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Adami G, Alarcon G, Albert D, Allen K, Aringer M, Arkema EV, Ashour HM, Atzeni F, Ayan G, Baer A, Baker J, Barber C, Bautista-Molano W, Beça S, Beamer B, Bergstra SA, Bermas B, Bilgin E, Boers M, Bolster M, Bosco J, Bowden JL, Buttgereit F, Calabrese L, Campochiaro C, Cappelli L, Carmona L, Carvalho J, Castañeda S, Chao Chao CM, Chatterjee S, Cherry L, Christensen R, Coates LC, Cohen SB, Collins JE, Cornec D, D'Agostino MA, Daikeler T, D'Angelo S, de Boysson H, de Jong P, de Wit M, Dellaripa P, Dessein P, Diekhoff T, Doumen M, Eckstein F, Elhai M, Fairley JL, Felson D, Amaro IF, Ferucci E, Fiorentino D, FitzGerald J, Fleischmann R, Galloway J, Salinas RG, Giorgi V, Golightly Y, Gono T, Gonzalez-Gay MA, Goules A, Gravallese E, Griffith M, Grosman S, Gupta L, Hamuryudan V, Hana C, Haschka J, Hawker G, Hervas-Perez JP, Hocevar A, Iudici M, Iyer P, Jasmin M, Judson M, Kerschbaumer A, Kiefer D, Kiltz U, Kivity S, Kremer JM, Kroon FPB, Kviatkovsky S, Lee BS, Liew D, Lim SY, Littlejohn G, Medina CL, Maksymowych W, March L, Marotte H, Navarro OM, Mavragani C, McInnes I, McMahan Z, Meara A, Mecoli C, Merriman T, Mikdashi J, Mikuls T, Misra DP, Mitchell BD, Moore T, Moutsopoulos H, Naredo E, Nash P, Nurmohamed M, Oddis C, Ojaimi S, Oliver M, Ozen S, Ozgocmen S, Palmowski A, Pascart T, Perelas A, Pile K, Pincus T, Poddubnyy D, Ramiro S, Reddy A, Regierer A, Roccatello D, Rookes T, Rosenthal A, Rubinstein T, Rudwaleit M, Rueda-Gotor J, Rus V, Saketkoo LA, Samson M, Schur P, Sepriano A, Shadmanfar S, Shmagel A, Sibbitt WL, de Souza AWS, Sims C, Singh N, Sjöwall C, Smith V, Song JJ, Soriano ER, Sparks J, Studenic P, Sugihara T, Suissa S, Szekanecz Z, Tascilar K, Taylor P, Terkeltaub R, Tiniakou E, Todd N, Vilarino GT, Treemarcki E, Tsuji H, Turesson C, Twilt M, Vassilopoulos D, Vojinovic T, Volkmann E, Vosse D, Wagner-Weiner L, Wallace ZS, Wallace D, Wang GC, Wei J, Weisman MH, Westhovens R, Winthrop K, Wysham KD, Xue J, Yang C, Yau M, Yazici Y, Yazici H, YIM ICW, Young J, Zhang W. Referees. Semin Arthritis Rheum 2024:152375. [PMID: 38245402 DOI: 10.1016/j.semarthrit.2024.152375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
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Jiang X, Sparks J, Wallace Z, Deng X, Li H, Lu N, Xie D, Wang Y, Zeng C, Lei G, Wei J, Zhang Y. Risk of COVID-19 among unvaccinated and vaccinated patients with systemic lupus erythematosus: a general population study. RMD Open 2023; 9:rmdopen-2022-002839. [PMID: 36889799 PMCID: PMC10008206 DOI: 10.1136/rmdopen-2022-002839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE To compare the risk of SARS-CoV-2 infection and its related severe sequelae between patients with systemic lupus erythematosus (SLE) and the general population according to COVID-19 vaccination status. METHODS We performed cohort studies using data from The Health Improvement Network to compare the risks of SARS-CoV-2 infection and severe sequelae between patients with SLE and the general population. Individuals aged 18-90 years with no previously documented SARS-CoV-2 infection were included. We estimated the incidence rates and HRs of SARS-CoV-2 infection and severe sequelae between patients with SLE and the general population according to COVID-19 vaccination status using exposure score overlap weighted Cox proportional hazards model. RESULTS We identified 3245 patients with SLE and 1 755 034 non-SLE individuals from the unvaccinated cohort. The rates of SARS-CoV-2 infection, COVID-19 hospitalisation, COVID-19 death and combined severe outcomes per 1000 person-months were 10.95, 3.21, 1.16 and 3.86 among patients with SLE, and 8.50, 1.77, 0.53 and 2.18 among general population, respectively. The corresponding adjusted HRs were 1.28 (95% CI: 1.03 to 1.59), 1.82 (95% CI: 1.21 to 2.74), 2.16 (95% CI: 1.00 to 4.79) and 1.78 (95% CI: 1.21 to 2.61). However, no statistically significant differences were observed between vaccinated patients with SLE and vaccinated general population over 9 months of follow-up. CONCLUSION While unvaccinated patients with SLE were at higher risk of SARS-CoV-2 infection and its severe sequelae than the general population, no such difference was observed among vaccinated population. The findings indicate that COVID-19 vaccination provides an adequate protection to most patients with SLE from COVID-19 breakthrough infection and its severe sequelae.
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Affiliation(s)
- Xiaofeng Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jeffrey Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary Wallace
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xinjia Deng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Na Lu
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China .,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Maguire S, Al-Emadi S, Alba P, Aguiar MC, Lawati TA, Alle G, Bermas B, Bhana S, Branimir A, Bulina I, Clowse M, Cogo K, Colunga I, Cook C, Cortez KJ, Dao K, Gianfrancesco M, Gore-Massey M, Gossec L, Grainger R, Hausman J, Hsu TYT, Hyrich K, Isnardi C, Kawano Y, Kilding R, Kusevich DA, Lawson-Tovey S, Liew J, McCarthy E, Montgumery A, Moyano S, Nasir N, Padjen I, Papagoras C, Patel NJ, Pera M, Pisoni C, Pons-Estel G, Quiambao AL, Quintana R, Ruderman E, Sattui S, Savio V, Sciascia S, Sencarova M, Morales RS, Siddique F, Sirotich E, Sparks J, Strangfeld A, Sufka P, Tanner H, Tissera Y, Wallace Z, Werner ML, Wise L, Worthing AB, Zell J, Zepa J, Machado PM, Yazdany J, Robinson P, Conway R. Obstetric Outcomes in Women with Rheumatic Disease and COVID-19 in the Context of Vaccination Status. Rheumatology (Oxford) 2022; 62:1621-1626. [PMID: 36124987 DOI: 10.1093/rheumatology/keac534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe obstetric outcomes based on COVID-19 vaccination status, in women with rheumatic and musculoskeletal diseases (RMDs) who developed COVID-19 during pregnancy. METHODS Data regarding pregnant women entered into the COVID-19 Global Rheumatology Alliance registry from 24 March 2020-25 February 2022 were analysed. Obstetric outcomes were stratified by number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Descriptive differences between groups were tested using the chi -square or Fisher's exact test. RESULTS There were 73 pregnancies in 73 women with RMD and COVID-19. Overall, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies 90.9% (50) of pregnancies resulted in livebirths. At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one vaccine dose while 35.6% (n = 26) had two or more doses. Although 83.6% (n = 61) of women required no treatment for COVID-19, 20.5% (n = 15) required hospital admission. COVID-19 resulted in delivery in 6.8% (n = 3) of unvaccinated women and 3.8% (n = 1) of fully vaccinated women. There was a greater number of preterm births (PTB) in unvaccinated women compared with fully vaccinated 29.5% (n = 13) vs 18.2%(n = 2). CONCLUSION In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a greater number of PTB compared with those fully vaccinated against COVID-19. Additionally, the need for COVID-19 pharmacological treatment was uncommon in pregnant women with RMD regardless of vaccination status. These results support active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy.
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Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Samar Al-Emadi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Paula Alba
- Hospital Cordoba, Rheumatology Unit, Cordoba, Argentina.,Universidad Nacional de Cordoba, School of Medicine, Cordoba, Argentina
| | | | - Talal Al Lawati
- Department of Rheumatology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Gelsomina Alle
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Suleman Bhana
- Department of Rheumatology, Crystal Run Healthcare, Middleton, New York, USA
| | - Anic Branimir
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Inita Bulina
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Riga, Latvia.,Department of Internal Diseases, Riga Stradins University, Riga, Latvia
| | - Megan Clowse
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Karina Cogo
- Department of Rheumatology, Hospital Interzonal Luis Guemes, Buenos Aires, Argentina.,Hospital San Juan De Dios, Department of Rheumatology, Buenos Aires, Argentina
| | - Iris Colunga
- Hospital Universitario Dr Jose Eleuterio Gonzalez, Department of Rheumatology, Monterrey, Mexico
| | - Claire Cook
- Division of Rheumatology, Massachusetts General Hospital, Allergy & Immunology, Boston, Massachusetts, USA
| | - Karen J Cortez
- Baguio General Hospital and Medical Center, Department of Rheumatology, Baguio City, Philippines
| | - Kathryn Dao
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Laure Gossec
- Sorbonne Universite, Paris, France.,Pitie-Salpetriere Hospital, Paris, France
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathon Hausman
- Department of Pediatric Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Rheumatology and Clinical Immunology, Beth Isreal Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tiffany Y T Hsu
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kimme Hyrich
- The University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UK.,Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,Department of Biomedical Research, UK and National Institute of Health Research Manchester, Manchester, UK
| | - Carolina Isnardi
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Yumeko Kawano
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA
| | - Rachael Kilding
- Department of Rheumatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Daria A Kusevich
- Nasonova Research Institute of Rheumatology, Department of Rheumatology, Vidnoe, Russia
| | - Saskia Lawson-Tovey
- Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,UK and National Institute of Health Research Manchester, Department of Biomedical Research, Manchester, UK.,University of Manchester, Centre for Musculoskeletal Research, Centre for Genetics and Genomics Versus Arthritis, Manchester, UK.,Department of Biomedical Research, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jean Liew
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eoghan McCarthy
- Department of Rheumatology, Beaumont Hospital, Dublin, Ireland
| | - Anna Montgumery
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA.,VA Medical Center, Department of Health Research, San Francisco, California, USA
| | - Sebastian Moyano
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Noreen Nasir
- The Aga Khan University Hospital, Section of Internal Medicine, Department of Medicine, Karachi, Pakistan
| | - Ivan Padjen
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Charalampos Papagoras
- Democritus University of Thrace, First Department of Internal Medicine, Alexandroupolis, Greece
| | - Naomi J Patel
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA
| | - Mariana Pera
- Hospital Angel C Padilla, Department of Rheumatology, Tucuman, Argentina
| | - Cecilia Pisoni
- CEMIC, Rheumatology and Immunology Section, Department of Internal Medicine, Buenos Aires, Argentina
| | - Guillermo Pons-Estel
- Sheffield Teaching Hospitals, NHS Foundation Trust, Department of Rheumatology, Sheffield, UK
| | - Antonio L Quiambao
- East Avenue Medical Center, Department of Rheumatology, Quezon City, Philippines
| | - Rosana Quintana
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Eric Ruderman
- Northwestern University Feinberg School of Medicine, Department of Medicine/Rheumatology, Chicago, Illinois, USA
| | - Sebastian Sattui
- University of Pittsburgh, Department of Rheumatology, Pittsburgh, Pennsylvania, USA
| | | | - Savino Sciascia
- Osedale San Giovanni Bosco, Centro Multidisciplinare de Recerche di Immunopatologia e Documentazione su Malattie Rare (C.M.I.D.), Turin, Italy
| | - Marieta Sencarova
- Univerzitna Nemocnica L Pasteura, Department of Rheumatology, Slovakia
| | - Rosa Serrano Morales
- Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | - Faizah Siddique
- Department of Rheumatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Emily Sirotich
- McMaster University, Department of Health Research, Evidence and Impact, Hamilton, Ontario, Canada
| | - Jeffrey Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Anja Strangfeld
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | - Paul Sufka
- Healthcare Partners, St Paul, Minnesota, USA
| | - Helen Tanner
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia
| | | | - Zachary Wallace
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Marina L Werner
- Hospital Nacional de Clinicas, Department of Rheumatology, Cordoba, Argentina
| | - Leanna Wise
- University of Southern California, Keck School of Medicine, Los Angelos, California, USA
| | - Angus B Worthing
- Department of Rheumatology, Arthritis and Rheumatism Associates PC, Washington, DC, USA.,Georgetown University Medical Center, Washington, DC, USA
| | - JoAnn Zell
- Division of Rheumatology, University of Colorado Health, Aurora, Colorado, USA
| | - Julija Zepa
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Latvia, Riga.,Riga Stradins University, School of Medicine, Latvia, Riga
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK.,Department of Rheumatology, Northwick Park Hospital, London, UK
| | - Jinoos Yazdany
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA
| | - Philip Robinson
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia.,Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
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Sparks J, Obermeyer K, Lamoreaux B. AB1039 PATIENT REPORTED OUTCOMES AMONG PATIENTS RECEIVING TREATMENT FROM THE PEGLOTICASE PHASE 3 CLINICAL TRIALS FOR UNCONTROLLED GOUT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGout affects more than 9 million Americans,1 with some suffering so severely that everyday life becomes painful and difficult.2 Pegloticase is an infused uricase-based medicine that significantly reduces serum uric acid (sUA) levels in patients suffering from treatment-resistant gout,3 but the direct effect of treatment on quality of life (QoL) by response status has not yet been reported.4ObjectivesTo determine if the effect of pegloticase treatment on QoL and other patient-reported outcomes is significant compared to placebo, regardless of treatment response status.MethodsThis analysis utilized results from two parallel 6-month randomized phase 3 registrational clinical trials in which subjects were treated with 8 mg of pegloticase or placebo biweekly. Responders were those who maintained sUA levels <6 mg/dL for ≥80% of the time during Months 3 and 6 combined. Multiple QoL measurements were taken throughout the 6-month treatment period, including the Health Assessment Questionnaire (HAQ; Pain, Disability Index [DI], and Health), the 36-Item Short Form Health Survey Questionnaire (SF-36), and the number of swollen and/or tender joints. This analysis assessed the differences between three groups: treatment responders, treatment non-responders, and placebo-treated patients. The change from baseline to Week 25 in each assessment was analyzed using a mixed model for repeated measures adjusting for age, visit, presence of tophi at baseline, and the interaction between visit and group.ResultsA total of 36, 49, and 43 patients were included in the treatment responder, treatment non-responder, and placebo-treated groups, respectively. Significant differences in the change from baseline to Week 25 in HAQ-Pain, HAQ-DI, HAQ-Health, and SF-36 Physical Component Score (PCS) between treatment responders and placebo-treated patients were observed (all P ≤ 0.006, Figure 1). The reduction in the number of swollen or tender joints was also significantly greater in treatment responders compared to placebo-treated patients (P < 0.001). Between treatment responders and treatment non-responders, there were no significant differences in the change from baseline in HAQ-Pain, HAQ-DI, HAQ-Health, and SF-36 PCS. Significant differences were observed between treatment non-responders and placebo-treated patients in the change in HAQ-Pain, HAQ-DI, HAQ-Health, and SF-36 PCS (all P ≤ 0.003), as well as the number of swollen or tender joints (P = 0.049, Figure 1). The change in SF-36 Mental Component Score was not significantly different between any of the 3 groups examined.ConclusionIn the Phase 3 registration trials of pegloticase used as monotherapy for uncontrolled gout, QoL parameters improved among pegloticase-treated patients regardless of response status.References[1]Chen-Xu M, et al. Arthritis Rheumatol 2019;71:991-9.[2]Becker MA, et al. J Rheumatol 2009;36:1041-8.[3]Sundy JS, et al. JAMA 2011;306:711-20.[4]Strand V, et al. J Rheumatol 2012;39:1450-7.Disclosure of InterestsJacy Sparks: None declared, Katie Obermeyer Shareholder of: Horizon Therapeutics., Employee of: Horizon Therapeutics., Brian LaMoreaux Shareholder of: Horizon Therapeutics., Employee of: Horizon Therapeutics.
