POS1238 GLUCOCORTICOIDS, RITUXIMAB AND THE PRESENCE OF INTERSTITIAL LUNG DISEASE ARE ASSOCIATED WITH POOR OUTCOMES OF THE SARS-COV-2 INFECTION IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE NATIONAL REGISTRY SAR-COVID

Background

High disease activity, treatment with glucocorticoids (GC) and rituximab (RTX), have been related to worse outcomes of COVID-19.

Objectives

To assess the clinical characteristics and severity of the SARS-CoV-2 infection in patients with rheumatoid arthritis (RA) included in the SAR-COVID registry and to identify factors associated with poor outcomes.

Methods

SAR-COVID is a national, longitudinal and observational registry. Patients of ≥18 years old, with diagnosis of RA (ACR-EULAR criteria 2010) who had confirmed SARS-CoV-2 infection (RT-PCR or positive serology) were included between 13-8-20 and 31-7-21. Sociodemographic and clinical data, comorbidities, disease activity and treatment at the moment of the SARS-CoV-2 infection were collected. Additionally, infection symptoms, complications, medical interventions and treatments for COVID-19 were registered. Infection severity was assessed using the WHO-ordinal scale (WHO-OS)1. A cut-off value of ≥5 identified patients with severe COVID-19 and those who died.

Statistical analysis: Descriptive statistics. Chi2 or Fischer test, Student T test or Mann-Whitney and Kruskal Wallis or ANOVA, as appropriate. Multiple logistic regression model.

Results

A total of 801 patients were included, with a mean age of 53.1 ± 12.9 years, most of them were female (84.5%) and the median (m) disease duration was 8 years (IQR 4-14). One third were in remission and 46.4% had comorbidities, being the most frequent, hypertension (26.9 %), dyslipidemia (13.5 %), obesity (13.4 %) and diabetes (8.9%). Moreover, 3.2% had interstitial lung disease (ILD) associated with RA. At SARS-CoV-2 diagnosis, 42.5% were receiving glucocorticoids (GC), 73.9% conventional (c) disease modifying antirheumatic drugs (DMARD), 24% biologic (b) DMARD and 9.1% targeted synthetic (ts) DMARD. Among bDMARD, the most frequently used were TNF inhibitors (17%), followed by abatacept (2.8%), IL-6 inhibitors (2.4%) and rituximab (RTX) (2.1%). During the SARS-CoV-2 infection, 95.8% had symptoms, 27% required hospitalization, 7.9% presented complications and 4.4% died due to COVID-19. Severe disease and death (WHO-OS≥5) was present in 7.5% of the patients. They were older (62.9±12.5 vs 52.2±12.7, p<0.001), and they had more frequently ILD (18.5% vs 2%, p<0.001), comorbidities (82.5% vs 43.7%, p<0.001), ≥2 comorbidities (60.3% vs 25.8%, p<0.001), treatment with GC (61% vs 40.7%, p=0.04) and RTX (8.3% vs 1.6%, p=0.007). Conversely, the use of cDMARD and TNF inhibitors was more frequent in patients with WHO-OS<5, nevertheless this difference was not significant. Disease activity was comparable between groups. In multivariable analysis, older age, the presence of diabetes, ILD, the use of GC and RTX were significantly associated with WHO-OS≥5 (Figure 1). Furthermore, older age (65.7±10.8 vs 52.4±12.8, p<0.001), the presence of comorbidities (87.9% vs 44.7%, p<0.001), chronic obstructive pulmonary disease (21.9% vs 5.2%, p=0.002), diabetes (30.3% vs 7.9%, p<0.001), hypertension (57.6% vs 25.6%, p<0.001), cardiovascular disease (15.6% vs 3.2%, p=0.005), cancer (9.1% vs 1.3%, p=0.001), ILD (23.3% vs 2.4%, p<0.001) and the use of GC (61.8% vs 41.4%, p=0.02) were associated with mortality. Older age [OR 1.1 IC95% 1.06-1.13] and the use of GC 5-10 mg/day [OR 4.6 IC95% 1.8-11.6] remained significantly associated with death due to COVID-19.

Figure 1.

Factors associated with severe disease and death due to COVID-19 (WHO-OS≥5) in patients with rheumatoid arthritis. Multivariable analysis. (ref.: reference; PDN: prednisone; OR: odds ratio; CI: confidence interval)

Conclusion

Treatment with RTX and GC, as well as older age, the presence of diabetes and ILD were associated with poor COVID-19 outcomes in this national cohort of patients with RA. Older patients and those taking GC had a higher mortality rate.

References

[1]World Health Organization coronavirus disease (COVID-19) Therapeutic Trial Synopsis Draft 2020.

Disclosure of Interests

None declared

POS1201 SAFETY OF SARS-COV-2 VACCINES IN PATIENTS WITH RHEUMATIC DISEASES: DATA FROM THE NATIONAL REGISTRY SAR-CoVAC FROM ARGENTINA

Background

Patients with rheumatic diseases (RD) have been excluded from SARS-CoV-2 vaccine trials, though data appear to show safety and efficacy, mostly evidence remains in mRNA vaccines. In our country, adenovirus-vector, inactivated and heterologous scheme vaccines are frequently used.

Objectives

To describe the safety of SARS-CoV-2 vaccines in patients with RD from the national registry SAR-CoVAC and to assess sociodemographic and clinical factors associated to AE and disease flares after vaccination.

