SAT0399 RISK OF OSTEOARTHRITIS IN AN INCIDENT COHORT OF PEOPLE WITH PSORIATIC ARTHRITIS: A POPULATION-BASED COHORT STUDY

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that causes pain, stiffness and swelling around the joints. PsA is reported to affect between 10 and 40% of individuals with psoriasis1and in the majority of patients presents after, or synchronously with, psoriasis onset.2Osteoarthritis (OA) is a common form of non-inflammatory arthritis related to joint degeneration and typically commences late in the fifth decade. PsA and OA have long been considered two distinct arthropathies, however they do have some overlapping features and symptoms and in certain circumstances it can be difficult to differentiate between them, particularly in the small joints of the hands or spine.3

Objectives:

To determine the risk of a diagnosis of osteoarthritis in psoriatic arthritis patients compared to patients with psoriasis and a general population cohort.

Methods:

Incident PsA patients aged 18-89 years at diagnosis were identified from the UK Clinical Practice Research Datalink between 1998 and 2014. All PsA patients were matched to a cohort of patients with psoriasis and a general population cohort (with no psoriasis or PsA) at a 1:4 ratio based on index date, year of birth, sex and general practice. The baseline prevalence of OA of any site was calculated as a percentage for each study cohort and then those prevalent cases were excluded from the numerators and denominators of the incident calculations. The incidence of OA was calculated and relative risks (RRadj), adjusting for body mass index (BMI), were calculated using conditional Poisson regression.

Results:

In total, 6,783 incident PsA patients were identified. The baseline prevalence of OA ranged from 22.1% (CI9521.1-23.1) in the PsA cohort to 12.6% (CI9512.2-13.0) and 11.0% (CI9510.6-11.3) in the psoriasis and general population cohorts respectively. The incidence of OA was significantly higher in the PsA cohort compared to the psoriasis and general population cohorts after adjusting for BMI (RRadj1.68 CI951.46-1.93 and RRadj1.86 CI951.62-2.14 respectively) (Tables 1 and 2).

Conclusion:

An increased risk of OA was observed in patients with PsA compared to patients with psoriasis alone and those in the general population. Further work is needed to determine whether this reflects a true increase in OA risk or misdiagnosed PsA and the extent to which it can be explained by differences in the opportunity for OA diagnosis between cohorts.

Table 1.

Incidence of osteoarthritis in the PsA, psoriasis and general population cohorts

CasesMedian age (years) at diagnosis (IQR)Person yearsIncidence rate per10,000 person yearsCI95Any OAϮGeneral population137459 (51 - 66)125,798109.2(103.5 - 115.0)Psoriasis143259 (53 - 67)122,279117.1(111.0 - 123.2)PsA46459 (51 - 66)28,574162.4(147.6 - 177.2)

Ϯincluding spondylosis

References:

[1]Ogdie A, Weiss P. Rheum Dis Clin North Am. 2015;41(4):545-568.

[2]Tillett Wet al.Rheumatol. 2017;56(12):2109-2113.

[3]McGonagle Det al. Rheumatology. 2015;54(1):29-38.

Table 2.

Risk of osteoarthritis in patients with PsA compared with patients in the general population and patients with psoriasis

PsA compared with a general population cohortPsA compared with a psoriasis cohortUnadjustedAdjusted†UnadjustedAdjusted†RRCI95PRRCI95PRRCI95PRRCI95POA1.871.67-2.10<0.00011.861.62-2.14<0.00011.681.50-1.88<0.00011.681.46-1.93<0.0001

†adjusted for BMI taken as the closest entry within 3 years of the index date

Acknowledgments:

This report is independent research funded by the National Institute for Health Research, Programme Grants for Applied Research [Early detection to improve outcome in patients with undiagnosed PsA (‘PROMPT’), RP-PG-1212-20007]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Disclosure of Interests:

None declared

0167 The Effect of Nocturnal Dinner Type “Light” Versus “Heavy” on Sleep, Attention and Microbial Composition

Introduction

Nutrition and sleep are two essential functions for the physiological existence of the organism. Furthermore, both have an acquired cultural, educational and social behavioral component. This study examined the effect of nocturnal dinner type (“light” vs. “heavy”) on the quality and quantity of sleep, attention abilities, fatigue, and mood in the following morning. In addition, the microbial composition was examined.