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DI Iorio M, Cook C, Vanni K, Patel N, D’silva K, Fu X, Wang J, Prisco L, Kowalski E, Zaccardelli A, Martin L, Qian G, Hsu T, Wallace Z, Sparks J. POS1234 DMARD DISRUPTION, INCREASED DISEASE ACTIVITY, AND PROLONGED SYMPTOM DURATION AFTER ACUTE COVID-19 AMONG PATIENTS WITH RHEUMATIC DISEASE: A PROSPECTIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic autoimmune rheumatic disease (SARD) patients may be at risk for disease flare and prolonged symptom duration after COVID-19, perhaps related to DMARD disruption and immune activation.ObjectivesTo describe DMARD disruption and identify differences in SARD activity among patients with and without prolonged COVID-19 symptom duration.MethodsWe identified all SARD patients with confirmed COVID-19 at the Mass General Brigham healthcare system in Boston, USA; prospective recruitment is ongoing. Surveys were used to collect demographics, clinical characteristics, DMARD disruption, COVID-19 course, and SARD disease activity before and after COVID-19. The survey included validated instruments measuring disease activity, pain, fatigue, functional status, and respiratory quality of life. Prolonged symptom duration was defined as COVID-19 symptoms lasting ≥28 days. We compared differences in patient-reported measures between those with and without prolonged symptoms.ResultsWe analyzed survey responses from 174 COVID-19 survivors with SARDs (mean age 52±16 years, 81% female, 80% White). The most common SARDs were RA (40%) and SLE (14%). Fifty-one percent of the 127 respondents on any DMARD reported a disruption to their regimen at COVID-19 onset (Figure 1). Among individual DMARDs, 56-77% were reported to have any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41% of respondents (Table 1). Patient global assessment of SARD activity was worse after COVID-19 (mean 7.6±2.3 before vs. 6.6±2.9 after COVID-19, p<0.001). Prolonged symptom duration was reported by 45% of participants. Those with prolonged symptoms had a higher initial COVID-19 symptom count (median 7 vs. 4, p<0.001) and were more likely to be hospitalized for COVID-19 (28% vs. 17%, p=0.001). Respondents experiencing prolonged symptom duration had higher disease activity on RAPID3 (p=0.007) as well as more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms.Table 1.Acute COVID-19 course, SARD flare/activity, and patient-reported outcomes among COVID-19 survivors with SARDs.All COVID-19 survivors with SARDs (n=174)Prolonged symptom duration ≥28 days (n=78)No prolonged symptom duration/(n=96)p-value (prolonged vs. not)Acute COVID-19 courseCOVID-19 symptom duration, days, median [IQR]14 [9, 29]46 [30, 65]11 [7, 14]<0.0001Initial symptom count, median [IQR]6 [3, 8]7 [6, 9]4 [2, 7]<0.001Hospitalized, n (%)38 (22)22 (28)16 (17)0.001SARD flare/activitySelf-reported SARD flare after COVID-19, n (%)71 (41)38 (49)33 (34)0.15Disease activity by RAPID3, median [IQR]9 [4, 14]11.2 [6, 16]7 [3, 13]0.0067RAPID3 categorical score, n (%)0.13Remission (0)11 (7)4 (5)7 (7)Near remission (0.3-1.0)23 (14)5 (7)18 (19)Low severity (1.3-2.0)26 (15)10 (14)16 (17)Moderate severity (2.3-4.0)55 (33)27 (36)28 (29)High severity (4.3-10.0)54 (32)28 (38)26 (27)Patient-reported outcomesPain by SF-MPQ, median [IQR]2 [1, 2]2 [1, 2]1 [0, 2]0.0008Fatigue by FSI, median [IQR]53 [27, 84]66 [31, 91.5]43 [26, 76]0.031mHAQ, median [IQR]0.125 [0, 0.38]0.25 [0, 0.75]0.125 [0, 0.38]0.11Respiratory quality of life by SGRQ, global [IQR]15 [4, 29]16 [4, 36]10 [4, 26]0.49RAPID3, Routine Assessment of Patient Index Data 3; SF-MPQ, Short-form McGill Pain Questionnaire; FSI, Fatigue Symptom Inventory; mHAQ, modified Health Assessment Questionnaire; SGRQ, Saint George’s Respiratory Questionnaire.Figure 1.Frequency of baseline DMARD use and proportion with any disruption at COVID-19 onset.ConclusionDMARD disruption, SARD flare, and prolonged symptoms were common in this prospective study of COVID-19 survivors with SARDs. Those with prolonged COVID-19 symptom duration, defined as ≥28 days, had higher SARD activity, more pain, and more fatigue compared to those without prolonged symptoms. These findings suggest that post-acute sequelae of COVID-19 may have a large impact on underlying SARD activity and quality of life.Disclosure of InterestsMichael Di Iorio: None declared, Claire Cook: None declared, Kathleen Vanni: None declared, Naomi Patel Consultant of: Receives consulting fees from FVC Health unrelated to this work., Kristin D’Silva: None declared, Xiaoqing Fu: None declared, Jiaqi Wang: None declared, Lauren Prisco: None declared, Emily Kowalski: None declared, Alessandra Zaccardelli: None declared, Lily Martin: None declared, Grace Qian: None declared, Tiffany Hsu: None declared, Zachary Wallace Consultant of: Receives consulting fees from Viela Bio, Zenas BioPharma, and MedPace unrelated to this work., Grant/research support from: Receives research support from Bristol-Myers Squibb and Principia/Sanofi., Jeffrey Sparks Consultant of: Receives consultant fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer unrelated to this work., Grant/research support from: Receives research support from Bristol Myers Squibb.
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Fleischmann RM, Bessette L, Sparks J, Hall S, Jain M, Kakehasi A, Song Y, Meerwein S, Demasi R, Suboticki J, Rubbert-Roth A. POS0683 EFFICACY AND SAFETY OF UPADACITINIB IN TNFi-IR PATIENTS WITH RHEUMATOID ARTHRITIS FROM THREE PHASE 3 CLINICAL TRIALS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFor patients with RA who are refractory to biologic DMARDs (bDMARDs), such as tumor necrosis factor inhibitors (TNFis), optimal disease control is less likely to be achieved with subsequent therapy.1 In line with recommendations from EULAR and ACR, switching to a treatment with a different mechanism of action is appropriate for these patients.ObjectivesTo describe the efficacy and safety of upadacitinib (UPA) 15 mg once daily in patients with RA and an inadequate response or intolerance to TNFis (TNFi-IR).MethodsA post hoc subgroup analysis was conducted in TNFi-IR patients who were treated with UPA 15 mg once daily in three Phase 3 clinical trials: SELECT-BEYOND,2 -CHOICE,3 and -COMPARE.4 For COMPARE, only patients treated with adalimumab and switched to UPA as rescue therapy were included. ≥20/50/70% improvement in ACR criteria, DAS28(CRP), CDAI, and SDAI, as well as change from baseline in HAQ-DI and other patient-reported outcomes (PROs) were reported through 24 weeks. Non-responder imputation was used for all missing categorical outcomes; as observed (COMPARE) or multiple imputation (CHOICE, BEYOND) were used for missing continuous outcomes. Pooled safety results were presented as exposure-adjusted event rates (EAERs) with a cut-off of June 30, 2021.Results568 TNFi-IR patients were included: 146 from BEYOND, 263 from CHOICE, and 159 from COMPARE. Mean duration since RA diagnosis was longer for BEYOND and CHOICE versus COMPARE; cardiovascular (CV) risk factors were common among this refractory population (Table 1). ACR20/50/70 and disease activity outcomes observed in the TNFi-IR population were generally consistent with the overall BEYOND2 and CHOICE3 bDMARD-IR populations, and consistent across the three studies in the TNFi-IR subgroups (Figure 1). Improvements in PROs including HAQ-DI, fatigue, pain, and morning stiffness over 24 weeks were observed (data not shown). Pooled safety results reporting 1574.8 patient-years (PY) of exposure in the TNFi-IR subgroup showed similar results to the overall BEYOND2 and CHOICE3 bDMARD-IR study populations, with EAERs of 3.1 events/100 PY for herpes zoster and 0.8 events/100 PY for adjudicated major adverse CV events, adjudicated venous thromboembolism (VTE), and malignancy excluding non-melanoma skin cancer. The EAER of any AE leading to death was 1.4 events/100 PY.Table 1.Baseline characteristics of TNFi-IR patients treated with UPA 15 mgn (%), unless specifiedSELECT-BEYOND (n=146)SELECT-CHOICE (n=263)SELECT-COMPARE (ADA → UPA) (n=159)Female122 (83.6)219 (83.3)133 (83.6)Mean (SD) age, years56.6 (11.0)55.5 (11.1)53.9 (10.6)Mean (SD) duration of RA diagnosis, years13.2 (9.5)12.5 (9.4)8.2 (8.5)Concomitant csDMARDs MTX alone100 (70.4)195 (74.1)159 (100.0) MTX and other csDMARDs20 (14.1)25 (9.5)0 csDMARDs other than MTX22 (15.5)38 (14.4)0Concomitant oral steroids73 (50.0)140 (53.2)98 (61.6)1 prior bDMARD68 (46.6)172 (65.4)142 (89.3)2 prior bDMARDs40 (27.4)62 (23.6)17 (10.7)a≥3 prior bDMARDs38 (26.0)29 (11.0)0Failed ≥1 prior TNFi due to lack of efficacyb131 (89.7)223 (84.8)159 (100.0)History of VTE / CV event3 (2.1) / 28 (19.2)6 (2.3) / 20 (7.6)4 (2.5) / 14 (8.8)CV risk factors Hypertension72 (49.3)109 (41.4)68 (42.8) Diabetes mellitus22 (15.1)34 (12.9)17 (10.7) Smoking (current former past)68 (46.6)109 (41.5)55 (34.6) Elevated LDL-C (≥3.36 mmol/L)38 (26.0)52 (20.0)48 (30.2) Low HDL-C (≤1.55 mmol/L)80 (54.8)171 (65.0)88 (55.3)aThese patients received one bDMARD before entry into SELECT-COMPARE.bRemaining patients were intolerant to ≥1 prior TNFi.ConclusionIn this post hoc subgroup analysis, TNFi-IR patients treated with UPA 15 mg achieved clinically meaningful efficacy responses over 24 weeks, with safety consistent with the overall bDMARD-IR patient population in the Phase 3 program.References[1]Rendas-Baum R, et al. Arthritis Res Ther 2011;13:R25;[2]Genovese C, et al. Lancet 2018;391:2513–24;[3]Rubbert-Roth A, et al. NEJM 2020;383:1511–21;[4]Fleischmann R, et al. Ann Rheum Dis 2019;78:1454–62.AcknowledgementsAbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. No honoraria or payments were made for authorship. Medical writing support was provided by Amy Wilson, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of InterestsRoy M. Fleischmann Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Galvani, Gilead, GSK, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Biosplice, Bristol-Myers Squibb, Flexion, Gilead, Horizon, Eli Lilly, Galvani, Janssen, Novartis, Pfizer, Sanofi-Aventis, Selecta, Teva, UCB, Viela, and Vorso, Louis Bessette Speakers bureau: AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB, Consultant of: AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB, Jeffrey Sparks Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer, Stephen Hall Consultant of: AbbVie, Amgen, Bristol-Meyers Sqibb, Eli Lilly, Gilead, Janssen, Merck, Novartis, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Meyers Sqibb, Eli Lilly, Gilead, Janssen, Merck, Novartis, and UCB, Manish Jain Consultant of: AbbVie, Amgen, Eli Lilly, Novartis, and Pfizer, Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, and Pfizer, Adriana Kakehasi Speakers bureau: AbbVie, Amgen, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, and UCB, Consultant of: AbbVie, Amgen, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, and UCB, Grant/research support from: AbbVie, Amgen, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, and UCB, Yanna Song Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Sebastian Meerwein Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Ryan DeMasi Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Jessica Suboticki Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Andrea Rubbert-Roth Consultant of: AbbVie, AbbVie Deutschland, Amgen, Bristol-Myers Squibb, Chugai Pharmaceuticals, Eli Lilly, F. Hoffman-La Roche, Gilead Sciences, Janssen Global Services, Novartis, and Sanofi Pasteur
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Gilbert E, Figueroa-Parra G, Valenzuela-Almada M, Vallejo S, Neville MR, Patel N, Cook C, Fu X, Hagi R, McDermott G, Di Iorio M, Masto L, Vanni K, Kowalski E, Qian G, Wallace Z, Duarte-Garcia A, Sparks J. OP0251 IMPACT OF INTERSTITIAL LUNG DISEASE ON SEVERE COVID-19 OUTCOMES FOR PATIENTS WITH RHEUMATOID ARTHRITIS: A MULTICENTER STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRA has been associated with poor COVID-19 outcomes, but few studies have investigated outcomes in RA features such as interstitial lung disease.ObjectivesTo assess COVID-19 outcomes in patients with RA overall, and those with and without ILD, compared to general population comparators.MethodsA multicenter, retrospective cohort study was conducted at Mayo Clinic (19 hospitals and affiliated outpatient centers in 4 states) and Mass General Brigham (14 hospitals and affiliated outpatient centers in New England). Consecutive patients with RA meeting ACR/EULAR criteria and a positive COVID-19 test from March 1, 2020 through June 6, 2021 were matched 1:5 on age, sex, race, and COVID-19 test date with general population comparators without RA. RA features assessed included: RA-ILD per Bongartz criteria [1], duration, rheumatoid factor (RF), cyclic citrullinated peptide antibody (CCP), bone erosions, and treatments. The primary outcome was a composite of hospitalization or death following COVID-19 diagnosis. We used multivariable Cox regression to investigate the association of RA, and features such as ILD, with COVID-19 outcomes compared to matched comparators.ResultsWe analyzed 582 patients with RA and 2892 comparators without RA, all with COVID-19. Mean age was 62 years, 51% were female, and 79% were White. Mean RA duration was 11 years, 67% were seropositive (52% RF+ and 54% CCP+), 27% had bone erosions, 28% were on steroids, and 79% were on DMARDs. 50/582 (9%) patients with RA had ILD.The COVID-19 hospitalization or death rate for RA patients was higher than comparators (3.0 per 1,000 days [95% CI 2.5-3.6] vs. 1.9 per 1,000 days [95% CI 1.7-2.1], respectively). Overall, RA patients had a 53% higher risk of hospitalization or death than comparators after adjustment (95% CI 1.20-1.94).Among those with RA-ILD, the hospitalization or death rate was significantly higher than comparators (10.9 [95% CI 6.7-15.2] vs. 2.5 per 1,000 days [1.8-3.2], respectively). RA-ILD was associated with nearly 3-fold higher risk for hospitalization or death than comparators (multivariable HR 2.84 [95% CI 1.64-4.91], Table 1). There was a significant interaction between RA/comparator status and presence/absence of ILD for risk of severe COVID-19 (p<0.001, Figure 1). The elevated risk for severe COVID-19 was similar for RA subgroups defined by serostatus or bone erosions.Table 1.Frequencies, proportions, and hazard ratios for COVID-19 outcomes, comparing all RA patients, and subgroups with or without RA-ILD, to matched comparators.COVID-19 OutcomesAll RA Patients (n=582)RA-ILD (n=50)RA Patients without ILD (n=532)Comparators (n=2,892)Hospitalization, n (%)121 (21)24 (48)97 (18)402 (14)Unadjusted HR (95% CI)1.58 (1.27, 1.96)2.65 (1.71, 4.09)1.43 (1.12, 1.82)Ref.Adjusted* HR (95% CI)1.45 (1.14, 1.83)2.35 (1.38, 4.00)1.31 (1.00, 1.70)Ref.Death, n (%)26 (4)9 (18)17 (3)63 (2)Unadjusted HR (95% CI)1.72 (0.98, 3.01)5.88 (2.07, 16.71)1.13 (0.56, 2.29)Ref.Adjusted* HR (95% CI)1.24 (0.66, 2.32)13.94 (4.30, 45.18)0.75 (0.35, 1.63)Ref.Hospitalization or death, n (%)126 (22)25 (50)101 (19)419 (14)Unadjusted HR (95% CI)1.66 (1.33, 2.07)3.01 (1.93, 4.70)1.47 (1.14, 1.89)Ref.Adjusted* HR (95% CI)1.53 (1.20, 1.94)2.84 (1.64, 4.91)1.34 (1.02, 1.77)Ref.*Adjusted for age, sex, race, and smokingFigure 1.Multivariable hazard ratios for the composite outcome of hospitalization or death from COVID-19, comparing all RA and subgroups by serostatus, bone erosions, and ILD to matched comparators without RA.ConclusionWe confirmed that RA was associated with severe COVID-19 outcomes compared to the general population. We found evidence that ILD may be an effect modifier for the relationship between RA and severe COVID-19 outcomes, but RA subgroups defined by serostatus and bone erosions had similarly elevated risk. These findings suggest that ILD or its treatment may be a major contributor to severe COVID-19 outcomes in RA.References[1]Bongartz, T, et al, Arthritis Rheum. 2010 Jun;62(6):1583-91.Disclosure of InterestsNone declared
