs: disease-modifying antirheumatic drugs; JAK inhibitors: Janus kinase inhibitors.

PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5; p=0.002), had more frequently hypertension (52.2% vs 23%; p=0.011) and dyslipidemia (39.1% vs 15%; p=0.017). In the multivariate analysis, age (OR 1.06; 95% CI 1.02–1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34; 95% CI 0.11–0.92) and biological DMARDs (OR 0.28; 95% CI 0.09–0.78) had a better outcome.

Conclusion

Although PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar. Most of the patients had mild SARS-CoV-2 infection and a low death rate.

References

[1]Beigel JH, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826.

Disclosure of Interests

None declared

POS1200 DIFFERENCES BETWEEN THE FIRST AND THE SECOND WAVE OF SARS-COV-2 INFECTION IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES IN ARGENTINA: DATA FROM THE SAR-COVID REGISTRY

Background

In Argentina we have witnessed two COVID 19 waves between 2020 and 2021. The first wave occurred during the spring of 2020 and it was related to the wild type of the virus, the second occurred during the fall/winter of 2021 when the gamma variant showed a clear predominance. During the first wave, patient with rheumatic diseases showed a higher frequency of hospitalization and mortality (4% vs 0.26%) when compared to the general population1; at that time, however, vaccination was not yet available.

Objectives

To compare sociodemographic and disease characteristics, course and outcomes of SARS-CoV-2 infection in patients with immune-mediated/autoinflammatory diseases (IMADs) during the first and second waves in Argentina.

Methods

SAR-COVID is a national, multicenter, longitudinal and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had confirmed SARS-CoV-2 infection (RT-PCR or positive serology) were consecutively included since August 2020. For the purpose of this report, only patients with IMADs who had SARS-CoV-2 infection during the first wave (defined as cases occurred between March 2020 and March 2021) and the second wave (cases occurred between April and August 2021) were examined. Sociodemographic characteristics, disease diagnosis and activity, comorbidities, immunosuppressive treatment and COVID 19 clinical characteristics, complications and outcomes: hospitalization, intensive care unit (ICU) admission, use of mechanical ventilation and death were compared among groups. Descriptive statistical analysis was performed. Variables were compared with Chi squared test and Student T test or Mann Whitney test. Multivariable logistic regression models with forward and backward selection method, using hospitalization, ICU admission and death as dependent variables were carried out.

Results

A total of 1777 patients were included, 1342 from the first wave and 435 of the second one. Patients had a mean (SD) age of 50.7 (14.2) years and 81% were female. Both groups of patients were similar in terms of socio-demographic features, disease diagnosis, disease activity, the use of glucocorticoids ≥ 10 mg/day and the immunosuppressive drugs (Table 1 below). Patients infected during the first wave have higher frequency of comorbidities (49% vs 41%; p= 0.004). Hospitalizations due to COVID 19 (31% vs 20%; p <0.001) and ICU admissions (9% vs 5%; p= 0.009) were higher during the first wave. No differences in the use of mechanical ventilation (16% vs 16%; p= 0.97) nor in the mortality rate (5% vs 4%; p= 0.41) were observed. In the multivariable analysis, after adjusting for demographics, clinical features and immunosuppressive treatment, patients infected during the second wave were 40% less likely to be hospitalized (OR= 0.6, IC95% 0.4-0.8) and to be admitted to the ICU (OR= 0.6, IC95% 0.3-0.9).

Table 1.Variable (% or Mean – SD)First wave(n=1342)Second wave(n=435)p ValueFemale gender81800.7Age (years)51.0 (14.5)50.0 (13.3)0.2Disease diagnosis Rheumatoid arthritis46461 Ankylosing spondylitis10110.8 Systemic lupus erythematosus171850.9 Systemic Scleroderma551 Sjögren´s syndrome650.7 Inflammatory myopathies330.5 Vasculitis430.4Disease activity High430.5Use of immune modulatorsDMARDcs53560.2DMARDts460.1DMARDb82821Use of glucocorticoids ≥10 mg12120.9Comorbidities49410.004

Conclusion

The impact of COVID 19 in Argentina, in terms of mortality in patients with IMADs was still higher compared to the general population during the second wave. However, the frequency of hospitalizations and ICU admissions was lower. These findings could be explained by the introduction of the SARS COV 2 vaccination and, probably, by the cumulative knowledge and management improvement of this infection among physicians.

References

[1]Isnardi CA et al. Epidemiology and outcomes of patients with rheumatic diseases and SARS-COV-2 infection: data from the argentinean SAR-COVID Registry. Ann Rheum Dis, 2021, suppl 1, 887.