Methods

Twenty healthy subjects (10 men and 10 women), aged 25–33, were invited to two non-consecutive nights at the Sleep Institute for polysomnography test and filling out questionnaires: KSS; ESS; and Brief Symptom Inventory (BSI), attention abilities assessed with CPT-III. In one evening, the subjects consumed two hours before bedtime a “light” dinner based on vegetable ingredients (vegetables and vegetable proteins) with 342 calories that contained lentils, feta cheese, beet, and other vegetables. On the other evening, the subjects consumed two hours before bedtime a “heavy” dinner based on carbohydrates, fats, and animal protein with 501 calories that contained hamburger and French fries. In addition, subjects were required to give a microbial test before and after meals.

Results

There was no significant difference in the various sleep parameters between the two nights after each meal type: efficacy (t=-1.51,p=0.15); sleep latency stage 1 (t=1.81,p=0.08); sleep latency stage 2 (t=1.00,p=0.33); REM latency (t=0.57,p=0.57); total sleep time (t=-1.57,p=0.13); number of awakenings (t=0.30, p=0.76). No significant differences were found for: fatigue (KSS) (t=-0.30,p =0.77); sleepiness (ESS) (t=0.76,p =0.45); mood (BSI) (t=0.87,p =0.39); and attention deficit (CPT-III) (t=-0.68,p =0.50). The type of night meal did not show a significant effect on the microbial composition (H=0.059,p= 0.81).

Conclusion

The findings of this study show that, contrary to popular belief, “heavy” dinner did not affect the quality of sleep and functions measured in the study compared to a “light” dinner. In the current research, the population that was examined included only young and healthy subjects, therefore, the results may differ if the research in this field will extend and include other populations such as adults and subjects with different disorders. Future studies are needed to examine the relationships between sleep and nutrtion.

Support

No support

0029 Light Emitted from Media Devices at Night is Associated with Decline in Sperm Quality

Introduction

The last several decades have been characterized by the widespread usage of digital devices, especially smartphones. At the same time, there have been reports of male fertility decline. The aim of this study was to assess the relationship between evening exposure to the light-emitting screens of digital media devices and sperm quality.

Methods

Semen samples were obtained from 116 men adults aged between 21 and 59 (35.2 ±7.2) undergoing fertility evaluation for the following sperm variables: volume (mL), pH, sperm concentration (n/mL), motility percentage (progressive% + non-progressive motility%) and total sperm count. Exposure to the screens of electronic devices and sleep habits were obtained by means of a questionnaire.

Results

Smartphone and tablet usage in the evening and after bedtime was negatively correlated (p&lt;0.05) with sperm motility, sperm progressive motility, and sperm concentration, and positively correlated with the percentage of immotile sperm. In addition, sleep duration was positively correlated with sperm total and progressive motility and negatively correlated with semen pH (p&lt;0.05). A significant negative correlation was observed between subjective sleepiness and total and progressive motility as well as total motile sperm number (p&lt;0.05).

Conclusion

The results of this study revealed a link between evening and post-bedtime exposure to light-emitting digital media screens and sperm quality. To the best of our knowledge, this is the first study to report these types of correlations between sperm quality and exposure time to SWL emitted from digital media, especially smartphones and tablets, in the evening and after bedtime.

