Metalla-Carbaporphyrinoids Consisting of an Acyclic N-Confused Tetrapyrrole Analogue Served as Stable Near-Infrared-II Dyes

We present herein the synthesis of novel pseudo-metalla-carbaporphyrinoid species (1M: M=Pd and Pt) achieved through the inner coordination of palladium(II) and platinum(II) with an acyclic N-confused tetrapyrrin analogue. Despite their tetrapyrrole frameworks being small, akin to well-known porphyrins, these species exhibit an unusually narrow HOMO-LUMO gap, resulting in an unprecedentedly low-energy absorption in the second near-infrared (NIR-II) region. Density functional theory (DFT) calculations revealed unique dπ-pπ-conjugated electronic structures involving the metal dπ-ligand pπ hybridized molecular orbitals of 1M. Magnetic circular dichroism (MCD) spectroscopy confirmed distinct electronic structures. Remarkably, the complexes feature an open-metal coordination site in the peripheral NN dipyrrin site, forming hetero-metal complexes (1Pd-BF2 and 1Pt-BF2) through boron difluoride complexation. The resulting hetero metalla-carbaporphyrinoid species displayed further redshifted NIR-II absorption, highly efficient photothermal conversion efficiencies (η; 62-65 %), and exceptional photostability. Despite the challenges associated with the theoretical and experimental assessment of dπ-pπ-conjugated metalla-aromaticity in relatively larger (more than 18π electrons) polycyclic ring systems, these organometallic planar tetrapyrrole systems could serve as potential molecular platforms for aromaticity-relevant NIR-II dyes.

One-pot synthesis of azabora[6]helicene by a Schiff base forming reaction

Azabora[6]helicene as a new heterohelicene analogue was synthesized by a one-pot reaction of commercially available 2,6-diaminopyridine and benzo[c,d]indole-2(1H)-one and subsequent boron coordination. While the single-crystal X-ray diffraction analysis elucidated a helical structure in the solid state, a dynamic helicity inversion was observed in solution.

Pericardial effusion in oncological patients: current knowledge and principles of management

BACKGROUND

This article provides an up-to-date overview of pericardial effusion in oncological practice and a guidance on its management. Furthermore, it addresses the question of when malignancy should be suspected in case of newly diagnosed pericardial effusion.

MAIN BODY

Cancer-related pericardial effusion is commonly the result of localization of lung and breast cancer, melanoma, or lymphoma to the pericardium via direct invasion, lymphatic dissemination, or hematogenous spread. Several cancer therapies may also cause pericardial effusion, most often during or shortly after administration. Pericardial effusion following radiation therapy may instead develop after years. Other diseases, such as infections, and, rarely, primary tumors of the pericardium complete the spectrum of the possible etiologies of pericardial effusion in oncological patients. The diagnosis of cancer-related pericardial effusion is usually incidental, but cancer accounts for approximately one third of all cardiac tamponades. Drainage, which is mainly attained by pericardiocentesis, is needed when cancer or cancer treatment-related pericardial effusion leads to hemodynamic impairment. Placement of a pericardial catheter for 2-5 days is advised after pericardial fluid removal. In contrast, even a large pericardial effusion should be conservatively managed when the patient is stable, although the best frequency and timing of monitoring by echocardiography in this context are yet to be established. Pericardial effusion secondary to immune checkpoint inhibitors typically responds to corticosteroid therapy. Pericardiocentesis may also be considered to confirm the presence of neoplastic cells in the pericardial fluid, but the yield of cytological examination is low. In case of newly found pericardial effusion in individuals without active cancer and/or recent cancer treatment, a history of malignancy, unremitting or recurrent course, large effusion or presentation with cardiac tamponade, incomplete response to empirical therapy with nonsteroidal anti-inflammatory, and hemorrhagic fluid at pericardiocentesis suggest a neoplastic etiology.

Synthesis and photothermal conversion properties of sandwich N-fused porphyrin rhodium-μ-dichloride dimer complexes: π-extended analog of pentamethylcyclopentadienyl dirhodium(III)-μ-dichloride dimer

Anionic cyclopentadienyl (Cp) and its pentamethyl-substituted derivative (Cp*) serve as crucial ligands for creating stable π-coordinated materials, including catalysts. From a structural perspective, the π-extended analog of Cp, known as an N-fused porphyrin (NFP), is recognized as an intriguing 18π aromatic chromophore, offering near-infrared (NIR) optical properties that can be fine-tuned through metal complexation. When coordinated with rhodium at the central NFP core, it forms a sandwich binuclear rhodium(III) complex along with terminal and bridging chloride ligands, denoted as Rh-1, and its bromo derivative, Rh-1-Br. In contrast to the bis-NFP complex of iron(II) reported previously by our team, both Rh-1 and Rh-1-Br complexes exhibit strong NIR optical properties and narrow HOMO-LUMO energy gaps, attributed to minimal orbital interactions between the two co-facial NFP ligands. Leveraging these NIR absorption properties, we assessed the photothermal conversion properties of Rh-1 and ligand 1, revealing high conversion efficiency. This suggests their potential application as photothermal agents for use in photothermal therapy.

