Brain Injury in Fetuses with Vein of Galen Malformation and Nongalenic Arteriovenous Fistulas: Static Snapshot or a Portent of More?

BACKGROUND AND PURPOSE

Brain injury in fetuses with vein of Galen malformations and nongalenic AVFs is a rare complication whose appearance, course, and prognosis are poorly studied. We sought to characterize the MR imaging features and examine associations with postnatal outcome.

MATERIALS AND METHODS

This was a retrospective analysis of fetal MRIs of subjects with vein of Galen malformation and nongalenic arteriovenous fistulas. Two pediatric neuroradiologists independently reviewed examinations to determine the presence of abnormalities on structural imaging (T1 volumetric interpolated breath-hold examination and T2-HASTE), DWI, and T2*-weighted images; discrepancies were adjudicated by a third reviewer. Radiologic progression of injury was determined by additional fetal or neonatal MRIs. A simple composite score evaluating poor neonatal clinical outcome as either intubation or death by postnatal day 2 was also queried. A body fetal imager evaluated the presence of systemic findings of right heart strain.

RESULTS

Forty-nine fetal MR imaging examinations corresponding to 31 subjects (27 vein of Galen malformations and 4 nongalenic AVF cases) were analyzed. Injury was observed in 8 subjects (26%) with 14 fetal examinations; the mean gestational age at identification of injury was 32.2 (SD 4.9) weeks. Structural abnormalities were present in all subjects with injury; restricted diffusion, in 5/7 subjects with available data; and T2* abnormalities, in all subjects with available data (n = 7). Radiologic progression was documented in all cases with follow-up imaging (n = 7). All subjects with fetal brain injury had a poor neonatal clinical outcome.

CONCLUSIONS

Brain injury in fetuses with vein of Galen malformation and nongalenic AVFs shows a combination of structural abnormalities, restricted diffusion, and blooming on T2* images. Injury appears to portend a poor prognosis, with relentless progression and a likely association with adverse neonatal outcomes.

POS0235 INTEGRATED SAFETY ANALYSIS UPDATE FOR FILGOTINIB (FIL) IN PATIENTS (PTS) WITH MODERATELY TO SEVERELY ACTIVE RHEUMATOID ARTHRITIS (RA) RECEIVING TREATMENT OVER A MEDIAN OF 2.2 YEARS (Y)

Background

The preferential Janus kinase-1 inhibitor FIL significantly improved signs and symptoms of RA in Phase 2 and 3 trials.1–5 FIL is approved for treatment of moderate to severe active RA in Europe and Japan. Integrated safety analysis of FIL with patient data through 2019 was presented at the 2020 ACR virtual meeting.6

Objectives

To report updated, as-treated data from the FIL integrated safety analysis with increased study drug exposure.

Methods

Data were integrated from 2 Phase 2 (NCT01668641, NCT01894516), 3 Phase 3 (NCT02889796, NCT02873936, NCT02886728), and 2 long-term extension (LTE) (NCT02065700, NCT03025308) trials. Phase 2 and 3 LTE data were through Nov 2020 and Jan 2021, respectively. The as-treated analysis set included all available data for pts receiving ≥1 dose FIL 200 (FIL200) or 100 mg (FIL100), including those rerandomized to FIL for LTE. Exposure-adjusted incidence rates (EAIR)/100 patient-y exposure (PYE) of treatment-emergent adverse events (TEAEs; onset after first dose and no later than 30 days after last dose or new drug first dose date −1 day) and TEAEs of special interest (AESIs) are presented.

Results

3691 pts received FIL200 or FIL100 for 8085.1 PYE (median 2.2, maximum 6.8 y). In the as-treated set, 61% of FIL200 and 45% of FIL100 pts received FIL for ≥2 y, 19% and 5% for ≥3 y, and 11% and 0.5% for ≥4.5 y, respectively. EAIR for TEAEs was higher with FIL100 than FIL200; EAIRs for deaths were 0.5 and 0.3 for FIL200 and FIL100 (Figure 1). Incidences of infections and serious infections were numerically greater for FIL100 vs FIL200, while EAIRs for other AESIs were comparable between doses (Table 1). EAIRs for AESIs tended to decrease since the previous update, except for venous thromboembolism (total FIL 0.1 to 0.2) and malignancies excluding NMSC (total FIL 0.5 to 0.6).

Table 1.

TEAEs of special interest, as-treated set

TEAE, n (%) and EAIR per 100 PYE (95% CI)FIL 200 mgn=2267PYE=5302.5FIL 100 mgn=1647PYE=2782.6Total FILN=3691PYE=8085.1Infectious AEs1206 (53.2)747 (45.4)1927 (52.2)EAIR21.1 (19.7, 22.5)30.2 (26.8, 34.0)21.0 (19.9, 22.3)Serious infectious AEs80 (3.5)57 (3.5)137 (3.7)EAIR1.5 (1.1, 1.9)2.7 (1.9, 3.9)1.6 (1.3, 2.0)Opportunistic infections5 (0.2)4 (0.2)9 (0.2)EAIR0.1 (0, 0.2)*0.1 (0.1, 0.4)*0.1 (0.1, 0.2)*Active tuberculosis03 (0.2)3 (<0.1)EAIR00.1 (0, 0.3)*0 (0, 0.1)*Herpes zoster84 (3.7)30 (1.8)114 (3.1)EAIR1.6 (1.2, 2.0)1.1 (0.8, 1.5)*1.4 (1.1, 1.7)Major adverse cardiovascular eventsa19 (0.8)14 (0.9)33 (0.9)EAIR0.3 (0.2, 0.5)0.5 (0.3, 0.8)*0.4 (0.2, 0.6)Venous thromboembolismb11 (0.5)4 (0.2)15 (0.4)EAIR0.2 (0.1, 0.4)*0.1 (0.1, 0.4)*0.2 (0.1, 0.3)*Atrial systemic thrombotic eventsa1 (<0.1)1 (<0.1)2 (<0.1)EAIR0 (0, 0.1)0 (0, 0.3)0 (0, 0.1)Malignancy excluding NMSC32 (1.4)17 (1.0)49 (1.3)EAIR0.6 (0.4, 0.9)0.6 (0.4, 1.0)*0.6 (0.4, 0.8)NMSC15 (0.7)5 (0.3)20 (0.5)EAIR0.3 (0.2, 0.5)*0.2 (0.1, 0.4)*0.2 (0.2, 0.4)*Gastrointestinal perforations3 (0.1)1 (<0.1)4 (0.1)EAIR0.1 (0, 0.2)*0 (0, 0.3)*0 (0, 0.1)*

*Except when any study had 0 event within the treatment, the Poisson model was not adjusted by study. PYE was defined as (last dose date − first dose date + 1)/365.25.

a

Positively adjudicated.

b

Adjudicated as deep vein thrombosis or pulmonary embolism.

