OP0141 TREAT TO TARGET IN SYSTEMIC LUPUS ERYTHEMATOSUS FROM THE PATIENTS’ PERSPECTIVE – RESULTS FROM AN INTERNATIONAL PATIENT SURVEY

Background

Treat-to-target (T2T) is a generally accepted treatment concept in rheumatology care. It is assumed that T2T could significantly improve systemic lupus erythematosus (SLE) care and the patients’ outcomes. However, T2T has not yet been studied systematically and clinical trials are currently in preparation [1]. Furthermore, the patients’ opinion on T2T has barely been taken into account.

Objectives

As the success of T2T is largely determined by the involvement of patients, it was our aim to investigate the attitude towards, need, and willingness of SLE patients to participate in a T2T study and to identify possible obstacles.

Methods

A questionnaire on T2T, its acceptance, the need and willingness to participate in a T2T trial and possible obstacles for T2T was designed by the authors in cooperation with patient research partner and performed in the Netherlands (NL), Austria (AU), Germany (GE) and Bulgaria (BG). The web-based survey consisted of 13 questions with single and multiple answers and/or free text. After back-and-forth translation from German to Dutch and Bulgarian, it was distributed among members of the patient organizations of NL, GE, AU, BG via newsletter (GE, AU, BG), personal invitation (NL) and a closed Facebook group (BG). Castor Electronic Data Capture (NL) and SoSci-Survey (GE, AU, BG) were used as platforms.

Results

A total of 863 patients (n=316 NL, n=271 GE, n=232 BG, n=44 AU) with self-declared diagnosis of SLE completed the questionnaire. 93.3% were female, 52.2% were 41-60 years old. The disease duration was longer than 10 years in 54.8%, 12.4% had a disease duration of 0-2 years. Regarding the satisfaction with the current health status, 56.2% were somewhat to all the way satisfied, 29.3% were not at all or hardly satisfied. 65.5% were satisfied with their current therapeutic treatment, 14.8% where not at all or hardly satisfied.

48.4% declared being currently in remission, 13% did not know if they were in remission. As most important treatment goal, normalization of quality of life was chosen most frequently (37.4%) followed by prevention of organ damage (24.6%) and the absence of disease activity (22.6 %).

Regarding shared decision making, the majority reported to be somewhat to all the way involved in treatment decisions (62.1%) while 20,7% where hardly or not at all involved.

As most difficult decisions in T2T and shared decision making, respondents named the start of new SLE medication (37.9%) and to change medication while feeling good (39.4%). An increase in the dose of glucocorticoids to reach remission was difficult for 22.7%.

The majority of patients considered research of T2T in SLE useful (55,4% all the way, 29.8% somewhat useful) and 67% would probably or definitely participate in such scientific research. The perceived advantages and disadvantages of T2T are depicted in Figure 1.

Figure 1.

Consequences of T2T rated as advantage or disadvantage by SLE patients. SLE systemic lupus erythematosus, T2T treat-to-target.

Conclusion

Despite many SLE patients being satisfied with their treatment and health status, T2T is considered an important subject to be studied in clinical trials. Advantages did overweigh possible disadvantages of T2T with the possibility of more doctors’ visits and the prescription of a new drug as biggest disadvantage. Quality of life named as most important treatment goal emphasizes its importance as outcome parameter. Most patients would be willing to participate in a trial about T2T.

References

[1]Mucke J, Kuss O, Brinks R, Schanze S, Schneider M. LUPUS-BEST-treat-to-target in systemic lupus erythematosus: study protocol for a three-armed cluster-randomised trial. Lupus Sci Med 2021; 8(1)

