Surgical outcomes of very-early-onset ulcerative colitis: retrospective comparative study with older pediatric patients

PURPOSE

The study compares the surgical outcomes of very-early-onset ulcerative colitis (VEO-UC), which is a rare disease diagnosed in pediatric patients < 6 years, with those of older pediatric patients with ulcerative colitis (UC).

METHODS

A retrospective observational study of 57 pediatric patients with UC was conducted at a single center. The study compared surgical complications and postoperative growth between the two groups.

RESULTS

Out of the 57 patients, 6 had VEO-UC, and 5 of them underwent total colectomy. Compared with the surgical cases of older patients with UC (n = 6), the rate of postoperative complications in patients with VEO-UC (n = 5) was not significantly different, except for high-output ileostomy (80% vs. 0% at 3 weeks postoperatively, p = 0.02). The rate of postoperative central venous catheter (CVC) placement at > 90 days was higher in patients with VEO-UC (100% vs. 17%, p = 0.02). The median change in the Z-score of height before and 2 years after colectomy was not significantly different between VEO-UC and older patients (1.1 vs. 0.3, p = 0.13).

CONCLUSION

With regard to complications and outcomes, total colectomy for VEO-UC patients and that for older pediatric UC patients is comparable. However, high-output ileostomy and the long duration of CVC placement may pose management challenges.

Latent ion tracks were finally observed in diamond

Injecting high-energy heavy ions in the electronic stopping regime into solids can create cylindrical damage zones called latent ion tracks. Although these tracks form in many materials, none have ever been observed in diamond, even when irradiated with high-energy GeV uranium ions. Here we report the first observation of ion track formation in diamond irradiated with 2-9 MeV C60 fullerene ions. Depending on the ion energy, the mean track length (diameter) changed from 17 (3.2) nm to 52 (7.1) nm. High resolution scanning transmission electron microscopy (HR-STEM) indicated the amorphization in the tracks, in which π-bonding signal from graphite was detected by the electron energy loss spectroscopy (EELS). Since the melting transition is not induced in diamond at atmospheric pressure, conventional inelastic thermal spike calculations cannot be applied. Two-temperature molecular dynamics simulations succeeded in the reproduction of both the track formation under MeV C60 irradiations and the no-track formation under GeV monoatomic ion irradiations.

Left ventricular apical aneurysm resection and mitral valve replacement for apical hypertrophic cardiomyopathy

Key clinical message

Left ventricular apical hypertrophic cardiomyopathy with an apical aneurysm carries a risk of thrombosis and can also lead to atrial fibrillation and functional mitral regurgitation.

Abstract

A 78-year-old woman underwent left ventricular apical aneurysm (LVAA) resection and mitral valve replacement for severe atrial functional mitral regurgitation. ApHCM can cause atrial fibrillation and atrial functional mitral valve regurgitation. LVAA resection in addition to mitral valve replacement was reasonable to prevent fatal complications associated with LVAA.

Thermomechanical performance of continuous carbon fibre composite materials produced by a modified 3D printer

First of all, this article aimed to evidence the role of a modified printer developed for continuous carbon fibre reinforced PolyAmide (cCF/PA6-I) together with the use of a fully open slicing step on the printing quality and the longitudinal/transverse tensile and in-plane shear properties. A comprehensive assessment of the microstructure and properties with a similar material (cCF/PA6-I), but produced with a commercial printer (i.e., Markforged® MarkTwo) has been achieved. Our customised printer and the open slicer used have made possible to better control the print conditions (i.e., layer height and distance between filaments), to reduce the porosity from more than 10% to about 2% and improve the mechanical properties. Moreover, the understanding of the behaviour of these 3D printed composites with wide-ranging external temperatures is mandatory for future use in a severe environment and/or development of new thermally active 4D printed composites. The 3D printed cCF/PA6-I composites have been then thermomechanically characterised along different printing directions (0, 90 and ± 45°) from -55 to +100 °C. Unlike the longitudinal properties that hardly change with temperature, the transverse and in-plane shear stiffness and strength of these 3D printed composites were particularly sensitive to temperature variations, with decreases of 25-30% and 30-55%, respectively. This was due to the high sensitivity of the polymer matrix, the fibre/matrix and interfilament interfaces when the composites were loaded along those directions, because damages induced by internal thermal stresses. Fractography has also been carried out to reveal damage mechanisms.

Relationships among Grip Strength Measurement, Response Time, and Frailty Criteria

BACKGROUND

Muscle response in older adults is believed to decrease with maximal muscle strength, although it has not been adequately assessed; further, the relationship between frailty and muscle response remains unexamined.

OBJECTIVES

This study aimed to develop a practical method for measuring muscle response using grip strength in older adults and to clarify the relationship between frailty and grip strength response.

DESIGN, SETTING, AND PARTICIPANTS

We performed a cross-sectional, clinical, observational study. A total of 248 patients (94 men and 154 women, mean age: 78.2 years) who visited the outpatient unit in the Integrated Healthy Aging Clinic of our Hospital for the first time were enrolled.

MEASUREMENTS

Using a grip strength measuring device originally developed by us, we measured grip strength response indices, such as reaction time, time constant, rate of force development (response speed), and maximum grip strength. Grip strength response indices were compared among three groups (robust, pre-frail, and frail) according to the Fried and Kihon checklist assessments for frailty.

RESULTS

Based on Fried's assessment, marked differences were found between groups not only in maximal grip strength but also in response time and response speed. Based on the Kihon checklist assessment, there was no significant difference in response time; however, a considerable difference in response speed for the left hand was observed. Moreover, according to the Kihon checklist assessment, some cases showed differences in muscle response although not in maximal muscle strength.

CONCLUSIONS

The response speed of grip strength was suggested to decrease with frailty. The results suggest that measurement of grip strength response in both hands is useful to examine the relationship between frailty and grip strength response.

Temporal Profiles of Symptom Scores After Palliative Radiotherapy for Bleeding Gastric Cancer With Adjustment for the Palliative Prognostic Index: An Exploratory Analysis of a Multicentre Prospective Observational Study (JROSG 17-3)

AIMS

Although palliative radiotherapy for gastric cancer may improve some symptoms, it may also have a negative impact due to its toxicity. We investigated whether symptoms improved after radiotherapy with adjustment for the Palliative Prognostic Index (PPI) considering that patients with limited survival tend to experience deterioration of symptoms.

MATERIALS AND METHODS

This study was an exploratory analysis of the Japanese Radiation Oncology Study Group study (JROSG 17-3). We assessed six symptom scores (nausea, anorexia, fatigue, shortness of breath, pain at the irradiated area and distress) at registration and 2, 4 and 8 weeks thereafter. We tested whether symptoms linearly improved after adjusting for the baseline PPI. Shared parameter models were used to adjust for potential bias in missing data.

RESULTS

The present study analysed all 55 patients enrolled in JROSG 17-3. With time from registration as the only explanatory variable in the model, a significant linear decrease was observed in shortness of breath, pain and distress (slopes, -0.26, -0.22 and -0.19, respectively). Given that the interaction terms (i.e. PPI × time) were not significantly associated with symptom scores in any of the six symptoms, only PPI was included as the main effect in the final multivariable models. After adjusting for the PPI, shortness of breath, pain and distress significantly improved (slope, -0.25, -0.19 and -0.17; P < 0.001, 0.002 and 0.047, respectively). An improvement in fatigue and distress was observed only in patients treated with a biologically effective dose ≤14.4 Gy.

CONCLUSION

Shortness of breath, pain and distress improved after radiotherapy. Moreover, a higher PPI was significantly associated with higher symptom scores at all time points, including baseline. In contrast, PPI did not seem to influence the improvement of these symptoms. Regardless of the expected survival, patients receiving radiotherapy for gastric cancer can expect an improvement in shortness of breath, pain and distress over 8 weeks. Multiple-fraction radiotherapy might hamper the improvement in fatigue and distress by its toxicity or treatment burden.

AB0343 LONG-TERM TOCILIZUMAB TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS IN DAILY CLINICAL PRACTICE

Background

Tocilizumab (TCZ) is a humanized anti-IL-6 receptor monoclonal antibody that improves the signs and symptoms of rheumatoid arthritis (RA). In previous clinical trials, long-term outcomes have been increasingly evaluated in daily clinical practice. We report the five-year outcomes of TCZ treatment at our institute.

Objectives

This retrospective study determined the long-term trends in TCZ use in clinical practice.

Methods

Data from the Toyohashi RA database (TRAD) were used. The TRAD is single-center retrospective data. Last observation carried forward was used as a complementary method for missing data. Participants were 59 RA patients in whom TCZ therapy was started at our institute from September 2009 to May 2016. Subsequent items, baseline patient characteristics, disease activity, treatment continuation rates of TCZ using the Kaplan-Meier method, reasons for stopping TCZ, concomitant use of methotrexate (MTX) and prednisolone (PSL) were investigated.

Results

Baseline characteristics at the start of TCZ treatment were 17 men and 42 women with a mean age of 58.6 years (30–81). The mean RA duration was 8.7 years (0–31). The mean SDAI score was 27.9 ± 11.6; the mean DAS28-CRP was 5.0 ± 1.0. CRP was 4.1 ± 3.0 mg/dl and MMP-3 388.3 ± 311.5 ng/ml. Methotrexate (MTX) was administered in 37 patients (62.7%, mean 6.0 mg, mean MTX dose administered in cases, 9.6 mg/week). Prednisolone (PSL) was administered in 37 patients (62.7%, mean 3.6 mg; the mean PSL dose administered in cases 5.7 mg/day).

Regarding disease activity, the mean SDAI was 27.9 at baseline; 12.3 at three months; 8.1 at one year; 7.3 at two years; 6.5 at three years; 46.7 at four years; 5.6 at five years, and 5.2 at final observation. The SDAI significantly improved after two years compared to baseline. Remission and low disease activity also significantly improved at one year and gradually improved after one year (Figure 1). The remission rate at the final observation was 55.2%, with an SDAI ≦3.3.