Synthesis, Structural, and Optical Properties of Azuleno[1,2-c]pyran-1-ones: Bro̷nsted Acid-Mediated Cyclization of 2-Azulenylalkynes

Pyrones and their aromatic ring-fused derivatives have gained significant attention due to their diverse biological activities and potential as foundational frameworks for advanced materials. In this paper, we describe a proficient approach for the preparation of azuleno[1,2-c]pyran-1-ones, which are difficult to produce by using conventional methods. The synthesis was achieved through Bro̷nsted acid-mediated cyclization of 2-azulenylalkynes. The structural and optical properties of azuleno[1,2-c]pyran-1-ones were characterized by single-crystal X-ray analysis, NMR, UV/vis, and fluorescence spectroscopies. Under acidic conditions, these compounds displayed notable spectral alterations and emission, distinct from their spectra in neutral medium. These results suggest that azuleno[1,2-c]pyran-1-ones hold great potential for applications in organic electronic materials and fluorescent pH sensors.

Oxidation of 5,15-Dioxaporphyrin: Its Generality and Novelty as an Oxaporphyrin Analogue

5,15-Dioxaporphyrin (DOP) is a novel meso-oxaporphyrin analogue and exhibits unique 20π-antiaromaticity, unlike its mother congener of 18π-aromatic 5-oxaporphyrin, commonly known as its cationic iron complex called verdohem, which is a key intermediate of heme catabolism. To reveal its reactivities and properties as an oxaporphyrin analogue, the oxidation of tetra-β-arylated DOP (DOP-Ar4 ) was explored in this study. Stepwise oxidation from the 20π-electron neutral state was achieved, and the corresponding 19π-electron radical cation and 18π-electron dication were characterized. Further oxidation of the 18π-aromatic dication resulted in the formation of a ring-opened dipyrrindione product by hydrolysis. Considering a similar reaction of verdoheme to ring-opened biliverdin in the heme degradation in nature, the current result consolidates the ring-opening reactivity of oxaporphyrinium cation species.

Substituent effects on paratropicity and diatropicity in π-extended hexapyrrolohexaazacoronene

Research into the application of antiaromatic compounds as molecular materials is an attractive strategy in the development of electronic materials. Antiaromatic compounds have traditionally been considered to be unstable, and thus, the creation of stable antiaromatic compounds has been sought in the field of organic chemistry. Recently, some studies have been reported on the synthesis, isolation, and elucidation of the physical properties of compounds with stability and definitive antiaromatic properties. In general, antiaromatic compounds are considered to be more susceptible to substituents due to their inherently narrow HOMO-LUMO gap compared to aromatic compounds. However, there have been no studies examining substituent effects in antiaromatic compounds. In this study, we have developed a synthetic method to introduce various substituents into π-extended hexapyrrolohexaazacoronene (homoHPHAC⁺), one of the stable and clearly antiaromatic compounds, and investigated the substituent effects on the optical, redox, and geometrical properties and paratropicity of a series of compounds. In addition, the properties of the two-electron oxidized form, homoHPHAC³⁺, were investigated. Control of electronic properties by introducing substituents into antiaromatic compounds provides a new design guideline for molecular materials.

Pyrrole-Fused Azacoronene Analog with Sulfur Embedded in the Outer Periphery

The synthesis of sulfur-embedded hexapyrrolohexaazacoronene (HPHAC) analog 2 and its corresponding desulfurized and rearranged compounds was achieved from tetrafluoroisothianaphthene. Structures of all the new π-skeletons were determined by X-ray crystallography. Comparison of the electronic spectrum of 2 with those of its derivatives revealed less involvement of the sulfur atom in π-conjugation. Similar to the reference HPHAC (1), compound 2 and its derivatives exhibited reversible oxidation behavior. The aromaticity of both neutral and dication states has been investigated through DFT calculations.

Synthesis of Peripherally Annulated Phenanthroporphyrins

Synthesis of unusual phenanthroporphyrins was achieved by a stepwise precursor method. Precursor porphyrins fused with aryl-substituted bicyclo[2.2.2]octadiene afforded the corresponding arylbenzoporphyrins (arylBPs) by a retro Diels-Alder reaction. Unusual phenanthroporphyrins were obtained via the intramolecular Scholl reaction of arylBPs. X-ray crystallographic analysis revealed a distorted, helical porphyrin plane. Red-shifted absorptions of tetraphenanthroporphyrin are observed at ca. 580 nm for the B band and at 700-900 nm for the Q bands. Analysis of magnetic circular dichroism spectra and time-dependent density functional theory calculations was used to explain the optical properties and electronic structures.

