BCD020 rituximab bioanalog compared to standard treatment in juvenile systemic lupus erythematosus: The data of 12 months case-control study

BACKGROUND

Systemic lupus erythematosus (SLE) is the most frequent and serious systemic connective tissue disease. Nowadays there is no clear guidance on its treatment in childhood. There are a lot of negative effects of standard-of-care treatment (SOCT), including steroid toxicity. Rituximab (RTX) is the biological B-lymphocyte-depleting agent suggested as a basic therapy in pediatric SLE.

AIM

To compare the benefits of RTX above SOCT.

METHODS

The data from case histories of 79 children from the Saint-Petersburg State Pediatric Medical University from 2012 to 2022 years, were analyzed. The diagnosis of SLE was established with SLICC criteria. We compared the outcomes of treatment of SLE in children treated with and without RTX. Laboratory data, doses of glucocorticosteroids, disease activity measured with SELENA-SLEDAI, and organ damage were assessed at the time of initiation of therapy and one year later.

RESULTS

Patients, treated with RTX initially had a higher degree of disease activity with prevalence of central nervous system and kidney involvement, compared to patients with SOCT. One year later the disease characteristics became similar between groups with a more marked reduction of disease activity (SELENA-SLEDAI activity index) in the children who received RTX [-19 points (17; 23) since baseline] compared to children with SOCT [-10 (5; 15.5) points since baseline, P = 0.001], the number of patients with active lupus nephritis, and daily proteinuria. During RTX therapy, infectious diseases had three patients; one patient developed a bi-cytopenia.

CONCLUSION

RTX can be considered as the option in the treatment of severe forms of SLE, due to its ability to arrest disease activity compared to SOCT.

Rituximab Biosimilar BCD020 Shows Superior Efficacy above Conventional Non-Biologics Treatment in Pediatric Lupus Nephritis: The Data of Retrospective Cohort Study

BACKGROUND

Pediatric lupus nephritis (LN) is one of the most serious manifestations of systemic lupus erythematosus (SLE) in children, determining the outcomes of the disease. There are no standardized treatment protocols for pediatric LN, and the role of biologics has not yet been conclusively defined.

OBJECTIVES

analyze the safety and efficacy of rituximab biosimilar BCD020 in pediatric patients with lupus nephritis.

METHODS

in a retrospective cohort study, the data from the case histories of 25 patients with LN (10 boys and 15 girls) with an onset age of 13 (9-16) years, who failed conventional non-biologic treatment or developed corticosteroid dependence/toxicity, were included. The diagnosis was made using Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. Rituximab biosimilar BCD020 was prescribed in a dosage of 375 mg/m² every week (2-4 infusions) with repeated courses every 6-12 months (2-4 infusions) according to disease activity, B-cell depletion, and IgG levels. The dynamics of clinical and laboratory data, the activity of the disease by SLEDAI, and corticosteroid doses were assessed at the onset and during the rituximab trial.

RESULTS

The main patient's characteristics were: Pre-rituximab non-biologic conventional treatment included: cyclophosphamide 15 (60%), MMF 8 (32%), azathioprine 3 (12%), hydroxychloroquine 12 (48%), and pulse therapy of methylprednisolone followed by oral methylprednisolone 25 (100%). The time before rituximab was 7.0 (3.0-24.0) months, and the whole observation period was 7.0 (0; 24) months. The initial pre-rituximab treatment slightly reduced SLEDAI levels and the proportion of patients with LN. A significant reduction of SLEDAI, the anti-dsDNA level, proteinuria, hematuria, C4 complement, ESR, and the median corticosteroid dose by 80% from the initial value, as well as the proportion of patients without corticosteroids, was observed after rituximab administration. Two deaths were observed due to catastrophic SLE with macrophage activation syndrome, accompanied by a severe infection (invasive aspergillosis, n = 2). Three patients developed serious adverse events: pneumonia (n = 2), transient agranulocytosis (n = 1) after the third rituximab infusion, and meningitis, caused by Listeria monocytosis, after the first rituximab infusion. Eight patients received antibacterial treatment for different respiratory infections without hospital admissions.

CONCLUSIONS

Rituximab biosimilar BCD020 showed effectiveness in LN, whereas previous non-biologic treatment was insufficiently effective. Randomized controlled trials are required to evaluate the efficacy and safety of rituximab and evaluate the benefits when compared with conventional SLE treatment.