TCZ continuation rates were 86.9% at one year, 78.7％ at three years, and 68.9% at five years (Figure 2). TCZ was discontinued due to adverse events in 11 cases (18%), and inadequate efficacy occurred in 9 (14.8%). The adverse events were respiratory infection (5), purulent arthritis (1), infectious endocarditis (1), subarachnoid hemorrhage (1), breast cancer (1), pruritis (1), and skin ulcer (1). Other reasons for discontinuation were dialysis (2), suspension of hospital visits (2), kidney transplant (1), and financial difficulties (1). Concomitant use from baseline to final observation declined from 62.7% to 15.3% for MTX and from 62.7% to 23.7% for PSL.

Conclusion

Long-term treatment with TCZ was acceptable. We found that with TCZ therapy, the remission and low disease activity rates significantly improved at one year and continued to improve after one year. Treatment persistence was high, but careful monitoring for infection is necessary.

Disclosure of Interests

None declared

AB0368 EFFECTS OF SWITCHING FROM ETANERCEPT ORIGINATOR TO ETANERCEPT BIOSIMILAR ON DISEASE ACTIVITY, PHYSICAL FUNCTION, AND PATIENT-REPORTED OUTCOME REGARDING A SELF-INJECTION DEVICE IN PATIENTS WITH WELL-CONTROLLED RHEUMATOID ARTHRITIS

Background

Although biological drugs have dramatically changed and improved the outcome of patients with rheumatoid arthritis (RA), a lot of unresolved problems still exist. Although comorbidity by which enough treatment drugs cannot be prescribed or RA patients refractory to biological agents are representatives, financial difficulty is another representative. There are RA patients who hesitate biological treatment or treatment with Janus-kinase inhibitor due to financial difficulty. Although biosimilar disease-modifying anti-rheumatic drugs (DMARDs) are promising treatment options for such patients, real-world clinical experiences are still lacking in respect to exchanging from biological originator DMARDs to biosimilar DMARDs.

Objectives

This retrospective study investigated the effects of switching from etanercept originator (ETN-OR) to ETN biosimilar (ETN-BS: LBEC0101 developed by LG Chem) on disease activity, physical function, and patient reported outcome (PRO) regarding a self-injection device in patients with well-controlled RA.

Methods

Data from the Toyohashi RA Database (TRAD) was used, which is a collection of single-center retrospective data. We retrospectively investigated disease activity, modified health assessment questionnaire (mHAQ), and patient characteristics in 42 RA patients that switched from ETN-OR to ETN-BS at least 6 months prior. Patients were also requested to answer the Toyohashi Self-Injection Assessment Questionnaire (T-SAQ), originally designed to assess PRO. T-SAQ consisted of 18 questions about self-injection device such as burden, learning, pain, convenience, handling and so on. Best was 0 and worst was 4 in each question and mean score of 18 questions was called total T-SAQ score.　

Results

All the patients were female. The mean age, RA duration, and ETN-OR treatment duration were 63.1 years, 18.3 years, and 3107 days, respectively. Mean disease activity and mean mHAQ after switching were as follows (baseline-3 months-6): DAS28-CRP (1.86-2.00-2.03), SDAI (4.3-5.0-5.3), and mHAQ (0.43-0.44-0.46). SDAI after 6 months was significantly elevated compare to baseline. Among each parameter, tender joints count at 3 months and patients’ global assessment at 6 months after switching are significantly increased compared to baseline (Table 1). Other parameters such as swollen joint counts, physician global assessment and CRP were not significantly changed. Total T-SAQ scores before and after switching were 1.3 and 1.1 (p < 0.01), respectively. Ease of use, mental tension, and pain were especially improved after switching to ETN-BS.

Conclusion

Switching from ETN-OR to ETN-BS worsened disease activity in well-controlled RA patients in our real-world clinical practice due to not objective findings, but subjective complaints by RA patient. We thought that nocebo effect was one of the reasons to explain the results. On the other hand, the PRO regarding the injection device was improved. This improvement may be due to Finer needle of ETN-BS (ETN-OR: 27G, ETN-OR: 29G).

Disclosure of Interests

None declared

AB1016 ROMOSOZUMAB AS A TREATMENT FOR OSTEOPOROSIS: PREDICTORS OF EFFICACY AT 12 MONTHS

Background

Romosozumab (ROMO) is an antisclerostin antibody that is used in the treatment of severe osteoporosis (OP). In March 2019, ROMO was approved for use in Japan for treating severe OP in clinical practice, causing an increase in its prescription in our institute. Although efficacy data for ROMO have been presented in clinical trials, there is a lack of real-world data. In our experience, ROMO treatment results in significant bone mineral density (BMD) gain in some patients, but not all. Therefore, understanding the predictors that enhance the efficacy of ROMO treatments to achieve BMD gain is essential.

Objectives

This study investigated the efficacy of a 12-month ROMO treatment in patients with OP and explored the efficacy predictors of increased BMD.

Methods

Our study included 52 patients with OP, who were started on ROMO treatment between June 2019 and August 2020. The following information was collected: 1) baseline characteristics, 2) time-course of BMD (lumbar spine [LS] and total hip [TH]) and bone turnover markers (BTM; bone-specific alkaline phosphatase [BAP], type I procollagen-N-propeptide [P1NP], type I procollagen-N-propeptide[NTX], and tartrate-resistant acid phosphatase-5b [TRACP-5b]), 3) multiple regression analysis results following Spearman’s correlation analysis of increased BMD values (%) at 12 months and BL characteristics, including BTM change (%) at one month, to investigate the efficacy predictors of ROMO.

Results

1) The mean age of the participants was 72.9 years (48 female and four male). Of the 52 understudied patients, 78.8% had past insufficiency fractures, whereas 21.2% had been treated with concomitant prednisolone. Furthermore, 21 patients had primary OP, 20 had rheumatoid arthritis, nine had glucocorticoid-induced OP, and two had other conditions. Pretreatments for OP were bisphosphonate (33 patients), vitamin D (6), none (5), selective estrogen receptor modulator (4), and denosumab (3).

2) Both mean LS- and TH-BMD significantly increased in the patients for whom ROMO administration was continued for 12 months. The average percentage changes of LS- and TH-BMD were 7.1% and 1.6% at six months and 11.7% and 3.0% at 12 months, respectively (Figure 1). However, BAP and P1NP increased steeply at one month, followed by a gradual decrease. As observed, the average percentage changes of BAP and P1NP were +70.1% and +166.8% at one month, +50.3% and +91.7% at six months, and +24.4% and +41.5% at 12 months, respectively. The results also showed that TRACP-5b decreased from one to 12 months, with the average percentage changes being −22.9% at one month, −13.8% at six months, and −17.7% at 12 months. Moreover, NTX, a bone-resorptive marker, was slightly increased during ROMO treatment.

3) Multiple regression analysis results revealed that the baseline BAP and percentage calcium changes at 12 months were significant factors positively correlated with the percentage change of LS-BMD at 12 months. As observed, the baseline T-score of LS-BMD was a significant factor negatively correlated with the percentage change of LS-BMD at 12 months. The standardized partial regression coefficient values were +0.68, +0.26, and −0.40, respectively. Moreover, the multiple regression analysis results revealed no significant factor that was correlated with the percentage changes of TH-BMD at 12 months.

Figure 1.

Conclusion

ROMO treatments rapidly increased BMD, especially LS-BMD, and changed BTM after one month. Baseline BAP were correlated with increased LS-BMD but not with TH-BMD. The factors correlated with increased BMD may differ between LS-BMD and TH-BMD.

Disclosure of Interests

None declared

POS1143 FIVE-YEAR TREATMENT OUTCOME OF DENOSUMAB ON OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS, IN CLINICAL PRACTICE

Background

Osteoporosis (OP) is a frequent complication identified in patients with rheumatoid arthritis (RA). Effective treatment must be provided to treat OP in RA (RAOP). Denosumab (DMB) is a promising drug, currently being used for the treatment of RAOP. Although DMB was determined to be effective in a long-term FREEDOM extension trial [1] for treating postmenopausal OP, its efficacy in the treatment of RAOP in real-world is not be fully evaluated.

Objectives

This retrospective study assessed the five-year treatment outcome of DMB in Japanese patients with RAOP.

Methods

Data from the Toyohashi RA Database (TRAD) was used, which is a collection of single-center retrospective data. Our study included 65 female patients with RAOP for whom DMB treatment was initiated between October 2013 and May 2016. The following information was collected: 1) baseline characteristics, 2) DMB continuation rates using the Kaplan–Meier method and reasons for stopping DMB, 3) fracture occurrence during DMB treatment, and 4) time-course of bone mineral density (BMD) [lumbar spine (LS) and total hip (TH)] and bone turnover markers (BTM) [bone-specific alkaline phosphatase (BAP), type I procollagen-N-propeptide (P1NP), type I procollagen-N-propeptide (NTX), and tartrate-resistant acid phosphatase-5b (TRACP-5b)] in 38 patients who underwent DMB treatment over a period of five years.

Results

1) The mean age and RA duration were 69.4 years (46–86) and 17.2 years (1–49), respectively. Prednisolone and biologics were administered in 21 (32.3%) and 20 (30.8%) patients, respectively. Twenty-seven patients (41.5%) had a history of fragility fractures, and 24 patients (36.9%) had a history of vertebral fractures. Pretreatment drugs for OP were as follows: bisphosphonate in 22 patients; teriparatide, 17; none, 16; activated vitamin D, 7; and selective estrogen receptor modulator, 3.

2) Continuation rates of DMB were 96.9% at one year, 95.4% at two years, 85.8% at three years, 79.4% at four years, and 71.1% at five years. DMB treatment was terminated in 24 patients due to lack of efficacy in nine patients, death in seven patients (unknown reason in four, pneumonia in two, and senile decay in one), adverse events except death in five patients (worsening of dementia in two, brain hemorrhage in one, necrosis of jaw in one, and pneumonia in one), and other reasons in three patients.

3) Nine patients (13.8%) experienced fractures during DMB treatment; vertebral and non-vertebral fractures occurred in three and four patients, respectively. Two cases of fractures remained undefined.