Methods

Adult patients with RD who have been vaccinated for SARS-CoV-2 from de Argentine Society of Rheumatology Vaccine Registry (SAR-CoVAC) were consecutively included between June 1st and December 21st, 2021, This is a national multicentric observational registry that includes patients that have received at least one dose of any SARS-CoV-2 available vaccines in Argentina. Data is voluntarily collected by the treating physician. Naranjo scale was use to assess the association between the AE and vaccination.

Homologous and heterologous schedules were defined according to whether both vaccines received were the same or different, respectively. Descriptive statics, Chi2 test, Fischer test, T test, ANOVA and multivariate regression logistic model were used.

Results

A total of 1679 patients, with 2795 SARS-CoV-2 vaccine doses were included. Vaccines more frequently used were: Gam-COVID-Vac (1227 doses, 44%), ChAdOx1 nCov-19 (872 doses, 31%), BBIBP-CorV (482 doses, 17%) and mRAN-1273 (172 doses, 6%). Altogether, 510 EA were experienced by 449 (27%) patients. Pseudo-flu syndrome was the most frequent (11%), followed by injection site reaction (7%). They were significantly more frequent after the first dose in comparison to the second one (13% vs 7% and 9% vs 5%, respectively, p<0.001 in both cases). All were mild or moderate and no patient was hospitalized due to an AE. One case of moderate anaphylaxis was reported by a patient who received Gam-COVID-Vac. No cases of vaccine-induced thrombotic thrombocytopenia were observed. There were 25 disease flares reported, 17 (68%) cases of arthritis. Among patients with two doses, those with heterologous schedule presented AE more frequent after the second dose (39% vs 17%).

Total incidence of EA was 182.5 events/10 00 doses, it was significantly lower for BBIBP-CorV (105.9 events/1000 dosis, p<0.002 for all cases). The higher incidence of AE was observed for mRAN-1273 (261.6 events/1000 doses) and ChAdOx1 nCov-19 (232.8 events/1000 doses).

Patients with AE were younger [mean 55 years (SD 14) vs 59 years (SD 14), p <0.010], not Caucasian ethnicity [48% vs 35%, p<0.001], had higher education level [mean 13.8 years (SD 4) vs 11.9 years (SD 5), p<0.001], were more frequently employed [54% vs 44%, p<0.001], lived mostly in urban area [99% vs 95% p <0.001, had more frequently dyslipidemia [38% vs 28% p 0.012], and less frequently arterial hypertension [49% vs 65%, p<0.001]. Systemic lupus erythematosus [11% vs 7%, p=0.039] and Sjögren syndrome [6% vs 1.8%, p<0.001] were more frequent among them, while non inflammatory diseases were less prevalent [19% vs 31%, p<0.001]. They were taking steroids [24 vs 18%, p=0.007], antimalarials [17% vs 10%, p<0.001] and methotrexate [41% vs 31%, p <0.001] more frequently.

In the multivariable analysis, mRAN-1273 and ChAdOx1 nCov-19 were associated with AE, while BBIBP-CorV with lower probability of having one. (Figure 1)

Figure 1.

Variables associated with the development of AE. Multivariate logistic regression model

Conclusion

The incidence of AE was 1825 events/1000 doses, were significantly higher for mRAN-1273 and ChAdOx1 nCov-19 and lower for BBIBP-CorV. Most common AE was pseudo-flu syndrome. Female sex, being younger, higher education level, ChAdOx1 nCov-19 and mRAN-1273 vaccines, the use of methotrexate and antimalarials were related of EA in patients with RD.

References

[1]Sattui SE et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2021;7.

Disclosure of Interests

None declared

POS0655 SURVIVAL AND SAFETY OF BIOLOGICAL AND TARGETED SYNTHETIC THERAPIES AS REGARDS TO AGE GROUPS. BIOBADASAR 3.0 REGISTRY

Background

Advances in rheumatology and new therapeutic options have certainly impacted patient survival, changing the age range, from youth to seniors. The differences between the age groups could influence the evolution of the disease and the adverse events (AEs) related to the treatments. There are few real-world data on the safety and efficacy of treatments in different age groups.

Objectives

To evaluate the frequency of AEs and the survival of treatments according to the age in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS).

Methods

Retrospective, observational, multicenter study of real-life data of patients included in the BIOBADASAR 3.0 registry; exposed and not exposed to original biological treatments (b-DMARDs), biosimilars, targeted synthetic drugs (ts-DMARDs). The unexposed group received treatment with conventional disease-modifying drugs (cDMARDs). A Kaplan-Meier and Log Rank Test analysis was performed to study AEs-free survival and treatment in different age groups (young people <25; young adults 25-34; mature adults 34-65; old adults >65). Factors related to treatment survival were evaluated using Cox regression models.

Results

5,297 patients were included, 80.3% female, mean age 43.7 years (SD 15.6) and median disease progression 14.3 [IQR 11.5]. RA 4658 (87.9%); APs 490 (9.25%) and EA 149 (2.8%). The main reason for treatment discontinuation was ineffectiveness, in 624 patients in the exposed group and in 53 (2.5%) patients in control group, followed by the presence of AEs in 352 (11.2%) and 83 (3.9%), respectively (p=0.001).