Disclosure of Interests

Johanna Mucke Speakers bureau: AbbVie Deutschland GmbH & Co. KG, Bristol Myers Squibb, Celgene GmbH, Chugai Pharma Germany GmbH, Gilead Sciences Inc., GSK, Janssen-Cilag GmbH, Lilly Deutschlang GmbH, Novartis Pharma GmbH, Consultant of: AbbVie Deutschland GmbH & Co. KG, Amgen, Astra Zeneca, BMS, Celgene GmbH, Gilead Sciences Inc., GlaxoSmithKline, Novartis Pharma GmbH, Lilly Deutschland GmbH, Medac GmbH, Mylan, Grant/research support from: Sanofi Aventis, Daliya Pencheva: None declared, Agner Parra Sanchez Grant/research support from: AstraZeneca, Kyra Kramer: None declared, Matthias Schneider Speakers bureau: MSD, Abbott, AbbVie, Pfizer, GlaxoSmithKline, UCB, Roche, AstraZeneca, Lilly, Janssen-Cilag, Sanofi-Aventis, Chugai, Celgene, Novartis, Boehringer Ingelheim and Bristol-Myers Squibb, Consultant of: MSD, Abbott, AbbVie, Pfizer, GlaxoSmithKline, UCB, Roche, AstraZeneca, Lilly, Janssen-Cilag, Sanofi-Aventis, Chugai, Celgene, Novartis, Boehringer Ingelheim and Bristol-Myers Squibb, Grant/research support from: GSK, UCB, Irene Bultink Speakers bureau: Speaker fees from Eli Lilly, MSD, Amgen, UCB, GSK, Roche, Sanofi Genzyme (outside the submitted work), Consultant of: Consultancy fees from Sanofi Genzyme and AstraZeneca (outside the submitted work)

Hypersensibilité au vaccin anti-COVID ? analyses de 1000 avis allergologiques

Introduction (contexte de la recherche)

Les services d’allergologie ont été fortement sollicités en raison de l’appréhension vis-à-vis du risque allergique des vaccins contre la COVID-19.

Objectif

Nous rapportons les 1000 premières prises en charge proposées et le résultat des investigations allergologiques réalisées.

Méthodes

Nous avons mis en place un système d’avis-COVID par mail à l’aide d’un questionnaire. Ceci nous a permis de colliger, de façon rétrospective les données démographiques des patients, les conduites à tenir proposées, en fonction des données cliniques fournies et des recommandations de la SFA. Pour certains, des tests cutanés ont été nécessaires : prick-test aux PEGs 3500/1500 et polysorbate 80 avec des concentrations maximales respectives de 100 mg/mL et 1000 mg/mL. Lorsque des fonds de flacon de vaccin étaient disponibles, nous avons réalisé : prick-test et IDR jusqu’à leur concentration pure. Certaines vaccinations jugées à risque ont été réalisées dans le service.

Résultats

Du 20 janvier au 24 novembre 2021, 1000 avis allergologiques ont été donnés par mail en dehors des heures de consultation. Il s’agissait de 773 avis pré-vaccinaux et 227 post-vaccinaux. L’âge moyen des patients était de 55 ans, avec une majorité de femmes. Nous avons levé la contre-indication allergologique à la vaccination dans 99,4 % des cas. Elle a été recommandée en centre de vaccination conventionnel pour 44 % sans précaution particulière, 31 % sous antihistaminique, 30 % avec 30 minutes de surveillance. 31 patients ont été vaccinés dans notre service sans réaction. L’indication de tests cutanés a été retenue dans 6,9 % des cas. Nous avons mis en évidence une sensibilisation aux excipients et aux vaccins chez 4 patients du groupe pré-vaccinal et chez une patiente du groupe post-vaccinal qui a bénéficié d’une désensibilisation avec succès.

Conclusions

La gestion par mail des avis-COVID a permis de limiter les consultations dédiées en présentiel et de maintenir l’intégralité des activités du service. Nous avons proposé une réponse rapide avec traçabilité écrite, souvent exigée. Seuls 4 patients restent à ce jour contre-indiqués à la vaccination en raison d’une allergie aux PEGs.

