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Howarth E, Vabulas G, Connolly S, Green D, Smolley S. Developing accessible speech technology with users with dysarthric speech. Assist Technol 2024:1-8. [PMID: 38537126 DOI: 10.1080/10400435.2024.2328082] [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] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
The Voiceitt app is designed for people with dysarthric speech, to support vocal communication and access to voice-driven technologies. Sixty-six participants were recruited to test the Voiceitt app and share feedback with developers. Most had physical, sensory, or cognitive impairments in addition to atypical speech. The project team liaised with individuals, their families and local support teams to provide access to the app and associated equipment. Testing was user-led, with participants asked to identify and test use cases most relevant to their daily lives over three months or more. Ongoing technical support and training were provided remotely and in-person throughout their testing. Semi-structured interviews were used to collect feedback on users' experiences, with delivery adapted to individuals' needs and preferences. Informal feedback was collected through ongoing contact between participants, their families and support teams and the project team. User feedback has led to improvements to the user interface and functionality, including faster voice training, simplified navigation, the introduction of game-style features and of switch access as an alternative to touchscreen access. This work offers a case-study in meaningful engagement with diverse disabled users of assistive technology in commercial software development.
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Affiliation(s)
| | | | | | - Dawn Green
- Project Coordination, Karten Network, London, UK
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Curran S, Heffernan E, Connolly S, Levins K, Cronin K, Dolan R. Letter to the Editor: Subdermal contraceptive implant-related neuropathy of the upper limb: A time for change. J Plast Reconstr Aesthet Surg 2024; 88:55-56. [PMID: 37952437 DOI: 10.1016/j.bjps.2023.10.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Affiliation(s)
- S Curran
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - E Heffernan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - S Connolly
- Department of Clinical Neurophysiology, St. Vincent's University Hospital, Dublin, Ireland
| | - K Levins
- Department of Pain Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - K Cronin
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; UCD School of Medicine & Medical Sciences, UCD, Dublin, Ireland
| | - R Dolan
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Fullam S, Togher Z, Power A, Kennelly L, McHugh JC, O'Dowd S, Tubridy N, Hardiman O, Costigan D, Ryan A, Lefter S, Connolly S, Murphy SM. Late-onset Tay-Sachs disease presenting with a neuromuscular phenotype-a case series. Eur J Neurol 2024; 31:e16069. [PMID: 37754769 DOI: 10.1111/ene.16069] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND PURPOSE Tay-Sachs disease is a rare and often fatal, autosomal recessive, lysosomal storage disease. Deficiency in β-hexosaminidase leads to accumulation of GM2 ganglioside resulting in neuronal swelling and degeneration. Typical onset is in infancy with developmental regression and early death. Late-onset Tay-Sachs disease (LOTS) is extremely rare, especially in the non-Ashkenazi Jewish population, and is characterized by a more indolent presentation typically encompassing features of cerebellar and anterior horn cell dysfunction in addition to extrapyramidal and neuropsychiatric symptoms. CASES A case series of four unrelated patients of non-Ashkenazi Jewish origin with a predominantly, and in some cases pure, neuromuscular phenotype with evidence of a motor neuronopathy on electromyography is presented. Cerebellar atrophy, reported to be a ubiquitous feature in LOTS, was absent in all patients. CONCLUSION This case series provides evidence to support a pure neuromuscular phenotype in LOTS, which should be considered in the differential diagnosis of anterior horn cell disorders.
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Affiliation(s)
- Sarah Fullam
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
| | - Zara Togher
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
| | - Alan Power
- Department of Neurology, Cork University Hospital, Cork, Ireland
| | - Laura Kennelly
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - John C McHugh
- Department of Clinical Neurophysiology, Tallaght University Hospital, Dublin, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Niall Tubridy
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Orla Hardiman
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Donal Costigan
- Department of Clinical Neurophysiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Aisling Ryan
- Department of Neurology, Cork University Hospital, Cork, Ireland
| | - Stela Lefter
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Sean Connolly
- Department of Clinical Neurophysiology, St Vincent's University Hospital, Dublin, Ireland
| | - Sinead M Murphy
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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Jacobs M, Ezekowitz M, Nagarakanti R, Eikelboom J, Khan O, Reiss J, Liu H, McAndrew T, Francese D, Arce J, Brueckmann M, Connolly S, Yusuf S. Body mass index from the RE-LY trial: further evidence of the obesity paradox. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The obesity paradox has been reported in 3 post-hoc analyses evaluating the direct oral anticoagulants (DOAC) against warfarin (W): apixaban (ARISTOTLE), rivaroxaban (ROCKET), and edoxaban (ENGAGE-AF).
Purpose
To evaluate the obesity paradox in a post-hoc analysis of the RE-LY trial, comparing dabigatran 110 mg BID (D110), 150 mg BID (D150), and W by body mass index (BMI).
Methods
Baseline characteristics were evaluated using World Health Organization (WHO) criteria of overweight and obese (BMI ≥25 kg/m2) and under and normal weight (BMI <25 kg/m2). Stroke and systemic embolism, ischemic stroke, major bleeding, mortality, and intracranial hemorrhage were evaluated using BMI as a continuous variable and by the WHO criteria using a cox proportional hazard model.
Results
BMI was available in 99.9% of patients randomized; 74% had a BMI ≥25. At baseline, patients with a BMI ≥25 were younger (70.9 vs 73.1, p<0.001) and had fewer prior strokes (11.5% vs 15.6%, p<0.001), but higher mean creatinine clearance (78.3 vs 57.0, p<0.001) and rates of diabetes (25.8% vs 16.1%, p<0.001) (Table 1). Independent of drug assignment, patients with a BMI ≥25 had lower rates of stroke and systemic embolism (HR 0.65 [95% CI 0.54–0.79], p<0.001), ischemic stroke (0.75 [95% CI 0.60, 0.94], p=0.01), major bleeding (HR 0.79 [95% CI 0.69,0.89], p<0.001), mortality (HR 0.60 [95% CI 0.53, 0.67], p<0.001) and intracranial hemorrhage (HR 0.53 [95% CI 0.38, 0.73], p<0.001) compared to those with a BMI <25. Using BMI as a continuous variable combining all outcomes at 3 years, endpoint rates declined as BMI approached 25 in all 3 treatment groups. The exceptions were intracranial hemorrhage for D110 and D150 and stroke in D150 patients, where rates were low independent of BMI. No significant interaction between BMI and treatment was observed in individual outcomes except for the D110 vs. D150 comparison for major bleeding, in favor of D110 for patients with BMI ≥25 (HR 0.77 [95% CI 0.65, 0.91] and HR 1.12 [95% CI 0.86, 1.47], interaction p=0.0190).
Conclusions
In RE-LY, independent of drug assignment, patients with a higher BMI had improved outcomes, demonstrating the obesity paradox. As BMI increased towards 25, outcome rates improved except for intracranial hemorrhage rates for both D110 and D150 and ischemic stroke rates for D150, which were low independent of BMI. Patients treated with D110 with a BMI ≥25 kg/m2 had significantly lower rates of bleeding compared to D150.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Sharpe Strumia Foundation
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Affiliation(s)
- M Jacobs
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Ezekowitz
- Thomas Jefferson University, Sidney Kimmel Medical College , Philadelphia , United States of America
| | - R Nagarakanti
- Bryn Mawr Hospital Mainline Health , Bryn Mawr , United States of America
| | | | - O Khan
- Lankenau Hospital , Wynnewood , United States of America
| | - J Reiss
- Lankenau Hospital , Wynnewood , United States of America
| | - H Liu
- Thomas Jefferson University, Sidney Kimmel Medical College , Philadelphia , United States of America
| | - T McAndrew
- Cardiovascular Research Foundation , New York , United States of America
| | - D Francese
- Cardiovascular Research Foundation , New York , United States of America
| | - J Arce
- Montefiore Medical Center , Bronx , United States of America
| | - M Brueckmann
- Boehringer-Ingelheim , Ingelheim-am-Rhein , Germany
| | | | - S Yusuf
- Mcmaster University , Ontario , Canada
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Gaffney E, Murphy D, Walsh A, Connolly S, Basdeo SA, Keane J, Phelan JJ. Defining the role of neutrophils in the lung during infection: Implications for tuberculosis disease. Front Immunol 2022; 13:984293. [PMID: 36203565 PMCID: PMC9531133 DOI: 10.3389/fimmu.2022.984293] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Neutrophils are implicated in the pathogenesis of many diseases involving inflammation. Neutrophils are also critical to host defence and have a key role in the innate immune response to infection. Despite their efficiencies against a wide range of pathogens however, their ability to contain and combat Mycobacterium tuberculosis (Mtb) in the lung remains uncertain and contentious. The host response to Mtb infection is very complex, involving the secretion of various cytokines and chemokines from a wide variety of immune cells, including neutrophils, macrophages, monocytes, T cells, B cells, NK cells and dendritic cells. Considering the contributing role neutrophils play in the advancement of many diseases, understanding how an inflammatory microenvironment affects neutrophils, and how neutrophils interact with other immune cells, particularly in the context of the infected lung, may aid the design of immunomodulatory therapies. In the current review, we provide a brief overview of the mechanisms that underpin pathogen clearance by neutrophils and discuss their role in the context of Mtb and non-Mtb infection. Next, we examine the current evidence demonstrating how neutrophils interact with a range of human and non-human immune cells and how these interactions can differentially prime, activate and alter a repertoire of neutrophil effector functions. Furthermore, we discuss the metabolic pathways employed by neutrophils in modulating their response to activation, pathogen stimulation and infection. To conclude, we highlight knowledge gaps in the field and discuss plausible novel drug treatments that target host neutrophil metabolism and function which could hold therapeutic potential for people suffering from respiratory infections.
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Clare McKenna M, Kehoe C, Kinsella J, McGuigan C, Connolly S. TH-293. Evaluation of sensory neuronopathies using nerve conduction studies: Don't forget the soleus H-reflex. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.479] [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]
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O’Connor C, Msellati A, Collins P, Hegazy M, O’Beirne E, Galvin D, Hegarty N, Connolly S, Nason G, O’Malley K. Body Mass Index (BMI) and estimated blood-loss (EBL) in patients undergoing robot assisted radical prostatectomy (RARP). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00905-3] [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: 10/14/2022] Open
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Mares J, Khan J, Selinger E, Collins P, O’Beirn E, O’Connor C, Hegazy M, O’Malley K, Hegarty N, Galvin D, Connolly S, Nason G. Factors associated with non-viable testis due to testicular torsion at scrotal exploration. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00969-7] [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: 10/14/2022] Open
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Gilligan M, Mooney S, O’Riordan S, Connolly S. 062 Ictal asystole during a generalised seizure following a photoparoxysmal response. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.106] [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
BackgroundIctal asystole is the transient cessation of cardiac electrical activity during an epileptic seizure. It has been described in association with focal seizures, most often arising from the left temporal lobe in patients with refractory epilepsy.Case and Results of InvestigationsA 31-year-old right-handed male had a first generalised seizure at work following a period of increased alcohol consumption and sleep deprivation. There was no family history of epilepsy and neurological examination was normal. Generalised sharpened discharges with polyspikes occurred in an EEG two days later. A second EEG performed three months later contained a photopar- oxysmal response followed by a generalised seizure accompanied by a 7.5-second period of asystole. Electrographically the seizure was generalised in onset, without lateralising features, although the clinical semiology was notable for some initial focal features. MRI brain did not reveal any focal abnormality. The patient was commenced on levetiracetam and has remained seizure-free since.DiscussionThis is a rare case of ictal asystole in a patient with a generalised-onset seizure, and probable underlying primary generalised epilepsy.