Disclosure of Interests

None declared

POS0025 PREVALENCE OF ATTENTION DEFICIT HYPERACTIVITY DISORDER AMONG ADULT PATIENTS WITH FIBROMYALGIA

Background

Fibromyalgia (FM) and attention deficit hyperactivity disorder (ADHD) share some clinical features, and a reduced dopamine function has been proposed for both disorders. ADHD is a chronic condition, marked by persistent inattention, impaired concentration, hyperactivity, impulsivity, emotional lability, anxiety and disorganized behaviour. High rates of comorbidity between ADHD and FM have been reported, as well as some evidence that patients with both conditions experience heightened disease severity.

Objectives

Our purpose was to determine the prevalence of ADHD symptoms in patients with FM and to assess the relationship with disease impact.

Methods

Consecutive patients, older than 18 years, with diagnosis of FM (ACR 2016 criteria) without known cognitive impairment, seen at the Rheumatology Unit between April 2018 and December 2019, were included. At inclusion visit the collected data included Revised Fibromyalgia Impact Questionnaire (FIQ-R) and Health Assessment Questionnaire, Argentine version (HAQ-A). During the Neurology visit, the following tests were performed: Montreal Cognitive Assessment (MoCA) test for evaluating the presence of cognitive impairment, Conners Continuous Performance Test II (CPT II) for the assessment of ADHD, and Wender-Utah Rating Scale (WURS) to retrospectively assess childhood ADHD symptoms. Univariate analysis was performed using t-tests for normally distributed continuous variables, and Wilcoxon rank sum test for non-normally distributed continuous variables. A chi-square or Fisher test was used when appropriate for categorical variables. Predictors that were found to be related to ADHD (p ≤ 0.20) were then entered into a multivariable logistic regression model.

Results

60 patients with FM and 71 matched controls without FM or known cognitive impairment were included. FM patients’ characteristics are shown in Table 1. 61.7% (n=37) of the patients with FM tested positive for adult ADHD. In 48.6% (18/37) of them, the diagnosis had been missed in childhood. Participants with both FM and a positive adult ADHD screening test did not score significantly higher on the FIQ-R (52.3, SD= 16.1 vs. 47.9, SD= 12.3; p= 0.2693) and HAQ-A (0.693, SD= 0.455 vs. 0.521, SD= 0.428; p=0.1523) compared with patients without ADHD. Retrospectively assessed childhood ADHD was significantly associated with adult persistence (OR 55.1, CI=3.6 to 842.6, p=0.004).

Table 1.

Clinical and demographic characteristics of patients with FM.

Characteristicsn=60Female, n (%)53 (88.3)Age (years), mean (SD)58.3 (14.2)Time from diagnosis (years), mean (SD)5.2 (5)Scholarity (years), mean (SD)12.9 (3.4)HAQ-A, mean (SD)0.627 (0.449)FIQ-R, mean (SD)50.6 (14.8)Cognitive complaint, n (%)34 (56.7)Depression, n (%)35 (58.3)Anxiety, n (%)27 (45)Concomitant personality disorders39 (65)

Patients with FM had significantly higher prevalence of cognitive impairment (43.3% vs. 16.9%; p<0.0001), childhood ADHD symptoms (31.7% vs. 14.1%; p=0.016) and adult ADHD symptoms (61.7% vs. 23.9%; p<0.0001) than the control group (Figure 1).

Figure 1.

Percentage of FM patients with cognitive impairment, childhood and adult ADHD. Comparison with the control population.

Conclusion

The co-occurrence of adult ADHD in FM was highly prevalent. In nearly half of the patients the diagnosis had been overlooked during childhood and it was associated with adult persistence. The prevalence of cognitive impairment, and childhood and adult ADHD was higher in patients with FM compared with the control group. ADHD was not associated with the FM impact. Evaluation of ADHD symptoms in patients with FM is important for recognition and treatment of this comorbidity.

References

[1]Stefano P et al. J Psychiatr Res. 2021 Apr;136:537-542.

[2]Karas H et a.l Int J Psychiatry Clin Pract. 2020 Sep;24(3):257-263.

[3]Kessler RC et al. Biol Psychiatry. 2005 Jun 1;57(11):1442-51.

Acknowledgements

The authors thank the patients who agreed to participate in

this study.

Disclosure of Interests

None declared

POS1208 EPIDEMIOLOGY AND OUTCOMES OF PATIENTS WITH RHEUMATIC DISEASES AND SARS-CoV-2 INFECTION: DATA FROM THE ARGENTINEAN SAR-COVID REGISTRY

Background:

In the last time, many papers about SARS-CoV-2 have been published in the world. However, data from latinamerican patients is still scarce. In order to assess the impact of SARS-CoV-2 infection in patients with rheumatic diseases in our country and contribute to the global knowledge about the effect of immunosuppressive therapies in this group, the Argentine Society of Rheumatology has developed the National Registry of Patients with Rheumatic Diseases and COVID-19 (SAR-COVID).