NMSC, nonmelanoma skin cancer

Conclusion

With 1 additional year of exposure since the 2020 report, FIL continues to be well tolerated with no new safety concerns emerging. EAIRs of TEAEs, including deaths, and AESIs remained stable or decreased since the 2020 report, except for slight increases in rates of NMSC and malignancies excluding NMSC. In the context of demonstrated efficacy, both FIL doses had an acceptable risk/benefit profile.

References

[1]Westhovens R et al. Ann Rheum Dis 2017;76:998–1008.

[2]Kavanaugh A et al. Ann Rheum Dis 2017;76:1009–19.

[3]Combe B et al. Ann Rheum Dis 2021;80:848–58.

[4]Genovese MC et al. JAMA 2019;322:315–25.

[5]Westhovens R et al. Ann Rheum Dis 2021;80:727–38.

[6]Winthrop K et al. Arthritis Rheumatol 2020;72(suppl 10); abstract 0229.

Acknowledgements

Funding for DARWIN 1 and 2 was provided by Galapagos NV, and funding for DARWIN 3, FINCH 1, 2, 3, and 4 was provided by Gilead Sciences, Inc., Foster City, CA. Funding for this analysis was provided by Gilead Sciences, Inc. The sponsors participated in the planning, execution, and interpretation of the research. Medical writing support was provided by Gregory Bezkorovainy, MA, of AlphaScientia, LLC, San Francisco, CA; and funded by Gilead Sciences, Inc., Foster City, CA.

Disclosure of Interests

Kevin Winthrop Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly and Co., Galapagos NV, Gilead Sciences, Inc., GlaxoSmithKline, Pfizer, Roche, Regeneron, Sanofi, and UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, and Pfizer, Yoshiya Tanaka Speakers bureau: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol Myers Squibb, Eisai, Chugai, AbbVie, Astellas, Pfizer, Sanofi, Asahi-Kasei, GSK, Mitsubishi-Tanabe, Gilead Sciences, Inc., and Janssen, Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Taisho, and Sanofi, Grant/research support from: AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda, Tsutomu Takeuchi Speakers bureau: AbbVie, AYUMI, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Dainippon Sumitomo, Eisai, Eli Lilly Japan, Gilead Sciences, Inc., Mitsubishi-Tanabe, Novartis, Pfizer Japan, and Sanofi, Consultant of: Astellas, Chugai, and Eli Lilly Japan, Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Mitsubishi-Tanabe, Shionogi, Takeda, and UCB Japan, Alan Kivitz Shareholder of: Amgen, Gilead Sciences, Inc., GlaxoSmithKline, Pfizer, and Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, and Sanofi, Paid instructor for: Celgene, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, and Sanofi, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Genzyme, Gilead Sciences, Inc., Janssen, Novartis, Pfizer, Regeneron, Sanofi, and SUN Pharma Advanced Research, Mark C. Genovese Shareholder of: Gilead Sciences, Inc., Consultant of: AbbVie, Amgen, Beigene, Eli Lilly and Co., Genentech, Inc., Gilead Sciences, Inc., Sanofi Genzyme, RPharm, and SetPoint, Employee of: Gilead Sciences, Inc., Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Franziska Matzkies Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Beatrix Bartok Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Kun Chen Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Deyuan Jiang Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Iyabode Tiamiyu Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Robin Besuyen Shareholder of: Galapagos BV, Employee of: Galapagos BV, Sander Strengholt Shareholder of: Galapagos BV, Employee of: Galapagos BV, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly and Co., Galapagos, Gilead Sciences, Inc., and Pfizer, Consultant of: AbbVie, Eli Lilly and Co., Galapagos, Gilead Sciences, Inc., and Pfizer, Jacques-Eric Gottenberg Speakers bureau: AbbVie, Eli Lilly and Co., Galapagos BV, Gilead Sciences, Inc., Roche, Sanofi Genzyme, and UCB, Consultant of: Bristol Myers Squibb, Sanofi Genzyme, and UCB, Grant/research support from: Bristol Myers Squibb and Pfizer

POS0848 HEALTHCARE RESOURCE UTILIZATION AND COST BURDEN OF DERMATOMYOSITIS

Background

Dermatomyositis (DM) is a rare chronic systemic autoimmune disease characterized by muscle weakness and skin rashes. DM is also frequently associated with other clinical manifestations including interstitial lung disease, calcinosis, dysphagia, cardiac involvement, and malignancy. With few approved treatment options, DM has high morbidity and mortality. Limited information is available on the economic impact imposed by DM on the healthcare system.

Objectives

To estimate the economic burden associated with DM in a prevalence cohort, including healthcare resource utilization and costs from both the health insurance plan and patient perspectives.

Methods

A retrospective cohort study was conducted using a large, integrated administrative database of employer-sponsored commercial and public health plans in the United States (PharMetrics Plus, Jan 2014 - June 2020). Patients (age ≥18 years) were selected if they were diagnosed with dermatomyositis (≥1 inpatient claim or ≥2 outpatient claims ≥30 days apart with International Classification of Diseases, 10th Revision, Clinical Modification: M33.0x, M33.1x, or M33.9x) and continuously enrolled in the health plan during the 6 months before (baseline) and 1 year after (follow-up) a randomly selected DM diagnosis date (index date). Patients were matched 1:3 to a control group without DM or related myositis conditions based on birth year, gender, census region, insurance plan type, and index year. Healthcare resource use (HCRU) and costs over the 1-year follow-up period were compared between patients with DM versus matched controls to assess the incremental economic burden of DM. Statistical comparisons were conducted using generalized estimating equation models with binomial, negative binomial, or Tweedie distributions for binary, count, and cost outcomes, respectively. The models used robustly clustered standard errors to account for correlation between the matched samples.

