O-006 Annotation-free embryo score calculated by iDAScore® correlated with live birth and has no correlation with neonatal outcomes after single vitrified-warmed blastocyst transfer

Study question

Does the embryo score calculated by annotation-free embryo scoring system based on deep learning and time-lapse sequence images correlate with live birth (LB) and neonatal outcomes?

Summary answer

Annotation-free embryo score calculated by iDAScore correlates with decreased miscarriage and increased LB and has no correlation with neonatal outcomes.

What is known already

Embryo ranking models have recently been developed based on artificial intelligence (AI) and deep learning to rank embryos according to their potential for pregnancy. The practicability and usability of such models have been reported. And the previous report suggested iDAScore which is one of the deep learning models for embryo scoring was superior to traditional morphological assessment methods and morphokinetic embryo assessment models. However, few studies have used independent datasets to analyze the correlation between the score calculated by AI models, LB, and neonatal outcomes.

Study design, size, duration

A total of 3,010 single vitrified-warmed blastocyst transfer (SVBT) cycles were analyzed retrospectively. The quality and scoring of embryos were assessed using iDAScore v1.0 (iDAScore, Vitrolife, Sweden). The cohort was divided into four groups based on the iDAScore according to the percentile (9.9-9.3, 9.2-8.7, 8.6-7.3 and, 7.2-1.0).

Participants/materials, setting, methods

Scores were calculated using the iDAScore software module in the Vitrolife Technology Hub (Vitrolife, Gothenburg, Sweden). The correlation between iDAScore, LB rates and total miscarriage (TM), including 1st and 2nd trimester miscarriage, were analysed using a trend-test and multivariable logistic regression analysis. Furthermore, similarly, correlation between the iDAScore and neonatal outcomes were analysed.

Main results and the role of chance

LB rates decreased as the iDAScore decreased (P < 0.05), and a similar inverse trend was observed for the TM rates (P < 0.05). Additionally, multivariate logistic regression analysis showed that iDAScore significantly correlated with increased LB (adjusted odds ratio: 1.742, 95% CI: 1.601–1.904, P < 0.05) and decreased TM (adjusted odds ratio: 0.799, 95% CI: 0.706–0.905, P < 0.05). There was no significant correlation between iDAScore and neonatal outcomes, including congenital malformations, sex, gestational age, and birth weight. Multivariate logistic regression analysis, which included maternal and paternal age, maternal body mass index, parity, smoking, and the presence or absence of caesarean section as confounding factors, revealed no significant difference in any neonatal characteristics (low birth weight, small for gestation, large for gestation, preterm birth, male sex rates, and major congenital malformation).

Limitations, reasons for caution

SVBT was performed following minimal stimulation and natural cycle in vitro fertilisation. Therefore, only a few cycles of elective blastocyst transfer were available. However, there was no bias in selecting embryos for SVBT.

Wider implications of the findings

Objective embryo assessment using a completely automatic and annotation-free model, like iDAScore, showed a good correlation with increased LB and decreased TM. Furthermore, it did not correlate with neonatal outcomes. Therefore, iDAScore may be an optimal LB prediction model after SVBT without affecting neonatal outcomes.

Trial registration number

not applicable

P-754 Perinatal outcomes and congenital anomalies after clomiphene citrate based minimal ovarian stimulation in vitro fertilisation stratified by embryo transfer method: a 10-year cohort study

Study question

Is the embryo transfer method associated with perinatal outcomes and congenital anomalies after minimal ovarian stimulation in vitro fertilisation (IVF) with clomiphene citrate (CC)?

Summary answer

Single vitrified-warmed blastocyst transfers in natural cycles had a lower incidence of pregnancy complications compared to single fresh cleaved embryo transfers after CC-based ovarian stimulation.

What is known already

Pregnancies resulting from IVF are associated with a higher risk of adverse perinatal outcomes compared to spontaneous conception; therefore, the next focus in reproductive medicine is to assess whether the increased risks are attributable to the IVF. Perinatal outcomes and congenital anomalies should be considered in addition to pregnancy outcomes in selecting the embryo transfer method. However, studies describing the influence of transfer methods on perinatal and maternal outcomes are limited.

Study design, size, duration

This study retrospectively analysed a single centre 10-year cohort. A total of 82,491 clinical records of women who underwent oocyte retrieval during a CC-based minimal stimulation cycle followed by single fresh cleaved embryo transfer (SFCT), single vitrified-warmed cleaved embryo transfer (SVCT), or single vitrified-warmed blastocyst transfer (SVBT) at the Kato Ladies Clinic between January 2008 and December 2017 were retrospectively analysed.

Participants/materials, setting, methods

The oocyte retrievals were performed in CC-based minimal ovarian stimulation. The embryos were transferred 2–3 days after retrieval, or vitrified at the cleavage or blastocyst stages. The vitrified embryos were warmed and transferred within the natural cycles. Perinatal outcomes and congenital anomalies were stratified by the transfer method. Multivariate logistic regression analysis was performed to evaluate the effect of transfer methods on pregnancy complications and congenital anomalies.

Main results and the role of chance

The perinatal outcomes and congenital anomalies in 19,069 singleton pregnancies were analysed. Multivariate logistic regression analysis revealed that the incidence of hypertensive disorders of pregnancy was significantly lower in the SVBT group compared with the SFCT group (adjusted odds ratio [AOR], 0.628; P < 0.0001). The incidence of low-lying placenta (AOR 0.359 P = 0.0483; AOR 0.452 P < 0.0001, respectively) and placenta previa (AOR 0.300 P = 0.0021; AOR 0.542 P < 0.0001, respectively) were lower in the SVCT and SVBT groups than in the SFCT group. The rate of preterm delivery was lower in SVBT compared with SFCT (AOR 0.732 P < 0.0001). The rate of low birth weight was significantly lower after SVCT and SVBT, compared with the SFCT group (AOR 0.751; P = 0.0261: AOR, 0.560; P < 0.0001: respectively). A lower incidence of small for gestational age (AOR 0.720 P = 0.0436; AOR 0.494 P < 0.0001, respectively) and higher incidence of large for gestational age (AOR 1.287 P = 0.0332; AOR 1.706 P < 0.0001, respectively) were observed in the SVCT and SVBT groups compared to the SFCT group. The incidence of each congenital anomaly was similar among the groups.

Limitations, reasons for caution

The data was collected through self-reported parental questionnaires on neonatal outcomes and congenital malformations. Furthermore, this study was retrospective in nature; further studies are necessary to ascertain the generalisability of these findings to other clinics with different protocols and/or patient demographics.

Wider implications of the findings

This study demonstrated reassuring outcomes for SVBT, in terms of a lower incidence of pregnancy complications compared with SFCT. Our findings provide valuable knowledge to improve perinatal outcomes in CC-based stimulation and to inform couples of the possible benefits and harms of each type of embryo transfer method.

Trial registration number

not applicable

P-152 The first morphokinetic map of human abnormal fertilisation

Study question

What are the similarities and differences between the morphokinetics of abnormal, one- (1PN) and three-pronuclear (3PN) and normal bi-pronuclear (2PN) fertilisation?

Summary answer

The morphokinetic analysis of 1PN/3PN fertilisation reveals novel aspects of abnormal early development.

What is known already

Assisted reproduction technology has allowed the observation of early human development. Initially assessed statically at a single time point, fertilization has revealed its complexity once observed by Time-Lapse Microscopy (TLM). Detailed morphokinetic analysis of fertilisation has been reported in the last few years, unveiling previously unknown cytoplasmic phenomena (e.g. the cytoplasmic wave and halo) and the importance of cell symmetry for embryo development. At present, abnormal fertilization remains neglected, despite potential for understanding the physiology and pathology of early human development.

