Temporal trends in the inclusion of patient-reported outcomes in heart failure randomized trials published in high-impact medical journals: a systematic bibliometric review

Background

Patient reported outcomes (PROs) are important measures of health, particularly in symptomatic conditions such as heart failure (HF), and regulatory agencies have encouraged their collection in randomized controlled trials (RCTs).

Purpose

To assess temporal trends in the inclusion of patient-reported outcomes (PROs) in heart failure (HF) randomized controlled trials (RCTs) published in high-impact medical journals, explore trial characteristics associated with inclusion of PROs, and describe the quality of PRO reporting in HF RCTs.

Methods

We searched MEDLINE, EMBASE and CINAHL for studies published between January 1, 2000 and July 17, 2020. We included RCTs published in journals with impact factor ≥10. We assessed temporal trends using the Jonckheere-Terpstra test and conducted multivariable logistic regression analysis to explore trial characteristics independently associated with inclusion of PROs. We assessed the quality of PRO reporting using the Consolidated Standards for Trial Reporting PRO extension statement.

Results

We identified 12,342 articles, of which 417 RCTs met inclusion criteria. PROs were included in 224 RCTs (53.7%, 95% confidence interval [CI]: 48.8%-58.6%), of which 44 (19.6%) reported PRO as primary or co-primary endpoint. The proportion of RCTs with PROs increased significantly between 2000–2003 (37.4%) and 2016–2020 (65.1%) (p<0.001). PROs had higher odds of inclusion in RCTs that were multicenter (odds ratio [OR]: 1.95; 95% CI: 1.05–3.64; p=0.036); medium-sized (n=51–250) (OR: 2.29; 95% CI: 1.24–4.23; p=0.008); coordinated in in Central and South America (OR: 6.79; 95% CI: 1.34–34.36; p=0.021); and assessed health services (OR: 4.21; 1.97–8.98; p<0.001), device / surgical (OR: 6.24; 95% CI 3.05–12.80; p<0.001), or exercise and rehabilitation interventions (OR: 3.98; 95% CI 1.59–9.97; p=0.003). A majority (54.9%) of the 224 RCTs reported four or less of the eleven CONSORT-PRO items. The median number of CONSORT-PRO items reported was 4 (interquartile range [IQR] 3–6 items per trial), with improved reporting in trials with PRO as primary or co-primary endpoint.

Conclusions

PROs are included in in just over half of HF RCTs, with an increased reporting of PROs between 2000 and 2020. Large, pharmacotherapy trials conducted in North America and Europe were less likely to include PROs. The quality of PRO reporting in HF RCTs was modest, with trials most often reporting four of eleven CONSORT-PRO items.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research

Transcriptome analysis reveals the effect of high-grain pelleted and non-pelleted diets on ruminal epithelium of Hu-lamb

High-grain non-pelleted (HG) and high-grain pelleted (HP) diets are becoming prevalent for ruminant feeding in intensive farms. However, rare information is about their effect on sheep and the comparison between these two kinds of diets. The current study investigated how HG and HP diets affected the transcriptome profiles of rumen epithelium in Hu-lamb. Fifteen male Hu-lambs were assigned randomly to three groups (n = 5 for each group). Lambs in the control (CON), HG, and HP groups were fed with low-grain non-pelleted diet (30% grain), HG diet (70% grain), and HP diet (70% grain), respectively, for 42 days. All these lambs were slaughtered to collect ruminal epithelium samples for transcriptome analysis. Results showed both HG and HP diets obviously changed the transcriptome profiles, and 192, 319, and three differentially expressed genes (DEGs) were identified for CON_HG, CON_HP, and HG_HP comparisons, respectively. Clusters of orthologous group functional classification of CON_HG and CON_HP DEG datasets both showed the enrichments of DEGs in pathways involved in protein biogenesis and modification as well as energy production and conversion. Kyoto encyclopedia of genes and genomes pathway analysis of CON_HG and CON_HP DEG datasets both displayed the enrichments of DEGs in ribosome and oxidative phosphorylation. Almost all these DEGs involved in translation and ribosomal structure and biogenesis as well as oxidative phosphorylation were downregulated in the HG and HP groups compared to the CON group. Furthermore, CON_HP comparison demonstrated more DEGs related to these two pathways than CON_HG comparison. In conclusion, both HG and HP diets inhibited energy production and conversion as well as protein synthesis and modification in ruminal epithelium. HP diet showed lower growth benefits, induced severer rumen acidosis, and more seriously inhibited energy production and protein synthesis as compared to HG diet.

A new transoral modality for the treatment of lingual thyroglossal duct cyst with suspension laryngoscopy by plasma coblation

INTRODUCTION

Lingual thyroglossal duct cysts (LTGDC) are a rare kind of thyroglossal duct cyst. However, Sistrunk surgery is not very suitable for this type of cyst. This study aimed to explore the efficacy of transoral excision of LTGDC by plasma coblation.