Post-Modification of Pyrrolopyrrole Aza-BODIPY toward High Near-Infrared Fluorescence Brightness

Pyrrolopyrrole aza-BODIPYs (PPABs), dimeric aza-BODIPY analogues, exhibit intense absorption and fluorescence in the visible and near-infrared (NIR) regions. Here, we developed a facile postmodification by palladium-catalyzed coupling reactions to synthesize a series of donor-acceptor-donor (D-A-D) PPABs. Despite the possible fluorescence quenching dictated by the energy-gap low, D-A-D PPABs exhibit high-fluorescence brightness in the NIR region, implying their potential use as a bright NIR emitter.

Synthetic Model for FRET Constructed from Covalently Linked Porphyrin Dimers through a Pyrene Bridge

We report the synthesis and characterization of two porphyrin arrays C₆F₅-PyZnDP and Mes-PyZnDP covalently linked by a pyrene moiety which differs from their substituents at their meso-positions. The key precursor bis-dipyrromethane linked with a pyrene bridge was prepared by the acid-catalyzed condensation of pyrene-1,6-dialdehyde with excess pyrrole. The synthesis of C₆F₅-PyZnDP was carried out via two different synthetic routes, with one being efficient over the other. Therefore, the superior route was employed for the synthesis of C₆F₅-PyZnDP and Mes-PyZnDP. Both the free base and metalated diporphyrins show bathochromically shifted absorption and intense red emission due to the extended π-conjugation through pyrene and porphyrins. The single-crystal X-ray structure reveals an orthogonal orientation of pyrene in between the two planar porphyrins and a slipped stacked packing arrangement in the crystal structure with large meso-meso distances. DFT analysis of both the ground state and the excited S1 state of the macrocycles indicates the difference in the HOMO and LUMO contribution in both the states arising from slight twisting from the mean orthogonal position in the excited state. Further, the Förster energy transfer (FRET) efficiencies from pyrene (donor) to the covalently linked Zn-porphyrins (acceptor) are estimated to be 85 and 91% for Mes-PyZnDP and C₆F₅-PyZnDP, respectively.

Synthesis, Structure, and Optical Properties of a Bis-Macrocycle Derived from a Highly Emissive 1,3,6,8-Tetra(1H-pyrrol-2-yl)pyrene

A tetra-functionalized pyrene precursor 4b is prepared using the Suzuki-Miyaura coupling of 1,3,6,8-tetrabromopyrene with N-Boc-2-pyrroleboronic acid. 4b displayed a blue emission with a high quantum yield (ϕ_F = 0.89). 4b is subjected to [3 + 2] Lewis acid-catalyzed condensation with 2,2'-bithiophene-dialcohol 5, affording a planar bis-N₂S₂ internally linked with pyrene. The single-crystal X-ray structure of bis-N₂S₂ revealed a planar conformation with all of the pyrrolic nitrogens and thiophenic sulfurs pointing toward the macrocyclic core. Further, the reduction of bis-N₂S₂ was attempted in the presence of Zn/NH₄Cl at room temperature in CHCl₃. A sharp color change from pink to brown was observed presumably due to the formation of its reduced congener bis-N₂S₂-2H. However, the reduced species was found to revert back to its oxidized form over a period of 25 min in CHCl₃. Density functional theory (DFT) studies reveal that the two monocyclic halves of bis-N₂S₂-2H exhibit differences in aromaticity depending on amino and imino pyrroles present inside each individual core. Such a conversion was also monitored by ultraviolet-visible (UV-vis) absorption spectral studies, and the exact composition of bis-N₂S₂-2H was confirmed by High-resolution/mass spectrometry (HR/MS) analysis. Experimental and theoretical studies reveal a weak aromatic character of bis-N₂S₂ due to the absence of global conjugation.

Cumulative risk of developing a new symptom in patients with primary biliary cholangitis and its impact on prognosis

Background and Aim

Symptoms of primary biliary cholangitis (PBC) frequently impair one's quality of life (QOL). Nonetheless, with improved treatment, the prognosis of PBC also improves. QOL plays an important role in patients with PBC. In this study, we aimed to reevaluate the transition of new symptom development in PBC and its predictive factors.

Methods

This retrospective multicenter study enrolled 382 patients with PBC for symptom analysis. The impact of a newly developed symptom on PBC prognosis was investigated by Kaplan–Meier analysis with propensity score matching and logistic progression analysis.

