AB1272 ONLINE EDUCATION BOOSTS CLINICIAN KNOWLEDGE ABOUT EMERGING THERAPIES FOR PATIENTS WITH SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background:

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) has traditionally been treated with therapies such as cyclophosphamide, mycophenolate mofetil, and hematopoietic stem cell transplantation. However, these therapies are limited by potential toxicity, as well as duration and magnitude of effect. Clinicians need awareness of emerging therapies in late-stage clinical trials that may address these limitations.

Objectives:

This study was conducted to determine whether online independent medical education could improve rheumatologists’ and pulmonologists’ knowledge of emerging therapies for the management of SSc-ILD.

Methods:

Physicians (N = 2,076) participated in a 30-minute, 2-faculty, video-based, online CME with synchronized slides.1The majority of participants were rheumatologists (n = 522) or pulmonologists (n = 557), but the cohort also included clinical immunologists (n = 132) and other physicians with an interest in the topic (n = 865). This study focuses on the 120 rheumatologists and 111 pulmonologists who completed all pre- and post-questions. The effects of the education on knowledge was assessed using a 3-question, repeated pairs, pre-assessment/post-assessment study design. For all questions combined, the chi-square test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. The activity launched on September 17, 2019, and data were collected through November 5, 2019.

Results:

Overall significant improvements were seen after participation for both rheumatologists (average correct response rate of 55% at pre-assessment vs 75% at post-assessment; P<.001, N=120), and pulmonologists (average correct response rate of 60% at pre-assessment vs 77% at post-assessment; P<.001, N=111). Specifically, significant improvements were observed in clinicians’ knowledge of clinical trial data for emerging SSc-ILD therapies (figure).

Figure.

Clinicians from APAC (n = 67) and Europe (n = 79) made up the majority of the cohort, and had similar rates of correct responses without significant differences, indicating consistent effects, independent of the region of origin. After participating in the activity, 48% of pulmonologists and rheumatologists had measurable improved confidence related to their knowledge of emerging therapies for patients with SSc-ILD.

Despite the increases in knowledge and confidence observed, the rates of correct responses suggest there is still room for improvement; therefore, ongoing education will be needed to reinforce knowledge of the latest data evaluating new therapies for SSc-ILD and what they will mean for future practice.

Conclusion:

This study demonstrates the success of online, video-based education in improving rheumatologists’ and pulmonologists’ knowledge of the latest clinical data on emerging therapies for SSc-ILD. This could lead to earlier adoption of new, efficacious therapies that may slow disease progression and improve overall outcomes for these patients.

References:

[1]Distler O, Hoffmann-Vold A-M. How Can We Meet the Treatment Needs of Patients With Systemic Sclerosis-Interstitial Lung Disease? Launched: 9/17/2019. Data as of 11/5/2019. Available atwww.medscape.org/viewarticle/917034

Disclosure of Interests:

Christy Rohani-Montez: None declared, Marinella Calle: None declared, Chris Allen: None declared, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche

THU0584 CASE-BASED ONLINE EDUCATION SIGNIFICANTLY INCREASES CLINICIAN COMPETENCE IN ASSESSING SSC-ILD DISEASE PROGRESSION AND IMPLEMENTING APPROPRIATE THERAPY

Background:

Due to the heterogeneity in both the initial manifestations of systemic sclerosis (SSc) and progression with SSc-associated interstitial lung disease (SSc-ILD), diagnosis and prognosis can be challenging in clinical practice. Clinicians need expert case-based guidance on how best to monitor patients with SSc and the treatment implications.

Objectives:

This study was conducted to determine whether online case-based independent medical education could improve rheumatologists’ and pulmonologists’ competence in evaluating and monitoring SSc-ILD progression and initiating the right treatments when progression is identified.

Methods:

Rheumatologists and pulmonologists participated in two comprehensive online case studies, using a ‘test then teach’ approach and completed all pre- and post-questions.1The effects of the education on knowledge and competence were assessed using a 3-question, repeated pairs, pre-assessment/post-assessment study design. For all questions combined, the chi-square test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. The activity launched on September 24, 2019, and data were collected through December 9, 2019.

Results:

Overall significant improvements were seen after participation for both rheumatologists (average correct response rate of 65% at pre-assessment vs 97% at post-assessment; P<.001, N=89), and pulmonologists (average correct response rate of 64% at pre-assessment vs 95% at post-assessment; P<.001, N=71). Specifically, significant improvements were observed in clinicians’ competence in assessing response to therapy and monitoring for disease progression; and managing evidence of disease worsening (figure).