METHODS

The present study reviewed 11 patients, comprising seven males and four females, who had been diagnosed with LTGDC preoperatively by computed tomography (CT) and fibre-optic electronic laryngoscopy. Of those patients, two had recurrence after surgery of epiglottic cysts. All these patients underwent transoral excision by plasma coblation. Then, we collected preoperative data of the patients, observed the effect of surgery, and analysed factors relevant to LTGDC, including the estimated bleeding amount, postoperative hospitalisation, complications and recurrence rates.

RESULTS

The connection between LTGDC and hyoid was tapered on sagittal images of CT, which was vital evidence for the diagnosis of LTGDC. Surgery was performed successfully for all 11 patients, and all recovered without complication. There was no evidence of recurrence after surgery, during follow up for 3-43 months.

CONCLUSIONS

Transoral surgery for LTGDC can be performed successfully by plasma coblation, which is an effective and safe surgical treatment. Fibre-optic electronic laryngoscopy and CT are essential to the diagnosis of LTGDC in order to avoid missing detection and misdiagnosis.

[Clinical application of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation]

Objective: To examine the clinical application value of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer. Methods: From February 2014 to July 2019, the clinic-pathological data of 34 early breast cancer patients received single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation at Department of General Surgery, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed and followed up. All the patients were female, with an age of 46(11) years (M(Q_R)) (range: 26 to 64 years). The radical cure degree of operation, cosmetic effect after operation were evaluated. The satisfaction to operation and personal quality of life after operation was accessed by BREAST-Q scale. Results: All surgical procedures were successfully completed. The operation time was (313.4±11.7) minutes (range: 200 to 485 minutes). The blooding-liquid was (33.8±3.3) ml (range: 10 to 100 ml). There were 5 cases (14.7%) of nipple areola necrosis after operation, of which 1 patient received taking the prosthesis out because of prosthesis exposure. There was no capsular contracture or postoperative bleeding case. The follow-up time was 35(17) months (range: 12 to 77 months), and there was one case suffering local recurrence and metastasis, and another suffering metastasis. The scores of postoperative breast satisfaction, psychosocial status, chest wall status and sexual health were 78.32±2.57 (range: 55 to 100), 89.12±2.30 (range: 82 to 100), 91.47±1.33 (range: 43 to 100), and 78.50±2.68 (range: 39 to 100). Conclusion: Single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer can achieve provided curative and cosmetic effect on patients with breast cancer, with good patients' postoperative quality of life and satisfaction.

[Prognosis analysis of local recurrence after excision of breast phyllodes tumors]

Objective: To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence. Methods: This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People's Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30^th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm (M(Q_R)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results: According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% (P=0.300). Conclusion: Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.

Efficacy of sonothrombolysis using acoustically activated perflutren nanodroplets versus perflutren microbubbles

Background

The use of intermittent high mechanical index (HMI) ultrasound impulses in combination with intravenously administered microbubbles (MB) has been shown to dissolve arterial and microvascular thrombi. The recent development of liquid droplets with nanoscale diameter from commercially available microbubbles may optimize thrombus permeation and subsequent thrombus dissolution.

Methods

Thrombi were formed from fresh porcine arterial whole blood mixed with thrombin, and placed in a vascular system mimicking branching epicardial coronary circulation (Figure 1A) at 37 Celsius and flow rate. A diagnostic ultrasound system with a tissue mimicking phantom was placed on top of the thrombus to simulate transthoracic echocardiography. Thrombus treatment consisted of a 10-minute infusion of either diluted nanodroplets (ND) or MB (same concentration) with intermittent HMI fundamental multipulse (3 usec pulse duration; FUS) or single pulse harmonic (HUS) impulses. All treatments were randomized and compared with HMI impulses alone. Efficacy was evaluated by percentage thrombus dissolution (%TD). Transmission electron microscopy (TEM) of residual thrombi after treatment was performed to examine for droplet permeation and resultant formed microbubble size.

Results

A relatively monodisperse nanodroplets size distribution was formed from microbubble cooled compression (mean diameter was 147±54 nm). A total of 60 porcine arterial thrombi were tested, 20 in each MB and ND treated group (20 control). Overall, there was a significant difference in %TD between ND treated thrombi (combining HUS and FUS HMI treated groups) versus MB treated thrombi and control (p&lt;0.0001 and p=0.02, respectively; ANOVA, Figure 1B). The highest %TD was seen in the FUS HMI treated ND group (mean 51±17%; Figure 1B). TEM of the DND treated group demonstrated significant expansion (diameters of 6 microns; Figure 1 C) of acoustically activated droplets embedded within the thrombi.

Conclusion

ND in combination with intermittent HMI ultrasound resulted in significantly greater thrombolysis compared to MB. In-vivo studies on nanodroplet mediated sonothrombolysis for vascular and microvascular thrombi should be performed with this modification of a commercially available microbubble.

Figure 1

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Theodore F. Hubbard Foundation

The effect of computer decision support on optimizing appropriate dosing of novel oral anticoagulant therapy in the IMPACT-AF study

Background

Guidelines favour use of the non-vitamin K oral anticoagulants (NOACs) over vitamin-K antagonists for stroke prevention in atrial fibrillation (AF). However, studies have shown these agents are being under-dosed relative to the doses recommended in the product labels.