A mean Charlson Score of 0.268 (SD 0.6) in the exposed group and 0.306 (SD 0.7) in the control group (p=0.095). Median EAs-free survival in the exposed group was 12.5 years [IQR 16.6] while in controls was 28 years [IQR 11], p<0.0001. Median AEs-free survival was 12 years (IQR 11) in young people, 11.5 years [IQR: 4.9] in young adults, 10 years [IQR: 3.25] in mature adults and 7.6 years [IQR: 6] in old adults with a difference statistically significant (p>0.017). The exposed group presented a median treatment survival in years of 11.25 years [IQR: 10] in young people; 12.5 years [IQR: 4.7] in young adults, 7.5 years [IQR: 12.1] in mature adults and 4.5 years [IQR: 1.14] in old adults (p>0.0001). Considering only the first line of treatment, a median survival of 11.5 years [IQR: 10] was evidenced in the age group <25; 12 years [IQR: 2.6] between 25-34 years old, 10 years [IQR: 12] in the group between 34-65 years old and 5.5 years [IQR: 1.14] in the group > 65 years old (p>0.004). (Figure 1). Considering the second line of treatment, the differences between the groups were not statistically significant (p=0.57). In the multivariate regression model for patients with RA, the factors with the greatest impact on treatment survival were female sex (HR 1.3, 95% CI 1.2-1.4), old age (HR 1.01, 95% CI 1.008-1.01), treatment with steroids (HR 1.19, 95% CI1.1-1.2) and longer disease duration (HR 1.01, 95% CI1.01 – 1.02).

Conclusion

In the present study we were able to demonstrate a greater occurrence of AEs in old adults and mature adults compared to young people and young adults. Conversely, survival for b-DMARDs and ts-DMARDs were greater in youth and young adults. In patients with RA, female sex, corticosteroid therapy, old aged and longer disease duration were associated with treatment discontinuation.

References

[1]Souto A, et al. Rate of discontinuation and drug survival of biologic therapies in rheumatoid arthritis: a systematic review and meta-analysis of drug registries and health care databases. Rheumatology (Oxford). 2016;55(3):523–34.

[2]Ray D, et al. Immune senescence, epigenetics and autoimmunity. Clin Immunol. 2018 Nov;196:59-63. doi: 10.1016/j.clim.2018.04.002. Epub 2018 Apr 11.

[3]Vela P, et al. Influence of age on the occurrence of adverse events in rheumatic patients at the onset of biological treatment: data from the BIOBADASER III register. Arthritis Res Ther. 2020 Jun 15;22(1):143. doi: 10.1186/s13075-020-02231-x.

Disclosure of Interests

None declared

Montessori mealtimes for dementia: A pathway to person-centred care

PURPOSE

This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project.

METHOD

An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19-32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service.

RESULTS

A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes.

IMPLICATIONS

The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.

Feasibility of an automated interview grounded in multiple mini interview (MMI) methodology for selection into the health professions: an international multimethod evaluation

OBJECTIVES

Global, COVID-driven restrictions around face-to-face interviews for healthcare student selection have forced admission staff to rapidly adopt adapted online systems before supporting evidence is available. We have developed, what we believe is, the first automated interview grounded in multiple mini-interview (MMI) methodology. This study aimed to explore test-retest reliability, acceptability and usability of the system.

DESIGN, SETTING AND PARTICIPANTS

Multimethod feasibility study in Physician Associate programmes from two UK and one US university during 2019-2020.

PRIMARY, SECONDARY OUTCOMES

Feasibility measures (test-retest reliability, acceptability and usability) were assessed using intraclass correlation (ICC), descriptive statistics, thematic and content analysis.

METHODS

Volunteers took (T1), then repeated (T2), the automated MMI, with a 7-day interval (±2) then completed an evaluation questionnaire. Admission staff participated in focus group discussions.

RESULTS

Sixty-two students and seven admission staff participated; 34 students and 4 staff from UK and 28 students and 3 staff from US universities. Good-excellent test-retest reliability was observed at two sites (US and UK2) with T1 and T2 ICC between 0.65 and 0.81 (p<0.001) when assessed by individual total scores (range 80.6-119), station total scores 0.6-0.91, p<0.005 and individual site (≥0.79 p<0.001). Mean test re-test ICC across all three sites was 0.82 p<0.001 (95% CI 0.7 to 0.9). Admission staff reported potential to reduce resource costs and bias through a more objective screening tool for preselection or to replace some MMI stations in a 'hybrid model'. Maintaining human interaction through 'touch points' was considered essential. Users positively evaluated the system, stating it was intuitive with an accessible interface. Concepts chosen for dynamic probing needed to be appropriately tailored.

CONCLUSION

These preliminary findings suggest that the system is reliable, generating consistent scores for candidates and is acceptable to end users provided human touchpoints are maintained. Thus, there is evidence for the potential of such an automated system to augment healthcare student selection.

Assessment of the Sources of Information by Patients With Rheumatic Diseases

OBJECTIVE

The aim of this study was to ascertain the frequency of use, search intent (SI), level of accessibility, and degree of reliability of sources of information (SOIs) in rheumatology.

METHODS

A survey among adult outpatients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritis was conducted. They were asked if they had procured information from 12 selected SOIs during the past year. Search intent was defined as the source they would like to consult. Accessibility and reliability were assessed through 0-to-10 scales (minimum and maximum, respectively).

