Comparative effectiveness of safety planning intervention with instrumental support calls (ISC) versus safety planning intervention with two-way text message caring contacts (CC) in adolescents and adults screening positive for suicide risk in emergency departments and primary care clinics: Protocol for a pragmatic randomized controlled trial

BACKGROUND

Suicide is a leading cause of death in adolescents and adults in the US. Follow-up support delivered when patients return home after an emergency department (ED) or primary care encounter can significantly reduce suicidal ideation and attempts. Two follow-up models to augment usual care including the Safety Planning Intervention have high efficacy: Instrumental Support Calls (ISC) and Caring Contacts (CC) two-way text messages, but they have never been compared to assess which works best. This protocol for the Suicide Prevention Among Recipients of Care (SPARC) Trial aims to determine which model is most effective for adolescents and adults with suicide risk.

METHODS

The SPARC Trial is a pragmatic randomized controlled trial comparing the effectiveness of ISC versus CC. The sample includes 720 adolescents (12-17 years) and 790 adults (18+ years) who screen positive for suicide risk during an ED or primary care encounter. All participants receive usual care and are randomized 1:1 to ISC or CC. The state suicide hotline delivers both follow-up interventions. The trial is single-masked, with participants unaware of the alternative treatment, and is stratified by adolescents/adults. The primary outcome is suicidal ideation and behavior, measured using the Columbia Suicide Severity Rating Scale (C-SSRS) screener at 6 months. Secondary outcomes include C-SSRS at 12 months, and loneliness, return to crisis care for suicidality, and utilization of outpatient mental health services at 6 and 12 months.

DISCUSSION

Directly comparing ISC and CC will determine which follow-up intervention is most effective for suicide prevention in adolescents and adults.

GLP-2 as an indicator and modulator of acute inflammation improves cardiac function and survival in sepsis

Purpose

GLP-1 and GLP-2 (glucagon-like peptide-1/2) are gut hormones secreted in response to food. While GLP-1 controls glucose metabolism, GLP-2 is a local gut growth factor regulating intestinal nutrient absorption. GLP-2 has been found to be upregulated in patients with colitis. We hypothesize that beyond its local intestinal function GLP-2 might be involved in systemic immune responses.

Methods and results

To analyze whether GLP-2 secretion is modulated by the immune system, we measured circulating GLP-2 levels in 2 clinical cohorts. In the first cohort (n=34) GLP-2 levels increased over time following cardiac surgery as an inflammatory stimulus. In the second cohort 223 patients with sepsis had a 3.9 fold increase of GLP-2 plasma levels vs. 53 healthy controls (3.0 ng/mL vs. 11.4 ng/mL; p<0.001). High GLP-2 levels were associated with markers of inflammation (IL-6, PCT, CRP), septic cardiomyopathy (NT-proBNP) and independently predicted mortality in humans with sepsis. Induction of sepsis in mice by endotoxin or cecal ligation puncture strongly increased GLP-2 levels independent from food intake. By injecting various proinflammatory cytokines and inducing sepsis in IL1R−/− and IL6−/− mice we identified that inflammation upregulates GLP-2 secretion through IL-6. To identify the source of GLP-2 secretion under inflammation, we induced sepsis in Gcg−/− mice lacking endogenous GLP-2 production with a tissue-specific reactivation of Gcg in gut L-cells (GcgRAΔvilCre) or pancretic alpha cells (GcgRAΔPDX1-Cre). We observed sepsis-induced GLP-2 secretion to be derived from the pancreas and not from the gut. Additional in-vitro and ex-vivo approaches revealed that IL-6 directly activates GLP-2 secretion from pancreatic alpha cells. Gcg−/− mice lacking GLP-2 production and Glp2r−/− mice show aggravated sepsis indicating that endogenous upregulation of GLP-2 is protective. Finally, we analyzed whether inflammatory upregulation of GLP-2 has immunomodulatory relevance. We administered GLP-2 or saline as control per central jugular vein catheter mice who underwent CLP. GLP-2 treatment improved LV-contractility (dp/dtmax) in septic cardiomyopathy (control 7361 vs. GLP-2 9500 mmHg/s; p<0.01), inhibited sepsis-induced hypotension and reduced mortality (p=0.018). Mechanistically GLP-2 reduced myeloid immune cell infiltration into heart and liver tissue and decreased proinflammatory cytokine levels in various organs and the blood (TNF-α, IL-6 and IL-1β). After broad GLP-2 receptor profiling we found maximum mRNA expression in gut tissues with no expression on immune cells. By further mechanistic studies we found GLP-2 to protect against sepsis-induced gut barrier dysfunction.

Conclusions

Here we identified a counter-regulatory control system in which IL-6 derived upregulation of GLP-2 secretion limits excessive innate immune responses and protects against sepsis. These findings might open new avenues for the treatment of patients with inflammatory diseases.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): European Foundation for the Study of Diabetes, European Research Area Network on Cardiovascular Diseases (ERA-CVD and BMBF), Deutsche Forschungsgemeinschaft (DFG)

POS0301 STRUCTURAL OUTCOMES IN THE SACROILIAC JOINT AFTER IXEKIZUMAB TREATMENT FOR 16 WEEKS IN PATIENTS WITH ACTIVE NON‑RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS STRATIFIED BY GENDER, HLA-B27, AND BASELINE MRI INFLAMMATION

Background

Ixekizumab (IXE) has demonstrated clinical efficacy in patients with active non-radiographic axial spondyloarthritis (nr-axSpA) together with significant repair of structural lesions in the sacroiliac joint (SIJ) on MRI. There is, however, a paucity of data as to which patients may be most responsive.

Objectives

We aimed to evaluate whether patients’ gender, HLA-B27 status, and presence of MRI inflammation impacted the effect of treatment with IXE versus placebo (PBO) on MRI structural lesions in the SIJ in patients with nr-axSpA.

Methods

Patients with active nr-axSpA, biologic-naïve (COAST-X, NCT02757352) were randomized 1:1:1 to ixekizumab 80 mg every 4 (Q4W) or 2 weeks (Q2W) or PBO. Structural lesions on SIJ MRI were assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI SIJ structural score (SSS). Treatment comparisons used analysis of covariance based on observed cases. SPARCC SSS subgroup analyses were performed according to baseline gender, HLA-B27 status, and SPARCC MRI SIJ bone marrow oedema (BME) <4 and ≥4 subgroups, which reflects a definite MRI for inflammation in the SIJ typical of axSpA.

Results

Of 303 randomized patients, 266 patients (Q4W: n=85, Q2W: n=91, PBO: n=90) had an MRI scan at baseline and week 16. At baseline, SPARCC scores were consistently higher in males, and mostly higher in HLA-B27 and BME≥4 positive subgroups. Significant differences between patients treated with IXE versus PBO were observed for male patients, HLA-B27 positives, and those with baseline SPARCC BME ≥4. Numerically similar changes were observed in female patients, patients with negative HLA-B27, and patients with SPARCC BME<4, though not statistically significant.

Conclusion

Effects of IXE on structural repair are most evident in males, HLA-B27 positives, and patients with definite MRI inflammation at baseline.

Table 1.

MRI SIJ Structural Lesion Outcomes.

LesionAnalysisPBOIXE Q4WIXE Q2WMale (n=39)Female (n=51)Male (n=44)Female (n=41)Male (n=43)Female (n=48)ErosionBL mean5·1671·9803·5452·8173·5232·594LS mean CFB (SE)0·51 (0·20)-0·11 (0·17)-0·63 (0·18)-0·11 (0·19)-0·51 (0·18)-0·32 (0·17)P value vs PBONANAp<0·001p>0·99p<0·001p=0·37FatBL mean2·0510·9122·0911·2931·4650·677LS mean CFB (SE)-0·02 (0·09)-0·03 (0·08)0·29 (0·08)0·03 (0·08)0·21 (0·08)0·04 (0·08)P value vs PBONANAp=0·01p=0·65p=0·062p=0·51BackfillBL mean1·1540·1670·6630·4150·7910·323LS mean CFB (SE)-0·20 (0·13)0·01 (0·11)0·39 (0·12)0·01 (0·12)0·34 (0·12)0·14 (0·11)P value vs PBONANAp<0·001p>0·99p=0·002p=0·38LesionAnalysisHLA-B27+HLA-B27-HLA-B27+HLA-B27-HLA-B27+HLA-B27-(n=64)(n=25)(n=61)(n=23)(n=65)(n=26)ErosionBL mean3·8202·1003·4672·5433·5151·827LS mean CFB (SE)0·27 (0·15)-0·10 (0·24)-0·49 (0·15)-0·01 (0·25)-0·50 (0·15)-0·17 (0·24)P value vs PBONANAp<0·001p=0·79p<0·001p=0·84FatBL mean1·5781·0201·3282·7831·2850·462LS mean CFB (SE)-0·06 (0·06)-0·06 (0·10)0·22 (0·06)0·01 (0·10)0·13 (0·06)0·10 (0·10)P value vs PBONANAp=0·002p=0·65p=0·027p=0·25BackfillBL mean0·7420·2400·5420·5650·7620LS mean CFB (SE)-0·12 (0·10)0·01 (0·16)0·28 (0·10)0 (0·17)0·27 (0·10)0·16 (0·16)P value vs PBONANAp=0·005p=0·96p=0·005p=0·52LesionAnalysisBME ≥4BME <4BME ≥4BME <4BME ≥4BME <4(n=40)(n=50)(n=27)(n=58)(n=38)(n=53)ErosionBL mean4·8632·1605·3522·1905·2761·425LS mean CFB (SE)0·42 (0·19)-0·06 (0·17)-0·70 (0·23)-0·23 (0·16)-0·71 (0·20)-0·19 (0·17)P value vs PBONANAp<0·001p=0·47p<0·001p=0·57FatBL mean0·7751·9101·9261·6031·6710·604LS mean CFB (SE)-0·02 (0·08)-0·02 (0·07)0·54 (0·10)-0·01 (0·07)0·28 (0·08)0·01 (0·07)P value vs PBONANAp<0·001p=0·90p=0·013p=0·74BackfillBL mean0·7500·4701·0190·3280·7630·387LS mean CFB (SE)-0·21 (0·12)0·01 (0·11)0·41 (0·15)0·11 (0·10)0·49 (0·13)0·05 (0·11)P value vs PBONANAp=0·002p=0·52p<0·001p=0·80

CFB=change from BL. BL=baseline, LS=least squares.

Acknowledgements

Study was sponsored by Eli Lilly and Company

Disclosure of Interests

Walter P Maksymowych Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Galapagos, Janssen, Novartis, Pfizer, and UCB and is Chief Medical Officer of CARE Arthritis Ltd, Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Xenofon Baraliakos Grant/research support from: Abbvie, Amgen, BMS, Chugai, Galapagos, Gilead, Eli Lilly and Company, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, Robert G Lambert Consultant of: CARE Arthritis, Image Analysis Group, Parexel, and Pfizer, Robert B.M. Landewé Consultant of: AbbVie, Astra-Zeneca, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Janssen, Gilead, Galapagos, Glaxo-Smith-Kline, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Novartis, Pfizer, and UCB; and is director of Imaging Rheumatology BV, which is a registered company under Dutch Law, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Hilde Carlier Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Lisse Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Xiaoqi Li Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Maja Hojnik Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Mikkel Østergaard Speakers bureau: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly and Company, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly and Company, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Grant/research support from: AbbVie, BMS, Merck, Celgene, and Novartis

OP0034 IXEKIZUMAB IMPROVES SIGNS, SYMPTOMS, AND QUALITY OF LIFE IN PATIENTS WITH AXIAL SpA IRRESPECTIVE OF DISEASE DURATION: RESULTS FROM THE COAST-V, COAST-W AND COAST-X TRIALS

Background

Ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting interleukin-17A,1 has demonstrated superior efficacy to placebo (PBO) in the treatment of patients (pts) with radiographic axial spondyloarthritis (r-axSpA) (COAST-V [NCT02696785]; -W [NCT02696798]), and non-radiographic axial spondyloarthritis (nr-axSpA) (COAST-X [NCT02757352]).

Objectives

Assess treatment response to IXE categorised by disease duration since symptom onset (<5 years (yrs), ≥5yrs) in pts with r-axSpA and nr-axSpA up to 52 Weeks (Wks).

Methods

Pts fulfilled ASAS classification criteria for r-axSpA or nr-axSpA and were randomised to receive 80mg subcutaneous IXE every 2Wks or 4Wks, or PBO (16Wks COAST-V/W; 52Wks COAST-X). Data were summarized by disease duration and treatment in eligible intent-to-treat (ITT) pts. Wk16 treatment comparisons were conducted using Cochran-Haenszel-Mantel test and ANCOVA. Missing data were handled using non-responder imputation and modified baseline observation carried forward, for categorical and continuous endpoints, respectively.