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McKenna MC, McGovern E, Farrell M, Killeen RP, McGuigan C, Connolly S. Neurogenic muscle hypertrophy following L5 motor radiculopathy. Pract Neurol 2022; 22:422-424. [DOI: 10.1136/pn-2022-003461] [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] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
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Alten R, Rauch C, Chartier M, Nurmohamed MT, Connolly S, Buch MH, Peichl P, Mariette X, Patel Y, Marsal S, Caporali R, Griffiths H, Sanmartí R, Bannert B, Elbez Y, Lozenski K. POS0512 ANTI-CITRULLINATED PROTEIN ANTIBODY SEROSTATUS DETERMINES 2-YEAR RETENTION OF IV AND SC ABATACEPT IN PATIENTS WITH RA IN A REAL-WORLD SETTING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.878] [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
BackgroundA treat-to-target approach for RA management is recommended.1,2 However, up to half of patients discontinue DMARD treatment within 18 months.2 Predictive biomarkers, such as anti-citrullinated protein antibodies (ACPAs) and RF, may be useful to stratify patients to the most appropriate treatment. ACTION (AbataCepT In rOutiNe clinical practice; NCT02109666) and ASCORE (Abatacept SubCutaneOus in Routine Clinical PracticE; NCT02090556) were 2-year, international, observational, prospective, multicenter studies of IV and SC abatacept, respectively, for the treatment of RA in routine clinical practice.3,4 Higher retention has been previously reported in patients with double ACPA/RF seropositive RA compared with double ACPA/RF seronegative RA.3,4ObjectivesTo assess the independent effect of ACPA or RF single seropositivity on abatacept retention in patients with RA receiving abatacept in a post hoc analysis of ACTION and ASCORE.MethodsThis post hoc analysis included patients aged ≥ 18 years, with active moderate-to-severe RA (ACR/EULAR 2010 criteria) who initiated IV (body weight–adjusted dosing) or SC (125 mg once weekly) abatacept.3,4 Patients were stratified by baseline ACPA/RF status: ACPA+/RF− (ACPA+ only), ACPA/RF double positive (+/+), ACPA−/RF+ (RF+ only), and ACPA/RF double negative (−/−). Abatacept retention rate at 2 years was estimated by Kaplan–Meier (KM) analysis.ResultsPatients with ACPA/RF serostatus data from the ACTION and ASCORE studies (N = 1679 and N = 1748, respectively) were evaluated. Baseline demographic and disease characteristics were similar across studies and serostatus groups (Table 1). In patients with ACPA+ only RA, abatacept retention rates were similar to the +/+ group and greater than the RF+ only and −/− groups (Figure 1). In ASCORE (Figure 1A), retention rates were significantly higher in ACPA+ only and +/+ groups when compared with the −/− group. In contrast, retention rates for patients with RF+ only RA were not significantly different vs −/− patients. Results were similar in ACTION, although the higher retention in the ACPA+ group did not reach statistical significance (Figure 1B).Table 1.Baseline demographics and disease characteristics by ACPA/RF status for the ASCORE and ACTION studiesASCORE+/+RF+ onlyACPA+ only−/−(n = 1079)(n = 142)(n = 184)(n = 343)Age, years57.1 (12.8)58.2 (11.8)57.4 (13.5)57.8 (13.9)DAS28 (CRP)4.7 (1.2)4.6 (1.1)4.4 (1.0)4.8 (1.2)CDAI26.6 (12.5)25.8 (12.0)23.6 (10.9)28.2 (13.2)SDAI28.1 (13.0)27.2 (12.4)24.4 (10.8)29.7 (13.9)ACTION+/+RF+ onlyACPA+ only−/−(n = 1028)(n = 161)(n = 98)(n = 392)Age, years58.2 (12.0)58.4 (13.4)58.5 (14.0)57.0 (13.3)DAS28 (CRP)4.9 (1.1)5.0 (1.1)4.9 (1.0)5.0 (1.1)CDAI28.7 (12.2)29.2 (12.4)28.7 (11.5)30.1 (12.9)SDAI30.4 (13.1)31.2 (13.4)29.8 (11.5)31.7 (13.4)Data are mean (SD). Patients with missing data for baseline ACPA/RF status are excluded.ConclusionIn this post hoc analysis of the real-world ACTION and ASCORE studies, ACPA positivity was associated with an increased likelihood of retention over 2 years. Patients with ACPA+ only RA were equally as likely to be retained on abatacept as patients with ACPA/RF double positivity. In contrast, patients with RF+ only RA were less likely to be retained on abatacept over 2 years. These findings suggest that ACPA positivity played a more important role than RF positivity in abatacept retention. The higher retention seen in patients with ACPA+ only vs RF+ only disease demonstrates the key role of ACPA in RA and supports the importance of precision medicine in treating patients.References[1]Fraenkel L, et al. Arthritis Care Res (Hoboken) 2021;73:924–39.[2]Smolen JS, et al. Ann Rheum Dis 2020;79:685–99.[3]Alten R, et al. Clin Rheumatol 2019;38:1413–24.[4]Alten R, et al. Ann Rheum Dis 2021;80(suppl 1):OP0180.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Medical writing and editorial assistance was provided by Fiona Boswell, PhD, of Caudex, and was funded by Bristol Myers Squibb. Study management provided by Syneos (CRO).Disclosure of InterestsRieke Alten Speakers bureau: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Paid instructor for: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Consultant of: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Grant/research support from: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Christiane Rauch Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Melanie Chartier Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, M.T. Nurmohamed Speakers bureau: AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, MSD, Pfizer, Sean Connolly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Maya H Buch Speakers bureau: AbbVie, Consultant of: AbbVie, Galapagos, Gilead, Pfizer, Grant/research support from: Gilead, Pfizer, UCB, Peter Peichl Speakers bureau: GlaxoSmithKline, Janssen, Xavier Mariette Consultant of: Bristol Myers Squibb, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sanofi, UCB, Yusuf Patel: None declared, Sara Marsal Speakers bureau: Bristol Myers Squibb, Lilly, MSD, Novartis - Sandoz, Pfizer, Roche, Consultant of: AbbVie, Galapagos, Pfizer, Sanofi; IMIDomics (executive role), Grant/research support from: AbbVie, Bristol Myers Squibb, Galapagos, Janssen, Lilly, MSD, Novartis - Sandoz, Pfizer, Roche, Sanofi, UCB, Roberto Caporali Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Fresenius-Kabi, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, Hedley Griffiths Consultant of: Amgen, Raimón Sanmartí Speakers bureau: AbbVie, Bristol Myers Squibb, Lilly, MSD, Pfizer, Roche, Sanofi, Grant/research support from: AbbVie, Bristol Myers Squibb, MSD, Pfizer, Roche, Bettina Bannert Speakers bureau: Novartis Pharma Schweiz AG, Yedid Elbez Consultant of: Bristol Myers Squibb, Employee of: Signifience, Karissa Lozenski Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb.
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Alten R, Rauch C, Chartier M, Nurmohamed MT, Connolly S, Buch MH, Peichl P, Mariette X, Patel Y, Marsal S, Caporali R, Griffiths H, Sanmartí R, Bannert B, Elbez Y, Lozenski K. POS0107 ACPA POSITIVITY DETERMINES REMISSION IN PATIENTS WITH RA TREATED WITH IV AND SC ABATACEPT: A POST HOC ANALYSIS OF THE REAL-WORLD OBSERVATIONAL ACTION AND ASCORE STUDIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.887] [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
BackgroundThe goal of treatment for RA is achieving low disease activity and/or remission1,2; however, disease course and management can be complicated by additional factors that may be influenced by serostatus. Anti-citrullinated protein antibodies (ACPAs) and RF contribute to a more severe RA disease pattern3 and may be useful in predicting response to treatment.4 ACTION (AbataCepT In rOutiNe clinical practice; NCT02109666) and ASCORE (Abatacept SubCutaneOus in Routine Clinical PracticE; NCT02090556) were 2-year, international, observational, prospective, multicenter studies of IV and SC abatacept, respectively, for the treatment of RA in routine clinical practice.4,5 Previous analyses have shown that ACPA/RF double-positive serostatus was associated with better treatment outcomes compared with ACPA/RF double-negative serostatus.4–6ObjectivesTo assess the independent effect of ACPA or RF single seropositivity among patients with RA on achieving remission after treatment with abatacept for 2 years, and to compare outcomes among patients with single versus double serostatus.MethodsThis post hoc analysis included patients from ACTION and ASCORE who initiated IV (body weight–adjusted dosing) or SC abatacept (125 mg once weekly), respectively. Patients were stratified by baseline ACPA/RF status: ACPA+/RF− (ACPA+ only), ACPA/RF double positive (+/+), ACPA−/RF+ (RF+ only), and ACPA/RF double negative (−/−). DAS28 (CRP) and CDAI remission rates (defined as < 2.6 and 0–2.8, respectively) at 2 years for patients who were ACPA+ or RF+ only at baseline were assessed and compared with those who were +/+ and −/−. Patients with missing baseline ACPA/RF status were excluded. Last observation carried forward efficacy analyses were used to impute missing values.ResultsThis analysis included 1679 patients from ACTION (ACPA+ only, n = 98; +/+, n = 1028; RF+ only, n = 161; and −/−, n = 392) and 1748 patients from ASCORE (ACPA+ only, n = 184; +/+, n = 1079; RF+ only, n = 142; and −/−, n = 343). Across studies and serogroups, baseline demographics and disease characteristics were similar (data not shown). In both ACTION and ASCORE, a higher proportion of patients who were only ACPA+ achieved DAS28 (CRP) and CDAI remission at 2 years compared with patients who were only RF+ (Figure 1). Additionally, a similar proportion of patients who were only ACPA+ achieved DAS28 (CRP) and CDAI remission at 2 years compared with patients who were +/+. In contrast, a lower proportion of patients who were only RF+ achieved DAS28 (CRP) and CDAI remission at 2 years compared with patients who were +/+.ConclusionIn this post hoc analysis of real-world data from ACTION and ASCORE, ACPA positivity was associated with an increased likelihood of achieving DAS28 (CRP) and CDAI remission at 2 years. Patients who were ACPA+ only were as likely to achieve remission as +/+ patients, suggesting that RF serostatus had less influence than ACPA serostatus on remission status at 2 years. In line with this, patients who were RF+ only were less likely to achieve remission at 2 years. This is the first large, real-world study to show that ACPA positivity plays a more important role than RF positivity in achieving remission whilst on abatacept. These results highlight the importance of assessing baseline ACPA status when considering treatment options for patients with RA.References[1]Smolen JS, et al. Ann Rheum Dis 2020;79:685–99.[2]Fraenkel L, et al. Arthritis Care Res (Hoboken) 2021;73:924–39.[3]Katchamart, W, et al. Rheumatol Int 2015;35:1693–9.[4]Alten R, et al. Ann Rheum Dis 2021;80(suppl 1):OP0180.[5]Alten R, et al. Clin Rheumatol 2019;38:1413–24.[6]Alten R, et al. RMD Open 2017;3:e000345.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Medical writing and editorial assistance was provided by Rachel Rankin, PhD, of Caudex, and was funded by Bristol Myers Squibb. Study management provided by Syneos (CRO).Disclosure of InterestsRieke Alten Speakers bureau: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Paid instructor for: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Consultant of: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Grant/research support from: AbbVie, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Christiane Rauch Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Melanie Chartier Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, M.T. Nurmohamed Speakers bureau: AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, MSD, Pfizer, Sean Connolly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Maya H Buch Speakers bureau: AbbVie, Consultant of: AbbVie, Galapagos, Gilead, Pfizer, Grant/research support from: Gilead, Pfizer, UCB, Peter Peichl Speakers bureau: Janssen, GlaxoSmithKline, Xavier Mariette Consultant of: Bristol Myers Squibb, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sanofi, UCB, Yusuf Patel: None declared, Sara Marsal Speakers bureau: Bristol Myers Squibb, Lilly, MSD, Novartis - Sandoz, Pfizer, Roche, Consultant of: AbbVie, Galapagos, Pfizer, Sanofi; IMIDomics (executive role), Grant/research support from: AbbVie, Bristol Myers Squibb, Galapagos, Janssen, Lilly, MSD, Novartis - Sandoz, Pfizer, Roche, Sanofi, UCB, Roberto Caporali Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Fresenius-Kabi, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, Hedley Griffiths Consultant of: Amgen, Raimón Sanmartí Speakers bureau: AbbVie, Bristol Myers Squibb, Lilly, MSD, Pfizer, Roche, Sanofi, Grant/research support from: AbbVie, Bristol Myers Squibb, MSD, Pfizer, Roche, Bettina Bannert: None declared, Yedid Elbez Consultant of: Bristol Myers Squibb, Employee of: Signifience, Karissa Lozenski Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Verstappen M, Matthijssen X, Connolly S, Maldonado MA, Huizinga T, Van der Helm-van Mil A. POS0104 ACPA-NEGATIVE AND ACPA-POSITIVE RA-PATIENTS ACHIEVING DISEASE RESOLUTION DEMONSTRATE DISTINCT PATTERNS OF MRI-DETECTED JOINT-INFLAMMATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.675] [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
BackgroundSustained DMARD-free remission (SDFR), the sustained absence of clinical-synovitis after DMARD-discontinuation, is increasingly achievable in RA. However, prevalence differs significantly between ACPA-negative (40%) and ACPA-positive RA (5-10%). In addition, early-DAS-remission (DAS4months<1.6) associates with SDFR in ACPA-negative RA but not in ACPA-positive RA.1 Based on these differences, we hypothesized that longitudinal patterns of local tissue-inflammation (synovitis/tenosynovitis/osteitis) might also differ between ACPA-negative and ACPA-positive RA-patients achieving SDFR.ObjectivesWith the ultimate aim to increase understanding of disease-resolution in RA, we studied MRI-detected joint-inflammation over time in relation to SDFR-development in ACPA-negative RA and ACPA-positive RA.Methods198 RA-patients (94 ACPA-negative and 104 ACPA-positive) underwent repeated MRIs (0/4/12/24-months) and were followed on SDFR-development. The course of MRI-detected total-inflammation, and synovitis/tenosynovitis/osteitis individually, were compared between RA-patients who did and did not achieve SDFR, using Poisson-mixed-models. 170 ACPA-positive RA-patients from the AVERT-1 were studied as ACPA-positive validation-population.ResultsIn ACPA-negative RA, patients achieving SDFR had similar baseline total inflammation-levels, which declined 2.0-times stronger in the first-year of DMARD-treatment (IRR 0.50, 95%CI;0.32-0.77, p<0.01) compared to patients without SDFR. This stronger decline was seen in tenosynovitis/synovitis/osteitis. In contrast, ACPA-positive RA-patients achieving SDFR, had already lower inflammation-levels (especially synovitis/osteitis) at disease-presentation (IRR 0.45, 95%CI;0.24-0.86, p=0.02) compared to non-SDFR patients, and remained lower during follow-up (p=0.02). Similar results were found in the ACPA-positive validation-population.ConclusionCompared to RA-patients without disease-resolution, ACPA-positive RA-patients achieving SDFR have less severe joint-inflammation from diagnosis onwards, whilst ACPA-negative RA-patients present with similar inflammation-levels but demonstrate a stronger decline in the first year of DMARD-therapy. These different trajectories suggest that mechanisms underlying resolution of RA-chronicity in both RA-subsets might be different and indicates the relevance of the total inflammatory-load in ACPA-positive-RA.References[1]Verstappen M, Niemantsverdriet E, Matthijssen XME, le Cessie S, van der Helm-van Mil AHM. Early DAS response after DMARD-start increases probability of achieving sustained DMARD-free remission in rheumatoid arthritis. Arthritis Res Ther. 2020 Nov 23;22(1):276.Figure 1.Patterns of MRI-detected joint-inflammation in RA-patients achieving SDFR compared to those who did not, stratified for ACPA-statusDisclosure of InterestsMarloes Verstappen: None declared, Xanthe Matthijssen: None declared, Sean Connolly Shareholder of: Dr. Sean E. Connolly, Ph.D. is a shareholder of Bristol Myers Squibb, Employee of: Dr. Sean E. Connolly, Ph.D. is an employee of Bristol Myers Squibb, Michael A Maldonado Shareholder of: Dr. M. Maldonado, Ph.D. is a shareholder of Bristol Myers Squibb, Employee of: Dr. M. Maldonado, Ph.D. is an employee of Bristol Myers Squibb, Thomas Huizinga Speakers bureau: Tom WJ Huizinga/the department of rheumatology LUMC has received research support/lecture fees/consultancy fees from Merck, UCB, Bristol Myers Squibb, Janssen, Pfizer, Novartis, Sanofi-Aventis, Galapagos, Boeringher and Eli Lilly, Consultant of: Tom WJ Huizinga/the department of rheumatology LUMC has received research support/lecture fees/consultancy fees from Merck, UCB, Bristol Myers Squibb, Janssen, Pfizer, Novartis, Sanofi-Aventis, Galapagos, Boeringher and Eli Lilly, Grant/research support from: Tom WJ Huizinga/the department of rheumatology LUMC has received research support/lecture fees/consultancy fees from Merck, UCB, Bristol Myers Squibb, Janssen, Pfizer, Novartis, Sanofi-Aventis, Galapagos, Boeringher and Eli Lilly, Annette van der Helm-van Mil: None declared
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Raheem I, Durrani R, Hopp S, Orlic M, Connolly S, Choudhary M, Kouri B, Regan J, Miller M. Abstract No. 83 Retrospective analysis of splenic artery embolization methods and outcomes for grade III–V blunt splenic injuries. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.164] [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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Mitchell EJ, Goodman K, Wakefield N, Cochran C, Cockayne S, Connolly S, Desai R, Hartley S, Lawton SA, Oatey K, Rhodes S, Savage JS, Taylor J, Youssouf NFJ. Clinical trial management: a profession in crisis? Trials 2022; 23:357. [PMID: 35477835 PMCID: PMC9044377 DOI: 10.1186/s13063-022-06315-8] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Clinical trial managers play a vital role in the design and conduct of clinical trials in the UK. There is a current recruitment and retention crisis for this specialist role due to a complex set of factors, most likely to have come to a head due to the COVID-19 pandemic. Academic clinical trial units and departments are struggling to recruit trial managers to vacant positions, and multiple influences are affecting the retention of this highly skilled workforce. Without tackling this issue, we face major challenges in the delivery on the Department of Health and Social Care's Future of UK Clinical Research Delivery implementation plan. This article, led by a leading network of and for UK Trial Managers, presents some of the issues and ways in which national stakeholders may be able to address this.