Support

No Support

Genome-wide association meta-analyses combining multiple risk phenotypes provide insights into the genetic architecture of cutaneous melanoma susceptibility

Most genetic susceptibility to cutaneous melanoma remains to be discovered. Meta-analysis genome-wide association study (GWAS) of 36,760 cases of melanoma (67% newly genotyped) and 375,188 controls identified 54 significant (P < 5 × 10-8) loci with 68 independent single nucleotide polymorphisms. Analysis of risk estimates across geographical regions and host factors suggests the acral melanoma subtype is uniquely unrelated to pigmentation. Combining this meta-analysis with GWAS of nevus count and hair color, and transcriptome association approaches, uncovered 31 potential secondary loci for a total of 85 cutaneous melanoma susceptibility loci. These findings provide insights into cutaneous melanoma genetic architecture, reinforcing the importance of nevogenesis, pigmentation and telomere maintenance, together with identifying potential new pathways for cutaneous melanoma pathogenesis.

Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI

AIM

To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden.

MATERIALS AND METHODS

A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression.

RESULTS

One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan.

CONCLUSIONS

Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study

OBJECTIVE

To compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths.

DESIGN

Cost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses.

SETTING

Queensland, Australia.

PARTICIPANTS

Men and women with a mean age 50 years modelled for 30 years.

INTERVENTIONS

Daily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo.

PRIMARY AND SECONDARY OUTCOMES

Costs, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years.

RESULTS

Per 100 000 individuals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%).

CONCLUSIONS

Compared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.

PL3.5 Efficacy and safety of selinexor in recurrent glioblastoma

BACKGROUND

New treatment modalities are needed for recurrent glioblastoma (rGBM). Selinexor is a novel, oral selective inhibitor of nuclear export which forces nuclear retention of tumor suppressor proteins including p53 and p27, leading to apoptosis. We previously reported interim results showing tolerability, preliminary efficacy, and blood-brain barrier penetration in a surgical cohort (N=8). We now report updated results following completion of accrual to non-surgical cohorts (N=68).

MATERIALS AND METHODS

This is an open-label, multicenter, phase 2 study of selinexor monotherapy. Patients (pts) not undergoing surgery for measurable rGBM per response assessment neuro-oncology criteria (RANO) were enrolled in one of 3 arms encompassing different dosing schedules of selinexor (50 mg/m2 [~ 85 mg] BIW, 60 mg BIW, and 80 mg QW). Treatment was continuous, although cycles were defined as 28 days and response was assessed every other cycle by MRI. Prior treatment with radiotherapy and temozolomide was required and prior bevacizumab was exclusionary. The primary endpoint was 6-month progression free survival (6mPFS) rate, calculated by the Kaplan-Meier method.

RESULTS

76 pts were enrolled; 24, 14 and 30 pts on doses of ~85 mg BIW, 60 mg BIW, and 80 mg QW, respectively. Median age was 56 years (range 21–78). Median number of prior treatments was 2 (range 1–7)

At the end of the 6 cycles, 30.2% pts on 80 mg QW were free from progression. The 6mPFS rate on 80 mg QW was 18.9%. Best RANO-defined responses (assessed locally) among 26 evaluable pts on 80 mg QW included 1 complete response, 2 partial responses, 7 stable disease, and 16 with progressive disease. Complete and partial responses were durable: the complete and a partial responder remain on selinexor for 393 and 1093 days respectively, as of the cut-off date. Median duration of response was 10.8 months. The most common related adverse events (all grades) in pts on ~85 mg BIW/60 mg BIW/80 mg QW were nausea (42%/64%/63%), leukopenia (38%/7%/43%), fatigue (71%/71%/47%), neutropenia (29%/14%/33%), decreased appetite (46%/71%/27%), and thrombocytopenia (67%/29%/23%).

CONCLUSION

Selinexor demonstrated efficacy, with durable responses and disease stabilization in rGBM. Based on the favorable efficacy and safety profile, selinexor at a dose of 80 mg QW is recommended for further development in rGBM.

