AB1204 COST-EFFECTIVENESS OF ABATACEPT IN SPAIN IN SEROPOSITIVE BIOLOGIC-NAÏVE EARLY RHEUMATOID ARTHRITIS PATIENTS WITH SHARED EPITOPE

Background:

The HLA class II Shared Epitope (SE) is a known Rheumatoid Arthritis (RA) risk allele linked to autoantibody production and disease progression. The recent Early AMPLE study suggests an enhanced treatment benefit of abatacept (ABA) over adalimumab (ADA) in SE positive patients with early seropositive RA.1Economic implications beyond the trial follow-up duration are unknown.

Objectives:

To estimate the cost-effectiveness of ABA vs ADA in biologic-naive RA patients seropositive for anti-citrullinated protein antibody and rheumatoid factor based on the Early AMPLE study.

Methods:

We developed a microsimulation model to estimate clinical response, medical cost, quality of life and survival from a Spanish payer perspective. The model captures the patient’s disease and treatment journey using response outcomes and the Health Assessment Questionnaire (HAQ) score. Patients who fail to respond switch to the next treatment line. Six treatment lines are included to capture a lifetime horizon. Responding patients (ACR50 and EULAR response) achieve an improvement in their HAQ score. Patient mortality was modelled as a function of HAQ. For both the overall Early AMPLE population and SE+ patients, incremental monthly cost per response over 2 years and incremental cost per QALY over a lifetime were estimated. Costs were based on local tariffs in Spain.

Results:

Baseline characteristics for the Early AMPLE (n=80) and the SE+ (n=61) patients were well balanced between the treatment groups.2Compared to ADA, the ABA cohort had a lower cost per response and the difference was more pronounced in the SE+ population, compared to the entire Early AMPLE population for both the response criteria (Table 1). Compared with ADA, the ABA cohort showed greater quality adjusted life years (QALYs) gains, and a modest increase in cost due to a prolonged time on treatment (Table 2). The incremental cost per QALY over a lifetime fell below commonly used thresholds in Spain (25-60 thousand Euros per QALY).3

Table 1.

Cost per response results

Full Early AMPLEACR50EULARABAADAABAADACost per response (€) – 2 years25,86040,65426,99340,643Incremental monthly cost per response (€)-616-569SE positiveACR 50EULARABAADAABAADACost per response (€) – 2 years24,27240,24925,33741,425Incremental monthly cost per response (€)-666-670

All incremental results are for ABA – ADA

Table 2.

Cost-effectiveness results (discounted)

Full Early AMPLEACR50EULARABAADAABAADALYs*30.1430.0630.1130.03QALYs8.327.817.577.12Time on treatment (years)4.172.035.143.06Costs (€)75,54768,15785,12280,933Incremental LYs*0.080.08Incremental QALYs0.520.45Incremental Costs (€)7,3904,189Incremental cost per QALY (€)14,3089,275SE positiveACR50EULARABAADAABAADALYs*30.3830.2230.1630.09QALYs8.207.597.406.90Time on treatment (years)4.482.025.383.02Costs (€)78,11368,65187,58681,321Incremental LYs*0.150.06Incremental QALYs0.610.50Incremental Costs (€)9,4626,265Incremental cost per QALY (€)15,41012,503

*LY results are presented undiscounted. All incremental results are for ABA – ADA

Conclusion:

Compared with ADA, ABA is a cost-effective alternative and is associated with a lower 2 years cost per response for both populations. The economic benefit and quality of life gain is greater in a SE+ patient population.

References:

[1]Rigby W, et al. EULAR Annual Meeting, June 2019; Poster LB0008

[2]Buckner J, et al. ACR/ARP Annual Meeting, Nov 2019; Poster 1424

[3]Sacristán JA, et al.Gaceta Sanitaria2019

Disclosure of Interests:

José M. Rodríguez-Heredia: None declared, Lisanne Verburg-Baltussen Consultant of: Consultant for Bristol-Myers Squibb, Paid instructor for: Training sessions for Pharmaceutical companies, Dhanda Devender Shareholder of: BMS, Employee of: BMS, Nicholas Durno Consultant of: Consultant for Bristol-Myers Squibb, Paid instructor for: Training sessions for Pharmaceutical companies, Carlos Sanchez Shareholder of: Shareholder of Bristol-Myers Squibb, Employee of: Bristol Myers-Squibb, Neelanjana Ray Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Maarten Treur Consultant of: Consultant for Bristol-Myers Squibb, Paid instructor for: Training sessions for Pharmaceutical companies, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb

AB0073 BOSWELLIA SERRATA EXTRACT AND CURCUMIN INCREASE GDF15 PRODUCTION BY HUMAN PRIMARY OSTEOARTHRITIS CHONDROCYTES: A NEW MECHANISM OF ACTION

Background:

Boswellia serrata extract (BSE) and curcumin are used to relief symptoms in osteoarthritis (OA).

Objectives:

This study aims to better understand the mode of action of these compounds on OA chondrocytesin vitro.

Methods:

Therapeutic plasmatic concentrations of the different components of BSE correspond to anin vitrorange from 25 to 100 µg/ml of total BSE (100 µg/ml of BSE corresponds to 9.2 µM of 11-keto-β-boswellic acid (KBA), 5.2 µM of acetylKBA, 22 µM de αBA, 34 µM de βBA, 4.4 µM de acetylαBA and 13.2 acetyl βBA), and between 2 to 10 µM for bioavaibility-increased curcumin. BSE (5-100 µg/ml) and curcumin (0.04 to 4 µg/ml corresponding to 0.1 to 10 µM) were tested separately on primary chondrocytes from 3 OA patients. Lactate Deshydrogenase LDH, nitrite (NO2), interleukin (IL)-6 and Growth Differentiation Factor (GDF)15 were quantified in 72h-treated supernatant using enzyme activity, Griess reaction and ELISAs, respectively.

Results:

No mortality was observed at the tested concentrations. BSE and curcumin both decreased concentration-dependently NO2and IL-6 production, and increased GDF15 production. For NO2production, the decrease was observed from 0.2 µg/ml of curcumin and 10 µg/ml of BSE. For IL-6 production, the decrease was observed from 1 µg/ml for curcumin and 10 µg/ml for BSE. For GDF-15, the increase was observed from 2 µg/ml for curcumin and 50 µg/ml for BSE. Maximal effect was observed at 4 µg/ml for curcumin: -67% NO2(p<0.0001), -71% IL-6 (p=0.0001) and +80% GDF15 (p<0.0001) and at 100 µg/ml for BSE: -40% NO2(p=0.0003), -70% IL-6 (p=0.0003) and +73% for GDF15 (p=0.0017).

Conclusion:

At therapeutic plasmatic concentrations, BSE and curcumin decreased the production of NO2and IL-6, two inflammatory mediators. Furthermore, BSE and curcumin enhanced GDF-15 production, an anti-inflammatory growth factor. GDF15 was first identified as Macrophage inhibitory cytokine-1 or NSAID-activated gene-1 (by a prostanoid-independent manner), and is known as a regulator of inflammatory, cell repair and apoptosis pathways. GDF-15 has pro-apoptotic and anti-tumorigenic activity in vitro and in vivo. It could represent a new pathway explaining the beneficial effects of BSE and the curcumin on synovium inflammation and cartilage degradation.

Disclosure of Interests:

christelle sanchez: None declared, Jérémie Zappia: None declared, Yvan Dierckxsens Shareholder of: Tilman SA, Employee of: Tilman SA, Jean-Pierre Delcour: None declared, Yves Henrotin Grant/research support from: HEEL, TILMAN

AB0072 A MULTICOMPONENT MEDICATION PROMOTES CHONDROGENESIS AND REDUCES MMP-13 IN PRIMARY ARTICULAR CHONDROCYTES FROM KNEE OSTEOARTHRITIS PATIENTS IN VITRO

Background:

HE-1100 is a multicomponent medicinal product. Initial preclinical data potentially suggest a preventive effect on cartilage degradation.

Objectives:

This study aims to understand the mode of action of HE-1100 on OA chondrocytesin vitro.