Figure.

After participating in the activity, 54% of rheumatologists and 51% of pulmonologists had measurable improved confidence related to communicating with patients with SSc-ILD about the possibility of disease progression.

Given that only around half of clinicians provided correct responses at baseline, it will be important to continue to reinforce these learnings in ongoing education.

Conclusion:

This study demonstrates the success of online, case-based education in improving rheumatologists’ and pulmonologists’ competence in managing patients with SSc-ILD. This could lead to earlier changes in therapeutic approach for those with signs of progression and result in improved overall outcomes for these patients.

References:

[1]Denton C. When SSc-ILD Starts Progressing: Monitoring and Managing Those at Risk for Poor Prognosis. Launched: 9/24/2019. Data as of 12/9/2019. Available atwww.medscape.org/viewarticle/918465

Disclosure of Interests:

Christy Rohani-Montez: None declared, Marinella Calle: None declared, Chris Allen: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer

Progress in High-Speed Spin Testing of Superconducting Wire and Tapes for High-Field NMR Magnet Qualification

This paper summarizes the status of a 3-year, NIH-funded research project to study the strength of high temperature superconductors under high circumferential hoop stress, in order to qualify these materials for high-field (> 1 GHz-class NMR magnets. The unique approach presented here is to spin test coils at high rotational speeds, approaching 100,000 rpm, in order to induce the necessary hoop stress. Thermal strain compatibility between the Bi-2212 wire and Inconel wire has been qualified, including thermal cycling. Assembly and testing of the first low-speed (< 30,000 rpm) rotor is now in process, and the design of second, higher speed (> 60,000 rpm) rotor, is also underway.

P6484Invasive and non-invasive characterisation of low gradient aortic stenosis

Background

Low gradient severe aortic stenosis (LGAS) is associated with unfavourable outcomes when compared to high gradient aortic stenosis (HGAS), yet the contributing pathophysiology is poorly understood.

Methods

Symptomatic LGAS and HGAS patients undergoing trans-catheter aortic valve implantation (TAVI) underwent 3T stress perfusion cardiac magnetic resonance imaging (CMR) pre-(within 24 hours) and post-(4–6 months) TAVI. Left ventricular (LV) contractility and coronary flow/pressure were measured during hyperaemia and rapid pacing, immediately before and after TAVI, using a conductance LV catheter and dual-pressure and Doppler sensor–tipped guidewire in the mid-left anterior descending coronary artery.

Results

24 patients were recruited resulting in 19 suitable datasets (LGAS N=9, HGAS N=10, equally matched for comorbidities and B-natriuretic peptide level). LGAS patients had a smaller LV end diastolic volume index (p=0.035) and lower LV mass index (LVMI) (p=0.037). Pre-TAVI stress global endocardium-epicardium gradient was 0.88±0.09 and global myocardial perfusion reserve (MPR) 2.0±0.48 in 14 patients (6 LGAS and 8 HGAS patients, no difference between groups). Pre-TAVI, baseline coronary data demonstrated lower augmentation pressure (AP, p=0.035) and augmentation index (AIx, p=0.02) in the LGAS group. LGAS patients also exhibited a shorter ejection time (p=0.015), larger forward compression waves during rest, hyperaemia and rapid pacing, and smaller backward expansion waves (BEW) (p=0.001). Lower baseline end systolic pressure (p=0.004), inotropy (dP/dt+, p=0.045), lusitropy (dP/dt-, p=0.069), and stroke work (p=0.019) were observed in the LGAS group. Whilst LV size was smaller the LGAS group, rapid pacing induced a more significant drop in end systolic volume (p=0.045) and ejection fraction (p=0.015) in patients with HGAS. Post-TAVI, the hyperaemic BEW fell sharply (p<0.001), along with coronary VTI (p=0.02), and average pulse velocity (p=0.028), and AP and AIx remained lower (p=0.034 and p=0.031, respectively). The forward expansion wave was reduced in LGAS during rapid pacing. The HGAS group displayed a more profound drop in dP/dt+ (p=0.011) and dP/dt- p=0.014) at rest following intervention. Repeat CMR demonstrated statistically significant reduction in LV size and LVMI (p=0.012 and p<0.001, respectively) with significant increase in 3D global peak radial, circumferential and longitudinal strain (p=0.004, p=0.001 and p=0.018, respectively). Post-TAVI stress global endocardium-epicardium gradient was 0.88±0.13 and MPR 2.46±0.59 (improved from pre-TAVI, p=0.05). There was no difference in remodelling patterns or perfusion between the two groups.