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Juge PA, Granger B, Debray MP, Ebstein E, Louis-Sidney F, Kedra J, Doyle T, Borie R, Constantin A, Combe B, Flipo RM, Mariette X, Vittecoq O, Saraux A, Carvajal Alegria G, Sibilia J, Berenbaum F, Kannengiesser C, Boileau C, Sparks J, Crestani B, Fautrel B, Dieudé P. POS0062 A RISK SCORE TO DETECT SUBCLINICAL RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDespite a high morbi-mortality rate, there are no definite strategy for subclinical interstitial lung disease (ILD) screening in patients with rheumatoid arthritis (RA).ObjectivesOur objectives were: 1. to identify risk factors for subclinical RA-ILD in a prospective discovery cohort (ESPOIR) 2.to develop a risk score for subclinical RA-ILD and 3. to validate the risk score in an independent replication cohort (TRANSLATE 2).MethodsPatients without pulmonary symptoms from 2 prospective RA cohorts who underwent chest HRCT scans were included. All patients were genotyped for MUC5B rs35705950. A risk score based on independent risk factors for subclinical RA-ILD was developed using multiple logistic regression in the discovery cohort. The risk score was tested for validation in the replication cohort.ResultsDiscovery and replication cohorts included 163 and 89 patients, respectively. Subclinical ILD was detected in 19.0% and 16.9% of the patients, respectively. In the discovery cohort, independent risk factors for subclinical RA-ILD were the MUC5B rs35705950 T risk allele (odds ratio [OR]=3.74; 95% confidence interval [CI] [1.37–10.39], male sex (OR=3.93; 95%CI [1.40–11.39]), older age at RA onset (for each year, OR=1.10; 95%CI [1.04–1.16]) and increased mean DAS28-ESR (for each unit, OR=2.03; 95%CI [1.24–3.42]). We developed a risk score for subclinical RA-ILD with AUC=0.82; 95%CI [0.70–0.94] (sensitivity (Se)=71.0%) and specificity (Sp)=79.6%). The risk score was validated in the replication cohort with AUC=0.78; 95%CI [0.65–0.92] (Se=86.7%, Sp=62.2%).ConclusionOur risk score could help identifying patients at high-risk for subclinical RA-ILD before the onset of pulmonary symptoms.Disclosure of InterestsPierre-Antoine Juge Speakers bureau: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Consultant of: Bristol Myers Squibb, Benjamin Granger: None declared, Marie-Pierre Debray: None declared, Esther Ebstein: None declared, Fabienne Louis-Sidney: None declared, Joanna KEDRA: None declared, Tracy Doyle: None declared, Raphael Borie: None declared, Arnaud Constantin Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer Ingelheim, Fresenius Kabi, Galapagos, Janssen, Lilly, Medac, MSD, Mylan, Novartis, Pfizer, Procter & Gamble, Roche, Sanofi, UCB, Viatris, Bernard Combe Consultant of: AbbVie, BMS, Eli-Lilly, Gilead, Janssen, Merck, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, René-Marc Flipo Consultant of: Abbvie, Janssen, MSD and Pfizer. He reports research grants from Abbvie, Janssen, Novartis and Pfizer, Xavier Mariette Consultant of: BMS, Gilead, Janssen, Pfizer, Samsung, UCB, Olivier VITTECOQ: None declared, Alain Saraux: None declared, Guillermo CARVAJAL ALEGRIA: None declared, Jean Sibilia Consultant of: AbbVie, Lilly, MSD, Amgen, Pfizer, BMS, Janssen, Roche, Sandoz, Sanofi-Genzyme, SOBI, UCB, Novartis, Grant/research support from: AbbVie, Lilly, MSD, Amgen, Pfizer, BMS, Janssen, Roche, Sandoz, Sanofi-Genzyme, SOBI, UCB, Novartis, Francis Berenbaum: None declared, Caroline Kannengiesser: None declared, Catherine Boileau: None declared, Jeffrey Sparks Consultant of: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer, Grant/research support from: National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers R01 AR077607, P30 AR070253, and P30 AR072577), The R. Bruce and Joan M. Mickey Research Scholar Fund, Bristol Myers Squibb,Bruno Crestani Speakers bureau: Boehringer Ingelheim, AstraZeneca, Roche, Sanofi, Grant/research support from: MedImmune, Roche, Boehringer Ingelheim, Bruno Fautrel Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Fresenius Kabi, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, SOBI, UCB, Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Philippe Dieudé Speakers bureau: Roche – Chugai, Bristol Myers Squibb, Consultant of: Pfizer, Roche – Chugai, Bristol Myers Squibb, Abbvie, MSD, Grant/research support from: Novartis
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Rubbert-Roth A, Sparks J, Constantin A, Xavier R, Song Y, Suboticki J, Fleischmann RM. AB0352 IMPACT OF SEROLOGIC STATUS ON CLINICAL RESPONSES TO UPADACITINIB OR ABATACEPT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND PRIOR INADEQUATE RESPONSE TO BIOLOGIC DMARDs: SUB-GROUP ANALYSIS FROM THE PHASE 3 SELECT-CHOICE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn patients with RA who had a prior inadequate response or intolerance to biologic DMARDs, the oral Janus kinase inhibitor, upadacitinib (UPA), demonstrated superiority in change from baseline in DAS28(CRP) and DAS28(CRP)<2.6 at week 12 and improved responses across additional endpoints compared to abatacept (ABA) in the phase 3 SELECT-CHOICE study. Seropositive patients have been reported to respond better to treatment than seronegative patients.ObjectivesTo evaluate clinical responses with UPA versus ABA among RA patients based on serologic status.MethodsIn SELECT-CHOICE (24-week, phase 3, double-blind, controlled trial), RA patients were randomized to oral UPA (15 mg once daily) or intravenous (IV) ABA (at day 1 and weeks 2, 4, 8, 12, 16, and 20; <60 kg, 500 mg; 60-100 kg, 750 mg; >100 kg, 1000 mg).1 UPA patients also received IV placebo and ABA patients also received oral placebo. All patients continued stable background conventional synthetic DMARDs. Starting at week 12, background RA medications were adjusted or added if patients did not experience ≥20% improvement compared to baseline in tender and swollen joint counts at two consecutive visits. For this sub-group analysis, patients were categorized as follows: RF+ and ACPA+, RF+ and/or ACPA+, and RF- and ACPA-. Mean change from baseline in DAS28(CRP), Clinical Disease Activity Index (CDAI), ACR responses, HAQ-DI, patient’s assessment of pain, and Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F) were evaluated at weeks 12 and 24. Statistical inference was conducted using Chi-square tests or analysis of covariance (ANCOVA) with non-responder imputation or multiple imputation used for missing data and nominal P-values shown.ResultsOf the total population (N=612), the majority of patients were seropositive for RF and/or ACPA at baseline (80.4%) (Table 1). Most patients were female (~80%), ~55 years old, and one-third had previously experienced ≥2 biologic DMARDs. Mean change from baseline in DAS28(CRP) and CDAI were numerically higher with UPA vs ABA at weeks 12 and 24 across all sub-groups (Figure 1). Regardless of serologic status, UPA demonstrated numerically higher responses vs ABA for ACR 20/50/70 and proportions of patients in low disease activity and remission at both timepoints (Table 1). Mean change from baseline in the HAQ-DI and the patient’s assessment of pain was numerically higher with UPA compared to ABA across all sub-groups and timepoints (data not shown). Clinical responses were generally numerically higher at week 24 compared to week 12, and for the seropositive groups compared to the seronegative group, with both UPA and ABA.Table 1.Clinical Responses with UPA 15 mg or ABA in RA Patients Across Serologic Status Sub-Groups at Weeks 12 and 24RF+ and ACPA+ (n=390)RF+ and/or ACPA+ (n=492)RF- and ACPA- (n=120)UPA n=189ABA n=201UPA n=242ABA n=250UPA n=61ABA n=59Proportion of Patients (%) (NRI)† WeekACR201281*7179*71624724847882776759ACR501251*4051**4026*122463*5363*544432ACR7012231624*151172439*2840**282520DAS28(CRP) ≤3.21254***3454***3333**102465**4965**505437DAS28(CRP) <2.61232***1733***1518*52446**3348***333925CDAI ≤10124239433933*1724595560565134CDAI ≤2.81210*310**3202423*1423**141112*P<0.05; **P<0.01; ***P<0.001 UPA vs. ABA; nominal P-values are presented and not adjusted for multiple comparisons†NRI was used for missing dataConclusionAcross serologic statuses, clinical responses with UPA 15 mg vs ABA were numerically higher at weeks 12 and 24 among RA patients with prior inadequate response or intolerance to biologic DMARDs. In addition, clinical responses were numerically higher for seropositive patients compared to seronegative patients across all endpoints assessed, although the seronegative group had a smaller sample size in this post-hoc analysis.AcknowledgementsAbbVie funded these studies and participated in the study design, research, analysis, data collection, interpretation of data. No honoraria or payments were made for authorship. Medical writing support was provided by Monica R.P. Elmore, PhD of AbbVie.Disclosure of InterestsAndrea Rubbert-Roth Speakers bureau: AbbVie, BMS, Chugai, Roche, Gilead, Janssen, Lilly, Sanofi, Amgen, Novartis, Consultant of: AbbVie, BMS, Chugai, Roche, Gilead, Janssen, Lilly, Sanofi, Amgen, Novartis, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum, and Pfizer., Arnaud Constantin Speakers bureau: AbbVie, BMS, Galapagos, Janssen, Lilly, Novartis, Pfizer, Sanofi, and UCB, Consultant of: AbbVie, BMS, Galapagos, Janssen, Lilly, Novartis, Pfizer, Sanofi, and UCB, Ricardo Xavier Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Roy M. Fleischmann Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, and UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Janssen, Novartis, Pfizer Inc, Regeneron, Roche, Sanofi-Aventis and UCB
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Wang R, Singaraju A, Marks KE, Shakib L, Dunlap G, Cunningham-Bussel A, Greisen SR, Chen L, Tirpack A, Fein M, Todd D, Macfarlane L, Goodman S, Dicarlo E, Massarotti E, Sparks J, Hamnvik OP, Min L, Jonsson AH, Brenner M, Chan KK, Bass A, Donlin L, Rao D. POS0402 CLONALLY EXPANDED CD38hi CYTOTOXIC CD8 T CELLS DEFINE THE T CELL INFILTRATE IN CHECKPOINT INHIBITOR-ASSOCIATED ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundImmune checkpoint inhibitor (ICI) therapies that promote T cell activation have improved outcomes for advanced malignancies yet can also elicit harmful autoimmune reactions. The T cell mechanisms mediating these iatrogenic autoimmune events remain unclear.ObjectivesTo investigate the immunophenotype, transcriptomic feature and clonotypes of T cells from joints of patients affected by ICI-induced inflammatory arthritis (ICI-arthritis).MethodsDetailed immunophenotyping was performed on mononuclear cells from synovial fluid (SF) using mass cytometry and flow cytometry to identify significantly altered populations in ICI-A compared to seropositive rhrumatoid arthritis (RA) and psoriatic arthritis (PsA) (p<0.05). Bulk RNA-seq was performed on altered SF CD8 T cell subsets from ICI-A, RA and PsA to investigate their transcriptomic features. Cytokine profile and pathways enriched in ICI-A CD8 T cells were examined using differentially expressed genes, intracellular staining, and in vitro culture. TCR clonotypes were examined using single cell RNA-seq of T cells from synovial fluid, tissue and blood of ICI-A.ResultsCompared to the autoimmune arthritides RA and PsA, ICI-arthritis joints contained an expanded CD38hi CD127- CD8+ T cell subset that displays cytotoxic, effector, and interferon (IFN) response signatures. Exposure of synovial T cells to Type I IFN, more so than IFN-γ, induced the CD38hi cytotoxic phenotype. Single cell transcriptomic and T cell repertoire (TCR) analyses indicated that the abundance of CD38hi CD8 T cells in ICI-arthritis resulted from proliferation of a limited number of clones. The CD38hi population appeared distinct from dysfunctional T cells and clonally most related to TCF7+ memory populations. Comparison of synovial tissue from bilateral knees of the same patient demonstrated considerable sharing of TCR clonotypes among CD38hi CD8 T cells between the two joints. Further, TCR clonotypes expanded in synovial fluid of ICI-arthritis patients were detected in circulating T cells, and circulating CD38hi CD8 T cells are also expanded in ICI-arthritis patients.ConclusionThese results define a distinct CD8 T cell subset in the synovial fluid and in the circulation of patients with ICI-A that may be directly activated by ICI therapy to mediate a tissue-specific autoimmune response.Disclosure of InterestsNone declared.