Results

Patients with DM (N=3,207) and matched controls (N=9,621) were 49.4 years old on average and 76.8% were female. HCRU was significantly higher among patients with DM than controls in terms of outpatient, inpatient, emergency room, and other medical visits (all p<0.001; Table 1). Medical service and pharmacy costs to the plan were also significantly higher for patients with DM (p<0.001 vs. controls for all cost categories; Figure 1). Total annual costs to the healthcare plan were 5.4-fold higher among patients with DM (mean ± standard deviation: $39,508 ± 83,093) relative to controls without DM ($7,349 ± 32,816) (Δ=$32,159; p<0.001). Outpatient visit costs ($28,131) comprised 71.2% of the total for patients with DM; costs of outpatient-administered DM-related treatments ($15,855) accounted for the majority of outpatient visit costs. Patients with DM incurred 2-fold higher out-of-pocket costs (coinsurance, copayments, or deductibles) than controls ($4,803 ± 13,181 vs. $2,456 ± 10,708; Δ=$2,346; p<0.001).

Table 1.

Annual resource use in patients with DM vs. controls

Patients with DM N = 3,207Controls N = 9,621IRR or OR95% confidence intervalP-valueInpatient admissions, mean ± SD0.2 ± 0.70.1 ± 0.43.1(2.6 - 3.7)< 0.001Any inpatient admission, %12.1%4.9%2.7(2.3 - 3.1)< 0.001Outpatient visits, mean ± SD27.7 ± 31.710.8 ± 18.92.6(2.4 - 2.7)< 0.001Emergency room visits, mean ± SD0.7 ± 1.60.4 ± 1.21.8(1.6 - 2.0)< 0.001Any emergency room visit, %30.4%20.7%1.7(1.5 - 1.8)< 0.001Other visits, mean ± SD0.3 ± 0.80.2 ± 0.71.8(1.6 - 2.1)< 0.001Any other visit, %20.0%11.2%2.0(1.8 - 2.2)< 0.001

IRR: incidence rate ratio; OP, outpatient; OR: odds ratio, SD: standard deviation.

Notes: IRRs are reported for count outcomes; ORs are reported for binary outcomes. Other visits include durable medical equipment and dental or vision care.

Conclusion

DM is associated with substantial HCRU and costs per patient, with average incremental costs of $32,159 to the health plan and $2,346 to the patient annually as compared to controls. This study is among the first to document the clinical burden leading to high economic impacts of DM.

Acknowledgements

Funding for this study was provided by Pfizer Inc.

Disclosure of Interests

Arielle Bensimon Consultant of: Pfizer, as an employee of Analysis Group, Kristina Chen Employee of: Pfizer, Ahmed Noman Consultant of: Pfizer, as an employee of Analysis Group, Riley Taiji Consultant of: Pfizer, as an employee of Analysis Group at the time that this study was conducted, Erica Yim Consultant of: Pfizer, as an employee of Analysis Group, Vanja Sikirica Shareholder of: Pfizer, which manufactures medications approved for use in Rheumatology., Employee of: Pfizer at the time of this work and a current employee of Moderna., Rohit Aggarwal Consultant of: Abbvie, Alexion, AstraZeneca, Pfizer, Octapharma, Csl Behring, BMS, Argenx, Corbus, EMD, Janssen, Kezar, Kyverna, Roivant, Q32, Corbus, EMD Serono, Jubliant, Scipher, Boehringer Ingelheim and Mallinckrodt, Grant/research support from: Pfizer, BMS, Q32, EMD Serono, Mallinckrodt, Genentech, and Boehringer Ingelheim

[Dynamic changes and influencing factors of HIV-1 DNA load in HIV-1 infected individuals under antiretroviral therapy]

Objective: To analyze the dynamic changes and influencing factors of HIV-1 DNA load in HIV-1 infected individuals under antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefecture, Yunnan province, and provide information support for the clinical use of HIV-1 DNA quantitative detection. Methods: The HIV infection cases in recent infection cohort from Dehong Center for Disease Control and Prevention during 2009-2018 were selected as study subjects. The dynamic curve of HIV-1 DNA load varrying with time was generated and logistic regression analysis was conducted to identify the risk factors for HIV-1 load in the recent follow up after ART and statistical analysis was performed by using SPSS 17.0. Results: Among the 113 HIV infection cases detected from the recent infection cohort, the recent HIV infection rate were 49.6%(56/113) males, sexual transmission cases and drug injection transmission cases accounted for 53.1% (60/113), 80.5% (91/113) and 19.5% (22/113), respectively. The dynamic changes curve showed that HIV-1 DNA load was relatively high (>800 copies /10⁶ PBMCs) before ART, and droped rapidly (<400 copies /10⁶ PBMCs) after ART for 1 year. However, HIV-1 DNA load decreased insignificantly from the second year of ART, and remained to be 269 copies/10⁶ PBMCs after ART for 6 years. Univariable logistic regression analysis indicated that OR (95%CI) of CD8, CD4/CD8 and HIV-1 DNA load were 1.00 (1.00-1.00), 0.30 (0.09-1.05) and 1.01 (1.00-1.01), respectively. Multivariable logistic regression analysis showed that OR value of HIV-1 DNA load base was 1.00 (1.00-1.01). Conclusions: HIV-1 DNA load decreased significantly in the first year of ART, then remained stable for years. HIV-1 DNA load base was the key factor associated with the decrease of HIV-1 DNA load, the lower the HIV-1 DNA load base, the lower HIV-1 DNA load. Therefore, earlier ART can contribute to the decrease of HIV-1 DNA load.

MAP2K6 remodels chromatin and facilitates reprogramming by activating Gatad2b-phosphorylation dependent heterochromatin loosening

Somatic cell reprogramming is an ideal model for studying epigenetic regulation as it undergoes dramatic chromatin remodeling. However, a role for phosphorylation signaling in chromatin protein modifications for reprogramming remains unclear. Here, we identified mitogen-activated protein kinase kinase 6 (Mkk6) as a chromatin relaxer and found that it could significantly enhance reprogramming. The function of Mkk6 in heterochromatin loosening and reprogramming requires its kinase activity but does not depend on its best-known target, P38. We identified Gatad2b as a novel target of Mkk6 phosphorylation that acts downstream to elevate histone acetylation levels and loosen heterochromatin. As a result, Mkk6 over-expression facilitates binding of Sox2 and Klf4 to their targets and promotes pluripotency gene expression during reprogramming. Our studies not only reveal an Mkk phosphorylation mediated modulation of chromatin status in reprogramming, but also provide new rationales to further investigate and improve the cell fate determination processes.