Antidiabetic Properties of Plant Secondary Metabolites

The prevalence of diabetes mellitus is one of the major medical problems that the modern world is currently facing. Type 1 and Type 2 diabetes mellitus both result in early disability and death, as well as serious social and financial problems. In some cases, synthetic drugs can be quite effective in the treatment of diabetes, though they have side effects. Plant-derived pharmacological substances are of particular interest. This review aims to study the antidiabetic properties of secondary plant metabolites. Existing review and research articles on the investigation of the antidiabetic properties of secondary plant metabolites, the methods of their isolation, and their use in diabetes mellitus, as well as separate articles that confirm the relevance of the topic and expand the understanding of the properties and mechanisms of action of plant metabolites, were analyzed for this review. The structure and properties of plants used for the treatment of diabetes mellitus, including plant antioxidants, polysaccharides, alkaloids, and insulin-like plant substances, as well as their antidiabetic properties and mechanisms for lowering blood sugar, are presented. The main advantages and disadvantages of using phytocomponents to treat diabetes are outlined. The types of complications of diabetes mellitus and the effects of medicinal plants and their phytocomponents on them are described. The effects of phytopreparations used to treat diabetes mellitus on the human gut microbiota are discussed. Plants with a general tonic effect, plants containing insulin-like substances, plants-purifiers, and plants rich in vitamins, organic acids, etc. have been shown to play an important role in the treatment of type 2 diabetes mellitus and the prevention of its complications.

Meaning of life as a resource for coping with psychological crisis: Comparisons of suicidal and non-suicidal patients

Introduction

Meaning is an important psychological resource both in situations of accomplishment and in situations of ongoing adversity and psychological crisis. Meaning in life underlies the reasons for staying alive both in everyday and in critical circumstances, fulfilling a buffering function with respect to life adversities.

Aim

The aim of the present study was to reveal the role of both meaningfulness, including specific sources of meaning and reasons for living, and meaninglessness (alienation) in patients suffering from profound crisis situations with or without suicidal intentions and behavior.

Methods

The sample included 148 patients (all Caucasian) who were referred to a crisis center in Moscow, Russia. Seventy-seven patients (54 females, mean age 32.00 ± 11.98 years) reported a current crisis situation in their life but denied suicidal thoughts or behavior. Twenty-nine patients (21 females, mean age 31.55 ± 13.76 years) reported suicidal ideations but denied suicidal attempts or self-harming behavior. Forty-two patients (31 females, mean age 30.64 ± 11.38 years) had episodes of suicidal attempts or self-harming behavior accompanied by suicidal intentions. There were no significant gender or age differences between groups.

Participants completed a number of measures of different aspects of meaning and meaninglessness, well-being, ill-being and psychological resources. For some patients (N = 74), a clinical checklist was completed by their doctors assessing 28 various characteristics associated with the patient’s clinical status.

Results and discussion

Meaningfulness and reasons for living were more helpful in distinguishing between reactions to profound crisis situations (suicidal intentions versus non-suicidal behavior) than were measures of well-being, ill-being, meaning crisis or personality resources. In both suicidal and non-suicidal crisis patients meaningfulness predicted more positive reasons for living. The relationship between meaningfulness and most reasons for living remained significant after controlling for clinically appraised suicidal “readiness,” acute stress and lack of social support. Self-transcendence was the major specific source of meaning predicting higher reasons for living after adjusting for general meaningfulness.

Conclusion

The data cast some light on the psychological meaning of suicide. It follows that prevention efforts are to be focused not on eliminating the factors “pushing” one to suicidal behavior, but rather on supporting inner strengths conducive of a positive decision, to be, through enhancing meaningfulness and reasons for living.

POS1320 SAFETY AND EFFICACY OF RITUXIMAB IN PATIENTS WITH JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS: THE PRELIMINARY DATA OF RETROSPECTIVE COHORT STUDY

Background

juvenile systemic lupus erythematosus (jSLE) is the most frequent pediatric connective tissue disease with multiorgan involvement and different outcomes and prognosis. Corticosteroids remain the base treatment option and steroid-sparing treatment is strongly required to avoid steroid toxicity. Rituximab (RTX) is one of biologics, which efficacy was proved in case reports and case series of SLE, but no data from big randomized trials, confirming the efficacy have existed.

Objectives

to evaluate safety and efficiency of RTX in jSLE.

Methods

in the retrospective observation study the information of 48 jSLE patients (12 boys, 36 girls) who received at least one RTX dose before 18 years, included. Diagnosis was made using SLICC criteria. The main indications for RTX were high disease activity with lupus nephritis (LN), CNS and hematology disturbances (hemolytic anemia, thrombocytopenia) and avoiding steroid toxicity. RTX was prescribed in dosage 375 mg/m2 every week (2-4 infusions) with repeated courses every 6-12 months according disease activity, the degree of B-cell depletion and hypoIgG-emia. The dynamics of clinical, laboratory data, activity of the disease by SLEDAI, GCS doses were assessed in the onset and during RTX trial.