Results

The cumulative risk of developing a new symptom after 10 and 20 years of follow‐up was 7.6 and 28.2%, and specifically that of pruritus, which was the most common symptom, was 6.7 and 23.3%, respectively. In Cox hazard risk analysis, serum Alb level (hazard ratio [HR], 1.097; 95% confidence interval [CI], 1.033–1.165; P = 0.002), the serum D‐Bil level (HR, 6.262; 95% CI, 2.522–15.553, P < 0.001), and Paris II criteria (HR, 0.435; 95% CI, 0.183–1.036; P = 0.037) were significant independent predictors of a new symptom. Kaplan–Meier analysis showed that the overall survival and liver‐related death were not significant between patients with and without a new symptom.

Conclusion

The cumulative risk of new symptom development is roughly 30% 20 years after diagnosis and could be predicted by factors including serum albumin levels, serum D‐Bil level, and Paris II criteria.

POS0670 EVALUATION OF UPADACITINIB IN RHEUMATOID ARTHRITIS PATIENTS WITH INADEQUATE RESPONSE TO FIRST-GENERATION JANUS KINASE INHIBITORS

Background

Janus kinase inhibitors (JAKi) are effective in the treatment of patients with difficult-to-treat rheumatoid arthritis (D2T RA), regardless of previous use of biological disease-modifying antirheumatic drugs (bDMARDs), and receive equal billing with biological therapies in the latest version of the EULAR recommendations for treatment of RA1. However, as with bDMARDs, cases of discontinuation due to intolerance or inadequate response have been observed in patients treated with the so-called first-generation JAKi, leading to the development of a new generation of JAKi that aims to maximize efficacy and improve safety by enhancing kinase selectivity. The results of randomized controlled trials and meta-analyses suggest that the efficacy and safety of Upadacitinib (UPA) treatment are favorable. Although there have been no head-to-head trials between JAKi, a matched-adjusted indirect comparative study has shown a difference in efficacy between JAKi2, suggesting that the new generation of JAKi may be effective in rheumatoid arthritis patients with intolerance or inadequate response to first-generation JAKi. It is already apparent that a clear need exists for a JAK-IR trial to give guidance in those difficult patients who are JAKi non-responders3.

Objectives

To evaluate real world efficacy of a second-generation JAK1-selective JAKi UPA in single-center cohort of RA patients who had discontinued first-generation JAKi.

Methods

Patients with RA who had discontinued tofacitinib and/or baricitinib due to inadequate response or intolerance, regardless of whether they had used bDMARDs or not, were eligible for the study if they had received UPA by October 2021 and had been followed up for at least 12 weeks. Endpoints were Kaplan-Meier survival rate with inadequate response or intolerance as reasons for discontinuation, various disease activity assessments (DAS28-ESR, SDAI, CDAI, etc.), and patient reported outcomes (visual analogue scales (VASs) such as pain and stiffness, HAQ-DI, FACIT-Fatigue Scale, etc.) at 12 weeks. In addition, the reasons for discontinuation were investigated.

Results

Fifty-one patients were included in the study, all of whom had D2T RA and had used at least one bDMARD as well as JAKi. The mean (median) age was 72.7 (77) years, disease duration 18.0 (17) years, number of bDMARDs used 3.34 (3), number of JAKi used 1.3(1), 5 patients with methotrexate, 6 patients with prednisolone, and DAS28-ESR 3.83 (3.9). At 12 weeks, the overall survival rate was 94% (94.6% in 37 cases used as 2nd JAKi and 92.9% in 14 cases used as 3rd JAKi). For reference, there was no significant difference from the 100% of the 15 cases used as the 1st JAKi (P=0.49). DAS28-ESR <3.2 and <2.6 were achieved in 60.8% and 29.4%, VASs for pain and stiffness decreased by a mean of 12.9 mm (9 mm) and 12.1 mm (7 mm), respectively, and FACIT-Fatigue scale improved by a mean of 3.0 (1). The reasons for discontinuation in the three patients were inadequate efficacy in two and leg cramps due to venous thromboembolism in one.

Conclusion

UPA is more selective for JAK1 than first generation JAKi, and is expected to reduce adverse reactions caused by inhibition of JAK family members other than JAK1. The present study suggests that UPA is effective and well tolerated, regardless of the number and type of first-generation JAKi used in the past, albeit for a short period of time. Limitations include the small number of cases and the short time frame for discussing adverse reactions.

References

[1]Smolen JS, Landewé BM, Bijlsma WJ et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020;79:685–699.

[2]Christopher JE, Ruta S, Vishvas G et al. A Matching-Adjusted Indirect Comparison of Upadacitinib Versus Tofacitinib in Adults with Moderate-to-Severe Rheumatoid Arthritis. Rheumatol Ther 2021; 8:167–181.

[3]Peter Nash, Clinical use of Jak 1 inhibitors for rheumatoid arthritis. Rheumatology, Volume 60, Issue Supplement_2, May 2021, Pages ii31–ii38

Disclosure of Interests

None declared

Tropo(thio)ne-Embedded HomoHPHACs: Does the Tropylium Cation Induce Global Antiaromaticity in Expanded Hexapyrrolohexaazacoronene?