[Changes in the structure of intestinal mucosal flora in colorectal cancer patients]

OBJECTIVE

To investigate the changes in bacterial flora in fecal samples, at the tumor loci and in adjacent mucosa in patients with colorectal cancer (CRC).

METHODS

We collected fecal samples from 13 patients with CRC and 20 healthy individuals and tumor and adjacent mucosa samples from 6 CRC patients. The differences in bacterial composition between the fecal and mucosa samples were analyzed with 16S rDNA sequencing and bioinformatics methods. We also detected the total number of bacteria in the feces using flow cytometry, isolated and identified the microorganisms in the fecal and mucosa samples using common bacterial culture media. We further tested the effects of 7 isolated bacterial strains on apoptosis of 3 CRC cell lines using lactate dehydrogenase detection kit.

RESULTS

The bacterial α-diversity in the feces of healthy individuals and in adjacent mucosa of CRC patients was significantly higher than that in the feces and tumor mucosa in CRC patients (P < 0.05). Lactobacillaceae is a specific bacteria in the feces, while Escherichia, Enterococcus, and Fusobacterium are specific bacteria in tumor mucosa of CRC patients as compared with healthy individuals. Cell experiment with3 CRC cell lines showed that Bacteroides fragilis isolated from the tumor mucosa of CRC patients produced significant inhibitory effects on cell proliferation (P < 0.0001), while the isolated strain Fusobacterium nucleatum obviously promoted the proliferation of the cell lines (P < 0.001).

CONCLUSION

The bacterial flora in the feces, tumor mucosa and adjacent mucosa of CRC patients is significantly different from that in the feces of healthy individuals, and the fecal flora of CRC patients can not represent the specific flora of the tumor mucosa. Inhibition of F. nucleatum colonization in the tumor mucosa and promoting B. fragilis colonization may prove beneficial for CRC treatment.

[Analysis of gene variation and clinical characteristics of Wiedemann-Steiner syndrome]

Objective: To summarize and analyze the clinical characteristics and gene mutations of 6 patients with Wiedemann-Steiner syndrome (WDSTS). Methods: To review and analyze the clinical data, including general conditions, clinical manifestations, growth hormone, cranial or pituitary gland magnetic resonance imaging (MRI),gene results and other data, 6 cases with WDSTS admitted to the Department of Endocrinology, Genetics and Metabolism of Jiangxi Provincial Children's Hospital and the Department of Child Care of Pingxiang Maternity and Child Care from April 2017 to February 2021 were recruited. Results: Of the 6 patients, 2 were male and 4 were female. The age of the first visit ranged from 1.0 to 11.2 years. All the 6 children presented with growth retardation and mental retardation and they all had typical facial dysmorphism and hypertrichosis (mainly on the back and limbs). Among them, case 5 had a growth hormone deficiency, and case 2 and 4 had abnormalities revealed by cranial MRI. Variations in KMT2A gene were identified in these 6 patients: c.10900+2T>C,c.10837C>T(p.Gln3613*), c.4332G>A(p.E1444E), c.2508dupC(p.W838Lfs*9), c.11695_11696delinsT(p.T3899Sfs*73), c.9915dupA (p.P3306Tfs*22).Among these variations, c.4332G>A, c.11695_11696delinsT and c.9915dupA were novel mutations. Therefore, the final diagnosis of these patients was WDSTS. Conclusions: Patients presented with short stature and mental retardation, typical facial dysmorphism and hypertrichosis should be considered WDSTS. Whole-exome sequencing plays an important role in disease diagnosis and genetic counseling.

[Diagnosis and treatment of 21-hydroxylase deficiency with testicular adrenal rest tumors:a report of three cases and literature review]

Objective: To provide insight into the diagnosis for clinicians, the clinical characteristics, diagnosis and treatment history of 3 patients with 21-hydroxylase deficiency (21-OHD) and testicular adrenal rest tumors (TART) were analyzed. Methods: The clinical, laboratory and imaging data of 3 male patients with 21-OHD and TART, confirmed with CYP21 gene sequencing, from May 2010 to May 2021 in the First Medical Center of Chinese PLA General Hospital were analyzed retrospectively. The treatment strategy and clinical outcome were followed up. Results: All the 3 patients were first diagnosed with bilateral adrenal mass at the age of 27-42 years old. They were 145-162 cm tall. The levels of progesterone, 17-hydroxyprogesterone, and adrenocorticotropic hormone (ACTH) of the 3 patients were relatively high, and that of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) of the 3 patients were low. Testosterone level of 1 patient was significantly elevated, and that of the other 2 patients was below the lower limit of normal range. Testicular ultrasound showed heterogeneous hyperechoic masses in both testes. CT of the adrenal glands showed bilateral adrenal enlargement with mass. All 3 patients were treated with dexamethasone. After 4-96 months of follow-up, 17-hydroxyprogesterone level was kept above the median normal level. One of the patients got married and had a baby after treatment. The sizes of adrenal hyperplasia and testicular masses reduced to various degrees with the change of the testicular masses being proportional to that of adrenal hyperplasia. Conclusions: Patients with 21-OHD are prone to have TART, leading to the impaired testicular function. Early glucocorticold therapy is beneficial to the reduction of TART and restoration of testicular function.

A high precision phase measurement system implemented in FPGA with phase interpolator

High precision timing distribution is crucial to many large scale cosmology and particle physics experiments. Besides the space and energy information, the accurate timing provides an extra dimension for physics event reconstruction. In the timing distribution system, accurate clock phase measurement is an indispensable tool to monitor the phase drift and to achieve accurate phase adjustment. This paper introduces a novel phase measurement method implemented in the Xilinx Field Programmable Gate Array (FPGA). It uses the dedicated phase interpolator in the multi-gigabit transceiver. A design based on this method is implemented within the Kintex Ultrascale series FPGA. The preliminary test result shows that a sub-picosecond level precision is achieved. With this system, the nonlinearity of the phase adjustment in the Xilinx transceiver is measured.