Results

The main patient’s characteristics were: onset age 13.0 (11.5; 15.0) years, inclusion age 18.0 (16.0; 20.0) years, LN 25 (52%)/III+IV class 9/11 (82%), CNS involvement 26 (54%). Pre-RTX non-biologic conventional treatment includes: cyclophosphamide 24 (50%), MMF 14 (29%), azathyoprine 7 (15%), methotrexate 6 (13%), cyclosporine A 2 (4%). Observation period ranged from 6 months to 6 years with median time 0.75 (0.2; 2.75) years. Initial pre-RTX treatment (GCS, hydroxychloroquine, non-biologic DMARDS) partially reduced SLE activity (SLEDAI, ANA titer, anti-dsDNA level), and median GCS dose by 25% from the initial dose, without changes in proteinuria, hematuria, C3, C4, WBC, hemoglobin, PLT and ESR levels. Administration of the RTX realized in prominent reducing of SLEDAI, anti-dsDNA level, proteinuria, hematuria, C4, ESR, number of patients with anemia, thrombocytopenia, and median GCS dose by 90% from the initial. The hemoglobin level and WBC have increased. 19 patients received IVIG for treatment of MAS (n=3), infection (n=5) and as replacement treatment in cases where IgG<4.5 g/l (n=11). 3 deaths were observed due to catastrophic SLE with MAS, accompanied severe infection (invasive aspergillosis, n=2). 6 patients realized SAE: pneumonia (n=3), transient agranulocytosis (n=1) after 3rd RTX infusion and meningitis, caused by Lysteria monocytogenis, after 1st RTX infusion (further RTX treatment continued without adverse events), patella osteomyelitis (n=1). 10 patients received antibiotics for respiratory infections. On pre-RTX 13 had antibiotics (p=1.0).

Table 1.

Dynamics of SLE features pre-RTX and during RTX trial

ParameterSLE onsetRTX (baseline)pLast visitp*SLEDAI16 (11.0; 23.5)13.5 (6.5; 21.5)0.00024 (0; 8.0)0.00002Patients with elevated anti-dsDNA n, (%)33 (69)20 (42)0.00811 (23)0.034Anti-dsDNA, U/ml (n.v.<25)112 (1; 200)24.7 (1; 130)0.0590 (0; 27)0.008Proteinuria, g/l2.6 (0.8; 4.4)3.8 (0.3; 7.5)0.6870 (0; 0.2)0.004Hematuria, # cells40 (8; 86)50 (6; 120)0.1910 (0; 1)0.0016C4, g/l0.12 (0.1; 0.24)0.12 (0.06; 0.19)0.3980.15 (0.11; 0.21)0.016Patients with leucopenia, n(%)12 (25)10 (21)0.6295 (10)0.00001Patients with anemia n (%)19 (40)16 (33)0.097 (15)0.0015Hemoglobin, g/l113 (95;131)115 (91; 132)0.830128 (107; 134)0.063Patients with thrombocytopenia n (%)17 (35)9 (19)0.0052 (4)0.00001ESR, mm/h17 (8; 31)15 (7; 22)0.1347 (2; 20)0.054Patients with GCS therapy n, (%)45 (94)45 (94)1.040 (83)0.00001GCS, mg/kg1.0 (0.6; 1.0)0.75 (0.2; 1.0)0.0350.1 (0.08; 0.28)0.000001

*compare to RTX baseline

Conclusion

RTX showed effectiveness in the cases, where previous non-biologic treatment was insufficiently effective. Randomized controlled trials are required to evaluate the efficacy and safety of RTX.

Acknowledgements

This research was funded by the Ministry of Science and Higher Education of the Russian Federation (Agreement No. 075-15-2020-901)

Disclosure of Interests

None declared

Algae: Study of Edible and Biologically Active Fractions, Their Properties and Applications

The beneficial properties of algae make them perfect functional ingredients for food products. Algae have a high energy value and are a source of biologically active substances, proteins, fats, carbohydrates, vitamins, and macro- and microelements. They are also rich in polyunsaturated fatty acids, proteins, mycosporine-like amino acids, polysaccharides, polyphenols, carotenoids, sterols, steroids, lectins, halogenated compounds, polyketides, alkaloids, and carrageenans. Different extraction parameters are used depending on the purpose and the substances to be isolated. In this study, the following parameters were used: hydromodule 1:10 and an extraction duration of 1-2 h at the extraction temperature of 25-40 °C. A 30-50% solution of ethanol in water was used as an extractant. Algae extracts can be considered as potential natural sources of biologically active compounds with antimicrobial activity and antiviral properties. The content of crude protein, crude fat, and carbohydrates in U. Prolifera, C. racemosa var. peltata (Chlorophyta), S. oligocystum and S. fusiforme (SF-1) was studied. It was found that C. muelleri (Bacillariophyta), I. galbana (Haptophyta), and T. weissflogii (Bacillariophyta) contain about 1.9 times more omega-3 than omega-6 fatty acids. N. gaditana (Ochrophyta), D. salina (Chlorophyta), P. tricornutum (Bacillaryophyta) and I. galbana (Haptophyta) extracts showed inhibitory activity of varying intensities against E. coli or P. aeruginosa. In addition, algae and algae-derived compounds have been proposed to offer attractive possibilities in the food industry, especially in the meat sector, to evolve functional foods with myriad functionalities. Algae can increase the biological activity of food products, while the further study of the structure of compounds found in algae can broaden their future application possibilities.