RESULTS

Four hundred two patients were surveyed. They had consulted a median of 3 SOIs (interquartile range, 2-6) but described a higher SI: median of 5 SOIs (interquartile range 3-8); p = 0.001.The most consulted SOIs were the physician (83%), other patients (45%), and Facebook (36%). The main differences between SI and the searches actually performed were observed in community lectures by health care professionals (49%), scientific societies (48%), and associations of patients (27%); p < 0.001. These 3 sources showed low level of accessibility. Facebook, press, radio, and YouTube were the least reliable sources.

CONCLUSIONS

Patients consulted a median of 3 SOIs but reported a significantly higher SI. Although patients demand more information, the request is leveled at SOIs with difficult accessibility but high reliability.

O-P01 Potential Utility of Intraoperative Fluid Amylase Measurement During Pancreaticoduodenectomy

Background

Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a source of major morbidity and mortality. Early diagnosis and treatment of POPF is mandatory to improve patient outcomes, and clinical risk scores may be combined with postoperative drain fluid amylase (DFA) values to stratify patients.

The aim of this study was to determine if intraoperative fluid amylase values (IFA) correlate with DFA1 and POPF.

Methods

In consecutive patients undergoing PD between February and November 2020, intraoperative samples of intra-abdominal fluid adjacent to the pancreatic anastomosis were taken and sent for fluid amylase measurement prior to abdominal closure. Data regarding patient demographics, postoperative DFA values, complications and mortality were prospectively collected.

Results

Patient Demographics: Data was obtained for 52 patients with a median alternative Fistula Risk Score (aFRS) of 9.4. Postoperative complications occurred in 20 patients (38%), including five Clavien grade 3+. There were eight POPFs and two patients died (pneumonia/sepsis). There was significant correlation between IFA and DFA1 (Pearson’s correlation: R2=0.713; p &lt; 0.001) and DFA3 (p &lt; 0.001), and median IFA was higher in patients with POPF than patients without (1232.5 vs. 122; p = 0.0003). IFA&gt;260 U/l predicted POPF with sensitivity, specificity, PPV and NPV of 88%, 75%, 39% and 97%, respectively. The incidence of POPF was 43% in high risk (high aFRS/IFA) and 0% in low risk patients (low aFRS/IFA).

Complications:

Conclusions

Intraoperative fluid amylase closely correlated with postoperative pancreatic fistula, and may be a useful adjunct to clinical risk scores to stratify patients during pancreatico-duodenectomy, allowing targeted intervention to reduce the clinical impact of pancreatic fistula.It is possible to detect fluid amylase adjacent to the completed pancreatic anastomosis in patients undergoing PD. Presence of IFA correlates with postoperative DFA and POPF.

IFA increases the accuracy of the alternate Fistula Risk Score in predicting POPF. Low risk patients with a low IFA may be suitable for a ‘no drain’ strategy, whilst patients with a high IFA may benefit from intraoperative mitigation strategies to reduce the incidence and/or severity of a postoperative pancreatic fistula.

First Nation Peoples' nutrition and exercise group programmes: transforming success through the lifeworld

PURPOSE

Previous literature has applied system-focused structures to understand the success of First Nations Peoples' nutrition and exercise group programmes. Existing system-focused measures have included biomedical outcomes, access and service utilization. By broadening the focus of programme success beyond the system, we can evaluate programmes from a First Nations Peoples' lifeworld perspective. Critical hermeneutics and yarning using a lens of Habermas' Theory of Communicative Action to the literature has the potential to transform understandings of "success" in First Nations Peoples' nutrition and exercise group programmes.

METHODS

In this literature interpretation, we explored the critical success factors from a lifeworld perspective, giving scope to go beyond a system perspective to include a cultural, social or personal perspective.

RESULTS

Our yarning led us to understand that there is a communicative relationship between explicit system structures and implicit lifeworld concepts that are critical success factors for First Nations nutrition and exercise group programmes. We have developed a set of reflective questions to guide others in considering a lifeworld perspective.

CONCLUSIONS

Our findings represent a shift away from success measured by the dominant power structure to respect the lifeworld culture, knowledges and values of First Nations Peoples towards shared understanding and mutual decision-making.

POS1188 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES: COMPARISON OF DATA FROM THE ARGENTINE REGISTRY (SAR-COVID), WITH THE LATIN AMERICAN AND GLOBAL REGISTRY (GLOBAL RHEUMATOLOGY ALLIANCE)

Background:

SARS CoV-2 infection has recently burst onto the global scene, and the knowledge of the course of this infection in patients with rheumatic diseases receiving immunomodulatory treatment is still insufficient. The Argentine Society of Rheumatology (SAR) designed a national registry called SAR-COVID in order to get to assess our reality.

Objectives:

To identify the particular characteristics of patients with rheumatic diseases and COVID-19 in Argentina (SAR-COVID Registry), and to compare them with the data reported at the Latin American and Global level (Global International Alliance Rheum-COVID Registry).

Methods:

A national, multicenter, prospective and observational registry was carried out. Patients older than 18 years, with a diagnosis of rheumatic disease and SARS-CoV-2 infection by PCR or serology, were included between August 13, 2020 and January 17, 2021. Demographic data, underlying rheumatic disease (activity of the disease, current treatment), comorbidities, clinical-laboratory characteristics of the SARS-CoV-2 infection, as well as received treatments (pharmacological, oxygen therapy / ventilatory support) and outcomes (hospitalization, mortality) were recorded. The characteristics of the included patients were compared with the data reported at the Latin American and global level. Descriptive statistics were performed. Comparisons between groups were made using ANOVA, chi2 or Fisher’s test, according to the type of variable.