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Affiliation(s)
- E J Mitchell
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - K Goodman
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0NA, UK
| | - N Wakefield
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C Cochran
- Centre for Healthcare and Randomised Controlled Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, AB23 2ZD, UK
| | - S Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Connolly
- Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - R Desai
- King's Ophthalmology Research Unit, King's College Hospital, London, SE5 9RS, UK
| | - S Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - S A Lawton
- Keele Clinical Trials Unit, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - K Oatey
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, EH16 4UX, UK
| | - S Rhodes
- Exeter Clinical Trials Unit, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - J S Savage
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - J Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - N F J Youssouf
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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de Loizaga SR, Arthur L, Arya B, Beckman B, Belay W, Brokamp C, Hyun Choi N, Connolly S, Dasgupta S, Dibert T, Dryer MM, Gokanapudy Hahn LR, Greene EA, Kernizan D, Khalid O, Klein J, Kobayashi R, Lahiri S, Lorenzoni RP, Otero Luna A, Marshall J, Millette T, Moore L, Muhamed B, Murali M, Parikh K, Sanyahumbi A, Shakti D, Stein E, Shah S, Wilkins H, Windom M, Wirth S, Zimmerman M, Beck AF, Ollberding N, Sable C, Beaton A. Rheumatic Heart Disease in the United States: Forgotten But Not Gone: Results of a 10 Year Multicenter Review. J Am Heart Assoc 2021; 10:e020992. [PMID: 34348475 PMCID: PMC8475057 DOI: 10.1161/jaha.120.020992] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty‐two US pediatric institutions participated in a 10‐year review (2008–2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract‐based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non‐White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08–1.46). Conclusions The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline‐based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States.
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Affiliation(s)
| | - Lindsay Arthur
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | - Bhawna Arya
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Wubishet Belay
- Monroe Carell Jr Children's Hospital at Vanderbilt Nashville TN
| | - Cole Brokamp
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nak Hyun Choi
- Morgan Stanley Children's Hospital of New York PresbyterianColumbia University Medical Center New York NY
| | - Sean Connolly
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL
| | - Soham Dasgupta
- Children's Healthcare of AtlantaEmory University Atlanta GA
| | - Tavenner Dibert
- University of Florida Health, Shands Children's Hospital Gainesville FL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elizabeth Stein
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Hannah Wilkins
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | | | - Scott Wirth
- Cincinnati Children's Hospital Medical Center Cincinnati OH
| | | | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nicholas Ollberding
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | | | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
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Lehane M, Connolly S, Crowley M, Hart C, O"flynn AM. Kidney function decline in heart failure patients: an audit of out-patient heart failure services. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A bidirectional relationship exists between the kidney and the heart; the lower the eGFR the more challenging it is to manage the heart failure (HF) patient. Worsening renal function is common in HF patients and associated with a two-fold increase in mortality and a lower likelihood of being prescribed efficacious HF therapy. The role of cardio-renal interactions in HF is essential to identify risk and subsequent treatment strategies.
Purpose
The purpose of this audit is to provide insights into the assessment of renal function in a real world heart failure population by identifying the degree of renal dysfunction and changes in renal function over a five year time frame.
Methods
A retrospective audit included patients with HFrEF attending a heart failure service. These patients were classified using KIDGO criteria CKD 1-5. A current eGFR sample was compared with a sample taken five years earlier, identified using the electronic laboratory record. Ethical approval was granted from the Research Ethics Committee.
Resultss
100 patients with HFrEF attending a heart failure service fulfilled the selection criteria of which sixty three patients with an eGFR >60ml/min/1.73 m2 were audited. Of this group 43 were CKD class 2 and 20 were CKD class 1. Thirty seven patients had an eGFR <60ml/min/1.73 m2 of which 9 were class 3b, 9 were CKD class 4 and 1 was CKD Class 5.
Of the 100 patients enrolled, 6 were excluded from the analysis of kidney function decline as an eGFR from five years earlier was unavailable. Within a five year time span, 44 patients did not change their CKD class, 31 patients declined by one class, 9 patients declined by two classes, 3 patients declined by three classes and 7 patients improved their kidney function.
GFR < 60mL/min/1.73m2,
n = 37
GFR > 60mL/min/1.73m2, n = 63
Age – mean (range)
77.8 (49-94)
66.5 (45-89)
Gender – female (%)
12 (32%)
16 (25%)
Average renal function measurements (mean, range)
6.4
6.7
Total albumin
creatinine ratio measurements
8
6
Actively attending renal service
6
0
Conclusion
Nurses should be aware of the increasing risk conferred by the dual diagnosis of heart failure and chronic kidney disease. Patients with heart failure who have decreasing eGFR levels (especially less than 30 mL/min), should have collaborative management with nephrology services to optimise outcomes. Recognition of CKD in our institution and referral to nephrology services was suboptimal and further work is necessary to optimise the management of these patients.
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Affiliation(s)
- M Lehane
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - S Connolly
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - M Crowley
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - C Hart
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - AM O"flynn
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
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Mcgaffin S, Taggart M, Smyth D, O"doherty D, Brown J, Teague S, Slevin C, Montgomery L, Coll M, Lindsay C, Crumley B, Gibson L, Elliott H, Hughes S, Connolly S. Transitioning a cardiovascular health and rehabilitation programme to a virtual platform during covid 19. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Our Hearts Our Minds
Purpose
Can a virtual cardiovascular prevention and rehabilitation programme be as effective as face-to-face programme.
Background
The Our Hearts Our Minds (OHOM) prevention and rehabilitation programme rapidly transitioned to a virtual platform in the covid era. Here we compare if a virtual programme potentially could offer the same standard of the nursing intervention (education, smoking cessation, medical risk factor management and psychosocial health) as the previous face to face programme
Methods
Both the initial assessment (IA) and end of programme (EOP) assessments were conducted via telephone/video as per patient preference. The following measures were recorded at both time points (home blood pressure (BP) monitors were provided)
Smoking (self report) BP/Heart rate, Lipids/HbA1c (facilitated by phlebotomy hub), cardio protective drugs (doses, adherence), Hospital Anxiety and Depression score, EuroQoL
Nursing Intervention Smoking cessation counselling and pharmacotherapy where appropriate
Weekly meeting with cardiologist to optimise BP and lipid management and up titration cardio protective drugs
Bimonthly virtual coaching consultation for monitoring/goal resetting
Bimonthly group video education sessions
Results
From April to November 2020, of the 432 referrals received 400 were eligible with 377 accepting the offer of an IA (94% response rate). 262 have had an IA with the remaining 115 awaiting an assessment date. Of the completed IA’s 257 were willing to attend the programme (98% uptake). 120 had been offered an end of programme assessment with 114 attending (96% of those offered). The results for the virtual programme were then compared to the same period one year previously when the programme was fully face to face and are outlined in the table below.
The comparison of results delivered via remote delivery are remarkably similar to those achieved in the previous year delivered via face to face.
Conclusion
Initial data has shown that virtual delivery of the nursing component of the OHOM prevention/rehabilitation programme was highly acceptable to patients and was as effective as that of the traditional face to face service.
Table 1 below exhibits the clinical and patient-reported outcomes.
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Affiliation(s)
- S Mcgaffin
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - M Taggart
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D Smyth
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D O"doherty
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - J Brown
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - S Teague
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - C Slevin
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - L Montgomery
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - M Coll
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - C Lindsay
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - B Crumley
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - L Gibson
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - H Elliott
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - S Connolly
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
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Østergaard M, Bird P, Pachai C, Du S, Wu C, Landis J, Fuerst T, Ahmad HA, Connolly S, Conaghan PG. POS1040 IMPLEMENTATION OF THE OMERACT PSAMRIS IN A PHASE IIB, RANDOMISED PLACEBO-CONTROLLED STUDY OF ABATACEPT IN PSORIATIC ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.972] [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:The semi-quantitative Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) was developed for the evaluation of inflammatory and destructive changes in PsA,1 but has limited trial usage.Objectives:To retrospectively utilise the PsAMRIS in a multi-dose, randomised Phase IIb study of abatacept in patients with PsA who have inadequate response to DMARDs (NCT00534313).2Methods:Patients were randomised to abatacept (3, 10 or 30/10 mg/kg [the 30-mg/kg group switched to 10 mg/kg after the first two doses]) or placebo and treated for 169 days, after which all patients received abatacept 10 mg/kg through to Day 365. MRI scans of one hand or foot from 123 patients with PsA collected at baseline and on Days 85, 169 and 365 were centrally evaluated by two readers blinded to chronological order and treatment arm. Synovitis, bone oedema, tenosynovitis, periarticular inflammation, bone erosion, bone proliferation and joint space narrowing were assessed as per OMERACT PsAMRIS; a novel total inflammation score was calculated from the sum of synovitis, bone oedema, tenosynovitis and periarticular inflammation. Variables were analysed using all cases (hand or foot) and by hand and foot cases separately.Results:At Day 169, the abatacept 30/10 mg/kg or 10 mg/kg group showed the most decrease (improvement) in each inflammatory assessment (Figure 1). The Day 169 change from baseline severity in synovitis and tenosynovitis in the abatacept 30/10 mg/kg and 10 mg/kg groups, respectively, were significantly reduced (improved) compared with placebo (estimated differences of –0.966 [p=0.039] and –1.652 [p=0.014], respectively) (Table 1). Patients originally randomised to placebo and then switched to abatacept 10 mg/kg at Day 169 showed significant improvements in synovitis, tenosynovitis and total inflammation from Day 169 to Day 365 (Table 1, Figure 1). The structural outcomes joint space narrowing and bone erosion remained stable within each treatment group, showing little change from baseline to Days 85, 169 and 365. After separating hand and foot analyses (72 hand and 51 foot cases), only hand tenosynovitis in the 10-mg/kg group and foot synovitis in the 3-mg/kg group were significantly reduced (improved) at Day 169 compared with placebo (differences of –2.331 [p=0.017] and –1.689 [p=0.010], respectively). In general, more comparisons in the hand analysis were statistically significant versus in the foot analysis.Conclusion:This analysis confirmed the efficacy of abatacept 10 and 30/10 mg/kg when assessed with the OMERACT PsAMRIS. The inflammatory pathologies, synovitis and tenosynovitis, appeared to be the most responsive MRI outcomes. Analysing hand and foot cases together yielded results consistent with the primary clinical efficacy endpoint (ACR20 response rate), as the abatacept 10- and 30/10-mg/kg groups showed significant differences versus placebo at Day 169;2 reduced sample size in separate hand and foot assessments may have prevented finding significant results corresponding to the combined analysis. These results also demonstrate the responsiveness of the PsAMRIS in PsA randomised clinical trials.References:[1]Glinatsi D, et al. J Rheumatol 2015;42:2473–2479.[2]Mease P, et al. Arthritis Rheum 2011;63:939–948.Table 1.MRI variables showing significant treatment effectsaBetween groups at Day 169MRI scoreComparatorComparatorDifferenceSEp valueSynovitisPlaceboAbatacept 30/10 mg/kg–0.9660.4610.039TenosynovitisPlaceboAbatacept 10 mg/kg–1.6520.6620.014Placebo group before/after switchbMRI scoreTreatment, Day 169Treatment, Day 365DifferenceSEp valueSynovitisPlaceboAbatacept 10 mg/kg–1.0180.4580.029TenosynovitisPlaceboAbatacept 10 mg/kg–0.9400.3900.018Total inflammationPlaceboAbatacept 10 mg/kg–2.2751.0670.036aBased on change from baseline at the stated time points (unadjusted p values).bPatients were switched to abatacept 10 mg/kg after Day 169.Acknowledgements:Professional medical writing and editorial assistance was provided by Rob Coover, MPH, at Caudex and was funded by Bristol Myers Squibb.Disclosure of Interests:Mikkel Østergaard Speakers bureau: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sanofi, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, Celgene, Merck, Novartis, Paul Bird Speakers bureau: AbbVie, Bristol Myers Squibb, Eli Lilly, Novartis, Pfizer, UCB, Grant/research support from: Gilead, Chahin Pachai Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Shuyan Du Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Chun Wu Employee of: Bristol Myers Squibb, Jessica Landis Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Thomas Fuerst Employee of: Bioclinica, Inc., a contract research service providing radiology central reading services to pharmaceutical, biotech and medical device companies, Harris A Ahmad Employee of: Bristol Myers Squibb, Sean Connolly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Philip G Conaghan Speakers bureau: AbbVie, Novartis, Consultant of: AstraZeneca, Bristol Myers Squibb, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer.