Purpose

To assess the ability of a CDS tool, employed to support management of patients with AF in primary care, to optimize NOAC prescribing.

Methods

The Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) study was a cluster randomized controlled trial that assessed the ability of a CDS tool to optimize care of community-based AF patients. Between September 2014 and December 2016, 203 primary care providers (104 randomized to CDS use, 99 to usual care [UC]) and 1133 of their patients (n=597 CDS, n=548 UC) were enrolled. Among other functions, 9 CDS program rules provided recommendations on NOAC prescribing based upon a given patient's clinical profile, as per product labels. Appropriate NOAC prescribing within the IMPACT-AF study population was compared between patients managed with the CDS versus UC at baseline and 12-months.

Results

Of those patients prescribed a NOAC, a high proportion (approximately 70%) were managed as per NOAC prescribing recommendations at baseline (Fig. 1). At 12 months, this proportion did not appreciably change in the UC arm (Fig. 1). In the CDS arm, an 8.2% absolute/11.8% relative improvement in appropriate NOAC prescribing over baseline was seen at 12-months (Fig. 1).

A comparison of patients at baseline and 12-months within each arm revealed a non-significant decline in the level of appropriate NOAC prescribing in the UC group (p=0.53). In the CDS arm, a significant improvement was observed in appropriate NOAC prescribing over time (p&lt;0.001).

Conclusion

Even prior to any quality improvement efforts, appropriate NOAC prescribing was higher than anticipated in this contemporary cohort of community-based AF patients. At 12-months, significant further improvements were seen in the CDS but not the UC arm. These findings suggest that physician decision support can help enhance appropriate NOAC prescribing in the primary care setting.

Figure 1. Appropriate NOAC prescribing

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Inc.

[Advances in research on Crouzon syndrome and related ophthalmic complications]

Crouzon syndrome is an autosomal dominant disorder characterized by acrocephaly, exophthalmos, hypertelorism, strabismus, parrot-beaked nose, and hypoplastic maxilla. It is usually caused by a pathogenic mutation in the fibroblast growth factor receptor 2 gene and premature fusion of the sutures of the cranium and the base of the skull. This article documents the ophthalmic complications in patients with Crouzon syndrome before and after the influence of craniofacial surgery with particular emphasis on the different mechanisms and treatments involved. It is important to perform timely decompressive surgery before the presence of optic atrophy and corneal defects, and make early detection and adequate management of amblyopia, ptosis and strabismus. (Chin J Ophthalmol, 2020, 56: 544-548).

Comparison of postoperative complications and facial nerve recovery rates after conventional and partial superficial parotidectomy of benign parotid tumours: a prospective study

The aim of this study was to compare postoperative complications and facial nerve (FN) recovery rates between conventional superficial parotidectomy (CSP) and partial superficial parotidectomy (PSP) as surgical treatment for benign parotid tumours. A prospective study was conducted on 55 consecutive patients who underwent either CSP (n=35) or PSP (n=20) for benign parotid tumours. The primary outcomes were FN injury, FN recovery rates, and Frey syndrome. Secondary outcomes were operative time, hospital stay, sialocele, haematoma, and auricular numbness. The degree of FN injury was evaluated at 1 week, 1, 3, 6, and 12 months postoperative using the House-Brackmann grading system. Frey syndrome was assessed using a subjective clinical questionnaire and objective Minor starch-iodine test. No patient in either group experienced permanent FN paralysis. There was a significantly higher incidence of temporary FN weakness in the CSP group (P=0.007). The respective FN recovery rates at 1, 3, 6, and 12 months were 60%, 88.6%, 94.3%, and 100% in the CSP group and 90%, 95%, 100%, and 100% in the PSP group. No significant difference was observed between the groups regarding the incidence of Frey syndrome, sialocele, and haematoma. The operative time and hospital stay were both shorter in the PSP group. Although the PSP is a more conservative procedure with significantly reduced FN injury, operative time, and hospital stay compared to CSP, the CSP procedure shows a comparable FN recovery rate to the PSP.

Lee Silverman Voice Treatment for dysarthria in patients with Parkinson's disease: a systematic review and meta-analysis

Approximately 89% of patients with Parkinson's disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta-analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage', monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31 dB, respectively, after 1 month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage' and monologue immediately after treatment (13.39, 6.66 and 3.19 dB). Positive improvement still existed after 24 months. There was no difference in the therapeutic effect between face-to-face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.

Comparative safety of flavocoxid vs prescription NSAIDs among osteoarthritis patients

OBJECTIVE

Flavocoxid is a prescription medical food used to manage osteoarthritis (OA) symptoms. Safety concerns based on case reports raised an association with acute liver injury and hypersensitivity pneumonitis. We determined incidence rates (IR) of these safety events in a cohort of new users of flavocoxid and prescription non-steroidal anti-inflammatory drugs (NSAIDs).