Study design, size, duration

This retrospective study involved TLM observation of normally (2PN, n = 2,685) and abnormally (1PN, n = 41; 3PN, n = 127) fertilised oocytes generated in ICSI cycles. Oocyte retrievals were carried out after the clomiphene citrate-based minimal ovarian stimulation, between October 2019 and December 2020. Oocytes of patients with different diagnoses of infertility were included in the analysis, while cases involving cryopreserved gametes or surgically retrieved sperm were excluded.

Participants/materials, setting, methods

Microinjected oocytes were assessed by a combined TLM-culture system (Embryoscope). Oocytes not suitable for TLM assessment, due to excess of residual corona cells or inadequate orientation for correct observation, were not analysed. Phenomena, relevant to meiotic resumption, pronuclear dynamics, cytoplasmic/cortical modifications, cleavage pattern, and embryo quality, were annotated and compared between groups.

Main results and the role of chance

Second polar body (PBII) extrusion was observed in all 1PN- and in a majority of 3PN-zygotes (92.1%). A 0.3-hour delay in PBII extrusion was confirmed in 3PN-zygotes (P = 0.0439). In a significant proportion of 3PN-zygotes, a third (female) PN formed from reabsorption of the PBII. The cytoplasmic wave was observed not only in 2PN- and 3PN-, but also in 1PN-zygotes. The presence and position of cytoplasmic halo were comparable among the three classes of zygotes. However, the duration of the cytoplasmic halo was prolonged in 1PN-zygotes (P < 0.0001). PN juxtaposition immediately before PN breakdown was less frequent in 3PN- compared with 2PN-zygotes (P = 0.0159). Furthermore, asynchronous PN breakdown was increased in 3PN- compared with 2PN-zygotes (P = 0.0026). The PN area of 1PN- was larger than that of 2PN-zygotes; however, the PN area of 3PN-zygotes was smaller than that of 2PN-zygotes. In 1PN-zygotes, a developmental delay was observed starting from the disappearance of the cytoplasmic halo, reaching 9 hours at the time of cleavage (P < 0.0001). A higher incidence of abnormal cleavage (P = 0.0019) and blastomere fragmentation (P < 0.0001) was observed in 1PN-zygotes. Cleavage progression was increasingly affected especially in 1PN-zygotes, resulting in blastocyst formation rates of 70.2%, 12.2% and 53.5% in 2PN-, 1PN- and 3PN-zygotes, respectively (P < 0.0001).

Limitations, reasons for caution

The study data derive from treatments carried out in a single centre. The study findings therefore require independent verification from other research groups.

Wider implications of the findings

These observations suggest that 1PN and 3PN fertilisation follow the general pattern of normal fertilization. Crucially, they also shed light on diverse and previously undescribed phenomena - e.g. reabsorption of the PBII in 3PN zygotes - underpinning the origins of abnormal fertilization and potentially clinically relevant.

Trial registration number

not applicable

Expanding the phenotypic spectrum of ARCN1-related syndrome

PURPOSE

This study aimed to describe the phenotypic and molecular characteristics of ARCN1-related syndrome.

METHODS

Patients with ARCN1 variants were identified, and clinician researchers were connected using GeneMatcher and physician referrals. Clinical histories were collected from each patient.

RESULTS

In total, we identified 14 cases of ARCN1-related syndrome, (9 pediatrics, and 5 fetal cases from 3 families). The clinical features these newly identified cases were compared to 6 previously reported cases for a total of 20 cases. Intrauterine growth restriction, micrognathia, and short stature were present in all patients. Other common features included prematurity (11/15, 73.3%), developmental delay (10/14, 71.4%), genitourinary malformations in males (6/8, 75%), and microcephaly (12/15, 80%). Novel features of ARCN1-related syndrome included transient liver dysfunction and specific glycosylation abnormalities during illness, giant cell hepatitis, hepatoblastoma, cataracts, and lethal skeletal manifestations. Developmental delay was seen in 73% of patients, but only 3 patients had intellectual disability, which is less common than previously reported.

CONCLUSION

ARCN1-related syndrome presents with a wide clinical spectrum ranging from a severe embryonic lethal syndrome to a mild syndrome with intrauterine growth restriction, micrognathia, and short stature without intellectual disability. Patients with ARCN1-related syndrome should be monitored for liver dysfunction during illness, cataracts, and hepatoblastoma. Additional research to further define the phenotypic spectrum and possible genotype-phenotype correlations are required.

POS0081 LONG-TERM EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS: 2-YEAR RESULTS FROM THE PHASE 3 SELECT-PsA 1 STUDY

Background

In SELECT-PsA 1, patients (pts) with psoriatic arthritis (PsA) and an inadequate response or intolerance to ≥1 non-biologic disease-modifying antirheumatic drug showed improvement in the signs and symptoms of PsA with upadacitinib 15 mg (UPA15) or 30 mg (UPA30), an oral Janus kinase (JAK) inhibitor, through week (wk) 56.1

Objectives

To evaluate the efficacy and safety of UPA and UPA vs adalimumab (ADA) at wk 104 from the ongoing long-term extension of SELECT-PsA 1.

Methods

Pts received UPA15, UPA30, ADA 40 mg, or placebo (PBO) for 24 wks, at which point, PBO pts switched to UPA15 or UPA30. Efficacy endpoints were analyzed using non-responder imputation (NRI) and as observed (AO) (binary endpoints) or mixed-effect model repeated measures and AO (continuous endpoints), with nominal P-values shown, for continuous UPA and ADA treatment groups. Treatment-emergent adverse events were summarized for pts who received ≥1 dose of study drug using a visit-based cut-off at wk 104.

Results

1704 pts received ≥1 dose of study drug. At wk 104, 25.4% of patients had discontinued study drug. The proportions of pts who achieved ACR20/50/70, MDA, PASI75/90/100, and resolution of enthesitis or dactylitis showed consistent responses, or further improvements, from wk 561 to wk 104 (Table 1). ACR20/50/70 and MDA responses, as well as mean change from baseline (BL) in HAQ-DI, patient’s assessment of pain, BASDAI, and ASDAS, were greater with UPA vs ADA. Mean change from BL in modified total Sharp/van der Heijde Score (mTSS) was generally similar across groups and comparable to wk 56.1 The safety profile of UPA was generally comparable to ADA (Figure 1) and consistent with wk 561 data. Rates of serious infection, herpes zoster, lymphopenia, and elevated CPK remained numerically higher with UPA30 vs UPA15; rates in both UPA groups were higher vs ADA. Rates of malignancies, MACE, or VTE were similar across groups, and consistent with wk 561 data. Two deaths were reported with UPA15, 1 with UPA30, and 1 with ADA.

Table 1.