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Alsoufi B, Kozik D, Sparks J, Wilkens S, Austin E, Trivedi J. Increasing Donor-Recipient Weight Mismatch is Associated with Shorter Waitlist Duration and No Increased Morbidity or Mortality. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Liew J, Gianfrancesco M, Harrison C, Izadi Z, Rush S, Lawson-Tovey S, Jacobsohn L, Ja C, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Schäfer M, Frãzao-Mateus E, Bulina I, Stafford F, Tufan A, Graver C, Yardımcı GK, Zepa J, Al Emadi S, Cook C, Abutiban F, Dey D, Katigbak G, Kaufman L, Kowalski E, Martínez-Martínez MU, Patel NJ, Reyes-Cordero G, Salido E, Smith E, Snow D, Sparks J, Wise L, Bhana S, Gore-Massy M, Grainger R, Hausmann J, Sirotich E, Sufka P, Wallace Z, Machado PM, Robinson PC, Yazdany J. SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry. RMD Open 2022; 8:e002187. [PMID: 35387864 PMCID: PMC8987210 DOI: 10.1136/rmdopen-2021-002187] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. METHODS We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes. RESULTS SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died. CONCLUSION More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.
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Affiliation(s)
- Jean Liew
- Medicine, Section of Rheumatology, Boston University, Boston, Massachusetts, USA
| | - Milena Gianfrancesco
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | | | - Zara Izadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Stephanie Rush
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lindsay Jacobsohn
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | - Clairissa Ja
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Martin Schäfer
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | | | - Inita Bulina
- Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | | | - Gözde Kübra Yardımcı
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe University, Ankara, Turkey
| | - Julija Zepa
- Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Claire Cook
- Rheumatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Dfiza Dey
- University of Ghana Medical School, Accra, Ghana
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Lauren Kaufman
- Rheumatology Associates Louisville, Louisville, Kentucky, USA
| | - Emily Kowalski
- Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marco Ulises Martínez-Martínez
- Rheumatology, Hospital Central "Dr Ignacio Morones Prieto", San Luis Potosí, Mexico
- Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis, Mexico
| | - Naomi J Patel
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Evelyn Salido
- University of the Philippines Manila, Manila, Philippines
| | - Ellison Smith
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Asheville Arthritis & Osteoporosis Center, Asheville, North Carolina, USA
| | - David Snow
- Cape Fear Arthritis Care, Leland, North Carolina, USA
| | - Jeffrey Sparks
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leanna Wise
- Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
| | | | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
- University Of Otago, Wellington, New Zealand
| | - Jonathan Hausmann
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emily Sirotich
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Zachary Wallace
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital Health Service District, Herston, Queensland, Australia
| | - Jinoos Yazdany
- Medicine/Rheumatology, University of California, San Francisco, California, USA
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Young K, Yeoh SA, Putman M, Sattui S, Conway R, Graef E, Kilian A, Konig M, Sparks J, Ugarte-Gil M, Upton L, Berenbaum F, Bhana S, Costello W, Hausmann J, Machado P, Robinson P, Sirotich E, Sufka P, Yazdany J, Liew J, Grainger R, Wallace Z, Jayatilleke A. The Impact of Covid-19 on rheumatology training - Results from the COVID-19 Global Rheumatology Alliance trainee survey. Rheumatol Adv Pract 2022; 6:rkac001. [PMID: 35392427 PMCID: PMC8982766 DOI: 10.1093/rap/rkac001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Objective The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical experiences, research opportunities and well-being of rheumatology trainees. Methods A voluntary, anonymous, Web-based survey was administered in English, Spanish or French from 19 August 2020 to 5 October 2020. Adult and paediatric rheumatology trainees were invited to participate via social media and email. Using multiple-choice questions and Likert scales, the perceptions of trainees regarding the impact of the COVID-19 pandemic on patient care and redeployment, learning and supervision, research and well-being were assessed. Results There were 302 respondents from 33 countries, with 83% in adult rheumatology training. An increase in non-rheumatology clinical work was reported by 45%, with 68% of these having been redeployed to COVID-19. Overall, trainees reported a negative impact on their learning opportunities during rheumatology training, including outpatient clinics (79%), inpatient consultations (59%), didactic teaching (55%), procedures (53%), teaching opportunities (52%) and ultrasonography (36%). Impacts on research experiences were reported by 46% of respondents, with 39% of these reporting that COVID-19 negatively affected their ability to continue their pre-pandemic research. Burnout and increases in stress were reported by 50% and 68%, respectively. Physical health was negatively impacted by training programme changes in 25% of respondents. Conclusion The COVID-19 pandemic has had a substantial impact on rheumatology training and trainee well-being. Our study highlights the extent of this impact on research opportunities and clinical care, which are highly relevant to future curriculum planning and the clinical learning environment.
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Affiliation(s)
- Kristen Young
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Su-Ann Yeoh
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Michael Putman
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Sebastian Sattui
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Richard Conway
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Elizabeth Graef
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Adam Kilian
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Maximilian Konig
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jeffrey Sparks
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Manuel Ugarte-Gil
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Laura Upton
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Francis Berenbaum
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Suleman Bhana
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Wendy Costello
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jonathan Hausmann
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Pedro Machado
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Philip Robinson
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Emily Sirotich
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Paul Sufka
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jinoos Yazdany
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jean Liew
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Rebecca Grainger
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Zachary Wallace
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Arundathi Jayatilleke
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
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Yeoh SA, Young K, Putman M, Sattui S, Conway R, Graef E, Kilian A, Konig M, Sparks J, Ugarte-Gil M, Upton L, Berenbaum F, Bhana S, Costello W, Hausmann J, Machado P, Robinson P, Sirotich E, Sufka P, Yazdany J, Liew J, Grainger R, Wallace Z, Jayatilleke A. Rapid Adoption of Telemedicine in Rheumatology Care During the COVID-19 Pandemic Highlights Training and Supervision Concerns Among Rheumatology Trainees. ACR Open Rheumatol 2021; 4:128-133. [PMID: 34791821 PMCID: PMC8652624 DOI: 10.1002/acr2.11355] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/21/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the impact of telemedicine use during the coronavirus disease 2019 (COVID-19) pandemic on rheumatology trainees. METHODS A voluntary, anonymous, web-based survey was administered in English, Spanish, or French from August 19 to October 5, 2020. Adult and pediatric rheumatology trainees were invited to participate via social media and email. Using multiple-choice questions and Likert scales, the survey assessed prior and current telemedicine use, impact on training, and supervision after COVID-19 prompted rapid telemedicine implementation. RESULTS Surveys were received from 302 trainees from 33 countries, with 83% in adult rheumatology training programs. Reported telemedicine use increased from 13% before the pandemic to 82% during the pandemic. United States trainees predominantly used video visits, whereas outside the United States telemedicine was predominantly audio only. Most (65%) evaluated new patients using telemedicine. More respondents were comfortable using telemedicine for follow-up patients (69%) than for new patients (25%). Only 39% of respondents reported receiving telemedicine-focused training, including instruction on software, clinical skills, and billing, whereas more than half of United States trainees (59%) had training. Postconsultation verbal discussion was the most frequent form of supervision; 24% reported no supervision. Trainees found that telemedicine negatively impacted supervision (50%) and the quality of clinical teaching received (70%), with only 9% reporting a positive impact. CONCLUSIONS Despite widespread uptake of telemedicine, a low proportion of trainees received telemedicine training, and many lacked comfort in evaluating patients, particularly new patients. Inadequate supervision and clinical teaching were areas of concern. If telemedicine remains in widespread use, ensuring appropriate trainee supervision and teaching should be prioritized.
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Affiliation(s)
| | | | | | | | | | | | - Adam Kilian
- The George Washington University, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | - Emily Sirotich
- Canadian Arthritis Patient Alliance, McMaster University, Hamilton, Ontario, Canada
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Young K, Yeoh SA, Putman M, Graef E, Berenbaum F, Conway R, Grainger R, Kilian A, Konig M, Liew J, Machado PM, Sattui SE, Sparks J, Sufka P, Ugarte-Gil M, Upton L, Wallace Z, Yazdany J, Jayatilleke A. POS0051 THE IMPACT OF COVID-19 ON RHEUMATOLOGY TRAINING: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE TRAINEE SURVEY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The COVID-19 pandemic has disrupted healthcare delivery and education of physicians, including rheumatology trainees.Objectives:To assess the impact of the COVID-19 pandemic on the clinical experiences, research opportunities, and well-being of rheumatology trainees.Methods:A voluntary, anonymous, web-based survey was administered in English, Spanish, or French from 19/08/2020 to 05/10/2020. Adult and paediatric rheumatology trainees worldwide in training in 2020 were invited to participate via social media and email. Using multiple choice questions, Likert scales, and free text answers, we assessed trainee patient care activities, redeployment, research, and well-being.Results:The 302 respondents were from 33 countries, with most (83%, 252/302) in adult rheumatology training. Many trainees (45%, 135/300) reported an increase in non-rheumatology clinical work (e.g. care of COVID-19 patients), with 52% of these (70/135) also continuing rheumatology clinical work. COVID-19 redeployment was not optional for 68% (91/134).Trainees reported a negative impact of the pandemic in their growth in rheumatology (Figure 1). They also reported a substantial impact on several training areas: outpatient clinics (79%, 238/302), inpatient consultations (59%, 177/302), formal teaching (55%, 167/302), procedures (53%, 147/302), teaching opportunities (52%, 157/302), and ultrasonography (36%, 110/302), with 87-96% perceiving a negative impact on these areas. Only 54% (159/294) reported feeling comfortable with their level of clinical supervision during the pandemic (Figure 1).Many trainees (46%, 128/280) reported changes in research experiences during the pandemic; 39% (110/285) reported that COVID-19 negatively affected their ability to continue their pre-pandemic research and 50% (142/285) reported difficulty maintaining research goals (Figure 1).Some rheumatology trainees reported having health condition(s) putting them at high risk for COVID-19 (10%, 30/302) and 14% of trainees (41/302) reported having had COVID-19 (Table 1). Only 53% (160/302) reported feeling physically safe in the workplace while 25% (76/302) reported not feeling physically safe; reasons included lack of training about COVID-19, lack of comfort in the clinical setting, insufficient personal protective equipment, immunocompromised state, and pregnancy. Half (151/302) reported burnout and 68% (204/302) an increase in stress from work during the pandemic (Figure 1), whilst 25% (75/302) reported that changes to their training programme negatively impacted their physical health.Conclusion:The COVID-19 pandemic has negatively impacted the experience of rheumatology training as well as the well-being of trainees globally. Our data highlight concerns for rheumatology trainees including research opportunities and clinical care which should be a focus for curriculum planning.Figure 1.Rheumatology trainee perceptions of pandemic impact and changes in training programme.Table 1.Estimated hazard ratios, adjusted for age and gender, for individuals with rheumatoid arthritisEuropen = 89ROWn = 213Combinedn = 302Disability1 (1)9 (4)10 (3)High risk7 (8)23 (11)30 (10)Pregnant4 (5)15 (7)19 (6)Shielding/Quarantining12 (13)70 (33)82 (27)Acquired COVID-1920 (22)21 (10)41 (14)Disclosure of Interests:Kristen Young: None declared, Su-Ann Yeoh: None declared, Michael Putman: None declared, Elizabeth Graef: None declared, Francis Berenbaum: None declared, Richard Conway: None declared, Rebecca Grainger Speakers bureau: Speaker fees from Abbvie, Janssen, Novartis, Pfizer, Cornerstones, all not related to this work, Consultant of: Consultancy fees from Abbvie, Janssen, Novartis, Pfizer, Cornerstones, all not related to this work, Grant/research support from: Travel assistance from Pfizer, not related to this work, Adam Kilian: None declared, Maximilian Konig: None declared, Jean Liew Grant/research support from: Research grant from Pfizer unrelated to this manuscript, Pedro M Machado Speakers bureau: Speaker fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, Consultant of: Consulting fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, Sebastian E. Sattui: None declared, Jeffrey Sparks Consultant of: Consultancy for Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum, and Pfizer unrelated to this manuscript, Grant/research support from: Research support from Bristol-Myers Squibb unrelated to this manuscript, Paul Sufka: None declared, Manuel Ugarte-Gil Grant/research support from: Research grants from Janssen and Pfizer unrelated to this manuscript, Laura Upton: None declared, Zachary Wallace: None declared, Jinoos Yazdany Consultant of: Consultancy for Astra Zeneca, Eli Lilly, and Pfizer, not related to this work, Grant/research support from: Research grants from Gilead and Pfizer, not related to this work, Arundathi Jayatilleke: None declared.