4) Both mean LS-BMD and TH-BMD significantly increased in 38 patients for whom DMB administration was continued for five years. Average percent changes of LS-BMD and TH-BMD were 3.9% and 3.0% at six months, 5.5% and 3.8% at one year, 7.6% and 4.1% at two years, 9.8% and 5.7% at three years, 10.8% and 6.5% at four years, and 12.9% and 6.8% at five years (Figure 1). Four BTMs, BAP, P1NP, NTX, and TRACP-5b, significantly decreased from six months to five years when compared to baseline values, with average changes at 5 years equaling −38.4%, −37.8%, −23.8%, and −24.6%, respectively.

Conclusion

DMB treatment of RAOP proved effective and reasonably safe, and it increased BMD by a percentage similar to that observed in the FREEDOM extension trial. However, DMB administration was ceased in 13.8% of cases due to fractures and lack of efficacy. Although DMB is recommended for the treatment of RAOP, future evaluations should be conducted to predict its efficacy and determine alternative treatment strategies.

References

[1]Bone HG et al. Lancet Diabetes Endocrinol. 2017.

Disclosure of Interests

None declared

Anxiety relaxation during MRI with a patient-friendly audiovisual system

INTRODUCTION

Many patients experience anxiety, not limited to claustrophobia, before magnetic resonance imaging (MRI) examination. We performed a non-randomized controlled trial to evaluate whether a patient-friendly audiovisual (AV) system in the MR scanner room reduces patient anxiety.

METHODS

We randomly selected 61 participants from outpatients who required brain MRI examination. Patients were informed that they could choose to undergo an MRI examination with a patient-friendly AV system (Ambient Experience, Philips Healthcare, Best, The Netherlands) or the standard system. To complete the MRI examination without affecting clinical practice, all patients who preferred the patient-friendly AV system were assigned to the preferring AV group. Patients who indicated that either system was acceptable were randomly assigned to the no preference but allocated AV group or control (using the standard system) groups. In both groups, state anxiety using the State-Trait Anxiety Inventory (STAI) was assessed before and after the MRI examination (A-State-before and A-State-after MRI, respectively). The changes in A-State-before and A-State-after MRI were categorized as follows: relieved high-state anxiety, no change in high-state anxiety, stable easiness, and intensified anxiety.

RESULTS

Among the 61 included patients, 19 were assigned to the preferring AV group, 20 to the no preference but allocated AV group, and 22 to the control group. There were no significant differences between the group. However, in patients with high-state anxiety before MRI, the preferring AV group and the no preference but allocated AV group, which used the patient-friendly AV system, relieved high-state anxiety by 63.6% (7 of 11 patients) and 81.8% (9 of 11 patients), respectively. In contrast, the control group using the standard system relieved high-level anxiety by only 42.9% (three out of seven patients).

CONCLUSION

The patient-friendly AV system may reduce anxiety in patients undergoing MRI examinations.

IMPLICATIONS FOR PRACTICE

The patient-friendly AV system may reduce anxiety in patients undergoing MRI examination by providing a more patient-centered MRI examination environment. These findings may help ameliorate negative perceptions associated with MRI examination.

Large left atrial thrombus resection in a patient in sinus rhythm without mitral valve disease: A case report

Introduction

Left atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging.

Presentation of a case

A 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported.

Discussion

In this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death.

Conclusion

An LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes.

•

Causes of left atrial thrombus include mitral valve disease and atrial fibrillation.

•

Left atrial thrombi can be difficult to differentiate from left atrial tumors.

•

Large left atrial thrombi can become free-floating or grow rapidly.

•

For large left atrial thrombi, prompt surgery is required.

Frank's sign with acute aortic dissection

A 59‐year‐old man with a long smoking history presented with sudden back pain. Frank's sign was noticed in his bilateral ears, and computed tomography revealed Stanford type A acute aortic dissection. If young patients have Frank's sign, attention should be paid to aortic disease in addition to coronary artery disease.

AB0233 REASONS AND RISK FACTOR FOR DISCONTINUATION OF BIOLOGIC AGENTS FOR RHEUMATOID ARTHRITIS PATIENTS IN LONG-TERM OBSERVATION

Background:

Rheumatoid arthritis (RA) patients who failed a first biologic agent due to any reasons have the option of switching to a second one along with the strategy of biologic agent treatment. Patients go over switching to the next one at failing their biologic agent. On the other hand, there are some patients who discontinue any biologic agent treatment due to various reasons such as tolerability concern, complications, economic issue, remission and so on1 2. The impact of this concern has been less studied.

Objectives:

The objective of this study was to investigate the reasons and the risk factors for discontinuation any biologic agent in RA patients.

Methods:

To Include patients who are observed long-term, patients who underwent biologic agent treatment between 2003 and 2007 at Nagoya University Hospital and 12 other institutes (Tsurumai Biologics Communication Study Group) were enrolled. 570 patients who were confirmed continuation or discontinuation of biologic agent treatment were enrolled. The last observation was September 2017. We analyzed the retention rate of biologic agent treatment and the reasons for discontinuation. To identify the risks for discontinuation, baseline demographics were compared between the continuing group and the disc continuing group using cox hazard regression analysis.

Results:

In total 570 patients, the average duration of treatment with biologics was 6.6±3.3 (years) and total patient-year was 3739 in this study. 458 patients were administered biologics continuously, 112 patients were withdrawn. Table 1 showed the demographic data in total patients. The retention rate was 96.0% (discontinuation n=23) at least 1 year from starting biologics treatment, 92.6% (n=42) at 3 years, 88.2% (n=67) at 5 years, 84.4% (n=89) at 7 years, 81.1% (n=108) at 10 years. In 112 patients who discontinued, the reasons were adverse events in 74 patients, lack of effectiveness in 11 patients, others in 27 patients. Comparison of incidence for discontinuation using cumulative hazard function, the reason of adverse events was significantly higher than others reasons (Figure 1). To identify the risks of discontinuation, we analyzed by multivariable Cox proportional hazard modeling in patients who discontinued treatment due to adverse events, the risk factors (hazard ratio: HR, confidence interval: CI) were over 3 of Steinblocker class (HR 1.85 [1.02-2.04]), age (HR:1.07 [1.04-1.10]) and Non-concomitant with methotrexate (HR 1.90 [1.08-3.33]) (Figure 2).

Table 1.Age (years)56.1 ± 13.4Gender n (% male)110 (19%) n (% female)460 (81%)Disease duration (years)11.1 ± 9.8stage 1,2104 (19%) 3,4455 (81%)class 1,2336 (60%) 3,4225 (40%)Methotrexate use, no (%)400 (70%)Glucocorticoid use, no (%)262 (47%)Rheumatoid Factor, no (%)287 (65%)anti CCP antibody, no (%)137 (87%)

Conclusion:

The most common reason for discontinuation was adverse events in long term observation. The risk factors for discontinuation were class, age, and non-concomitant MTX. These results suggested that comorbidity has a significant impact on continuation rates because there are some reasons of non-concomitant MTX in addition to relate with age and the activities of daily living.

References:

[1]Marussa B, et al. j.clin thera. 2011; 33(7): 901-913

[2]Alejandro S, et al. Rheumatol. 2016; 55(3): 523-34

Disclosure of Interests:

KENYA TERABE: None declared, Nobunori Takahashi Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan, Shuji Asai Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Yasuhide Kanayama: None declared, Toshihisa Kojima Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Consultant of: AbbVie, Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis

AB0131 DIFFERENCES IN CLINICAL PARAMETERS AND LABORATORY DATA OF RHEUMATOID ARTHRITIS PATIENTS IN REMISSION OR WITH LOW DISEASE ACTIVITY TREATED WITH BIOLOGIC AGENTS OR JANUS KINASE INHIBITORS

Background:

There are four kinds of drugs for rheumatoid arthritis (RA) patients who are refractory or intolerant to methotrexate (MTX) or other conventional synthetic disease-modifying anti-rheumatic drugs, namely, tumor necrosis factor inhibitors (TNFi), inteleukin-6 inhibitors (IL-6i), abatacept (ABT) and Janus kinase inhibitors (JAKi). Although these drugs have distinct mechanism of action (MOA) to reduce disease activity of RA, the effects of these drugs of reducing disease activity or inhibiting joint damage are similar according past clinical trials. However, their different MOA may induce different change in body of RA patients. If there are some differences in body of RA patients treated different drugs which have different MOA, some differences may appear in clinical parameters and laboratory data we clinician are able to know in daily clinical practice.

Objectives:

This retrospective cross-sectional study assessed differences in clinical parameters and laboratory data in RA patients who met the treatment goal with biologic agents (BIO) or JAKi.

Methods:

Data from the Toyohashi RA database (TRAD) was used. The TRAD is a collection of single-center retrospective data. Participants were BIO- or JAK-treated RA patients with clinical disease activity remission (REM) or low disease activity (LDA) [clinical disease activity index (CDAI) ≤ 10]categorized by BIO treatment with TNFi (reference), IL-6i, or ABT, and JAKi treatment. Clinical parameters [tender joint counts (TJ), swollen joint counts (SJ), patient’s global assessment (PtGA), patient’s pain assessment (PainVAS), physician’s global assessment (PhGA) and modified health assessment questionnaire (mHAQ)] and laboratory data [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), matrix metalloprotease-3 (MMP-3), white blood cell counts (WBC), hemoglobin (Hb), platelet cell counts (PLT), neutrophils counts (Neut), lymphocyte counts (Lymph) and estimated glomerular filtration rate (eGFR)] were investigated in cross-sectional manner. They are statistically compared using the Dunnett test.