Methods:

Primary chondrocytes were obtained from 10 knee osteoarthritis (OA) patients undergoing knee replacement surgery. The cultures were treated with 20% (v/v) HE-1100 or placebo. Samples were collected for subsequent RNA extraction using standard methods. The reads were generated with Illumina NextSeq5000 sequencer and aligned to the human reference genome (UCSC hg19) to generate the transcriptome. Differential expression analysis between HE-1100 and placebo was made in R using the DESeq2 package to identify the differentially expressed genes in the OA-associated regulatory pathways. The protein production of the selected genes was quantified by ELISA in 10 independent human OA chondrocytes cultures.

Results:

According to the DESeq2 analysis, HE-1100 significantly modified the expression of 13 genes in OA chondrocytes by at least 10% with an adjusted p-value < 0.05: EGR1 (+93%), FOS (+87%), NR4A1 (+43%), DUSP1 (+18%), ZFP36 (+18%), ZFP36L1 (+14%), NFKBIZ (+16%) and CYR61 (+14%) were upregulated and ATF7IP (-10%), TXNIP (-11%), C10orf10 (-12%), CLEC3A (-12%) and MMP13 (-18%) were downregulated after 24h HE-1100 treatment. HE-1100 significantly increased (2.3 fold +/-1.2 after 24h, p=0.0444 and 2.3-fold +/-1.0 after 72h, p=0.0239) the CYR61 protein production by human OA chondrocytes. After 72h, HE-1100 slightly but not significantly increased aggrecan production by 14 ± 19 % (p=0.1117) and significantly increased type II collagen pro-peptide production by 27 ± 20 % (p=0.0147). For both time points CYR61 production by OA chondrocytes was positively and significantly correlated with aggrecan (r=0.66, p=0.0004) and type II collagen pro-peptide (r=0.64, p=0.0008) production. In alginate beads culture, pro-MMP-13 was significantly decreased by HE-1100 treated cultures from day 7 to day 14 (from -16 to -25 %, p<0.05) and from day 17 to 21 (-22 %, p=0.0331) in comparison to controls.

Conclusion:

HE-1100 significantly modified the expression of DUSP1, C10orf10, ZFP36/L1 and CLEC3A, which are pathway mediators involved in MMP-13 expression and activation. Further, long-term (28 days) treatment with HE-1100 significantly reduced the production of pro-MMP-13, the inactive precursor of the metalloproteinase MMP-13 involved in type II collagen degradation. HE-1100 also promoted extracellular matrix formation probably through CYR61 production, a growth factor well correlated with type II collagen and aggrecan production.

References:

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Acknowledgments:

We would like to thank the staff of the GIGA ULiège Genomic Next Generation Sequencing platform for performing the RNA sequencing and Benoit Charloteaux for his help in RNAseq data analysis.

Disclosure of Interests:

christelle sanchez: None declared, Kathrin Hemmer Employee of: Heel, Natascha Kroemmelbein Employee of: Heel, Bernd Seilheimer Employee of: Heel, Jean-Emile Dubuc: None declared, Christophe Antoine Employee of: Artialis, Yves Henrotin Grant/research support from: HEEL, TILMAN

Predictors of a good response to inhaled corticosteroids in obesity-associated asthma

INTRODUCTION

Asthma in obese subjects is poorly understood. According to GINA guidelines, pulmonologists increase ICS in case of poor asthma control but lung volume restriction may also worsen respiratory symptoms in obese asthmatics leading to overtreatment in this subpopulation.

METHODS

We conducted a retrospective study on 1217 asthmatics recruited from University Hospital of Liege. 92 patients with a BMI ≥30 came at least two times at the asthma clinic (mean interval: 335 days). In this obese population, we identified predictors of good (decrease in ACQ ≥0.5) versus poor response (rise in ACQ ≥0.5) to ICS step-up therapy.

RESULTS

Obese asthmatics had a poorer asthma control and quality of life as compared to non-obese and exhibited reduced FVC, higher levels of blood leucocytes and markers of systemic inflammation. The proportion of asthma inflammatory phenotypes was similar to that observed in a general population of asthmatics. Among uncontrolled obese asthmatics receiving ICS step-up therapy, 53% improved their asthma control while 31% had a worsening of their asthma. Uncontrolled obese asthmatics showing a good response to increase in ICS had higher ACQ, lower CRP levels, higher sputum eosinophil counts and higher FeNO levels at visit 1. Uncontrolled obese asthmatics that worsened after increasing the dose of ICS had lower FVC, lower sputum eosinophil counts and higher sputum neutrophil counts.