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Alten R, Mariette X, Flipo RM, Caporali R, Buch MH, Patel Y, Sanmartí R, Marsal S, Nurmohamed MT, Griffiths H, Peichl P, Bannert B, Forster A, Chartier M, Connolly S, Elbez Y, Rauch C, Khaychuk V, Lozenski K. OP0180 IMPACT OF RF AND ANTI-CITRULLINATED PROTEIN ANTIBODY SEROSTATUS ON 2-YEAR RETENTION OF ABATACEPT IN PATIENTS WITH RA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.932] [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:Up to 50% of patients with RA discontinue DMARD treatment within 18 months.1 However, up to 20% of patients who fail multiple treatments may have a good treatment response to another therapy.1 Predictive biomarkers, such as RF and anti-citrullinated protein antibodies (ACPAs), may be useful to stratify patients with RA to the most appropriate treatment.1 ASCORE (Abatacept SubCutaneOus in Routine Clinical PracticE; NCT02090556) was a 2-year, observational, prospective, multicentre study of SC abatacept for the treatment of RA in routine clinical practice.2Objectives:To determine if RF/ACPA serostatus and treatment line impact abatacept retention in patients with RA in a post hoc analysis of ASCORE.Methods:Eligible patients, aged ≥18 years, with active moderate-to-severe RA (ACR/EULAR 2010 criteria) who were IV abatacept-naive and initiated SC abatacept 125 mg once weekly, were enrolled into two cohorts: biologic (b)DMARD-naive patients and those with ≥1 prior bDMARD treatment failure. This post hoc analysis assessed abatacept retention rate at 2 years in a subset of patients with RF/ACPA serostatus data (n=1748) from the ASCORE study (N=2892; as observed). Baseline (BL) serostatus groups examined by treatment line were: RF/ACPA double positive (+/+) RA, RF/ACPA single positive (RF+/ACPA– or RF–/ACPA+) RA (data not shown) and RF/ACPA double negative (–/–) RA. Last observation carried forward (LOCF) analyses were used to assess change from BL and measures of disease remission (DAS28 [CRP] <2.6, CDAI ≤2.8, and SDAI ≤3.3) in patients with +/+ RA versus –/– RA.Results:BL demographic and disease characteristics were similar across serostatus groups and treatment lines (Table 1). Mean age was 57.1 and 57.8 years for +/+ RA and –/– RA, respectively. Mean DAS28 (CRP) was 4.7 and 4.8 for +/+ RA and –/– RA, respectively. In patients with +/+ RA, abatacept retention was greater when given as first-line treatment (57% vs 48% when given as ≥ second-line) (Figure 1). Retention was similar in patients with –/– RA regardless of treatment line. After 2 years, mean (SE) change from BL (LOCF) in DAS28 (CRP) was –1.41 (0.06) and –0.97 (0.09) for patients with +/+ and –/– RA, respectively. For patients with +/+ RA, mean (SE) change from BL in DAS28 (CRP) was –1.62 (0.08) for those in whom abatacept was first-line and –1.19 (0.08) for those in whom abatacept was ≥ second-line. For patients with –/– RA, mean (SE) change from BL in DAS28 (CRP) was –1.03 (0.13) for those in whom abatacept was first-line and –0.93 (0.12) for those in whom abatacept was ≥ second-line. Remission rates (LOCF) were significantly (p<0.0001) higher in patients with +/+ RA vs –/– RA respectively: DAS28 (CRP) 38.4% (n=393) versus 19.3% (n=62); CDAI 50.6% (n=513) versus 33.0% (n=107); and SDAI 49.5% (n=497) versus 32.5% (n=102).Table 1.BL demographics and disease characteristics by RF/ACPA status+/+ RA(n=1079)–/– RA(n=343)First-line (n=511)≥ second-line (n=568)First-line(n=140)≥ second-line(n=203)Age57.1 (13.4)57.1 (12.2)59.5 (14.7)56.6 (13.2)DAS28 (CRP)4.7 (1.2)4.7 (1.2)4.8 (1.1)4.8 (1.2)CDAI26.6 (12.5)26.6 (12.4)27.7 (12.5)28.6 (13.8)SDAI28.1 (13.1)28.1 (12.9)29.1 (12.9)30.2 (14.7)Data are mean (SD). Patients with missing data for BL RF/ACPA status are excluded.ACPA=anti-citrullinated protein antibody; BL=baseline.Conclusion:In this real-world analysis, patients with +/+ RA treated with first-line abatacept had higher retention than patients receiving abatacept as a ≥ second-line therapy. Remission rates on abatacept were higher in patients with +/+ RA versus –/– RA. These results support early treatment with abatacept and highlight the importance of further evaluating precision medicine approaches in RA.References:[1]Smolen JS, et al. Ann Rheum Dis 2020;79:685–699.[2]Alten R, et al. Ann Rheum Dis 2019;78(suppl 2):A1639.Acknowledgements:Professional medical writing and editorial assistance was provided by Lindsay Craik at Caudex and was funded by Bristol Myers Squibb. This study was funded by Bristol Myers Squibb.Disclosure of Interests:Rieke Alten Speakers bureau: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Grant/research support from: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Xavier Mariette Consultant of: Bristol Myers Squibb, Galapagos, Gilead, GlaxoSmithKline, Janssen, Pfizer, UCB, Rene-Marc Flipo Speakers bureau: AbbVie, Bristol Myers Squibb, Janssen, Lilly, Medac, Merck Sharp & Dohme, Novartis, Pfizer, Roche-Chugai, Grant/research support from: Amgen, Janssen, Novartis, Pfizer, Roberto Caporali Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Fresenius Kabi, Galapagos, Gilead, Lilly, Merck Sharp & Dohme, Pfizer, Roche, Samsung Bioepis, Sanofi, UCB, Consultant of: Galapagos, Gilead, Janssen, Lilly, Merck Sharp & Dohme, Maya H Buch Speakers bureau: AbbVie, Consultant of: AbbVie, Eli Lilly, Gilead, Merck Serono, Pfizer, Roche, Sanofi, Grant/research support from: Gilead, Pfizer, Roche, UCB, Yusuf Patel: None declared, Raimón Sanmartí Speakers bureau: AbbVie, Bristol Myers Squibb, Gebro, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, Roche, Sanofi, Consultant of: AbbVie, Bristol Myers Squibb, Gebro, Lilly, Merck Sharp & Dohme, Pfizer, Roche, Sanofi, Grant/research support from: Bristol Myers Squibb, Merck Sharp & Dohme, Pfizer, Sara Marsal Speakers bureau: Bristol Myers Squibb, Celgene, Pfizer, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol Myers Squibb, Celgene, Galapagos, Merck Sharp & Dohme, Pfizer, Roche, Sanofi, UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi, UCB, M.T. Nurmohamed Speakers bureau: AbbVie, Bristol Myers Squibb, Eli Lilly, Roche, Sanofi, Consultant of: AbbVie, Celgene, Celltrion, Eli Lilly, Janssen, Grant/research support from: AbbVie, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Mundipharma, Novartis, Pfizer, Roche, Sanofi, Hedley Griffiths Consultant of: AbbVie, Gilead, Janssen, Novartis, Peter Peichl: None declared, Bettina Bannert: None declared, Adrian Forster: None declared, Melanie Chartier Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sean Connolly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Yedid Elbez Consultant of: Bristol Myers Squibb, Christiane Rauch Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vadim Khaychuk Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Karissa Lozenski Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Alten R, Behar C, Boileau C, Merckaert P, Afari E, Vannier-Moreau V, Connolly S, Najm A, Juge PA, Rai A, Elbez Y, Lozenski K. AB0205 A NOVEL METHOD FOR PREDICTING 1-YEAR RETENTION OF ABATACEPT USING MACHINE LEARNING TECHNIQUES: DIRECTIONALITY AND IMPORTANCE OF PREDICTORS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.868] [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:In the ACTION (NCT02109666) study, multivariable Cox proportional hazards regression models showed that the predictors of 1-year retention to abatacept treatment were: patient global pain assessment, country, reason for stopping last biologic, number of prior biologic treatments, abatacept monotherapy, RF/anti-cyclic citrullinated peptide (CCP) status, previous neoplasms, psychiatric disorders and cardiac disorders.1 Machine learning techniques, using the gradient-boosting model, subsequently identified additional predictors of abatacept retention in patients with moderate-to-severe RA enrolled in ACTION; however, the analysis did not show the directionality of the predictors.2Objectives:To improve the clinical interpretability of the machine learning model in terms of directionality and the importance of each variable in predicting retention.Methods:Previous analyses using the gradient-boosting model to identify predictors of abatacept retention at 1 year in the ACTION study have been described.2 This analysis used SHapley Additive exPlanations (SHAP), a mathematical framework, to show how a particular predictor value influences prediction in the context of all other predictors. Higher SHAP values indicate a higher likelihood of retention. The contribution of every variable in the model’s prediction (with the exception of country variables) was computed for each data point to capture individual variable impact. This enabled interpretation for level of importance and directionality at a patient level.Results:Using data from 2350 patients enrolled in ACTION (May 2008 to December 2013), the mean retention rate at 1 year was 59.3% (n=1393). Overall variable importance is shown in Figure 1. After removal of country variables, the top five baseline predictors of retention were: no previous corticosteroid use, ACR functional class II, ≥2 prior biologic treatments prior to abatacept initiation, abatacept monotherapy and HAQ-DI. In terms of directionality, no previous corticosteroid use, ≥2 prior biologic treatments prior to abatacept initiation, abatacept monotherapy and a higher HAQ-DI score at baseline were associated with a lower likelihood of retention; ACR functional class II was associated with a higher likelihood of retention.Conclusion:The gradient-boosting model previously identified predictors of abatacept retention from ACTION;2 the addition of SHAP in this analysis has provided information on the importance and directionality of those predictors. The most important predictor of abatacept retention was no previous corticosteroid use, which was associated with lower retention. The models and predictors identified could be further refined by using additional datasets from clinical trials. Machine learning offers an innovative and complementary approach to biostatistics and could be used to identify treatment response predictors at an individual patient level, leading to a more personalised treatment approach.References:[1]Alten R, et al. RMD Open 2017;3:e000538.[2]Alten R, et al. Presented at the virtual ACR Convergence 2020; 5–9 November 2020. Poster number 1745.Acknowledgements:This study was supported by Bristol Myers Squibb. Professional medical writing and editorial assistance was provided by Claire Line, PhD, at Caudex and was funded by Bristol Myers Squibb.Disclosure of Interests:Rieke Alten Speakers bureau: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Grant/research support from: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Claire Behar Shareholder of: I have not invested directly in pharmaceutical companies producing drugs/devices for use in rheumatology however I may have shares via the funds linked to my life insurance., Consultant of: Bristol Myers Squibb, Christine Boileau Consultant of: AstraZeneca, Bristol Myers Squibb, Nanobiotix, Pierre Merckaert Consultant of: Bristol Myers Squibb, Ebenezer Afari Consultant of: Bristol Myers Squibb, Virginie Vannier-Moreau Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sean Connolly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Aurelie Najm Speakers bureau: Bristol Myers Squibb, Consultant of: Bristol Myers Squibb, Pierre-Antoine Juge Consultant of: Bristol Myers Squibb, Angshu Rai Shareholder of: Amgen Inc, Consultant of: Amgen Inc, Employee of: Amgen Inc, Bristol Myers Squibb, Yedid Elbez Consultant of: Bristol Myers Squibb, Karissa Lozenski Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Rodgers A, Edwards W, Garrity J, Latimer D, Wilson D, Connolly S. Delivering a dietetic intervention to cardiovascular patients in the Covid era. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Department of Health
Introduction
Healthy diet and body composition are core components of cardiac rehabilitation. Following the COVID outbreak in March 2020, our face-to-face cardiac rehabilitation programme (Our Hearts Our Minds) was suspended. The programme was then quickly moved to a virtual platform to continue to deliver the programme.
Purpose
Here we describe how the OHOM programme adapted our service to deliver the dietetic assessment and intervention on a virtual platform.
Methods
Pre-Covid the dietary component of OHOM consisted of a face-to-face Initial Assessment (IA) with a dietitian, group education sessions and an End of Programme assessment (EOP). Anthropometric measures and dietary habits were assessed including adherence to the Mediterranean diet via the Mediterranean Diet Score (MDS) toolkit. Using behaviour change techniques, tailored dietary advice was provided and goals agreed to educate on healthier food choices, increase adherence to Mediterranean diet and (if appropriate) promote weight loss and reduce central obesity. The assessment and intervention is now delivered virtually via telephone or video. Anthropometrics are self-reported with tape-measures supplied to assess waist circumference and advice provided on home-weighing. MDS is still assessed. The programme includes fortnightly coaching telephone consultations to review and reset goals, the option to attend a dietitian-led virtual group education session, access to a filmed educational video and submission of food diaries via the Fitbit app.
Results
From April to November 2020, 114 patients completed the virtual programme (65 telephone, 39 video). Dietetic outcomes are outlined in Table 1 with inclusion of data for a similar period one year previously (face-to-face) for comparison. Reductions in anthropometric measures and increased adherence to a cardio-protective diet were noted and the results for the two time periods are remarkably similar.
Conclusion
Delivery of a virtual dietetic component in cardiac rehabilitation is feasible, acceptable and just as effective as face-to-face based on preliminary data.
Table 1: Dietary outcomes at IA and EOP Face-to-face assessments (April - March 2019) Virtual assessments (April - November 2020) IA EOP Change IA EOP Change Mean weight (in those with BMI >25kg/m2) 86.5 85.2 -1.3 91.4 88.6 -2.8 Waist circumference (cm) 104.3 103 -1.3 107 102 -5 Mean MDS (Range 1-14) 4.4 7.5 +3.1 4.8 7.8 +3 % Consuming oily fish once per week 20 57 +37 25 68 +43 Achieving fruit and vegetable target 16 61 +45 21 57 +36
Abstract Figure. Dietitian waist circumference tutorial
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Affiliation(s)
- A Rodgers
- Western Health and Social Care Trust, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - W Edwards
- Western Health and Social Care Trust, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - J Garrity
- Western Health and Social Care Trust, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D Latimer
- Western Health and Social Care Trust, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D Wilson
- Western Health and Social Care Trust, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - S Connolly
- Western Health and Social Care Trust, Londonderry, United Kingdom of Great Britain & Northern Ireland
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McFeely A, Doyle R, O’Riordan S, Connolly S, O’Dwyer C. Severe brachial plexopathy secondary to shingles (herpes zoster). Age Ageing 2021; 50:1001-1003. [PMID: 33765117 DOI: 10.1093/ageing/afab055] [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: 01/20/2020] [Indexed: 11/14/2022] Open
Abstract
Varicella zoster reactivation ("shingles" or "herpes zoster") usually presents as a self-limiting, unilateral, dermatomal vesicular rash in older adults. We present the case of a 73 year-old woman with unilateral brachial plexopathy, an unusual but debilitating complication of shingles. Despite treatment with intravenous acyclovir and immunoglobulin she had a marked residual motor paresis that required an upper limb rehabilitation program after discharge.