Results

Table 1 presents pt demographics and baseline characteristics. Data is from pooled IXE pts. In pts with r-axSpA and <5yrs symptom duration, ASAS40 response was achieved by 51.5% at Wk16 and 60.6% at Wk52, compared to 36.9% at Wk16, significantly different to PBO (p<0.001), and 40.5% at Wk52, in pts with ≥5yrs symptom duration. In pts with nr-axSpA and <5yrs symptom duration, ASAS40 response was achieved by 42.5% at Wk16, significantly different to PBO (p=0.012), and 54.8% at Wk52, compared to 36.0% at Wk16 and 41.4% at Wk52 in pts with ≥5yrs symptom duration (Figure 1). In pts with r-axSpA and <5yrs symptom duration, ASDAS LDA <2.1 response was achieved by 39.4% at Wk16 and 48.5% at Wk52, compared to 27.5% at Wk16, significantly different to PBO (p<0.001), and 35.6% at Wk52 in pts with ≥5yrs symptom duration. In pts with nr-axSpA and <5yrs symptom duration, ASDAS LDA <2.1 response was achieved by 32.9% at Wk16, significantly different to PBO (p=0.003), and 49.3% at Wk52, compared to 23.9% at Wk16 and 36.9% at Wk52 in pts with ≥5yrs symptom duration. At Wk16, in pts with r-axSpA pts and <5yrs symptom duration, the Change from Baseline (CFB) in SF-36 Physical Component Summary (PCS) Score (LSM±SE) was 7.91 (±1.52), compared to 6.81 (±0.40) in pts with ≥5yrs symptom duration. In pts with nr-axSpA and <5yrs symptom duration, this score was 8.95 (±0.95) compared to 7.07 (±0.73) in pts with ≥5yrs symptom duration; both were significantly different to PBO (r-axSpA: p<0.001; nr-axSpA: p=0.037).

Table 1.

Patient demographics and Baseline Characteristics

Pts with r-axSpAPts with nr-axSpA<5yrs (Ns=33)≥5yrs (Ns=306)<5yrs (Ns=73)≥5yrs (Ns=111)Age (years)33.1 (8.15)45.1 (12.12)31.9 (10.07)46.4 (11.86)Male, n (%)26 (78.8)245 (80.1)40 (54.8)53 (47.7)Female, n (%)7 (21.2)61 (19.9)33 (45.2)58 (52.3)Age at axSpA onset (years)30.4 (8.29)27.0 (9.06)29.9 (10.22)29.5 (8.76)ASDAS score, mean (SD)3.87 (0.79)4.03 (0.82)3.79 (0.80)3.85 (0.78)BASDAI score, mean (SD)7.16 (1.64)7.25 (1.35)7.00 (1.33)7.30 (1.26)SF-36 PCS, mean (SD)34.02 (7.73)32.86 (7.63)32.84 (7.86)32.57 (6.97)

Abbreviations: IXE=ixekizumab, n=number of pts in specified category, Ns=number of pts in each subgroup, SD=standard deviation.

Figure 1.

ASAS40 Response Rates for patients with r-axSpA (COAST-V/W) and nr-axSpA (COAST-X) Symptom Duration <5 and ≥5 years up to Week 52, ITT, NRI: Significantly greater response of IXE versus PBO at Week 16 denotated by * (p≤0.05), *** (p≤0.001). Abbreviations: PBO, placebo; IXE, Ixekizumab; NRI, nonresponder imputation; ITT, Intent-to-Treat (population), ASAS, Assessment of Spondyloarthritis International Society.

Conclusion

Efficacy response to the therapy with IXE was observed in both subgroups based on disease duration (<5 and ≥5yrs) with more robust responses in the <5 years subgroup.

References

[1]Paller AS, Br J Dermatol. 2020;183(2):231-241.

Disclosure of Interests

Victoria Navarro-Compán Speakers bureau: AbbVie, Janssen, Eli Lilly and Company, Novartis, Pfizer and UCB, Paid instructor for: AbbVie, Janssen, Eli Lilly and Company, Novartis, Pfizer and UCB, Consultant of: AbbVie, Eli Lilly and Company, Novartis, Pfizer and UCB, Grant/research support from: ASAS: Research grant 2018 and 2021.

Novartis: Research grant 2021 (Payment to institution), John D Reveille Speakers bureau: Eli Lilly and Company and UCB Pharma, Consultant of: UCB Pharma, Grant/research support from: Eli Lilly and Company, Proton Rahman Speakers bureau: Abbott, AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, and Company Janssen, Novartis, and Pfizer., Paid instructor for: Advisory Board: Abbott, AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, Novartis, and Pfizer., Grant/research support from: Janssen and Novartis, José Maldonado-Cocco Speakers bureau: Pfizer, Merck Sharp Dohme, Wyeth, Sanofi Aventis, Novartis, Bristol Myers Squibb, Roche, Shering-Plough, Abbvie, UCB, Gilead., Consultant of: Pfizer, Merck Sharp Dohme, Wyeth, Sanofi Aventis, Novartis, Bristol Myers Squibb, Roche, Shering-Plough, Abbvie, UCB, Gilead., Grant/research support from: Pfizer, Merck Sharp Dohme, Wyeth, Sanofi Aventis, Novartis, Bristol Myers Squibb, Roche, Shering-Plough, Abbvie, UCB, Gilead., Marina Magrey Speakers bureau: Novartis, Abbvie, Eli Lilly and Company., Consultant of: Novartis, Eli Lilly and Comapny, Pfizer, Janssen, UCB Pharma, Abbvie, BMS., Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, So Young Park Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Martin Rudwaleit Speakers bureau: Abbvie, BMS, Boehringer Ingelheim, Chugai, Eli Lilly and Company, Novartis, Pfizer, UCB., Paid instructor for: Abbvie, Eli Lilly, Novartis, UCB., Consultant of: UCB, Grant/research support from: Galapagos, UCB, Novartis.

Rol del fisioterapeuta en el entorno escolar

Introducción: el rol del fisioterapeutav en el entorno escolar, como profesional partícipe en el desarrollo neuromotor del niño y su proceso de aprendizaje, se observa como un campo profesional desde un enfoque no clínico, convirtiéndose en una oportunidad de generación de nuevas alternativas laborales y conocimientos disciplinares. Esta investigación se orienta con el objetivo de analizar el rol del fisioterapeuta en el entorno escolar. Metodología: se realizó una búsqueda sistemática en las bases de datos PubMed, Scopus, PEDro, Lilacs y Google Scholar, desde el inicio de las bases de datos hasta octubre del 2019. Los criterios de selección fueron previamente definidos según la edad de la población y el tema del artículo. Resultados: de los 9 artículos incluidos, las principales actividades encontradas se refieren a la promoción de la actividad física, psicomotricidad, inclusión escolar, rehabilitación en la escuela y asesoría a los docentes. De los roles encontrados, el de mayor frecuencia es el de facilitador de la inclusión escolar, dado que es la actividad más visibilizada. Conclusiones: de las 5 actividades identificadas del fisioterapeuta enla escuela, se destaca, principalmente, la inclusión escolar y la asesoría al docente. Sin embargo, la labor como promotor de la actividad física cobra importancia en la intervención del fisioterapeuta en la salud pública. REGISTRO PROSPEROCRD42020160617.

Survey of Trichinella in American minks (Neovison vison Schreber, 1777) and wild rodents (Muridae and Cricetidae) in Chile

Trichinellosis is a zoonosis with worldwide distribution. Several hosts have been recognized around the world; however, there is a lack of knowledge of the role of feral mammals in Chile in its transmission. Herein, we tested muscle samples from 555 individuals among American minks (Neovison vison Schreber, 1777. n = 100) and several myomorph rodent species (Muridae and Cricetidae. n = 455) from southern Chile by artificial digestion to detect Trichinella larvae and identified the larvae at the species level through molecular analyses. Rodents were captured in agricultural and wild protected areas of several administrative regions (hereafter: region), while minks were captured in agricultural areas of the Los Ríos region. Trichinella spiralis larvae were detected in a synanthropic black rat (0.24%) of the Ñuble region and in seven minks (7%) trapped in agricultural areas of the Los Ríos region. The present results suggest that T. spiralis circulation is restricted to synanthropic rodents and minks living in agricultural areas where the parasite circulates among domesticated pigs. This study represents the first record of T. spiralis in a mustelid mammal in South America, increasing the number of feral species that could participate in the reservoir.

First record of Trichinella in Leopardus guigna (Carnivora, Felidae) and Galictis cuja (Carnivora, Mustelidae): new hosts in Chile

Background

Trichinellosis is a zoonotic disease with a worldwide distribution. It is caused by several species of nematodes in the genus Trichinella. Trichinella spp. are transmitted through predation or carrion consumption and occur in domestic and sylvatic cycles. In humans trichinellosis occurs due to the consumption of raw or undercooked, infected meat and is mainly associated with the household slaughter of pigs or the consumption of game animals without veterinary inspection, a cultural practice that is difficult to resolve. Therefore, knowledge of this parasite's reservoir is relevant for better implementing public health strategies. The aim of this study was to assess the presence of Trichinella sp. in several carnivore and omnivore vertebrates in central-southern Chile.

Methods

We collected muscle tissue from a total of 53 animals from 15 species and were digested to detect Trichinella larvae which were further identified to species level using molecular techniques.

Results

We detected Trichinella larvae in Leopardus guigna (Felidae) and Galictis cuja (Mustelidae). We identified the larvae collected from L. guigna as Trichinella spiralis, but we were unable to molecularly characterize the larvae from G. cuja. This is the first record of Trichinella in a native mustelid of South America and the first record of T. spiralis in L. guigna. This study identified two novel hosts; however, further work is needed to identify the role that these and other hosts play in the cycle of Trichinella in Chile.

POS0908 EFFICACY OF IXEKIZUMAB THROUGH 52 WEEKS FOR IMPROVING PERIPHERAL JOINT INVOLVEMENT AMONG PATIENTS WITH RADIOGRAPHIC-AXIAL SPONDYLOARTHRITIS

Background:

Radiographic-axial spondyloarthritis (r-axSpA) is a progressive chronic inflammatory disease primarily affecting the spine and sacroiliac joints. However, about 30-40% of patients (pts) with axSpA can have peripheral joint involvement, including joint tenderness and swelling, which can contribute significantly to burden of disease. Ixekizumab (IXE), a monoclonal antibody that neutralizes the pro-inflammatory cytokine interleukin-17A, has demonstrated a high level of efficacy in the treatment of r-axSpA.

Objectives:

The aim of this study is to evaluate the efficacy of IXE through 52 weeks (wks) in improving peripheral joint pain and swelling for pts with r-axSpA.

Methods:

Data was derived from two phase III randomised, double-blind, placebo (PBO)-controlled trials: one in pts with r-axSpA, who were biological disease-modifying anti-rheumatic drug (bDMARD)-naïve (COAST-V: NCT02696785), and the other in pts who were tumor necrosis factor inhibitor-experienced (COAST-W: NCT02696798). All pts had a confirmed diagnosis of r-axSpA and had to meet ASAS (Assessment of SpondyloArthritis international Society) criteria. IXE (80 mg) or PBO were administered subcutaneously every 2 (Q2W) or 4 (Q4W) wks during a 52-wk treatment period, after receiving a starting dose of 80 mg or 160 mg at wk 0. COAST-V/W pts originally randomised to PBO were re-randomised 1:1 to IXE Q4W or Q2W at wk 16. We present a post-hoc analysis of data from an integrated dataset from COAST-V and W (COAST-V/W); with intent to treat (ITT) pts categorized by baseline (BL) peripheral joint status. The presence of peripheral joint involvement was defined using a 46-joint tender joint count (TJC) >0 or 44-joint swollen joint count (SJC) >0. Treatment response through wk 52 was evaluated based on % improvement (20%, 50% or 70%) and resolution of tender or swollen joints of pts with BL TJC>0 or SJC>0, respectively. Missing data were imputed by non-responder imputation (NRI). Treatment comparison vs PBO at wk 16 was performed using Cochran-Mantel-Haenszel test.

Results:

This analysis includes 359 pts (63.4% of ITT) with baseline TJC>0 and 203 pts (35.9% ITT) with baseline SJC>0. The mean (SD) baseline TJC and SJC were 7.7 (8.3) and 4.3 (4.5), respectively. Mean BL TJC and SJC values by treatment group are presented in Table 1. A significant improvement of SJC by 20% and 50% was seen in pts treated with IXE Q4W compared to PBO at wk 16. Pts treated with IXE resulted in a numerically higher improvement in TJC and SJC symptoms up to wk 16 compared to PBO, and efficacy was sustained up to wk 52 (Table 1). A higher proportion of IXE-treated pts achieved high-hurdle efficacy endpoints (50% and 70% improvements) in comparison to PBO at wk 16 (Table 1). Over this time period, IXE treatment led to a high proportion of pts experiencing complete resolution of TJC or SJC vs PBO at wk 16, which was sustained up to wk 52 (Fig 1).

Conclusion:

In this post hoc analysis, pts with r-axSpA treated with IXE showed substantial improvement in peripheral joint pain and swelling.

Table 1.

Improvement of Tender or Swollen Joint Counts for pts with radiographic-axSpA with TJC>0 or SJC>0 at baseline (COAST-V/W)a - NRI Results

% ImprovementRadiographic-AxSpAWk1652bPBOIXE Q4WIXE Q2WIXE Q4WIXE Q2WN (TJC>0)116129114129114BL TJC mean (SD)7.4 (8.8)8.4 (8.4)7.3 (7.5)%TJC improvement20%66.475.271.168.272.850%52.661.264.9*65.167.570%37.947.35055.854.4N (SJC>0)6772647264BL SJC mean (SD)3.8 (4.6)5.2 (5.2)3.8 (3.3)%SJC improvement20%64.283.3*76.677.878.150%56.777.8†70.37576.670%46.362.560.969.471.9

Abbreviations: COAST-V/W= integrated COAST-V and COAST-W; PBO = placebo; IXE= ixekizumab; Q4W = 80 mg IXE every 4 wks; Q2W = 80 mg IXE every 2 wks

aImprovement in the number of tender or swollen joints were summarized on ITT patients who had tender (TJC>0) or swollen (SJC>0) joints at baseline, respectively

bCOAST-V/W PBO data are not available at wk 52 as pts originally randomised to PBO were re-randomised 1:1 to IXE Q4W or IXE Q2W at wk 16p-value vs. PBO at wk 16: *P<0.05, †P<0.01, ‡P<0.001

Acknowledgements:

Writing support was provided by Sinéad O’ Loughlin, an employee of Eli Lilly and Company

Disclosure of Interests:

Marina Magrey Consultant of: Novartis, UCB, Pfizer, Eli Lilly, Abbvie, Janssen, Kurt de Vlam Speakers bureau: UCB, Novartis, Pfizer, Eli Lilly, Amgen, Celgene, Paid instructor for: UCB, Amgen, Celgene, Consultant of: UCB, Novartis, Pfizer, Eli Lilly, Amgen, Celgene, Grant/research support from: Pfizer, Amgen, Celgene, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Xiaoqi Li Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Biocad, Gilead, GlaxoSmithKline, Eli Lilly, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer

POS0912 LONG-TERM TREATMENT WITH IXEKIZUMAB IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: TWO-YEAR RESULTS FROM COAST-Y

Background:

The efficacy and safety of the interleukin-17 inhibitor ixekizumab (IXE) for the treatment of radiographic (r-) and non-radiographic (nr-) axial spondyloarthritis (axSpA) has been shown for up to 52 weeks.1-2

Objectives:

To study the efficacy and safety of ixekizumab in the treatment of patients with r- and nr-axSpA for up to 116 weeks.