Efficacy Endpoints at Week 104

EndpointUPA15(n=429)UPA30(n=423)ADA(n=429)Proportion of Pts (%)aNRIAONRIAONRIAOACR2069.087.969.587.963.485.1ACR5053.667.459.3*74.147.162.3ACR7038.0*47.443.5*54.429.439.1Minimal Disease Activity (MDA)42.054.845.9*56.837.850.3PASI75b57.973.462.478.658.876.5PASI90b46.759.053.366.548.863.3PASI100b34.143.442.451.434.144.0Resolution of enthesitis by LEIc53.375.552.272.049.173.9Resolution of dactylitis by LDId69.994.571.796.272.495.2Change from BLeMMRMAOMMRMAOMMRMAOHealth Assessment Questionnaire - Disability Index (HAQ-DI)-0.55*-0.57-0.55*-0.59-0.45-0.47Patient’s assessment of pain (numeric rating scale)-3.3-3.5-3.4*-3.6-3.0-3.2Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)f-3.0-3.2-3.3-3.6-2.7-2.6Ankylosing Spondylitis Disease Activity Score (ASDAS)f-1.6-1.8-1.9*-2.1-1.5-1.6Modified total Sharp/van der Heijde Score (mTSS)0.030.010.010.000.110.11

ACR20/50/70, ≥20%/50%/70% improvement in American College of Rheumatology criteria; ADA, adalimumab; AO, as observed; BL, baseline; LDI, Leeds Dactylitis Index; LEI, Leeds Enthesitis Index; MMRM, mixed effect model repeated measurement; NRI, non-responder imputation; PASI75/90/100, ≥75%/90%/100% improvement in Psoriasis Area and Severity Index; pts, patients; UPA, upadacitinib.

aData shown as NRI and AO for binary endpoints.

bFor pts with psoriasis affecting ≥3% of body surface area at BL.

cFor pts with LEI >0 at BL; resolution LEI=0.

dFor pts with LDI >0 at BL; resolution LDI=0.

eData shown as MMRM (LS mean) and AO (mean) for continuous endpoints.

fFor pts with psoriatic spondylitis at BL.

Nominal *P<0.05, UPA15 or UPA30 vs ADA for NRI and MMRM; AO descriptive only.

Conclusion

In PsA pts, efficacy responses were similar or greater with UPA15 or UPA30 vs ADA at wk 104, and inhibition of radiographic progression was maintained. No new safety signals were identified with long-term exposure to UPA up to 2 years.

References

[1]McInnes I, et al. RMD Open, 2021; 7(3):e001838.

Acknowledgements

AbbVie and the authors thank the patients, study sites, and investigators who participated in this clinical trial (NCT03104400). AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by Monica R.P. Elmore, PhD of AbbVie.

Disclosure of Interests

Iain McInnes Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, and UCB Pharma, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, and UCB Pharma, Koji Kato Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Marina Magrey Consultant of: UCB, Novartis, Eli Lilly, Pfizer, and Janssen, Grant/research support from: Amgen, AbbVie, and UCB Pharma, Joseph F. Merola Consultant of: Merck, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma, Mitsumasa Kishimoto Consultant of: AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Celgene, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma, Derek Haaland Speakers bureau: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, Sanofi Genzyme, Takeda, Consultant of: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli-Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi Genzyme, Takeda, UCB, Grant/research support from: AbbVie, Adiga Life-Sciences, Amgen, Bristol-Myers Squibb, Can-Fite Biopharma, Celgene, Eli-Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Regeneron, Sanofi-Genzyme, UCB, Liang Chen Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Yuanyuan Duan Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Jianzhong Liu Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Ralph Lippe Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Peter Wung Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie

OP0024 DIFFERENTIATION BETWEEN IL-6 AND IL-17 PATHWAY INHIBITION IN RELATIONSHIP WITH CLINICAL OUTCOMES IN NON-BIOLOGICAL DMARD-IR AND BIOLOGICAL DMARD-IR PSORIATIC ARTHRITIS PATIENTS TREATED WITH UPADACITINIB IN SELECT-PsA 1 AND SELECT-PsA 2 STUDIES

Background

The differential contribution of IL-6 and IL-17 pathways to the pathogenesis of psoriatic arthritis (PsA) is not fully understood. Upadacitinib (UPA), an oral JAK inhibitor, was more effective than placebo (PBO) in improving key clinical manifestations of PsA in two global phase 3 trials, SELECT-PsA 1 (non-biological DMARD-IR, nbDMARD-IR) and SELECT-PsA 2 (biological DMARD-IR, bDMARD-IR).1,2 Targeted proteomic analysis suggested that UPA modulates multiple biological pathways in innate and adaptive immune systems via direct and indirect inhibition of key regulators, including IL-6 and IL-17 pathways, with a possible shift from Th1 predominance in nbDMARD-IR PsA to a more Th17 bias in bDMARD-IR PsA.3

Objectives

We assessed the relationship between IL-6 and IL-17 pathway modulation and different clinical outcomes after UPA treatment in nbDMARD-IR and bDMARD-IR PsA patients.

Methods

A subset of patients was randomly selected from SELECT-PsA 1 (n=74 of UPA 15 mg QD, n=74 of PBO) and PsA 2 studies (n=90 of UPA 15 mg QD, n=81 of PBO). Serum levels of IL-6, IL-17A, IL-17F, and beta-defensin 2 (BD2) proteins were measured at baseline, week 2, and week 12 by validated immunoassays. The quantitative cytokine measurements were transformed as log10, and PASI score was transformed as log10 (x+1) prior to analysis. A Repeated Measure Mixed Linear Model was used to compare UPA versus PBO treatment effects in overall selected patients and between responders and non-responders defined by PASDAS score ≤ 3.6 (Minimal Disease Activity, MDA)4 and PASI75 at week 12, respectively. The relationships between cytokines and clinical outcomes (PASI and DAS28-CRP) were assessed by Pearson’s correlation at baseline and after treatment.

Results

In nbDMARD-IR PsA patients, baseline IL-17A, IL-17F, and BD2 levels correlated with each other and with PASI, while IL-6 appeared independent from the IL-17 pathway and correlated with DAS28-CRP. At week 12, UPA treatment significantly decreased IL-6 and BD2. The decrease of IL-6 was more pronounced in PASDAS MDA responders and correlated with DAS28-CRP improvement, but the decrease of BD2 was significant in PASI75 responders and correlated with PASI improvement. In contrast, IL-17A and IL-17F were not significantly changed after UPA treatment, neither correlated with clinical outcomes at week 12.

In bDMARD-IR PsA patients, baseline IL-17A level was significantly elevated compared to nbDMARD-IR patients but weakly correlated with other cytokines and show no correlation with PASI. At week 12, the reduction of IL-6 after UPA treatment was not different between responders and non-responders (PASDAS MDA or PASI75) and did not correlate with DAS28-CRP improvement, while the reduction of BD2 remained significant in PASI75 responders and correlated with PASI improvement. Further, UPA treatment significantly reduced IL-17A in PASDAS MDA responders and IL-17F in PASI75 responders compared to non-responders, respectively. The reduction of IL-17F correlated with PASI improvement at week 12.

Conclusion

IL-6 and IL-17 pathway inhibition after UPA treatment showed different profiles in relationship with clinical outcomes in nbDMARD-IR versus bDMARD-IR PsA patients. IL-6 decrease was more pronounced in nbDMARD-IR PsA patients and associated with joint manifestation improvement, while IL-17A and IL-17F decreases were only observed in bDMARD-IR PsA patients and associated with psoriasis improvement. BD2, a biomarker of Th17-associated skin pathology, significantly decreased after UPA treatment in both nbDMARD-IR and bDMARD-IR PsA studies, which likely contributed to UPA effects on psoriasis improvement in a broad range of PsA patients.

References

[1]McInnes IB, et al. N Engl J Med 2021;384:1227-39.

[2]Mease PJ, et al. Ann Rheum Dis 2020;80:312-20.

[3]Sornasse T, et al. Ann Rheum Dis 2021;80:433.

[4]Salaffi F, et al. Biomed Res Int 2014;2014:528105.