Objectives:

The aim of this study was to evaluate clinical characteristics and outcomes of SARS-CoV-2 infection in patients with rheumatic diseases, treated or not with immunomodulators and/or immunosuppressants.

Methods:

SAR-COVID is a national, multicenter, prospective and observational registry, in which patients, ≥18 years of age, with a diagnosis of a rheumatic disease who had SARS-CoV-2 infection (PCR or positive serology) are consecutively included between August 13, 2020 and January 17, 2021. Sociodemographic data, comorbidities, underlying rheumatic disease and treatment, clinical characteristics, complications, laboratory and treatment of the SARS-CoV-2 infection were recorded. Hospitalization, mechanical ventilation requirements and death were assessed to evaluate COVID-19 outcome. Statistical analysis: Descriptive analysis. Chi2 or Fischer test and T test or Mann-Whitney U test or ANOVA, as appropriate. Multiple logistic regression.

Results:

A total of 525 patients were included, 80.4% were female, with a median age of 52 years (IQR 40-62). Comorbidities were reported in half of them (53.3%). The most frequent rheumatological diseases were rheumatoid arthritis (40.4%) and systemic lupus erythematosus (14.9%). At the time of the infection, most of them were in remission or in minimal/low disease activity (68.2%) and 72.9% were receiving immunosuppressive or immunomodulatory treatment.

Symptoms were present in 96% of the patients, the most frequent being fever (56.2%), cough (46.7%) and headache (39.2%). During infection, 35.1% received some pharmacological treatment, dexamethasone (20%) the most frequently used. One third (35.1%) of the patients were hospitalized, 11.6% were admitted to the ICU, 10.1% needed mechanical ventilation and 6.9% died due to COVID-19. Complications were reported in 12.4%, being acute respiratory distress syndrome the most prevalent (8.8%).

Patients over 65 years of age were more frequently hospitalized, admitted to the ICU, needed mechanical ventilation and died due to COVID-19 (50% vs 31.4%, 22% vs 9%, 16.3% vs 5.2%, 14% vs 5%, respectively; p<0.001 in all cases). Similar results were seen in patients with vasculitis (57.7% vs 33.9%, 46.2 vs 9.8%, 34.6% vs 6 %; 30.8% vs 5.6%, respectively; p< 0.001 in all cases) and those with moderate/high disease activity (55.7% vs 26.5%, 21.3 vs 7.8%, 17.2% vs 4.2 %; 17.2% vs 4.2 %, respectively; p< 0.001 in all cases). Patients with APS were more frequently admitted to the ICU (29.4% vs 11%, p= 0.037). The presence of comorbidities was associated with higher hospitalization (46% vs 22.6%, p<0.001), admission to the ICU (17.2% vs 5.9%, p<0.001) and mechanical ventilation (10.2% vs 4.6%, p= 0.028). Immunosuppressive treatment was not associated with worse outcomes.

Conclusion:

In this cohort of patients with a wide distribution of rheumatic diseases, we have found clinical characteristics similar to those reported by other international cohorts. Compared with national data, the mortality reported in these patients is higher. However, it should be noted that these are early data collected during isolation and that there may be an underreporting of asymptomatic patients or with mild symptoms who do not attend the rheumatologist.

Older patients, those with comorbidities, with vasculitis and with higher disease activity showed poor COVID-19 outcomes.

Disclosure of Interests:

Carolina Ayelen Isnardi Speakers bureau: Janssen, BMS, Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rosana Quintana Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Karen Roberts Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Vanessa Viviana Castro Coello Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Alvaro Andres Reyes Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Yohana Tissera Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Micaela Cosatti Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Romina Rojas Tessel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Julia Scafati Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Tatiana Barbich Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., María Soledad Gálvez Elkin Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Gustavo Fabian Rodriguez Gil Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Sebastian Moyano Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Marina Laura Werner Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Jonathan Rebak Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Julieta Morbiducci Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Victoria Martire Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., María Sol Castaño Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Dieguez Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Gisela Constanza Subils Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Guillermo Pons-Estel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.