Results:

171 TNFi, 71 IL-6i, 50 ABT, and 18 JAKi cases are categorized in REM or LDA. Patients’ characteristics (means) are as follows (TNFi/IL-6i/ABT/JAKi). Age (63.1/63.7/72.4/60.6; years old), RA duration (17.0/12.7/18.2/11.3; years), %female (83.0/71.8/88.0/83.3), %rheumatoid factor positive (81.9/80.3/90.0/88.9), %anti-cyclic citrullinated peptide antibody (84.6/74.6/97.9/73.3), %prednisolone (PSL) concomitant (3.5/4.2/18.0/11.1) and %MTX concomitant (77.2/15.5/26.0/83.3). Parameters with statistical significance (means) were: TNFi/IL-6i-ESR 34.5/14.0 mm/hr, MMP-3 47.5/71.9 ng/mL, WBC 6124/5404 /µL, Lymph 2112/1646 µL; TNFi/ABT-TJ 0.4/1.0, PtGA 13.3/20.0 mm, PainVAS 15.7/21.6 mm, PhGA 7.4/11.1 mm, CRP 0.1/0.4 mg/dL, ESR 34.5/44.2 mm/hr, MMP-3: 47.5/72.9 ng/mL, Lymph 2112/1816 µL, Neut 3364/4233 µL, eGFR 75.4/65.3 mL/min/1.73m2; and TNFi/JAKi-PLT 21.7/29.3 104/µL, Lymph 2112/1326 µL.

Conclusion:

Although differences of rates of administering concomitant PSL or MTX should be considered, clinical parameter and laboratory data differences result from differences in the targeted cytokine between TNFi and IL-6i, differences in patient characteristics between TNFi and ABT, and differences in the MOA between TNFi and JAKi.

Disclosure of Interests:

None declared

POS0450 INCIDENCE RATES OF DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS IN REAL-WORLD CLINICAL PRACTICE

Background:

A definition of difficult-to-treat rheumatoid arthritis (D2T RA) was recently proposed by the European League Against Rheumatism (EULAR) [1]. However, information on the incidence rates of D2T RA in real-world clinical practice is lacking.

Objectives:

The aim of this retrospective cross-sectional study was to evaluate the incidence rates of D2T RA in clinical practice in Japan.

Methods:

Data from the Toyohashi RA database (TRAD) was used. The TRAD is a collection of single-center retrospective data. Patients with RA who fulfilled the following three requirements were included in this study: (1) had been treated with >1 biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD); (2) >1 year had passed since b/tsDMARD treatment was initiated; and (3) regularly visited our institute at the time of investigation. The number of targeted patients was 363. The criteria of D2T RA used in this study were modified from the EULAR definition for simplification of the investigation as follows: (a) ≥2 b/t DMARDs with different mechanisms of action had been administered; (b) at least moderate disease activity (DAS28-ESR > 3.2 or clinical disease activity index [CDAI] > 10) at the time of investigation; and (c) 7.5-mg/day of prednisolone (PSL) or more was administered at the time of investigation. In this study, D2T RA was defined as criteria (a) + (b) or (a) + (c) or (a) + (b) + (c). The 363 patients were categorized into four groups as follows: group A, DT2 RA; group B, patients with RA who had been treated with ≥2 b/tsDMARDs and did not fulfill the D2T RA definition; group C, RA patients who had been treated with one kind of b/tsDMARD with the same mechanism of action (e.g., two kinds of tumor necrosis factor inhibitors) and fulfilled either or both criteria (b) and (c); and group D, patients with RA who had been treated with one kind of b/tsDMARD with the same mechanism of action (e.g., a tumor necrosis factor inhibitors or two interleukin 6 inhibitors) and did not fulfill either or both criteria (b) and (c). The incidence rates of D2T RA were calculated, and the patients’ characteristics at the time of initiation of the b/tsDMARD treatment were compared between the groups.

Results:

The number of patients in groups A, B, C, and D were 34, 53, 94, and 182, respectively. Of all the patients included in this study, 9.4% were categorized into group A, those with D2T RA, and 39.1% were treated with ≥2 b/tsDMARDs and categorized into group A (Fig 1). The patients’ characteristics were as follows (group A/B/C/D): mean age (57.1/54.3/61.4/56.2 years), RA duration (10.0/6.7/13.8/8.2 years), %Steinbrocker stage III+IV (%; 84.0/60.0/77.3/54.3), %Steinbrocker class 3 + 4 (%; 68.0/33.3/43.4/23.0), methotrexate (MTX) concomitant rate (%; 79.4/92.5/74.5/91.8), PSL concomitant rate (%; 91.2/52.8/55.3/43.4), DAS28-ESR score (5.5/5.0/5.5/4.7), and CDAI score (12.3/13.7/22.7/16.9). There were statistically significant differences in RA duration, %stage III+IV, %class 3 + 4 and PSL concomitant rate between group A and B.

Conclusion:

D2T RA occurred in 9.4% of patients treated with b/tsDMARDs. Incidence rate was increased to 39.1% after the treatment with ≥2 b/tsDMARDs. The patients with D2T RA tended to be older, have a long RA duration, be treated without concomitant MTX, be treated with concomitant PSL, and have higher disease activity at the time of starting the b/tsDMARD treatment. The baseline patient characteristics in group C were similar to those in group A. In the future, we suggest that patients with D2T RA be included in group C.

References:

[1]Nagy et al. Ann Rheum Dis 2021; 80: 31-35.

Disclosure of Interests:

None declared

AB0222 COMPARISON OF SELF-INJECTION DEVICES FOR ADMINISTERING ANTI-TUMOR NECROSIS FACTOR AGENTS USING THE ORIGINAL QUESTIONNAIRE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Self-injection of biological agents has become a general practice in the treatment of rheumatoid arthritis (RA). Self-injectable biological agents differ in shape, needle thickness, drug fluid volume, and so on. These differences may affect patients’ evaluations of self-injection devices. Five kinds of anti-tumor necrosis factor (TNF) agents can be administered by self-injection in clinical practice in Japan. Information on patients’ evaluations of self-injection devices is important in choosing the agent for the treatment of RA among several agents with the same mechanism of action.

Objectives:

The aim of this retrospective cross-sectional study was to compare patient evaluations of anti-TNF self-injection devices in the treatment of RA.

Methods:

RA patients in whom etanercept (ETN) pen 50 mg (Embrel Pen) was switched to ETN biosimilar (BS) 50 mg (ETN-BS [MA]), adalimumab (ADA) syringe 40 mg (Humira syringe) was switched to ADA pen 40 mg (Humira pen), golimumab (GLM) syringe 50 mg (Simponi syringe) was switched to GLM autoinjector (Simponi AI), and certolizumab pegol (CZP) syringe (Cimzia syringe) was switched to CZP autoclicks (Cimzia AC) were asked to answer an originally developed questionnaire (Toyohashi Self-injection Assessment Questionnaire [T-SAQ]; Table 1) before and after switching agents. T-SAQ included 18 questions. A score of 0 indicated “best” and 4 indicated “worst” for each question, with a highest possible score of 72. The patients’ characteristics and T-SAQ scores before and after switching agents were investigated. A statistical analysis of the difference in T-SAQ score between before and after switching was performed using the Wilcoxon signed-rank test. A P value < 0.05 was considered significant.

Results:

The patients were divided into groups according to the agents they received with switching as follows: switchers from ETN pen to ETN-BS, n = 32; switchers from ADA syringe to ADA pen, n = 28; switchers from GLM syringe to GLM-AI, n = 25; and switchers from CZP syringe to CZP-AC, n = 10. The total T-SAQ scores were as follows, respectively: ETN pen and ETN-BS, 23.5 and 19.0; ADA syringe and ADA pen, 25.8 and 14.9; GLM syringe and GLM-AI, 23.8 and 17.4; and CZP syringe and CZP-AC, 30.6 and 18.8. The total T-SAQ was significantly improved after switching to the pen devices in all the switching groups. In the switchers from ETN pen to ETN-BS, the scores for questions 5, 10, 11, 12, 16, 17, and 18 were significantly improved after switching. The total T-SAQ scores were significantly improved for questions 1, 2, 3, 4, 5, 7, 11, 12, 13, 15, 16, and 17 in the switchers from ADA syringe to ADA pen, for questions 1, 2, 5, 7, 10, 16, and 17 in the switchers from GLM syringe to GLM-AI, and for questions of 1, 2, 3, 4, 5, 7, 11, and 15 in the switchers from CZP syringe to GLM-AC.

Conclusion:

The pen devices were favorably assessed by the RA patients in whom syringe devices were switched to pen devices for the same agent. The total T-SAQ score improved in the RA patients in whom ETN pen was switched to ETN-BS probably because the thickness of the needle was thinner in the ETN-BS than in the ETN pen. The total T-SAQ score for the ADA pen was lowest probably because the thinnest needle was used (29 gauge) and the amount of drug fluid is smallest (0.4ml). The total T-SAQ score for the CZP syringe was the lowest probably because the thickest needle was used (25 gauge).

Disclosure of Interests:

None declared

Ion tracks in silicon formed by much lower energy deposition than the track formation threshold

Damaged regions of cylindrical shapes called ion tracks, typically in nano-meters wide and tens micro-meters long, are formed along the ion trajectories in many insulators, when high energy ions in the electronic stopping regime are injected. In most cases, the ion tracks were assumed as consequences of dense electronic energy deposition from the high energy ions, except some cases where the synergy effect with the nuclear energy deposition plays an important role. In crystalline Si (c-Si), no tracks have been observed with any monomer ions up to GeV. Tracks are formed in c-Si under 40 MeV fullerene (C₆₀) cluster ion irradiation, which provides much higher energy deposition than monomer ions. The track diameter decreases with decreasing the ion energy until they disappear at an extrapolated value of ~ 17 MeV. However, here we report the track formation of 10 nm in diameter under C₆₀ ion irradiation of 6 MeV, i.e., much lower than the extrapolated threshold. The diameters of 10 nm were comparable to those under 40 MeV C₆₀ irradiation. Furthermore, the tracks formed by 6 MeV C₆₀ irradiation consisted of damaged crystalline, while those formed by 40 MeV C₆₀ irradiation were amorphous. The track formation was observed down to 1 MeV and probably lower with decreasing the track diameters. The track lengths were much shorter than those expected from the drop of S_e below the threshold. These track formations at such low energies cannot be explained by the conventional purely electronic energy deposition mechanism, indicating another origin, e.g., the synergy effect between the electronic and nuclear energy depositions, or dual transitions of transient melting and boiling.

