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Bayat S, Tascilar K, Kaufmann V, Kleyer A, Simon D, Knitza J, Hartmann F, Adam S, Hueber A, Schett G. AB0330 HIGH REMISSION RATES IN RA – REAL LIFE DATA FROM BARITICINIB. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Recent developments of targeted treatments such as targeted synthetic DMARDs (tsDMARDs) increase the chances of a sustained low disease activity (LDA) or remission state for patients suffering rheumatoid arthritis (RA). tsDMARDs such as baricitinib, an oral inhibitor of the Janus Kinases (JAK1/JAK2) was recently approved for the treatment of RA with an inadequate response to conventional (cDMARD) and biological (bDMARD) therapy. (1, 2).Objectives:Aim of this study is to analyze the effect of baricitinb on disease activity (DAS28, LDA) in patients with RA in real life, to analyze drug persistance and associate these effects with various baseline characteristics.Methods:All RA patients were seen in our outpatient clinic. If a patient was switched to a baricitinib due to medical reasons, these patients were included in our prospective, observational study which started in April 2017. Clinical scores (SJC/TJC 76/78), composite scores (DAS28), PROs (HAQ-DI; RAID; FACIT), safety parameters (not reported in this abstract) as well as laboratory biomarkers were collected at each visit every three months. Linear mixed effects models for repeated measurements were used to analyze the time course of disease activity, patient reported outcomes and laboratory results. We estimated the probabilities of continued baricitinib treatment and the probabilities of LDA and remission by DAS-28 as well as Boolean remission up to one year using survival analysis and explored their association with disease characteristics using multivariable Cox regression. All patients gave informed consent. The study is approved by the local ethics.Results:95 patients were included and 85 analyzed with available follow-up data until November 2019. Demographics are shown in table 1. Mean follow-up duration after starting baricitinib was 49.3 (28.9) weeks. 51 patients (60%) were on monotherapy. Baricitinib survival (95%CI) was 82% (73% to 91%) at one year. Cumulative number (%probability, 95%CI) of patients that attained DAS-28 LDA at least once up to one year was 67 (92%, 80% to 97%) and the number of patients attaining DAS-28 and Boolean remission were 31 (50%, 34% to 61%) and 12(20%, 9% to 30%) respectively. Median time to DAS-28 LDA was 16 weeks (Figure 1). Cox regression analyses did not show any sufficiently precise association of remission or LDA with age, gender, seropositivity, disease duration, concomitant DMARD use and number of previous bDMARDs. Increasing number of previous bDMARDs was associated with poor baricitinib survival (HR=1.5, 95%CI 1.1 to 2.2) while this association was not robust to adjustment for baseline disease activity. Favorable changes were observed in tender and swollen joint counts, pain-VAS, patient and physician disease assessment scores, RAID, FACIT and the acute phase response.Conclusion:In this prospective observational study, we observed high rates of LDA and DAS-28 remission and significant improvements in disease activity and patient reported outcome measurements over time.References:[1]Keystone EC, Taylor PC, Drescher E, Schlichting DE, Beattie SD, Berclaz PY, et al. Safety and efficacy of baricitinib at 24 weeks in patients with rheumatoid arthritis who have had an inadequate response to methotrexate. Annals of the rheumatic diseases. 2015 Feb;74(2):333-40.[2]Genovese MC, Kremer J, Zamani O, Ludivico C, Krogulec M, Xie L, et al. Baricitinib in Patients with Refractory Rheumatoid Arthritis. The New England journal of medicine. 2016 Mar 31;374(13):1243-52.Figure 1.Cumulative probability of low disease activity or remission under treatment with baricitinib.Disclosure of Interests:Sara Bayat Speakers bureau: Novartis, Koray Tascilar: None declared, Veronica Kaufmann: None declared, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Johannes Knitza Grant/research support from: Research Grant: Novartis, Fabian Hartmann: None declared, Susanne Adam: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB
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Leitner M, Kaufmann V, Mager J, Geiter S, Siegemund A, Wagner L. Evaluation of assay performance monitoring Rivaroxaban with TECHNOCHROM anti-Xa on different analyzers. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leitner M, Riha M, Kaufmann V, Mager J, Geiter S, Wagner L. Evaluation of assay performance monitoring direct thrombin inhibitors with TECHNOCLOT® DTI. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lerman C, Wileyto EP, Patterson F, Rukstalis M, Audrain-McGovern J, Restine S, Shields PG, Kaufmann V, Redden D, Benowitz N, Berrettini WH. The functional mu opioid receptor (OPRM1) Asn40Asp variant predicts short-term response to nicotine replacement therapy in a clinical trial. Pharmacogenomics J 2004; 4:184-92. [PMID: 15007373 DOI: 10.1038/sj.tpj.6500238] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To determine whether the functional mu-opioid receptor (OPRM1) Asn40Asp variant predicts the comparative efficacy of different forms of NRT, we conducted a clinical trial of transdermal nicotine (TN) vs nicotine nasal spray (NS) in 320 smokers of European ancestry. Smokers carrying the OPRM1 Asp40 variant (n=82) were significantly more likely than those homozygous for the Asn40 variant (n=238) to be abstinent at the end of treatment, and reported less mood disturbance and weight gain. The genotype effect on treatment outcome was most pronounced among smokers receiving TN, particularly during the 21 mg dose phase. Smokers who carry the OPRM1 Asp40 variant are likely to have a favorable response to TN and may benefit from extended therapy with the 21 mg dose.