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Sparks J, Vanni K, Sparks M, Xu C, Santacroce L, Glynn R, Ridker P, Solomon D. POS0219 EFFECT OF LOW-DOSE METHOTREXATE ON ESTIMATED GLOMERULAR FILTRATION RATE AND KIDNEY ADVERSE EVENTS IN THE CARDIOVASCULAR INFLAMMATION REDUCTION TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Low-dose methotrexate (LD-MTX) is a common first-line treatment for systemic rheumatic diseases, and its use is contraindicated in advanced chronic kidney disease (CKD) because it is primarily excreted by the kidneys. Among patients with preserved kidney function, the safety of LD-MTX on estimated glomerular filtration rate (eGFR) and kidney adverse events (AEs) has not been established.Objectives:To investigate the effect of LD-MTX on eGFR and kidney AEs using data from a randomized clinical trial.Methods:We performed a secondary analysis for eGFR and kidney AEs using the randomized double-blind, placebo-controlled Cardiovascular Inflammation Reduction Trial. Adults with known cardiovascular disease and diabetes and/or metabolic syndrome were randomly allocated to oral LD-MTX (target dose 15-20 mg/week) or placebo. All participants took folic acid 1 mg six days/week. Exclusion criteria included systemic inflammatory disease and creatinine clearance <40 mL/min (by Cockcroft-Gault). eGFR was calculated using the CKD-EPI formula. Clinical kidney AEs were blindly adjudicated. The least-squares mean change of eGFR from baseline was calculated at each study visit; the difference in eGFR slopes between LD-MTX and placebo was compared using a modified intention-to-treat approach. We also compared rates of kidney AEs for LD-MTX versus placebo using Cox proportional hazards models.Results:A total of 2,391 subjects were randomized to LD-MTX and 2,395 to placebo. At baseline, mean age was 66 years, 19% were female, mean eGFR was 80.0 mL/min/1.73m2, and 18% had stage 3 CKD or worse. Median follow-up duration was 23 months, and median LD-MTX dose was 16 mg/week. Those randomized to LD-MTX had less decline in eGFR over the entire follow-up compared to placebo (slope difference 1.12, 95%CI 0.59-1.65, p<0.001, Figure 1). Those with CKD stage 3 or worse on LD-MTX saw less eGFR decline than those with CKD stage 2 or better (slope difference among CKD stage 3 or worse: 2.46, 95%CI 1.10-3.82, p<0.001; p for interaction 0.02). The LD-MTX group had higher eGFR than placebo over the first 24 months of study follow-up (p<0.05 at each visit). On safety laboratory monitoring, there were 159 acute kidney injury AEs in the LD-MTX group and 187 in the placebo group (HR 0.83, 95%CI 0.67-1.02, Table 1). There were 37 clinical kidney AEs in the LD-MTX group and 42 in the placebo group (0.87, 95%CI 0.56-1.36). One subject began dialysis in the LD-MTX group compared to 3 in the placebo group.Table 1.Rates and hazard ratios for kidney adverse events per random assignment of low-dose methotrexate or placebo in the Cardiovascular Inflammation Reduction Trial (n=4,786).Low-dose methotrexate (n=2,391)Placebo (n=2,395) (reference)HR (95%CI)EventsRate per 100 person-years (95%CI)EventsRate per 100 person-years (95%CI)SCr collected at safety visitsAny event*1593.42 (2.93, 3.98)1874.06 (3.53, 4.67)0.83 (0.67, 1.02)Mild (SCr 1.5-1.9x baseline)1543.47 (2.97, 4.06)1774.06 (3.51, 4.69)0.85 (0.68, 1.06)Moderate (SCr 2-2.9x baseline)190.41 (0.26, 0.64)240.52 (0.35, 0.78)0.78 (0.43, 1.43)Severe (SCr ≥3x baseline)20.04 (0.01, 0.17)50.11 (0.05, 0.26)0.40 (0.08, 2.04)Adjudicated clinical kidney adverse eventsAny event*370.80 (0.58, 1.11)420.92 (0.68, 1.24)0.87 (0.56, 1.36)Mild240.52 (0.35, 0.77)250.55 (0.37, 0.81)0.95 (0.55, 1.67)Moderate110.24 (0.13, 0.43)110.24 (0.13, 0.43)1.00 (0.43, 2.29)Severe40.09 (0.03, 0.23)80.17 (0.09, 0.35)0.50 (0.15, 1.64)New dialysis10.02 (0.00, 0.15)30.17 (0.09, 0.35)0.34 (0.04, 3.17)*Acute kidney injury presence and severity was defined by KDIGO (Kidney Disease: Improving Global Outcomes) classification.CI, confidence interval; HR, hazard ratio; SCr, serum creatinine.Conclusion:These results demonstrate the kidney safety of LD-MTX among patients without advanced CKD at baseline. We observed a possible beneficial effect of LD-MTX on preserving kidney function, suggesting that inflammation may be involved in the pathogenesis of CKD in this population.Disclosure of Interests:Jeffrey Sparks Consultant of: Dr. J Sparks has performed consultancy for Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum, and Pfizer unrelated to this work., Grant/research support from: Dr. J Sparks has received research support from Bristol-Myers Squibb., Kathleen Vanni: None declared, Matthew Sparks: None declared, Chang Xu: None declared, Leah Santacroce: None declared, Robert Glynn Grant/research support from: Dr. Glynn has received grant support unrelated to the present research from AstraZeneca, Kowa, Pfizer, and Novartis., Paul Ridker Consultant of: Dr. Ridker has served as a consultant to Corvidia, Inflazome, and CiviBioPharm., Grant/research support from: Dr. Ridker receives research support unrelated to the present study from Kowa, Novartis, and Amarin., Daniel Solomon Grant/research support from: Dr. Solomon receives research support unrelated to the present study from Abbvie, Amgen, Corrona, Genentech, Janssen, and Pfizer.
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Ugarte-Gil MF, Alarcon GS, Seet A, Izadi Z, Reategui Sokolova C, Clarke AE, Wise L, Pons-Estel G, Santos MJ, Bernatsky S, Mathias L, Lim N, Sparks J, Wallace Z, Hyrich K, Strangfeld A, Gossec L, Carmona L, Mateus E, Lawson-Tovey S, Trupin L, Rush S, Schmajuk G, Katz P, Jacobsohn L, Al Emadi S, Gilbert E, Duarte-Garcia A, Valenzuela-Almada M, Hsu T, D’silva K, Serling-Boyd N, Dieudé P, Nikiphorou E, Kronzer V, Singh N, Wallace B, Akpabio A, Thomas R, Bhana S, Costello W, Grainger R, Hausmann J, Liew J, Sirotich E, Sufka P, Robinson P, Machado P, Gianfrancesco M, Yazdany J. OP0286 CHARACTERISTICS ASSOCIATED WITH SEVERE COVID-19 OUTCOMES IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE (COVID-19 GRA). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:An increased risk of severe COVID-19 outcomes may be seen in patients with autoimmune diseases on moderate to high daily doses of glucocorticoids, as well as in those with comorbidities. However, specific information about COVID-19 outcomes in SLE is scarce.Objectives:To determine the characteristics associated with severe COVID-19 outcomes in a multi-national cross-sectional registry of COVID-19 patients with SLE.Methods:SLE adult patients from a physician-reported registry of the COVID-19 GRA were studied. Variables collected at COVID-19 diagnosis included age, sex, race/ethnicity, region, comorbidities, disease activity, time period of COVID-19 diagnosis, glucocorticoid (GC) dose, and immunomodulatory therapy. Immunomodulatory therapy was categorized as: antimalarials only, no SLE therapy, traditional immunosuppressive (IS) drug monotherapy, biologics/targeted synthetic IS drug monotherapy, and biologic and traditional IS drug combination therapy. We used an ordinal COVID-19 severity outcome defined as: not hospitalized/hospitalized without supplementary oxygen; hospitalized with non-invasive ventilation; hospitalized with mechanical ventilation/extracorporeal membrane oxygenation; and death. An ordinal logistic regression model was constructed to assess the association between demographic characteristics, comorbidities, medications, disease activity and COVID-19 severity. This assumed that the relationship between each pair of outcome groups is of the same direction and magnitude.Results:Of 1069 SLE patients included, 1047 (89.6%) were female, with a mean age of 44.5 (SD: 14.1) years. Patient outcomes included 815 (78.8%) not hospitalized/hospitalized without supplementary oxygen; 116 (11.2) hospitalized with non-invasive ventilation, 25 (2.4%) hospitalized with mechanical ventilation/extracorporeal membrane oxygenation and 78 (7.5%) died. In a multivariate model (n=804), increased age [OR=1.03 (1.01, 1.04)], male sex [OR =1.93 (1.21, 3.08)], COVID-19 diagnosis between June 2020 and January 2021 (OR =1.87 (1.17, 3.00)), no IS drug use [OR =2.29 (1.34, 3.91)], chronic renal disease [OR =2.34 (1.48, 3.70)], cardiovascular disease [OR =1.93 (1.34, 3.91)] and moderate/high disease activity [OR =2.24 (1.46, 3.43)] were associated with more severe COVID-19 outcomes. Compared with no use of GC, patients using GC had a higher odds of poor outcome: 0-5 mg/d, OR =1.98 (1.33, 2.96); 5-10 mg/d, OR =2.88 (1.27, 6.56); >10 mg/d, OR =2.01 (1.26, 3.21) (Table 1).Table 1.Characteristics associated with more severe COVID-19 outcomes in SLE. (N=804)OR (95% CI)Age, years1.03 (1.01, 1.04)Sex, Male1.93 (1.21, 3.08)Race/Ethnicity, Non-White vs White1.47 (0.87, 2.50)RegionEuropeRef.North America0.67 (0.29, 1.54)South America0.67 (0.29, 1.54)Other1.93 (0.85, 4.39)Season, June 16th 2020-January 8th 2021 vs January-June 15th 20201.87 (1.17, 3.00)Glucocorticoids0 mg/dayRef.0-5 mg/day1.98 (1.33, 2.96)5-10 mg/day2.88 (1.27, 6.56)=>10 mg/day2.01 (1.26, 3.21)Medication CategoryAntimalarial onlyRef.No IS drugs2.29 (1.34, 3.91)Traditional IS drugs as monotherapy1.17 (0.77, 1.77)b/ts IS drugs as monotherapy1.00 (0.37, 2.71)Combination of traditional and b/ts IS1.00 (0.55, 1.82)Comorbidity BurdenNumber of Comorbidities (excluding renal and cardiovascular disease)1.39 (0.97, 1.99)Chronic renal disease2.34 (1.48, 3.70)Cardiovascular disease1.93 (1.34, 3.91)Disease Activity, Moderate/ high vs Remission/ low 2.24 (1.46, 3.43)IS: immunosuppressive. b/ts: biologics/targeted syntheticsConclusion:Increased age, male sex, glucocorticoid use, chronic renal disease, cardiovascular disease and moderate/high disease activity at time of COVID-19 diagnosis were associated with more severe COVID-19 outcomes in SLE. Potential limitations include possible selection bias (physician reporting), the cross-sectional nature of the data, and the assumptions underlying the outcomes modelling.Acknowledgements:The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the ACR, EULAR) the UK National Health Service, the National Institute for Health Research (NIHR), or the UK Department of Health, or any other organization.Disclosure of Interests:Manuel F. Ugarte-Gil Grant/research support from: Pfizer, Janssen, Graciela S Alarcon: None declared, Andrea Seet: None declared, Zara Izadi: None declared, Cristina Reategui Sokolova: None declared, Ann E Clarke Consultant of: AstraZeneca, BristolMyersSquibb, GlaxoSmithKline, Exagen Diagnostics, Leanna Wise: None declared, Guillermo Pons-Estel: None declared, Maria Jose Santos: None declared, Sasha Bernatsky: None declared, Lauren Mathias: None declared, Nathan Lim: None declared, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum unrelated to this work., Grant/research support from: Amgen and Bristol-Myers Squibb, Zachary Wallace Consultant of: Viela Bio and MedPace, Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi, Kimme Hyrich Speakers bureau: Abbvie, Grant/research support from: MS, UCB, and Pfizer, Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, Pfizer, Grant/research support from: AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB, Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, Grant/research support from: Lilly, Mylan, Pfizer, Loreto Carmona: None declared, Elsa Mateus Grant/research support from: Pfizer, Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA, Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Patti Katz: None declared, Lindsay Jacobsohn: None declared, Samar Al Emadi: None declared, Emily Gilbert: None declared, Ali Duarte-Garcia: None declared, Maria Valenzuela-Almada: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Philippe Dieudé Consultant of: Boerhinger Ingelheim, Bristol-Myers Squibb, Lilly, Sanofi, Pfizer, Chugai, Roche, Janssen unrelated to this work, Grant/research support from: Bristol-Myers Squibb, Chugaii, Pfizer, unrelated to this work, Elena Nikiphorou: None declared, Vanessa Kronzer: None declared, Namrata Singh: None declared, Beth Wallace: None declared, Akpabio Akpabio: None declared, Ranjeny Thomas: None declared, Suleman Bhana Consultant of: AbbVie, Horizon, Novartis, and Pfizer (all <$10,000) unrelated to this work, Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones, Jonathan Hausmann Consultant of: Novartis, Sobi, Biogen, all unrelated to this work (<$10,000), Jean Liew Grant/research support from: Pfizer outside the submitted work, Emily Sirotich Grant/research support from: Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer based organization whose activities are largely supported by independent grants from pharmaceutical companies, Paul Sufka: None declared, Philip Robinson Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000), Milena Gianfrancesco: None declared, Jinoos Yazdany Consultant of: Eli Lilly and AstraZeneca unrelated to this project
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Yeoh SA, Young K, Putman M, Graef E, Berenbaum F, Conway R, Grainger R, Kilian A, Konig M, Liew J, Machado PM, Sattui SE, Sparks J, Sufka P, Ugarte-Gil M, Upton L, Wallace Z, Yazdany J, Jayatilleke A. AB0674 RAPID ADOPTION OF TELEMEDICINE IN RHEUMATOLOGY TRAINING: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE TRAINEE SURVEY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The COVID-19 pandemic led to a rapid increase in remote consultations in rheumatology care. Due to the potential impact of this change on rheumatology clinical training, we investigated trainees’ experiences with telemedicine.Objectives:To assess the impact of telemedicine use during the COVID-19 pandemic on rheumatology training, including supervision.Methods:A voluntary, anonymous web-based survey was administered in English, Spanish, or French from 19/08/2020 to 05/10/2020. Adult and paediatric rheumatology trainees worldwide in training in 2020 were invited to participate via social media and email. Using multiple choice questions, Likert scales, and free text answers, we collected data regarding prior and current telemedicine use, training, and supervision.Results:302 respondents from 33 countries completed the survey, with most (83%, 252/302) in adult rheumatology training. Reported use of telemedicine increased from 13% (39/302) pre-pandemic to 82% (247/302) (Table 1). European trainees predominantly utilised audio-only compared to trainees from the rest of the world (ROW) who predominantly utilised audio-video telemedicine.Most trainees continued to evaluate new patients using telemedicine (65%, 161/247). A larger proportion of trainees were comfortable using telemedicine to evaluate follow-up (69% 170/247) versus new patients (25%, 41/161) (Figure 1).Only 32% (97/302) were trained in telemedicine, with the highest proportion among United States (US) trainees (59%, 69/116); subjects included software, clinical skills, and billing. The majority of trainees found this helpful (92%, 89/97).Supervision was most frequently in the form of verbal discussion after the consultation (Table 1); 24% (59/247) had no telemedicine supervision during the pandemic. In general, trainees found telemedicine negatively impacted their supervision (51%, 123/242) and clinical teaching quality (70%, 171/244); only 9% reported a positive impact on these areas.Conclusion:Adoption of telemedicine during the COVID-19 pandemic has led to areas of concern for rheumatology trainees including inadequate supervision and clinical teaching. Our results suggest a need for education on evaluation of new patients using telemedicine, increasing telemedicine training, and ensuring adequate supervisory arrangements.Table 1.Telemedicine use, supervision, and training by region. Data is presented as n (%). Rest of the world (ROW) data includes Asia (50), Central and South America (23), Canada (12), Australia (8), and Africa (4).Europen = 89USn = 116ROWn = 97Combinedn = 302Telemedicine usePre-pandemic15 (17)9 (8)15 (15)39 (13)During pandemic64 (72)112 (97)71 (73)247 (82)Telemedicine modalitypre-pandemicAudio-only14 (93)3 (33)8 (53)25 (64)Audio-video1 (7)7 (78)7 (47)15 (38)Telemedicine modality during pandemicAudio-only56 (88)47 (42)51 (72)154 (62)Audio-video7 (11)100 (89)29 (41)136 (55)Supervisionpre-pandemicReal-time observation (part of visit)0 (0)4 (44)3 (20)7 (18)Real-time observation (full visit)0 (0)2 (22)2 (13)4 (10)Verbal discussion after8 (53)3 (33)7 (47)18 (46)Written communication after0 (0)0 (0)1 (7)1 (3)None7 (47)2 (22)5 (33)14 (36)Supervision during pandemicReal-time observation (part of visit)2 (3)54 (48)15 (21)71 (29)Real-time observation (full visit)3 (5)32 (29)8 (11)43 (17)Verbal discussion after32 (50)65 (58)28 (39)125 (51)Written communication after7 (11)15 (13)9 (13)31 (13)None28 (44)9 (8)22 (31)59 (24)Figure 1.Rheumatology trainee comfort levels in using telemedicine during the pandemic.Disclosure of Interests:Su-Ann Yeoh: None declared, Kristen Young: None declared, Michael Putman: None declared, Elizabeth Graef: None declared, Francis Berenbaum: None declared, Richard Conway: None declared, Rebecca Grainger Speakers bureau: Speaker fees from Abbvie, Janssen, Novartis, Pfizer, Cornerstones, all not related to this work, Consultant of: Consultancy fees from Abbvie, Janssen, Novartis, Pfizer, Cornerstones, all not related to this work, Grant/research support from: Travel assistance from Pfizer, not related to this work, Adam Kilian: None declared, Maximilian Konig: None declared, Jean Liew Grant/research support from: Research grant from Pfizer unrelated to this manuscript, Pedro M Machado Speakers bureau: Speaker fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, Consultant of: Consulting fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, Sebastian E. Sattui: None declared, Jeffrey Sparks Consultant of: Consultancy for Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum, and Pfizer unrelated to this manuscript, Grant/research support from: Research support from Bristol-Myers Squibb unrelated to this manuscript, Paul Sufka: None declared, Manuel Ugarte-Gil Grant/research support from: Research grants from Janssen and Pfizer unrelated to this manuscript, Laura Upton: None declared, Zachary Wallace: None declared, Jinoos Yazdany Consultant of: Consultancy for Astra Zeneca, Eli Lilly, and Pfizer, not related to this work, Grant/research support from: Research grants from Gilead and Pfizer, not related to this work, Arundathi Jayatilleke: None declared