POS0080 TOFACITINIB TREATMENT IN CHILDREN WITH RHEUMATIC DISEASES: SINGLE-CENTER EXPERIENCE

Background:

While efficacy of tofacitinib (TOF) has been proven in many adult immune-mediated conditions, the information on its’ safety and efficacy in the pediatric population is limited.

Objectives:

to evaluate the safety and efficacy of TOF in children with immune-mediated diseases.

Methods:

from 23 children whom TOF has been initiated, 17 children with treatment duration of > 6 months were extracted including 16 girls and 1 boy with the following diagnosis: JIA (n=10), autoinflammatory diseases (AID) (n=5) and juvenile dermatomyositis (JDM) (n=2) due to impossibility to taper corticosteroids (CS) or previous biologic treatment failed. The treatment outcome was classified according to the opinion of the attending physicians as complete response (CR) i.e., the absence of disease activity, partial response (PR) – a significant improvement of symptoms and disease activity or no response (NR) - no changes in disease activity.

Results:

Mean duration of TOF treatment was 25.4±18.9 months. TOF was used as monotherapy in 3 cases, in combination with methotrexate (MTX) in 6, and in combination with other biologics in 3 children: tocilizumab (n=2) and canakinumab (n=1). Nine patients received CS. (Table 1). In two JIA patients with alopecia TOF induced intensive hair growth and controlled joint inflammation. 9 patients had CR: AID (n=3), JIA (n=4) and JDM(n=1): 7 patients had PR and 1 was NR. 13 patients had a previous history of several subsequent failed biologic: 4 biologics (n=1), 3 biologics (n=6), 2 biologics (n=1), 1 biologic (n=5). TOF treatment allowed discontinuation of CS in patient#6 and reducing the CS in 8/10 patients from 0.4 ±0.27 mg/kg to 0.15±0.1 mg/kg in 3.7±3.4 times: in 2 cases the tapering of steroids failed (Figure 1). 4 patients had side effects not requiring treatment discontinuation: liver enzymes elevation (n=2), hypercholesterolemia (n=1), lymphadenitis (n=1). In pt#6 after achievement of the remission the TOF dosage was decreased up to 2 times and tocilizumab intervals were increased up to 6 weeks.

Table 1.#DiagnosisIndicationPrevious biologicsCurrent treat-mentTOF, dose, mg/kgDurationof TOF treatment, monthsGeneticvariantsdetectedEfficacy1AIDSevere inflamma-tion, aortitis, colitisINX, TCZ, ADACS, TOF0.57NOD2 c.2578G>A (p.A860T); NOD2 c.2722G>C (p.G908R)ADA2 c.927G>A (p.M309I)PR2JDMrecurrent skin rashCS, TOF, MTX0.55PR3JDMskin involvement, ulcerationCS, MTX, TOF0.77NLRP12c.154G>A (p.G52S)CR4AID,IFPskin rash, recurrent inflammation, failure to thriveCAN, TCZCS, TOF, CAN0.532RNASEH2Bc.916dupA (p.I309Nfs*7)CR5JIA,polysevere arthritisETA,TCZ, ADATOF,TCZ0.2722PR6soJIAresistant to CS and biologic systemic inflammation, arthritisTCZ, ABC, CANTOF, TCZ0.423PR7JIA,poly (RF+) alopeciaSevere arthritis, lung involvement,alopeciaETA, ABC, TCZ, ADATOF, MTX, CS0.337IL1RN c.10G>C (p.A4P); NLRP3 c.2113C>A (p.Q705L); MEFV c.1105C>T (p.P369S)CR8IFP, CANDLE-likerecurrent inflammation, digital ischemia, ulcers, CS-dependencyETA, RTX, CANTOF, CS0.2543MDA5NLRP3CR9AID, IFPsystemic inflammation, ulcersETATOF, CS0.513СR10JIA, ERAarthritisETATOF, MTX0.244CR11JIA, polyarthritisABC, ETATOF, MTX0.2538CR12JIA, polyArthritis, alopeciaETATOF0.1531PR13soJIA + MASsystemic inflammation, arthritisTCZ, CAN, ETATOF, CS0.538NR14JIA, polyarthritisINX, ETA, ADA, TCZTOF, MTX0.224PR15AIDSystemic inflammation, CS-dependencyTCZTOF,CS0.521STAT3, c1343A>CPR16JIA, ERAarthritisETATOF0.2521PR17JIA, polyarthritisADA, TCZ, ETATOF0.1539СRFigure 1.

Conclusion:

Tofacitinib is a promising agent in treating pediatric rheumatic diseases. In our study the best results were in AID patients with rare alleles in interferon pathway genes, patients with arthritis and alopecia and in children with JDM. Future studies are needed to identify clear indications for treatment with JAK-inhibitors.