Methods:

COAST-Y (NCT03129100) is the 2-year extension of the COAST-V, -W, and -X trials. Patients continued with the dose received at the end of the originating trial at Week 52, either with 80 mg IXE every 4 weeks (Q4W) or every 2 weeks (Q2W). Patients who had been assigned to adalimumab or placebo were re-randomized to IXE Q4W or Q2W at Week 16 in COAST-V and -W. Patients who had received placebo for 52 weeks in COAST-X were switched to IXE Q4W in COAST-Y. Patients who switched from placebo or adalimumab treatment to IXE (COAST-V, -W, or -X) or from IXE Q4W to open-label IXE Q2W (COAST-X) during the originating studies were analyzed separately from patients continuously treated with IXE. Standardized efficacy measures were used (Table 1). Missing data were handled by non-responder imputation for categorical data and modified baseline observation carried forward for continuous data. Safety data were analyzed for all patients who received ≥1 dose of IXE.

Table 1.

Demographic and efficacy results for patients continuously treated with IXE for 116 weeks

IXE Q4W N=157IXE Q2W N=195Demographics Age42.7 (13.0)41.8 (11.2) Male (n, [%])124 (79.0)132 (67.7) Baseline ASDAS3.92 (0.80)3.95 (0.76) Baseline BASDAI7.07 (1.26)7.18 (1.35) Baseline BASFI6.57 (1.76)6.74 (1.86) Baseline BASMI4.08 (1.46)3.97 (1.52) Baseline SF-36 PCS33.90 (7.27)33.26 (6.88)Outcome measureResponse (n, [%])Week 52Week 116Week 52Week 116 ASDAS <2.175 (47.8)69 (43.9)88 (45.1)96 (49.2) ASAS partial remission34 (21.7)31 (19.7)35 (17.9)39 (20.0) ASAS4082 (52.2)89 (56.7)99 (50.8)108 (55.4) BASDAI5078 (49.7)75 (47.8)83 (42.6)99 (50.8)Change from baseline ASDAS-1.64 (1.05)-1.60 (1.15)-1.63 (1.03)-1.78 (1.04) BASFI-2.88 (2.31)-2.76 (2.39)-2.83 (2.38)-3.15 (2.34) BASMI-0.57 (0.95)-0.57 (0.93)-0.53 (0.92)-0.60 (1.00) SF-36 PCS9.03 (8.62)8.43 (8.70)8.87 (7.57)9.86 (8.45)

Data are mean (SD) unless otherwise noted. Non-responder imputation was used for categorical variables, and modified baseline observation carried forward for continuous variables.

Results:

Of the 773 patients enrolled in COAST-Y, 86.0% completed Week 116 of treatment (52 weeks of one of the originating trials and 64 weeks of COAST-Y). Among the patients continuously treated with IXE for 116 weeks (IXE Q4W: N=157; IXE Q2W: N=195), 46.9% achieved low disease activity (ASDAS <2.1), and 19.9% achieved ASAS partial remission at 116 weeks (Table 1; Figure 1). In comparison to baseline, 56.0% achieved ASAS40 (Table 1). The mean change from baseline at Week 116 was –1.70 for ASDAS, –2.98 for BASFI, and 9.22 for SF-36 Physical Component Summary (Table 1). Similar observed responses were achieved between the patients continuously treated with IXE and patients initially treated with placebo or adalimumab. For the 932 patients in the safety population, no new safety signals were identified.

Conclusion:

Ixekizumab treatment led to consistent and sustained long-term improvements in disease activity and quality of life in patients with r- and nr-axSpA, with no new safety signals after up to 2 years of treatment.

References:

[1]Dougados, et al. Ann Rheum Dis 2020;79:176-185.

[2]Deodhar, et al. Lancet 2020; 395:53-64.

Disclosure of Interests:

Juergen Braun Speakers bureau: Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD, Mundipharma, Novartis, Pfizer, Roche, Sanofi-Aventis, and UCB, Consultant of: Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD, Mundipharma, Novartis, Pfizer, Roche, Sanofi-Aventis, and UCB, Grant/research support from: Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD, Mundipharma, Novartis, Pfizer, Roche, Sanofi-Aventis, and UCB, Uta Kiltz Speakers bureau: AbbVie, Hexal, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Hexal, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Novartis, and Pfizer, Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Giliad, GlaxoSmith & Kline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmith & Kline, Novartis, Pfizer, and UCB, Tetsuya Tomita Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe, Novartis, Takeda, Pfizer, Consultant of: AbbVie, Astellas, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe, Novartis, Takeda, Pfizer, Maxime Dougados Consultant of: AbbVie, BMS, Eli Lilly and Company, Merck, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, BMS, Eli Lilly and Company, Merck, Novartis, Pfizer, Roche, and UCB, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Chen-Yen Lin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Merck, and Pfizer

POS0228 BASELINE CHARACTERISTICS AND TREATMENT RESPONSE TO IXEKIZUMAB CATEGORISED BY SEX IN RADIOGRAPHIC AND NON-RADIOGRAPHIC AXIAL SPONDYLARTHRITIS PATIENTS THROUGH 52 WEEKS: DATA FROM 3 PHASE III, RANDOMIZED, CONTROLLED TRIALS

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of the axial skeleton comprising two subtypes within the same spectrum: radiographic (r-axSpA) and non-radiographic (nr-axSpA). Previous studies have shown that clinical presentation and treatment response of males and females may differ1 despite similar disease burden.2 Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets interleukin-17A, has demonstrated superior efficacy to placebo in the treatment of patients with r-axSpA (COAST-V/W [bDMARD- naïve/TNFi-experienced]) and nr-axSpA (COAST-X [bDMARD-naïve]).3

Objectives:

Assess baseline characteristics and treatment response to IXE categorised by sex in patients with r-axSpA and nr-axSpA for up to 52 weeks.

Methods:

Patients fulfilled the ASAS classification criteria for r-axSpA or nr-axSpA. Patients were randomized to receive 80 mg subcutaneous IXE every 2 weeks (Q2W) or 4 weeks (Q4W), or to placebo (PBO) [16 weeks COAST-V/W; 52 weeks COAST-X]. Baseline characteristics and treatment outcomes were assessed. Patients were categorised by sex, missing data was controlled for using non-responder imputation (NRI) and modified baseline observation carried forward (mBOCF) analysis was conducted on continuous efficacy variables.

Results:

At baseline, females were older, with significantly higher pain and fatigue scores and peripheral joint symptoms (table 1). ASAS40 response rate with IXEQ4W was achieved in 39% of males with r-axSpA by week 16, and 44% by week 52. Females achieved 16.7% at week 16, and 33.3% at week 52. In nr-axSpA, 46% of IXEQ4W males achieved ASAS40 at week 16 and 30% at week 52. 23.9% of females achieved ASAS40 at week 16, increasing to 30.4% at week 52.

Table 1.

Baseline Characteristics of Patients Categorised by Sex

Patients with r-axSpA(COAST-V/W)(n=376)Patients with nr-axSpA(COAST-X)(n=198)CharacteristicMale (n=298)Female (n=78)p valueMale (n=99)Female (n=99)p valueAge at onset (yrs), mean (SD)26.5 (8.7)30.1 (10.1)0.002*27.9 (7.7)32.0 (10.7)0.002*Symptom duration (yrs), mean (SD)16.7 (10.5)17.8 (12.2)0.4209.5 (9.2)12.3 (11.3)0.057ASDAS, mean (SD)4.0 (0.8)3.9 (0.7)0.3043.7 (0.8)3.9 (0.8)0.143BASDAI, mean (SD)7.10 (1.4)7.4 (1.5)0.1796.9 (1.4)7.4 1.4)0.013*Fatigue/tiredness (BASDAI Q1), mean (SD)7.4 (1.6)7.8 (1.5)0.036*7.0 (1.6)7.9 (1.5)<0.001*Spinal pain (BASDAI Q2), mean (SD)7.9 (1.5)8.0 (1.5)0.6827.5 (1.4)7.9 (1.5)0.029*Pain/swelling in other joints (BASDAI Q3), mean (SD)6.5 (2.1)6.9 (2.2)0.1296.6 (2.3)7.2 (1.9)0.039*Tenderness to touch/pressure (BASDAI Q4), mean (SD)6.8 (1.8)7.0 (1.9)0.3396.6 (1.9)6.8 (1.8)0.404Morning stiffness (BASDAI Q5), mean (SD)7.5 (1.6)7.7 (1.8)0.5047.3 (1.7)7.7 (1.9)0.137Morning stiffness duration (BASDAI Q6), mean (SD)6.5 (2.3)6.5 (2.8)0.9446.3 (2.3)6.6 (2.5)0.392Spinal pain at night NRS, mean (SD)7.4 (1.5)7.8 (1.7)0.033*7.0 (1.8)7.6 (1.8)0.027*BASFI, mean (SD)6.8 (1.8)7.0 (2.0)0.4666.2 (1.8)6.7 (2.1)0.108SF-36 PCS, mean (SD)30.9 (8.3)28.9 (8.2)0.07533.1 (7.7)32.1 (7.2)0.348

p-value from Fisher’s exact test analysis of variance (ANOVA) with sex as a factor for continuous data. Data includes pooled IXEQ2W and IXEQ4W.

Conclusion:

This analysis demonstrates that for the axSpA disease spectrum, females present with higher disease burden as reflected by higher scores in fatigue/tiredness, and spinal pain at night. Our findings indicate that males and females respond to IXE; however, females experience this benefit later in their treatment course, with a more prolonged attainment of peak response.

References:

[1]van der Horst-Bruinsma IE, et al. Ann Rheum Dis. 2019;78:1550-1558.

[2]Zhao SS, et al. Rheumatology. 2019;58:2025-2030.

[3]Deodhar A, et al. Lancet. 2020;395:53-64.

Figure 1.

COAST-V/W ASAS40 (ITT, NRI) Patients initially randomized to PBO in COAST-V/W switched to IXEQ2W or Q4W at week 16 by study design; PBO data are summarised up to week 16.

Acknowledgements:

Writing support was provided by Dr Geraldine Fahy, an employee of Eli Lilly and Company

Disclosure of Interests:

Irene van der Horst-Bruinsma Speakers bureau: BMS, AbbVie, Pfizer, UCB, MSD, Consultant of: Abbvie, UCB, MSD, Lilly, Novartis, Grant/research support from: MSD, Pfizer, AbbVie, Rebecca Bolce Shareholder of: Eli Lilly, Employee of: Eli Lilly, Theresa Hunter Shareholder of: Eli Lilly, Employee of: Eli Lilly, David Sandoval Shareholder of: Eli Lilly, Employee of: Eli Lilly, Danting Zhu Employee of: Eli Lilly, Vladimir J. Geneus Employee of: Eli Lilly, Jeffrey Lisse Shareholder of: Eli Lilly, Employee of: Eli Lilly, Soyi Liu Leage Shareholder of: Eli Lilly, Employee of: Eli Lilly, Marina Magrey Consultant of: Novartis, Eli Lilly, Pfizer, Abbvie, UCB and Jansen, Grant/research support from: Amgen, AbbVie, and UCB Pharma

POS0915 SUSTAINABILITY OF IXEKIZUMAB RESPONSE AT THE INDIVIDUAL PATIENT LEVEL OVER TIME IN RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background:

Ixekizumab (IXE) has demonstrated efficacy in treating the signs and symptoms of radiographic axial spondyloarthritis (r-axSpA) in patients (pts) up to week (Wk) 52 [1]. Pts may experience fluctuations in the improvements of their symptoms, which may impact their overall quality of life [2]. Providing data at the pt level is important to support consistency and sustainability of efficacy.

Objectives:

To analyse IXE response for sustainability at the individual pt level, between Wks 16 and 52.

Methods:

COAST-V (NCT02696785) and COAST-W (NCT02696798) were two phase 3, multicentre, randomised, double-blind, placebo-controlled studies (adalimumab was the active control in COAST-V). Pts with active r-axSpA who were either biologic disease modifying anti-rheumatic drug (bDMARD) naïve (COAST-V) or, inadequate responders or intolerant to up to 2 TNF inhibitors (COAST-W) received IXE every 4 weeks (Q4W) or every 2 weeks (Q2W). Only IXE Q4W pts were included in the present analysis (approved dosage for the indication). Separate analyses were conducted on pts who achieved either endpoint; ASAS40 or ASDAS<2.1. The proportion (%) of pts who achieved either ASAS40 or ASDAS<2.1, at Wk 16 and at each visit out to Wk 52 (total of 8 visits) was assessed. Missing data were imputed as non-response. Heatmaps were used to depict the data analysed at the individual patient level across all visits.