[A case report of Legionella pneumonia in a patient with ulcerative colitis undergoing remission maintenance using azathioprine]

A 67-year-old man was diagnosed with ulcerative colitis one year ago. Remission was induced via the oral administration of prednisolone and azathioprine;prednisolone was gradually reduced and discontinued. He maintained remission with azathioprine but developed fever and general malaise and visited the Kagawa Prefectural Central Hospital. Chest radiography and a urinary antigen test revealed Legionella pneumonia. His symptoms reduced immediately after the initiation of levofloxacin. Azathioprine suppresses cellular immunity and may increase the risk of Legionella pneumonia.

One-year outcome of the rule-out group according to the 0-h /1-hour algorithm with suspected myocardial infarction in Asian countries

 

Background/Introduction; A rapid rule-out or rule-in protocol based on the 0-h/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC). Around 40–50% were stratified into “rule-out” group, and their 30-days prognosis was excellent. However, the one-year prognosis is uncertain. We aimed to better characterize these patients.

Methods

This study was a prospective, multi-center, observational study of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS) admitted to 5 hospitals in Japan and Taiwan from 2014 November to 2018 December, respectively.

All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, standard blood test, chest radiography. Exclusion criteria were ST elevated myocardial infarction, chronic kidney disease (serum creatinine more than 3 mg/dL) and congestive heart failure, arrhythmia, or infection disease. The patients were divided into three groups according to the algorithm; “rule-out”, “observe” and “rule-in”. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction. After hospital discharge patients were follow after one-year b telephone or in written form. Major adverse cardiovascular events (including death myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention (PCI)) were recorded by establishing contact with the patient and the family physicians. The primary prognosis end point was all-cause mortality.

Results

Of the 1,187 patients were analyzed after exclusion. The prevalence rate of AMI was 16.1%. According to the algorithm, 42% (n=493) of patients were assigned to “rule-out” group and had no AMI nor death. The most common final adjudicated diagnoses were atypical chest pain (80%), gallstone attack (3%) and vasospastic angina pectoris (2%). All patients with unstable angina (4.7%) underwent PCI.

Conclusion(s)

Our findings suggest that the “rule-out” group patients according to ESC 0-h/1-hour algorithm provides very high safety and efficacy for the triage toward AMI.

Funding Acknowledgement

Type of funding source: None

AB0898 IMPACT OF BIOLOGICAL AGENTS, ORAL GLUCOCORTICOIDS, OR BOTH ON THE EFFICACY OF DAILY TERIPARATIDE TREATMENT FOR OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Daily teriparatide (dTP) strongly affects bone metabolism in patients with rheumatoid arthritis (RA), resulting in increased bone mineral density (BMD). We reported the 2-year results of dTP treatment for osteoporosis (OP) in patients with RA in EULAR2014 [1]. Drugs affecting bone metabolism, such as biological agents (BIOs) and glucocorticoids (GCs), are frequently administered to patients with RA in addition to dTP in daily clinical practice. Although dTP increases bone turnover, BIOs reduce osteoclast activity and GCs decrease bone turnover. We reported the effects of GCs or BIOs on the efficacy of dTP in EULAR2015 [2]. The present retrospective study investigated the effects of GCs or BIOs on the efficacy of dTP in patients with RA using a larger patient cohort.

Objectives:

To evaluate the effects of BIOs, GCs, or both on the efficacy of dTP treatment for OP in patients with RA.

Methods:

The study included 56 female patients who had completed 2 years of dTP treatment. We separated these patients into four groups according to their treatment regimen at dTP initiation: B(−)G(−),included patients who did not receive BIOs or GCs (n = 14); B(+)G(−), included patients treated only with BIOs (n = 8); B(−)G(+), included patients treated only with GCs (n = 24); and B(+)G(+),included patients treated with both BIOs and GCs (n = 10). We determined baseline (BL) characteristics, % changes in BMD in the lumbar spine (LS) and total hip (TH) from BL to 24 months, and % changes in serum bone turnover markers (BTMs), such as BAP, P1NP, NTX, and TRACP-5b, from BL to 6 months after dTP initiation. Dunnett’s test was used for comparisons between B(−)G(−) and other groups.

Results:

The mean ages of the B(−)G(−), B(+)G(−), B(−)G(+), and B(+)G(+) groups at BL were 70.0, 65.5, 69.6, and 71.5 years, whereas the mean duration of RA in these groups were 15.4, 20.8, 69.9, and 71.5 years, respectively. Furthermore, the mean baseline DAS28-CRP levels in these groups were 2.8, 2.2, 2.8, and 2.3. The mean LS-BMD (g/cm2) at BL were 0.795, 0.819, 0.826, and 0.853, whereas the mean TH-BMD at BL were 0.619, 0.570, 0.601, and 0.629, respectively. The mean % changes in LS-BMD at 24 months were 15.5%, 12.7%, 11.9%, and 8.1%, respectively (Fig 1A). There were no significant differences between B(−)G(−) and other groups. The mean % changes in TH-BMD at 24 months in the B(−)G(−), B(+)G(−), B(−)G(+), and B(+)G(+) groups were 6.4%, 5.3%, 4.4%, and 1.5%, respectively (Fig 1B) A significant difference was observed between the B(−)G(−) and B(+)G(+) groups (p = 0.03). The % changes in BTMs in the B(−)G(−), B(+)G(−), B(−)G(+), and B(+)G(+) groups were as follows: BAP, 90.5%, 44.0%, 29.5%, and 87.7%; P1NP, 374.1%, 338.2%, 225.9%, and 640.0%; NTX, 75.2%, 106.6%, 42.5%, and 80.5%; and TRACP-5b, 75.8%, 43.85, 20.4%, and 122.3%, respectively. No significant differences were observed in the changes in BTMs among the groups.

Conclusion:

This study suggested that concomitant use of BIOs and GCs inhibited the increase in BMD induced by dTP treatment in patients with RA, particularly TH-BMD. Although BTM analysis revealed no statistical significance, GCs tended to decrease the % change in BTMs.

References:

[1]Hirano et al. Ann Rheum Dis 2014: 73 (Suppl 2): 166

[2]Hirano et al. Ann Rheum Dis 2015: 74 (Suppl 2): 528

Disclosure of Interests:

Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Hironobu Kosugiyama: None declared, Kyosuke Hattori: None declared, Daisuke Kihira: None declared

AB0362 HERPES ZOSTER IN BARICITINIB-TREATED JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS USING REAL-WORLD CLINICAL DATA

Background:

Similar to biologic disease-modifying anti-rheumatic drugs, the association between Janus kinase (JAK) inhibitors and infection is particularly interesting. The incidence of herpes zoster (HZ) among patients treated with JAK inhibitors is twofold to threefold higher in several regions of Asia (e.g., Japan and Korea) as compared with that observed in North America and Western Europe [1].

Objectives:

To evaluate the characteristics of patients who developed HZ during baricitinib treatment using real-world, multicenter, clinical data for Japanese population.

Methods:

The study enrolled 97 patients with rheumatoid arthritis (RA) who were treated with baricitinib therapy (68 biologic-naïve patients and 29 biologic-experienced patients) were enrolled in the study (observation period: 2–27 months). The severity of HZ infection was determined based on the extent of the rash and the presence or absence of organ damage. We evaluated the characteristics and clinical courses of patients who developed HZ.

Results:

Eight patients with HZ. The incidence ratio (IR) was 8.2 per patient-year. Patient data are described in Table 1 and Table 2. The IR was a little higher than that reported in clinical trials [2], which could be attributed to the high average age (i.e., 67.3 years) of the patients in this study. It was reported that adverse events occurred more frequently in elderly patients aged ≥65 years compared with younger patients [3]. The period from baricitinib administration to the onset of HZ varied between 2 months and 16 months. It is suggested that HZ may develop at any time during baricitinib therapy. There were no distinctive patient characteristics, except for age, at the time of initial baricitinib administration between patients who developed HZ and those who did not.

Table 2.

Response rates of non-medical Switch from Cellcept to Myfortic

Case- No.Age (years)Time (years) from RA onsetGenderFemale:FMale: M)BMIBari dose (mg/d)PSL(mg/d)MTX (mg/w)HZ historyNumber of prior biologics1741.5F25.64012No226133F19.2206No136111.1F23.64010Yes04730.5M23.3408Yes057421.9F20.9200No06781.2F19.8406No074823.2F24.1448No08795.0F22.422.54No0Table 1.

Fatigue in NPSLE and non-NPSLE patients (N = 222)

Case No.HZ incidence period after baricitinib administration (months)Priod of baricitinib withdrawal (weeks)Severity(Mild; MilModerate: Mod)1164Mod224Mod3131Mil431Mil586Mod634Mil ~ Mod733Mod820Discontinuation due to pateient’s choiceMod

None of the patients had severe symptoms, and none of them experienced organ damage. All patients were cured with anti-viral agents. It should be noted that patients who had a history of HZ had milder symptoms than those who had no history of HZ. We noted an interesting finding in one patient (case 2). The half-life of baricitinib in the blood was very short (about 6 hours), and it is reported that the drug is almost fully excreted from the body 24 hours after its administration [4]. However, this patient developed an incidence of HZ at 17 days after the withdrawal of baricitinib for surgery management. Cells may take longer time to regain their original immune status even after excretion of the drug, especially, during intense stress such as in cases of surgical invasion.

Conclusion:

The HZ risk in Japanese patients with RA treated with baricitinib in real-world practice was high, especially in elderly patients. It is notable that HZ events were nonserious and that patients could restart baricitinib treatment after healing with antiviral therapy, for the most part.

References:

[1]Taylor PC et al. N Engl J Med. 2017;376:652-62

[2]Harigai M et al. Mod Reumatol. 2019;20:1-8.

[3]Fleischmann R et al. RMD open. 2017;3:e000546.