Acknowledgements:

This work was supported by the RSF grant №20-45-01005.

Disclosure of Interests:

None declared.

AB0748 ARE ANY DIFFERENCES BETWEEN JIA - ASSOCIATED UVEITIS, DEVELOPED BEFORE AND AFTER JOINT MANIFESTATION

Background:

Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA). Usually uveitis developed during first two years after arthritis occurred [1]. In the previous studies was shown the shorter time interval between arthritis and uveitis the severe uveitis course was observed [2]. Information about course of uveitis developed before arthritis is scarce.

Objectives:

We aimed to evaluate the clinical features and therapy of JIA-associated uveitis, which developed before and after joint manifestation.

Methods:

In the retrospective study 191 pediatric autoimmune uveitis included. The onset age ranged from 1 to 17 years. We evaluated differences in clinical, laboratorial and treatment differences between groups, i) where uveitis developed before (n=58) and ii) after (n=133) arthritis. Chronic autoimmune uveitis without joint manifestations was excluded.

Results:

Uveitits before arthritis developed in 58 (30.4%) cases. Patients whom uveitis developed before arthritis had were elder and characterized equal gender involvement, rare ANA positivity, and rare use of immunosupression, e.g. corticosteroids, biologics and methotrexate, due to treatment by ophthalmologist predominantly. Patients developed uveitis before arthritis received biologics earlier due to severity of uveitis (LogRank test, p=0.016, HR=1.97 (95%CI: 1.3; 3.1, p=0.004). Data are in the Table 1 and Figure 1.

Conclusion:

Patients with JIA associated uveitis with initial ocular presentation demonstrated more severe course and delayed diagnostics and treatment due to lack of contacts with pediatric rheumatologist. Cooperation between ophthalmologist and pediatric rheumatologist is strictly required in all cases with chronic anterior uveitis.

Table 1.Table 1.ParameterUveitis before arthritis (n=58)Uveitis after arthritis (n=133)pSex, female32 (55,2)97 (72,9)0.016Onset age, years6.7 (4.6; 10.2)3.2 (2; 6.1)0.000001JIA categoryOligoarthritis41 (70.7)84 (63.6)0.174Polyarthritis9 (15.5)36 (27.3)Enthesytis-related arthritis8 (13.8)12 (9.1)Type of uveitisAnterior44 (75.9)111 (84.1)0.315Peripheral3 (5.2)2 (1.5)Posterior3 (5.2)3 (2.3)Panuveitis8 (13.8)16 (12.1)Unilateral uveitis, n (%)19 (32.8)48 (36.1)0.632ANA posititivity, n (%)25/54 (46.3)72/110 (65.5)0.019HLA B27 positivity, n (%)8/35 (22.9)13/62 (21.0)0.828Methotrexate, n (%)3 (5.2)57/132 (43.2)0.0000001Systemic corticosteroids, n (%)3 (5.2)44/131 (33.6)0.00003Biologic, n (%)26 (44.8)88 (66.2)0.006ESR, mm/h19.0 (4.0; 25.0)23 (15.0; 32.0)0.095CRP, mg/l97.0 (0.1; 107.5)8.1 (0.9; 57.4)0.493Time between arthritis and uveitis, years2.7 (0.9; 4.3)4.0 (2.0; 7.1)0.016Time before biologic, years2.5 (0.9; 3.5)1.3 (0.5; 5.0)0.462

This work supported by the Russian Foundation for Basic Research (grant № 18-515-57001).

References:

[1]Verazza S, et al. Pediatr Rheumatol Online J 2008;6(Suppl 1):77.

[2]Zannin ME, et al. Acta Ophthalmol 2012;90:91-5.

Disclosure of Interests:

None declared

Figure 1.

POS1310 CANAKINUMAB IS A RESCUE TREATMENT FOR MACROPHAGE ACTIVATION SYNDROME IN PATIENTS WITH SYSTEMIC ONSET JUVENILE IDIOPATHIC ARTHRITIS: SINGLE CENTER EXPERIENCE

Background:

Macrophage activation syndrome (MAS) is a severe life-threatening complication of the systemic-onset juvenile idiopathic arthritis (soJIA). The treatment options included high-dose of the corticosteroids (CS), cyclosporine A (CsA), intravenous immunoglobulin (IVIG) and biologics, predominantly IL-1 antagonist – anakinra. In Russia anakinra has not approved yet, so canakinumab (CAN) is a single anti-IL-1 option, available in Russia.

Objectives:

To evaluate the safety and efficacy of canakinumab in patients with severe MAS in soJIA, who failed the previous treatment.

Methods:

In the retrospective case series study were included 9 soJIA patients (4 boys and 5 girls) with severe MAS, resistant to combination of high-dose CS, IVIG and CsA.