METHOD

MarketScan® claims data (2006-2017) was used to identify patients initiating flavocoxid or NSAIDs. Propensity score matching (1:2 ratio) was used to balance patient characteristics. Outcomes included hospitalization for hypersensitivity pneumonitis, liver injury, gastrointestinal bleeding, myocardial infarction, and acute kidney injury. Poisson regression was used to calculate IRs and Cox regression for calculating adjusted hazard ratios (aHR).

RESULTS

3,337 flavocoxid and 6,674 NSAID users met eligibility criteria. Before matching, flavocoxid users were older (mean 57 vs 51 years), had more polypharmacy (68% vs 29% taking ≥11 medications). After matching, characteristics were well balanced. The rate of hypersensitivity pneumonitis was 1.1 (95% CI 0.0-5.9) per 1,000 PY for flavocoxid and 0.0 (95% CI 0.0-2.2) for NSAIDs. For hospitalized liver injury, it was 3.2 (95% CI 0.7-9.3) for flavocoxid and 2.4 (95% CI 0.7-6.1) for NSAIDs, aHR = 1.16, 95% CI 0.23-6.01. A lower rate of GI bleed was observed, IR: 5.3 (1.7-12.3) for flavocoxid and 10.2 (5.9-16.3) for NSAIDs, aHR 0.49 (0.18-1.68). There were no significant differences for MI or AKI.

CONCLUSION

The rate of hypersensitivity pneumonitis and liver injury associated with flavocoxid was low and minimally elevated compared to NSAIDs. Flavocoxid users had a significantly lower risk for hospitalized GI bleeding. The risk-benefit profile of flavocoxid may warrant reevaluation in light of these findings.

FRI0553 DEVELOPMENT AND VALIDATION OF A BIOMARKER-BASED CARDIOVASCULAR RISK PREDICTION SCORE IN RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) patients are at elevated risk for cardiovascular (CV) events, but risk stratification based on CV prediction models is not part of routine rheumatology practice.

Objectives:

To develop and validate a biomarker-based CV risk prediction model and compare it to alternative risk prediction models.

Methods:

We constructed a cohort of RA patients - age ≥40 with ≥1 RA diagnosis from a rheumatologist, excluding patients with malignancy, past myocardial infarction (MI) or stroke - by linking Medicare administrative data from 2006-2016 to multi-biomarker disease activity (MBDA) test results obtained as part of routine care. The cohort was split 2:1 to create training and internal validation datasets. The composite CV outcome was MI, stroke or CV death occurring within 3 years. Clinical predictors examined were: age, sex, race, traditional CV risk factors (e.g. diabetes, hypertension, hyperlipidemia, high-risk CV conditions [e.g. angina]), RA-related factors (e.g. glucocorticoid use, MTX, number of prior biologics), adjusted MBDA score1and its 12 biomarkers, log-transformed. Backward elimination was used to remove predictors with p ≥0.05. The resulting CV risk score was compared to four prediction models (age+sex; age+sex+CRP; age+sex+diabetes+hypertension+ smoking+high risk CV [±CRP]) in the validation dataset. We evaluated: 1) incremental improvement in the likelihood ratio test (LRT) statistic, 2) discrimination (AUROC), and 3) goodness-of-fit (predicted vs. observed, based on Kaplan-Meier estimates). Validation analyses were prespecified.

Results:

30,751 RA patients with 904 CV events were linked to MBDA test results and eligible for analysis. Patient characteristics were mean (SD) age 68.7 (9.5) years; 23.4% age <65; 82% women. Comorbidities included diabetes (39%), hypertension (78%), smoking (24%) and history of high-risk CV condition (37%). RA-related features included use of glucocorticoids (58%), MTX (60%), TNFi (33%) and other biologics (16%). Mean (SD) MBDA score was 41 (14). The final covariates included in the MBDA-based CV risk score were age, diabetes, hypertension, smoking, history of high-risk CV conditions, adjusted MBDA score, leptin, TNFRI and MMP-3. Median (IQR) of the predicted 3-year CV risk was 3.4% (2.1%, 5.6%). Based on extrapolation to 10-year risk, 9.4% of patients would be considered low, 10.2% borderline, 52.2% intermediate, and 28.2% high risk per 2019 ACC/AHA guidelines.

Compared to four simpler CV prediction models, significant improvement in the LRT statistic was observed with the addition of the biomarker-based CV risk score (Figure 1). Model fit was good across deciles (Figure 2). The AUROC was 0.70. The MBDA-based model reclassified 28.5% of patients vs. the model based on age+sex+diabetes+hypertension +smoking+high risk CV+CRP.

Figure 1.

Incremental Improvement of MBDA-based CV Risk Score Compared to Other CV Risk Prediction Models

Figure 2.

MBDA-Based CV Risk Score Calibration for Composite CV Outcome at 3 Years

Conclusion:

A biomarker-based prediction score incorporating a few clinical risk factors appears to have good accuracy to predict CV risk in RA. Additional validation in independent cohorts will help verify its performance characteristics.