[4]Shi JG et al. J Clin Pharmacol. 2014;54:1354-61

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

FRI0097 EFFECTS OF BIOLOGICAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUG TREATMENT ON PHYSICAL ACTIVITY, MUSCLE POWER, AGILITY AND INHIBITION OF FALL IN PATIENTS WITH RHEUMATOID ARTHRITIS -THE 2-YEAR RESULTS

Background:

Treatment with biological DMARDs (bDMARDs) rapidly improves signs and symptoms in patients with rheumatoid arthritis (RA). The efficacy of these bDMARDs was evaluated using composite measures or biomarkers used in daily clinical practice or clinical studies. Although a rapid improvement in composite measures or biomarkers is important in the treatment of RA, the primary goal of treatment is improvement of long-term health-related quality of life (HR-QOL) [1]. HR-QOL is evaluated based on physical functions (PF) such as muscle power and agility. We reported the 1-year results of our study presented at EULAR 2019 [2]. The present study was conducted to investigate the 2-year results of our study by including more patents than those included in the previous one.

Objectives:

This study was aimed at investigating the efficacy of bDMARDs with respect to PF and fall risk in RA patients.

Methods:

At our institute, in addition to routine rheumatology evaluation, periodic evaluation of physical function is performed by staff members in our rehabilitation center in RA patients in whom the first bDMARD treatment was initiated in Oct. 2015–Feb. 2018. In total, 41 cases were registered in this study. Evaluation of PF included evaluation of muscle power [grasping power (GP) and knee extension power (KEP)]; agility [time up and go test (TUG) and 10-m walking time (10 mW)]; and a questionnaire using modified HAQ, portable fall risk index [3], and the 25-question geriatric locomotive function scale (locomo25) [4] at baseline (BL), which implies the time at the initiation of bDMARD treatment, i.e., 1, 3, 6, 12, and 24 months. Disease activity of RA was evaluated at the same time points. Although 2 years had elapsed from BL in 37 patients, 13 patients dropped out from the evaluation of physical function owing to cessation of bDMARD treatment, rejection of evaluation for physical function, or major joint surgery performed in a patient. The results of 24 patients who completed the evaluation at 24 months were investigated in this study.

Results:

Baseline characteristics of the 24 patients were as follows: mean age 60.8 years, RA duration 12.3 years, mean SDAI 19.0, and mean CRP level 2.1 mg/dl. The bDMARDs used in the study were abatacept in 7 patients, adalimumab in 4 patients, tocilizumab in 4 patients, golimumab in 4 patients, etanercept in 3 patients, certolizumab in 1 patient, and an infliximab biosimilar in 1 patients. Data are presented as mean values at BL and at 1, 3, 6, 12, and 24 months (Fig.1). SDAI and CRP levels were significantly improved at and after 1 month. GP and KEP were significantly improved at and after 3 and 6 months. TUG and 10 mW results were significantly improved at and after 3 and 6 months. Modified HAQ results were significantly improved at and after 3 months. Locomo25 scores were significantly improved at and after 1 month. Portable fall risk index values were significantly improved at and after 12 months.

Conclusion:

Although there was a rapid improvement in the signs and symptoms of RA after the initiation of bDMARD treatment, improvement in PF was slightly delayed. Significant improvement of muscle power and agility was achieved after 3–6 months onward. Inhibition of fall risk was achieved at and after 12 months after the initiation of bDMARD treatment. These results suggest that physiotherapy plays a vital role in RA patients who undergo treatment with bDMARDs to gain more rapid improvement of PF.

References:

[1]Smolen JS et al. Ann Rheum Dis, 2016.

[2]Hirano Y et al. Ann Rheum Dis, suppl. 2, 2019.

[3]Toba K et al. Jpn J Geriat, 2005.

[4]Seichi A at al. J Orthop Sci, 2012.

Disclosure of Interests:

Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Ayako Morisaka: None declared, Hironobu Kosugiyama: None declared, Shiori Inuzuka: None declared, Takeshi Kamiya: None declared, Hiroyuki Mori: None declared, Naohito Morishima: None declared, Tomoji Ishikawa: None declared

SAT0472 GOAL-DIRECTED TREATMENT OF OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS USING DENOSUMAB FOR FIVE YEARS

Background:

Osteoporosis (OP) is frequent complication identified in patients with rheumatoid arthritis (RA). Effective treatment must be provided to treat OP in RA (RAOP). Denosumab (DMB) is one of the promising drugs that are currently being used for the treatment of RAOP. We reported the results of 12-month DMB treatment for RAOP as part of Japanese multicenter registry study (TBCR-BONE) in EULAR2016 [1]. Recently, a treatment goal of OP was reported by the American Society for Bone and Mineral Research and the National Osteoporosis Foundation (ASBMR-NOF) working group [2]. This report advocated that the goal of treatment is a T-score of >-2.5 at the femoral neck, total hip (TH) or lumbar spine (LS) on DXA if the primary reason for starting treatment was a T-score of ≤-2.5 at the abovementioned skeletal sites. The working group noted that it was reasonable to expect that initial treatment should offer at least a 50% chance of achieving the treatment goal within 3 to 5 years of initiating therapy. We have reported the achievement rates of treatment goal in RAOP with 3-year DMB treatment on RAOP in EULAR2019 [3].

Objectives:

The aim of this retrospective study was to evaluate whether 5-year DMB treatment can achieve treatment goal of OP using data from TBCR-BONE.

Methods:

The study included 46 female patients who had completed 5-year DMB treatment. The LS-BMD analysis included 22 patients with a baseline (BL) LS-BMD T-score of ≤ -2.5. The TH-BMD analysis included 29 patients with a BL TH-BMD T-score of ≤ -2.5. Similar to clinical setting in Japan, 60mg of DMB was administered once every 6 months with a vitamin D3 supplement. BL characteristics, change in T-score over time, and achievement of the treatment goal (T-score>-2.5) were evaluated.

Results:

BL characteristics of the 46 female patients included: mean age of 69.1 years and RA duration of 16 years. Prednisolone was administered to 37% of the patients. In the LS-BMD analysis, T-scores improved significantly; the mean value at BL was −3.4, which increased to −3.0 at 1 year, −2.6 at 3 years, and ultimately to −2.5 at 5 years. The fraction of patients who achieved the treatment goal was as follows: 36.4% at 1 year, 40.9% at 2 years, 45.5% at 3 years, 50.0% at 4 years, and 54.5% at 5 years (Fig. 1A). The patients who achieved this treatment goal were those who had a significantly lower risk of fracture at BL as determined by FRAX (17.9% vs. 32.2%, p = 0.044), who had significantly higher BL serum TRACP-5b level (572.8 vs. 401.0: p = 0.03), and who had significantly better BL LS-BMD T-scores (−3.0 vs. −3.9, p < 0.01) than the nonachievers. In the TH-BMD analysis, T-scores improved significantly; the mean value at BL was −3.0, and it increased to −3.0 at 1 year, −2.7 at 3 years, and reached −2.7 at 5 years. The fraction of patients who achieved the treatment goal was as follows: 20.7% at 1 year, 31.0% at 2 years, 34.5% at 3 years, 31.0% at 4 years, and 37.9% at 5 years (Fig. 1B). The patients who achieved this treatment goal were those who had significantly better BL TH-BMD T-scores (−2.7 vs. −3.2: p < 0.01) than the nonachievers. Cut-off values at BL for achievement of the treatment goal determined using ROC analysis were −3.1 for the LS-BMD (sensitivity 83.3%, specificity 90.0%) and −2.85 for the TH-BMD (sensitivity 100.0%, specificity 81.0%).

Conclusion:

The results of this study suggested that achievement of the treatment goal was comparatively easy for those with LS-BMD loss; however, it was comparatively difficult for those with TH-BMD loss. Early initiation or longer duration of DMB therapy may be necessary to improve achievement rates. Likewise, other agents, such as romosozumab, may be considered for those with significant TH-BMD loss.

References:

[1]Hiranoet al.Ann Rheum Dis 2016; 75 (Suppl 2): 94

[2]Cummingset al.J Bone Miner Res 2017; 32: 3-10

[3]Hiranoet al.Ann Rheum Dis 2019; 78 (Suppl 2): A940

Disclosure of Interests:

Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Yasuhide Kanayama: None declared, Hironobu Kosugiyama: None declared, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda

THU0182 THE EFFECTIVENESS OF BIOLOGICAL AGENTS CONCOMITANT WITH TACROLIMUS IN RHEUMATOID ARTHRITIS

Background:

In Japan, oral tacrolimus (TAC) was approved for the treatment of RA in 2005 and the improvement of symptoms thorough the use concomitant with disease modifying antirheumatic drugs (DMARDs), including MTX has been reported1 2. On the other hand, the efficacy and tolerance of biological agents therapy concomitant with TAC are unknown.

Objectives:

The objective of this study was to investigate the efficacy and tolerance of biological agents concomitant with TAC in Japanese patients with RA using retention rate analysis.

Methods:

Total patients (n=2860) who underwent 5 biological agents (etanercept: ETN, adalimumab: ADA, golimumab:GLM, tocilizumab: TCZ, abatacept: ABT) treatment between 2003 and 2017 at Nagoya University Hospital and 12 other institutes (Tsurumai Biologics Communication Study Group) were enrolled3. In each biologics analysis, patients were divided into three groups: (1) concomitant only MTX (MTX group) (2) concomitant only TAC (TAC group) (3) others (others group). In TAC or MTX group, these drugs were only ones which concomitant with biologics. Kaplan-Meier analysis was used to estimate retention rate in each biologics group. To estimate the tolerance of concomitant biologics with TAC, cumulative hazard function in adverse events rate was performed in each biologics group. In both analyses, hazard ratios (HR) were assessed by Cox proportional hazards modeling adjusted for age, sex, disease duration and previously used biologics.

Results:

In total 2860 patients, 142 patients (5.0%) administered each biologics concomitant with TAC (ETN: n=47, ADA: n=10 GLM: n=14, TCZ: n=27, ABT: n=49). Baseline characteristics of 142 patients were shown in table 1. Average dosages of TAC at starting were ETN: 2.2±0.7mg ADA: 2.4±1.0mg GLM: 1.9±1.0mg TCZ: 1.7±0.9mg ABT: 1.9±0.9mg. With comparison of retention rate between 3 groups in each biologics under analysis of cox proportional hazard modeling, in ETN and ABT analysis, the retention rate of TAC group was higher than others group (table 2, figure 1). Comparison of incidence of adverse event between 3 group using cumulative hazard function and cox proportional hazard modeling in ETN and ABT analysis. In ETN analysis, incident rate of other group was higher than TAC group. In ABT analysis, there was no significant difference between 3 gruops (figure 2).