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Martin L, Prisco L, Huang W, Mcdermott G, Shadick N, Doyle T, Sparks J. POS0522 PREVALENCE OF BRONCHIECTASIS IN RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Bronchiectasis is a known extra-articular manifestation of rheumatoid arthritis (RA) and can lead to decreased quality of life as well as increased risk for infection and mortality. Understanding the burden of bronchiectasis in RA may lead to a better understanding of pathogenesis and improved management. We performed a systematic review and meta-analysis to determine the prevalence of bronchiectasis in RA.Objectives:We investigated the prevalence of RA-related bronchiectasis (RA-BR) using a systematic review and meta-analysis.Methods:We followed the PRISMA-P 2015 guideline for systematic reviews and registered this analysis (ID#199080) on PROSPERO. We queried PubMed and EMBASE databases using the search strategy “rheumatoid arthritis; AND; bronchiectasis” as of July 31, 2020. The inclusion and exclusion criteria were assessed for study eligibility by two independent abstractors. Exclusion criteria included: (1) non-primary literature (i.e., review articles, editorials); (2) case reports involving less than 5 patients; (3) published in a language other than English; (4) did not relate to both RA and bronchiectasis; and (5) studies not involving humans (e.g., mouse models). After the initial screen, we conducted a full text review to verify that inclusion criteria were met: (1) reported frequency of RA-BR and denominator of all RA patients in the study sample. Data including type of study design, method of RA-BR detection, and RA characteristics were extracted by two independent abstractors. We performed meta-analyses using random effects models to estimate prevalence of RA-BR among RA overall and restricted to retrospective or prospective studies.Results:Out of a total of 208 studies, 37 studies were identified that reported frequency of RA-BR among RA. The included studies had heterogeneous methods to identify RA-BR that were based on either clinical or research chest computed tomography (CT) imaging and had varying methods to adjudicate images. Some studies focused on patients with respiratory symptoms or suspected RA-associated interstitial lung disease (RA-ILD). There were a total of 8,646 patients with RA, and 612 were identified as having RA-BR. The pooled overall prevalence of RA-BR in the random effects meta-analysis was 18.2% (95%CI 13.3-23.7%, Figure 1). Among prospective studies (n=24), the prevalence of RA-BR in the meta-analysis was 20.7% (95% CI 14.7-27.4%). Among retrospective studies (n=13) reporting RA-BR, the prevalence was 14.5% (95% CI 7.2-23.7%). Prevalence was lowest in retrospective studies where RA-BR was identified through clinical care (e.g., two large retrospective studies that investigated 4,000 and 1,129 RA patients reported RA-BR prevalence of 0.6% and 2.7%, respectively). The two largest prospective studies that incorporated a research protocol performing chest CT imaging on all enrolled patients investigated 150 and 332 patients with RA and reported a RA-BR prevalence of 8.0% and 9.6%, respectively. Smaller studies of both study design types generally reported higher prevalence of RA-BR.Figure 1.Pooled prevalence of RA-related bronchiectasis in RA among all studies identified (n=37).Conclusion:The prevalence of RA-BR in this systematic review and meta-analysis was 18.2%, emphasizing that bronchiectasis is a common extra-articular feature of RA. However, some studies may have identified subclinical RA-BR through research imaging or RA-BR may have been secondary to RA-ILD. Future studies should standardize methods to identify RA-BR cases and investigate the natural history and clinical course given the relatively high prevalence that we report.Disclosure of Interests:Lily Martin: None declared, Lauren Prisco: None declared, Weixing Huang: None declared, Gregory McDermott: None declared, Nancy Shadick Consultant of: Consultant < 5K Bristol-Myers Squibb, Grant/research support from: BMS Amgen Lilly, Mallinckrodt, and Sanofi, Tracy Doyle Consultant of: Boehringer Ingelheim (<5K), Grant/research support from: Bristol Myers Squibb and Genentech, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum, and Pfizer, Grant/research support from: Bristol-Myers Squibb
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Izadi Z, Gianfrancesco M, Hyrich K, Strangfeld A, Gossec L, Carmona L, Mateus E, Lawson-Tovey S, Trupin L, Rush S, Schmajuk G, Jacobsohn L, Katz P, Al Emadi S, Wise L, Gilbert E, Valenzuela-Almada M, Duarte-Garcia A, Sparks J, Hsu T, D’silva K, Serling-Boyd N, Bhana S, Costello W, Grainger R, Hausmann J, Liew J, Sirotich E, Sufka P, Wallace Z, Machado P, Robinson P, Yazdany J. OP0288 MACHINE LEARNING ALGORITHMS TO PREDICT COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME IN PATIENTS WITH RHEUMATIC DISEASES: RESULTS FROM THE GLOBAL RHEUMATOLOGY ALLIANCE PROVIDER REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Acute Respiratory Distress Syndrome (ARDS) is a life-threatening complication of COVID-19 and has been reported in approximately one-third of hospitalized patients with COVID-191. Risk factors associated with the development of ARDS include older age and diabetes2. However, little is known about factors associated with ARDS in the setting of COVID-19, in patients with rheumatic disease or those receiving immunosuppressive medications. Prediction algorithms using traditional regression methods perform poorly with rare outcomes, often yielding high specificity but very low sensitivity. Machine learning algorithms optimized for rare events are an alternative approach with potentially improved sensitivity for rare events, such as ARDS in COVID-19 among patients with rheumatic disease.Objectives:We aimed to develop a prediction model for ARDS in people with COVID-19 and pre-existing rheumatic disease using a series of machine learning algorithms and to identify risk factors associated with ARDS in this population.Methods:We used data from the COVID-19 Global Rheumatology Alliance (GRA) Registry from March 24 to Nov 1, 2020. ARDS diagnosis was indicated by the reporting clinician. Five machine learning algorithms optimized for rare events predicted ARDS using 42 variables covering patient demographics, rheumatic disease diagnoses, medications used at the time of COVID-19 diagnosis, and comorbidities. Model performance was assessed using accuracy, area under curve, sensitivity, specificity, positive predictive value, and negative predictive value. Adjusted odds ratios corresponding to the 10 most influential predictors from the best performing model were derived using hierarchical multivariate mixed-effects logistic regression that accounted for within-country correlations.Results:A total of 5,931 COVID-19 cases from 67 countries were included in the analysis. Mean (SD) age was 54.9 (16.0) years, 4,152 (70.0%) were female, and 2,399 (40.5%) were hospitalized. ARDS was reported in 388 (6.5% of total and 15.6% of hospitalized) cases. Statistically significant differences in the risk of ARDS were observed by demographics, diagnoses, medications, and comorbidities using unadjusted univariate comparisons (data not shown). Gradient boosting machine (GBM) had the highest sensitivity (0.81) and was considered the best performing model (Table 1). Hypertension, interstitial lung disease, kidney disease, diabetes, older age, glucocorticoids, and anti-CD20 monoclonal antibodies were associated with the development of ARDS while tumor necrosis factor inhibitors were associated with a protective effect (Figure 1).Table 1.Performance of machine learning algorithms.GBMSVMGLMNETNNETRFAccuracy0.790.680.660.660.67AUC0.750.700.740.580.74Sensitivity0.810.680.650.680.67Specificity0.490.600.730.480.68PPV0.960.960.970.950.97NPV0.160.120.130.090.13GBM: Gradient Boosting Machine, SVM: Support vector machines, GLMNET: Lasso and Elastic-Net Regularized Generalized Linear Models, NNET: Neural Networks, RF: Random Forest. AUC: Area Under Curve; PPV: Positive Predictive Value; NPV: Negative Predictive Value.Conclusion:In this global cohort of patients with rheumatic disease, a machine learning model, GBM, predicted the onset of ARDS with 81% sensitivity using baseline information obtained at the time of COVID-19 diagnosis. These results identify patients who may be at higher risk of severe COVID-19 outcomes. Further studies are necessary to validate the proposed prediction model in external cohorts and to evaluate its clinical utility. Disclaimer: The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance, and do not necessarily represent the views of the ACR, NIH, (UK) NHS, NIHR, or the department of Health.References:[1]Tzotzos SJ, Fischer B, Fischer H, Zeitlinger M. 2020;24(1):516.[2]Wu C, Chen X, Cai Y, et al. JAMA Intern Med. 2020;180(7):934-943.Acknowledgements:The COVID-19 Global Rheumatology Alliance.Disclosure of Interests:Zara Izadi: None declared, Milena Gianfrancesco: None declared, Kimme Hyrich Speakers bureau: Abbvie and grant income from BMS, UCB, and Pfizer, all unrelated to this study., Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work., Grant/research support from: A consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB) supporting the German RABBIT register., Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB., Grant/research support from: Lilly, Mylan, Pfizer, all unrelated to this study., Loreto Carmona Consultant of: Loreto Carmona’s institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis, Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH, and UCB Pharma., Elsa Mateus Grant/research support from: LPCDR received grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA and Pfizer., Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Lindsay Jacobsohn: None declared, Patti Katz: None declared, Samar Al Emadi: None declared, Leanna Wise: None declared, Emily Gilbert: None declared, Maria Valenzuela-Almada: None declared, Ali Duarte-Garcia: None declared, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum unrelated to this work., Grant/research support from: Amgen and Bristol-Myers Squibb., Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Suleman Bhana Employee of: Suleman Bhana reports non-branded marketing campaigns for Novartis (<$10,000)., Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones and travel assistance from Pfizer (all < $10,000)., Jonathan Hausmann Consultant of: Novartis, unrelated to this work (<$10,000)., Jean Liew Grant/research support from: Pfizer, outside the submitted work., Emily Sirotich Grant/research support from: Emily Sirotich is a Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer-based organization whose activities are largely supported by independent grants from pharmaceutical companies., Paul Sufka: None declared, Zachary Wallace Consultant of: Viela Bio and MedPace, outside the submitted work., Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi., Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Philip Robinson Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB and travel assistance from Roche (all < $10,000)., Jinoos Yazdany Consultant of: Eli Lilly and Astra Zeneca, unrelated to this project.
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Hsu T, D’silva K, Serling-Boyd N, Wang J, Mueller A, Fu X, Prisco L, Martin L, Vanni K, Zaccardelli A, Cook C, Choi H, Zhang Y, Gravallese E, Wallace Z, Sparks J. POS1174 HYPERINFLAMMATION AND CLINICAL OUTCOMES FOR PATIENTS WITH SYSTEMIC RHEUMATIC DISEASES HOSPITALIZED FOR COVID-19: A COMPARATIVE COHORT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:COVID-19 can induce a hyperinflammatory state resulting in cytokine storm, which can lead to poor outcomes. Patients with systemic rheumatic diseases may be at increased risk for respiratory failure with COVID-19. Therefore, we investigated the relationship between rheumatic disease, hyperinflammation, and clinical outcomes among hospitalized COVID-19 patients.Objectives:To compare laboratory values, hyperinflammation, and clinical outcomes of hospitalized COVID-19 rheumatic patients and matched comparators.Methods:We performed a comparative cohort study of patients with polymerase chain reaction (PCR)-confirmed COVID-19 requiring hospitalization between 3/1/20-7/7/20 at a large health care system. We compared each systemic rheumatic disease case to up to 5 matched (by age, sex, and date of +SARS-CoV-2 PCR) comparators without systemic rheumatic disease. We extracted laboratory values from their hospitalization to compare peaks/troughs of individual laboratory results by case status and derived the COVID-19-associated hyperinflammation score (cHIS), a composite of 6 laboratory domains (0-6, ≥2 indicating hyperinflammation), as previously developed1. We used multivariable logistic regression to estimate ORs for COVID-19 outcomes by hyperinflammation and case status.Results:We identified 57 hospitalized rheumatic disease cases (mean age 67 years, 67% female) and 232 matched comparators hospitalized with PCR-confirmed COVID-19. Among cases, 26 (46%) had rheumatoid arthritis and 14 (25%) had systemic lupus erythematosus. Most cases (34, 60%) had active rheumatic disease. At baseline, 15 (27%) of cases were treated with biologic DMARDs, and 32 (56%) were using glucocorticoids. We analyzed 39,900 total laboratory results (median 85 per patient). Cases had higher peak neutrophil-to-lymphocyte ratio (9.6 vs 7.8, p=0.02), LDH (421 vs 345 U/L, p=0.04), creatinine (1.2 vs 1.0 mg/dL, p=0.01), and BUN (31 vs 23 mg/dL, p=0.03) than comparators but similar peak CRP (149 vs 116 mg/L, p=0.11, Figure 1). Cases had higher peak median cHIS (3 vs 2, p=0.01). Peak cHIS ≥2 had higher odds of intensive care unit (ICU) admission (OR 3.45, 95%CI 1.98-5.99), mechanical ventilation (OR 66.0, 95%CI 9.0-487.8), and mortality (OR 16.4, 95%CI 4.8-56.4) compared to cHIS <2 (Table 1). Cases had increased risk of ICU admission (OR 2.0, 95%CI 1.1-3.7) and mechanical ventilation (OR 2.7, 95%CI 1.4-5.2) than comparators.Table 1.Associations of peak cHIS and systemic rheumatic disease with COVID-19 hospitalization outcomesIntensive care unit admissionMechanical ventilationDeath%Adjusted OR (95%CI)%Adjusted OR (95%CI)%Adjusted OR (95%CI)Hospitalization outcomes by hyperinflammation on cHIS1cHIS <2 (n=112)21%1.0 (Ref)1%1.0 (Ref)3%1.0 (Ref)cHIS ≥2 (n=177)48%3.5 (2.0-6.0)37%66.2 (9.0-487.8)27%16.4 (4.8-56.4)Hospitalization outcomes by rheumatic disease statusComparators (n=232)30%1.0 (Ref)19%1.0 (Ref)16%1.0 (Ref)Rheumatic cases (n=57)51%1.87 (1.03-3.40)39%2.46 (1.30-4.67)21%1.32 (0.61-2.88)Matching factors: age, sex, and date of +PCR.1Adjusted for age, sex, and case status.2Adjusted for race, smoking, comorbidities, and body mass index.cHIS, COVID-19-associated hyperinflammation score; CI, confidence interval; OR, odds ratio; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.Conclusion:Patients with systemic rheumatic disease hospitalized for COVID-19 had higher risk for hyperinflammation, kidney injury, and mechanical ventilation than non-rheumatic comparators. We validated the cHIS in our cohort, which was strongly associated with poor COVID-19 outcomes. These findings highlight that hospitalized patients with rheumatic diseases may be vulnerable to poor COVID-19 outcomes.References:[1]Webb BJ et al. Clinical criteria for COVID-19-associated hyperinflammatory syndrome. Lancet Rheumatol. 2020 Dec;2(12):e754-e763.Disclosure of Interests:Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Jiaqi Wang: None declared, Alisa Mueller: None declared, Xiaoqing Fu: None declared, Lauren Prisco: None declared, Lily Martin: None declared, Kathleen Vanni: None declared, Alessandra Zaccardelli: None declared, Claire Cook: None declared, Hyon Choi Consultant of: Dr. Choi reports consultancy fees from Takeda, Selecta, GlaxoSmithKline, and Horizon, Grant/research support from: Dr. Choi reports research support from AstraZeneca., Yuqing Zhang: None declared, Ellen Gravallese: None declared, Zachary Wallace Consultant of: Dr. Wallace reports consulting fees from Viela Bio and MedPace., Grant/research support from: Dr. Wallace reports research support from Bristol-Myers Squibb and Principia., Jeffrey Sparks Consultant of: Dr. Sparks reports consultancy fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, Optum, and Pfizer., Grant/research support from: Dr. Sparks reports research support from Amgen and Bristol-Myers Squibb.