References:

[1] Curtis et al.,Rheumatology2018;58:874.

Disclosure of Interests:

Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Fenglong Xie: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Brent Mabey Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Darl Flake Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Richard Bamford Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Cheryl Chin Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Eric Sasso Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Elena Hitraya Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Rotem Ben-Shachar Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Alexander Gutin Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc., Jerry Lanchbury Shareholder of: Myriad Genetics, Inc., Employee of: Myriad Genetics, Inc.

THU0564 PARTICIPANT ENGAGEMENT IN AN ARTHRITISPOWER REAL-WORLD STUDY TO CAPTURE SMARTWATCH AND PATIENT-REPORTED OUTCOME DATA AMONG RHEUMATOID ARTHRITIS PATIENTS

Background:

Clear characterization of how different types of patient-generated data reflect patient experience is needed to guide integration of electronic patient-reported outcome (ePRO) measures and biometrics in generating real-word evidence (RWE) related to rheumatoid arthritis (RA).

Objectives:

To characterize the level of participant (pt) engagement/adherence and data completeness in an ongoing study of 250 RA pts enrolled in the Digital Tracking of Arthritis Longitudinally (DIGITAL) study1of the ArthritisPower real-world registry.

Methods:

ArthritisPower pts with RA were invited to join a digital RWE study with 14-day lead-in and 12-week main study period. In the lead-in, pts were required to electronically complete: a) two daily single-item Pain and Fatigue numeric rating scales and b) longer weekly sets of ePROs. Successful completers of the lead-in were mailed a smartwatch (Fitbit Versa) and study materials. The smartwatch collected activity, heart rate, and sleep duration/quality biosensor data; a study-specific customization of the ArthritisPower mobile application collected ePROs. The main study period included automated and manual reminders/prompts about completing ePROs, wearing the smartwatch and regularly syncing it. Study coordinators monitored pt data and contacted pts via email, text and/or phone to resolve adherence issues during the conduct of the study based on pre-determined rules triggering pt contact. Rules were based chiefly on consecutive spans of missing data. Pts were considered adherent in giving complete data for each week if providing (1) daily ePROs for ≥5 of 7 days/week, (2) weekly ePROs and (3) ≥80% of synced activity data for ≥5 of 7 days/week. Composite adherence for the first month of the main study period required meeting >70% weekly adherence parameters during the first 30 days, ie completing daily ePROs for ≥5 of 7 days/week, weekly ePROs ≥3 of 4 weeks and ≥80% of synced activity data for ≥5 of 7 days/week.

Results:

As of December 2019, 170 ArthritisPower members enrolled and completed at least 30 days of the main study period; 92.9% female with mean (SD) age 52.5 (10.7) and 10.5 (10.4) years since diagnosis. The overall conversion rate from initial interest to successful completion of the lead-in period was 49.0%. Pts who advanced to the main study were significantly more likely than those who did not to be currently employed (52.9% vs. 41.8%, p=0.038) and be on biologic DMARD monotherapy (64.7% vs. 47.5%, p=0.001). Overall, daily ePRO data had the lowest adherence with 70.0% of pts providing >70% of the requested data consistently across the first 30 days of the main study period (Figure 1). Composite adherence was met by 66.5% of pts. The most common time of day to provide ePRO data was morning, in the hours around scheduled app and email notifications at 10 a.m. in pt’s local time zone. Activity data had the highest adherence and persistence, with 92.9% of pts providing 80% or more of activity data for each 24-hour period in the first 30 days (Figures 1 & 2). Observed weekly adherence did not decline over time. Of 5100 possible person days in the study at day 30, we observed 643 days (91.0% of actual to maximum possible total patient days) where activity data was provided for at least 80% of the 24-hour period.

Conclusion:

RWE studies involving passive data collection in RA require pt-centric implementation and design to minimize pt burden, promote longitudinal engagement and maximize adherence. Passive data capture via activity trackers such as smartwatches, along with regular contact such as automated reminders, may facilitate greater pt adherence in providing longitudinal data for clinical trials.

References:

[1]Nowell WB, et al. JMIR Res Protoc. 2019;8(9):e14665.

Disclosure of Interests:

W. Benjamin Nowell: None declared, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Fenglong Xie: None declared, Hong Zhao: None declared, David Curtis: None declared, Kelly Gavigan: None declared, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, Jessica Boles: None declared, Justin Owensby: None declared, Cassie Clinton: None declared, Ilya Lipkovich Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Amy Calvin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Virginia S. Haynes Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company

SAT0150 CHANGES IN PATIENT-REPORTED OUTCOME (PRO) SCORES FOR NAUSEA AND FATIGUE FOLLOWING WEEKLY METHOTREXATE DOSE IN A REAL-WORLD SAMPLE OF RA AND PSA PATIENTS IN THE ARTHRITISPOWER REGISTRY

Background:

Methotrexate (MTX) is frequently used in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) because of its beneficial effects in both populations1-3. Despite the well-known benefits of MTX, it is associated with a number of potential side effects4-6These include nausea and fatigue, are often temporally related to the timing of weekly MTX administration, and can be severe. The combined patient-reported side effects, along with potential of long-term toxicity, may make use of MTX more burdensome. Currently, there is a gap in patient-centered studies that focus on patients’ experience with MTX.