Acknowledgements

AbbVie, Inc., in collaboration with the authors, contributed to the study design, data collection and analysis, interpretation of the results, and preparation, review and approval of the final version. No honoraria or payments were made for authorship.

Disclosure of Interests

Fang Cai Shareholder of: AbbVie, Employee of: AbbVie, Thierry Sornasse Shareholder of: AbbVie, Employee of: AbbVie, Melanie Ruzek Shareholder of: AbbVie, Employee of: AbbVie, Yuni Fang Shareholder of: AbbVie, Employee of: AbbVie, Koji Kato Shareholder of: AbbVie, Employee of: AbbVie, Peter Wung Shareholder of: AbbVie, Employee of: AbbVie, Iain McInnes Consultant of: AbbVie, AstraZeneca, BMS, Lilly, Amgen, Causeway, Oxford Biodynamics, Novartis, Janssen, Pfizer, Boehringer, and UCB, Grant/research support from: AbbVie, AstraZeneca, BMS, Lilly, Amgen, Causeway, Oxford Biodynamics, Novartis, Janssen, Pfizer, Boehringer, and UCB.

Abstract 417: Elevation Of Serum Hdl And Apoe Level In A Novel Vps35l Deficient Mouse Model

Aim: Defect of the endosomal protein sorting factor VPS35L causes novel congenital anomalies syndrome, in which cholesterol dysmetabolism is one of the symptoms. To reveal the biochemical mechanisms, the a model mouse was developed and characterized.

Methods: Loss-of-function mutation, N995del, VPS35L knock-in (KI) mice were generated. Serum lipoprotein profiles were assessed by LipoSEARCH™ (Immuno-Biological Laboratories, Japan). For biochemical assays, 70 micro-L of serum was sub-fractionated with Superose 6 column in PBS and total and free cholesterol detected using LabAssay™cholesterol (Fujifilm Wako Chemicals, Japan) and Pureauto™S F-CHO-N (SEKISUI MEDICAL, Japan) assay kits. Negative images of fractioned lipoproteins were observed by TEM (JEM-1400Plus, JEOL, Japan). ApoA-I and apoE in the fractions were determined by use of a mouse apoA1 ELISA PRO kit and a mouse apoE ELISA PRO kit (Mabtech AB, Sweden). Mouse liver total RNA was isolated by ISOGEN (Nippon Gene, Japan) and first-strand cDNA generated using the Invitrogen™ SuperScript™IV First-Strand Synthesis system with random hexamers. For quantitative real-time PCR, the StepOnePlus™ real-time PCR system (Thermo Fisher) was used, and the PCR end product of each well confirmed by the melt curve analysis.

Results: Lipoprotein analysis indicated the KI mice showed 1.9-fold higher total cholesterol than WT mice. LDL-C and HDL-C were increased 2.9- and 1.9-fold compared to WT mice, respectively. ApoA-I levels in the large HDL and HDL fractions were all significantly increased 1.5-, and 1.6-fold, whereas apoE levels were elevated 25-, and 8.4-fold, respectively.

Conclusions: Ablation of VPS35L in MEF(3T3) cells caused loss of endocytosis of the LDL receptor and LRP1, and perhaps even SR-BI, which may lead to increased serum LDL and HDL levels in the loss-of-function KI model mice. Surprisingly. a high level of apoE was detected in KI mice, especially in the HDL fraction. In this case, apoE catabolism became abnormal due to the lack of LRP1 at the cell surface. Abnormal metabolism of apoE may affect the central nervous system or neuron generation. Further examination of the phenotype of this this model mouse line are warranted.

Germline variants in tumor suppressor FBXW7 lead to impaired ubiquitination and a neurodevelopmental syndrome

Neurodevelopmental disorders are highly heterogenous conditions resulting from abnormalities of brain architecture and/or function. FBXW7 (F-box and WD-repeat-domain-containing 7), a recognized developmental regulator and tumor suppressor, has been shown to regulate cell-cycle progression and cell growth and survival by targeting substrates including CYCLIN E1/2 and NOTCH for degradation via the ubiquitin proteasome system. We used a genotype-first approach and global data-sharing platforms to identify 35 individuals harboring de novo and inherited FBXW7 germline monoallelic chromosomal deletions and nonsense, frameshift, splice-site, and missense variants associated with a neurodevelopmental syndrome. The FBXW7 neurodevelopmental syndrome is distinguished by global developmental delay, borderline to severe intellectual disability, hypotonia, and gastrointestinal issues. Brain imaging detailed variable underlying structural abnormalities affecting the cerebellum, corpus collosum, and white matter. A crystal-structure model of FBXW7 predicted that missense variants were clustered at the substrate-binding surface of the WD40 domain and that these might reduce FBXW7 substrate binding affinity. Expression of recombinant FBXW7 missense variants in cultured cells demonstrated impaired CYCLIN E1 and CYCLIN E2 turnover. Pan-neuronal knockdown of the Drosophila ortholog, archipelago, impaired learning and neuronal function. Collectively, the data presented herein provide compelling evidence of an F-Box protein-related, phenotypically variable neurodevelopmental disorder associated with monoallelic variants in FBXW7.

Early onset of heart failure in Japanese ARVC patients with pathogenic desmosomal gene variants

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy mainly caused by desmosomal gene variants. Although there are a lot of reports regarding to European ARVC patients, the ones in Asian are a few, and the characteristics of Asian ARVC have been still unclear. We have reported that the genetic backgrounds in Japanese ARVC patients were different from those in European ones. In this study, we aimed to examine the phenotype and outcome of Japanese ARVC patients with specific genetic backgrounds.

Methods and results

This study included 104 Japanese ARVC patients who were diagnosed as definite in the 2010 Task Force Criteria for ARVC and received genetic analysis (79 males [76%]; median age at diagnosis, 40 years [IQR 22–53 years].) Fifty-seven patients carried variants in desmosomal genes classified as pathogenic based on ACMG guideline: 30 in DSG2 (29%), 22 in PKP2 (21%), 2 in DSC2 (2%) and 3 in DSP (3%). The median age of diagnosis was significantly younger in the patients with the pathogenic variants than in those without (37 years [IQR 21–49 years] vs. 46 years [IQR 34–58 years], P=0.01). During a median follow-up of 9.3 years (IQR 3.5–20.9 years), 10 patients died and 2 were received heart transplantation. Sixty-two suffered lethal arrhythmic events including cardiopulmonary arrest, ventricular fibrillation, sustained ventricular tachycardia and appropriate shocks by implantable cardioverter defibrillator. Twenty-two were hospitalized for heart failure. There was no difference in these events rate between the two groups. However, survival analysis revealed that patients with pathogenic variants hospitalized for heart failure significantly earlier in their life than those without (P=0.04, log-rank test, Figure 1).

Conclusions

The Japanese ARVC patients with pathogenic variants in desmosomal genes are diagnosed and hospitalize for heart failure at younger age than those without. These findings have not been reported in other ethnics. Our study warns that we should be cautious for not only the prevention of lethal arrhythmic events but also the progress of the heart failure in Japanese ARVC patients with pathogenic variants.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Japan Agency for Medical Research and Development Figure 1

O-223 Fatty acid supplementation into warming solutions improve the developmental competence of mouse, bovine, and human oocytes and embryos after vitrification

Study question

Does fatty acid (FA) supplementation into vitrification and warming solutions influence the developmental competence of oocyte and embryo after vitrification and warming?

Summary answer

FA supplementation during the warming process improves the developmental competence of vitrified-warmed mouse oocytes and embryonic-morphologies after vitrification at the cleavage-stage in bovines and humans.