Tropo(thio)ne-embedded homoHPHACs and their dications were synthesised by an electrophilic annulation of secoHPHAC and successive oxidation. 13C NMR spectra of the dications represented global 22π homoaromaticity via homoconjugation, while alkylation...

Luminescent Iridium(III) Dipyrrinato Complexes: Synthesis, X-ray Structures, DFT and Photocytotoxicity Studies of Glycosylated Derivatives

A series of luminescent Ir(III) dipyrrinato complexes were synthesized having various aromatic chromophores on the C-5 position of dipyrrin ligand. The presence of different chromophores on the Ir(III) dipyrrinato complexes...

Superomedial pedicle skin-reducing mastectomy in ptotic and large-sized breasts with two-stage reconstruction through transaxillary video-assisted technique: An effective surgical and anesthetic approach

Introduction

Skin-reducing mastectomy has been applied to several surgical techniques in which subcutaneous mastectomy is associated with various types of skin reduction, with preservation of a lower dermal flap to reinforce the inferior lateral seat of an implant. The aim of the study is to present a case series of patients with pendulous/ptotic and/or large-sized breasts treated for breast cancer at the Breast Surgery Unit of Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy, with the superomedial pedicle skin-reducing mastectomy technique, two-stage reconstruction, and transaxillary video-assisted technique, when a postoperative radiotherapy was indicated. We verified its effectiveness by discussing its results, especially in patients who are candidates for postmastectomy radiotherapy.

Materials and methods

A single-center retrospective study was performed between January 2020 and March 2021 on a prospectively filled database of conservative mastectomies. Of the 64 patients who underwent nipple/skin-sparing mastectomies in the mentioned period, 17 (mean age 46 years, range 30-62 years) were treated with superomedial pedicle skin-reducing mastectomy, with two-stage breast reconstruction through transaxillary video-assisted replacement expander with definitive prosthesis and contralateral symmetrization, selected for postmastectomy radiotherapy.

Results

We had only three minor complications. No flap necrosis, no infections, no breast seromas, and no reconstructive failures were observed. During follow-up of the patients treated with video-assisted reconstruction, there were no cases of infection, hematoma, implant rupture, or suture dehiscence in the reconstructed breast.

Discussion

Skin-reducing mastectomy with superomedial pedicle is a safe and reliable procedure to treat breast cancer in selected patients, i.e., those with pendulous/ptotic and or large-sized breasts. Particularly, in patients who undergo postmastectomy radiotherapy, the two-stage reconstruction with video-assisted transaxillary endoscopic approach can find its main indication, using incisions positioned far from the mammary region, offering numerous advantages.

Synthesis of Non- or Antiaromatic Dicarbaamethyrin: [24]Diazulihexaphyrin(0.1.0.0.1.0)

A "3+3" condensation reaction of 1,3-di(2-pyrrolyl)azulene with aryl aldehyde followed by an oxidative aromatization afforded diazuliamethyrin, [24]diazulihexaphyrin(0.1.0.0.1.0). X-ray diffraction analysis revealed a relatively planar structure of diprotonated diazuliamethyrin with a mean plane deviation of 0.37 Å. A 24π non- or antiaromatic character was confirmed by ¹H NMR, absorption, MCD spectra, and TD-DFT calculations that included the NICS values and ACID plots.

Disruption of Antiaromaticity in Structurally Related Expanded Porphyrin-like Macrocycles with Benzene Linkers

1,4-Phenylene-linked cyclotrimer (3T) and cyclotetramer (4T) have been synthesized via Lewis acid-catalyzed self-condensation of appropriate precursors. Structural and Density Functional Theory (DFT) studies reveal the disruption of annulenic conjugation in both 3T and 4T by linking phenylene rings prevented them from global antiaromaticity. The single crystal X-ray structure of 4T reveals all the nitrogens are pointing toward the macrocyclic core with near-planar and square-shaped geometry, thus in sharp contrast to the ring-strained conformation of 3T.

Synthesis, Properties, and Packing Structures of Wing-Shaped N-Doped Nanographene in Various Oxidation States

A rigid wing-shaped bicyclo[2.2.2]octadiene-fused bis-hexapyrrolohexaazacoronene (HPHAC) is synthesized, and subsequent chemical oxidation affords a stable biradical dication and an aromatic tetracation. The physicochemical properties and single-crystal structures in various oxidation states are characterized. The face-to-face π-stacked dimeric structures are observed in the neutral and dicationic states. The HPHAC flakes can act as aromatic walls in a tetracation state, producing enlarged induced magnetic shielding space through the superimposition effect.