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Sparks J, Wallace Z, Seet A, Gianfrancesco M, Izadi Z, Hyrich K, Strangfeld A, Gossec L, Carmona L, Mateus E, Lawson-Tovey S, Trupin L, Rush S, Schmajuk G, Katz P, Jacobsohn L, Al Emadi S, Wise L, Gilbert E, Duarte-Garcia A, Valenzuela-Almada M, Hsu T, D’silva K, Serling-Boyd N, Dieudé P, Nikiphorou E, Kronzer V, Singh N, Ugarte-Gil MF, Wallace B, Akpabio A, Thomas R, Bhana S, Costello W, Grainger R, Hausmann J, Liew J, Sirotich E, Sufka P, Robinson P, Machado P, Yazdany J. OP0006 ASSOCIATIONS OF BASELINE USE OF BIOLOGIC OR TARGETED SYNTHETIC DMARDS WITH COVID-19 SEVERITY IN RHEUMATOID ARTHRITIS: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Targeted DMARDs may dampen the inflammatory response in COVID-19, perhaps leading to a less severe clinical course. However, some DMARD targets may impair viral immune defenses. Due to sample size limitations, previous studies of DMARD use and COVID-19 outcomes have combined several heterogeneous rheumatic diseases and medications, investigating a single outcome (e.g., hospitalization).Objectives:To investigate the associations of baseline use of biologic or targeted synthetic (b/ts) DMARDs with a range of poor COVID-19 outcomes in rheumatoid arthritis (RA).Methods:We analyzed voluntarily reported cases of COVID-19 in patients with rheumatic diseases in the COVID-19 Global Rheumatology Alliance physician registry (March 12, 2020 - January 6, 2021). We investigated RA treated with b/tsDMARD at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAK), interleukin-6 inhibitors (IL6i), or tumor necrosis factor inhibitors (TNFi). The outcome was an ordinal scale (1-4) for COVID-19 severity: 1) no hospitalization, 2) hospitalization without oxygen need, 3) hospitalization with any oxygen need or ventilation, or 4) death. Baseline covariates including age, sex, smoking, obesity, comorbidities (e.g., cardiovascular disease, cancer, interstitial lung disease [ILD]), concomitant non-biologic DMARD use, glucocorticoid use/dose, RA disease activity, country, and calendar time were used to estimate propensity scores (PS) for b/tsDMARD. The primary analysis used PS matching to compare each drug class to TNFi. Ordinal logistic regression estimated ORs for the COVID-19 severity outcome. In a sensitivity analysis, we used traditional multivariable ordinal logistic regression adjusting for covariates without matching.Results:Of the 1,673 patients with RA on b/tsDMARDs at the onset of COVID-19, (mean age 56.7 years, 79.6% female) there were n=154 on ABA, n=224 on RTX, n=306 on JAK, n=180 on IL6i, and n=809 on TNFi. Overall, 498 (34.3%) were hospitalized and 112 (6.7%) died. Among all patients, 353 (25.3%) were ever smokers, 197 (11.8%) were obese, 462 (27.6%) were on glucocorticoids, 1,002 (59.8%) were on concomitant DMARDs, and 299 (21.7%) had moderate/high RA disease activity. RTX users were more likely than TNFi users to have ILD (11.6% vs. 1.7%) and history of cancer (7.1% vs. 2.0%); JAK users were more likely than TNFi users to be obese (17.3% vs. 9.0%). After propensity score matching, RTX was strongly associated with greater odds of having a worse outcome compared to TNFi (OR 3.80, 95% CI 2.47, 5.85; Figure). Among RTX users, 42 (18.8%) died compared to 27 (3.3%) of TNFi users (Table). JAK use was also associated with greater odds of having a worse COVID-19 severity (OR 1.52, 95%CI 1.02, 2.28). ABA or IL6i use were not associated with COVID-19 severity compared to TNFi. Results were similar in the sensitivity analysis and after excluding cancer or ILD.Table 1.Frequencies for the ordinal COVID-19 severity outcome for patients with RA on biologic or targeted synthetic DMARDs (n=1673).COVID-19 outcomes by severity scale (n,%)ABAn=154RTXn=224JAKn=306IL6in=180TNFi n=8091)Not hospitalized113 (73.3%)121 (54.0%)220 (71.9%)150 (83.3%)666 (82.3%)2)Hospitalization without oxygenation10 (6.5%)14 (6.2%)11 (3.6%)9 (5.0%)53 (6.5%)3)Hospitalization with any oxygenation or ventilation16 (10.4%)47 (21.0%)52 (17.0%)16 (8.9%)63 (7.8%)4)Death15 (9.7%)42 (18.8%)23 (7.5%)5 (2.8%)27 (3.3%)Conclusion:In this large global registry of patients with RA and COVID-19, baseline use of RTX or JAK was associated with worse severity of COVID-19 compared to TNFi use. The very elevated odds for poor COVID-19 outcomes in RTX users highlights the urgent need for risk-mitigation strategies, such as the optimal timing of vaccination. The novel association of JAK with poor COVID-19 outcomes requires replication.Acknowledgements:The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the ACR, EULAR, the UK National Health Service, the National Institute for Health Research, the UK Department of Health, or any other organization.Disclosure of Interests:Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum, unrelated to this work, Grant/research support from: Amgen and Bristol-Myers Squibb, unrelated to this work, Zachary Wallace Consultant of: Viela Bio and MedPace, outside the submitted work., Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi, Andrea Seet: None declared, Milena Gianfrancesco: None declared, Zara Izadi: None declared, Kimme Hyrich Speakers bureau: Abbvie unrelated to this study, Grant/research support from: BMS, UCB, and Pfizer, all unrelated to this study, Anja Strangfeld Paid instructor for: AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work, Grant/research support from: grants from a consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB) supporting the German RABBIT register, outside the submitted work, Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, unrelated to this study, Grant/research support from: Lilly, Mylan, Pfizer, all unrelated to this study, Loreto Carmona: None declared, Elsa Mateus Grant/research support from: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer, outside the submitted work, Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Patti Katz: None declared, Lindsay Jacobsohn: None declared, Samar Al Emadi: None declared, Leanna Wise: None declared, Emily Gilbert: None declared, Ali Duarte-Garcia: None declared, Maria Valenzuela-Almada: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Philippe Dieudé Consultant of: Boerhinger Ingelheim, Bristol-Myers Squibb, Lilly, Sanofi, Pfizer, Chugai, Roche, Janssen unrelated to this work, Grant/research support from: Bristol-Myers Squibb, Chugaii, Pfizer, unrelated to this work, Elena Nikiphorou: None declared, Vanessa Kronzer: None declared, Namrata Singh: None declared, Manuel F. Ugarte-Gil Grant/research support from: Janssen and Pfizer, Beth Wallace: None declared, Akpabio Akpabio: None declared, Ranjeny Thomas: None declared, Suleman Bhana Consultant of: AbbVie, Horizon, Novartis, and Pfizer (all <$10,000) unrelated to this work, Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones, Jonathan Hausmann Consultant of: Novartis, Sobi, Biogen, all unrelated to this work (<$10,000), Jean Liew Grant/research support from: Yes, I have received research funding from Pfizer outside the submitted work., Emily Sirotich Grant/research support from: Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer based organization whose activities are largely supported by independent grants from pharmaceutical companies, Paul Sufka: None declared, Philip Robinson Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Pedro Machado Speakers bureau: Yes, I have received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Consultant of: Yes, I have received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Jinoos Yazdany Consultant of: Eli Lilly and AstraZeneca unrelated to this project
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Shezad M, Rosenthal D, Larkins C, Heile T, Zafar F, Jeewa A, Barnes A, Lorts A, Joong A, Kwiatkowski D, Sutcliffe D, Sparks J, Simpson K, Ploutz M, Ghanayem N, Niebler R, Davies R, Auerbach S. The Adjudication Process at ACTION - Providing Real-World High-Quality Data. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sparks J, Huang W, Lu B, Huang S, Cagan A, Gainer V, Finan S, Savova G, Solomon D, Karlson E, Liao K. OP0111 RHEUMATOID ARTHRITIS SEROLOGIC PHENOTYPE AT DIAGNOSIS AND SUBSEQUENT RISK FOR PNEUMONIA IDENTIFIED USING MACHINE LEARNING APPROACHES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with rheumatoid arthritis (RA) are at increased risk of serious infections, with considerable excess morbidity and mortality after pneumonia. RA-related autoantibodies such as anti-cyclic citrullinated peptide (CCP) and rheumatoid factor (RF) may be generated at inflamed pulmonary mucosa prior to clinical RA onset. Therefore, patients with seropositive RA may be at increased risk for pneumonia after RA diagnosis due to subclinical pulmonary injury.Objectives:We investigated whether seropositive RA was associated with increased pneumonia risk compared to seronegative RA.Methods:We performed a retrospective cohort study among RA patients seen at a health care system in Boston, MA. RA patients were identified using a previously validated electronic health record (EHR) algorithm incorporating billing codes, natural language processing (NLP) of notes, medications, and laboratory results at 97% specificity1. We constructed an incident RA cohort using NLP for the index date of initial mention of RA. All patients were required to have both CCP and RF data from clinical care to determine serologic RA phenotype. We used semi-supervised machine learning approaches to identify pneumonia using billing codes and terms extracted using NLP, with the Centers for Disease Control definition of pneumonia from medical record review as a gold standard. The area under the receiver operating curve (AUROC) for this billing code+NLP pneumonia algorithm was 0.94 compared to the standard rule-based pneumonia algorithm (billing code on inpatient discharge) AUROC of 0.86 (p<0.001). Smoking status was extracted using NLP methods. Other covariates, including a previous validated weighted RA multimorbidity score2, were determined using structured EHR data. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for pneumonia adjusting for potential confounders.Results:We analyzed a total of 4,110 patients with incident RA and both CCP/RF data available. Mean age at index date was 53.0 years (SD 14.8), 77.2% were female, and 79.8% were CCP+ or RF+. During 32,248 patient-years of follow-up (mean 7.8 years/patient), we identified 240 pneumonia cases. Patients with seropositive RA had a HR of 1.99 (95%CI 1.30-3.01, Table) for pneumonia compared to patients with seronegative RA, adjusted for age, sex, smoking, index year, ESR level, glucocorticoid use, DMARD use, and weighted RA multimorbidity score. While CCP+ RA (HR 1.91, 95%CI 1.23-2.97) and RF+ RA (HR 2.07, 95%CI 1.35-3.16) had increased pneumonia risk compared to seronegative RA, the CCP+RF- RA subgroup had no association with pneumonia (HR 0.67, 95%CI 0.23-1.93).Conclusion:Patients with incident seropositive RA, particularly RF+ RA, had increased risk for pneumonia throughout the RA disease course that was not explained by measured confounders including smoking status, multimorbidity, medications, and ESR level. Further studies should investigate how RF+ may predispose RA patients to later develop pneumonia after clinical RA diagnosis.References:[1]Liao KP, Cai T, Gainer V, et al. Electronic medical records for discovery research in rheumatoid arthritis. Arthritis Care Res. 2010;62(8):1120–1127.[2]Radner H, Yoshida K, Mjaavatten MD, et al. Development of a multimorbidity index: Impact on quality of life using a rheumatoid arthritis cohort. Semin Arthritis Rheum. 2015;45(2):167–173.Disclosure of Interests:Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Optum, Janssen, Gilead, Weixing Huang: None declared, Bing Lu: None declared, Sicong Huang: None declared, Andrew Cagan: None declared, Vivian Gainer: None declared, Sean Finan: None declared, Guergana Savova: None declared, Daniel Solomon Grant/research support from: Funding from Abbvie and Amgen unrelated to this work, Elizabeth Karlson: None declared, Katherine Liao: None declared
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Urschel S, McCoy M, Cantor R, Koehl D, Zuckerman W, Dipchand A, Reinhardt Z, Kanter K, Ballweg J, Sparks J, Kirklin J, Carlo W. ABO Incompatible Heart Transplantation in Young Children: Less Rejection and Infection. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Urschel S, McCoy M, Reinhardt Z, Dipchand A, Cantor R, Koehl D, Kirklin J, Ballweg J, Kanter K, Zuckerman W, Sparks J, Carlo W. ABO Incompatible Listing in Early Childhood Results in Earlier Transplantation and Equal Post-Transplant Survival Despite Predominant Use in Sicker Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Foster K, Bilir P, Kruger E, Kowal S, Holmes JH, Hickerson W, Nystrom S, Turley D, Sparks J, Iyer N, Quick A. 288 Cost-effectiveness (CE) of an Autologous Regenerative Epithelial Suspension (RES) versus Standard of Care (SOC) for Treatment of Severe Burns in the United States. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- K Foster
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - P Bilir
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - E Kruger
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - S Kowal
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - J H Holmes
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - W Hickerson
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - S Nystrom
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - D Turley
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - J Sparks
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - N Iyer
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
| | - A Quick
- University of Arizona College of Medicine, Phoenix, AZ; QuintilesIMS, San Francisco, CA; Wake Forest Baptist Medical Center, Winston-Salem, AZ; Memphis Medical Center, Memphis, TN; Office of Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (DHHS), Washington D.C, WA; Office of Assistant Secretary for Preparedness and Response (ASPR), US Dept. of
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Phillips K, Thrush P, Lal A, Kindel S, Castleberry C, Sparks J, Daly K, Johnson J. Marijuana in Pediatric and Adult Congenital Heart Transplant Listing: A Survey of Provider Practices and Attitudes. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Roberts T, Sparks J. Third Party HLA Antibody as a Surrogate Marker for Treatment of Non-HLA AMR. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Killeen J, Castillo E, Vilke G, Chan T, Dunford J, Kahn C, Powell R, Sparks J, Pringles J, Chavez D, Branning M. 3 Out-of-Hospital to Emergency Department Data Exchange: A SAFR Transition of Care. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rizzo M, Dawson JD, Uc EY, Anderson S, Philippi CL, Sparks J. Relative rates of visual and cognitive decline in Alzheimer's Disease. J Vis 2010. [DOI: 10.1167/6.6.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Philippi CL, Sparks J, Marron MA, Rizzo M. Effects of dorsal and ventral visual pathway lesions on visual vigilance. J Vis 2010. [DOI: 10.1167/6.6.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Severson M, Uc EY, Sparks J, Rizzo M. Effect of UFOV impairment on kinematics of curve driving. J Vis 2010. [DOI: 10.1167/7.9.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sparks J, Stammen J, Herriott R, Jones K, Bolte J. Blunt hepatic trauma—Investigating the relationship between intravascular pressure and liver injury severity. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)83544-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Eye Movement Desensitization and Reprocessing (EMDR) as a clinical technique may enhance treatment effectiveness when applied within a couple therapy approach that is emotionally and experientially oriented. Clinical experience indicates that EMDR-based interventions are useful for accessing, activating, tolerating, and reprocessing the intense emotions that often fuel dysfunctional couple interactions. Using EMDR within conjoint sessions to reprocess negative emotions can amplify intimacy, increase connection, and subsequently lead to a change in problematic relationship patterns.