Table 1.Baseline characteristic (n=142)age (years)63 ± 3gendermale33 (23%)female109 (77%)disease duration (years)12.0 ± 7.8stage1,234 (24%)3,4108 (76%)class1,299 (70%)3,443 (30%)naïve vs switchnaïve71 (50%)switch71 (50%)corticosteroid use, no (%)+98 (75%)-32 (25%)corticosteroid dose (mg)5.6 ± 3.2DAS28-ESR4.71 ± 1.55Table 2.HR (95%CI)/p-valuen (MTX/TAC/others)ETNADAGLMTCZABT(774/ 47/ 486)(339/ 10/ 135)(156/ 14/ 61)(272/ 27/ 207)(213/ 49/ 178)TAC vs others0.27 (0.16-0.45)<0.0010.9 (0.37-2.20)ns0.46 (0.13-1.63)ns0.55 (0.24-1.31)ns0.51 (0.26-0.97)<0.05TAC vs MTX0.65 (0.38-1.08)ns1.42 (0.61-3.31)ns0.83 (0.24-2.87)ns0.5 (0.21-1.17)ns0.74 (0.39-1.42)nsMTX vs others0.42 (0.35-0.50)<0.0010.9 (0.50-0.88)<0.0010.56 (0.33-0.96)<0.051.01 (0.78-1.57)ns0.68 (0.46-0.99)<0.05

Bold italic: p<0.05CI: confidence interval ns: not significant

Conclusion:

We suspected that, in ETN and ABT treatment, combination therapy with TAC are subsequent options for treatment to RA patients, especially in whom MTX cannot be administration.

References:

[1]Kino T, et al. Antibiot. 1987 Sep 40(9): 1256-65

[2]Kondo H, et al. J Rheumatol. 2004 Feb;31(2):243-51

[3]Kojima T, et al. Mod Rheumatol. 2011 Sep 3.

Disclosure of Interests:

KENYA TERABE: None declared, Nobunori Takahashi Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan, Shuji Asai Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan, Atsushi Kaneko Speakers bureau: Abbvie, Asahi-Kasei, Astellas, Bristol-Myers Squibb, Chugai, Eisai, Eli Lily, Mitsubishi-Tanabe, Pfizer, and UCB Japan, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Yasuhide Kanayama: None declared, Yuichiro Yabe Speakers bureau: Asahi Kasei, Janssen, and Mitsubishi Tanabe, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama

SAT0156 EFFECTIVE OF BARICITINIB ON RADIOGRAPHIC PROGRESSION OF STRUCTURAL JOINT DAMAGE AT 48 WEEKS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD MULTICENTER CLINICAL DATA

Background:

Baricitinib (bari) is an oral Janus kinase 1 (JAK1)/JAK2 selective inhibitor that has demonstrated good efficacy in patients with rheumatoid arthritis (RA) and adequate response to conventional synthetic (cs) DMARDs in some clinical trials [1,2]. We report the efficacy and safety of bari within 24 weeks in real-world clinical data at EULAR2019.

Objectives:

To evaluate the radiographic progression of structural joint damage at 48 weeks in Japanese patients with RA in real-world multicenter clinical data.

Methods:

We included 53 Japanese patients with RA who showed an inadequate response to csDMARDs or biologic (b) DMARDs. Patients were scheduled to receive a once-daily dose of 4 or 2 mg/day bari as monotherapy or in combination with other csDMARDs. We divided the patients into two groups: those treated with 2 mg/day of bari (2mg-group; n = 27) and those treated with 4 mg/day of bari (4-mg group; n = 26) throughout the observation period. Patients were allowed to decrease their predonisolone and csDMARDs combined with bari treatment if their disease activity improved. First, we evaluated changes in CDAI and HAQ-DI after 48 weeks. Second, we evaluated the change in the van der Heijdge modified total sharp score (ΔmTSS), erosion score (ΔERN), and joint space narrowing score (ΔJSN). In addition, we assessed predictors for suppression of joint destruction at 48 weeks after bari treatment.

Results:

The baseline characteristics of the patients were as summarized in Table 1. There were no significant differences in any items. CDAI scores significantly improved 4 weeks after the treatment. This tendency continued until the final evaluation (Table 2). At 48 weeks, remission and low disease activity rates were 37.0% and 74.1% in the 2-mg group and 38.4% and 76.9% in the 4-mg group, respectively. Structural remission (mTSS ≤ 0.5) was noted in 21 patients (80.8%) and 21 patients (77.8%) in 4-mg group and 2-mg group, respectively (Figure). Mean scores (ΔmTSS, ΔERN, and ΔJSN) of all patients in the 2-mg group and 4-mg groups were (0.26, 0.15, and 0.11), (0.30, 0.17, and 0.13) and (0.23, 0.13, and 0.10), respectively (Figure). There were no significant differences in ΔmTSS scores between the two groups. A matrix metalloproteinase-3 score within the standard value at 12 weeks after the treatment was associated with a predictor for suppression of joint destruction at 48 weeks (logistic regression analysis; odds ratio = 11.6, 95% confidence interval: 1.5–112.4,P= 0.020).

Table 1.

Characteristics of patients at baricitinib initiation

2mg-group (n=27)4mg-group (n=26)p-valueAge (years)69.1 (12.0)65.6 (10.3)0.20Gender, female, n (%)19 (73.1)23 (85.2)0.28Disease duration (years),9.7 (10.4)5.7 (7.4)0.23Prior use of biologics, (0/1/2/3)(18/6/2/1)(18/2/5/1)------MTX (mg/week),4.5 (3.7)6.5 (4.29)0.08PSL (mg/day)1.0 (1.9)1.2 (1.8)0.49RF, U/ml254 (372)134 (222)0.21ACPA, U/m152 (176)133 (301)0.45MMP-3196 (220)215 (221)0.43Table 2.

Serial change of clinical assessment

2mg-groupBaseline4 week12 week24 week48 weekCDAI22.5 (9.2)7.4 (7.7)6.7 (6.9)6.9 (6.8)6.9 (6.8)HAQ-DI0.88 (0.51)0.45 (0.47)0.53 (0.58)0.56 (0.56)0.56 (0.56)MMP-3196 (221)98.9 (62.2)115 (164)106 (78)106 (78)4mg-groupBaseline4 week12 week24 week48 weekCDAI24.4 (9.7)9.4 (5.7)8.6 (6.3)6.7 (8.6)6.8 (8.6)HAQ-DI1.01 (0.51)0.58 (0.48)0.54 (0.60)0.45 (0.49)0.44 (0.45)MMP-3216 (222)99 (62)101 (123)89 (72)95 (81)

Conclusion:

The data showed that bari has a favorable effect on the radiographic progression of structural joint damage regardless of its dose in a real-world clinical setting. In consideration of the risk/benefit balance, we suggest that the dose of bari could be reduced in patients with favorable disease activity.

References:

[1]Tanaka Y et al. Mod Rheumatol. 2018;28:583-91

[2]Tanaka Y et al. Mod Rheumatol. 2018;28:20-9

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

THU0171 EFFICACY OF ABATACEPT FOR SUPPRESSING RADIOGRAPHIC PROGRESSION OF CERVICAL LESIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS COMPARISON WITH METHOTREXATE TREATMENT; TWO YEARS OF FOLLOW-UP ~A MULTICENTER REGISTRY STUDY ~

Background:

Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with biological agents are more clinically effective than the DMARDs that were in use previously, in particular, with their efficacy in suppressing joint destruction having been emphasized. We reported the efficacy of infliximab, anti-tumor necrosis factor antibodies for suppressing the radiographic progression of RA cervical lesions at ACR2009, EULAR2010, 11, 12, 13, 14,16 and 18. However there is still few studies of efficacy of against RA cervical lesions of Abatacept (ABT) that inhibits T cell activation by binding to CD80/86.

Objectives:

To evaluate the efficacy of ABT for suppressing the radiographic progression of RA cervical lesions comparison with MTX for 2 years.

Methods:

We used ABT or MTX for treating Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of each 60 and 75 patients received continuous ABT and MTX treatment for at least 2 years. For evaluation of cervical lesions, the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value were measured by plain lateral radiographs in the flexion position, at initiation and Year 1,2.

Results:

In the patients receiving ABT (n=60) and MTX (n =75), the number of female were each 48(80%) and 52(69%) cases(p=0.160). The mean age was 67.7 ± 12.9 and 63.6 ± 11.0 years old (p=0.004); disease duration was 16.7 ± 14.2 and 8.0 ± 9.5 years (p<0.001) and the mean dose of MTX was 8.4 ± 3.6 and 8.2 ± 2.9 mg/w (p=0.804). Clinical findings related to RA were as follows; CRP 2.2± 2.1 and 1.7± 2.3 mg/dl(p=0.008); ESR 47.2 ± 23.4 and 31.9 ± 21.8mm/h(p<0.001); MMP3 253 ± 280 and 223 ± 350ng/ml(p=0.003); the number of RF-positive 57(95%) and 60(80%) cases(p=0.011); DAS28-ESR 5.13 ± 0.99 and 4.30 ± 1.38 (p<0.001); ADI 3.6 ± 2.1 and 2.6 ± 1.6mm(p=0.003); SAC 18.5 ± 2.8 and 20.8 ± 2.5mm(p<0.001) and Ranawat value 14.4 ± 1.9 and 16.0 ± 1.5mm (p<0.001). The respective changes in cervical lesion parameters after 1 year were as follows: ADI: 0.20 ± 0.40 and 0.27 ± 0.45 mm (p = 0.367); SAC: −0.12 ± 0.32 and −0.17 ± 0.38 mm (p = 0.359); and Ranawat value: −0.15 ± 0.36 and −0.13 ± 0.34 mm (p = 0.783). The respective changes in cervical lesion parameters after 2 years were as follows: ADI: 0.35 ± 0.58 and 0.55 ± 0.70 mm (p = 0.099); SAC: −0.25 ± 0.47 and −0.45 ± 0.62 mm (p = 0.047); and Ranawat value: −0.23 ± 0.47 and −0.33 ± 0.55 mm (p = 0.293) in the patients receiving ABT and MTX (Fig. 1). The numbers of patients who did not showed progression in ADI, SAC and Ranawat value were each 42(70%) and 43(57%) cases(p=0.130); 46(77%) and 46(61%) cases(p=0.057) and 47(78%) and 53(71%) cases(p=0.313) after 2 years. Also the number who was able to suppress progression in all three parameters were each 42 cases (70%) receiving ABT and 43 cases (57%) receiving MTX (p=0.130) after 2 years (Fig. 2).