CONCLUSION

We observed poorer asthma control in obese asthmatics despite similar bronchial inflammation. Managing obese asthmatics according to ACQ alone seems to underestimate asthma control and the contribution of restriction to dyspnea. Increasing the dose of ICS in the absence of sputum eosinophilic inflammation or in the presence of restriction or bronchial neutrophilia led to poorer asthma control. In those patients, management of obesity should be the first choice.

Recent advances in circulating nucleic acids in oncology

Circulating cell-free DNA (cfDNA) is one of the fastest growing and most exciting areas in oncology in recent years. Its potential clinical uses cover now each phase of cancer patient management care (predictive information, detection of the minimal residual disease, early detection of resistance, treatment monitoring, recurrence surveillance, and cancer early detection/screening). This review relates the recent advances in the application of circulating DNA or RNA in oncology building on unpublished or initial findings/work presented at the 10th international symposium on circulating nucleic acids in plasma and serum held in Montpellier from the 20th to the 22nd of September 2017. This year, presenters revealed their latest data and crucial observations notably in relation to (i) the circulating cell-free (cfDNA) structure and implications regarding their optimal detection; (ii) their role in the metastatic or immunological processes; (iii) evaluation of miRNA panels for cancer patient follow up; (iv) the detection of the minimal residual disease; (v) the evaluation of a screening tests for cancer using cfDNA analysis; and (vi) elements of preanalytical guidelines. This work reviews the recent progresses in the field brought to light in the meeting, as well as in the most important reports from the literature, past and present. It proposes a broader picture of the basic research and its potential, and of the implementation and current challenges in the use of circulating nucleic acids in oncology.

Peritoneal Dialysis in Liver Disorders

The purpose of this paper is to review the specific role of peritoneal dialysis (PD) in patients with liver disorders. We will pay attention to the confluence of liver diseases and situations for which chronic dialysis treatment is required.

Hemodialysis (HD) and peritoneal membranes are safe barriers against the passage of the hepatitis C virus; consequently, while peritoneal effluent or HD ultrafiltrate drained from hepatitis S patients/carriers is infective, that from hepatitis C patients does not appear to present this risk. An important issue is horizontal transmission, which appears to occur with both viruses in HD units, and which is absent in peritoneal dialysis units. The incidence of hepatitis C among continuous ambulatory peritoneal dialysis (CAPD) patients is quite low, while it may reach almost 50% -60% of HD patients in some units. While hepatitis C transmission mechanisms are not completely understood and a vaccine is not available, PD provides some degree of protection when compared with HD, for end-stage renal disease patients.

In summary, our experience and that of others, with a total of 19 PD-treated chronic liver disease patients, supports CAPD as the treatment of choice for cirrhotic patients with ascites who require chronic dialysis. Data on peritoneal diffusion of low molecular weight substances revealed a marked increase in most patients. The ultrafiltration capacity was clearly augmented with respect to noncirrhotic patients, making the use of hypertonic bags unnecessary. Hemodynamic tolerance was excellent. Complications and death were mainly related to liver disease complications.

Spontaneous bacterial peritonitis (SSP), caused by gram-negative germs, is the most important complication directly related to ascites and may have some points in common with PD-related peritonitis. However, and in contrast to most PD peritonitis, two pathogenetic mechanisms have been suggested for SSP: (1) translocation of bacteria from the gut to the mesenteric lymph nodes, and (2) bacteremia in these patients is secondary to the general abnormal host defense mechanisms. Local factors such as intrahepatic shunting and the impairment of bactericidal activity in ascitic fluid favor the bacteria ascites. The hypothesis of a direct transmural contamination from bowel to ascitic fluid has been relegated to secondary bacterial peritonitis. Would cirrhotic patients with temporal or permanent renal function compromise benefit from peritoneal catheter placement and other PD practices to perform repetitive small ascitic drainages at home? Perhaps the time has arrived when hepatologists and PD nephrologists begin to work shoulder to shoulder in this particular field, as we have a common problem, the peritoneal cavity filled with fluid.