A randomized, controlled trial of once-weekly teriparatide injection versus alendronate in patients at high risk of osteoporotic fracture: primary results of the Japanese Osteoporosis Intervention Trial-05

In this randomized, controlled trial, treatment with once-weekly subcutaneous injection of teriparatide for 72 weeks was found to be associated with a significant reduction in the incidence of morphometric vertebral fractures compared with alendronate in women with primary osteoporosis who were at high risk of fracture.

INTRODUCTION

To determine whether the anti-fracture efficacy of teriparatide is superior to that of alendronate, a prospective, randomized, open-label, blinded-endpoint trial was performed.

METHODS

Japanese women aged at least 75 years were eligible for the study if they had primary osteoporosis and were at high risk of fracture. Patients were randomly assigned in a 1:1 ratio to receive sequential therapy (once-weekly subcutaneous injection of teriparatide 56.5 μg for 72 weeks followed by alendronate for 48 weeks) or monotherapy with alendronate for 120 weeks. The primary endpoint was the incidence of morphometric vertebral fractures at 72 weeks (at the end of teriparatide treatment).

RESULTS

Between October 2014 and December 2017, 1011 patients (505 in the teriparatide group and 506 in the alendronate group) were enrolled. Of these, 778 patients (351 and 427, respectively) were included in the primary analysis. The incidence of morphometric vertebral fractures was significantly lower in the teriparatide group (56 per 419.9 person-years, annual incidence rate 0.1334) than in the alendronate group (96 per 553.6 person-years, annual incidence rate 0.1734), with a rate ratio of 0.78 (95% confidence interval 0.61 to 0.99, P = 0.04). In both groups, adverse events were most frequently reported in the following system organ classes: infections and infestations, gastrointestinal disorders, and musculoskeletal and connective tissue disorders.

CONCLUSION

Once-weekly subcutaneous injection of teriparatide significantly reduced the incidence of morphometric vertebral fractures compared with alendronate in women with primary osteoporosis who were at high risk of fracture.

TRIAL REGISTRATION

jRCTs031180235 and UMIN000015573, March 12, 2019.

Phenolate-bridged A2B-type subporphyrin dimer

An ether cleavage reaction of A2B-type subporphyrin bearing an ortho-anisyl substituent afforded a phenolate-bridged dimer. A head-to-tail structure of the dimer was unambiguously elucidated by single crystal X-ray diffraction analysis. UV-vis absorption and magnetic circular dichroism spectra indicated a minor interaction between the subporphyrin chromophores. Density functional theory calculations provided a detailed insight into the electronic structures of the subporphyrin dimer.

Synthesis of antiaromatic tetrabenzodithiaamethyrin

Bicyclo[2.2.2]octadiene(BCOD)-fused dithiaamethyrin 4 was synthesized via a “3+3” condensation method. Thermal conversion of the BCOD moieties afforded tetrabenzodithiaamethyrin 5. The highly planar structures of 4 and 5 were confirmed by X-ray diffraction studies. The 1H NMR, absorption and MCD spectra, together with TD-DFT calculations revealed that both BCOD-fused and [Formula: see text]-extended dithiaamethyrins have a 24[Formula: see text] antiaromatic character.

Janus Pyrrolopyrrole Aza-dipyrrin: Hydrogen-Bonded Assemblies and Slow Magnetic Relaxation of the Cobalt(II) Complex in the Solid State

A novel pyrrolopyrrole azadipyrrin (Janus-PPAD) with Janus duality was synthesized by a Schiff base-forming reaction of diketopyrrolopyrrole. The orthogonal interactions of the hydrogen-bonding ketopyrrole and metal-coordinating azadipyrrin moieties in Janus-PPAD enabled the metal ions to be arranged at regular intervals: zinc(II) and cobalt(II) coordination provided metal-coordinated Janus-PPAD dimers, which can subsequently form hydrogen-bonded one-dimensional arrays both in solution and in the solid state. The supramolecular assembly of the zinc(II) complex in solution was investigated by ¹ H NMR spectroscopy based on the isodesmic model, in which a binding constant for the elongation of assemblies is constant. Owing to the tetrahedral coordination, in the solid state, the cobalt(II) complex exhibited a slow magnetic relaxation due to the negative D value of -27.1 cm^-1 with an effective relaxation energy barrier U_eff of 38.0 cm^-1 . The effect of magnetic dilution on the relaxation behavior is discussed. The relaxation mechanism at low temperature was analyzed by considering spin lattice interactions and quantum tunneling effects. The easy-axis magnetic anisotropy was confirmed, and the relevant wave functions were obtained by ab initio CASSCF calculations.