Association of Homocysteine and Risks of Long-Term Cardiovascular Events and All-Cause Death among Older Patients with Obstructive Sleep Apnea: A Prospective Study

OBJECTIVES

This study aimed to assess whether raised baseline plasma tHcy concentrations increased the risks of major adverse cardiovascular events (MACE) and all-cause death outcomes in older patients with obstructive sleep apnea (OSA).

DESIGN

A multicenter, prospective, observational study.

SETTING

Beijing, Shandong Province, Gansu Province of China.

PARTICIPANTS

A total of 1, 290 OSA patients aged 60 to 96 years from sleep centers of six hospitals in China consecutively recruited between January 2015 and October 2017.

MEASUREMENTS

Cox proportional models assessed the association between tHcy and the risk of new-onset all events among Chinese older OSA patients.

RESULTS

The final analysis (60.1% male; median age, 66 years) used data from 1, 100 subjects during a median follow-up of 42 months, a total of 105 (9.5%) patients developed MACE and 42 (3.8%) patients died. Multivariable Cox regression analysis showed higher adjusted hazard ratios (aHRs) of MACE, myocardial infarction (MI), hospitalization for unstable angina, and composite of all events with tHcy levels in the 4th quartile (HR=5.93, 95% CI: 2.79-12.59; HR=4.72, 95% CI:1.36-4.61; HR=4.26, 95% CI:1.62-5.71; HR=4.17, 95% CI:2.23-7.81) and the 3rd quartile (HR=3.79, 95% CI:1.76-8.20; HR=3.65, 95% CI:1.04-2.98; HR=2.75, 95% CI:1.08-3.76; HR=2.51, 95% CI:1.31-4.83) compared to reference tHcy levels in quartile 1, respectively, while the aHRs (95% CIs) of all-cause death showed significantly higher only in the highest tHcy level quartile than in the lowest quartile (HR=3.20, 95% CI=1.16-8.84, P=0.025) with no significant differences in risks of cardiovascular death and hospitalisation for heart failure among groups (P>0.05).

CONCLUSIONS

tHcy, a marker of prognosis for older OSA patients, was significantly associated with the increased risk of MACE and all-cause death in this population independent of BMI, smoking status, and other potential risk factors, but not all clinical components events of MACE. New therapeutic approaches for older patients with OSA should mitigate tHcy-associated risks of MACE, and even all-cause death.

Deletion in KRT75L4 linked to frizzle feather in Xiushui Yellow Chickens

Bird feathers are the product of interactions between natural and artificial selection. Feather-related traits are important for chicken selection and breeding. Frizzle feather is characterized by the abnormally development of feathers in chickens. In the current study, frizzle feather characteristics were observed in a local breed called Xiushui Yellow Chicken in Jiangxi, China. To determine the molecular mechanisms that underlie frizzle feather in Xiushui Yellow Chicken, four populations of three breeds (Xiushui Yellow Chicken with frizzle feathers, Xiushui Yellow Chicken with normal feathers, Guangfeng White-Ear Yellow Chicken, and Ningdu Yellow Chicken) were selected for whole-genome resequencing. Using a comparative genome strategy and genome-wide association study, a missense mutation (g.5281494A>G) and a 15-bp deletion (g.5285437-5285451delGATGCCGGCAGGACG) in KRT75L4 were identified as candidate mutations associated with frizzle feather in Xiushui Yellow Chicken. Based on genotyping performed in a large Xiushui Yellow Chicken population, the g.5285437-5285451delGATGCCGGCAGGACG mutation in KRT75L4 was confirmed as the putative causative mutation of frizzle feather. These results deepen the understanding of the molecular mechanisms responsible for frizzle feather, as well as facilitating the molecular detection and selection of the feather phenotype in Xiushui Yellow Chickens.

[Association of high-density lipoprotein cholesterol with risk of cardiovascular disease mortality]

Objective: To analyze the association between high density lipoprotein cholesterol (HDL-C) and the risk of cardiovascular disease mortality. Methods: A total of 71 618 residents aged over 18 years with complete baseline data, who were filed on the health information big data platform of Yinzhou district, Ningbo city, Zhejiang Province from 2009 to 2014, were selected as the research population. The research population were divided into four groups according to the level of HDL-C: low-level group (HDL-C<1.0 mmol/L), intermediate-level group (1.0 mmol/L≤HDL-C<1.5 mmol/L), medium-high-level group (1.5 mmol/L≤HDL-C<2.0 mmol/L) and high-level group (HDL-C≥2.0 mmol/L). Cox proportional hazard model was used to calculate the risk ratio of cardiovascular diseases mortality in different groups. Results: The study population was followed up for a total of 427 989.4 person-years, follow-up time of (5.98±1.04)years. During the follow-up period, there were 799 deaths due to cardiovascular diseases. After adjusting for confounding factors, compared with the medium-high-level group as the reference group, the HR (95%CI) for cardiovascular diseases mortality was 1.43 (1.13-1.82) in the low-level group and 1.22 (1.02-1.46) in the high-level group. Conclusion: The low level of HDL-C (<1.5 mmol/L) is associated with a higher risk of cardiovascular disease deaths. The level of HDL-C can be used as a biological indicator to monitor the development of cardiovascular diseases and guide treatment.

Efficacy of Bifidobacterium animalis subsp. lactis, BB-12® on infant colic - a randomised, double-blinded, placebo-controlled study

To evaluate the administration of Bifidobacterium animalis subsp. lactis, BB-12^® (BB-12) on infant colic in breastfed infants, a double-blind, placebo-controlled randomised study was conducted in Chengdu, China from April 2016 to October 2017 with 192 full-term infants less than 3 months of age and meeting the ROME III criteria for infant colic. After a 1-week run-in the infants were randomly assigned to receive daily BB-12 (1×10⁹ cfu/day) or placebo for 3 weeks. Crying/fussing time were recorded using a 24 h structured diary. The primary endpoint was the proportion of infants achieving a reduction in crying and fussing time of ≥50% from baseline. Parent's/caregiver's health related quality of life was measured using a modified PedsQL^™ 2.0 Family Impact Module and immunological biomarkers were evaluated from faecal samples at baseline and after the 21-day intervention. The percentage of infants achieving a reduction in the daily crying/fussing time ≥50% after the 21-day intervention was significantly higher in the infants supplemented with BB-12 (P<0.001). The mean number of crying episodes was significantly reduced in the BB-12 group compared to the placebo group (10.0±3.0 to 5.0±1.87 vs 10.5±2.6 to 7.5±2.8, respectively) (P<0.001) and the mean daily sleep duration was markedly increased from baseline to end of intervention in the BB-12 group compared to the infants in the placebo group (60.7±104.0 vs 31.9±102.7 min/day, respectively) (P<0.001). The faecal levels of human beta defensin 2, cathelicidin, slgA, calprotectin and butyrate were statistically higher in the BB-12 group compared to the placebo group after the 21-day intervention. At the end of the intervention the parent's/caregiver's physical, emotional and social functioning scores were significantly higher for the BB-12 group compared to the placebo group (all P<0.05). Supplementation of BB-12 is effective in reducing crying and fussing in infants diagnosed with infant colic.