Results:

In COAST-V, 81 pts enrolled in the trial were initially randomised to IXE Q4W. Of those, 48% (N=39) of pts achieved ASAS40 at Wk 16 (Figure 1), of which 59% (N=23) maintained ASAS40 at every visit afterwards. In total, 85% (N=33) of the ASAS40 achievers at Wk 16 maintained ASAS40 with some (26% (N=10)) fluctuations, between ASAS40 and ASAS20. In COAST-W, 114 pts enrolled in the trial were initially randomised to IXE Q4W. Of those, 25.4% (N=29) pts achieved ASAS40 at Wk 16, of which, 69% (N=20) maintained ASAS40 at every visit afterwards. In total, 83% (N=24), of the ASAS40 achievers at Wk 16 maintained ASAS40 with some (14% (N=4)) fluctuations, between ASAS40 and ASAS20.

Of the 81 pts initially randomised to IXE Q4W in COAST-V, 35 pts achieved low disease activity (ASDAS<2.1, LDA) at Wk 16. Of those, 54% (N=19) of pts maintained LDA at every visit afterwards. In total, 91% (N=32) of the ASDAS-LDA achievers at Wk 16 maintained LDA with some (37% (N=13)) fluctuations, between LDA and high disease activity (ASDAS 2.1-3.5, HDA). Of the 114 pts initially randomised to IXE Q4W in COAST-W, 20 pts achieved LDA at Wk 16. Of those, 50% (N=10) of pts maintained LDA at every visit afterwards. In total, 95% (N=19) of the ASDAS-LDA achievers at Wk 16 maintained LDA with some (45% (N=9)) fluctuations between LDA and HDA.

Conclusion:

This analysis demonstrates that pts with r-axSpA and treated with IXE Q4W who achieve ASAS40 or ASDAS-LDA at Wk 16 show a sustainable response, at the individual patient level, with similar levels of efficacy over time and at each visit out to week 52.

References:

[1]Dougados et al., Ann Rheum Dis. 2020; 79(2):176-185.

[2]Essers et al., Rheumatology. 2016;55(11):2014-22.

Figure 1.

Heatmap diagram depicting the sustained effect of IXE over time at the pt level in pts with r-axSpA from COAST-V. Each row corresponds to an individual ASAS40 responder at Wk 16.

Acknowledgements:

Edel Hughes, an employee of Eli Lilly and Company, provided editorial and writing support.

Disclosure of Interests:

Sofia Ramiro Speakers bureau: AbbVie, Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Sanofi, UCB, Grant/research support from: MSD, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, So Young Park Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Beilei Wu: None declared, Jessica A. Walsh Consultant of: AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Merck, Pfizer

AB0539 IXEKIZUMAB TREATMENT RESPONSE: CONSISTENCY OVER TIME AND AT EACH VISIT IN PSORIATIC ARTHRITIS

Background:

Ixekizumab (IXE), a high-affinity monoclonal antibody targeting IL-17A, has demonstrated superiority in achieving the combined endpoint of ACR50 and PASI100 at week (Wk) 24 compared to adalimumab (ADA) in the SPIRIT-H2H trial [1]. In this analysis, we looked at the efficacy responses at the individual patient (pt) level to assess consistency over time and at each visit.

Objectives:

To determine the American College of Rheumatology 50% (ACR50) response and Disease Activity in psoriatic arthritis (PsA) (DAPSA) response in pts treated with IXE and describe response consistency over time and at each visit from Wk 24 through Wk 52.

Methods:

This post-hoc analysis used data from SPIRIT-H2H (NCT03151551), a phase3b/4 randomised, open-label parallel-group study between IXE and ADA. Pts were randomised to receive either IXE 80 mg, every 4 Wks (IXE Q4W)) or ADA 40 mg, every 2 Wks (ADA Q2W)). The proportion (%) of pts in the intent-to-treat population who achieved each endpoint, either ACR50 or DAPSA≤14, at Wk 24 and at each post-baseline visit out to Wk 52 was assessed. Nine pts with active psoriasis and body surface area (BSA) ≥3% were assessed as PASI=0 at baseline, a medical inconsistency that was resolved using medical judgement. These pts were considered PASI100 responders if PASI=0 and BSA=0 at post baseline visits.

Results:

A total of 566 patients enrolled in the trial received either IXE (N=283) or ADA (N=283). Of the 143 pts treated with IXE who achieved ACR50 at Wk 24, 65% (N=93) maintained ACR50 at every visit. In total, 83% (N=118) of the ACR50 achievers at Wk 24 maintained ACR50 with some (18% (N=25)) fluctuations, between ACR50 and ACR20 (Figure 1). Of the 132 pts treated with ADA who achieved ACR50 at Wk 24, 55% (N=72) maintained ACR50 at every visit. In total, 80% (N=105) of ACR50 achievers maintained ACR50 with some (25% (N=33)) fluctuations between ACR50 and ACR20 (Table 1). Furthermore, of the174 pts treated with IXE who achieved low DA (DAPSA≤14) at Wk 24, 68% (N=119) maintained low DA at every visit. Of the low DA achievers at Wk 24, 82% (N=142) of pts maintained low DA with some (13% (N=23)) fluctuations between moderate and low DA (Figure 1B). Of the 171 pts treated with ADA who achieved low DA at Wk 24; 57% (N=97) maintained low DA at every visit. In total, 77% (N=131) of low DA achievers at Wk 24 maintained low DA with some (20% (N=34)) fluctuations between moderate and low DA (Table 1).

Conclusion:

This analysis demonstrates that a numerically higher proportion of pts treated with IXE versus ADA show consistency of response, as measured by ACR50 and DAPSA responses, over time and for each visit at the pt level.

References:

[1]Mease et al. Ann Rheum Dis. 2020;79(1):123-131

Table 1.

Consistency over time of the effect of ADA in pts with PsA.

IXE Q4W(N=283)ADA Q2W(N=283)ACR50Response,% (n)DAPSA≤14low DA,% (n)ACR50Response,% (n)DAPSA≤14low DA,% (n)Patients who achieved the response at Wk 2451% (143)61% (174)47% (132)60% (171)Achieved endpoint at Wk 24 and maintained out to Wk 52 with some fluctuations*83% (N=118)82% (N=142)80% (105)77% (131)Maintained endpoint at every visit65% (N=93)68% (N=119)55% (72)57% (97)Had some fluctuations*18% (N=25)13% (N=23)25% (33)20% (34)

* fluctuations between ACR50 and ACR20, or between low and moderate disease activity.

Figure 1.

Heatmap diagram describing consistency over time of the effect of IXE in pts with PsA who achieved DAPSA≤14 (low disease activity) at Wk 24.

Acknowledgements :

Edel Hughes, an employee of Eli Lilly and Company, provided editorial and writing support.

Disclosure of Interests:

Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis, David Sandoval Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Rebecca Bolce Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Chen-Yen Lin Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Keri Stenger Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Aubrey Trevelin Sprabery Shareholder of: Eli Lilly and Company; Johnson and Johnson, Employee of: Eli Lilly and Company, Arthur Kavanaugh Consultant of: AbbVie, Amgen, Eli Lilly, BMS, Pfizer, Novartis, Janssen.

POS0918 EVALUATION OF SPINAL RADIOGRAPHIC PROGRESSION IN PATIENTS WITH RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS RECEIVING IXEKIZUMAB THERAPY OVER 2 YEARS

Background:

It is important to understand the potential effect long-term therapy with biologics can have on structural changes in the spine among patients with active radiographic axial spondyloarthritis (r-axSpA, ankylosing spondylitis).

Objectives:

We examined radiographic progression in the spine among patients with active r-axSpA treated with ixekizumab, an IL-17A antagonist, for 2 years, and potential predictors of spinal radiographic progression.

Methods:

Patients with active r-axSpA, biologic-naive (COAST-V, NCT02696785) or with prior experience with a maximum of 2 TNF inhibitors (COAST-W, NCT02696798), received 80 mg ixekizumab every 2 or 4 weeks for 2 years (108 weeks, of which 56 weeks were the COAST-Y extension study, NCT03129100). Mean change from baseline of modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) (average score from 2 selected readers, blinded for time order) for patients treated with ixekizumab for 2 years with data at both baseline and year 2 is presented (N=230; 54% of total randomized patients). Non-progression is presented for all patients and subgroups based on TNFi-experience. Predictors were identified in multivariate logistic regression models with stepwise selection criteria of p-value <0.1. All data are observed.

Results:

At baseline, patients (N=230) were predominately male (82%) with an average age of 43 years, mean symptom duration of 16 years, 52% were TNFi-experienced, mean (SD) ASDAS score was 4.0 (0.7), most were HLA-B27 positive (87%) and 40% had syndesmophytes (identified by both selected readers at the same location). Baseline mSASSS (SD) was 11.0 (16.3) and change from baseline at year 2 of treatment was 0.3 (1.8) (Table 1). The proportion of non-progressors (mSASSS change from baseline <2) over 2 years was 89.6% (total IXE [all patients]), 90.9% (biologic-naive) and 88.3% (TNFi-experienced), and, if defined as mSASSS change from baseline ≤0, 75.7% (total IXE [all patients]), 78.2% (biologic-naive) and 73.3% (TNFi-experienced) (Table 1). Predictors of structural progression at year 2 (mSASSS change >0) were age, baseline syndesmophytes, HLA-B27 status and gender (Table 1). Week 52 inflammation in MRI SPARCC spine was also identified as a predictor for structural progression at year 2 in a separate model for patients from COAST-V where MRI measures were available at baseline and Week 52 (N=109).

Conclusion:

The majority of patients treated with ixekizumab for 2 years did not show radiographic progression, and the overall mean progression was low. Similar levels of non-progression were observed in biologic-naive patients and patients previously exposed to TNFis. Predictors were generally consistent with previous studies.

Table 1.

Spinal radiographic changes for patients with active r-axSpA treated with ixekizumab for 2 years

Change in mSASSS at year 2All patientsaN=230Biologic-naiveN=110TNFi-experiencedN=120 Baseline mSASSS, mean (SD)11.0 (16.3)10.1 (15.5)11.7 (17.0) Change at year 2, mean (SD)0.3 (1.8)0.3 (2.0)0.4 (1.6) Change in total mSASSS <2, n (%)206 (89.6)100 (90.9)106 (88.3) Change in total mSASSS ≤0, n (%)174 (75.7)86 (78.2)88 (73.3)Multivariable logistic regression modelPrediction for change in total mSASSS >0, OR (95% CI), p-valueAll patientsa,bN=228 Age (≥40 years vs. <40 years)2.97 (1.41, 6.28)p=0.004c Baseline syndesmophytesb (yes vs. no)2.31 (1.18, 4.54)p=0.015c Baseline HLA-B27 (positive vs. negative)3.78 (1.04, 13.75)p=0.044c Gender (male vs. female)3.16 (1.01, 9.86)p=0.047c Baseline ASDAS state (>3.5 vs. [2.1, 3.5])2.26 (0.96, 5.34)p=0.063

aCombined ixekizumab group of Q2W and Q4W patients with baseline and year-2 mSASSS data

bIdentified by both selected readers at the same location (2 patients were not evaluable by both readers)

cp<0.05

Abbreviations: ASDAS=Assessment of Disease Activity, CI=confidence interval, IXE=ixekizumab, mSASSS=modified Stoke Ankylosing Spondylitis Spinal Score, OR=odds ratio, Q2W=every 2 weeks, Q4W=every 4 weeks, SD=standard deviation, TNFi=tumor necrosis factor inhibitor

Disclosure of Interests:

Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma, Employee of: Director of Imaging Rheumatology bv., Mikkel Østergaard Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Eli Lilly and Company, Janssen, Merck, Pfizer, Roche, UCB, Celgene, Sanofi, Regeneron, Novartis, Grant/research support from: AbbVie, BMS, Merck, UCB, Celgene, Novartis, John D Reveille Paid instructor for: UCB, Eli Lilly and Company, Consultant of: UCB, Eli Lilly and Company, Pfizer, Novartis, Grant/research support from: Janssen, Eli Lilly and Company, Xenofon Baraliakos Speakers bureau: Abbvie, BMS, Lilly, Janssen, Novartis, MSD, Pfizer, Galapagos, Gilead, UCB, Paid instructor for: Abbvie, BMS, Lilly, Janssen, Novartis, MSD, Pfizer, Galapagos, Gilead, UCB, Consultant of: Abbvie, BMS, Lilly, Janssen, Novartis, MSD, Pfizer, Galapagos, Gilead, UCB, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Xiaoqi Li Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Hilde Carlier Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer, BMS, Eli Lilly and Company, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer

POS1045 Ixekizumab efficacy on spinal pain, disease activity and quality of life in patients with psoriatic arthritis presenting with symptoms suggestive of axial involvement

Background:

Many patients with psoriatic arthritis (PsA) experience back pain and stiffness, which may suggest axial involvement [1]. The prevalence of axial involvement in PsA varies between 25-70% [2]. Ixekizumab (IXE), a monoclonal antibody with high affinity for IL17-A, has been studied in Phase 3 trials in patients with PsA (SPIRIT-P1 [Biologic-naïve; NCT01695239] and SPIRIT-P2 [Inadequate response or intolerant to 1 or 2 TNF inhibitors (TNFi); NCT02349295]) [3] [4].

Objectives:

To determine the efficacy of IXE up to 52 weeks (Wks) in reducing axial symptoms in patients with active PsA presenting with symptoms suggestive of axial involvement.