On-line preconcentration system for bismuth determination in urine by flow injection hydride generation inductively coupled plasma atomic emission spectrometry

An on-line bismuth preconcentration and determination system implemented with hydride generation inductively coupled plasma atomic emission spectrometry (HG-ICP-AES) associated to flow injection (FI) was studied. Quinolin-8-ol and Amberlite XAD-7 were used for the retention of bismuth, at pH 4.5. The bismuth complex was removed from the micro-column with nitric acid. The detection limit value for the preconcentration of 100 ml of aqueous solution was 0.02 ng ml(-1) with a relative standard deviation (R.S.D.) of 3.5%, calculated from the peak heights obtained. The calibration graph using the preconcentration system for bismuth was linear with a correlation coefficient of 0.999 at levels near the detection limits up to at least 100 ng ml(-1). The method was successfully applied to the determination of bismuth in human urine samples.

Activation of the EGFR/ERK pathway in high-grade mucoepidermoid carcinomas of the salivary glands

Background:

Mucoepidermoid carcinoma (MEC) shows differences in biological behaviour depending mainly on its histological grade. High-grade tumours usually have an aggressive biological course and they require additional oncological treatment after surgery.

Methods:

In a series of 43 MECs of the salivary glands, we studied the epidermal growth factor receptor (EGFR) gene by using dual-colour chromogenic in situ hybridisation (CISH). Moreover, we assessed the protein expressions of the EGFR and the activated extracellular signal-regulated kinases (pERK1/2) by using immunohistochemistry. These results were correlated with the histological grade of the tumours and the outcome of the patients.

Results:

The CISH study demonstrated a high-EGFR gene copy number, with balanced chromosome 7 polysomy, in 8 out of 11 high-grade MECs (72.7%), whereas 27 low-grade and 15 intermediate-grade tumours had a normal EGFR gene copy number (P<0.001). The EGFR gene gains correlated with disease-free interval (P=0.003) and overall survival of the patients (P=0.019). The EGFR protein expression had a significant correlation with the histological grade of the tumours but not with the outcome of the patients. The pERK1/2 expression correlated with histological grade of tumours (P<0.001), disease-free interval (P=0.004) and overall survival (P=0.001).

Conclusions:

The EGFR/ERK pathway is activated in high-grade MECs with aggressive behaviour. Patients with these tumours who require oncological treatment in addition to surgery could benefit from EGFR and mitogen-activated protein kinase pathway inhibitors.

Acute and chronic effects of MDMA on molecular mechanisms implicated in memory formation in rat hippocampus: Surface expression of CaMKII and NMDA receptor subunits

Acute 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") treatment induces learning deficits in different animal models. In a passive avoidance learning task in rats, previous studies suggested a role for Ca2+/calmodulin-dependent protein kinase II (CaMKII) and N-methyl-D-aspartate (NMDA) receptors in the acute learning impairment. As cognitive deficits by "ecstasy" in humans have been only reported in frequent recreational users, we examined whether a repeated MDMA treatment could induce in rats lasting molecular changes related to memory consolidation of passive avoidance. In rats with a pronounced 5-HT depletion by MDMA, the effect of another drug challenge was also examined. The surface expression in the hippocampus of NMDA receptor subunits, the scaffolding postsynaptic density protein PSD-95, phosphorylated CaMKII and protein phosphatase 1 (PP1) was measured. In rats repeatedly treated with MDMA (10 mg/kg) twice daily for 4 consecutive days, hippocampal 5-HT levels were markedly reduced 1 week later. At this time, neither learning performance was affected nor changes in membrane levels of NMDA receptor subunits, PSD-95, CaMKII and PP1 were found. In these rats, however, another drug challenge produced a rapid reduction in PSD-95 immunoreactivity and prevented the learning-specific increase in the NMDA receptor NR1 subunit and phosphorylated CaMKII. The results show no lasting change in learning-associated molecular events after a neurotoxic MDMA treatment. This drug only produces transient effects on early molecular events involved in memory consolidation, which do not appear to depend on endogenous 5-HT levels.

NMDA receptor subunit and CaMKII changes in rat hippocampus induced by acute MDMA treatment: a mechanism for learning impairment

RATIONALE

Cognitive deficits have been reported in recreational 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") users. In rats and other animal species, acute MDMA administration produces an impairment in passive avoidance and other learning tasks. Different studies have shown that this learning deficit is not strictly related to the pronounced serotonin (5-HT) depletion induced by the drug.

OBJECTIVES

This study was aimed at determining if acute MDMA administration induces in the rat hippocampus early molecular changes related to memory impairment in a passive avoidance task. The membrane expression of key molecules in memory consolidation, such as the NR1 and NR2B subunits of the N-methyl-D-aspartate (NMDA) receptor, Ca2+/calmodulin-dependent protein kinase II (CaMKII) and protein phosphatase 1 (PP1) was measured. Some of these studies were also performed after 5-HT depletion induced by the 5-HT synthesis inhibitor p-chlorophenylalanine (PCPA).