[Assessment of biological activities of exopolysaccharides with different relative molecular masses extracted from Rhizopus nigricans]

OBJECTIVE

To evaluate the antioxidant, anti-tumor and immunomodulatory activities of exopolysaccharides with different molecular masses isolated from Rhizopus nigricans.

METHODS

Three polysaccharides with different molecular masses, namely RPS-1, RPS-2 and RPS-3, were separated from the fermentation broth of Rhizopus nigricans by fractional ethanol precipitation, and their capacity for scavenging DPPH, ABTS, and hydroxyl radicals was assessed. Cell counting kit-8 was used to analyze the changes in the viability of MFC, A549 and RAW 264.7 cells following treatments with the 3 polysaccharides; The level of nitric oxide in the supernatant of RAW 264.7 cells was detected using a nitric oxide detection kit, and the apoptosis rate of A549 cells was analyzed with flow cytometry.

RESULTS

All the 3 polysaccharides had good antioxidant activities, and among them RPS-1 with a medium molecular mass exhibited the strongest scavenging capacity for DPPH and ABTS radicals (P < 0.05) while RPS-3 with the lowest molecular mass had the best scavenging activity for hydroxyl radicals (P < 0.01). All the 3 polysaccharides were capable of inhibiting the proliferation of MFC cells and A549 cells, activating the macrophages RAW 264.7 cells, and inducing apoptosis of A549 cells. RPS-2 with the highest molecular mass showed the strongest inhibitory effects against MFC and A549 cells (P > 0.05), and RPS-2 had the strongest activity for inducing apoptosis in A549 cells (P < 0.05). Compared with the other two polysaccharides, RPS-2 more strongly promoted the proliferation of RAW 264.7 cells and enhanced NO release from the cells (P < 0.05).

CONCLUSION

The 3 polysaccharides all have antioxidant, anti-tumor and immunomodulatory activities, and among them RPS-1 and RPS-3 have better antioxidant activities, and RPS-2 has stronger anti-tumor and immunomodulatory activities.

[Study of abnormal lipid metabolism analysis and significance of fatty acid binding protein expression in patients with hepatocellular carcinoma]

Objective: Hepatocellular carcinoma (HCC) is the fourth most dominant cancer in the world and the second leading cause of cancer-related deaths in the China. With the increase in the incidence of metabolic syndrome (MS) in the population, the correlation between MS and HCC has gradually been recognized. MS manifests as non-alcoholic fatty liver disease (shortly known as NAFLD) in the liver. A large number of research results has shown that the development of fatty liver is closely related to the occurrence of HCC, in which lipid metabolism plays a key regulatory role, and lipid metabolism is regulated by fatty acid binding protein (FABP). This study signifies the lipid metabolism analysis and the key FABP expression conditions in HCC. Methods: Data of patients who were first diagnosed with primary HCC between January 2016 to July 2019 were collected, and were divided into two groups according to the etiology, namely the viral and non-viral hepatitis-related HCC group. The relationship between MS-related factors and HCC was analyzed by t-test and chi square test. The expressions of FABP1, FABP4 and FABP5 were detected in cancer and adjacent tissues by immunohistochemistry, and the expressions of FABP1, FABP4 and FABP5 in HCC with fatty liver were detected by immunofluorescence. Finally, the expressional characteristics of the above-mentioned FABPs in HCC patients were analyzed with different clinicopathological features. Results: There were statistically significant differences in the rate of abnormal lipid metabolism and the number of abnormalities in MS-related factors between the viral and non-viral hepatitis-related HCC group. FABP1, FABP4, and FABP5 expression in HCC tissues were lower than the corresponding adjacent tumor tissues. Compared with simple HCC, FABP1, FABP4, FABP5 expression were increased in HCC tissues with steatosis, and the expression of FABP was closely related to the clinical characteristics of patients. Conclusion: Abnormal lipid metabolism is closely related to non-viral hepatitis-related HCC. The expression of lipid metabolism regulatory proteins FABP1, FABP4, and FABP5 are down-regulated in HCC tissues, but up-regulated in HCC with fatty liver, suggesting that the relationship between MS, especially dyslipidemia, and HCC should be paid attention to in clinical practice for early intervention. FABP1, FABP4, FABP5 may regulate HCC occurrence and development.

Epigenome-Metabolome-Epigenome signaling cascade in cell biological processes

Cell fate determination as a fundamental question in cell biology has been extensively studied at different regulatory levels for many years. However, the mechanisms of multi-level regulation of cell fate determination remain unclear. Recently we have proposed an Epigenome-Metabolome-Epigenome (E-M-E) signaling cascade model to describe the crossover cooperation during mouse somatic cell reprogramming. In this review, we summarize the broad roles of E-M-E signaling cascade in different cell biological processes including cell differentiation and dedifferentiation, cell specialization, cell proliferation and cell pathological processes. Precise E-M-E signaling cascades are critical in these cell biological processes, and it is of worth to explore each step of E-M-E signaling cascade. E-M-E signaling cascade model sheds light on and may open a window to explore the mechanisms of multi-level regulation of cell biological processes.