Methods:

This post-hoc analysis included data from two subpopulations of patients with PsA (pooled SPIRIT-P1 and -P2). Symptoms suggestive of axial involvement were defined as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Q2 (back pain) ≥4, and an average of Q5 + Q6 (intensity and duration of morning stiffness in the spine) ≥4 at baseline. Patients included in the sensitivity analysis subgroup 1 were, in addition to the above-mentioned overall analysis criteria, <45 years of age, while patients included in sensitivity analysis subgroup 2 were aged <45 but also had elevated C-reactive protein (CRP) (> 5 mg/l) at baseline. Efficacy of IXE was analysed using BASDAI questions, total BASDAI, mBASDAI (without Q3), and Ankylosing Spondylitis Disease Activity Score (ASDAS) change from baseline, as well as BASDAI50 response and Short-Form-36 physical component summary (SF-36 PCS) improvement, at Wks 16, 24 and 52. Treatment comparison was done using logistic regression for BASDAI50, and analysis of covariance (ANCOVA) model for other endpoints. Missing data for binary and continuous endpoints were imputed by non-responder imputation and modified baseline observation carried forward (mBOCF), respectively.

Results:

A total of 313 patients (placebo (PBO), N=151; IXE Q4W, N=162) met the overall analysis inclusion criteria. Baseline values for BASDAI and ASDAS related endpoints were balanced across treatment arms (Table 1). Improvement in axial symptoms were significantly greater in patients treated with IXE compared to PBO at Wks 16 and 24 (Figure 1. next page) Improvement in quality of life (QoL) measures (SF-36 PCS) were also significantly greater in patients treated with IXE compared to PBO at Wks 16 and 24 (Table 1). Similar results were observed for patients < 45 years, and in patients < 45 years with CRP > 5 mg/l at baseline (sensitivity analysis, data not shown).

Table 1.

Baseline values and change from baseline (mBOCF) in the overall analysis population at Wks 16, 24 and 52 for BASDAI and ASDAS related endpoints in patients with PsA and axial pain. Data presented as mean (SD) unless otherwise specified. ‡p<0.001 vs PBO.

Conclusion:

IXE is effective in reducing axial symptoms and improving QoL in patients with active PsA presenting with symptoms suggestive of axial involvement.

References:

[1]Yap KS. Ann Rheum Dis. 2018;77(11)

[2]Feld J. Nat Rev Rheumatol. 2018;14

[3]Orbai A. Clin Exp Rheumatol. 2020[online]

[4]Genovese MC. Rheumatol. 2018;57(11)

Figure 1.

Change from baseline (mBOCF) in BASDAI and ASDAS related endpoints in patients with PsA and axial pain in the overall analysis population. Data presented as mean (SD). ‡p<0.001 vs PBO.

Acknowledgements:

Edel Hughes, an employee of Eli Lilly and Company, provided editorial and writing support.

Disclosure of Interests:

Atul Deodhar Speakers bureau: Janssen, Novartis, Pfizer, Paid instructor for: Boeheringer Ingelheim, Pfizer, Consultant of: AbbVie, Amgen, Boeheringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Glaxo Smith Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith Kline, Novartis, Pfizer, UCB, Dafna D Gladman Consultant of: Abbvie, Amgen, BMS, Galapagos, Gilead, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Rebecca Bolce Shareholder of: Employee and shareholder of Eli Lilly and Company, Employee of: Employee and shareholder of Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Currently employed by Eli Lilly and Company, So Young Park Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Soyi Liu Leage Shareholder of: Owns Lilly shares (company producing drug/devices for use in rheumatology), Employee of: Employee of Eli Lilly and Company, Peter Nash Speakers bureau: Honoraria for lectures on behalf Abbvie, BMS, Celgene, Roche, Sanofi, Lilly, Novartis, Janssen, Pfizer, Boehringer, Samsung, Consultant of: Advice on behalf Abbvie, BMS, Celgene, Roche, Sanofi, Lilly, Novartis, Janssen, Pfizer, Boehringer, Samsung, Grant/research support from: Research funding for clinical trials on behalf Abbvie, BMS, Celgene, Roche, Sanofi, Lilly, Novartis, Janssen, Pfizer, Boehringer, Samsung, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Gilead, GlaxoSmithKline, Eli Lilly, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer.

POS0909 IXEKIZUMAB IMPROVES SIGNS, SYMPTOMS AND QUALITY OF LIFE OF ANKYLOSING SPONDYLITIS IN PATIENTS IRRESPECTIVE OF HLA-B27 STATUS: POOLED RESULTS FROM THE COAST-V AND COAST-W TRIALS

Background:

Human leukocyte antigen-B27 (HLA-B27) is found in most patients (pts) with ankylosing spondylitis (AS). Although a subset of pts with AS are HLA-B27 negative (NEG), ensuring treatment efficacy in this subpopulation is important.

Objectives:

This analysis evaluated the efficacy of ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting interleukin-17A, in AS pts who are either HLA-B27 positive (POS) or NEG.

Methods:

COAST-V (NCT02696785) and COAST-W (NCT02696798) were 2 phase 3, multicenter, randomized, double-blind, PBO-controlled trials investigating the efficacy of 80-mg IXE administered every 4 weeks (Q4W) and every 2 weeks (Q2W) in pts naïve to biological disease-modifying anti-rheumatic drugs (bDMARDs; COAST-V) and in those who were inadequate responders or intolerant to 1 or 2 tumor necrosis factor inhibitors (TNFi; COAST-W). Only data from pts randomized at baseline to PBO, IXE Q4W or Q2W in both trials who met per protocol eligibility criteria were integrated and stratified based on HLA-B27 status (POS, NEG) for an ad hoc subgroup analysis. Efficacy was assessed using the Assessment of Spondyloarthritis International Society 40 (ASAS40), Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) and Short Form 36 Physical Component Scores (SF-36 PCS). Missing data were imputed by non-responder imputation (NRI) for binary measure and by modified baseline observation carried forward (mBOCF). Data from PBO was reported up to Week 16 and for pooled IXE Q4W and Q2W up to Week 52.

Results:

This analysis includes pts with AS who are HLA-B27 POS (N=453; PBO=155, IXE=298) or NEG (N=62, PBO=21, IXE=41). Overall, more pts were male (82.6%, POS; 77.4%, NEG), and for IXE treated pts, the duration of disease since r-axSpA diagnosis was 10.3 (SD=9.1) and 6.9 (SD=5.6) years, among POS and NEG pts respectively (Table 1). Among IXE treated patients, the mean age of HLA-B27 NEG pts was approximately 7-8 years older than HLA-B27 POS pts. At Week 16, 39.6% (n=118/298) of HLA-B27 POS and 29.3% (n=12/41) of HLA-B27 NEG pts achieved ASAS40, and 34.6% (n=103) of HLA-B27 POS and 17.1% (n=7) of HLA-B27 NEG pts achieved BASDAI50; improvements were seen as early as Week 1 and sustained or improved up to Week 52. The mean baseline SF-36 PCS was 33.2 (SD=7.63) for HLA-B27 POS and 31.4 (SD=7.67) for HLA-B27 NEG pts. At Week 16, the mean change from baseline in SF-36 PCS was 7.3 (SD 7.6) for HLA-B27 POS and 3.7 (SD=6.83) for HLA-B27 NEG pts. Improvements were sustained to Week 52 (Figure 1).

Conclusion:

IXE improves signs, symptoms, patient-reported outcomes and health-related quality of life in HLA-B27 POS and NEG pts with AS, however the HLA-B27 POS pts have a faster and more robust response than HLA-B27 NEG pts.

Table 1.

Baseline Characteristics by HLA-B27 Positive and Negative Status

Positive HLA-B27Negative HLA-B27PBO (N=155)IXE (N=298)PBO (N=21)IXE (N=41)Male, n (%)133 (85.8)241 (80.9)18 (85.7)30 (73.2)Age of r-axSpA onset (yr), mean (SD)25.2 (9.28)26.3 (8.38)35.4 (8.43)‡34.6 (10.32)‡Duration of symptoms since r-axSpA onset (yr)18.7 (11.82)17.1 (10.38)16.0 (9.69)15.9 (12.40)C-Reactive protein (mg/L), mean (SD)16.7 (22.43)16.9 (25.50)18.1 (21.69)13.7 (14.38)ASDAS score, mean (SD)4.0 (0.78)4.0 (0.83)4.3 (0.76)4.1 (0.73)BASDAI score, mean (SD)7.1 (1.25)7.2 (1.37)7.6 (1.31)*7.4 (1.41)SF-36 PCS, mean (SD)33.7 (7.50)33.2 (7.63)34.1 (8.28)31.4 (7.67)

Abbreviations: ASDAS, Assessment of Spondyloarthritis International Society 40; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; HLA-B27, Human leukocyte antigen-B27; IXE, pooled ixekizumab every 2 weeks and every 4 weeks; N, total number of patients in group; n, number of patients in category/subgroup; PBO, placebo; r-axSpA, axial spondyloarthritis; SD, standard deviation; SF-36 PCS, Short Form 36 Physical Component Scores; yr, years.

p-value: vs. HLA-B27 positive: *≤0.05,‡<0.0001

Figure 1.

Comparisons done using t-test and chi-square test for continuous and categorical variables.

Disclosure of Interests:

John D Reveille Consultant of: UCB (Union Chimique Belge), Eli Lilly, Novartis, and Pfizer, Grant/research support from: Janssen 2018; Eli Lilly 2020, Proton Rahman Speakers bureau: Abbott, AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Janssen, Novartis, and Pfizer, Consultant of: Abbot, AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Janssen, Novartis, and Pfizer, Grant/research support from: Janssen and Novartis, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Talia Muram Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, So Young Park Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Martin Rudwaleit Speakers bureau: AbbVie, Bristol-Meyers Squibb, Chugai, Janssen, Eli Lilly, MSD (Merck Sharp and Dohme), Novartis, Pfizer, UCD (Union Chimique Belge), Consultant of: AbbVie, Janssen, Eli Lilly, Novartis, Pfizer, UCB (Union Chimique Belge)

POS0901 IXEKIZUMAB SHOWS A DISTINCT PATTERN OF PAIN IMPROVEMENT BEYOND INFLAMMATION IN RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background:

The efficacy of ixekizumab (IXE) in biologic-naïve patients with radiographic axial spondyloarthritis (r-axSpA) has been previously presented using traditional axSpA outcome measures, such as BASDAI and ASAS.

Objectives:

In patients with active r-axSpA, to assess the analgesic efficacy of IXE as it relates to patient-reported and objective measures of inflammation.

Methods:

The Phase III COAST-V (NCT02696785) multi-center, randomized, double-blind, placebo (PBO)-controlled and active reference arm with adalimumab (ADA) trial investigated the efficacy of IXE in 341 patients (pts) with active r-axSpA for 52 weeks (W). Pts were initially randomized to IXEQ4W, IXEQ2W, PBO, and ADAQ2W. At W16, pts assigned to PBO and ADA were re-randomized to IXEQ2W or Q4W. Changes in spinal pain at night (SP-N) and spinal pain were measured at each study visit and analysed while controlling for CRP levels or mean of BASDAI questions 5 & 6 (Q5: Duration and Q6: Intensity of morning stiffness). Observed data analyses are presented for each group stratified by treatment arm and compared to PBO. In the initial analysis, pts were categorized into 2 sub-groups defined as “Sustained” and “Fluctuating” depending on: CRP <5 mg/L W4-16 vs. CRP ≥5 mg/L at any point beyond W4 between weeks 4-16 respectively. In a second analysis, pts were categorized based on BASDAI Q5/6 improvement: “Sustained” if ≥2-pt improvement W12-16 vs. “Fluctuating” if <2-pt improvement at any point beyond W12 between W12-16.

Results:

Between W0 and W16, pts treated (tx) with IXEQ4W experienced greater reduction in SP-N than pts tx with ADA, in both CRP sustained and fluctuating groups (Fig 1a). Pts in the IXEQ4W and ADA arms showed different trajectories of pain improvement in the CRP fluctuating groups. For the pts with a fluctuating CRP ≥5 mg/L, pts in IXEQ4W arm demonstrated a greater reduction in SP-N compared to pts in PBO arm (p < .001) at W16, whereas pts in ADA arm did not experience a reduction in SP-N compared to PBO (p = .416). For the pts with a sustained CRP <5mg/L, IXEQ4W and ADA treatments both significantly demonstrated reduction in SP-N compared to PBO at W16 (IXEQ4W: p = .002; ADA: p = .02), with IXEQ4W treatment showing a greater level of reduction (Fig 1a). The pts randomized to ADA and re-randomized to IXEQ2W or Q4W (ADA/IXE) experienced further improvement in SP-N. This effect was sustained over the 52-wk period (Fig 1b). The same pattern of improvement in SP-N was observed when controlling for the BASDAI Q5/6; the SP-N improvement was greater in pts with a sustained BASDAI Q5/6 compared to pts with a fluctuating BASDAI Q5/6, regardless of treatment (Table 1). In the fluctuating BASDAI Q5/6, for pts in ADA/IXE arm, further reduction of both spinal pain and SP-N were observed (Table 1).

Table 1.