Results:

All patients had a MAS during the onset of JIA. The main clinical features of disease onset included: fever 9 (100%), active arthritis 5 (56%), pleuritis 7 (78%), pericarditis – 5 (56%), peritonitis 2 (22%), rash 6 (67%), hepatomegaly 9 (100%), splenomegaly 9 (100%), lymphadenopathy 7 (78%), bleeding 4 (44%), CNS involvement – 3 (33%). Initial treatment included high doses CS 8 (89%), oral CS 9 (100%), methotrexate 5 (56%), tocilizumab 4 (44%), and canakinumab 5 (56%), CsA 4 (44%), IVIG 6 (67%). TCZ was discontinued due to infusion reaction (n=2), TCZ inefficacy (n=3) and presence of MAS in all patients (n=5). In children whom TCZ was switched on CAN we used the standard dose of CAN 4 mg/kg, but if MAS occurred on the CAN we temporally increased the doses since 8 to 25 mg/kg (300 mg). In all cases MAS episodes were successfully resolved during CAN treatment. In 5 (56%) MAS had repeated course during the CAN which lead to temporally increasing the doses of CAN (pt3, pt5, pt8, pt 9) or required to increase immunosupression with abatacept or tofacitinib. Three patients with repeated MAS developed interstitial lung disease (ILD). Two patients who successfully resolved MAS after CAN had relapses of arthritis and switched CAN to TCZ.

IDSexJIA onset, yRepeated MASInitial biologicMAS on CANExperience of increased CAN dosesOutcomesCurrent treatment1F7.7NTCZNNRemissionCAN2F11.5NCANNNsoJIA flare, ILDTCZ3F7.9YCANYYRemissionCAN4F3.4NTCZNYRemission, ILDCAN, CS, MMF5M0.8YTCZYYRemission, ILDCAN, abatacept, CsA, CS6M14.2YCANNNRemissionTCZ7M1.1YCANNNRemissionN8М1.3NCANYYRemissionCAN every 12 months9F9.1NTCZYYMinimal disease activityCAN, tofacitinib

Footnotes: CAN – canakinumab, CS – corticosteroids, CsA – cyclosporine A, ID – identification, ILD – interstitial lung disease, F – females, M – males, N- no, TCZ – tocilizumab, Y – yes.

Conclusion:

Canakinumab is an effective rescue treatment either soJIA either MAS. In patients with MAS developed on CAN required the temporal increasing of the doses.

Funding statement:

This work was supported by the Russian Foundation for Basic Research (grant № 18-515-57001).

Disclosure of Interests:

None declared

POS1324 TREATMENT OF UVEITIS ASSOCIATED WITH JUVENILE IDIOPATHIC ARTHRITIS: A SEVEN YEARS’ SINGLE-CENTRE EXPERIENCE

Background:

Uveitis (U) is one of the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA). It is usually revealed in 10-20% of children with JIA, often asymptomatic and sometimes the onset of U precedes the onset of arthritis. Being inappropriately treated, U leads to vision loss in up to 20% of children. Despite the efforts of the Standardization of Uveitis Nomenclature (SUN) Working Group and the European initiative Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) which optimized management of JIA-associated U [1], the actual treatment is mostly based on physicians’ experience. Initial treatment typically includes topical glucocorticoids (G) or systemic immunosuppressive therapy if topical G don’t work. Methotrexate (MTX) is the first-line systemic immunosuppressive agent, followed by tumor necrosis factor inhibitors (TNFi) [1,2].

Objectives:

To provide treatment recommendations for JIA-associated U based on monitoring of 221 patients during 7 years.

Methods:

Data collected during 2240 hospitalisations of 221 patients aged 3 - 17 years treated at the State Pediatric Medical University in years 2014 - 2020 were analyzed. U and JIA were diagnosed according to the SUN and ACR recommendations. Initial treatment of U included topical G or non-steroidal anti-inflammatory drugs (NSAIDs). Treatment of JIA included systemic NSAIDs, cytostatics (MTX, Cyclosporine or Cyclophosphamide) and biologics: Adalimumab (Ada), Infliximab (Inf), Etanercept (Eta), Abatacept (Aba), Tocilizumab (Toc), Golimumab (Gol). Statistical analysis included traditional Descriptive Statistics, Spearman Rank Order Correlation (SROC) and Multivariate Exploratory Techniques [Statistica for Windows, Statsoft].