Results:

Four hundred sixty-five patients from Argentina, 74 patients from Latin America and 583 from the rest of the world were included, mostly women (79.6%, 73% and 71% respectively), with a mean age of 50.2 (SD 15.3), 53.5 (DE 15.6) and 55.8 (15.5), years respectively. The most frequent rheumatic diseases in the three groups were rheumatoid arthritis (43.9%, 35%, and 39%) and systemic lupus erythematosus (16.1%, 22%, and 14%) (Table 1).

In Argentina, fewer patients received specific pharmacological treatment for COVID-19 (40.9%, 68% and 43% respectively, p <0.0001), and there was a lower requirement of NIMV / IMV (Non-Invasive Mechanical Ventilation/Invasive Mechanical Ventilation) than in the rest of Latin America and the world (10.5% vs 31% vs 13%, p <0.0001).

Hospitalization was lower in Argentina than in the rest of Latin America (37.4% vs 61% p 0.0002) and of the world (37.4% vs 45% p 0.0123), and mortality was numerically lower in Argentina, but without statistically significant differences between the three groups (6.9%, 12% and 11%; p 0.6311). Most of the patients, (86.9%) did not present any complications in Argentina, with a statistically significant difference with the rest of the groups (62% and 77%, p <0.0001) (Graph 1).

Conclusion:

The patients with rheumatic diseases and SARS-CoV-2 infection reported in this argentinian registry received less specific pharmacological treatment for COVID-19, presented fewer complications and required less ventilatory support, than those reported in the Latinoamerican and Global registry. However, no statistically significant differences were observed in terms of mortality.

Graph 1.

Main outcomes and evolution of patients with rheumatic disease and COVID-19.

References:

[1]Stokes, Erin K, Zambrano, Laura D, Anderson, Kayla N, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep; 69(24): 759-765, 2020 Jun 19.

[2]Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm síndromes and immunosuppression. Lancet 2020;395:1033–4.

[3]Gianfrancesco M, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859–866.

[4]Manuel F. Ugarte-Gil, et al. Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America. Global Rheumatology. Septiembre 2020.

Disclosure of Interests:

Alvaro Andres Reyes Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Gelsomina Alle Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Tanten Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Marina Scolnik Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Enrique Soriano Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Berbotto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Maria Haye Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, María Julieta Gamba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Nieto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Mercedes García Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Veronica Savio Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana Gonzalez Lucero Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Paula Alba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Lorena Takashima Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, FABIAN RISUEÑO Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana CASALLA Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Natalia Cucchiaro Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Ana Bertoli Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Sabrina POrta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carla Maldini Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Gallo Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Cecilia Goizueta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Eugenia Picco Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Quintana Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Karen Roberts Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carolina Ayelen Isnardi Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Pons-Estel Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”

POS1186 EFFECT OF SOCIO-ECONOMIC STATUS AND EDUCATIONAL LEVEL ON COVID-19 OUTCOMES IN PATIENTS WITH RHEUMATIC DISEASES FROM ARGENTINA: DATA FROM THE SAR-COVID REGISTRY

Background:

SARS-CoV-2 infection can present with a broad clinical spectrum, from asymptomatic to lethal. Different risk factors have been recognized. Socio-economic status and educational level may affect access to the healthcare system and therefore COVID-19 infection outcome.

Objectives:

The aim of this study was to assess the association between socio-demographic status and educational level and SARS-CoV-2 outcomes, such as hospitalization, ICU admission, need for mechanical ventilation and death, in Argentinean patients with rheumatic diseases from the SAR-COVID Registry.

Methods:

We performed a cross-sectional study of consecutive adult patients with rheumatic diseases and SARS-CoV-2 infection included in the multicentric Argentinean SAR-COVID Registry. The following variables were included: gender, ethnicity, age, health insurance, educational level (under or over 12 years of education), socio-economic level according to Graffar Scale in high, medium-high, medium, medium-low, low; underlying rheumatic disease, its duration and treatment at the time of infection.

SARS-CoV-2 infection outcomes were: hospitalization, admission to ICU, mechanical ventilation requirement and death.

Statistical analysis was performed using Chi2, Fisher, T-test, ANOVA.

Results:

Five hundred and twenty-five patients were included, 422 (80.4%) were female, with a mean age of 51.3 years (SD 15.2). Most of them were caucasians (48%) or mestizos (43%) and 96.8% lived in an urban environment. Almost half of the patients (47%) were categorized as middle-class, 24% middle-high or high class, 21% middle-low or low. 48.4% of the patients were employed. Regarding educational level, 54% had more than 12 years of education.

The most prevalent rheumatic disease was Rheumatoid Arthritis (40.4%), followed by Systemic Lupus Erythematosus (14.9%), Sjögren (5.5%) and Psoriatic Arthritis (5.5%). Treatments used at the time of SARS-CoV-2 infection were corticosteroids (19%), cs-DMARDs (49%), and b- and ts-DMARDs (16%).

Overall hospitalization frequency was 35%, median hospital stay was 10 days (IQR 10 days), 11.6% were admitted to the ICU, 10% required mechanical ventilation and the global mortality was 8%.

Notably, patients with less than 12 years of education required mechanical ventilation more frequently than the more educated ones (11.9% vs. 5.6%, p=0.026) and showed a higher mortality due to COVID-19 (9% vs. 2.8%, p=0.0004).