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Affiliation(s)
| | - Rachael Doyle
- Departments of Medicine for the Older Person, St. Columcilles Hospital, Dublin, Ireland
- St. Vincents Hospital, Dublin, Ireland
| | - Sean O’Riordan
- Departments of Neurology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Sean Connolly
- Clinical Neurophysiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Clodagh O’Dwyer
- Departments of Medicine for the Older Person, St. Columcilles Hospital, Dublin, Ireland
- St. Vincents Hospital, Dublin, Ireland
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Harrington B, Keenan R, Aboelmagd M, O'Malley K, Galvin D, Hegarty N, Connolly S. 54 Patient Satisfaction During A Pandemic – Virtually Impossible? Br J Surg 2021. [PMCID: PMC8135709 DOI: 10.1093/bjs/znab134.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Throughout the COVID-19 pandemic we conducted virtual urology clinics for the first time at our institution. We aimed to assess patient satisfaction with the virtual clinic format.
Method
Patients who underwent virtual consultation were contacted by phone and surveyed about their appointment. Convenience, thoroughness, satisfaction, preference and reason for appointment were assessed via questionnaire
Results
77 randomly selected patients were contacted. 63 males (82%), 14 females (18%). Median age 61 years (range 16–86). 62 (80%) reviews, 12 (16%) new referrals, and 3 (4%) post-operative patients were surveyed. 55 (71%) were booked for repeat appointment, 13 (17%) for further investigations, 6 (8%) discharged, and 3 (4%) listed for surgery.
73 (95%) found it convenient, 3 (4%) were neutral and 1 (1%) found it inconvenient. 74 (96%) felt thoroughly assessed and 76 (99%) of patients had all their concerns addressed. 74 (96%) were satisfied with their review, 2 (3%) were neutral, and 1 (1%) was dissatisfied. Going forward, 50 (65%) would prefer virtual follow-up and 27 (35%) would prefer an in-person review.
Conclusions
Virtual clinic is preferable to the majority of patients in our urology service and is deemed convenient, thorough and satisfactory by them. It should be facilitated going forward in appropriately selected patients.
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Affiliation(s)
- B Harrington
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - R Keenan
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - M Aboelmagd
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - K O'Malley
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - D Galvin
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - N Hegarty
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - S Connolly
- Mater Misercordiae University Hospital, Dublin, Ireland
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Gaughan M, Connolly S, O'Riordan S, Tubridy N, McGuigan C, Kinsella JA. Pediatric Parainfectious Encephalitis Associated With COVID-19. Neurology 2021; 96:541-544. [PMID: 33397771 DOI: 10.1212/wnl.0000000000011476] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/23/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Maria Gaughan
- From the Neurology Department (M.G., S.O, N.T., C.M., J.A.K.), St. Vincent's University Hospital, Elm Park, Dublin 4; and Clinical Neurophysiology Department (S.C.), St. Vincent's University Hospital, Elm Park, Dublin 4.
| | - Sean Connolly
- From the Neurology Department (M.G., S.O, N.T., C.M., J.A.K.), St. Vincent's University Hospital, Elm Park, Dublin 4; and Clinical Neurophysiology Department (S.C.), St. Vincent's University Hospital, Elm Park, Dublin 4
| | - Sean O'Riordan
- From the Neurology Department (M.G., S.O, N.T., C.M., J.A.K.), St. Vincent's University Hospital, Elm Park, Dublin 4; and Clinical Neurophysiology Department (S.C.), St. Vincent's University Hospital, Elm Park, Dublin 4
| | - Niall Tubridy
- From the Neurology Department (M.G., S.O, N.T., C.M., J.A.K.), St. Vincent's University Hospital, Elm Park, Dublin 4; and Clinical Neurophysiology Department (S.C.), St. Vincent's University Hospital, Elm Park, Dublin 4
| | - Chris McGuigan
- From the Neurology Department (M.G., S.O, N.T., C.M., J.A.K.), St. Vincent's University Hospital, Elm Park, Dublin 4; and Clinical Neurophysiology Department (S.C.), St. Vincent's University Hospital, Elm Park, Dublin 4
| | - Justin A Kinsella
- From the Neurology Department (M.G., S.O, N.T., C.M., J.A.K.), St. Vincent's University Hospital, Elm Park, Dublin 4; and Clinical Neurophysiology Department (S.C.), St. Vincent's University Hospital, Elm Park, Dublin 4
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Vanassche T, Verhamme P, Leong D, Bhatt D, Shestakovska O, Maggioni A, Fox K, Muehlhofer E, Connolly S, Yusuf S, Eikelboom J, Bosch J. Efficacy and safety of low-dose rivaroxaban on top of aspirin in patients with polypharmacy and multimorbidity: an analysis from the COMPASS trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In patients with coronary or peripheral artery disease, intensified antithrombotic therapy with aspirin plus low dose rivaroxaban reduced cardiovascular outcomes compared with aspirin alone. Polypharmacy and multimorbidity are frequent in patients with vascular disease and are often perceived as barriers to more intensive pharmacotherapy by both patients and physicians.
Purpose
To report cardiovascular outcomes and the efficacy, safety, and net benefit of low dose rivaroxaban plus aspirin in patients with stable vascular disease by the number of concomitant cardiovascular drugs and by the number of comorbidities.
Methods
We reported ischemic events (cardiovascular death, stroke, or MI), major bleeding (ISTH modified criteria), and a prespecified net clinical outcome in participants from the randomised, double-blind COMPASS study by number of cardiovascular medications (0–2, 3, 4, 5–7) and by number of concomitant medical conditions. We compared rates and hazard ratios of patients treated with rivaroxaban plus aspirin vs aspirin alone by category of number of medications and concomitant conditions and tested for interaction between polypharmacy and multimorbidity and antithrombotic regimen.
Results
Although patients with polypharmacy and multimorbidity have a higher risk of cardiovascular events (Figure) those who required many cardiovascular drugs derived the largest absolute reduction in the net clinical outcome when adding rivaroxaban on top of aspirin. The relative efficacy, safety, and net clinical benefit of adding low-dose rivaroxaban to aspirin in patients with stable vascular diseases were not affected by the number of cardiovascular drugs or by the number of comorbidities. Multimorbidity, but not polypharmacy, was related with a higher risk of major bleeding.
Conclusion
Addition of low-dose rivaroxaban conveyed a benefit irrespective of the number of concomitant drugs or comorbid conditions. Multiple comorbidities and/or polypharmacy should not dissuade the addition of low-dose rivaroxaban to aspirin in otherwise eligible patients.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The COMPASS trial was funded by Bayer AG.
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Affiliation(s)
- T Vanassche
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - P Verhamme
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - D Leong
- Population Health Research Institute, Hamilton, Canada
| | - D.L Bhatt
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | | | - A.P Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - K.A.A Fox
- University of Edinburgh, Center for Cardiovascular Science, Edinburgh, United Kingdom
| | - E Muehlhofer
- Bayer AG, Research & Development, Pharmaceuticals, TA Thrombosis & Hematology, Wuppertal, Germany
| | - S Connolly
- Population Health Research Institute, Hamilton, Canada
| | - S Yusuf
- Population Health Research Institute, Hamilton, Canada
| | - J Eikelboom
- Population Health Research Institute, Hamilton, Canada
| | - J Bosch
- McMaster University, School of Rehabilitation Science, Hamilton, Canada
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Whitlock R, Belley-Cote E, Healey J, Devereaux P, Eikelboom J, Lamy A, Brady K, Marsella B, Tagarakis G, Paparella D, Reents W, Punjabi P, Connolly S. Vitamin K antagonists versus direct oral anticoagulants after cardiac surgery: a 31-country cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
About 10% of patients undergoing cardiac surgery have a history of atrial fibrillation (AF). Among these patients, uncertainty exists regarding the safest and most effective oral anticoagulant (OAC) during the postoperative period.
Purpose
To evaluate practice patterns regarding OAC early after cardiac surgery in patients with a preoperative history of AF and to compare the safety and effectiveness of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs).
Methods
We conducted a nested cohort study within the Left Atrial Appendage Occlusion Study (LAAOS) III (NCT01561651). LAAOS III included patients with AF undergoing cardiac surgery with a CHA2DS2-VASC ≥2. In this substudy, we examined patients without end-stage renal dysfunction (eGFR >30 mL/min/1.73m2) who were discharged on OAC. We evaluated bleeding and thromboembolism within 90 days postoperatively using logistic regression adjusting for CHA2DS2-VASC score.
Results
Recruitment started in 2012 and completed in 2018 in 113 centres in 31 countries. Of the 4811 patients enrolled in LAAOS III, 3725 (77%) were included in this substudy. Preoperatively, 58% of patients received OAC: 56% DOACs and 44% VKAs. At hospital discharge 23% received DOACs and 77% VKAs; 55% of patients on a DOAC at baseline were switched to a VKA while 5% of patients on a VKA were switched to a DOAC. Patients discharged on a DOAC were older, had a higher CHA2DS2-VASC, and were more likely to be male. Patients having undergone an isolated coronary bypass procedure were more likely prescribed DOACs than VKAs (41% vs 23%, p<0.001) whereas isolated non-mechanical valve patients were more likely to be prescribed VKAs (43% vs 28%, p<0.001). Switching from a DOAC to a VKA postoperatively occurred in 42% of patients In Australia/New Zealand, 49% in Europe, and 63% in North America. Major bleeding between 48 hours postoperatively and 30 days occurred in 1.5% in the DOAC group and 1.3% in the VKA group (aOR 1.14, 95% CI 0.60–2.15, p=0.69) while between 48 hours and 90 days, it occurred in 1.8% of patients in both groups (aOR 0.97, 95% CI, 0.54–1.17, p=0.91). Cardiac tamponade, the composite of stroke and systemic arterial embolism, and the composite of stroke, systemic arterial embolism and death did not differ significantly at 30 and 90 days between the DOAC and VKA groups.
Conclusions
VKAs was the dominant OAC used early after cardiac surgery, but postoperative OAC practices varied by region. After adjustment for CHA2DS2-VASC score, the early postoperative incidence of major bleeding and of the composite of stroke and systemic arterial embolism did not differ significantly when DOACs were compared with VKAs.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): CIHR, Heart and Stroke Foundation
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Affiliation(s)
- R Whitlock
- Population Health Research Institute, Hamilton, Canada
| | | | - J Healey
- Population Health Research Institute, Hamilton, Canada
| | - P.J Devereaux
- Population Health Research Institute, Hamilton, Canada
| | - J Eikelboom
- Population Health Research Institute, Hamilton, Canada
| | - A Lamy
- Population Health Research Institute, Hamilton, Canada
| | - K Brady
- Population Health Research Institute, Hamilton, Canada
| | | | - G.I Tagarakis
- Aristotle University of Thessaloniki, Cardiothoracic Surgery, Thessaloniki, Greece
| | - D Paparella
- Santa Maria Hospital, Emergency and Organ Transplant, Bari, Italy
| | - W Reents
- Heart Center Bad Neustadt, Cardiac Surgery, Bad Neustadt a. d. Saale, Germany
| | - P Punjabi
- Imperial College London, Cardiothoracic Surgery, London, United Kingdom
| | - S Connolly
- Population Health Research Institute, Hamilton, Canada
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McIntyre W, Belley-Côté E, Vadakken M, Rai A, Lengyel A, Rochwerg B, Bhatnagar A, Deif B, Um K, Spence J, Connolly S, Bangdiwala S, Rao-Melacini P, Healey J, Whitlock R. HIGH-SENSITIVITY ESTIMATE OF THE INCIDENCE OF NEW-ONSET ATRIAL FIBRILLATION IN CRITICALLY ILL PATIENTS. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.102] [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: 10/23/2022] Open
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Kilcoyne C, Aboelmagd M, Jones A, Harrington B, Keenan R, Kuwaijo N, O’Meara S, McGarvey C, Soman N, Hegarty N, Connolly S, O’Malley K, Galvin D. Audit on The Impact of Warning Catheter Stickers on Reducing The Early Removal of Catheters Post-Prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35232-0] [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: 11/26/2022] Open
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Harrington B, Keenan R, Aboelmagd M, Jones A, O’Malley K, Galvin D, Hegarty N, Connolly S. Patient Satisfaction During a Pandemic – Virtually Impossible? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35226-5] [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: 11/17/2022] Open
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Keenan R, Haroon U, Harrington B, Jones A, Aboelmagd M, Connolly S, O’Malley K, Galvin D, Hegarty N. Urological Malignancy in Heart & Lung Transplant Recipients – An Irish National Cohort study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35258-7] [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: 10/23/2022] Open