Objectives:

Examine patient temporal experience of fatigue and nausea relating to oral MTX therapy for the treatment of RA and PsA.

Methods:

Adult US patients in the ArthritisPower registry with self-reported RA or PsA taking MTX for less than 10 years were invited to participate in the study via email invitation. Participants (pts) completed a screener and brief online survey. In an ancillary study to the ArthritisPower registry and using a self-controlled case series study design where pts serve as their own control to avoid between-person confounding, pts were asked to complete a set of up to 8 assessments within 6-36 hours (‘risk’) and 96-144 hours (‘control’) after taking their oral dose of MTX each week, for up to 4 weeks. Risk and control windows were selected based on the expected temporal relationship between MTX use and peak onset of these symptoms. Assessments included PROMIS short forms for same-day Fatigue, same-day Nausea/Vomiting, and Patient Global. Descriptive statistics were conducted using paired t-tests two-way comparisons. Within-person change in PROMIS scores between the risk (1-2 days after MTX) and control (4-6 days after MTX) windows were analyzed using mixed models for repeated measures, stratified on whether pts reported fatigue or nausea with MTX at baseline. Recruitment for this study is ongoing.

Results:

As of December 2019, 91 pts had participated, of whom 76.9% were living with RA and 28.6% with PsA, with mean baseline PROMIS Patient Global score (SD) of 39.5 (7.1). Mean age (SD) was 50.9 (12.0) years, 84.6% female, 92.3% White, with mean BMI 33.7 (8.8). Mean duration of MTX treatment among current users was 2.1 (2.8) years. Among pts, 41.8% were on a biologic DMARD and 58.2% on non-biologic DMARDs only. Among pts reporting baseline nausea (n=30, 33.0%) where paired within-week measures were observed (n=64 observations among 20 pts), the mean increase in the PROMIS Nausea score was 4.5 units (adjusted p=0.003). Among those reporting MTX-associated fatigue (n=39, 42.9%) as a side effect of MTX on their baseline survey where paired within-week measures were observed (n=96 observations among 28 pts), the mean increase in PROMIS Fatigue was 4.7 (adjusted p=0.004) units. In those pts, the proportion of pts with worsened nausea and fatigue with minimally important difference of >5 units7-8was 40.0% (nausea), and 60.7% (fatigue) [Figures 1 and 2].

Conclusion:

People taking MTX to manage RA or PsA commonly experience bothersome side effects, notably fatigue and nausea, that are temporally related to weekly MTX dosing. In this sample, one-third or more of pts were bothered by nausea or fatigue shortly after MTX dosing, many of them with clinically meaningful symptoms.

References:

[1]Singh JA, et al.Arthritis Rheumatol. 2016;68:1-26.

[2]Singh JA, et al.Arthritis Rheumatol. 2019;71:5-32.

[3]Mease P.Bull NYU Hosp Jt Dis. 2013;71.(suppl 1):S41.

[4]Wang W, et al.Eur J Med Chem. 2018;158:502-516.

[5]Wilsdon TD, et al.Cochrane Database Syst Rev. 2019;1:CD012722.

[6]Husted JA, et al.Ann Rheum Dis. 2009;68:1553-1558.

[7]Norman GR, et al.Med Care. 2003;41:582-92.

[8]Bingham CO, et al.J Patient Rep Outcomes. 2019;3:14.

Disclosure of Interests:

W. Benjamin Nowell: None declared, Elaine Karis Shareholder of: Amgen Inc., Employee of: Amgen Inc., Kelly Gavigan: None declared, Laura Stradford: None declared, Scott Stryker Shareholder of: Amgen Inc., Employee of: Amgen Inc., Huifeng Yun Grant/research support from: Bristol-Myers Squibb and Pfizer, Shilpa Venkatachalam: None declared, Greg Kricorian Shareholder of: Amgen Inc., Employee of: Amgen Inc., Lang Chen: None declared, Hong Zhao: None declared, Fenglong Xie: None declared, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB

FRI0018 USING SELF-REPORTED OUTCOMES TO DETECT NEW-ONSET FLARE IN A REAL-WORLD STUDY OF PARTICIPANTS WITH RHEUMATOID ARTHRITIS - INTERIM RESULTS FROM THE DIGITAL TRACKING OF ARTHRITIS LONGITUDINALLY (DIGITAL) STUDY

Background:

Patients with rheumatoid arthritis (RA) experience fluctuating symptoms, increased pain, decreased function and variable quality of life; such changes often occur between visits to clinicians. Digital Tracking of Arthritis Longitudinally (DIGITAL) study2is evaluating the use of electronically captured patient-reported outcomes (ePRO) and passive data collection from a Fitbit device to identify disease worsening in a real-world study of participants (pts) with RA.

Objectives:

Evaluate agreement between self-reported new-onset flare and ePROs in an interim analysis from DIGITAL using a classification model.