Patients categorized as upper social classes (middle-high and high) were admitted to the hospital on a more frequent basis (74.4% of cases), when compared with middle class (64.4%) and middle-low and low class (58%) (p=0.77). Median duration of hospitalization for the aforementioned groups was 12.5 (IQR 17.3), 10 (IQR 9) and 10.5 (IQR 9.3) days respectively (p=0.60).

Patients with health insurance were found to be hospitalized more frequently in comparison to those without insurance (42.4% vs. 33.7%, p=0.14), but showed similar admission rates to the ICU (11.8% vs. 12.8%; p=0.78), need for mechanical ventilation (10.7% vs. 8.7%; p=0.70) and mortality (7.1% vs. 6.5%; p=0.99).

Caucasian patients had fewer hospital admissions when compared against other ethnicities (mestizos mostly) (26.1% vs. 43.4%; p<0.0001), but showed no statistically significant difference in need for mechanical ventilation 10.3% vs. 9.9% (p=0.99) or mortality 8.7% vs. 5.1% (p=0.15).

Conclusion:

Patients with lower educational level needed twice the frequency of mechanical ventilation, and showed thrice the mortality than those with more than 12 years of education.

Albeit patients in upper social stratus and those with health insurance were admitted to the hospital in a more frequent manner, no statistically significant differences were found regarding the need for ICU, mechanical ventilation or mortality.

Caucasians were hospitalized less frequently than mestizos, but had no significant differences in the other measured outcomes.

Disclosure of Interests:

Laura Sorrentino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Jonathan Rebak Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Federico Maldonado Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Vanessa Viviana Castro Coello Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Alejandro Brigante Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Hamaui Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Diana Dubinsky Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Roberto Baez Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cecilia Pisoni Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla Gobbi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Leandro Carlevaris Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Romina Tanten Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Karina Cogo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria DeLaVega Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rodolfo Perez Alamino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Alicia Lazaro Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mariana Pera Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Susana Isabel Pineda Vidal Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Elena Calvo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Debora Guaglianone Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla G Alonso Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mara Guinsburg Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cinthya Retamozo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Aeschlimann Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rosana Quintana Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Karen Roberts Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Ayelen Isnardi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Guillermo Pons Estel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.

AB0342 OBSTETRIC AND THROMBOTIC ANTIPHOSPHOLIPID SYNDROME: ARE THEY DIFFERENT ENTITIES?

Background:

Several studies showed two main clinical phenotypes of antiphospholipid syndrome (APS): thrombotic (TAPS) and obstetric APS (OAPS). Although they have the same autoantibody profile, one of them developed thrombosis and other one obstetric morbidity.

Objectives:

To study clinical, demographic and antibody profile in patients with TAPS and OAPS.

Methods:

we retrospectively evaluated TAPS and OAPS patients who were included in Argentine Antiphospholipid antibodies registry. We studied clinical, demographic and antibody profile in both groups.

Results:

238 patients were included in the registry. 201 (84.81%) of them were female. 122 (60.69 %) of them fullfilled APS Sydney classification criteria, 47 (38.52%) TAPS and 52 (42.62%) OAPS. 23 (18.85%) patients had both thrombotic and obstetric events so they were excluded in this analysis.

Arterial Hypertension (HBP) and Hyperlipidemia were more frequent in TAPS versus OAPS. Older age was found in TAPS as well as in association with Systemic lupus erythematosus (SLE). There was no difference in antibody profile between the 2 groups, and the Global Antiphospholipid Syndrome Score (aGAPSS) was higher in TAPS than OAPS.

18 (38.3%) of TAPS patients had at least 1 pregnancy. Mean number of pregnancies of TAPS was 2.5 (1.10) and 3.84 (1.86) in OAPS. Thrombotic events were not found in TAPS during pregnancy and puerperium. HBP and gestational diabetes (GD) and other pregnancy related comorbidities were found in TAPS.

OAPS (n=52)TAPS (n=47)POAPS(n=52)TAPS(n=18)SLE, n (%)11 (21.2)28 (59.6)0.0002N% (DE)N % (DE)aGAPSS, mean (RIQ)4 (5)8 (5)<0.0001Abortions (<10 weeks)3338.4 (36.2)826.5 (35.3)Age, mean (DE)39.3 (6.24)43.1 (13.5)<0.0001Live Birth3633.5 (28.1)1672.2 (34.7)HBP, n (%)5 (9.6)15 (31.9)0.0121 >37 weeks2116.4 (2.38)1661.1 (31.7)Hyperlipidemia, n (%)4 (7.7)12(25.5)0.0267Prematurity <37 >34 weeks118.76 (1.97)0-GD, n (%)3(5.8)2(4.3)0.9999Prematurity <34 weeks96.37 (1.49)11.39 (5.89)Obesity, n (%)8 (15.4)4 (8.5)0.2912Pre eclampsia >34-<37 weeks10.490 (0.0350)24.63 (0.138)Smoking, n (%)11 (21.1)13 (27.6)0.4019Placental Hematoma31.86 (8.18)12.78 (11.8)Sedentary lifestyle, n (%)16 (30.8)17 (36.2)0.8486Abruptio Placentae21.96 (9.80)24.17 (12.9)Triple Positivity59.648.50.8323 Normal delivery2017.8 (27.9)1447.7 (33.9)Double Positivity11.936.4Cesarean section2217.2 (21.6)211.1 (32.3)Simple Positivity2938.51940.4Urgent Cesarean section139.80 (20.3)412.5 (24.6)GD21.37 (7.49)12.78 (11.8)HBP63.46 (10.3)310.2 (26.3)

Conclusion:

Antibody profile was similar in TAPS and OAPS. However, clinical manifestations and cardiovascular risk were different. These results should be evaluated in prospective studies.