Conclusion

This is the first study detailing the combined invasive and CMR pathophysiological changes in LGAS. Despite invasive parameters indicating a disease of less severe AS, the level of perfusion abnormality is disproportionate which may in part, relate to their adverse prognosis.

Acknowledgement/Funding

This research is funded by a Clinical Research Training Fellowship grant from the British Heart Foundation (FS/16/51/32365).

Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment

INTRODUCTION

The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas.

MATERIALS AND METHODS

A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively.

RESULTS

Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture.

CONCLUSIONS

This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.

Preparation for fatherhood: A role for olfactory communication during human pregnancy?

There is evidence across a range of bi-parental species that physiological changes may occur in partnered males prior to the birth of an infant. It has been hypothesised that these hormonal changes might facilitate care-giving behaviours, which could augment infant survival. The mechanism that induces these changes has not been identified, but evidence from several species suggests that odour may play a role. The current study investigated this in humans by recording testosterone and psychological measures related to infant interest and care in men (n = 91) both before and after exposure to odours from either pregnant women or non-pregnant control women. We found no evidence for an effect of odour cues of pregnancy on psychological measures including self-reported sociosexual orientation and social dominance scores, ratings of infant or adult faces, or testosterone levels. However, we found that brief exposure to post-partum odours significantly increased the reward value of infant faces. Our study is the first to show that the odour of peri-partum women may lead to upregulation of men's interest in infants.

Hunger and socioeconomic background additively predict impulsivity in humans

Impulsivity refers to the valuation of future rewards relative to immediate ones. From an evolutionary perspective, we should expect impulsivity to be sensitive to the current state of the organism (for example, hunger), and also its long-term developmental history. There is evidence that both current hunger and childhood socioeconomic deprivation are individually associated with impulsivity, but it is not known how these combine. For example, acute hunger might over-ride social gradients in baseline impulsivity, or alternatively, individuals who have experienced greater deprivation might respond more strongly to acute hunger. We aimed to investigate whether hunger and childhood socioeconomic deprivation act additively or interactively in three studies utilising delay discounting tasks. Childhood socioeconomic deprivation was measured using childhood postcode and a self-report measure. In two studies hunger was experimentally manipulated (n = 95 & n = 93 respectively), and in the third we simply measured natural variation. We employed a standard hypothetical delay discounting task in two studies, and a behavioural task with experienced delays in the third (n = 330). Although the individual studies varied in which predictors were statistically significant, when we meta-analysed them, a clear pattern emerged. Hunger predicted greater impulsivity; childhood socioeconomic deprivation predicted greater impulsivity; and these two effects were additive rather than interactive.

Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Gallagher MP, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, 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Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Regulatory experience of TOPS: an internet-based system to prevent healthy subjects from over-volunteering for UK clinical trials

PURPOSE

The aim was to review the use of The Over-volunteering Prevention System (TOPS) since the HRA began hosting it in 2013, and the Medicines and Healthcare products Regulatory Agency (MHRA) experience of monitoring its use by UK clinical research units.

METHODS

The HRA searched the TOPS database for the number, type and location of units and the number of entries. The MHRA inspectors reviewed their findings from routine inspections.

RESULTS

Twenty-two additional UK units registered to use TOPS during 2013-2016, making a total of 84 units since TOPS was established in 2002. Use of TOPS is now a condition of research ethics committee approval of a phase 1 study and fulfils MHRA accreditation requirements for preventing over-volunteering. The total number of entries by all active units during 2013-2016 was 89,335, of which 84% were UK citizens and 16% non-UK citizens. The total number of entries during 2002-2016 was 249,612. Only 15 of 24,531 subjects (1/1600) and 18 of 18,745 subjects (1/1040) entered in 2015 and 2016, respectively, were deemed potential over-volunteers.

CONCLUSIONS

The findings continue to support the concept that TOPS not only helps to prevent over-volunteering, but also deters subjects from trying to do so. Regulation of TOPS by the HRA and MHRA has enhanced its effectiveness, benefited all users and helped to improve the safety of volunteers who participate in non-therapeutic trials in the UK. The UK is still the only country with a national database to prevent over-volunteering that has published data on its widespread use and effectiveness.