Results:

Of all patients with JIA-associated U the proportion of those treated with biologics during the monitoring increased from 60 to 70% (of them, Ada 79 - 93%, Inf 7 - 1%, Eta 5 - 1%, Aba 7 - 3%, Toc 7 - 0%, Gol 0 - 3%). Of all children in whom U was diagnosed later than arthritis 36% were treated with systemic NSAIDs, 25% - with cytostatics (MTX - 84%, Cyclosporine - 8%, Cyclophosphamide - 8%), 23% - with systemic G, 6% - with biologics (Eta - 83%, Toc - 17%). Of patients in whom U and arthritis were diagnosed simultaneously, 95% were treated with cytostatics (MTX - 95%, Cyclosporine - 15%), 93% - with topical G, 91% - with topical NSAIDs, 81% - with systemic G, 60% - with systemic NSAIDs. Efficacy of treatment in terms of SROK showed evidence of steady improvement already after 1 month of therapy with TNFi or with MTX (increase of r during the first year from 0.37 to 0,62, p<0.02; from 0.37 to 0.55, p<0.05 respectively), though r was never higher than 0.84 during the first 3 years of treatment. Topical NSAIDs and G were less effective: improvement was revealed after 3 months of treatment, it was not so steady and r was never higher than 0.35. Systemic NSAID’s were not effective at all.

Conclusion:

1. The likelihood of improvement of U treated with TNFi (Eta excepted) after one month, after 1 and after 3 years of therapy was 37%, 62% and 84% respectively. For MTX this likelihood was 37% after 1 month and 55% after 3 months.

2. TNFi (Eta excepted) in treatment of JIA prevents the onset of U, thereby supposing its early administration.

3. Eta neither prevents nor treats U.

4. Topical NSAIDs and G can hardly be recommended as a reliable means for treatment of U without TNFi and MTX.

5. Systemic NSAIDs neither prevent nor treat JIA-associated U.

References:

[1]Constantin T, Foeldvari I, Anton J, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative Ann Rheum Dis 2018;77:1107–1117

[2]Angeles-Han ST, Ringold S, Beukelman T, Lovell D et al., 2018 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken). 2019 June; 71(6): 703–716

Disclosure of Interests:

None declared

Estimates of African Dust Deposition Along the Trans-Atlantic Transit Using the Decade-long Record of Aerosol Measurements from CALIOP, MODIS, MISR, and IASI

Deposition of mineral dust into ocean fertilizes ecosystems and influences biogeochemical cycles and climate. In-situ observations of dust deposition are scarce, and model simulations depend on the highly parameterized representations of dust processes with few constraints. By taking advantage of satellites' routine sampling on global and decadal scales, we estimate African dust deposition flux and loss frequency (LF, a ratio of deposition flux to mass loading) along the trans-Atlantic transit using the three-dimensional distributions of aerosol retrieved by spaceborne lidar (CALIOP) and radiometers (MODIS, MISR, and IASI). On the basis of a ten-year (2007-2016) and basin scale average, the amount of dust deposition into the tropical Atlantic Ocean is estimated at 136 - 222 Tg yr-1. The 65-83% of satellite-based estimates agree with the in-situ climatology within a factor of 2. The magnitudes of dust deposition are highest in boreal summer and lowest in fall, whereas the interannual variability as measured by the normalized standard deviation with mean is largest in spring (28-41%) and smallest (7-15%) in summer. The dust deposition displays high spatial heterogeneity, revealing that the meridional shifts of major dust deposition belts are modulated by the seasonal migration of the intertropical convergence zone (ITCZ). On the basis of the annual and basin mean, the dust LF derived from the satellite observations ranges from 0.078 to 0.100 d-1, which is lower than model simulations by up to factors of 2 to 5. The most efficient loss of dust occurs in winter, consistent with the higher possibility of low-altitude transported dust in southern trajectories being intercepted by rainfall associated with the ITCZ. The satellite-based estimates of dust deposition can be used to fill the geographical gaps and extend time span of in-situ measurements, study the dust-ocean interactions, and evaluate model simulations of dust processes.

Quantifying the direct radiative effect of absorbing aerosols for numerical weather prediction: a case study

We conceptualize aerosol radiative transfer processes arising from the hypothetical coupling of a global aerosol transport model and a global numerical weather prediction model by applying the US Naval Research Laboratory Navy Aerosol Analysis and Prediction System (NAAPS) and the Navy Global Environmental Model (NAVGEM) meteorological and surface reflectance fields. A unique experimental design during the 2013 NASA Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC⁴RS) field mission allowed for collocated airborne sampling by the high spectral resolution Lidar (HSRL), the Airborne Multi-angle SpectroPolarimetric Imager (AirMSPI), up/down shortwave (SW) and infrared (IR) broadband radiometers, as well as NASA A-Train support from the Moderate Resolution Imaging Spectroradiometer (MODIS), to attempt direct aerosol forcing closure. The results demonstrate the sensitivity of modeled fields to aerosol radiative fluxes and heating rates, specifically in the SW, as induced in this event from transported smoke and regional urban aerosols. Limitations are identified with respect to aerosol attribution, vertical distribution, and the choice of optical and surface polarimetric properties, which are discussed within the context of their influence on numerical weather prediction output that is particularly important as the community propels forward towards inline aerosol modeling within global forecast systems.