Pharmacological treatment for Type 2 diabetes integrating findings from cardiovascular outcome trials: an expert consensus in the UK

In people with Type 2 diabetes, cardiovascular disease is a leading cause of morbidity and mortality. Thus, as well as controlling glucose, reducing the risk of cardiovascular events is a key goal. The results of cardiovascular outcome trials have led to updates for many national and international guidelines. England, Wales and Northern Ireland remain exceptions, with the most recent update to the National Institute for Health and Care Excellence (NICE) guidelines published in 2015. We reviewed current national and international guidelines and recommendations on the management of people with Type 2 diabetes. This article shares our consensus on clinical recommendations for the use of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) in people with Type 2 diabetes and established or at very high risk of cardiovascular disease in the UK. We also consider cost-effectiveness for these therapies. We recommend considering each person's cardiovascular risk and using diabetes therapies with proven cardiovascular benefits when appropriate to improve long-term outcomes and cost-effectiveness.

An observational cohort study of exercise and education for people with chronic obstructive pulmonary disease not meeting criteria for formal pulmonary rehabilitation programmes

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Pulmonary rehabilitation (PR) is offered to patients with functional breathlessness. However, access to PR is limited. The objective of this study was to evaluate whether a 4-week education and exercise programme offered to COPD patients with Medical Research Council (MRC) dyspnoea 1-2 improves disease self-management. Patients were recruited by their GP to attend four weekly 2-h sessions provided by a multidisciplinary team. Patients completed outcome measures before and after the program. Forty-two patients entered the programme and 26 out of 42 (61.9%) completed all sessions. The Bristol COPD Knowledge Questionnaire and Patient Activation Measure improved (both p ≤ 0.001). Disease burden was not reduced according to the COPD assessment test. All patients accepted a referral for ongoing exercise. Fourteen current smokers (81.3%) accepted a referral for smoking cessation, three patients with anxiety or depression (37.5%) accepted a psychological therapies referral. The programme improved COPD disease knowledge, patient activation and stimulated referrals to further services supporting disease management. Randomised controlled trials are warranted for similar interventions for COPD patients with early stage disease.

Cardiovascular, antidepressant and immunosuppressive drug use in relation to risk of cutaneous melanoma: a protocol for a prospective case-control study

INTRODUCTION

The incidence of cutaneous melanoma (hereafter melanoma) has increased dramatically among fair-skinned populations worldwide. In Norway, melanoma is the most rapidly growing type of cancer, with a 47% increase among women and 57% among men in 2000-2016. Intermittent ultraviolet exposure early in life and phenotypic characteristics like a fair complexion, freckles and nevi are established risk factors, yet the aetiology of melanoma is multifactorial. Certain prescription drugs may have carcinogenic side effects on the risk of melanoma. Some cardiovascular, antidepressant and immunosuppressive drugs can influence certain biological processes that modulate photosensitivity and immunoregulation. We aim to study whether these drugs are related to melanoma risk.

METHODS AND ANALYSIS

A population-based matched case-control study will be conducted using nation-wide registry data. Cases will consist of all first primary, histologically verified melanoma cases diagnosed between 2007 and 2015 identified in the Cancer Registry of Norway (14 000 cases). Ten melanoma-free controls per case (on date of case melanoma diagnosis) will be matched based on sex and year of birth from the National Registry of Norway. For the period 2004-2015, and by using the unique personal identification numbers assigned to all Norwegian citizens, the case-control data set will be linked to the Norwegian Prescription Database for information on drugs dispensed prior to the melanoma diagnosis, and to the Medical Birth Registry of Norway for data regarding the number of child births. Conditional logistic regression will be used to estimate associations between drug use and melanoma risk, taking potential confounding factors into account.

ETHICS AND DISSEMINATION

The project is approved by the Regional Committee for Medical Research Ethics in Norway and by the Norwegian Data Protection Authority. The study is funded by the Southeastern Norway Regional Health Authority. Results will be published in peer-reviewed journals and disseminated further through scientific conferences, news media and relevant patient interest groups.