METHODS

Neurochemical studies were performed in rats treated with MDMA and killed 90 min later and also in rats subjected to passive avoidance 30 min after MDMA treatment. Western blotting was used for measuring the levels of NMDA receptor subunits, CAMKII and PP1. Enzyme activity assays were also performed.

RESULTS

In hippocampal membrane extracts, passive avoidance training increased NMDA receptor NR1 subunit expression as well as CaMKII levels and phosphorylated CaMKII. In untrained rats, MDMA reduced NR1 and NR2B protein levels, membrane CaMKII levels and enzyme activity, and enhanced PP1 levels and activity. In trained rats, MDMA prevented the learning-specific increase in NR1 subunit expression and membrane CaMKII/pCaMKII levels. After pronounced 5-HT depletion by PCPA, MDMA impaired passive avoidance retention to a similar extent and also prevented the training-associated changes in NR1 levels and CaMKII activity.

CONCLUSIONS

Diminished function of hippocampal CaMKII and reduced levels of synaptic NMDA receptor subunits appear to be involved in the impairment of passive avoidance learning induced in rats by acute MDMA treatment.

Composting of fish offal and biosolids in northwestern Patagonia

Composting of fish processing wastes and biosolids with wood by-products and yard trimmings was conducted during the summer of 1996 and winter of 1997 in NW Patagonia using: (i) static piles for fish offal and (ii) turning piles for biosolids. Fish offal was mixed with sawdust + wood shavings (FOC) at 3:1 ratio by weight and biosolids with wood shavings (BCw) and yard trimmings (BCt) at 1:1 ratio by volume. Samples were taken at six dates during the composting period and analyzed to determine the factors that predict compost maturity. Composting of biosolids was affected by the type of bulking agent during winter. Thermophilic temperatures > or = 55 degrees C were sustained long enough to satisfy the USEPA requirements for processes to further reduce pathogens (PFRP) in FOC and BCt, and for processes to significantly reduce pathogens (PSRP) in summer BCw, while in winter BCw temperatures were lower than those recommended for effective pathogen reduction. However, coliform fecal content in all BC treatments was less than 10 most probable number (MPN) g(-1) dry sample at the end of the process. The ratio of water soluble carbon (WSC) to total nitrogen (TN) appeared to be a more adequate index to predict compost maturity than the ratio of total organic carbon to nitrogen.

[Klebocins K6 and K150: production and activity in various experimental conditions]

Klebsiella is a common agent in hospital-acquired infections and its importance in disease transmission was evident in the isolation obtained in a health center in the city of Rio Cuarto. Bacteriocinogenic strains by the cross-streak method in tryptic-soy agar were investigated. Two Klebsiella produced bacteriocins with broad patterns of sensitivity among the tested strains. The K150 klebocin was more active than the K6 klebocin, but this one was more heat-stable than K150. The klebocins were not detected in the synthetic media employed and they caused inhibitory areas in complex media, except in triptose-beef extract. K150 was not active in eosine-methylene blue and nutrient agar. The bacteriocins were associated to lipase activity and hemolytic effect on chicken erythrocytes. The strains 6 and 150 were multiresistant to antimicrobial agents, with a pattern of sensitivity different from that of other multiresistant strains.

Klebocin activity of Klebsiella pneumoniae strains and its heterologous effect on Staphylococcus sp

Thirty six Klebsiella pneumoniae strains were assayed in a test to determine bacterial interference; two of them had bacteriocinic effects on homologous species, strains 6 and 150 inhibited sensitive K. pneumoniae and they also acted on positive and negative Staphylococci coagulase. All cocci were sensitive to the bacteriocinogenic K. pneumoniae and none of the non-bacteriocinogenic strains inhibited them. Klebocin with homologous activity on K. pneumoniae seemed to be undistinguishable from the compound with heterologous action on Staphylococci in the aspects that were characterized in this work; both were heat labile to the same degree; optimum pH was 7, acidity decreased klebocin activity more intensely than alkaline pH. The antagonistic substance was not produced in the synthetic medium employed and was developed in tryptic soy, nutrient agar, brain heart agar and blood agar; tryptone-beef extract agar complex medium neither permitted the homologous activity nor allowed the interference on Staphylococci. The compound (or compounds) responsible for homologous antimicrobial effect had a low molecular weight as demonstrated by the fact that it pierces a dialysis membrane with molecular weight of 10,000 D cut-offs. Ethidium bromide treatment of strains 6 and 150 produced five strains without bacteriocinic activity which simultaneously lost their homologous and heterologous inhibitory capacity.