Change in Pain Outcome at baseline, week 16 and week 52 by Inflammation Status as assessed by BASDAI or CRP levels for patients receiving placebo (PBO), adalimumab (ADA), and ixekizumab every 4 weeks (IXE Q4W)

Change from baselinePBOADAIXEQ4WbaselineWeek 16(as observed)Week 52PBO/IXE(as observed)baselineWeek 16(as observed)Week 52ADA/IXE(as observed)baselineWeek 16(as observed)Week 52(as observed)Spinal painBASDAI Q5/6 sustained7.54-3.33-4.657.21-4.07-4.57.4-4.52-4.94BASDAI Q5/6 fluctuating7.37-1.32-2.826.76-1.2-2.246.97-1.3-2.52CRP sustained7-1.53-1.936.83-2.9-3.67.23-3.57-4.21CRP fluctuating7.51-1.96-3.637.28-2-2.897.24-2.91-3.93Spinal pain at nightBASDAI Q5/6 sustained7.12-3.21-4.617.26-4.63-4.927.12-4.73-4.91BASDAI Q5/6 fluctuating7.05-1.15-2.886.6-1.2-2.497.03-2.17-2.92CRP sustained7.2-1.87-2.276.76-3.2-3.856.89-3.8-4.12CRP fluctuating7.04-1.69-3.67.24-2.21-3.397.35-3.68-4.38

Conclusion:

IXE reduced SP-N and spinal pain irrespective of CRP or morning stiffness. Additionally, pts treated with ADA re-randomized to IXE experienced a further reduction in SP-N and spinal pain. Collectively, these results support the additive benefits of IXE in reducing pain above measurable effects on inflammation.

Acknowledgements:

The authors would like to thank Eglantine Julle-Daniere for writing and editorial contributions

Disclosure of Interests:

Kurt de Vlam Speakers bureau: Eli Lilly, Novartis, Pfizer, Paid instructor for: Celgene, Amgen, Consultant of: Elil Lillyn Novartis, UCB, Galapagos, Sandoz, Pfizer, Grant/research support from: Celgene, Gaia Gallo Shareholder of: Eli Lilly, Employee of: Eli Lilly, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun, UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun, UCB, Proton Rahman Speakers bureau: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Grant/research support from: Janssen, Novartis, Venkatesh Krishnan Shareholder of: Eli Lilly, Employee of: Eli Lilly, David Sandoval Shareholder of: Eli Lilly, Employee of: Eli Lilly, Chen-Yen Lin Shareholder of: Eli Lilly, Employee of: Eli Lilly, Rebecca Bolce Shareholder of: Eli Lilly, Employee of: Eli Lilly, Philip G Conaghan Consultant of: personal fees from: AbbVie, AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer

AB0471 PATIENTS WITH RADIOGRAPHIC axSpA WHO PROGRESSED FROM ASAS20 AT WEEK 16 TO ASAS40 AT WEEK 52: RESULTS FROM COAST-W

Background:

The timeframe for maximum treatment response varies across patients with radiographic axial spondyloarthritis (r-axSpA). Understanding which patients may benefit from additional time on treatment could influence treatment decisions.

Objectives:

This post-hoc analysis aims to determine the percentage of patients, previously exposed to TNFi, who progressed from ASAS20 at week 16 to ASAS40 response at week 52 with ixekizumab (IXE) treatment and to explore factors that may associate with additional improvement after 16 weeks.

Methods:

Patients who achieved Assessment of SpondyloArthritis International Society (ASAS)20 at week 16 from COAST-W (NCT02696798), a Phase 3, randomized, double-blind, placebo-controlled trial, in tumour necrosis factor inhibitor (TNFi)-experienced patients who fulfilled the ASAS criteria for r-axSpA, were analysed. Patients treated with IXE 80 mg Q4W were categorized according to their ASAS response at week 52: sustaining ASAS20 but not reaching an ASAS40 response or achieving ASAS40. Patient demographics and disease characteristics at baseline were analysed by descriptive statistics, and the individual components determining ASAS response at baseline and at week 52 are provided.

Results:

At week 16, 22.8% (n=26/114) of patients achieved ASAS20 but not ASAS40; of these, 2 patients discontinued the study before week 52. Amongst the patients who continued through week 52, 50% (12/24) of patients achieved ASAS40; the other 50% sustained their ASAS20 response. Patients who achieved ASAS40 at week 52 were older, had longer disease duration, were less likely to be HLA-B27 positive, and had worse BASDAI and BASFI scores at baseline (Table 1, part a). Achieving ASAS40 appeared to depend most on the Patient Global Assessment of Disease Activity and spinal pain score over time (Table 1, part b).

Table 1.

a) Demographics and Characteristics at Baseline (week 0) and b) Descriptive observed data for the individual components of the ASAS response criteria at week 52, mean (SD)

a)IXEQ4WPatients sustaining an ASAS20 but not reaching an ASAS40 response at week 52 (n=12)Patients achieving an ASAS40 response at week 52 (n=12)Age, years47.3 (13.3)49.6 (12.3)Duration of symptoms since axSpA onset, years16.4 (9.2)18.6 (12.6)HLA B27 positive, n (%)12 (100)9 (75)Current tobacco use, n (%)4 (33.3)1 (8.3)ASDAS Score4.0 (1.0)4.2 (1.1)BASDAI Score7.4 (1.2)7.8 (1.7)Serum CRP concentration (mg/L)23.0 (47.1)28.0 (66.0)Spinal Pain due to Ankylosing Spondylitis (NRS)8.2 (0.8)8.5 (1.6)Patient Global Assessment of Disease Activity (NRS)7.8 (1.3)8.6 (1.2)BASFI7.1 (1.4)7.4 (2.3)BASDAI stiffness score7.1 (1.5)7.6 (2.2)b)IXEQ4WPatient Global Assessment of Disease Activity (NRS)5.5 (1)3.2 (1.3)Spinal Pain due to Ankylosing Spondylitis (NRS)5.6 (1)3 (1.9)BASFI5.0 (1.5)3.7 (2.1)BASDAI stiffness score4.1 (1.4)3.4 (2.3)

Values are mean (SD) unless stated otherwise

ASAS= Assessment of SpondyloArthritis International Society; ASDAS= Ankylosing Spondylitis Disease Activity Score; axSpa = axial spondyloarthritis; BASDAI= Bath Ankylosing Spondylitis Disease Activity Index; BASFI= Bath Ankylosing Spondylitis Functional Index; CRP= C-reactive protein; HLA= human leucocyte antigen; NRS = numeric rating scale; SD= standard deviation

Conclusion:

For patients with r-axSpA previously exposed to TNFis and showing modest response to IXE over 16 weeks, longer exposure to IXE may be required to achieve ASAS40.

Acknowledgements:

The authors would like to acknowledge Philana Fernandes, an employee of Eli Lilly, for her editorial and writing support.

Disclosure of Interests:

Xenofon Baraliakos Speakers bureau: Abbvie, BMS, Chugai, Celgene, Eli Lilly, Pfizer, Galapagos, UCB, MSD, Consultant of: Abbvie, BMS, Chugai, Celgene, Eli Lilly, Pfizer, Galapagos, UCB, MSD, Grant/research support from: Abbvie, Celgene, MSD, Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Giliad, GlaxoSmith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Boehringer Ingelheim, Eli Lilly, GlaxoSmith & Kline, Novartis, Pfizer, UCB, Soyi Liu Leage Employee of: Eli Lilly, Yves Schymura Employee of: Eli Lilly, Rebecca Bolce Shareholder of: Eli Lilly, Employee of: Eli Lilly, David Sandoval Shareholder of: Eli Lilly, Employee of: Eli Lilly, Jessica A. Walsh Consultant of: AbbVie, Novartis, Eli Lilly, UCB, Amgen & Pfizer, Grant/research support from: AbbVie, Pfizer, Merck, Joachim Sieper Speakers bureau: Abbvie, Janssen, Eli Lilly and Novartis, Consultant of: Abbvie, Janssen, Eli Lilly and Novartis.

Domestic dog origin of Carnivore Protoparvovirus 1 infection in a rescued free-ranging guiña (Leopardus guigna) in Chile

Carnivore protoparvovirus 1 is one of the most important pathogens affecting both wild and domestic carnivores. Here, we reported the genetic characterization of canine parvovirus (CPV-2) strains from a rescued guiña (Leopardus guigna) and domestic dogs from Chile. Guiña strain was classified as CPV-2c, and phylogenetic analysis of the complete coding genome showed that the guiña CPV-2c strain shares a recent common ancestor with Chilean domestic dogs' strains. These viruses showed >99% identity and exhibited three changes in the NS1 protein (V596A, E661K and L582F). This is the first detection and genetic characterization of CPV-2c infection in guiña worldwide, and one of the few comparative studies that show the source of infection was domestic dogs. The current findings highlight the fact that guiña is a susceptible species to protoparvovirus infection and that domestic dogs represent an important threat to its conservation. The CPV-2 cross-species transmission between domestic dogs and guiña should be taken into account for protection programmes of this endangered species.

THU0396 IMPACT OF IXEKIZUMAB ON WORK PRODUCTIVITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM THE COAST-V AND COAST-W TRIALS AT 52 WEEKS

Background:

Patients with ankylosing spondylitis (AS) are burdened with decreased work productivity.1Ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting interleukin-17A, has been shown to improve disease signs and symptoms in 2 phase 3 trials assessing patients with active AS.2, 3

Objectives:

This study investigated the effect of IXE treatment for 52 weeks on work productivity and activity impairment as measured by absenteeism, presenteeism, overall work impairment, and activity impairment in patients with active AS.

Methods:

COAST-V (NCT02696785) and COAST-W (NCT02696798) were phase 3, multicenter, randomized, double-blind, placebo (PBO)-controlled (COAST-V active-controlled with adalimumab) trials investigating the efficacy of IXE every 4 weeks (Q4W) and every 2 weeks (Q2W) in 341 patients with active AS naïve to biologic disease-modifying antirheumatic drugs (bDMARDs; COAST-V) and in 316 patients who were inadequate responders or intolerant to 1 or 2 tumor necrosis factor inhibitors (TNFi; COAST-W). Patients receiving PBO were switched to IXE Q4W or Q2W at Week 16; patients receiving adalimumab (ADA) were switched to IXE Q4W or Q2W at Week 20. Data for IXE Q4W and Q2W were combined for PBO/IXE and ADA/IXE groups. Changes from baseline in work productivity were measured for those reporting full- or part-time work at Weeks 16 and 52 with the Work Productivity and Activity Impairment (WPAI) Questionnaire for Spondyloarthritis.

Results:

Compared to bDMARD-naïve patients (COAST-V), TNFi-experienced patients (COAST-W) were slightly older, had longer disease duration, reported less paid employment, and had greater scores for impaired work productivity, signifying more severe baseline disease. At Week 16, bDMARD-naïve patients treated with IXE Q4W or Q2W had significant improvements in activity impairment compared to placebo (p<0.01); TNFi-experienced patients treated with IXE Q4W or Q2W had significant improvements in presenteeism (p<0.05) and overall work impairment (p<0.05; Figure). TNFi-experienced patients treated with IXE Q2W also had significant improvement in activity impairment at Week 16 (p<0.05; Figure). Improvements were sustained through Week 52 (Figure).

Conclusion:

Both bDMARD-naïve and TNFi-experienced patients with AS receiving IXE had greater improvements in aspects of work productivity compared to placebo. Improvements were sustained through Week 52.

References:

[1]Boonen, van der Linden. (2006).J Rheumatol Suppl.78:4-11.

[2]Van der Heijde, et al. (2018)Lancet. 392(10163):2441-51.

[3]Deodhar, et al. (2019)Arthritis Rheumatol.71(4):599-611.

Disclosure of Interests:

Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, James Cheng-Chung Wei Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eisai, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, UCB Pharma, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Xiaoqi Li Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Baojin Zhu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB

Figure.

Changes from baseline in Overall Work Impairment in A) bDMARD-naïve (COAST-V) and B) TNFi-experienced (COAST-W) patients and Activity Impairment in C) bDMARD-naïve and D) TNFi-experienced patients.

THU0384 IMPACT OF IXEKIZUMAB ON WORK PRODUCTIVITY IN NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS PATIENTS: RESULTS FROM THE COAST-X TRIAL AT 52 WEEKS

Background:

Patients with non-radiographic axial spondyloarthritis (nr-axSpA) experience impairments in health-related quality of life comparable to those seen in ankylosing spondylitis, including impacts on work productivity. Ixekizumab (IXE) is a high-affinity monoclonal antibody that selectively targets interleukin-17A and effectively treats axial spondyloarthritis.1,2,3

Objectives:

This analysis evaluated the effect of IXE treatment for 52 weeks on work productivity and activity impairment as measured by absenteeism, presenteeism, overall work impairment, and activity impairment in patients with active nr-axSpA.

Methods:

COAST-X (NCT02757352) was a phase 3, multicenter, randomized, double-blind, placebo-controlled, parallel-group outpatient study investigating the efficacy and safety of 80 mg IXE every 2 weeks (Q2W) and every 4 weeks (Q4W) compared to placebo (PBO) in 303 patients naïve to biologic disease-modifying anti-rheumatic drugs with active nr-axSpA during a 52-week treatment period. From Weeks 16 through 44, if patients’ disease activity required escalation of treatment at investigator discretion, patients were switched to open-label IXE Q2W or subsequent tumor necrosis factor inhibitor treatment. Analysis was performed for the intent-to-treat population, which included data up to the time of biologic switching. Patients who switched to open-label IXE were considered non-responders. Changes from baseline in work productivity were measured for patients reporting full- or part-time work at Weeks 16 and 52 with the Work Productivity and Activity Impairment (WPAI) Questionnaire for Spondyloarthritis and analyzed with an analysis of covariance model including treatment, geographic region, screening magnetic resonance imaging and C-reactive protein level status, and baseline value as factors. Missing data was imputed using the modified baseline observation carried forward.