Abstract GS3-06: Dynamics of breast cancer relapse reveal molecularly defined late recurring ER-positive subgroups: Results from the METABRIC study

Background: Recent studies have demonstrated that women with early stage ER-positive (ER+) and HER2-negative (HER2-) breast cancer have a persistent risk of recurrence and cancer related death up to 20 years post diagnosis, highlighting the chronic nature of ER+ breast cancer and critical need to identify tumor characteristics that are more predictive of risk of recurrence than standard clinical covariates. However, progress in delineating the dynamics of breast cancer relapse and biomarkers of late recurrence has been hindered by the lack of large cohorts with long-term clinical follow-up and molecular information.

Methods: We report the results of a cohort of 3,240 breast cancer patients from the United Kingdom and Canada with 20 years of follow-up (median 9.75 years), including 1,980 with accompanying molecular data from the primary breast tumor. Information for each patient on loco-regional recurrence (LR), distant recurrence (DR), and site(s) of metastases was collected. We developed a non-homogenous Markov chain model that accounted for different clinical endpoints and timescales, as well as competing risks of mortality and the distinct baseline hazards that characterize different molecular subgroups. This approach enabled robust analysis of the spatio-temporal dynamics of breast cancer recurrence across the clinical subgroups, PAM50 subgroups and the integrative clusters, while also enabling individual risk of relapse predictions.

Results: We employed our multistate model to compute the probability of experiencing a LR or DR, as well as the baseline transition probabilities from surgery, LR or DR at various time intervals for average individuals in each of the clinical/molecular subgroups. These analyses reveal four late-recurring ER+ (predominantly HER2-) subgroups, together accounting for 26% of all ER+ tumors, with high (median 42-55%) risk of recurrence up to 20 years post-diagnosis. Each of these four subgroups maps to one of the Integrative Clusters, defined based on genomic copy number alterations and gene expression, and is enriched for a characteristic copy number amplification events: 11q13 (CCND1, RSF1), 8p12 (FGFR1, ZNF703), 17q23 (RPS6KB1) and 8q24 (MYC). These four molecular subgroups are superior in predicting late DR than standard clinical variables.

Conclusions: A detailed understanding of the rates and routes of metastasis and their variability across the distinct molecular subtypes is essential for devising personalized approaches to breast cancer care. We describe a molecularly characterized breast cancer cohort with long-term clinical follow-up and a statistical modeling framework, enabling delineation of the dynamics of breast cancer recurrence at unprecedented resolution. These analyses reveal four late recurring ER+ subgroups and accompanying biomarkers that collectively define the quarter of ER+ cases at highest risk of recurrence. Our findings highlight opportunities for improved patient stratification and biomarker-driven clinical trials directed at the subset of breast cancer patients with persistent risk of recurrence.

Citation Format: Curtis C, Rueda OM, Sammut S-J, Chin S-F, Caswell-Jin JL, Seoane JA, Callari M, Batra R, Pereira B, Bruna A, Ali HR, Provenzano E, Liu B, Parisien M, Gillett C, McKinney S, Green A, Murphy L, Purushotham A, Ellis I, Pharoah P, Rueda C, Aparicio S, Caldas C. Dynamics of breast cancer relapse reveal molecularly defined late recurring ER-positive subgroups: Results from the METABRIC study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS3-06.

A review of the biomechanical determinants of rugby scrummaging performance

Background

The scrum is a physical contest unique to the game of rugby union, important for determining match outcomes.

Objective

This review will describe the current understanding of the kinetic and kinematic determinants of successful scrum performance to support coaching interventions and inform on future research.

Methods

Literature review.

Results

Individual and combined scrumming forces increase with playing level but there is no concurrent increase in body mass or player strength. There is very little variation in individual kinematics between individuals and across levels of play, suggesting that there are limited possible techniques for successful scrummaging. Live scrum contests are dynamic and require constant adjustments to body positions in response to increased compressive force and exaggerated lateral and vertical force components. Skilled performers are able to exert high levels of horizontal force while maintaining effective body positions within this dynamic environment.

Conclusion

Success in scrummaging depends on the optimisation of joint angles and force production at the individual level, and the coordination of effort at a team level. The analysis presented here demonstrates that producing large scrum-specific forces and achieving the optimal 'body shape' are essential for successful scrum performance.