Disclosure of Interests:

None declared

POS1208 EPIDEMIOLOGY AND OUTCOMES OF PATIENTS WITH RHEUMATIC DISEASES AND SARS-CoV-2 INFECTION: DATA FROM THE ARGENTINEAN SAR-COVID REGISTRY

Background:

In the last time, many papers about SARS-CoV-2 have been published in the world. However, data from latinamerican patients is still scarce. In order to assess the impact of SARS-CoV-2 infection in patients with rheumatic diseases in our country and contribute to the global knowledge about the effect of immunosuppressive therapies in this group, the Argentine Society of Rheumatology has developed the National Registry of Patients with Rheumatic Diseases and COVID-19 (SAR-COVID).

Objectives:

The aim of this study was to evaluate clinical characteristics and outcomes of SARS-CoV-2 infection in patients with rheumatic diseases, treated or not with immunomodulators and/or immunosuppressants.

Methods:

SAR-COVID is a national, multicenter, prospective and observational registry, in which patients, ≥18 years of age, with a diagnosis of a rheumatic disease who had SARS-CoV-2 infection (PCR or positive serology) are consecutively included between August 13, 2020 and January 17, 2021. Sociodemographic data, comorbidities, underlying rheumatic disease and treatment, clinical characteristics, complications, laboratory and treatment of the SARS-CoV-2 infection were recorded. Hospitalization, mechanical ventilation requirements and death were assessed to evaluate COVID-19 outcome. Statistical analysis: Descriptive analysis. Chi2 or Fischer test and T test or Mann-Whitney U test or ANOVA, as appropriate. Multiple logistic regression.

Results:

A total of 525 patients were included, 80.4% were female, with a median age of 52 years (IQR 40-62). Comorbidities were reported in half of them (53.3%). The most frequent rheumatological diseases were rheumatoid arthritis (40.4%) and systemic lupus erythematosus (14.9%). At the time of the infection, most of them were in remission or in minimal/low disease activity (68.2%) and 72.9% were receiving immunosuppressive or immunomodulatory treatment.

Symptoms were present in 96% of the patients, the most frequent being fever (56.2%), cough (46.7%) and headache (39.2%). During infection, 35.1% received some pharmacological treatment, dexamethasone (20%) the most frequently used. One third (35.1%) of the patients were hospitalized, 11.6% were admitted to the ICU, 10.1% needed mechanical ventilation and 6.9% died due to COVID-19. Complications were reported in 12.4%, being acute respiratory distress syndrome the most prevalent (8.8%).

Patients over 65 years of age were more frequently hospitalized, admitted to the ICU, needed mechanical ventilation and died due to COVID-19 (50% vs 31.4%, 22% vs 9%, 16.3% vs 5.2%, 14% vs 5%, respectively; p<0.001 in all cases). Similar results were seen in patients with vasculitis (57.7% vs 33.9%, 46.2 vs 9.8%, 34.6% vs 6 %; 30.8% vs 5.6%, respectively; p< 0.001 in all cases) and those with moderate/high disease activity (55.7% vs 26.5%, 21.3 vs 7.8%, 17.2% vs 4.2 %; 17.2% vs 4.2 %, respectively; p< 0.001 in all cases). Patients with APS were more frequently admitted to the ICU (29.4% vs 11%, p= 0.037). The presence of comorbidities was associated with higher hospitalization (46% vs 22.6%, p<0.001), admission to the ICU (17.2% vs 5.9%, p<0.001) and mechanical ventilation (10.2% vs 4.6%, p= 0.028). Immunosuppressive treatment was not associated with worse outcomes.

Conclusion:

In this cohort of patients with a wide distribution of rheumatic diseases, we have found clinical characteristics similar to those reported by other international cohorts. Compared with national data, the mortality reported in these patients is higher. However, it should be noted that these are early data collected during isolation and that there may be an underreporting of asymptomatic patients or with mild symptoms who do not attend the rheumatologist.

Older patients, those with comorbidities, with vasculitis and with higher disease activity showed poor COVID-19 outcomes.

Disclosure of Interests:

Carolina Ayelen Isnardi Speakers bureau: Janssen, BMS, Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rosana Quintana Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Karen Roberts Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Vanessa Viviana Castro Coello Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Alvaro Andres Reyes Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Yohana Tissera Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Micaela Cosatti Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Romina Rojas Tessel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Julia Scafati Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Tatiana Barbich Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., María Soledad Gálvez Elkin Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Gustavo Fabian Rodriguez Gil Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Sebastian Moyano Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Marina Laura Werner Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Jonathan Rebak Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Julieta Morbiducci Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Victoria Martire Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., María Sol Castaño Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Dieguez Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Gisela Constanza Subils Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Guillermo Pons-Estel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.