Atmospheric Correction of Satellite Ocean-Color Imagery During the PACE Era

The Plankton, Aerosol, Cloud, ocean Ecosystem (PACE) mission will carry into space the Ocean Color Instrument (OCI), a spectrometer measuring at 5nm spectral resolution in the ultraviolet (UV) to near infrared (NIR) with additional spectral bands in the shortwave infrared (SWIR), and two multi-angle polarimeters that will overlap the OCI spectral range and spatial coverage, i. e., the Spectrometer for Planetary Exploration (SPEXone) and the Hyper-Angular Rainbow Polarimeter (HARP2). These instruments, especially when used in synergy, have great potential for improving estimates of water reflectance in the post Earth Observing System (EOS) era. Extending the top-of-atmosphere (TOA) observations to the UV, where aerosol absorption is effective, adding spectral bands in the SWIR, where even the most turbid waters are black and sensitivity to the aerosol coarse mode is higher than at shorter wavelengths, and measuring in the oxygen A-band to estimate aerosol altitude will enable greater accuracy in atmospheric correction for ocean color science. The multi-angular and polarized measurements, sensitive to aerosol properties (e.g., size distribution, index of refraction), can further help to identify or constrain the aerosol model, or to retrieve directly water reflectance. Algorithms that exploit the new capabilities are presented, and their ability to improve accuracy is discussed. They embrace a modern, adapted heritage two-step algorithm and alternative schemes (deterministic, statistical) that aim at inverting the TOA signal in a single step. These schemes, by the nature of their construction, their robustness, their generalization properties, and their ability to associate uncertainties, are expected to become the new standard in the future. A strategy for atmospheric correction is presented that ensures continuity and consistency with past and present ocean-color missions while enabling full exploitation of the new dimensions and possibilities. Despite the major improvements anticipated with the PACE instruments, gaps/issues remain to be filled/tackled. They include dealing properly with whitecaps, taking into account Earth-curvature effects, correcting for adjacency effects, accounting for the coupling between scattering and absorption, modeling accurately water reflectance, and acquiring a sufficiently representative dataset of water reflectance in the UV to SWIR. Dedicated efforts, experimental and theoretical, are in order to gather the necessary information and rectify inadequacies. Ideas and solutions are put forward to address the unresolved issues. Thanks to its design and characteristics, the PACE mission will mark the beginning of a new era of unprecedented accuracy in ocean-color radiometry from space.

A130: Is the CCR5-delta32 Mutation Protective Against Systemic-Onset Juvenile Idiopathic Arthritis?

BACKGROUND/PURPOSE

The CCR5 protein is a chemokine receptor, and is known to be expressed on T cells, macrophages, dendritic and microglia cells. It is believed that different prevalence of HLA and CCR5- delta32-a 32 base pair deletion in the coding region-in various ethnic groups is associated with the severity and prevalence of chemokine-mediated autoimmune diseases, systemic-onset Juvenile Idiopathic Arthritis (soJIA) being among them (Del Rincon et al., 2003). Since the end of the last century the protective role of the CCR5-delta32 mutation against JIA is discussed (Hinks et al., 2010), though it seems the role of this mutation is less simple than was hitherto thought. The purposes of the study was to compare the prevalence of the CCR5-delta32 mutation in children with and without soJIA, to assess the association of this mutation with the severity of the disease and thus to evaluate its protective role.

METHODS

234 children (193 of European origin, 25-Hispanic or Latino, 14-Afro-Americans, 3-of Asian origin) with soJIA living in the USA and in the Northwestern part of Russia were enrolled in the study. Genomic DNA was isolated from blood samples using QIAamp Mini Kit and amplified by PCR. The following oligonucleotide primers were used to detect CCR5 d32: CCR5- Δ32-F: 5'CTTCATTACACCTGCAGTC3', CCR5-Δ32-R: 5'TGAAGATAAGCCTCACAGCC3' by following condition: 95°-5'×1; 95°-15″→55°-15″→72°-60″×40; 72°-10'×3→4°-∞; the resulting PCR products were separated on 2% agarose gel by electrophoresis and visualized by Gel Doc XR Plus.

RESULTS

Mutation was revealed only in children of European origin. Though the prevalence of the heterozygous CCR5-delta32 mutation being 16% and 21% in the USA and in Russia correspondingly didn't excel from its prevalence in populations in total (10-18% for Northwestern Russia, Kofiady, 2008; 11,8%- for white American group, Downer et al, 2002), some laboratory and clinical signs of soJIA proved to be related to the mutation (see ). Heterozygous CCR5-delta32 genotype was associated with milder so-JIA course and predominance of the articular features over systemic. [Table: see text]

CONCLUSION

The results of the study may be considered rather not supporting the idea of the protective role of the CCR5-delta32 mutation against soJIA, though the revealed associations-most of them related to the signs of the Macrophage Associated Syndrome-can be the basis for a more sophisticated research.