Novel Dual-Action Targeted Nanomedicine in Mice With Metastatic Thyroid Cancer and Pancreatic Neuroendocrine Tumors

Background

The advantages of nanomedicines include preferential delivery of the payload directly to tumor tissues. CYT-21625 is the novel, first-in-class gold nanomedicine designed to target tumor vasculature and cancer cells by specifically delivering recombinant human tumor necrosis factor alpha (rhTNF) and a paclitaxel prodrug.

Methods

We analyzed TNF receptor expression in publicly available gene expression profiling data and in thyroid tissue samples. Mice with metastatic FTC-133 and 8505C xenografts and the MEN1 conditional knock-out mice were treated weekly with CYT-21625 and gold nanoparticles with rhTNF only (CYT-6091); controls included mice treated with either paclitaxel or saline. In vivo luciferase activity was used to assess the effects on tumor growth. Computed tomography, magnetic resonance imaging, and 18F-Fludeoxyglucose positron emission tomography were used to study tumor selectivity in mice with insulin-secreting pancreatic neuroendocrine tumors (PNETs). All statistical tests were two-sided.

Results

Anaplastic thyroid cancer (ATC) expressed statistically significantly higher levels of TNF receptor superfamily 1A and 1B messenger RNA (n = 11) and protein (n = 6) than control samples (n = 45 and 13, respectively). Mice (n = 5-7 per group) with metastatic ATC (P < .009) and FTC-133 xenografts (P = .03 at week 3, but not statistically significant in week 4 owing to reduced sample size from death in non-CYT-21625 groups) treated with CYT-21625 had a statistically significantly lower tumor burden. Treatment with CYT-21625 resulted in loss of CD34 expression in intratumoral vasculature, decreased proliferating cell nuclear antigen, and increased cleaved caspase-3. Intratumoral vascular leakage occurred only in mice with PNET and ATC treated with CYT-6091 and CYT-21625. CYT-6091 and CYT-21625 preferentially deposited in PNETs and statistically significantly decreased serum insulin levels (n = 3 per group, P < .001). There were no toxicities observed in mice treated with CYT-21625.

Conclusions

CYT-21625 is effective in mice with PNETs and metastatic human thyroid cancer with no toxicities. Thus, CYT-21625 should be studied in patients with advanced PNETs and thyroid cancer.

Investigating the Robustness of the Illusory Truth Effect Across Individual Differences in Cognitive Ability, Need for Cognitive Closure, and Cognitive Style

People are more inclined to believe that information is true if they have encountered it before. Little is known about whether this illusory truth effect is influenced by individual differences in cognition. In seven studies (combined N = 2,196), using both trivia statements (Studies 1-6) and partisan news headlines (Study 7), we investigate moderation by three factors that have been shown to play a critical role in epistemic processes: cognitive ability (Studies 1, 2, 5), need for cognitive closure (Study 1), and cognitive style, that is, reliance on intuitive versus analytic thinking (Studies 1, 3-7). All studies showed a significant illusory truth effect, but there was no evidence for moderation by any of the cognitive measures across studies. These results indicate that the illusory truth effect is robust to individual differences in cognitive ability, need for cognitive closure, and cognitive style.

86-GBaud subcarrier multiplexed 16QAM signal generation using an electrical 90 degree hybrid and IQ mixers

We experimentally demonstrate an aggregate 86-GBaud (over three sub-bands and one polarization) signal generation based on subcarrier multiplexing technique using IQ mixers, an electrical 90 degree hybrid, and diplexers. The electrical hybrid allows transmitter-side digital signal processing to be simplified to pulse shaping and digital pre-emphasis. We verified the configuration by testing the performance of an 86-GBaud Nyquist-shaped 16 quadrature amplitude modulation signal with differential bit encoding. The implementation penalty assuming 7% hard-decision forward error correction is reduced to 2 dB by utilizing a 31-tap decision-directed least mean square based multiple-input multiple-output equalizer for sideband crosstalk mitigation.