What is known already

Vitrified metaphase II stage oocytes exhibit a diminished ability to develop into blastocysts and live births. Previous studies have shown reduction in intracellular lipid content as one of the factors associated with reduced developmental competence of oocytes after vitrification as the intracellular lipid content of oocytes is affected by vitrification. FAs derived from break down of lipids are primarily transferred to the mitochondria, where it plays a crucial role in cellular metabolism. However, the effects of FA supplementation in warming solutions on the cytoplasmic lipid content and subsequent embryo development are unknown.

Study design, size, duration

A chemically defined FA mixture was added to the vitrification and/or warming solutions. Oocytes collected from C57BL6/N (n = 80) were randomly divided into three groups (fresh, n = 634; non-FA (control), n = 961; FA, n = 1,686), and were vitrified-warmed with/without FA. Lipid composition, developmental competence, and gene expression levels were compared among the groups. Bovine embryos (fresh, n = 420; control, n = 524; FA, n = 492) and discarded human day-2 embryos (control, n = 87; FA, n = 92) were used to examine the developmental competence of embryos.

Participants/materials, setting, methods

Lipids in the ooplasm were stained with Nile red and the fluorescence intensity was analysed. The developmental competence of mouse oocytes was examined by performing intracytoplasmic sperm injection. Expressions of FA metabolism-related genes were measured. The bovine embryos were vitrified at the four-cell stage and cultured to the blastocyst stage after warming. Cryopreserved discarded human embryos were warmed and cultured. The obtained blastocysts were then placed on fibronectin-coated dishes to examine the outgrowth formation.

Main results and the role of chance

Lipid content of mouse oocytes was significantly lower in the control group compared to that in the fresh group (P &lt; 0.05). On the contrary, lipid contents of FA and fresh groups were comparable (P = 0.24). Blastocyst formation rate was significantly higher in the FA group than that in the control group (55.7% and 44.8%, respectively; P &lt; 0.05). To examine the optimal timing for FA supplementation, FA was added to the vitrification solution (FAvit), warming solution (FAthaw), and/or both solutions (FAvit-thaw). Blastocyst formation rate was significantly higher in the FAthaw group than that in the control group (59.8% and 50.0%, respectively; P &lt; 0.05). The mRNA expressions of Acaa2 and Hadha in mouse embryos were significantly higher in the FAthaw group compared to that in the control group (P &lt; 0.05). Moreover, FA supplemented warming solutions significantly improved the blastocyst formation rate in bovines (control, 53.5%; FAthaw, 64.5%; P &lt; 0.05). Developmental rate to the expanded blastocyst stage was slightly improved in human embryos (control, 53.7%; FAthaw, 63%; P = 0.38) and the proportion of Grade A in inner cell mass and trophectoderm was significantly higher in the FAthaw group than that in the control group (P &lt; 0.05). There were no differences in the outgrowth abilities between the control and FAthaw groups.

Limitations, reasons for caution

Since the experiments of the current study on human embryos were performed in vitro using discarded embryos, in vivo developmental ability was not evaluated. Therefore, to validate the application of our findings in human assisted reproductive technologies, further clinical trials (ART) are warranted.

Wider implications of the findings

FA supplementation into the warming solutions improved the developmental competence of vitrified–warmed oocytes and cleaved embryos by activating the β-oxidation pathway. These results indicate that FA supplementation into warming solutions is a potential strategy to improve clinical outcomes in human ART.

Trial registration number

not applicable

O-220 An annotation-free embryo scoring system (iDAScore®) based on deep learning shows high performance for pregnancy prediction after single-vitrified blastocyst transfer

Study question

How is the performance of an automated embryo scoring system for pregnancy prediction after single-vitrified blastocyst transfer (SVBT) compared to other, annotation-dependent blastocyst grading systems?

Summary answer

Automatic embryo ranking by iDAScore shows a higher or equal performance, with regards to pregnancy prediction after SVBT, compared to manual, annotation-dependent grading systems.

What is known already

Blastocyst viability can be assessed by blastocyst morphology grades and/or morphokinetic parameters. However, morphological and morphokinetic embryo assessment is prone to both inter- and intra-observer variation. Recently, embryo ranking models have been developed based on artificial intelligence (AI) and deep learning. Such models rank embryos according to their potential for pregnancy only based on images and do not require any user-dependent annotation. So far, no study has independently assessed the performance of AI models compared to other embryo scoring models, including traditional morphological grading.

Study design, size, duration

A total of 3,014 SVBT cycles were retrospectively analysed. Embryos were stratified according to SART age groups. The quality and scoring of embryos were assessed by iDAScore v1.0 (iDAS, Vitrolife, Sweden), KIDScoreTM D5 v3 (KS; Vitrolife), and Gardner criteria. The performance of the pregnancy prediction for each embryo scoring model was compared using the area under curve (AUC) of the receiver operating characteristic curve for each maternal age group.

Participants/materials, setting, methods

Embryos were cultured in the EmbryoScope+ and EmbryoScopeFlex (Vitrolife). iDAS was automatically calculated using the iDAScore model running on the EmbryoViewer (Vitrolife). KS was calculated in EmbryoViewer after annotation of the required parameters. ICM and TE were annotated according to the Gardner criteria. The degree of expansion in all blastocysts was Grade 4 due to our freezing policy. Furthermore, Gardner’s scores were stratified into four grades (Excellent: AA, Good: AB BA, Fair: BB, Poor: others).

Main results and the role of chance

The AUCs of the &lt; 35 years age group (n = 389) for pregnancy prediction were 0.72 for iDAS, 0.66 for KS and 0.64 for Gardner criteria. The AUC of iDAS was significantly higher (P &lt; 0.05) compared to the other two models. For the 35–37 years age group (n = 514) the AUCs were 0.68, 0.68, and 0.65 for iDAS, KS and Gardner, respectively, and were not significantly different. The AUCs of the 38–40 years age group (n = 796) were 0.67 for iDAS, 0.65 for KS and 0.64 for Gardner criteria and where was not significantly different. The AUCs of the 41–42 years age group (n = 636) were 0.66, 0.66, and 0.63 for iDAS, KS and Gardner, respectively, and there was no significant difference among the pregnancy prediction models. For the &gt; 42 years age group (n = 389) AUCs were 0.76 for iDAS, 0.75 for KS and 0.75 for Gardner criteria and not significantly different. Thus, for all age groups, iDAS was either highest or equal to the highest AUC, although a significant difference was only observed for the youngest age group.

Limitations, reasons for caution

In this study, SVBT was performed after minimal stimulation and natural cycle in vitro fertilisation (IVF). Therefore, we had only few cycles with elective blastocyst transfer. However, there was also no bias in selecting the embryos for SVBT.

Wider implications of the findings

Our results showed that objective embryo assessment by a completely automatic and annotation-free model, iDAScore, does perform as good or even better than more traditional embryo assessment or an annotation-dependent ranking tool. iDAS could be an optimal pregnancy prediction model after SVBT, especially in young and advanced age patients.