Conclusion:

This study suggested that ABT treatment can be used to suppress the progression of RA cervical lesions more than MTX treatment.

Disclosure of Interests:

Yasuhide Kanayama: None declared, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Nobunori Takahashi Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan, Yukiyoshi Oishi: None declared, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama

FRI0137 Discontinuation of baricitinib after achieving low disease activity in patients with rheumatoid arthritis in clinical practice; a multicenter observational study

Background:

Baricitinib (bari) is an oral Janus kinase (JAK) 1/JAK2 selective inhibitor that has shown good efficacy in patients with RA and adequate response to conventional synthetic DMARDs in some clinical trials [1,2]. However, concerning the high cost and long-term safety related to the inhibition of particular molecules, we would like to discontinue bari after achieving long low disease activity (LDA).

Objectives:

To evaluate the clinical outcomes in patients with RA who discontinued bari after achieving LDA for 24 weeks in real-world multicenter clinical data.

Methods:

Japanese 67 patients with RA who show an inadequate response to csDMARDs or bDMARDs were scheduled to receive bari 4 or 2 mg/day once daily dose as a monotherapy or in combination with other csDMARDs. We included 51 patients who achieved and maintained LDA at least for 24 weeks after baricitinib therapy. They were allowed to decrease baricitinib after discontinuation of prednisolone. Bari was either discontinued or continued after study enrolment. The decision of discontinuation and continuation of baricitinib was determined based on patient-physician decision making with informed consent. We divided patients into two groups: a discontinuation group (D group; n = 23) and a continuation group (C group; n = 28). We evaluated the proportion of patients who remained LDA for 24 weeks in both groups. Clinical outcomes including Clinical Disease Activity Index (CDAI), and HAQ-DI were compared between both groups. The last observational carried forward method was used for patients who could not discontinue baricitinib due to flare before 24 weeks. In D group, patients were treated with re-initiation of bari or initiation of the other DMARDs in the event of flare. We investigated the serial changes of patients treated with re-initiation of bari in CDAI after flare.

Results:

The baseline characteristics of the patients are summarized in Table. The titer of RF was lower in D group than that in C group. There were no significant differences in any other items. Ten of 23 (43.4%) in D group remained bari-free without disease activity flare. Serial changes of CDAI were summarized in Figure. CDAI in D group significantly increased from 3.6 at baseline to 9.8 at last observation. LDA rates in C group were 92.9% at last observation. CDAI in C group did not change throughout the follow-up period. CDAI at last observation was higher in D group than that in C group. HAQ-DI in D group changed from 0.28 at baseline to 0.45 at last observation. There was no significant change in HAQ-DI between both groups (P = 0.28). In D group, rescue by re-administration of bari or other DMARDs induced improvement, reducing CDAI from 15.5 at disease flare to 6.8. Especially, all patients treated with re-initiation of bari resulted in re-introduction of LDA in this study.

Table.

Characteristics of patients at baricitinib initiation

D group (n=23)C group (n=28)p-valueAge (years)66.9 (8.6)67.9 (12.7)0.31Gender, female, n (%)6 (73.9)24 (85.7)0.49Disease duration (years)7.6 (10.3)8.3 (9.9)0.37Prior use of biologics, n (0/1/2/≥3)(21/2/0/0)(17/6/4/1)------MTX (mg/w)5.5 (3.8)4.9 (4.3)0.62PSL (mg/d)1.4 (1.9)0.9 (0.9)0.51RF, U/ml99 (141)187 (214)0.04ACPA, U/ml135 (173)194 (214)0.11CDAI24.4 (9.2)22.5 (9.7)0.36HAQ-DI0.83 (0.49)0.83 (0.52)0.98

Conclusion:

It was possible to discontinue bari without flare in about 43% of patients with RA. Overall the patients treated with re-initiation of bari could result in re-introduction of LDA without deterioration of HAQ-DI.

References:

[1]Tanaka Y et al. Mod Rheumatol. 2018;28:583-91

[2]Tanaka Y et al. Mod Rheumatol. 2018;28:20-9

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

Matrix-material dependence on the elongation of embedded gold nanoparticles induced by 4 MeV C60 and 200 MeV Xe ion irradiation

We report the elongation of embedded Au nanoparticles (NPs) in three different matrices, i.e. amorphous carbon (a-C), crystalline indium tin oxide (In_xSn_1-xO_z; ITO) and crystalline calcium fluoride (CaF₂), under irradiations of 4 MeV C₆₀ ⁺ cluster ions and 200 MeV Xe¹⁴⁺ ions. Under 4 MeV C₆₀ cluster irradiation, strong sputtering is induced in CaF₂ layer so that the whole the layer was completely lost at a fluence of 5 × 10¹³ ions cm^-2. Au NPs were partly observed in the SiO₂, probably due to the recoil implantation. Amorphous carbon (a-C) layer exhibits low sputtering loss even under 4 MeV C₆₀ irradiation. However, the elongation in a-C layer was low. While the ITO layer showed a certain decrease in thickness under 4 MeV C₆₀ irradiation, large elongation of Au NPs was observed under both 4 MeV C₆₀ and 200 MeV Xe irradiation. The ITO layer preserved the crystallinity even after large elongation was induced. This is the first report of the elongation of metal NPs in a crystalline matrix.

How to Maintain Maximal Straight Path Running Speed on a Curved Path in Sprint Events

This study aims to clarify the ideal technique for running on a curved path during sprinting events. Participants were twelve male track and field athletes including long jumpers and sprinters. The participants performed a 60-m sprint with maximal effort on straight and curved paths. Participants were divided into "good curve runners" and "poor curve runners" according to the curved path running speed relative to that of the straight path. Kinematic variables and ground reaction forces (GRFs) were registered and compared between the groups and paths. The running speed, step length, and flight distance of the outside leg on the curved path were lower than on the straight path only in poor curve runners. The medial-lateral GRF and impulse showed an increase during curved path running for both groups. However, the maximum posterior GRF and impulse decreased only in poor curve runners. The ideal technique for running on a curved path is to maintain the same kinematics and kinetics in the sagittal plane as on a straight path.

A single-arm pilot study of guided self-help treatment based cognitive behavioral therapy for bulimia nervosa in Japanese clinical settings

Objective

Guided self-help treatments based on cognitive behavioral therapy (CBT-GSH) are regarded as a first-line effective treatment for bulimia nervosa (BN). With limited application for CBT-GSH in Japanese clinical settings, we conducted a single arm pilot study in order to confirm the acceptability and availability of CBT-GSH in Japan.

Results

25 women with BN received 16–20 sessions of face-to-face CBT-GSH. Primary outcomes were the completion rate of intervention and abstinence rates from objective bingeing and purging as assessed by the Eating Disorder Examination. Secondary outcomes were other self-report measurements of the frequency of bingeing and purging, and characteristic psychopathologies of eating disorders. Assessments were conducted before CBT as baseline as well as after CBT. 92% (23/25) of the participants completed the CBT sessions. After CBT-GSH, 40% (10/25) of the participants (intention-to-treat) achieved symptom abstinence. The mean binge and purge episodes during the previous 28 days improved from 21.88 to 10.96 (50% reduction) and from 22.44 to 10.88 (52% reduction), each (before CBT-GSH to after CBT-GSH), and the within-group effect sizes were medium (Cohen’s d = 0.67, 0.65, each). Our study provided a preliminary evidence about the feasibility of CBT-GSH in Japanese clinical settings for the future.

Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 10, 2013 (registration ID: UMIN000011120)

A Subjective Assessment of the Prevalence and Factors Associated with Poor Sleep Quality Amongst Elite Japanese Athletes

Background

The amount, quality, and timing of sleep are considered important for athletes’ ability to train, maximize training responses, and recover. However, some research has shown that elite athletes do not obtain sufficient sleep. Based on this background, researchers recently started to assess and manage sleep in elite athletes.

The purpose of this study was to clarify the prevalence of poor sleep quality and its associated factors amongst elite Japanese athletes.

Methods

Eight hundred and ninety-one candidates for the 17th Asian Games Incheon 2014, who were over 20 years old, participated in this study. They completed a questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, two-question case-finding instruments, and a checklist for sleep hygiene. Data from 817 of the 891 athletes (91.7%) with no missing values were analyzed.

Results

The mean time in bed was 7 h and 29 min. Two hundred and twenty-nine (28.0%) athletes showed a PSQI global score above the clinical criteria. A multiple logistic analysis revealed that sleep quality was significantly associated with five factors: “time in bed,” “eating breakfast every morning,” “avoiding the use of electronic devices (PC, smartphone, etc.) just before bedtime,” “depressive mood”, and “not thinking about troubles while in bed.” Forty percent of athletes reported they had been informed by someone about “snoring loudly” and/or “leg twitching or jerking during sleep.”

Conclusions

The results of this study demonstrate that 28% of the athletes showed the PSQI score above the cutoff for poor sleep quality (> 5.5), which suggests that there may be a high prevalence of poor sleep quality in this population of athletes. To improve athletes’ sleep, the five factors associated with sleep quality should be emphasized in athletes’ sleep education. Furthermore, in medical evaluations of athletes, it may be desirable to include screening for sleep disorders.

First report of serotype 23B Streptococcus pneumoniae isolated from an adult patient with invasive infection in Japan

Serotype 23B Streptococcus pneumoniae was isolated from a 67-year-old Japanese patient with meningitis. This isolate was susceptible to penicillin G, while genotyped as gPISP with a mutation in a penicillin-binding motif in PBP2b. The 23B isolate was assigned to ST11996 that is related to CC439, a dominant group among serotype 23B.