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Galbraith D, Caliskan M, Jabado O, Hu S, Fleischmann R, Weinblatt M, Connolly S, Maldonado MA, Gao S. THU0063 DIFFERENTIAL PHARMACODYNAMIC EFFECTS OF ABATACEPT AND ADALIMUMAB ON THE SERUM PROTEOME OF PATIENTS WITH RA USING THE SOMASCAN® PLATFORM. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1452] [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:Abatacept (ABA) versus adaliMumab (ADA) comParison in bioLogic-naïvERA subjects with background MTX (AMPLE) was a Phase IIIb clinical trial to compare the safety, efficacy and radiographic outcomes of ABA vs ADA in patients with RA who exhibited an inadequate response to MTX and who were naïve to biologic DMARDs.1While both therapies demonstrated similar efficacy across multiple outcomes, their mechanisms of action (MoAs) are quite different; ABA is a T-cell co-stimulation modulator and ADA is a TNFα inhibitor. Previous transcriptomic analysis of the whole blood samples showed differential pharmacodynamic (PD) effects between the treatments.1–3Objectives:To expand our understanding of differential PD changes in the serum proteome over time in patients treated with ABA or ADA in AMPLE using a novel proteomic platform.Methods:Serum was available from 440 patients in AMPLE at four time points (Days 1, 85, 365 and 729). Serum samples from the patients in AMPLE and 123 healthy individuals with matching demographics were subjected to proteomic quantification by a highly multiplexed DNA aptamer technology with wide dynamic ranges (SomaLogic SomaScan®platform).4A linear model analysis was used to identify protein abundance changes over time and changes specific to treatment. Other covariates included in the model were country of origin, ethnicity and sex. Additionally, patient effect was adjusted for as a random factor.Results:Both treatments exhibited a significant PD effect on serum proteome over the course of the 2-year trial, with 73 proteins modulated by ABA and 125 by ADA. There were large overlaps between the two treatments, including proteins associated with RA, such as C-X-C motif chemokine ligand 13 (CXCL13), matrix metalloproteinase-3 (MMP3) and serum amyloid A1/A2 (SAA1/2). Changes in the levels of these proteins may be indicative of general improvement of the disease. The proteins modulated by the treatments were enriched in the G-protein coupled receptor (GPCR) signalling and innate immunity pathways. Among the proteins that exhibited significantly different PD effects between the treatments were CRP, CC chemokine ligand 17 (CCL17) and β-defensin 112 (Figure). While patients showed marked improvement in their symptoms after 2 years of treatment, the overall serum proteomic profiles of the patients were still different from those of a normal healthy population.Conclusion:The SomaScan®platform provides a robust method for quantifying the PD change in a broad portion of the serum proteome in clinical trials. In AMPLE, abatacept was more selective than adalimumab in modulating protein biomarkers in patients with RA, though there was large overlap in proteins modulated by both treatments. The treatment-specific changes may reflect the different MoAs leading to similar clinical outcomes. While patients in both groups benefited from treatments, their serum proteome remained notably different from that of a healthy population. Further analysis by responder status may provide additional links between the treatment responses and proteomic changes. Proteomic approaches as described in our study could contribute to clinical trials and help shape treatment strategies for patients with RA.References:[1]Schiff M, et al.Ann Rheum Dis2014;73:86–94.[2]Bandyopadhyay S, et al.Arthritis Rheum2014;66:Abstract 1520.[3]Sokolove J, et al.Ann Rheum Dis2016;75:709–14.[4]Gold L, et al.PLoS One2010;5:e15004.Disclosure of Interests:David Galbraith Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Minal Caliskan Employee of: Bristol-Myers Squibb, Omar Jabado Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sarah Hu Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Roy Fleischmann Grant/research support from: AbbVie, Akros, Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer, IngelhCentrexion, Eli Lilly, EMD Serono, Genentech, Gilead, Janssen, Merck, Nektar, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Samsung, Sandoz, Sanofi Genzyme, Selecta, Taiho, UCB, Consultant of: AbbVie, ACEA, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Novartis, Pfizer, Sanofi Genzyme, UCB, Michael Weinblatt Grant/research support from: Amgen, Bristol-Myers Squibb, Crescendo, Lily, Sanofi/Regeneron, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Crescendo, Gilead, Horizon, Lily, Pfizer, Roche, Sean Connolly Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Michael A Maldonado Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sheng Gao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb
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Emery P, Tanaka Y, Bykerk V, Huizinga T, Citera G, Bingham C, Banerjee S, Connolly S, Zhuo J, Wong R, Huang KHG, Lozenski K, Elbez Y, Fleischmann R. SAT0104 MAINTENANCE OF SDAI REMISSION AND PATIENT-REPORTED OUTCOMES (PROS) FOLLOWING DOSE DE-ESCALATION OF ABATACEPT IN MTX-NAÏVE, ANTI-CITRULLINATED PROTEIN ANTIBODY (ACPA)+ PATIENTS WITH EARLY RA: RESULTS FROM AVERT-2, A RANDOMISED PHASE IIIB STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1429] [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 Phase IIIbAssessingVeryEarlyRATreatment (AVERT)-2 trial (NCT02504268) evaluated SC abatacept (ABA) + MTX vs ABA placebo (PBO) + MTX in ACPA+ patients (pts) with early, active RA.1Results from the 56-wk induction period (IP) showed a significantly greater proportion of pts treated with ABA + MTX (vs MTX alone) reported clinically meaningful improvements in HAQ-DI, global disease activity and pain, which were sustained at 52 wks.2Objectives:To report maintenance of SDAI remission and PROs from the AVERT-2 de-escalation (D-E) period.Methods:Pts received blinded SC ABA (125 mg once wkly [QW]) + MTX or ABA PBO + MTX induction treatment for 56 wks. In this analysis, pts who completed induction with ABA + MTX and had sustained SDAI remission (≤3.3 at Wks 40 and 52) were re-randomised 1:1:1 to ABA QW + MTX, stepwise D-E (ABA every other wk + MTX for 24 wks then ABA PBO + MTX for 24 wks), or ABA QW + MTX PBO for 48 wks in the D-E period. PROs included physical function (HAQ-DI [0–3; decrease=improvement] and Short-Form 36 [SF-36] v2.0 Physical Functioning Scale [PFS]; 0–100; increase=improvement), and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F] score; 0–52; decrease=improvement). Endpoints included: proportion of pts in SDAI remission and pts with HAQ-DI response (decrease from IP Day [D]1 in HAQ-DI ≥0.30); adjusted mean change (adMC) from D-E D1 in HAQ-DI, SF-36 PFS or FACIT-F to D-E Wk 48. adMCs were estimated using a mixed effect model with repeated measures.Results:147 ABA + MTX-treated pts were re-randomised in the D-E period. Across re-randomised arms, the range of mean scores was 1.87–2.52 for SDAI and 0.18–0.30 for HAQ-DI at entry into D-E period (D-E D1). 74% of pts receiving ABA QW + MTX maintained SDAI remission at D-E Wk 48 (Fig 1); this proportion was higher than in the ABA withdrawal and ABA QW + MTX PBO arms. Pts continuing ABA QW + MTX maintained HAQ-DI response during D-E (Fig 1), but by D-E Wk 48 the proportion of pts with HAQ-DI response in the ABA withdrawal arm declined by 30%. At D-E Wk 48, a small numerical decrease (adMC –0.04) in HAQ-DI was observed in the ABA QW + MTX arm; increases were seen in the withdrawal (adMC 0.26) and ABA QW + MTX PBO arms (adMC 0.16). By D-E Wk 48, SF-36 PFS increased (adMC 1.68) in the ABA QW + MTX arm but decreased in the withdrawal (adMC –3.34) and ABA QW + MTX PBO (adMC –1.45) arms. FACIT-F score increased during D-E in all arms, but the increase at D-E Wk 48 was lower in the ABA QW + MTX arm (adMC 0.79) vs the withdrawal (adMC 4.12) and ABA QW + MTX PBO (adMC 2.41) arms. Similar trends were seen for other PROs including Work Productivity and Activity Impairment-RA; while activity impairment remained stable in the ABA QW + MTX arm, there was a trend for worsening in the withdrawal arm.Conclusion:In the AVERT-2 D-E period, continued combination therapy (abatacept + MTX) resulted in maintenance of benefits on PROs, particularly physical functioning, in seropositive pts with early RA. D-E of abatacept followed by complete withdrawal was associated with the greatest loss of remission as well as worsening of PROs. The PRO results corresponded well to the maintenance of clinical (SDAI) remission.References:[1]Emery P, et al. ACR 2018; San Diego, USA: Poster 563.[2]Emery P, et al. ACR 2019; Atlanta, USA: Poster 1423.Acknowledgments:Joanna Wright (medical writing, Caudex; funding: Bristol-Myers Squibb)Disclosure of Interests:Paul Emery Grant/research support from: AbbVie, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Roche (all paid to employer), Consultant of: AbbVie (consultant, clinical trials, advisor), Bristol-Myers Squibb (consultant, clinical trials, advisor), Lilly (clinical trials, advisor), Merck Sharp & Dohme (consultant, clinical trials, advisor), Novartis (consultant, clinical trials, advisor), Pfizer (consultant, clinical trials, advisor), Roche (consultant, clinical trials, advisor), Samsung (clinical trials, advisor), Sandoz (clinical trials, advisor), UCB (consultant, clinical trials, advisor), Yoshiya Tanaka Grant/research support from: Asahi-kasei, Astellas, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Pfizer, and Ono, Consultant of: Abbvie, Astellas, Bristol-Myers Squibb, Eli Lilly, Pfizer, Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Sanofi, UCB, and Teijin, Vivian Bykerk: None declared, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Gustavo Citera Grant/research support from: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Consultant of: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Clifton Bingham Grant/research support from: Bristol-Myers Squibb, Consultant of: Bristol-Myers Squibb, Subhashis Banerjee Shareholder of: AbbVie, Bristol-Myers Squibb, Lily, Pfizer, Employee of: Bristol-Myers Squibb (current); AbbVie, Lily, Pfizer (past), Sean Connolly Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Robert Wong Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kuan-Hsiang Gary Huang Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Karissa Lozenski Employee of: Bristol-Myers Squibb, Yedid Elbez Consultant of: Bristol-Myers Squibb, Roy Fleischmann Grant/research support from: AbbVie, Akros, Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer, IngelhCentrexion, Eli Lilly, EMD Serono, Genentech, Gilead, Janssen, Merck, Nektar, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Samsung, Sandoz, Sanofi Genzyme, Selecta, Taiho, UCB, Consultant of: AbbVie, ACEA, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Novartis, Pfizer, Sanofi Genzyme, UCB
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Emery P, Tanaka Y, Bykerk V, Bingham C, Huizinga T, Citera G, Huang KHG, Connolly S, Elbez Y, Wong R, Lozenski K, Fleischmann R. FRI0090 MAINTENANCE OF CLINICAL RESPONSE WITH ABATACEPT IN COMBINATION WITH MTX IN INDIVIDUAL PATIENTS WITH EARLY RA WHO ARE MTX-NAÏVE AND ANTI-CITRULLINATED PROTEIN ANTIBODY (ACPA)+: RESULTS FROM THE INDUCTION PERIOD OF AVERT-2, A RANDOMISED PHASE IIIB STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2367] [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:In the 56-wk induction period (IP) of the Phase IIIbAssessingVeryEarlyRATreatment (AVERT)-2 trial (NCT02504268), more patients (pts) achieved SDAI remission (≤3.3) with abatacept (ABA) + MTX vs ABA placebo (PBO) + MTX at IP Wk 52.1It is unknown whether each individual pt within a treatment (Tx) group achieves and sustains the same efficacy endpoints at all time points during the IP.Objectives:To investigate whether ABA effectiveness is sustained by individual pts who achieved SDAI remission (≤3.3), SDAI low disease activity (LDA; >3.3–11), DAS28 (CRP) <2.6, ACR50/70 response or Boolean remission at IP Wk 24 (AVERT-2 primary endpoint) and both Wks 40 and 52 (Wks 40/52).Methods:Pts were randomised 3:2 to blinded SC ABA (125 mg/wk) + MTX or ABA PBO + MTX induction Tx for 56 wks. Key inclusion criteria: age ≥18 yrs; RA diagnosis (ACR/EULAR 2010 criteria); RA duration ≤6 mos; SDAI >11; ACPA+; CRP >3 mg/L or ESR ≥28 mm/h; TJC ≥3 and SJC ≥3; DMARD naïve. Response rates were investigated by Tx arm in the cohort 1 analysis population (all randomised pts treated in the IP [intent-to-treat analysis]).Results:Of randomised cohort 1, 752 pts were treated during the IP: 451 with ABA + MTX and 301 with ABA PBO + MTX. Baseline characteristics were similar across Tx arms.1Stringent SDAI remission endpoint at IP Wk 24 was achieved by 22% of ABA + MTX-treated pts; of these, 56% sustained SDAI remission at IP Wks 40/52 (Table). A similar proportion of ABA + MTX-treated pts achieved (17%) and sustained (58%) Boolean remission at IP Wks 24 and 40/52. At IP Wk 24, 42% of ABA + MTX-treated pts achieved DAS28 (CRP) <2.6 and 74% sustained DAS28 (CRP) <2.6 to IP Wks 40/52; a high proportion of patients sustained ACR50/70 responses at IP Wks 40/52 (83% and 79%, respectively). A lower proportion of pts sustained SDAI LDA to IP Wks 40/52 vs other endpoints (Table). Most efficacy endpoints were achieved by fewer pts who received ABA PBO + MTX than ABA + MTX (Table); among responders in this Tx group, fewer sustained remission at Wks 40/52, which correlates with a higher proportion of pts sustaining SDAI LDA at Wks 40/52 with ABA PBO + MTX than ABA + MTX.Conclusion:The majority of individual pts with RA who achieved clinically stringent endpoints such as SDAI remission, DAS28 (CRP) <2.6 or Boolean remission, as well as clinically meaningful endpoints such as ACR50/70 at IP Wk 24 with weekly SC abatacept, sustained their responses to Wks 40/52. The high proportion of patients achieving early stringent remission and response to SC abatacept by individual pts may be indicative of sustained efficacy over time.References:[1]Emery P, et al. ACR 2018; San Diego, USA: Poster 563.Table .Proportion of Pts With Response at IP Wk 24 Who Also Achieved Remission at Wks 40/52EndpointResponders at IP Wk 24, n (%)Responders at IP Wk 24 and Wks 40/52, n/N (%)ABA + MTX(n=451)ABA PBO + MTX(n=301)ABA + MTX*ABA PBO + MTX*SDAI remission (≤3.3)100 (22)40 (13)56/100 (56)17/40 (43)SDAI low disease activity (>3.3–11)167 (37)82 (27)46/167 (28)32/82 (39)DAS28 (CRP) <2.6188 (42)78 (26)139/188 (74)43/78 (55)ACR50 response†260 (58)125 (42)215/260 (83)92/125 (74)ACR70 response†156 (35)66 (22)123/156 (79)42/66 (64)Boolean remission76 (17)29 (10)44/76 (58)8/29 (28)*% based on number of pts within each Tx group who achieved response at IP Wk 24 (denominator);†Response at IP Wks 24 and 52Acknowledgments:Lola Parfitt (medical writing, Caudex; funding: Bristol-Myers Squibb)Disclosure of Interests:Paul Emery Grant/research support from: AbbVie, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Roche (all paid to employer), Consultant of: AbbVie (consultant, clinical trials, advisor), Bristol-Myers Squibb (consultant, clinical trials, advisor), Lilly (clinical trials, advisor), Merck Sharp & Dohme (consultant, clinical trials, advisor), Novartis (consultant, clinical trials, advisor), Pfizer (consultant, clinical trials, advisor), Roche (consultant, clinical trials, advisor), Samsung (clinical trials, advisor), Sandoz (clinical trials, advisor), UCB (consultant, clinical trials, advisor), Yoshiya Tanaka Grant/research support from: Asahi-kasei, Astellas, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Pfizer, and Ono, Consultant of: Abbvie, Astellas, Bristol-Myers Squibb, Eli Lilly, Pfizer, Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Sanofi, UCB, and Teijin, Vivian Bykerk: None declared, Clifton Bingham Grant/research support from: Bristol-Myers Squibb, Consultant of: Bristol-Myers Squibb, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Gustavo Citera Grant/research support from: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Consultant of: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Kuan-Hsiang Gary Huang Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sean Connolly Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Yedid Elbez Consultant of: Bristol-Myers Squibb, Robert Wong Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Karissa Lozenski Employee of: Bristol-Myers Squibb, Roy Fleischmann Grant/research support from: AbbVie, Akros, Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer, IngelhCentrexion, Eli Lilly, EMD Serono, Genentech, Gilead, Janssen, Merck, Nektar, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Samsung, Sandoz, Sanofi Genzyme, Selecta, Taiho, UCB, Consultant of: AbbVie, ACEA, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Novartis, Pfizer, Sanofi Genzyme, UCB