Selective targeting of non-centrosomal AURKA functions through use of a targeted protein degradation tool

Targeted protein degradation tools are becoming a new therapeutic modality, allowing small molecule ligands to be reformulated as heterobifunctional molecules (PROteolysis Targeting Chimeras, PROTACs) that recruit ubiquitin ligases to targets of interest, leading to ubiquitination and destruction of the targets. Several PROTACs against targets of clinical interest have been described, but detailed descriptions of the cell biology modulated by PROTACs are missing from the literature. Here we describe the functional characterization of a PROTAC derived from AURKA inhibitor MLN8237 (alisertib). We demonstrate efficient and specific destruction of both endogenous and overexpressed AURKA by Cereblon-directed PROTACs. At the subcellular level, we find differential targeting of AURKA on the mitotic spindle compared to centrosomes. The phenotypic consequences of PROTAC treatment are therefore distinct from those mediated by alisertib, and in mitotic cells differentially regulate centrosome- and chromatin- based microtubule spindle assembly pathways. In interphase cells PROTAC-mediated clearance of non-centrosomal AURKA modulates the cytoplasmic role played by AURKA in mitochondrial dynamics, whilst the centrosomal pool is refractory to PROTAC-mediated clearance. Our results point to differential sensitivity of subcellular pools of substrate, governed by substrate conformation or localization-dependent accessibility to PROTAC action, a phenomenon not previously described for this new class of degrader compounds.

Wang et al develop tools to target the mitotic regulator AURKA by synthesising PROTACs based on the inhibitor MLN8237. They find that the new PROTAC compound efficiently clears cytoplasmic and mitotic spindle-associated AURKA but does not eliminate AURKA activity from centrosomes, demonstrating the possibility of targeting subpopulations.

393 What Are the Risk Factors for Anastomotic Stricture After Bile Duct Injury Repair? A Systematic Review and Meta-Analysis

Introduction

Hepaticojejunostomy (HJ) is the standard repair following major bile duct injury (BDI), but anastomotic stricture can result in long-term morbidity. There is a need to assimilate high-level evidence to establish risk factors for the development of anastomotic stricture after HJ for BDI.

Method

A systematic review of studies reporting the rate of anastomotic stricture after HJ for BDI was performed according to PRISMA guidelines. Meta-analyses of proposed risk factors were then performed.

Results

Meta-analysis included five factors (n = 2,198 patients, 17 studies). Vascular injury (OR 2.71; 95%CI 1.37-5.35; p = 0.004), postoperative bile leak (OR: 8.03; 95%CI 2.04-31.71; p = 0.003), previous repair (OR: 5.36; 95%CI 1.04-27.76;p=0.05) and repair by non-specialist surgeon (OR 11.29; 95%CI 5.21-24.47; p &lt; 0.0001) were associated with HJ stricture after BDI. Strasberg injury grade was not associated with HJ stricture (OR: 1.05; 95%CI 0.63-1.75; p = 0.86). Due to heterogeneity of reporting it was not possible to perform meta-analysis for impact of timing of repair on anastomotic stricture rate.

Conclusions

This meta-analysis identifies factors that significantly increase the rate of anastomotic stricture after HJ for BDI. Knowledge of these risk factors will allow risk stratification in terms of follow-up for individual cases, better informed consent, and guidance for medico-legal cases.

AZD0364 Is a Potent and Selective ERK1/2 Inhibitor That Enhances Antitumor Activity in KRAS-Mutant Tumor Models when Combined with the MEK Inhibitor, Selumetinib

The RAS-regulated RAF-MEK1/2-ERK1/2 (RAS/MAPK) signaling pathway is a major driver in oncogenesis and is frequently dysregulated in human cancers, primarily by mutations in BRAF or RAS genes. The clinical benefit of inhibitors of this pathway as single agents has only been realized in BRAF-mutant melanoma, with limited effect of single-agent pathway inhibitors in KRAS-mutant tumors. Combined inhibition of multiple nodes within this pathway, such as MEK1/2 and ERK1/2, may be necessary to effectively suppress pathway signaling in KRAS-mutant tumors and achieve meaningful clinical benefit. Here, we report the discovery and characterization of AZD0364, a novel, reversible, ATP-competitive ERK1/2 inhibitor with high potency and kinase selectivity. In vitro, AZD0364 treatment resulted in inhibition of proximal and distal biomarkers and reduced proliferation in sensitive BRAF-mutant and KRAS-mutant cell lines. In multiple in vivo xenograft models, AZD0364 showed dose- and time-dependent modulation of ERK1/2-dependent signaling biomarkers resulting in tumor regression in sensitive BRAF- and KRAS-mutant xenografts. We demonstrate that AZD0364 in combination with the MEK1/2 inhibitor, selumetinib (AZD6244 and ARRY142886), enhances efficacy in KRAS-mutant preclinical models that are moderately sensitive or resistant to MEK1/2 inhibition. This combination results in deeper and more durable suppression of the RAS/MAPK signaling pathway that is not achievable with single-agent treatment. The AZD0364 and selumetinib combination also results in significant tumor regressions in multiple KRAS-mutant xenograft models. The combination of ERK1/2 and MEK1/2 inhibition thereby represents a viable clinical approach to target KRAS-mutant tumors.

Clinical features, damage accrual, and survival in patients with familial systemic lupus erythematosus: data from a multi-ethnic, multinational Latin American lupus cohort

Objectives

This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE).

Methods

A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality.

Results

A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08–3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00–2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14–0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%; p = 0.04) and musculoskeletal (6.1% vs. 1.9%; p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30–1.55) or mortality (HR = 1.23; 95% CI 0.26–4.81).

Conclusion

Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.