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Affiliation(s)
- C Lerman
- Department of Psychiatry, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA.
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Piper SN, Maleck WH, Triem JG, Isgro F, Kaufmann V, Saggau W. Myxoma complex associated with transient hyperthyroidism: are diseases of the thyroid part of the complex? Thorac Cardiovasc Surg 1997; 45:245-7. [PMID: 9402665 DOI: 10.1055/s-2007-1013736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The myxoma complex is a very rare disease. We report on a 31-year-old woman who suffered a hyperthyreosis, which resolved spontaneously. A few months later she developed a Cushing's syndrome, caused by a primary adrenocortical nodular dysplasia. A bilateral adrenalectomy had to be performed. 15 months after this operation she developed a cerebral infarction caused by an embolus from a left atrial myxoma. Our patient is a further case of Carney's syndrome. The aspect of the hyperthyreosis is interesting: Perhaps disease of the thyroid represents a new element of Carney's syndrome.
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Affiliation(s)
- S N Piper
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Germany
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Abstract
BACKGROUND Brucellosis is a zoonosis with good prognosis in cases of early diagnosis. To make the diagnosis is still a problem today. CASE REPORT A 60-year-old butcher was admitted with undulating fever, sweats, arthralgia and weight loss. Further examination revealed hepatosplenomegaly with laboratory findings of a hepatitis and multiple focal liver lesions shown by abdominal ultrasound and CT. Histologically, these lesions corresponded to caseous granulomas. Diagnosis of brucellosis was confirmed by detection of brucella species in prolonged incubation in blood culture. After the beginning of antibiotic resistance-tested therapy with tetracycline and quinolones, an endotoxic shock occurred during the first 24 hours of treatment and the patient died after multiorgan failure with disseminated intravascular coagulation. CONCLUSION In cases of undulating fever with liver involvement, a brucellosis should be considered. Good teamwork of the internal, pathological and microbiological departments is necessary for early and correct diagnosis. This is the first report of human brucellosis in association with lethal endotoxic shock.
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Affiliation(s)
- S Kress
- Medizinische Klinik C, Klinikum Ludwigshafen
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Abstract
Five patients with Whipple's disease all suffered from arthralgia for a long time (15 years in one case) before developing gastrointestinal or other symptoms. In all patients, arthralgia was seronegative, and there was no evidence of joint destruction. Arthralgias were symmetric and migrating. Whipple's disease is part of the differential diagnosis of enteropathic arthralgia. Thereby, the polymerase chain reaction can be a helpful tool to prove Whipple's disease in difficult differential diagnosis.
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Affiliation(s)
- D Schilling
- Medical Department, Klinikum Ludwigshafen, Academic Hospital, University of Mainz, Germany
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Abstract
Posterior cleft larynx is an uncommon congenital anomaly of variable extent representing an incomplete or absent separation of larynx and trachea from the hypopharynx and esophagus. This case report describes the histopathology of a type 2 cleft (classified according to Evans) associated with a subglottic stenosis due to elliptical shape of the cricoid cartilage and redundant submucosal tissue in a premature female infant.
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Affiliation(s)
- V Kaufmann
- Department of Pathology, Städtisches Klinikum Ludwigshafen/Rhine, Germany
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Benz C, Kohler B, Kaufmann V, Riemann JF. [Stomach wall abscess--endoscopic diagnosis and therapeutic possibilities]. Z Gastroenterol 1992; 30:264-7. [PMID: 1604911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This is a case report of a rare gastric wall abscess of a 70 year-old woman who came to hospital with non-characteristic pain in the upper abdomen. The diagnosis was made by endoscopy. After endosonography the patient was treated by endoscopic drainage, antibiotics and abstinence of food. Two weeks later the abscess had healed. Subsequently recurrent arterial emboli occurred in the left leg leading to several operations. Two months after hospitalisation the woman died as a result of circulation failure induced by septicaemia. Surprisingly, post mortem examination showed endocarditis of the mitral valve with septical metastases in multiple organs. A review of the literature is given and etiology and pathogenesis of the gastric wall abscess are reviewed. The surgical treatment is compared with endoscopic therapy.
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Affiliation(s)
- C Benz
- Medizinische Klinik C, Klinikums der Stadt, Ludwigshafen/Rhein, Bundesrepublik Deutschland
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Stösser L, Kaufmann V, Moritz R, Grosser W, Schaefer D, Künzel W. [Caries protective effect of a NaF containing toothpaste with and without calcium carbonate polishing agent]. Oralprophylaxe 1991; 13:11-6. [PMID: 1931193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A caries preventive effect depending on the free fluoride concentration was registrated on rats using dentifrices with NaF or MFP (alone or in combination) despite the presence of CaCO3 as abrasive material because the composition of these dentifrices was changed. The free fluoride concentration of dentifrices had induced the accumulation of fluoride into enamel. The ionized fluoride content of NaF-dentifrices was unchanged for 3 years. MFP was hydrolized and had continuously released fluoride ions. The caries preventive effect which was increased by HCO3- was reproducible in correspondence with the fluoride concentration after the storage for two years.
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Affiliation(s)
- L Stösser
- Sektion Stomatologie, Medizinische Akademie Erfurt
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