Methods:

Members of the ArthritisPower registry with RA were invited to participate in DIGITAL. Pts who successfully completed a two-week Lead-in period entered the Main Study in which they wore a smartwatch and provided daily (pain and fatigue numeric rating scales (NRS)) and weekly ePROs, including the OMERACT RA Flare Questionnaire (FLARE) and PROMIS measures. This interim analysis is of ePRO data from pts who completed at least 30 days of the Main Study. A “Yes” response to the FLARE item, “Are you having a flare now?” identified flare. For modeling association between new-onset flare and ePRO, the dataset was split into training (the first 30 days of the Main Study) and test data (Day 31 and following). Within each dataset, repeated binary outcomes (Flare/No Flare) per pt were defined each week. To focus on new-onset flare, within each dataset, outcomes for patient weeks for which flare was present in the previous week were excluded.

Candidate variables for the model included baseline and current FLARE score (0-50 scale) and each of its 5 items, daily pain, daily fatigue, and several PROMIS weekly instruments and their lagged values (last week or last 6 days for daily). ‘Baseline’ was calculated in non-flare weeks. Training data was used for logistic regression model selection combining clinical expertise with backward elimination. Performance of the final model was evaluated using test data.

Results:

The training data was composed of outcomes from 128 pts who reported 388 weekly flare assessments as no flare or onset flare over 2800 days during the first month of the Main Study. Of pts in the training dataset, 92.2% were female, 87.5% white, with mean age (SD) 52.7 (11.0) and years since RA diagnosis 10.4 (10.3); 62.5% were on a biologic. Among those in the training dataset, 58 flare outcomes occurred in 50 (39.1%) unique pts.

The test data comprised outcomes from 123 pts who reported 442 weekly flare assessments as no flare or onset flare over 3366 days in which 64 flare outcomes occurred, and primarily included continued observations from pts who contributed to the training dataset.

The best-performing model to classify flare in training data included the current and baseline FLARE instrument activity question (i.e. “Considering how active your rheumatoid arthritis has been, how much difficulty have you had when taking part in activities such as work, family life, social events that are typical for you during the last week”), current daily pain, and baseline daily pain average and standard deviation. In test data, this model had an area under the receiver operator curve of 0.81 (Figure). At a cut point requiring specificity to be ≥0.80, sensitivity to detect flare was 0.62 and overall accuracy was 0.78.

Conclusion:

New-onset flare is common among RA patients, and the FLARE instrument and daily pain scores appear effective to classify it. Evaluation of passive data as a proxy for self-reported new-onset flare is ongoing.

References:

[1]Bartlett SJ, et al. JRheumatol, 2017;44:1536-43.

[2]Nowell WB, et al. JMIR Res Protoc, 2019;8:e14665.

Disclosure of Interests:

Virginia S. Haynes Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Fenglong Xie: None declared, Ilya Lipkovich Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Hong Zhao: None declared, Carol L. Kannowski Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jiat-Ling Poon Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kelly Gavigan: None declared, David Curtis: None declared, Sandra K. Nolot Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, W. Benjamin Nowell: None declared

FRI0314 ANNUAL DIAGNOSTIC PREVALENCE OF ANKYLOSING SPONDYLITIS (AS) IN THE UNITED STATES USING MEDICARE AND MARKETSCAN DATA

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that affects the axial skeleton and sacroiliac joints, and can be classified as ankylosing spondylitis (AS) or non-radiographic (nr)-axSpA.1A 2016 analysis estimated the US diagnostic prevalence of axSpA to be 0.2% and AS to be 0.1%.2Previous studies use disparate populations and diagnostic definitions;3,4it is therefore unclear how AS prevalence has changed over time.

Objectives:

To investigate the annual diagnostic prevalence of AS in US healthcare insurance claims databases.

Methods:

A retrospective, observational cohort study was conducted using 2006–2014 data from US Medicare Fee-for-Service Claims (5% random sample of all enrolled patients [pts]) and Truven MarketScan®. Eligible pts were ≥20 years (yrs) and had ≥6 months of continuous medical and pharmacy enrolment prior to diagnosis. Diagnoses used relevant International Classification of Disease, 9thversion (ICD-9) diagnosis codes: ICD-9 720.x [x=any number] for “AS and other inflammatory spondylopathies [SpA]” or 720.0 for “AS”. Two diagnosis definitions were used: Definition 1, ≥1 relevant ICD-9 code from hospital discharge or ≥2 from rheumatologist visit; Definition 2, ≥1 relevant ICD-9 code from hospital discharge or rheumatologist visit. Annual diagnostic prevalence of SpA/AS was calculated as “number of enrolled pts who met the definition of SpA/AS within each calendar yr and had full insurance coverage (medical and pharmacy)”, divided by “total number of pts with full insurance coverage in the same yr”. A primary analysis of SpA prevalence rates used Definitions 1 and 2, followed by a sensitivity analysis for AS prevalence rates using only Definition 2. All prevalence rates are shown per 10,000 pts enrolled.