[Clinicopathological analysis in patients with chronic hepatitis B virus infection in immune tolerant phase]

Objective: To analyze the liver pathology, clinical characteristics and influence factors in patients with chronic hepatitis B virus (HBV) infection in immune tolerant phase (IT). Methods: The clinical data of 273 patients in IT phase who underwent liver biopsy from January 2015 to December 2019 were included in this study. The correlation between liver pathological changes and clinical features was analyzed. Results: There were 43 cases (15.75%) with liver histologic activity ≥ G2, 30 cases (10.99%) with liver fibrosis ≥ S2, and 55 cases (20.15%) with liver pathology ≥ G2 and/or ≥ S2. A total of 17.95% patients had liver steatosis. The majority (98.17%) of tissue samples were positive for HBsAg staining, while only 79.49% were positive for HBcAg. The characteristics of liver pathology were comparable in men from women patients. The differences of G and S were not statistically significant according to different HBsAg positivity, while those were statistically significant according to different HBcAg positivity. By univariate and multivariate analysis, the independent risk factors of pathological severity were HBcAg intensity, HBeAg level, and age. However, the differences of liver histologic activity and fibrosis were not statistically significant between those younger than 30 years old group from those older than 30 years old, neither between those younger or older than 40. Although the diagnostic value of liver inflammation and fibrosis 5 (LIF-5) was better than that of aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis 4 score (FIB-4), three diagnostic models for predicting the pathological severity were not strong enough (all area under the curves<0.8). Only the specificity of LIF-5 for predicting≥ G2, ≥ G2 and/or ≥ S2 was over 80%. Conclusions: Approximately 20% patients with chronic HBV infection in IT phase have progressive liver inflammation or fibrosis. The intensity of liver HBcAg and HBeAg level are negatively correlated with the severity of disease. The diagnostic models or most clinical indicators have low predictive effect for chronic HBV infections in IT phase.

Regulating Fibrocartilage Stem Cells via TNF-α/Nf-κB in TMJ Osteoarthritis

In this study, we investigate harnessing fibrocartilage stem cell (FCSC) capacities by regulating tumor necrosis factor α (TNF-α) signaling for cartilage repair in temporomandibular joint osteoarthritis (TMJOA). Stem cell specifics for FCSCs were characterized in the presence of TNF-α. Etanercept as a TNF-α inhibitor and BAY 11-7082 as an Nf-κB inhibitor were used to study TNF-α regulation of FCSCs. Lineage tracing was performed in Gli1-CreERT⁺;Tm^fl/fl mice when etanercept (1 mg/kg, every 3 d) or isometric vehicle was subcutaneously injected to trace specific changes in FCSCs. Surgically induced TMJOA Sprague-Dawley rats were generated with BAY 11-7082 (5 mg/kg, every 3 d) or vehicle subcutaneous injection to investigate the functional role of TNF-α/Nf-κB in TMJOA. Anterior disc displacement (ADD) rabbits were used to analyze the therapeutic effect of etanercept as a TMJOA intra-articular treatment with etanercept (0.02 mg in 100 μL, every 2 wk) or isometric vehicle. In vitro, TNF-α inhibited proliferation of FCSCs and increased FCSC apoptosis. TNF-α activation interfered with osteogenic and chondrogenic differentiation of FCSCs, while etanercept could partially recover FCSC specificity from TNF-α. FCSC lineage tracing in Gli1-CreERT⁺;Tm^fl/fl mice showed that the chondrogenic capacity of Gli1⁺ cell lineage was markedly suppressed in osteoarthritis cartilage, the phenotype of which could be significantly rescued by etanercept. Specifically blocking the Nf-κB pathway could significantly weaken the regulatory effect of TNF-α on FCSC specificity in vitro and in TMJOA rats in vivo. Finally, intra-articular etanercept treatment efficiently rescued TMJ cartilage degeneration and growth retardation in ADD rabbits. Inhibition of TNF-α signaling reduced Nf-κB transcripts and recovered FCSC specificities. In vivo, etanercept treatment effectively rescued the osteoarthritis phenotype in TMJOA mice and ADD rabbits. These data suggest a novel therapeutic mechanism whereby TNF-α/Nf-κB inhibition promotes FCSC chondrogenic capacity for cartilage transformation in TMJOA.

New thinking for filth fly control: residual, non-chemical wall spray from volcanic glass

Filth flies are of medical and veterinary importance because of the transfer of disease organisms to animals and humans. The traditional control methods include the use of chemical insecticides. A novel mechanical insecticide made from volcanic glass and originally developed to control mosquitoes (Imergard™ WP; ImG) was investigated for control of adult grey flesh flies, Sarcophaga bullata (Parker), secondary screwworms, Cochliomyia macellaria (F.), and house flies, Musca domestica L. In a modified WHO cone test device, the time to 50% mortality (LT₅₀ ) when applied at 5 g/m² (tested at 30 °C and 50% relative humidity (rH)) was 7.1, 4.3 and 3.2 h, respectively. When knockdown was included, the LT₅₀ s were 5.5, 1.5 and 2.8 h, respectively. Application rates of 1.25 and greater g/m² had the shortest LT₅₀ s. The time to the LT₅₀ increased for M. domestica as rH increased, but ImG was still active at the highest rH tested of 70%. Scanning electron micrographs showed ImG was present on all body parts, unlike that for mosquitoes where it was found mostly on the lower legs. These first studies on the use of Imergard WP against flies suggest this could be an alternative method for filth fly control.

[Association between sleep and prevalence of hypertension in elderly population]

Objective: To explore the association between sleep duration, sleep quality and the prevalence of hypertension in the elderly aged 65 years and above. Methods: This study was conducted among the elderly in communities in Yiwu, China from April to July, 2019, and participants were recruited through physical examination in the hospital. Face-to-face interview was performed to obtain basic information. Sleep duration and sleep quality were evaluated by Pittsburgh Sleep Quality Index (PSQI). Associations between sleep duration, sleep quality and hypertension were evaluated by multivariate logistic regression analysis. Results: A total of 3 169 elderly persons, aged ≥65 years old, were included in the study. The overall prevalence of hypertension was 50.8%. The elderly with very poor sleep quality and short sleep duration accounted for 22.4% and 28.5%, respectively. After adjusting for demographic characteristics, socioeconomic status, lifestyle and health status, the OR of hypertension for the elderly with very poor sleep quality was 1.42 (95%CI: 1.12-1.80) compared with those with very good sleep quality. Compared with the elderly with sleep duration of 6-7 h a night, the OR of hypertension for those with sleep duration <6 h was 1.37 (95%CI: 1.15-1.65). As the sleep quality decreased, the risk for hypertension increased. An U-shaped association was found between sleep duration and risk of hypertension. Subgroup analyses showed that this association existed in both men and women, but only significant in the elderly aged <75 years. Conclusion: Poor sleep quality and short sleep duration were associated with risk for hypertension in the elderly.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

POS0526 SEXUAL FUNCTION IN MALE AND FEMALE PATIENTS WITH RHEUMATOID ARTHRITIS: A POST-HOC ANALYSIS OF THE FINCH STUDIES

Background:

While sexual function is impaired in a high proportion of patients with rheumatoid arthritis (RA), it is often neglected in patient care.1 FINCH 1 (NCT02889796), FINCH 2 (NCT02873936) and FINCH 3 (NCT02886728) were Phase 3 studies to assess the safety and efficacy of filgotinib (FIL) for moderate-to-severe RA; patient-reported sexual function was also evaluated.