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Galbraith D, Caliskan M, Jabado O, Hu S, Fleischmann R, Weinblatt M, Connolly S, Maldonado MA, Gao S. FRI0576 IDENTIFICATION OF SERUM PROTEIN BIOMARKERS ASSOCIATED WITH RA DISEASE SEVERITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2208] [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:RA is a systemic autoimmune disease with heterogeneous manifestation. Recent advances in serum proteomics, such as the SomaScan®platform (SomaLogic, Inc., Boulder, USA), allow for a deeper exploration of the protein biomarkers associated with RA and a better understanding of the molecular aetiology of the disease.Objectives:To characterise the differences in baseline serum proteome of patients with RA (enrolled in the Phase IIIb Abatacept vs adaliMumab comParison in bioLogic-naïvERA subjects with background MTX [AMPLE] study)1compared with a healthy population, and to identify serum protein biomarkers associated with disease severity and radiographic progression.Methods:Patients in the AMPLE study had an inadequate response to MTX and were naïve to biologic DMARDs. Protein abundance was assessed in baseline serum samples from 440 AMPLE study patients and 123 healthy individuals with matching demographics using the SomaScan®platform, with 5000+ slow off-rate modified aptamers and up to 8 log of dynamic range.2Differential abundance testing was performed using linear models to identify differences in protein abundance in patients with RA vs healthy individuals. A separate analysis using a linear model was conducted in only the patients with RA to identify the proteins associated with DAS28 (CRP) and TSS. Pathway analyses were performed for proteins significantly (false discovery rate-adjusted p value <0.05) associated with RA and the disease severity measurements to identify over-representation of the molecular pathways.Results:Compared with healthy individuals, >2000 serum proteins were significantly differentially expressed in patients with RA, including many proteins that have been associated with RA (e.g. serum amyloid A [SAA], CRP) and complement. Most of the protein expression differences were of small magnitude (fold change <2). Proteins that were differentially expressed between patients with RA and healthy individuals were enriched in interleukin signalling, neutrophil degranulation, platelet activation/degranulation and extracellular matrix organisation pathways. DAS28 (CRP) was significantly associated with several biomarkers, including SAA, fibrinogen and CRP; in general, proteins associated with DAS28 (CRP) were most strongly enriched in the platelet activation/degranulation pathways (Figure 1), also seen in patients with RA vs healthy individuals. Additionally, many proteins were significantly associated with TSS, including SAA, matrix metalloproteinase-3 and cartilage acidic protein 1. Here, the proteins were most strongly enriched in the extracellular matrix remodelling pathways (Figure 2).Conclusion:Our study revealed that thousands of serum proteins are differentially expressed and several pathways are dysregulated between patients with RA and healthy individuals. Additional pathways were identified that reflect disease severity, including joint damage, distinct from those pathways associated with the disease. The SomaScan®platform provides a unique proteomic tool with a wide dynamic range for the identification of serum protein biomarkers associated with RA and disease severity. Proteomic signatures should be considered in clinical trials to better understand disease pathogenesis and predict risk in response to treatment.References:[1]Schiff M, et al.Ann Rheum Dis2014;73:86–94.[2]Gold L, et al.PLoS One2010;5:e15004.Acknowledgments:Rachel Rankin (medical writing, Caudex; funding: Bristol-Myers Squibb)Disclosure of Interests:David Galbraith Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Minal Caliskan Employee of: Bristol-Myers Squibb, Omar Jabado Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sarah Hu Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Roy Fleischmann Grant/research support from: AbbVie, Akros, Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer, IngelhCentrexion, Eli Lilly, EMD Serono, Genentech, Gilead, Janssen, Merck, Nektar, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Samsung, Sandoz, Sanofi Genzyme, Selecta, Taiho, UCB, Consultant of: AbbVie, ACEA, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Novartis, Pfizer, Sanofi Genzyme, UCB, Michael Weinblatt Grant/research support from: Amgen, Bristol-Myers Squibb, Crescendo, Lily, Sanofi/Regeneron, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Crescendo, Gilead, Horizon, Lily, Pfizer, Roche, Sean Connolly Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Michael A Maldonado Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sheng Gao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb
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Gandhi Y, Connolly S, Huang KHG, Wong R, Chilewski S, Murthy B. FRI0038 THE RELATIONSHIP BETWEEN ABATACEPT EXPOSURE AND EFFICACY MEASURES IN EARLY MTX-NAIVE ANTI-CITRULLINATED PROTEIN ANTIBODY-POSITIVE PATIENTS WITH RA DURING THE DE-ESCALATION PERIOD OF A PHASE IIIB STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6017] [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:Although EULAR/ACR guidelines suggest tapering biologic treatment for RA following sustained remission in patients (pts), specific de-escalation (DE) regimens are not defined. The Phase IIIb Assessing Very Early Rheumatoid arthritis Treatment (AVERT)-2 trial (NCT02504268) is evaluating SC abatacept (ABA) + MTX versus ABA placebo (PBO) + MTX in Anti-Citrullinated Protein Antibody (ACPA)-positive pts with early (ACR/EULAR 2010 criteria; disease duration ≤6 mths), active RA (SDAI >11). AVERT-2 was designed to investigate achievement of SDAI remission and a clinically meaningful dose DE strategy among pts in sustained remission who completed induction with ABA + MTX. In moderately to severely active RA and JIA patients, a relationship between ABA Cmin and efficacy was observed. Therefore, this analysis in very early RA patients, reports on the pharmacokinetics (PK) and immunogenicity of ABA and the maintenance of remission during the DE period of AVERT-2.Objectives:To assess the relationship between changes in ABA exposure and the maintenance of remission and the effect of immunogenicity on exposure during the DE period of AVERT-2.Methods:Pts received blinded SC ABA (125 mg once wkly [QW]) + MTX or ABA PBO + MTX induction treatment for 56 wks. Pts who completed induction with ABA + MTX and had sustained SDAI remission (≤3.3 at Wks 40 and 52) were re-randomized 1:1:1 to ABA QW + MTX for 48 wks (Arm C), ABA every other wk (EOW) + MTX for 24 wks followed by ABA PBO + MTX for 24 wks (Arm D), or ABA QW + MTX PBO for 48 wks (Arm E) in the DE period. ABA trough (Cmin) and anti-drug antibody (ADA) samples were collected in all subjects during the DE period. Serum ABA concentrations and ADA were measured using a validated enzyme immunoassay method and an electrochemiluminescence assay, respectively. Efficacy endpoints included change from DE Day 1 in SDAI score, HAQ-DI score, Physician’s Global Assessment (PhGA), and tender (TJC) and swollen (SJC) joint counts. The relationship between ABA Cmin and efficacy endpoints were assessed. Additionally, the impact of immunogenicity on ABA Cmin was explored.Results:Mean ABA Cmin values remained stable throughout the DE period for subjects in Arms C and E. ABA Cmin values decreased by ~50% in subjects in Arm D for the first 24 weeks from the start of DE and were ~0 for weeks 24-48 consistent with the change in the frequency of ABA dosing from EOW to ABA withdrawal (Figure 1 top).Figure 1:Mean (SD) ABA Cmin values (top) and Mean Change From Baseline in SDAI (bottom) in Subjects in DE Arm C (ABA QW + MTX), D (ABA EOW + MTX followed by ABA placebo + MTX), and E (ABA QW + MTX placebo)The incidence of immunogenicity appeared to increase upon withdrawal of ABA in Arm D. ADA formation did not appear to affect ABA Cmin, as ABA Cmin remained consistent between pts with and without ADA.Upon withdrawal of ABA in Arm D, there appeared to be an increase in the mean change from baseline (Day 1 of DE) in SDAI over time, which followed a similar time course as the washout of ABA (Figure 1 bottom). Similar results were observed for other efficacy endpoints such as HAQ-DI, PhGA, TJC, and SJC.Conclusion:The PK data in these early onset, MTX-naive, ACPA+ RA pts correlated well with the maintenance of remission in Arms A and E. Tapering of ABA from EOW to MTX only in Arm D results in a corresponding decrease in ABA Cmin, an increase in positive antibody response, and loss of remission.References:[1]Emery et. al. ACR [Abstract L11]. Nov. 2019. Atlanta GA USA[2]Li et. al. J Clin Pharmacol. Vol 59(2). Feb 2019.Disclosure of Interests:Yash Gandhi Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sean Connolly Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kuan-Hsiang Gary Huang Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Robert Wong Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Shannon Chilewski Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Bindu Murthy Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb
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Connolly S, Newport D, McGourty K. The mechanical responses of advecting cells in confined flow. Biomicrofluidics 2020; 14:031501. [PMID: 32454924 PMCID: PMC7200165 DOI: 10.1063/5.0005154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/21/2020] [Indexed: 05/03/2023]
Abstract
Fluid dynamics have long influenced cells in suspension. Red blood cells and white blood cells are advected through biological microchannels in both the cardiovascular and lymphatic systems and, as a result, are subject to a wide variety of complex fluidic forces as they pass through. In vivo, microfluidic forces influence different biological processes such as the spreading of infection, cancer metastasis, and cell viability, highlighting the importance of fluid dynamics in the blood and lymphatic vessels. This suggests that in vitro devices carrying cell suspensions may influence the viability and functionality of cells. Lab-on-a-chip, flow cytometry, and cell therapies involve cell suspensions flowing through microchannels of approximately 100-800 μ m. This review begins by examining the current fundamental theories and techniques behind the fluidic forces and inertial focusing acting on cells in suspension, before exploring studies that have investigated how these fluidic forces affect the reactions of suspended cells. In light of these studies' findings, both in vivo and in vitro fluidic cell microenvironments shall also be discussed before concluding with recommendations for the field.
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Affiliation(s)
- S Connolly
- School of Engineering, Bernal Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - D Newport
- School of Engineering, Bernal Institute, University of Limerick, Limerick V94 T9PX, Ireland
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Nickerson DP, Quinn M, Lin A, Mora A, Vuong C, Connolly S, Delgado B. Targeting of the membrane‐anchored Rab GAP (GTPase accelerating protein) Gyp8 to peroxisomes is regulated by the AAA ATPase Msp1. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.07117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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VanWagner LB, Holl JL, Montag S, Gregory D, Connolly S, Kosirog M, Campbell P, Pine S, Daud A, Finn D, Ladner D, Skaro AI, Levitsky J, Lloyd-Jones DM. Blood pressure control according to clinical practice guidelines is associated with decreased mortality and cardiovascular events among liver transplant recipients. Am J Transplant 2020; 20:797-807. [PMID: 31730286 PMCID: PMC7042060 DOI: 10.1111/ajt.15706] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/18/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 01/25/2023]
Abstract
Data for liver transplant recipients (LTRs) regarding the benefit of care concordant with clinical practice guidelines for management of blood pressure (BP) are sparse. This paper reports on clinician adherence with BP clinical practice guideline recommendations and whether BP control is associated with mortality and cardiovascular events (CVEs) among LTRs. We conducted a longitudinal cohort study of adult LTRs who survived to hospital discharge at a large tertiary care network between 2010 and 2016. The primary exposure was a BP of <140/<90 mm Hg within year 1 of LT. Among 602 LTRs (mean age 56.7 years, 64% men), 92% had hypertension and 38% had new onset hypertension. Less than 30% of LTRs achieved a BP of <140/<90 mm Hg over a mean of 43.2 months. In multivariable models, adjusted for key confounders, BP control post-LT compared with lack of control was associated with a significantly lower hazard of mortality (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.39, 0.87) and of CVEs (HR 0.65, 95% CI 0.43, 0.97). The association between BP control of <140/<90 mm Hg with improved survival and decreased CVEs in LTRs suggests that efforts to improve clinician adherence to BP clinical practice recommendations should be intensified.
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Affiliation(s)
- Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jane L. Holl
- Center for Healthcare Delivery Science and Innovation and Department of Neurology, biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Samantha Montag
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dyanna Gregory
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sean Connolly
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan Kosirog
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick Campbell
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stewart Pine
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amna Daud
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan Finn
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniela Ladner
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anton I. Skaro
- Department of Surgery, Division of General Surgery and Multi-Organ Transplant, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Josh Levitsky
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Volpe N, Connolly S, Cheema B, Angarone M. A Curious Case of Endocarditis and Liver Abscess in a Previously Healthy Man. Am J Med 2020; 133:186-190. [PMID: 31421067 DOI: 10.1016/j.amjmed.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Nicholas Volpe
- Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Sean Connolly
- Northwestern Medicine, Feinberg School of Medicine, Chicago, Ill.
| | - Baljash Cheema
- Northwestern Medicine, Feinberg School of Medicine, Chicago, Ill
| | - Michael Angarone
- Northwestern Medicine, Feinberg School of Medicine, Chicago, Ill
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Benz A, Healey J, Marsden T, Karthikeyan G, Hohnloser S, Oldgren J, Wallentin L, Ezekowitz M, Yusuf S, Connolly S. STROKE RISK PREDICTION IN PATIENTS WITH ATRIAL FIBRILLATION AND RHEUMATIC HEART DISEASE: RESULTS FROM THE RE-LY AF REGISTRY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Blomstrom-Lundqvist C, Marrouche N, Connolly S, Corp Dit Genti V, Wieloch M, Koren A, Hohnloser SH. P4784Efficacy and safety of dronedarone by duration of atrial fibrillation history: a post-hoc analysis of the ATHENA trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is known to progress over time and the effectiveness of antiarrhythmic therapy may vary based on the duration of a patient's AF history. Outcomes with dronedarone (DRO) based on duration of AF/atrial flutter (AFL) history have not been previously characterized.
Purpose
To evaluate the efficacy and safety of DRO by time since first known AF/AFL episode in patients studied in the ATHENA trial.
Methods
2859 (61.8%) patients from ATHENA with documented first known AF/AFL episode (of 4628 total patients randomized) were included in the analysis. Among these patients, first AF/AFL episode was reported at <3 months (shorter history), 3 to <24 months (intermediate), and ≥24 months (longer) in 1296 (45.3%), 845 (29.6%) and 718 (25.1%) patients, respectively. AF/AFL recurrence was evaluated in patients in sinus rhythm at baseline by ECG during study visits or symptom recurrence.
Results
Demographics (age, sex) were similar across all groups. Patients with longer AF/AFL history tended to have higher prevalence of coronary heart disease and structural heart disease; and were more likely to have AF/AFL (by 12-lead ECG) at baseline (30%) compared to 26% and 16% for intermediate and shorter history groups. Patients with a longer AF history likely had a prior ablation for AF/AFL (7%) vs patients with an intermediate (2%) or shorter AF/AFL history (1%), and more likely required cardioversion during the study (24%) vs intermediate (17%) and shorter history groups (11%). Outcomes and efficacy are reported in Table 1. Rates of treatment-emergent adverse events (TEAEs), serious TEAEs, permanent drug discontinuations, and deaths were similar across all AF/AFL groups.