Results:

A majority of patients (63.5–65.7%) reported part-time or full-time paid work at baseline, with baseline scores for presenteeism and overall work activity slightly higher for patients in the PBO arm (p<0.05). Patients treated with IXE Q4W had significantly greater improvement than PBO in activity impairment at Weeks 16 (p=0.003) and 52 (p=0.004), presenteeism at Weeks 16 (p=0.007) and 52 (p=0.003), and overall work impairment at Weeks 16 (p=0.014) and 52 (p=0.005; Figure). Patients treated with IXE Q2W had significantly greater improvement than PBO in activity impairment at Weeks 16 (p=0.007) and 52 (p=0.006; Figure). Patients treated with either IXE regimen had numeric improvements in all WPAI measures compared to those receiving PBO at Weeks 16 and 52 (Figure).

Conclusion:

Patients with nr-axSpA treated with either IXE regimen had significant improvements in activity impairment compared to PBO. Patients receiving IXE Q4W also had significant improvements in presenteeism and overall work impairment.

References:

[1]Sieper, et al. (2016)Clin Exp Rheumatol.34(6):975-83.

[2]Van der Heijde, et al. (2018)Lancet. 392(10163):2441-51.

[3]Deodhar, et al. (2019)Arthritis Rheumatol.71(4):599-611.

Figure.

Changes from baseline in A) Absenteeism, B) Presenteeism, C) Overall Work Impairment, and D) Activity Impairment.

Disclosure of Interests:

Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Baojin Zhu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung: None declared, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB

FRI0286 IXEKIZUMAB TREATMENT IMPROVES FATIGUE, SPINAL PAIN, STIFFNESS, AND SLEEP IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background:

Common symptoms of axial spondyloarthritis (axSpA) include fatigue, spinal pain, stiffness, and sleep problems, which can impair health-related quality of life. Ixekizumab (IXE) treatment shows efficacy in active non-radiographic axSpA (nr-axSpA).1

Objectives:

To assess fatigue, spinal pain, stiffness, and sleep with IXE treatment versus (vs) placebo (PBO) in patients (pts) with active nr-axSpA up to 16 and 52 weeks (wks).

Methods:

In COAST-X, pts with active nr-axSpA were randomized to 52 wks of double-blind IXE 80 mg once every 4 wks (Q4W) or 2 wks (Q2W), or PBO. Data were collected from baseline to Wk 52.

Results:

At Wk 16, IXE Q4W significantly improved fatigue, spinal pain, and stiffness, and IXE Q2W improved spinal pain, spinal pain at night, and stiffness vs PBO (Table). At Wk 52, IXE Q4W significantly improved stiffness, and IXE Q2W improved spinal pain, spinal pain at night, and stiffness vs PBO. Numeric improvements in sleep were not significant vs PBO. Wk 1, and up to Wk 16, IXE Q4W and Q2W significantly reduced spinal pain and stiffness vs PBO; stiffness was significantly reduced vs PBO up to Wk 52 (Figure).

Least squares mean (standard error) change from BL-ITT population (mixed-effect model of repeated measures)

MeasureTimepointPBO N=105IXE Q4W N=96IXE Q2W N=102Spinal painaWk 16-1.45 (0.244)-2.35 (0.248)*-2.59 (0.244)†Wk 52-2.29 (0.350)-2.92 (0.305)-3.32 (0.304)*Spinal pain at nightaWk 16-1.71 (0.262)-2.43 (0.267)-2.79 (0.263)*Wk 52-2.25 (0.358)-3.04 (0.312)-3.58 (0.311)*BASDAI-stiffnessb,cWk 16-1.44 (0.242)-2.44 (0.246)*-2.89 (0.242)†Wk 52-1.94 (0.332)-3.15 (0.290)*-3.48 (0.289)†Fatigue severity NRSdWk 16-1.4 (0.24)-2.1 (0.24)*-1.9 (0.24)Wk 52-2.1 (0.38)-2.6 (0.32)-2.7 (0.32)Sleep disturbanceeWk 16-2.3 (0.45)-2.0 (0.45)-2.5 (0.45)Wk 52-2.9 (0.63)-3.6 (0.52)-3.6 (0.53)Pt Global Assessment of Disease ActivityfWk 16-1.30 (0.246)-2.32 (0.251)*-2.64 (0.247)†Wk 52-1.81 (0.378)-2.77 (0.320)-3.30 (0.321)*

*P<.05 vs PBO;†P≤.001 vs PBO. ITT population: all randomized pts. Pts needing rescue treatment after Wk 16 per investigator could switch to open-label IXE Q2W; observations at visits thereafter not included in analyses. BL values similar across treatments. Numerical improvements in BASDAI-fatigue not significant vs PBO.

aScored 0 (no pain) to 10 (most severe pain) on NRS

bMean score BASDAI questions 5 (intensity) and 6 (duration)

cScored 1–10 on NRS

dScored 0 (no fatigue) to 10 (as bad as you can imagine)

eJenkins Sleep Evaluation Questionnaire scored 0 to 20: each of 4 items scored 0 (0 days) to 5 (22–30 days)

fScored 0 (not active) to 10 (very active) on NRS

BASDAI=Bath Ankylosing Spondylitis Disease Activity IndexBL=baselineITT=intent-to-treatIXE=ixekizumabN=number of pts in ITT populationNRS= numeric rating scalePBO=placebopt=patientQ2W=every 2 wksQ4W=every 4 wksvs=versuswk=week

Conclusion:

IXE Q4W and/or Q2W significantly improved spinal pain, spinal pain at night, and stiffness vs PBO at 16 and 52 wks in pts with nr-axSpA. IXE Q4W also improved fatigue at 16 wks in these pts. Numerical improvements in sleep were not significant vs PBO.

References:

[1]Deodhar A, et al. Lancet. 2019

Disclosure of Interests:

Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Baojin Zhu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung: None declared, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

FRI0278 IXEKIZUMAB IMPROVES SELF-REPORTED OVERALL FUNCTIONING AND HEALTH AS MEASURED BY THE ASAS HEALTH INDEX IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 52-WEEK RESULTS OF A PHASE 3 RANDOMIZED, ACTIVE AND PLACEBO-CONTROLLED TRIAL (COAST-X)

Background:

Ixekizumab has demonstrated efficacy in treating signs and symptoms of patients with non-radiographic axial spondyloarthritis (nr-axSpA).1The Assessment of SpondyloArthritis International Society Health Index (ASAS HI) is a composite measure consisting of 17 dichotomous items to assess overall functioning and health in patients with spondyloarthritis.2

Objectives:

To assess health outcomes using ASAS HI in patients with nr-axSpA treated with ixekizumab (IXE) for 52 weeks.

Methods:

COAST-X (NCT02757352) was a 52-week, randomized, double-blind, placebo (PBO)-controlled study enrolling adults with an established diagnosis of axSpA (ASAS classification criteria, but not modified New York criteria for sacroiliitis), had Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥4, back pain score ≥4, inflammation (sacroiliitis on magnetic resonance imaging [MRI] per ASAS criteria) or an elevated C-reactive protein [CRP] level >5 mg/L), and inadequate response or intolerance to nonsteroidal anti-inflammatory drugs. Patients were randomized 1:1:1 to receive PBO or 80 mg IXE every 4 weeks (Q4W) or every 2 weeks (Q2W). Changing background medications or switching to open-label IXE Q2W, or both, was allowed after week 16 at investigator discretion. Change from baseline in ASAS HI (score 0-17 with higher score indicating worse health) was analyzed using logistic regression analysis at Weeks 0, 4, 8, 16, 36, and 52. For the ASAS HI, the smallest detectable change was calculated as 3.0. Patients having an ASAS HI score ≤5 were defined as being in a good health state.3Comparisons between IXE treatments and PBO were made using logistic regression analysis. Non-responder imputation was used for missing data. Patients who switched to open label IXEQ2W were considered non-responders after they switched.

Results:

At baseline, ASAS HI scores were similar between the three groups (PBO 9.0 ± 3.7; IXE Q4W 8.6 ± 3.4; IXE Q2W 9.6 ± 3.4). Significantly more patients receiving IXE Q4W versus PBO achieved ASAS HI score ≤5 at Week 16 (p<0.05; Fig. A). From Week 36 to 52, significantly more patients receiving IXE Q4W and Q2W achieved ASAS HI score ≤5 (p<0.05; Fig. A). Significantly more patients receiving IXE Q2W versus PBO achieved a clinically meaningful improvement in ASAS HI score ≥3 at Week 16 (p<0.05; Fig. B). From Week 36 to 52 significantly more patients receiving IXE Q4W and Q2W achieved a clinically meaningful improvement in ASAS HI score ≥3 compared with PBO (p<0.05; Fig. B).

Figure.

Improvement in ASAS HI scores through Week 52.A: Proportion of patients who achieved an ASAS HI score ≤5 in patients with baseline ASAS HI score >5. B: Proportion of patients who achieved ≥3-point improvement in ASAS HI in patients with baseline ASAS HI score ≥3. ***p<0.001, **p<0.01, *p<0.05 versus PBO. Asterisk color indicates which IXE treatment group was compared with PBO. ASAS HI= Assessment of SpondyloArthritis International Society Health Index; IXE=ixekizumab; PBO=placebo; Q2W=every 2 weeks; Q4W=every 4 weeks

Conclusion:

Ixekizumab improves overall functioning and health in patients with nr-axSpA as assessed by ASAS HI, with significantly more patients achieving good health status.

References:

[1]Deodhar A, van der Heijde D, Gensler LS, et al.Lancet. 2020; 395(10217):53-64.

[2]Kiltz U, van der Heijde D, Boonen A, et al.Ann Rheum Dis. 2015;74(5):830-5.

[3]Kiltz U, van der Heijde D, Boonen A, et al.Ann Rheum Dis. 2018;77(9):1311-7.

Disclosure of Interests:

Uta Kiltz Grant/research support from: AbbVie, Amgen, Biogen, Novartis, Pfizer, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer, Roche, UCB, Jessica A. Walsh Grant/research support from: AbbVie, Pfizer, Janssen, Consultant of: AbbVie, Novartis, Eli Lilly and Company, UCB, Ruben Burgos Vargas: None declared, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung: None declared, Xiaoqi Li Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Emily Blue Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma

THU0395 EFFICACY OF IXEKIZUMAB ON DISEASE ACTIVITY AND QUALITY OF LIFE IN PATIENTS WITH ACTIVE NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS AND OBJECTIVE SIGNS OF INFLAMMATION, STRATIFIED BY BASELINE CRP/SACROILIAC JOINT MRI STATUS

Background:

Ixekizumab (IXE), a high-affinity anti-interleukin-17A monoclonal antibody, is effective in patients (pts) with active non-radiographic axial spondyloarthritis (nr-axSpA), who had elevated C-reactive protein (CRP) and/or active sacroiliitis on magnetic resonance imaging (MRI).1

Objectives:

To determine if disease activity and patient-reported outcomes at Week 16 were similar between groups after stratifying pts by CRP/sacroiliac joint (SIJ) MRI status at baseline.

Methods:

COAST-X (NCT02757352) included pts with active nr-axSpA and objective signs of inflammation, i.e. presence of sacroiliitis on MRI (Assessment of Spondyloarthritis International Society [ASAS]/ Outcome Measures in Rheumatology criteria) or elevation of serum CRP (>5.0 mg/L). Pts were randomized 1:1:1 to receive subcutaneous 80 mg IXE every 4 weeks (Q4W) or Q2W, or placebo (PBO). Depending on the baseline values of CRP and MRI SIJ (Spondyloarthritis Research Consortium of Canada [SPARCC] score), pts in the intent-to-treat population (N=239) were divided into 3 subgroups (CRP >5 and MRI ≥2; CRP ≤5 and MRI ≥2; CRP >5 and MRI <2). Logistic regression analysis with treatment, subgroup, and treatment-by-subgroup interaction was used to detect treatment group differences in ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) <2.1 (low disease activity), and Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) responses at Week 16. Analysis of covariance model with baseline value, treatment, subgroup, and treatment-by-subgroup interaction was used to detect the treatment group difference in change from baseline in Short Form-36 physical component score (SF-36 PCS).

Results:

The proportion of pts achieving ASAS40 (primary endpoint), ASDAS <2.1, and BASDAI50 (secondary endpoints) was higher in IXE treatment groups compared to PBO at Week 16 (Figure 1). The response rates in IXE-treated subjects were higher in all subgroups (CRP >5 and MRI ≥2; CRP ≤5 and MRI ≥2; CRP >5 and MRI <2) without consistent differences in efficacy between the subgroups. Similarly, pts in the IXE groups showed improvement in SF-36 PCS scores (secondary endpoint) versus pts on PBO at Week 16 (Figure 2).

Conclusion:

Pts with active nr-axSpA and objective signs of inflammation at baseline who were treated with IXE showed an overall improvement in the signs and symptoms of the disease. The efficacy was not different between pts with both elevated CRP and active sacroiliitis on MRI and pts with either elevated CRP or active sacroiliitis on MRI.

References:

[1]Deodhar A, et al.Lancet.2020.

Disclosure of Interests:

Walter P Maksymowych Grant/research support from: Received research and/or educational grants from Abbvie, Novartis, Pfizer, UCB, Consultant of: WPM is Chief Medical Officer of CARE Arthritis Limited, has received consultant/participated in advisory boards for Abbvie, Boehringer, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Received speaker fees from Abbvie, Janssen, Novartis, Pfizer, UCB., Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB, Joerg Ermann Grant/research support from: Boehringer-Ingelheim, Pfizer, Consultant of: Abbvie, Eli Lilly, Janssen, Novartis,

Pfizer, Takeda, UCB, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Gabriel Doridot Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Vladimir Geneus Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung: None declared, David Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Martin Rudwaleit Consultant of: AbbVie, BMS, Celgene, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma

First Molecular Identification of Canine Parvovirus Type 2 (CPV2) in Chile Reveals High Occurrence of CPV2c Antigenic Variant

Canine parvovirus type 2 (CPV2) is one of the most important intestinal pathogens in dogs and puppies. CPV2 has been evolved into three genetic and antigenic variants (2a, 2b, and 2c), which are distributed worldwide. We reported the first study of genetic diversity of CPV2 in Chile. Sixty-five samples were collected from puppies presenting with severe gastroenteritis and different vaccination statuses. PCR, restriction fragment length polymorphism (RFLP), and partial sequencing of the coding region of the structural viral protein VP2 was performed. Thirty of a total of 65 samples tested positive by PCR out of which 19 were further classified as CPV2c and one as CPV2a using RFLP and Sanger sequencing. The phylogeny was in concordance with the RFLP analysis. This is the first report of the genetic characterization of CPV2 in Chile and reveals a high occurrence of CPV2c.