Objectives:

To analyse disease characteristics associated with sexual function and explore the effect of FIL and adalimumab (ADA) on sexual function in males and females in the FINCH studies.

Methods:

Post-hoc analyses included data from patients who were randomised and received ≥1 dose of study drug in the FINCH studies. Male and female subgroup analyses were performed to describe the correlation between baseline disease characteristics and baseline visual analogue scale (VAS) sexual function score (using Pearson correlation coefficient) and to assess the treatment effect on the change from baseline in VAS sexual function (mm) up to Week 52 (FINCH 1 and 3) or Week 24 (FINCH 2). Patients indicated how RA affected their ability to have sex during the last week using an exploratory 0–100 VAS (0: no effect; 100: complete inhibition). Changes from baseline were analysed with a mixed-effects model for repeated measures. All P values are nominal for exploratory purposes.

Results:

Baseline characteristics are shown in the Table 1. Univariate analyses revealed significant positive correlations (P<0.05) between disease duration and baseline VAS sexual function score in male and female subgroups in FINCH 1; no significant correlations were seen in male and female subgroups of FINCH 2 and 3. In all studies, significant correlations (P<0.05) were observed between baseline VAS sexual function score and baseline disease characteristics (swollen/tender joint count 28, Disease Activity Score-28, Health Assessment Questionnaire Disability Index, 36-Item Short Form Survey, patient global VAS, pain VAS or fatigue) in males or females. In all studies, analysis of least-squares mean changes from baseline in VAS sexual function revealed improvements in both males and females on FIL as early as Week 2, until Week 52 (Week 24 in FINCH 2). Figure 1 shows data for FINCH 1.

Conclusion:

Sexual function should be considered as an important patient outcome in RA treatment. At baseline in the FINCH studies, disease activity negatively impacted sexual function in both male and female patients. Active treatment with FIL or ADA resulted in early and sustained improvements from baseline in sexual function.

References:

[1]Tristano AG. World J Orthop 2014;5:107–11

Table 1.

Mean (standard deviation) baseline characteristics

FINCH 1FINCH 2FINCH 3Male n=258Female n=990Malen=79Female n=270Male n=233Female n=691Duration of RA, yr6.8 (7.38)8.0 (7.63)11.3 (8.53)12.7 (9.35)2.1 (5.35)2.2 (4.85)SJC2811 (5.0)11 (5.1)13 (6.2)12 (6.1)11 (5.4)11 (5.7)TJC2814 (6.5)15 (6.4)15 (7.5)16 (7.0)14 (6.6)15 (6.7)HAQ-DI1.35 (0.614)1.64 (0.601)1.41 (0.689)1.73 (0.634)1.37 (0.651)1.62 (0.617)DAS28 (CRP)5.6 (0.95)5.8 (0.90)5.8 (1.08)5.9 (0.92)5.7 (1.00)5.7 (0.99)SF-36 PCS34.3 (7.72)33.0 (7.34)31.7 (8.48)30.9 (7.75)34.4 (7.72)33.4 (7.47)SF-36 MCS45.9 (10.15)43.6 (10.65)43.7 (11.20)44.5 (11.71)46.2 (11.75)43.0 (10.89)FACIT-fatigue30.0 (10.00)26.8 (10.49)26.3 (11.15)24.0 (11.64)30.7 (10.93)26.6 (10.89)Patient global VAS (mm)64 (19.8)67 (19.0)66 (20.0)70 (19.5)65 (22.4)66 (20.3)Pain VAS (mm)61 (20.6)66 (19.5)62 (22.3)68 (20.6)64 (22.3)66 (20.9)VAS sexual function score44 (30.2)49 (32.3)48 (34.6)49 (36.8)42 (34.4)48 (35.1)

Variables in bold significantly correlated with VAS sexual function score (P<0.05)

DAS28 (CRP), Disease Activity Score-28 using C-reactive protein; FACIT, Functional Assessment of Chronic Illness Therapy; HAQ-DI, Health Assessment Questionnaire Disability Index; MCS, mental component summary; PCS, physical component summary; RA, rheumatoid arthritis; SF-36, 36-Item Short Form Survey; S/TJC28, swollen/tender joint count based on 28 joints; VAS, visual analogue scale

Acknowledgements:

The FINCH studies were funded by Gilead Sciences, Inc (Foster City, CA, USA). Medical writing/editorial support was provided by Debbie Sherwood, BSc, CMPP (Aspire Scientific, Bollington, UK), funded by Galapagos NV (Mechelen, Belgium).

Disclosure of Interests:

Luis Fernando Perez-Garcia Consultant of: Galapagos, Grant/research support from: CONACYT, ReumaNederland, and ZonMw, Mihaela Micu Speakers bureau: AbbVie, Angelini, Eli Lilly, Ewopharma, Novartis, UCB, Consultant of: Galapagos, Lien Gheyle Shareholder of: Galapagos, Employee of: Galapagos, Zhaoyu Yin Shareholder of: Gilead, Employee of: Gilead, YingMeei Tan Shareholder of: Gilead, Employee of: Gilead, Kun Chen Shareholder of: Gilead, Employee of: Gilead, Patrick Papazian Speakers bureau: Amgen, Gilead, Janssen, MSD, Consultant of: Gilead, Janssen, MSD, Employee of: Galapagos, part-time employee since Sept 2020, Katrien Van Beneden Shareholder of: Galapagos, Employee of: Galapagos, Radboud Dolhain Speakers bureau: AbbVie, Genzyme, Novartis, Roche, UCB, Consultant of: Galapagos, Grant/research support from: UCB, Rene Westhovens Speakers bureau: Celltrion, Galapagos/Gilead, Consultant of: Celltrion, Galapagos/Gilead