Effects of geometrical isomerism on emissive behaviour of heteroleptic cyclometalated Ir(III) complexes

In this study, we report the emissive properties of a heteroleptic cyclometalated Ir(iii) complex, [Ir(bzq)2(PBO)] (bzqH = benzo[h]quinoline; PBOH = 2-(2-hydroxyphenyl)benzoxazole). The complex, [Ir(C^N)2(N^O)], was synthesised and optically resolved using a chiral column. Two geometrical isomers, trans-(N,N) and cis-(N,N) isomers, were obtained as the major and minor products in an enantiopure form, respectively. Their molecular structures were determined using single crystal X-ray analysis. In the crystalline states, the intermolecular C-Hπ interaction between PBO- and an H atom in bzq- was the main factor influencing molecular packing. When the complexes were dissolved in CH2Cl2 and excited at 430 nm under N2 atmosphere, yellow (λmax = 550 nm) and orange emissions (λmax = 570 nm) were observed for the trans-(N,N) and cis-(N,N) isomers, respectively, with the quantum yield higher for the former than the latter.

Iridium Complex of N-Fused Bilatrienone: Oxidative Cleavage of N-Fused Porphyrin Induced by Iridium-Cyclooctadiene Complexation

N-fused porphyrin (NFP) is a unique class of photostable near-infrared dyes with an 18π aromatic tetrapyrrole macrocyclic skeleton containing a tri-fused pentacyclic moiety. Here, the synthesis of an iridium complex of N-fused bilatrienone is reported as the degradation product of Ir-cyclooctadiene (cod)-induced oxidative cleavage of NFP under aerobic conditions. Similar to the native bilin chromophores, the ring-opened complex featured a broken π-conjugation circuit and exhibited a broad visible absorption band. In contrast, metalation of NFP using an iridium(I)(cod) complex under an inert atmosphere resulted in the formation of a cod-isomerized (κ¹ ,η³ -C₈ H₁₂ )-Ir complex.

AB0252 EFFICACY OF A SECOND JANUS KINASE INHIBITOR THAT WAS SWITCHED FOR DIFFICULT-TO-TREAT RA IN CLINICAL PRACTICE

Background:

In clinical practice, when refractory rheumatoid arthritis (RA) is present, of which the definition implies previous use of at least two biologic disease-modifying antirheumatic drugs (bDMARDs) (generally tumour necrosis factor inhibitors (TNFis)), the next treatment choice often made is a bDMARD of another class (non-TNFis) [1]. However, patients who are inadequately responding to bDMARDs need new treatment options because subsequent bDMARDs treatment reduces their response [2]. Janus Kinase inhibitors (JAKis) are the first targeted synthetic DMARDs (tsDMARD) licensed for the treatment of RA with comparable efficacy to bDMARDs. Unlike the single cytokine targeting approach of bDMARDs, JAKis are specifically designed to inhibit intracellular signalling molecules common to the receptors of multiple inflammatory cytokines implicated in RA pathogenesis. The choice of therapeutic agents for refractory RA is increasing, and its efficacy is expected. On the other hand, it is also true that some patients discontinued JAKis at a rate that cannot be overlooked because of insufficient efficacy. Difficult-to-treat (D2T) RA is defined as refractory to two or more b/ts DMARDs with different mechanisms of action, with active and progressive disease, as published by Eular(3)

Objectives:

To evaluate real world efficacy of approved JAKis switching in patients with D2T RA who were unable to control their disease activity due to insufficient efficacy despite the sequential use of multiple bDMARDs and JAKis, focusing on the drug retention rate.

Methods:

In our hospital, RA was diagnosed according to the 1987 or 2010 classification criteria, and when two or more bDMARDs (including both TNFis and non-TNFis) were inadequately effective, it was defined as D2T RA. We retrospectively investigated patients who switched to JAKis for D2T RA. The drug retention rate was investigated by the Kaplan-Meier method, and the difference was tested by the Logrank test.

Results:

The 1-year retention rate of JAKis for D2T RA was 50.8% in TOF 38 cases [28 women, age average 70.2 years, disease duration average 12.4 years, past bDMARDs use average 3.5 drugs, MTX combination 9 cases, DAS28 ESR average 4.11] and 66.3% in BAR 35 cases [26 cases, 73.0 years old, 14.8 years, 4.17 agents, 9 cases, 3.68], and there was no significant difference (P = 0.30). Among them, there were 17 cases [11 cases, 70.6 years old, 13.5 years, 4.18 drugs, 2 cases, 3.65] of switching between JAKis, all of which were switching from TOF to BAR. The 1-year retention rate was 45.8% [reason for discontinuation: insufficient effect in 3 cases, adverse events in 6 cases], which was not significantly different but tended to be lower than 72.7% [reason for discontinuation: insufficient effect in 1 case, adverse event in 2 cases, patient’s convenience in 1 case] in 16 patients [13 cases, 76.3 years old, 17.1 years, 3.19 drugs, 7 cases, 3.69] who received BAR as the first JAKi for D2T RA patients (P = 0.089).