Autochthonous cutaneous leishmaniasis in urban domestic animals (Felis catus / Canis lupus familiaris) from central-western Venezuela

Leishmaniasis is a zoonotic disease caused by intracellular protozoa of the Leishmania genus that are spread and transmitted by sandflies. Natural infection and clinical disease in domestic cats and dogs appear to be rare or perhaps largely under-reported in endemic areas. However, previous reports on infected domestic animals usually implicate the same Leishmania species that affect humans in tropical and subtropical areas of the world suggesting a potential role for zoonotic transmission. In the present study we assessed a representative sample of cats and dogs from endemic urban / suburban areas of Lara state in central western Venezuela. In both dogs and cats, cutaneous disease exhibits a spectrum of manifestations that range from single papules or nodules, which may evolve into ulcerative, plaque-like or scaly lesions. Cytochrome b (cyt b) PCR gene sequence analysis revealed L. mexicana as the causative agent in all cases, including two human cases proceeding from the same study area at the same time the study was carried out. In order to improve our understanding on feline/canine infection with Leishmania mexicana, and address potential zoonotic concerns it is necessary to characterize its enzootic reservoirs and vectors as well as the possible anthropophilic players linking to the peridomestic and domestic cycles.

PSXIII-12 Effects of altitudinal floor on nutrient digestibility, energy efficiency, visceral organ mass, and performance by guinea pigs

An experiment was conducted to evaluate the effect of altitude on nutrient digestibility, energy efficiency, performance, and, visceral organ mass by guinea pigs. Twenty male guinea pigs (initial BW 1.011 ± 0.096 kg) were selected in a crossover design experiment, maintained at metabolic cages (2 animals per cage) during a total digestibility period of 25 d (2 periods of 13-d). Animals were randomly assigned at 1 of 2 altitudinal sites, 2986 and 2480 m. above the sea level (masl; 5 cages per altitude). Animals were fed 45 g of alfalfa (DM) to meet energy requirements at maintenance levels. At the end of the digestion phase, an animal from each cage was slaughter to determine body fat content from body specific gravity and visceral organ mass. A subsequent performance phase was evaluated as completely randomized design, and animals were kept at the same altitudinal floor in which they ended period 2 of the crossover period. Animals were fed ad libitum with alfalfa. At the end of the performance phase, all remaining animals were slaughtered and visceral organ mass was measured. Energy intake and Dry matter, were increased by animals at 2986 compared to animals at 2480 masl (P<0.001). Metabolizable energy tended to be lower for animals kept at 2986 masl (P=0.053). Nutrient digestibility was lower for animals kept at 2986 compared to 2480 masl. Liver, kidneys and spleen mass were greater for animals maintained at 2986 masl (P<0.012). Heart mass tended to be greater for animasl kept at 2480 masl (P=0,060). Body fat was not alterd by altitudinal site (P>0.345). Final BW, ADG, and feed conversion rate was decreased by animals fed at 2986 masl (P<0.002). Results from this experiment suggest a novel approach to determine Energy efficiency as affected by altitudinal site. Data from this experiment evidenced a 7% increase on energy requirements on ME for animals kept 516 masl higher. Further research is requiered to apply to other biological models.

Enlarged adipocytes in subcutaneous adipose tissue associated to hyperandrogenism and visceral adipose tissue volume in women with polycystic ovary syndrome

CONTEXT

Polycystic ovary syndrome (PCOS) is an androgen excess disorder associated with obesity and adipose tissue disturbances. Our aim was to evaluate gene expression of adipocytokines and adipocyte characteristics in abdominal subcutaneous adipose tissue (SAT) of PCOS women.

DESIGN

Twelve PCOS (PCOSw) and 12 control (Cw) premenopausal women (BMI 20-35 kg/m²) were included, with measurements of whole-body composition assessed by dual-energy X-ray absorptiometry, and abdominal subcutaneous and visceral adipose tissue (VAT) volume, by magnetic resonance imaging. An oral glucose tolerance test was performed with measurements of glucose and insulin, and sex steroids, lipid profile and serum adipocytokines were determined in the fasting sample. Adipocytokine gene expression, mean adipocyte area and macrophage infiltration were evaluated in SAT biopsies.

RESULTS

Both groups were comparable in age and BMI. Trunk fat mass amount (p = .043), serum and SAT leptin/adiponectin ratio (p = .034 and p = .028, respectively) and adipocyte area (p = .015) were higher in PCOSw compared to Cw. Interestingly, trunk fat mass was positively correlated with adipocyte area in PCOSw (r = 0.821, p = .023), while the inverse correlation was found in Cw (r = -0.786, p = .021). Only in PCOSw, adipocyte area was positively correlated with serum testosterone (r = 0.857, p = .014) and visceral adipose tissue volume (r = 0.857, p = .014).

CONCLUSIONS

Our results indicate that PCOS women present adipose tissue dysfunction in the subcutaneous compartment, characterized by an alteration in adipocyte size and leptin/adiponectin expression and secretion, probably associated with higher androgen concentrations.

Puberty arises with testicular alterations and defective AMH expression in rams prenatally exposed to testosterone

The male gonadal tissue can be a sensitive target to the reprogramming effects of testosterone (T) during prenatal development. We have demonstrated that male lambs born to dams receiving T during pregnancy-a model system to the polycystic ovary syndrome (PCOS)-show a decreased number of germ cells early in life, and when adult, a reduced amount of sperm and ejaculate volume. These findings are a key to put attention to the male offspring of women bearing PCOS, as they are exposed to increased levels of androgen during pregnancy which can reprogram their reproductive outcome. A possible origin of these defects can be a disruption in the expression of the anti-Müllerian hormone (AMH), due to its critical role in gonadal function at many postnatal stages. Therefore, we addressed the impact of prenatal T excess on the expression of AMH and factors related to its expression like AP2, SOX9, FSHR, and AR in the testicular tissue through real-time PCR during the peripubertal age. We also analyzed the testicular morphology and quantified the number of Sertoli cells and germ cells to evaluate any further defect in the testicle. Experiments were performed in rams at 24 wk of age, hence, prior puberty. The experimental animals (T-males) consisted of rams born to mothers receiving 30 mg testosterone twice a wk from Day 30 to 90 of pregnancy and then increased to 40 mg until Day 120 of pregnancy. The control males (C-males) were born to mothers receiving the vehicle of the hormone. We found a significant increase in the expression of the mRNA of AMH and SOX9, but not of the AP2, FHSR nor AR, in the T-males. Moreover, T-males showed a dramatic decrease in the number of germ cells, together with a decrease in the weight of their testicles. The findings of the present study show that before puberty, T-males are manifesting clear signs of disruption in the gonadal functions probably due to an alteration in the expression pattern of the AMH gene. The precise way by which T reprograms the expression of AMH gene remains to be established.

Identification of a divergent genotype of equine arteritis virus from South American donkeys

A novel equine arteritis virus (EAV) was isolated and sequenced from feral donkeys in Chile. Phylogenetic analysis indicates that the new virus and South African asinine strains diverged at least 100 years from equine EAV strains. The results indicate that asinine strains belonged to a different EAV genotype.

A new time and space resolved transmission spectrometer for research in inertial confinement fusion and radiation source development

We describe the design and function of a new time and space resolved x-ray spectrometer for use in Z-pinch inertial confinement fusion and radiation source development experiments. The spectrometer is designed to measure x-rays in the range of 0.5-1.5 Å (8-25 keV) with a spectral resolution λ/Δλ ∼ 400. The purpose of this spectrometer is to measure the time- and one-dimensional space-dependent electron temperature and density during stagnation. These relatively high photon energies are required to escape the dense plasma created at stagnation and to obtain sensitivity to electron temperatures ≳3 keV. The spectrometer is of the Cauchois type, employing a large 30 × 36 mm², transmissive quartz optic for which a novel solid beryllium holder was designed. The performance of the crystal was verified using offline tests, and the integrated system was tested using experiments on the Z pulsed power accelerator.

Research Note. Trichinella spiralis parasitizing Puma concolor: first record in wildlife in Chile

The genus Trichinella is widespread in all continents but Antarctica. The only way to identify the species/genotypes is through molecular analyses. In Chile, only one study has reported Trichinella larvae in a cougar, but the species of Trichinella was not identified. In this work, the finding of Trichinella larvae in a cougar, together with their genotypic identification, is the first documentation of such in Chile. The cougar was found run over by a vehicle in the Biobío Region. Larvae were isolated following artificial digestion of the diaphragm and analyzed by means of multiplex polymerase chain reaction (PCR). A PCR product of 173 base pairs allowed for the classification of the larvae as T. spiralis. It is the first record of the species in Chilean wildlife. This finding in Chile is interesting in terms of human health, suggesting a possible role of the cougar as a reservoir for this parasite.

Frizzled-9 impairs acetylcholine receptor clustering in skeletal muscle cells

Cumulative evidence indicates that Wnt pathways play crucial and diverse roles to assemble the neuromuscular junction (NMJ), a peripheral synapse characterized by the clustering of acetylcholine receptors (AChR) on postsynaptic densities. The molecular determinants of Wnt effects at the NMJ are still to be fully elucidated. We report here that the Wnt receptor Frizzled-9 (Fzd9) is expressed in developing skeletal muscles during NMJ synaptogenesis. In cultured myotubes, gain- and loss-of-function experiments revealed that Fzd9-mediated signaling impairs the AChR-clustering activity of agrin, an organizer of postsynaptic differentiation. Overexpression of Fzd9 induced the cytosolic accumulation of β-catenin, a key regulator of Wnt signaling. Consistently, Fzd9 and β-catenin localize in the postsynaptic domain of embryonic NMJs in vivo. Our findings represent the first evidence pointing to a crucial role of a Fzd-mediated, β-catenin-dependent signaling on the assembly of the vertebrate NMJ.

Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility

PURPOSE

To evaluate imagery rehearsal therapy for the treatment of chronic nightmares in a sample of adolescent girls.

METHODS

Adolescent girls ranging in age from 13 to 18 years were recruited from the Wyoming Girls School in Sheridan, Wyoming (treatment group, n = 9; control group, n = 10). These girls had previously suffered a high prevalence of unwanted sexual experiences in childhood and adolescence, and thus many suffered from nightmares, sleep complaints, and posttraumatic stress symptoms. Imagery rehearsal therapy was provided in a 1-day (6-h) workshop. Imagery rehearsal consists of three steps, all of which are performed in the waking state: (a) select a nightmare, (b) "change the nightmare any way you wish," and (c) rehearse the images of the new version ("new dream") 5 to 20 min each day. Control participants received no intervention.

RESULTS

At baseline, these girls had been suffering from nightmares, on average, for 4.5 years, and they reported experiencing 20 nightmares per month, which occurred at a frequency of at least one bad dream every other night. At 3 months, self-reported, retrospectively assessed nightmare frequency measured in nights per month decreased 57% (p =.01, d = 1.4) and measured in nightmares per month decreased 71% (p =.01, d = 1.7) in the treatment group, compared with no significant changes in the control group. No significant changes were noted for sleep and posttraumatic stress disorder measures in either group.

CONCLUSION

Imagery rehearsal therapy was an effective treatment option for chronic nightmares in this adjudicated adolescent population.

Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial

CONTEXT

Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment.

OBJECTIVE

To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity.

DESIGN, SETTING, AND PARTICIPANTS

Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to-severe PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence.

INTERVENTION

Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued any ongoing treatment.

MAIN OUTCOME MEASURES

Scores on the Nightmare Frequency Questionnaire (NFQ), Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered PTSD Scale (CAPS) at 3- and 6-month follow-up.

RESULTS

A total of 114 participants completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n = 97-114), treatment significantly reduced nights per week with nightmares (Cohen d = 1.24; P<.001) and number of nightmares per week (Cohen d = 0.85; P<.001) on the NFQ and improved sleep (on the PSQI, Cohen d = 0.67; P<.001) and PTSD symptoms (on the PSS, Cohen d = 1.00; P<.001 and on the CAPS, Cohen d = 1.53; P<.001). Control participants showed small, nonsignificant improvements for the same measures (mean Cohen d = 0.21). In a 3-point analysis (n = 66-77), improvements occurred in the treatment group at 3-month follow-up (treatment vs control group, Cohen d = 1.15 vs 0.07 for nights per week with nightmares; 0.95 vs -0.06 for nightmares per week; 0.77 vs 0.31 on the PSQI, and 1.06 vs 0.31 on the PSS) and were sustained without further intervention or contact between 3 and 6 months. An intent-to-treat analysis (n = 168) confirmed significant differences between treatment and control groups for nightmares, sleep, and PTSD (all P<.02) with moderate effect sizes for treatment (mean Cohen d = 0.60) and small effect sizes for controls (mean Cohen d = 0.14). Posttraumatic stress symptoms decreased by at least 1 level of clinical severity in 65% of the treatment group compared with symptoms worsening or not changing in 69% of controls (chi(2)(1) = 12.80; P<.001).

CONCLUSIONS

Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.