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Affiliation(s)
- H Protinsky
- Marriage and Family Therapy Doctoral Program, Virginia Tech, 840 University City Blvd., Suite 1 (0515), Blacksburg, VA 24061, USA.
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Kujdych N, Lowe DA, Sparks J, Dottes A, Crook ED. Dignity or denial? Decisions regarding initiation of dialysis and medical therapy in the institutionalized severely mentally retarded. Am J Med Sci 2000; 320:374-8. [PMID: 11149549 DOI: 10.1097/00000441-200012000-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Decisions regarding health care of the severely mentally retarded can be difficult. We present 2 cases of patients with severe mental retardation who lived in long-term care facilities. Both patients had progressive loss of renal function and eventually reached end-stage renal disease. In each case, the decision was made not to initiate dialysis. We discuss issues of dialysis and medical care of the severely mentally retarded and advocate using the principles of "best respect" and "best interest" in making medical decisions in this population.
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Affiliation(s)
- N Kujdych
- University of Mississippi School of Pharmacy, Oxford 39216, USA
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40
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Sparks J, Rea T. Ischemic stroke: acute management and secondary prevention. Am J Manag Care 2000; 6:234-46; quiz 247-8. [PMID: 10977422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- J Sparks
- Department of Medicine, University of Washington, Seattle, USA
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41
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Weber K, Eisman R, Morey L, Patty A, Sparks J, Tausek M, Zeng ZB. An analysis of polygenes affecting wing shape on chromosome 3 in Drosophila melanogaster. Genetics 1999; 153:773-86. [PMID: 10511557 PMCID: PMC1460793 DOI: 10.1093/genetics/153.2.773] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Loci on the third chromosome of Drosophila melanogaster that affect an index of wing shape were mapped, using recombinant isogenic lines, with transposable elements as markers. Many genes with small subequal effects are dispersed along the whole chromosome. Their alleles act nearly additively in heterozygotes. They have small correlated effects on leg shape, but no detectable effects on halteres. Small negative net interactions occur over most of the chromosome. The data set of 519 recombinant isogenic lines can be explained reasonably well by two models. One model posits an indefinitely large number of loci with no interactions. The other model posits 11 loci with additive effects whose sum equals the total phenotypic range and with large positive and negative interactions that nearly cancel each other.
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Affiliation(s)
- K Weber
- Department of Biological Sciences, University of Southern Maine, Portland, Maine 04104-9300, USA.
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42
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Blumberg P, Sparks J. Tracing the evolution of critical evaluation skills in students' use of the Internet. Bull Med Libr Assoc 1999; 87:200-5. [PMID: 10219480 PMCID: PMC226559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This paper documents the evolving uses of the Internet made by public health graduate students and traces the development of their search methods and critical evaluative criteria. Early in the first semester and again six months later, twenty-four graduate students in a problem-based learning curriculum, which emphasizes evidence-based critical thinking skills, were required to describe their most helpful resources and to evaluate these resources critically. The answers were coded for the types of resources the students used, how frequently they were used, and why they were used. Student perception of the usefulness of resources, especially the Internet, and ability to evaluate these resources critically changed greatly. Initially, 96% of the students stated that the Internet was their most helpful resource. Six months later, these students continued to use the Internet; however, it was not their most useful source. At the later point, students had very specific uses for the Internet. Their most frequently used evaluation criterion was the reliability and objectivity of the source of the information. By the end of the first year of study, the majority of the students demonstrated an understanding of the principles of evidence-based practice and applied them to their research and analysis of information resources.
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Affiliation(s)
- P Blumberg
- School of Public Health, MCP Hahnemann University, Philadelphia, Pennsylvania 19102, USA
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Phillips S, McMillen C, Sparks J, Ueberle M. Concrete strategies for sensitizing youth-serving agencies to the needs of gay, lesbian, and other sexual minority youths. Child Welfare 1997; 76:393-409. [PMID: 9130379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In the past few years, several authors have detailed the needs of gay and lesbian youths and the obstacles youth-serving agencies face in addressing their needs. How administrators and practitioners can make changes in agencies that are not adequately serving sexual minority youths has been unclear. This article uses the experiences of two youth-serving agencies to offer recommendations on agency philosophies concerning the social realities of sexual minority youths and on several ways of creating a safe, welcoming, and productive environment.
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Affiliation(s)
- S Phillips
- Clinical Services, Youth in Need, St. Charles, MO, USA
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45
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Kurz ME, Schultz S, Griffith J, Broadus K, Sparks J, Dabdoub G, Brock J. Effect of background interference on accelerant detection by canines. J Forensic Sci 1996; 41:868-73. [PMID: 8789850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Additional studies were performed with respect to examining the lower limits at which canines can reliably detect products commonly used as accelerants and distinguish them from pyrolysis products or background hydrocarbons. As part of a testing exercise performed in conjunction with a national conference of the Canine Accelerant Detection Association (CADA), 34 canines were subjected to a series of tests, some of them were a recertification proficiency. In one of the tests, the dogs were nearly unanimously successful in locating one can (out of five) containing 50% evaporated gasoline at the 5 microL level on a burnt carpet matrix, and pinpointing the 6-in. square sector on a piece of plain carpeting where the same amount of gasoline (5 microL) was applied. However, only half were able to detect a second doped sample containing a lesser amount (0.05, 0.1, or 0.2 microL) of gasoline, and registered a number of alerts on samples containing only burnt carpeting material. The dogs were also tested on measured amounts (2 or 5 microL) of a variety of other light, medium, and heavy petroleum products applied to a variety of substances containing significant pyrolysis products. As a group, the canines were much less successful in pinpointing these products than they were with gasoline at this same level, and again registered a number of alerts on cans containing only pyrolysis products. The significant number of alerts by canines on samples not containing gasoline or other products points out the importance of obtaining laboratory confirmation on samples on which dogs alert, and on keeping accurate field and training records of canines to establish their credibility.
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Affiliation(s)
- M E Kurz
- Department of Chemistry, Illinois State University, Normal 61790, USA
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Melvin WS, Johnson JA, Sparks J, Innes JT, Ellison EC. Long-term prognosis of Zollinger-Ellison syndrome in multiple endocrine neoplasia. Surgery 1993; 114:1183-8. [PMID: 7903006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The long-term prognosis of Zollinger-Ellison Syndrome (ZES) is not well defined. The findings of other endocrinopathies, the need for long-term surveillance, and the role of surgical treatment are controversial. METHODS To help provide more information about these topics the records of 76 patients with ZES were reviewed. RESULTS Nineteen patients with gastrinoma had multiple endocrine neoplasia (MEN). Fifteen had hyperparathyroidism from 14 years before to 38 years after the diagnosis of ZES. Three patients had pituitary adenomas. The unusual findings of pheochromocytoma were also seen in three patients. Sixteen patients were followed at least 10 years and 12 were followed for more than 20 years. Surgical cure was achieved in only one patient after a 12-year follow-up. The actual 5-, 10-, 15-, and 20-year survival rates of 94%, 75%, 61%, and 58%, respectively, were compared with patients with sporadic ZES with 5-, 10-, 15-, and 20-year survival rates of 62%, 50%, 37%, and 31%, respectively. CONCLUSIONS Multiple endocrinopathies are common but are rarely diagnosed synchronously, mandating life-long surveillance for patients with ZES. Long-term prognosis is good. Survival is longer for patients with ZES and MEN compared with patients with sporadic ZES. Surgical cure is rare. Surgical excision without a single localized lesion does not seem justified.
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Affiliation(s)
- W S Melvin
- Ohio Digestive Disease Institute, Ohio State University, Columbus 43210-1228
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47
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Wise SR, Johnson J, Sparks J, Carey LC, Ellison EC. Gastrinoma: the predictive value of preoperative localization. Surgery 1989; 106:1087-92; discussion 1092-3. [PMID: 2686059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In the management of gastrinoma, a variety of preoperative tests for tumor localization are recommended. Their value in predicting surgical outcome is not well defined. We reviewed the preoperative investigation and operative outcome in 23 patients to assess the predictive value of localization before surgery. With results of laparotomy used as reference, the efficacy of computed tomography, angiography, ultrasonography, and magnetic resonance imaging, individually and combined for primary and metastatic disease, was determined. All investigative modalities were poor for the detection of primary gastrinomas, with individual sensitivities in the range of 20% to 29%. Their combined sensitivity was 53%, with a negative predictive value of only 38%. The detection of metastatic disease was better, with a combined accuracy of 83%. At laparotomy, tumor was identified in 19 of 23 (83%) patients. In 14 patients with negative preoperative workup, primary gastrinoma was found in 10 of 14 (71%) and resected for long-term cure in three of 14 (21%) patients. In all nine patients with positive preoperative test results, tumor was found and was resected for cure in four (44%) patients. In conclusion, preoperative localization of primary gastrinoma is unreliable, and a negative workup does not preclude cure. Therefore, despite the availability of effective palliative antiulcer therapy, all patients exclusive of those with multiple endocrine neoplasia, type I, or metastasis should undergo laparatomy with curative resection in mind.
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Affiliation(s)
- S R Wise
- Ohio Digestive Disease Institute, Grant Medical Center, Columbus 43215
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Campagnolo D, Gower WR, Fabri PJ, Sparks J, Mekhjian HS, O'Dorisio TM, Ellison EC. Effect of somatostatin analogue (SMS 201-995) on molecular species of gastrin in gastrinoma. Surgery 1987; 102:982-7. [PMID: 2891204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Somatostatin analogue (SMS 201-995) has been shown to decrease total serum gastrin in patients with gastrinoma; however, the gastrin level rarely returns to normal, despite the near-complete inhibition of acid secretion. This implies that SMS may have an inhibitory action on the biologically active molecular species of gastrin and have little effect on biologically inactive species. To test this hypothesis, we determined the effect of SMS on the molecular species of gastrin in eight patients with the Zollinger-Ellison syndrome. Serum obtained before treatment and 6 hours and 18 hours after treatment (SMS 1 microgram/kg, subcutaneously) was sampled and assayed for molecular species of gastrin by means of gel filtration chromatography and fractional quantitation of gastrin species by radioimmunoassay. There was a significant decrease in the amount of G-34 and G-17 species. BBG and G-14 decreased, a change not significant at 6 hours but significant 18 hours after SMS. The distribution of the various molecular species as a percent of total immunoreactive gastrin was analyzed before and after SMS. There was a shift in the distribution of the molecular species, so that 6 hours after SMS treatment nearly 50% of total gastrin activity was accounted for by BBG and component I. SMS seems to have a different potency to inhibit release of the various gastrin molecular species. This observation may explain the failure of total gastrin levels to return to normal after SMS treatment in patients with the Zollinger-Ellison syndrome.
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Affiliation(s)
- D Campagnolo
- Department of Surgery, Ohio State University College of Medicine, Columbus
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49
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Abstract
Recombinant human interleukin-2 (IL-2) expressed as Escherichia coli was isolated as insoluble aggregates of protein (inclusion bodies) after cell breakage. IL-2 and contaminants were dissolved in 6 M-guanidinium chloride/10 mM-dithiothreitol, pH 8.5, and further purified in reduced and denatured form by gel-permeation chromatography in the same solvent. Renaturation was effected by dilution and autoxidation; IL-2 of native specific activity was isolated at over 95% purity by reversed-phase h.p.l.c.; an additional peak of reduced protein was also observed. Most losses of native IL-2 occurred on refolding, probably because of an aggregation process; concentrations around 1 microgram/ml were necessary to achieve 30% recovery. It was essential to maintain the denatured protein in reduced form before renaturation and autoxidation, which was most efficient at pH 8.5 with 1.5 microM-CuSO4. A procedure based on these observations has been used to prepare IL-2 on the 50 micrograms scale.
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Affiliation(s)
- M P Weir
- Department of Biotechnology, Glaxo Group Research, Greenford, Middx., U.K
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50
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Abstract
Recombinant Interleukin-2 (IL-2) is expressed in E. coli as insoluble aggregates; a protocol has been developed for solubilization, renaturation and purification of IL-2 from such aggregates at the 5-10-mg level. IL-2 aggregates were isolated from soluble proteins by centrifugation, subjected to a 1 M guanidine hydrochloride wash and a butan-1-ol wash (the latter to remove lipid), dissolved in 8 M guanidine hydrochloride-10 mM dithiothreitol and partly purified by gel permeation chromatography. Refolding/oxidation was then performed by dilution into Tris-HCl, pH 8.5 containing 1.5 microM copper sulphate to accelerate autoxidation. Final purification was by successive cation-exchange and reversed-phase high-performance liquid chromatographic steps, yielding over 99.5% pure IL-2 with an overall recovery of 20%.
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