Trial registration number

not applicable

NF-kB decoy oligodeoxynucleotide preserves disc height in a rabbit anular-puncture model and reduces pain induction in a rat xenograft-radiculopathy model

While it is known that the degenerated intervertebral disc (IVD) is one of the primary reasons for low-back pain and subsequent need for medical care, there are currently no established effective methods for direct treatment. Nuclear factor-κB (NF-κB) is a transcription factor that regulates various genes' expression, among which are inflammatory cytokines, in many tissues including the IVD. NF-κB decoy is an oligodeoxynucleotide containing the NF-κB binding site that entraps NF-κB subunits, resulting in suppression of NF-κB activity. In the present preclinical study, NF-κB decoy was injected into degenerated IVDs using the rabbit anular-puncture model. In terms of distribution, NF-κB decoy persisted in the IVDs up to at least 4 weeks after injection. The remaining amount of NF-κB decoy indicated that it fit a double-exponential-decay equation. Investigation of puncture-caused degeneration of IVDs showed that NF-κB decoy injection recovered, dose-dependently, the reduced disc height that was associated with reparative cell cloning and morphological changes, as assessed through histology. Gene expression, by quantitative real-time polymerase chain reaction (qRT-PCR), showed that NF-κB decoy attenuated inflammatory gene expression, such as that of interleukin-1 and tumor necrosis factor-α, in rabbit degenerated IVDs. NF-κB decoy also reduced the pain response as seen using the "pain sensor" nude rat xenograft-radiculopathy model. This is the first report demonstrating that NF-κB decoy suppresses the inflammatory response in degenerated IVDs and restores IVD disc height loss. Therefore, the intradiscal injection of NF-κB decoy may have the potential as an effective therapeutic strategy for discogenic pain associated with degenerated IVDs.

Impact of tumor growth rate during preceding treatment on tumor response to nivolumab or irinotecan in advanced gastric cancer

Background

Nivolumab (NIVO) and irinotecan (IRI) are standard treatments for refractory advanced gastric cancer (AGC); however, it is unclear which drug should be administered first or in which cases. The tumor growth rate (TGR) during preceding treatment is reported to be associated with tumor response in metastatic colorectal cancer patients treated with regorafenib or trifluridine/tipiracil, suggesting that TGR may be useful for drug selection. Therefore, we evaluated the association between TGR during preceding treatment and the tumor response to NIVO or IRI.

Patients and methods

We retrospectively evaluated consecutive AGC patients treated with NIVO or IRI and divided them into slow-growing (Slow) and rapid-growing (Rapid) groups according to TGR and the presence or absence of new lesions (NL+/NL−, respectively) during preceding treatment (Slow group: NL− with low TGR <0.30%/day; Rapid group: NL+ or high TGR ≥0.30%/day).

Results

A total of 117 patients (Rapid/Slow groups, 72/45; NIVO/IRI groups, 32/85) were eligible. All baseline characteristics except peritoneal metastases were similar between patients treated with NIVO and IRI in the Rapid and Slow groups. The response rate was significantly higher in patients treated with NIVO compared with IRI [31%/3%; odds ratio (OR), 13.8; P = 0.01; adjusted OR, 52; P = 0.002] in the Slow group, but there was no difference between patients treated with NIVO and IRI (5%/8%; OR, 0.68; P = 0.73; adjusted OR, 0.94; P = 0.96) in the Rapid group. Disease control rate, progression-free survival, and overall survival were consistent with these results.

Conclusions

Our findings suggest that NIVO treatment is a more favorable option for patients with slow-growing tumors, and NIVO and IRI are similarly recommended for patients with rapid-growing tumors in refractory AGC. TGR and NL emergence during preceding treatment may be helpful for drug selection and warrant further investigation.

•

NIVO and IRI are standard treatments for refractory AGC, although it is unclear which should be administered first.

•

TGR may be useful for drug selection, therefore we evaluated the association between TGR and the tumor response to NIVO or IRI.

•

In the Slow group, the response rate (RR) was significantly higher in patients treated with NIVO compared with IRI.

•

In the Rapid group, there was no significant difference in RR between the NIVO and IRI groups.

•

TGR and NL emergence during preceding treatment may be useful for drug selection.

AB0357 LANDSCAPE REVIEW OF PATIENT-REPORTED OUTCOME MEASURES IN GIANT CELL ARTERITIS

Background:

Giant cell arteritis (GCA) is a systemic large vessel vasculitis that results in symptoms (e.g., headaches, jaw claudication, fatigue, pain, etc.) that can have multiple negative impacts on an individual’s health-related quality of life.

Objectives:

To identify important symptoms and impacts experienced by individuals with GCA, develop a conceptual model, and evaluate available patient reported outcome (PRO) measures for appropriateness for inclusion in GCA clinical studies.

Methods:

Published literature on disease experience from databases, conference abstracts, and Guidance/OMERACT documents were reviewed. A GCA conceptual model was developed based on the symptoms and impacts identified from this literature and supplemented with clinical input. A detailed review of selected PROs was then conducted to assess concept coverage and gaps to evaluate appropriateness for a GCA population.

Results:

Of 245 identified citations, 24 abstracts and 18 articles were reviewed. Key symptoms affecting GCA patients (e.g., ischemic and constitutional symptoms) and impacts to the lives of GCA patients (e.g., reduced physical, social and emotional functioning) formed the basis for a GCA conceptual model (see Figure 1).

No GCA-specific PROs were identified. Therefore, the PROs that were used most frequently in GCA clinical studies were reviewed and evaluated. These included the SF-36, FACIT-Fatigue, Patient Global Assessment (PtGA), Multidimensional Fatigue Inventory (MFI), EQ-5D, Health Assessment Questionnaire (HAQ), Brief Illness Perception Questionnaire (BIPQ), and Visual Functioning Questionnaire-25 (VFQ-25). These PROs included some key impacts but did not assess most GCA-specific symptoms (e.g., headaches, fever, etc.). No measures were developed with input from GCA patients and there has been limited evaluation of the measurement properties of these PROs in GCA patients.

The FACIT-Fatigue, SF-36, and the PtGA, which were frequently administered in published GCA studies, measure key GCA concepts such as fatigue, functioning, impact on daily activities and disease status. The measurement properties (reliability, validity, sensitivity to change) have been documented in several other rheumatologic diseases (Table 1).

Conclusion:

In the absence of a GCA-specific PRO, the SF-36, FACIT- Fatigue, and PtGA are recommended for use in GCA clinical studies for the assessment of key concepts identified in the literature. Qualitative and quantitative research should be conducted with GCA patients to assess the content validity and measurement properties of these PROs in a GCA population.

Table 1.

Summary of Recommended Measures

DescriptionSF-36FACIT-FatiguePtGATypeGeneric, health status measureFatigue and impact on function/daily activitiesMeasure of disease activityMethod of AdministrationSelf/InterviewerSelf/InterviewerSelf# of Items36131Recall periodPast 4 weeks/past weekPast 7 daysVariesScoring8 domain scores; 2 component summary scoresTotal scoreTotal scoreMeasurement propertiesMeasurement properties demonstrated in other rheumatologic diseases (SLE, RA, SpA, and chronic knee pain); construct validity demonstrated in a single study with GCA patientsMeasurement properties demonstrated in rheumatologic populations including SLE, PsA, and RASelect measurement properties have been demonstrated in GCA and other populations (RA, TAK, RP)Concept coverageGCA impacts (emotional, physical, and social functioning, and daily activities), bodily pain, fatigueFatigueOverall assessment of disease activityAdministered in recent GCA studiesYESYESYES

SLE= systemic lupus erythematosus, SpA = spondyloarthritis, PsA=psoriatic arthritis, RA=rheumatoid arthritis, GCA= giant cell arteritis, TAK=Takayasu’s arteritis, RP=relapsing polychondritis

Disclosure of Interests:

Hilary H Colwell Consultant of: Janssen Pharmaceutical Companies of Johnson & Johnson, Susan Mathias Consultant of: Janssen Pharmaceutical Companies of Johnson & Johnson, Kelly Kato Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Catherine E Najem Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Amy M Archer Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson

POS1030 EFFICACY OF UPADACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS STRATIFIED BY BASELINE SKIN SEVERITY: A SUBGROUP ANALYSIS OF TWO PHASE III TRIALS

Background:

In the SELECT-PsA 1 and 2 clinical trials, upadacitinib (UPA) demonstrated efficacy and safety in patients (pts) with active psoriatic arthritis (PsA).1,2 PsA is associated with varying degrees of psoriatic symptoms; however, the impact of skin severity on treatment outcomes is not well understood.