Results:

The annual diagnostic prevalence of SpA appeared to increase from 2006–2014 (Table). Similarly, the sensitivity analysis showed the annual diagnostic prevalence of AS appeared to increase during the period from 2006 (Medicare: 2.87/10,000 pts [n=501,031]; MarketScan: 1.37/10,000 pts [n=17,562,637]) to 2014 (Medicare: 4.77/10,000 pts [n=1,046,107]; MarketScan: 2.14/10,000 pts [n=34,553,135];Figure).

Conclusion:

The apparent increase in diagnostic prevalence of SpA and AS during the period from 2006–‍2014 may be a consequence of increased awareness and availability of effective treatments. Furthermore, the 2009 Assessment of SpondyloArthritis international Society development of the axSpA classification criteria to include pts with both established AS and nr-axSpA may have accelerated this increase.5

References:

[1]Strand V. Mayo Clin Proc 2017;92:555–64;

[2]Curtis J. Perm J 2016;20:15–151;

[3]Reveille J. Arthritis Care Res (Hoboken) 2012;64:905–10;

[4]Danve A. Clin Rheumatol 2019;38:625–34;

[5]Rudwaleit M. Ann Rheum Dis 2009;68:777–83.

Table.

Prevalence of SpA by calendar year and data source

Medicare (5% random sample)MarketScanCalendar yrTotal number of eligible ptsPrevalence/10,000 ptsTotal number of eligible ptsPrevalence/10,000 ptsDefinition 1Definition 2Definition 1Definition 22006501,0314.397.6217,562,6371.332.172007816,9705.258.7219,518,0661.472.372008825,4454.898.7828,603,5251.582.532009830,9675.229.2131,757,0691.903.092010844,5285.499.9031,126,1721.963.172011879,9966.3010.7138,295,1211.943.112012921,9946.1710.8840,320,4371.913.0420131,032,8276.7410.8233,826,0412.003.1920141,046,1076.5210.8534,553,1352.213.51

Medicare data included a 5% random sample of all enrolled pts age ≥20 yrs. pts: patients; SpA: ankylosing spondylitis and other inflammatory spondylopathies; yr: year.

Acknowledgments:

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests:

Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corona, Crescendo, Genentech, Janssen, Pfizer, Roche and UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corona, Crescendo, Genentech, Janssen, Pfizer, Roche and UCB Pharma, Kevin Winthrop Grant/research support from: Bristol-Myers Squibb, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead, GSK, Pfizer Inc, Roche, UCB, Benjamin Chan: None declared, Sarah Siegel: None declared, Jeffrey Stark Employee of: UCB Pharma, Robert Suruki Employee of: UCB Pharma, Rhonda Bohn Consultant of: UCB Pharma, Fenglong Xie: None declared, Huifeng Yun Grant/research support from: Bristol-Myers Squibb and Pfizer, Lang Chen: None declared, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB

[The analysis of clinical characteristics of 34 novel coronavirus pneumonia cases in Ningxia Hui autonomous region]

Objective: To analyze the clinical characteristics of 34 COVID-19 cases and to provide the basis for the prevention and control of the epidemic disease. Methods: Thirty-four COVID-19 patients diagnosed with RT-PCR in the isolation ward of the Fourth People's Hospital of Ningxia Hui autonomous region (infectious diseases hospital) from the January 22 to February 4, 2020 were selected as the research subjects. The clinical data were collected. Excel was used to describe the relationship between clinical classification and age distribution, contact history and date of onset. SPSS 25.0 statistical software was used for analysis. The general information, clinical symptoms, blood test, virus nucleic acid test results, epidemiology, CT imaging, treatment and prognosis were analyzed. Results: There were 5 mild cases (5/34), 24 ordinary cases (24/34), 5 severe cases (5/34). The elderly was more common in severe patients. The main clinical symptoms were fever (27/34)and dry cough(26/34). The peripheral blood showed normal or decreased leukocyte count (33/34), decreased lymphocyte count (12/34). The increase of C-reactive protein (CRP) and D-dimer was related to the severity of the disease. Some patients had mild liver and kidney damage. Six patients were diagnosed through 3 or more times of nucleic acid tests. Sixteen cases had Wuhan related history,13 cases were close contacts, 5 cases had no confirmed route. The clustered infections were found in 6 families. In typical cases, CT showed single or multiple patchy ground glass shadow with thickening of interlobular septum. In severe cases, diffuse lesions of both lungs were found, with ground glass shadow, consolidation shadow and strip shadow coexisting. Thirty-four patients were treated with interferon-α and Lopinavir/Ritonavir with good prognosis. Conclusions: The clinical characteristics of COVID-19 were similar to that of general viral pneumonia but with strong infectivity. Close contact and family aggregation caused disease outbreaks. COVID-19 could not be excluded if two nucleic acid tests were negative and high-resolution CT was helpful for differential diagnosis. Early detection, early isolation, early diagnosis and early treatment are important for good prognosis. The effectiveness of antiviral drugs needs to be further verified.