Conclusion:

Although the number of cases is small in the retrospective survey, it is suggested that the retention rate of BAR switched to D2T RA may be slightly lower in patients with a history of TOF discontinuation due to insufficient efficacy than in JAKi naive patients. It is expected that the number of new JAKi usage cases will increase in the future, and it is necessary to consider switching between other JAKis in addition to switching from BAR to TOF.

References:

[1]Smolen JS, Landewe R, Bijlsma J et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017;76:960_77.

[2]Rendas-Baum R, Wallenstein GV, Koncz T et al. Evaluating the efficacy of sequential biologic therapies for rheumatoid arthritis patients with an inadequate response to tumor necrosis factor-α inhibitors. Arthritis Res Ther 2011;13:R25.

[3]Nagy G, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80:31–35. doi:10.1136/annrheumdis-2020-217344.

Disclosure of Interests:

None declared

POS0088 EFFICACY OF JANUS KINASE INHIBITORS FOR DIFFICULT-TO-TREAT RA IN CLINICAL PRACTICE

Background:

In 20-30% of rheumatoid arthritis (RA) patients, the first biologic disease-modifying antirheumatic drugs (bDMARDs) (generally tumour necrosis factor inhibitors (TNFis)) is ineffective, and among the patients who do respond to therapy, 20% is faced with secondary ineffectiveness within the first 2 years of treatment [1]. In practice, when refractory RA is present, of which the definition implies previous use of at least two bDMARDs (generally TNFis), the next treatment choice often made is a bDMARD of another class (non-TNFis) [2]. On the other hand, patients who are inadequately responding to bDMARDs need new treatment options because subsequent bDMARD treatment reduces their response [3]. Janus Kinase inhibitors (JAKis) are the first targeted synthetic DMARDs (tsDMARD) licensed for the treatment of RA with comparable efficacy to bDMARDs. Unlike the single cytokine targeting approach of bDMARDs, JAKis are specifically designed to inhibit intracellular signalling molecules common to the receptors of multiple inflammatory cytokines implicated in RA pathogenesis.

Objectives:

Difficult-to-treat (D2T) RA is defined as refractory to two or more b/ts DMARDs with different mechanisms of action, with active and progressive disease, as published by Eular(4). We evaluated real world efficacy of approved JAKis and factors that may help to continue them in patients with D2T RA.

Methods:

Patients who had inadequate response to two or more bDMARDs (including both TNFis and non-TNFis) at our hospital by December 2019 were defined as D2T RA, and patients who switched to JAKis were retrospectively investigated. The drug retention rate was determined by Kaplan-Meier method, and the difference was tested by Logrank test. Multiple regression analysis was used as the statistical method to predict continuation of JAKis for more than 1 year, with patient background (age, gender, during the disease, number of bDMARDs used, with or without methotrexate and/or glucocorticoids, disease activity score assessing 28 joints using erythrocyte sedimentation rate’ presence of rheumatoid factor/anti-CCP antibody, matrix metalloproteinase 3 value, Health Assessment Questionnaire disability index) at the time of initiation as an explanatory variable.

Results:

A total of 915 bDMARDs had been administered to 394 RA patients. The retention rate of bDMARDs and the number of bDMARDs used were 89.3% and 1.48 bDMARDs at 1 year, 67.7% and 2.27 bDMARDs at 5 years, and 52.0% and 3.15 bDMARDs at 10 years, respectively. The retention rate of JAKis at 1 year was 60.2% in 65 patients with tofacitinib (TOF) and 67.2% in 70 patients with baricitinib (BAR) (P=0.38). Among them, the drug retention rate in D2T RA patients was 50.8% in 38 TOF patients and 66.3% in 35 BAR patients with no significant difference (P=0.30). There were no patient background factors that significantly predicted continuation at 1 year for any JAKis.

Conclusion:

Despite the limited number of patients and the retrospective nature of the study, TOF and BAR were shown to be effective options for D2T RA, regardless of patient background such as disease activity or number of bDMARDs used. Other JAKis and switches between JAKis need to be investigated in the future.

References:

[1]Schaeverbeke T, Truchetet ME, Kostine M et al. Immunogenicity of biologic agents in rheumatoid arthritis patients: lessons for clinical practice. Rheumatology 2016;55:210_20.

[2]Smolen JS, Landewe R, Bijlsma J et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017;76:960_77.

[3]Rendas-Baum R, Wallenstein GV, Koncz T et al. Evaluating the efficacy of sequential biologic therapies for rheumatoid arthritis patients with an inadequate response to tumor necrosis factor-α inhibitors. Arthritis Res Ther 2011;13:R25.

[4]Nagy G, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80:31–35. doi:10.1136/annrheumdis-2020-217344.

Disclosure of Interests:

None declared