Objectives:

This post-hoc analysis assessed the effects of baseline skin severity on UPA efficacy.

Methods:

SELECT-PsA 1 and SELECT-PsA 2 enrolled pts with PsA and prior inadequate response (IR) or intolerance to ≥1 non-biologic disease-modifying antirheumatic drug (DMARD)1 or ≥1 biologic DMARD2, respectively. In both trials, pts received once daily UPA 15 mg or UPA 30 mg or placebo (switched at Wk 24 to either UPA 15 mg or 30 mg); SELECT-PsA 1 also included the active comparator adalimumab (ADA). Only continuous UPA 15 mg and ADA are presented here. In this analysis, pts were divided into subgroups based on the extent of psoriasis at baseline (body surface area [BSA] of ≥3%-<10% or BSA ≥10%); efficacy endpoints were analyzed at Wk 56. Results for binary endpoints are based on non-responder imputation; continuous endpoints are based on mixed model repeated measures analysis with as-observed data.

Results:

In the UPA 15 mg and ADA groups, respectively, 32% (138/429) and 31% (132/429) of pts had a BSA ≥3-<10% at baseline in SELECT-PsA 1; 18% (76/429) in each treatment group had a BSA ≥10%. In SELECT-PsA 2, 38% (80/211) had a BSA ≥3-<10% and 24% (50/211) had a BSA ≥10% at baseline in the UPA 15 mg group. Across pt populations (non-biologic DMARD-IR and biologic DMARD-IR), generally consistent results were observed between patients in both skin severity subgroups (Figure 1). In non-biologic DMARD-IR pts, a numerically greater proportion of UPA 15 mg pts with lower skin involvement compared with higher skin involvement achieved PASI100 and PASI≤1, two more stringent skin endpoints. The achievement of MDA was generally consistent across skin severity subgroups; when pts were required to achieve the skin component of MDA, results were numerically better in the ≥3-<10% skin severity group (Table 1). In non-biologic DMARD-IR pts, results were similar between UPA 15 mg and ADA.

Conclusion:

UPA is a viable treatment option for pts with active PsA regardless of the extent of psoriasis at baseline. Although these results are of interest and hypothesis-generating, they should be interpreted with caution due to low sample size.

References:

[1]McInnes IB et al. Ann Rheum Dis, 2020; 79:12

[2]Mease PJ et al. Ann Rheum Dis, 2020; doi: 10.1136/annrheumdis-2020-218870

Table 1.

Additional Efficacy Outcomes at Week 56 Stratified by Severity of Skin Involvement at Baseline

SELECT-PsA 1n/N (%) [95% CI]UPA 15 mgADAsIGA 0/1 w/at least 2 point improvement from BLa ≥3%-<10%71/128 (55.5) [46.9, 64.1]53/124 (42.7) [34.0, 51.4] ≥10%29/76 (38.2) [27.2, 49.1]33/77 (42.9) [31.8, 53.9]MDA + skinb ≥3%-<10%58/138 (42.0) [33.8, 50.3]56/132 (42.4) [34.0, 50.9] ≥10%19/76 (25.0) [15.3, 34.7]28/79 (35.4) [24.9, 46.0]SELECT-PsA 2n/N (%) [95% CI]UPA 15 mgsIGA 0/1 w/at least 2 point improvement from BLa ≥3%-<10%24/71 (33.8) [22.8, 44.8] ≥10%18/50 (36.0) [22.7, 49.3] MDA + skinb ≥3%-<10%22/80 (27.5) [17.7, 37.3] ≥10%9/50 (18.0) [7.4, 28.6]

a defined as achieving an sIGA score of 0 or 1 and at least a 2 point improvement from BL, evaluated in pts with BL sIGA ≥2.

b defined as achieving 5 of the 7 criteria, with PASI ≤1 or BSA-psoriasis ≤3 as a required component.

ADA, adalimumab; BL, baseline; CI, confidence interval; MDA, minimal disease activity; sIGA, Static Investigator Global Assessment of psoriasis; UPA, upadacitinib

Acknowledgements:

AbbVie and the authors thank the patients, study sites, and investigators who participated in this clinical trial. AbbVie, Inc was the study sponsor, contributed to study design, data collection, analysis & interpretation, and to writing, reviewing, and approval of final version. No honoraria or payments were made for authorship. Medical writing support was provided by Ramona Vladea, PhD and Jamie Urbanik, PharmD both of AbbVie Inc.

Disclosure of Interests:

Joseph F. Merola Consultant of: Merck, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and Leo Pharma, Pascal Richette Consultant of: AbbVie, Biogen, Janssen, BMS, Roche, Pfizer, Amgen, Sanofi-Aventis, UCB, Lilly, Novartis, and Celgene, Ennio Lubrano Speakers bureau: AbbVie, Celgene, Janssen, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Celgene, Janssen, MSD, Novartis, and Pfizer, Grant/research support from: AbbVie, Celgene, Janssen, MSD, Novartis, and Pfizer, Edit Drescher: None declared, Lilian Soto: None declared, Charles Lovan Shareholder of: AbbVie, Employee of: AbbVie, Koji Kato Shareholder of: AbbVie, Employee of: AbbVie, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, Michael Lane Shareholder of: AbbVie, Employee of: AbbVie, Mitsumasa Kishimoto Consultant of: AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Celgene, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma.

OP0030 TREATMENT OF NON-BIOLOGIC-DMARD-IR PSA PATIENTS WITH UPADACITINIB OR ADALIMUMAB RESULTS IN THE MODULATION OF DISTINCT FUNCTIONAL PATHWAYS: PROTEOMICS ANALYSIS OF THE SELECT-PSA 1 PHASE 3 STUDY

Background:

Treatment of non-biologic-DMARD-IR (DMARD-IR) PsA patients with upadacitinib (UPA) at 15 mg QD, an oral JAK1 selective inhibitor, resulted in improvement in musculoskeletal symptoms, psoriasis, physical function, fatigue, quality of life, and inhibited radiographic progression; improvements were observed as early as Week 2 (ACR20 and ACR50). UPA 15 mg QD was non-inferior to adalimumab (ADA) 40 mg EOW for ACR201

Objectives:

To determine the relative biological pathway modulation of UPA compared with ADA in patients with PsA via the evaluation of a pre-defined set of plasma proteins associated with inflammation.

Methods:

Patients from the SELECT-PsA1 study (DMARD-IR PsA patients) were randomly selected (PBO, n=100; UPA 15 mg QD, n=100; ADA 40 mg EOW, n = 100). The levels of 92 inflammation related protein biomarkers (pBM) were analyzed using a multiplexed Proximity Extension Assay platform in plasma samples collected at baseline, week 2, and 12; change from baseline in protein levels were expressed as Log2 Fold Change; a Repeated Measure Mixed Linear Model identified proteins modulated by UPA and ADA compared to Baseline. Functional pathway prediction was performed in silico with a commercially distributed software where 52 significantly modulated pBM (mean |Log2 FC| ≥ 0.1 AND FDR ≤ 0.05) were selected; results were summarized based on 3 core biological groups: 1) adaptive immune system, 2) innate immune system, and 3) non-immune connective and vascular systems.