Table 1. Outcomes and efficacy summary Relative Risk, dronedarone (DRO) vs placebo (PBO)1 (95% CI)1,2 AF/AFL <3 months AF/AFL 3 to <24 months AF/AFL ≥24 months PBO (n=626) DRO (n=670) PBO (n=429) DRO (n=416) PBO (n=363) DRO (n=355) First CV hospitalization3 or death (any cause) 0.79 (0.65, 0.96) 0.72 (0.56, 0.92) 0.84 (0.66, 1.07) First CV hospitalization 0.78 (0.64, 0.96) 0.70 (0.55, 0.91) 0.82 (0.63, 1.05) Death (any cause) 0.82 (0.54, 1.24) 0.85 (0.43, 1.68) 1.13 (0.61, 2.10) First AF/AFL recurrence4 0.80 (0.65, 0.97) 0.67 (0.53, 0.84) 0.81 (0.65, 1.02) 1Cox regression model. 2On study period, all randomized patients. 3Main reason was AF/other supraventricular rhythm disorders. 4On selected patients in sinus rhythm at baseline (AF/AFL <3 months: PBO n=514, DRO n=529; 3 to <24 months: PBO n=288, DRO n=312; ≥24 months: PBO n=252, DRO n=250). CV = Cardiovascular.
Conclusions
Nearly half the patients in ATHENA had a shorter history (<3 months) of AF/AFL prior to randomization. Patients with a longer history of AF/AFL had a greater burden of AF/AFL based on baseline rhythm status, ablation history, and cardioversions required post randomization. Despite these differences, clinical outcomes, efficacy, and safety of DRO appeared to be generally consistent irrespective of duration of AF/AFL history.
Acknowledgement/Funding
Sanofi, New York, New York, United States of America
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Affiliation(s)
| | - N Marrouche
- University of Utah, Salt Lake City, Utah, United States of America
| | - S Connolly
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - M Wieloch
- Sanofi-Aventis, Paris, France; Skåne University Hospital, Malmö, Sweden
| | - A Koren
- Sanofi, New York, New York, United States of America
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Connolly S, Whyte R. Uptake of cancer screening services among middle and older ages in Ireland: the role of healthcare eligibility. Public Health 2019; 173:42-47. [DOI: 10.1016/j.puhe.2019.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/16/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
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George MD, Baker JF, Winthrop K, Alemao E, Chen L, Connolly S, Hsu JY, Simon TA, Wu Q, Xie F, Yang S, Curtis JR. Timing of Abatacept Before Elective Arthroplasty and Risk of Postoperative Outcomes. Arthritis Care Res (Hoboken) 2019; 71:1224-1233. [PMID: 30740938 DOI: 10.1002/acr.23843] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/05/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Guidelines recommend withholding biologic therapies before hip and knee arthroplasty, yet evidence to inform optimal timing is limited. The aim of this study was to determine whether withholding abatacept infusions is associated with lower risk of adverse postoperative outcomes. METHODS This retrospective cohort study, which used US Medicare and Truven MarketScan administrative data from January 2006 to September 2015, evaluated adults with rheumatoid arthritis who received intravenous abatacept (precisely dated in claims data) within 6 months of elective primary or revision hip or knee arthroplasty. Propensity weighted analyses using inverse probability weights compared the risk of 30-day hospitalized infection and 1-year prosthetic joint infection (PJI) between patients with different abatacept stop timing (time between last infusion and surgery). Secondary analyses evaluated nonurinary hospitalized infections and 30-day readmissions. RESULTS After 1,939 surgeries among 1,780 patients, there were 175 hospitalized infections (9.0%), 115 nonurinary hospitalized infections (5.9%), 39 PJIs (2.4/100 person-years), and 114/1,815 30-day readmissions (6.3%). There were no significant differences in outcomes with abatacept stop timing <4 weeks (1 dosing interval) versus 4-8 weeks (hospitalized infection odds ratio [OR] 0.93 [95% confidence interval (95% CI) 0.65-1.34]; nonurinary hospitalized infection OR 0.93 [95% CI 0.60-1.44]; PJI hazard ratio 1.29 [95% CI 0.62-2.69]; 30-day readmission OR 1.00 [95% CI 0.65-1.54]). Similarly, there were no significant differences in outcomes with abatacept stop timing <4 weeks versus ≥8 weeks. Glucocorticoid use >7.5 mg/day was associated with greater risk of hospitalized infection (OR 2.19 [95% CI 1.28-3.77]) and nonurinary hospitalized infection (OR 2.38 [95% CI 1.22-4.64]). CONCLUSION Compared to continuing intravenous abatacept, withholding abatacept for ≥4 weeks (one dosing interval) before surgery was not associated with a lower risk of hospitalized infection, nonurinary hospitalized infection, PJI, or 30-day readmission.
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Affiliation(s)
- Michael D George
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Joshua F Baker
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennyslvania
| | | | - Evo Alemao
- Bristol-Myers Squibb, Princeton, New Jersey
| | | | | | - Jesse Y Hsu
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Qufei Wu
- University of Pennsylvania Perelman School of Medicine, Philadelphia
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George MD, Baker JF, Winthrop K, Alemao E, Chen L, Connolly S, Hsu JY, Simon TA, Wu Q, Xie F, Yang S, Curtis JR. Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing Arthroplasty: A Cohort Study. Ann Intern Med 2019; 170:825-836. [PMID: 31108503 PMCID: PMC7197029 DOI: 10.7326/m18-2217] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) are at increased risk for infection after arthroplasty, yet risks of specific biologic medications are unknown. OBJECTIVE To compare risk for postoperative infection among biologics and to evaluate the risk associated with glucocorticoids. DESIGN Retrospective cohort study. SETTING Medicare and Truven MarketScan administrative data from January 2006 through September 2015. PATIENTS Adults with RA who were having elective inpatient total knee or hip arthroplasty, either primary or revision, and had a recent infusion of or prescription for abatacept, adalimumab, etanercept, infliximab, rituximab, or tocilizumab before surgery. MEASUREMENTS Propensity-adjusted analyses using inverse probability weights evaluated comparative risks for hospitalized infection within 30 days and prosthetic joint infection (PJI) within 1 year after surgery between biologics or with different dosages of glucocorticoids. Secondary analyses evaluated non-urinary tract hospitalized infections and 30-day readmissions. RESULTS Among 9911 patients treated with biologics, 10 923 surgical procedures were identified. Outcomes were similar in patients who received different biologics. Compared with an 8.16% risk for hospitalized infection with abatacept, predicted risk from propensity-weighted models ranged from 6.87% (95% CI, 5.30% to 8.90%) with adalimumab to 8.90% (CI, 5.70% to 13.52%) with rituximab. Compared with a 2.14% 1-year cumulative incidence of PJI with abatacept, predicted incidence ranged from 0.35% (CI, 0.11% to 1.12%) with rituximab to 3.67% (CI, 1.69% to 7.88%) with tocilizumab. Glucocorticoids were associated with a dose-dependent increase in postoperative risk for all outcomes. Propensity-weighted models showed that use of more than 10 mg of glucocorticoids per day (vs. no glucocorticoid use) resulted in a predicted risk for hospitalized infection of 13.25% (CI, 9.72% to 17.81%) (vs. 6.78%) and a predicted 1-year cumulative incidence of PJI of 3.83% (CI, 2.13% to 6.87%) (vs. 2.09%). LIMITATION Residual confounding is possible, and sample sizes for rituximab and tocilizumab were small. CONCLUSION Risks for hospitalized infection, PJI, and readmission after arthroplasty were similar across biologics. In contrast, glucocorticoid use, especially with dosages above 10 mg/d, was associated with greater risk for adverse outcomes. PRIMARY FUNDING SOURCE Rheumatology Research Foundation, National Institutes of Health, and Bristol-Myers Squibb.
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Affiliation(s)
- Michael D George
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G., J.Y.H., Q.W.)
| | - Joshua F Baker
- University of Pennsylvania Perelman School of Medicine and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (J.F.B.)
| | - Kevin Winthrop
- Oregon Health & Science University, Portland, Oregon (K.W.)
| | - Evo Alemao
- Bristol-Myers Squibb, New York, New York (E.A., S.C., T.A.S.)
| | - Lang Chen
- University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., S.Y., J.R.C.)
| | - Sean Connolly
- Bristol-Myers Squibb, New York, New York (E.A., S.C., T.A.S.)
| | - Jesse Y Hsu
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G., J.Y.H., Q.W.)
| | - Teresa A Simon
- Bristol-Myers Squibb, New York, New York (E.A., S.C., T.A.S.)
| | - Qufei Wu
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G., J.Y.H., Q.W.)
| | - Fenglong Xie
- University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., S.Y., J.R.C.)
| | - Shuo Yang
- University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., S.Y., J.R.C.)
| | - Jeffrey R Curtis
- University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., S.Y., J.R.C.)
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46
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Connolly S, Hountras P. A 49-Year-Old Woman With Chest Pain, Cough, and Hypoxemia After a Seizure. Chest 2019; 155:e113-e116. [PMID: 30955582 DOI: 10.1016/j.chest.2018.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/20/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022] Open
Abstract
CASE PRESENTATION A 49-year-old woman with a medical history of epilepsy presented to the ED 1 h after a single, 15-min, witnessed, tonic-clonic seizure. Over the preceding 6 months, she had experienced five similar seizures of shorter duration. There were no recent changes to her phenytoin dose nor had she started any new medications. The patient had traveled to Jamaica 3 weeks before presentation, where she smoked marijuana once but otherwise had not used illicit substances nor had she used tobacco or alcohol. She states she felt well during and after the trip until this presentation. While being evaluated by the neurology service, the patient complained of sudden-onset chest pain and cough with associated hypoxemia. She denied changes in her sleep habits, she had not experienced any fevers, and she had no changes in her exercise tolerance. The patient was admitted to the general medicine floor for further workup.
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Affiliation(s)
- Sean Connolly
- Internal Medicine, Northwestern Memorial Hospital, Chicago, IL
| | - Peter Hountras
- Pulmonary, Northwestern Medical Faculty Foundation, Chicago, IL.
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47
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Newcombe PJ, Connolly S, Seaman S, Richardson S, Sharp SJ. A two-step method for variable selection in the analysis of a case-cohort study. Int J Epidemiol 2019; 47:597-604. [PMID: 29136145 PMCID: PMC5913627 DOI: 10.1093/ije/dyx224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Accepted: 10/06/2017] [Indexed: 11/29/2022] Open
Abstract
Background Accurate detection and estimation of true exposure-outcome associations is important in aetiological analysis; when there are multiple potential exposure variables of interest, methods for detecting the subset of variables most likely to have true associations with the outcome of interest are required. Case-cohort studies often collect data on a large number of variables which have not been measured in the entire cohort (e.g. panels of biomarkers). There is a lack of guidance on methods for variable selection in case-cohort studies. Methods We describe and explore the application of three variable selection methods to data from a case-cohort study. These are: (i) selecting variables based on their level of significance in univariable (i.e. one-at-a-time) Prentice-weighted Cox regression models; (ii) stepwise selection applied to Prentice-weighted Cox regression; and (iii) a two-step method which applies a Bayesian variable selection algorithm to obtain posterior probabilities of selection for each variable using multivariable logistic regression followed by effect estimation using Prentice-weighted Cox regression. Results Across nine different simulation scenarios, the two-step method demonstrated higher sensitivity and lower false discovery rate than the one-at-a-time and stepwise methods. In an application of the methods to data from the EPIC-InterAct case-cohort study, the two-step method identified an additional two fatty acids as being associated with incident type 2 diabetes, compared with the one-at-a-time and stepwise methods. Conclusions The two-step method enables more powerful and accurate detection of exposure-outcome associations in case-cohort studies. An R package is available to enable researchers to apply this method.
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Affiliation(s)
| | | | - S Seaman
- MRC Biostatistics Unit, Cambridge, UK
| | | | - S J Sharp
- MRC Epidemiology Unit, Cambridge, UK
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48
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Van Spall H, Lee S, Averbuch T, Erbas Oz U, Perez R, Maingi M, Heffernan M, Mitoff P, Tjandrawidjaja M, Zia M, Simek K, Porepa L, Panju M, Ko D, Connolly S. A SIMPLE, POINT-OF-CARE RISK PREDICTION TOOL TO PREDICT 30-DAY OUTCOMES FOLLOWING HOSPITALIZATION FOR HEART FAILURE. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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49
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Spence J, Belley-Côté E, Jacobsohn E, Syed S, Whitlock R, Lee S, Bangdiwala S, Arora R, Sarkaria A, MacIsaac S, Girling L, LeManach Y, Lamy A, Devereaux P, Connolly S. BENZODIAZEPINE-FREE CARDIAC ANESTHESIA FOR REDUCTION OF DELIRIUM (B-FREE): A TWO-CENTRE PILOT STUDY TO DETERMINE THE FEASIBILITY OF A MULTI-CENTRE, RANDOMIZED, CLUSTER CROSSOVER TRIAL. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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50
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Hughes H, Tubridy N, Connolly S. A Life-Saving Palsy: Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) Presenting As Hand Weakness during Cardiopulmonary Resuscitation (CPR) Training. Ir Med J 2018; 111:808. [PMID: 30547545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim To describe a case of acute and transient hand weakness that developed during cardiopulmonary resuscitation (CPR) training. Hereditary neuropathy with liability to pressure palsies (HNPP) should be considered in patients with recurrent, painless motor or sensory neuropathies at sites of peripheral nerve compression. Methods Nerve conduction studies confirmed neuropraxia of the distal ulnar nerve with a mild background demyelinating peripheral neuropathy. Results A positive family history emerged and HNPP was confirmed by genetic testing. HNPP is most reliably diagnosed by molecular testing for peripheral myelin protein 22 (PMP22) gene deletion or point mutation on chromosome 17p11.2. Conclusion CPR, a procedure carried out by medical professionals on a daily basis, is a high-energy manual task and provides multiple opportunities for nerve compression. This case demonstrates the importance of having a high index of clinical suspicion of this disorder in patients. Recognising a diagnosis of HNPP may prevent unnecessary surgical decompression.
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Affiliation(s)
- H Hughes
- Department of Neurology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - N Tubridy
- Department of Neurology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - S Connolly
- Department of Clinical Neurophysiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
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