Results:

At the single pBM-level, at the week 2 and 12 time points, treatment with UPA 15 mg QD resulted in distinct down modulation of T cell-associated (CD5, CD8a, IL15Ra, SLAMF1, TRANCE) and myeloid cell-associated pBM (CSF-1, CCL7, CCL13) that was not observed in the ADA treated group. Reciprocally, treatment with ADA 40 mg EOW resulted in a specific down modulation of a subset of neutrophil associated pBM (CCL3, CCL4, and S100A12). Both treatments resulted in the down modulation of IFN-, IL6-, and TNF-related pBM (CXCL9, CXCL10, CXCL11, IL6, TNFRSF19, and TNSF14) suggesting a common node of activity related to these pivotal cytokine-signaling pathways.

Functional pathway prediction based on the pBM data revealed that treatment with UPA is preferentially associated with the inhibition of T cells, but also NK cells and lymphocytes, compared to the predicted effects of treatment with ADA. Treatment with UPA also preferentially inhibited pathways related to bone damage and angiogenesis, as compared to the predicted effect of treatment with ADA. Finally, both treatments were predicted to inhibit multiple pathways associated with the activity of myeloid cells and phagocytes.

Conclusion:

Consistent with previous observations in RA2, UPA is predicted to inhibit multiple functional pathways associated the pathobiology of PsA belonging to the general categories of adaptive and innate immunity but also non-immune vascular and connective tissue biology. In contrast, treatment with ADA appears to affect more specifically functional pathways associated with the innate immune system.

References:

[1]McInnes, I. et al. Annals of the Rheumatic Diseases 79, 16-17 (2020).

[2]Sornasse, T., Song, I.H., Radstake, T. & McInnes, I. Annals of the Rheumatic Diseases 79, 581-582 (2020).

Acknowledgements:

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship.

Disclosure of Interests:

Thierry Sornasse Shareholder of: AbbVie, Employee of: AbbVie, Jaclyn Anderson Shareholder of: AbbVie, Employee of: AbbVie, Koji Kato Shareholder of: AbbVie, Employee of: AbbVie, Apinya Lertratanakul Shareholder of: AbbVie, Employee of: AbbVie, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sun, UCB, Grant/research support from: AbbVie, Amgen, UCB, Iain McInnes Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, UCB Pharma, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, UCB Pharma

POS1047 IMPACT OF UPADACITINIB ON REDUCING PAIN IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: RESULTS FROM TWO PHASE 3 TRIALS IN PATIENTS WITH INADEQUATE RESPONSE TO NON-BIOLOGIC OR BIOLOGIC DMARDs

Background:

Pain is a dominant symptom of psoriatic arthritis (PsA), and pain reduction is a priority for patients (pts) that is often assessed in clinical trials. Upadacitinib (UPA), a Janus kinase (JAK) inhibitor engineered for increased selectivity for JAK1 over JAK2, JAK3, and tyrosine kinase2, has demonstrated safety and efficacy in pts with active PsA in the SELECT-PsA 1 and 2 studies.1,2

Objectives:

The objective of this analysis was to compare the efficacy of UPA vs placebo (PBO) and adalimumab (ADA) on pain using different assessments through 24 weeks (wks).

Methods:

The SELECT-PsA program enrolled adult pts with active PsA with prior inadequate response (IR) or intolerance to ≥1 non-biologic DMARD (SELECT-PsA 1; NCT03104400) or prior IR or intolerance to ≥1 biologic DMARD (SELECT-PsA 2; NCT03104374). Concomitant background therapy with ≤2 non-biologic DMARDs was allowed but not required. Pts were randomized to UPA 15 mg or UPA 30 mg once daily (QD) or PBO (both studies), or ADA 40 mg every other week (EOW; SELECT-PsA 1 only). Pain was assessed as proportion of pts achieving ≥30%, ≥50%, or ≥70% reduction from baseline (BL) in Pt’s global assessment (PGA) of pain numeric rating scale (NRS) score (0–10), proportion of pts achieving minimal clinically important difference (MCID) in pain (defined as ≥1 point reduction or 15% reduction from BL on a 0–10 NRS)3,4 and change from baseline in pain NRS (0–10) at all time points. In addition, change from BL in BASDAI questions 2 (spinal pain) and 3 (joint pain/swelling) and 36-Item Short Form Survey (SF-36) questions 7 (bodily pain) and 8 (pain interference) at weeks 12 and 24 were assessed. Non-responder imputation was used for binary endpoints and mixed-effects model for repeated measurements for continuous endpoints. The statistical significance defined as P<0.05 was exploratory in nature.

Results:

In both studies, a significantly higher proportion of pts receiving UPA 15 mg QD and UPA 30 mg QD vs PBO achieved improvements in most pain endpoints as early as wk 2, and improvements were generally either sustained or increased through wk 24 (nominal P<0.05). A significant improvement with UPA vs PBO was also observed for change from BL in PGA of pain NRS scores over time, as well as in BASDAI spinal pain and joint pain/swelling and SF-36 bodily pain and pain interference at weeks 12 and 24. In SELECT-PsA 1 significantly higher proportions of pts receiving UPA 30 mg QD vs ADA 40 mg EOW achieved improvements in most pain assessments as early as wk 2 which were sustained through wk 24; improvements in several assessments were also significantly greater with UPA 15 mg QD vs ADA 40 mg EOW at wk 24 (nominal P <0.05; Data will be presented).

Conclusion:

In pts with active PsA who had inadequate response to non-biologic or biologic DMARDs, a greater proportion of pts treated with UPA vs PBO achieved rapid, significant, and clinically meaningful reductions in pain across multiple pain assessments. The reductions in pain were sustained over 24 wks.

References:

[1]McInnes I. et al. Ann Rheum Dis. 2020;79(Suppl 1):12-13.

[2]Genovese M.C. et al. Ann Rheum Dis. 2020;79(Suppl 1):139.

[3]Dworkin, R.H. et al. J Pain. 2008;9(2):105-121.

[4]Salaffi F. et al. Eur J Pain. 2004;8:283–291.

Acknowledgements:

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by M Hovenden and J Matsuura of ICON plc (North Wales, PA) and was funded by AbbVie.

Disclosure of Interests:

Iain McInnes Consultant of: AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol Myers, Celgene, Janssen, Leo, Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol Myers, Celgene, Janssen, Leo, Lilly, Novartis, Pfizer, and UCB, William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, and UCB, Philip J Mease Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Kurt de Vlam Speakers bureau: Celgene Eli Lilly, Galapagos, Novartis, and UCB, Consultant of: Celgene, Eli Lilly, Galapagos, Novartis, and UCB, Grant/research support from: Celgene and Galapagos, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, and Sanofi, Consultant of: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Sanofi, Gilead, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Sanofi, and Gilead, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, anna maniccia Shareholder of: AbbVie, Employee of: AbbVie, Patrick Zueger Shareholder of: AbbVie, Employee of: AbbVie, Dai Feng Shareholder of: AbbVie, Employee of: AbbVie, Koji Kato Shareholder of: AbbVie, Employee of: AbbVie, Andrew Ostor Consultant of: AbbVie, BMS, Roche, Janssen, Lilly, Novartis, Pfizer, UCB, Gilead, and Paradigm.