Towards quantum simulations in particle physics and beyond on noisy intermediate-scale quantum devices

We review two algorithmic advances that bring us closer to reliable quantum simulations of model systems in high-energy physics and beyond on noisy intermediate-scale quantum (NISQ) devices. The first method is the dimensional expressivity analysis of quantum circuits, which allows for constructing minimal but maximally expressive quantum circuits. The second method is an efficient mitigation of readout errors on quantum devices. Both methods can lead to significant improvements in quantum simulations, e.g. when variational quantum eigensolvers are used. This article is part of the theme issue 'Quantum technologies in particle physics'.

Assessing the position of pacemaker leads via transthoracic echocardiography: a prospective study

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND/ INTRODUCTION

Lead-induced tricuspid regurgitation (TR) in patients with cardiac implantable electronic devices (CIED) is associated with increased morbidity and mortality. Mechanisms proposed to explain CIED-induced TR can be classified as primary (implantation-related, lead-related) and secondary (pacing related). Primary CIED-induced TR results from the direct interaction of the lead with the tricuspid valve (TV). Determination of exact lead position via echocardiography is crucial however often difficult via standard views. Previous research has shown the value of an atypical subcostal 2D en-face view to describe the exact anatomy of the TV (Figure 1) (1-3).

PURPOSE

In this prospective observational investigation, we aimed to demonstrate the feasibility of the subcostal 2D en-face view of the TV to determine RV lead position at the level of TV passage and thereby to unmask potentially unfavorable lead-positions and interactions with the TV, which might otherwise remain unnoted.

METHODS

Consecutive patients who underwent implantation of CIED with at least one RV lead were prospectively included. Comprehensive transthoracic echocardiography (TTE) was performed before and after the procedure. An en-face view of the TV by an approximately 90° counter-clockwise rotation of the transducer from a standard subcostal 4-chamber view was attempted in all patients. Exact lead-position (e.g. postero-septal commissural, central, etc., see Figure 1) was described whenever possible.

RESULTS

A total of  35 patients were included in the final analysis, median age was 62 years, 27/35 (77%) were male.

Thirteen patients (37%) already had an RV lead prior to the recent procedure and therefore showed 2 or more leads passing the TV in post-procedural controls.

Implanted devices included cardiac contractility modulation (CCM) (7/35 patients, 20%), implantable cardioverter-defibrillator (ICD) (11/35 patients, 31%), cardiac resynchronization therapy (CRT) (7/35 patients 20%) and pacemaker (PM) (7/35 patients, 20%). Three patients (9%) received an additional RV lead due to RV lead dysfunction.

The exact position of the RV lead could be determined applying the en-face view in 27/35 patients (77%). In the majority of cases (20/35 patients, 57%), the RV lead passed through the tricuspid plane in a postero-septal commissural position. Central trajectory was observed in 5/35 patients (14%). Anteroseptal and anteroposterior passage were each found in one patient.

In the remaining 8/35 patients (23%), lead position could not be determined due to inferior image quality from the subcostal view.

CONCLUSIONS

RV lead position can be determined from a subcostal en-face view of the TV in a majority of patients after CIED implantation. Hereby, 2D-TTE can add significant value to the management, follow-up, and monitoring and should therefore be included in the standard TTE protocol of every patient with CIED. Abstract Figure 1

Peri- and intraoperative EEG signatures in newborns and infants

OBJECTIVE

The electroencephalographic derived indices have been developed for adult patients, however these monitors have not been validated for infants.

METHODS

Frontal EEGs were recorded in 115 infants aged <1 year [0-3-months (N = 27), 4-6-months (N = 30), 7-9-months (N = 29) and 10-12-months (N = 29)] who received general anaesthesia with sevoflurane. Total power (µV²) and relative β-, α-, θ-, δ-power (%) were analyzed. Additionally, in 20 EEGs event marker were added (baseline, loss of consciousness, intraoperative situation, extubation) to assess perioperative EEG dynamics.

RESULTS

Newborns show a mean relative δ-power at 80% in intraoperative EEG compared to infants (10-12 months) showing 47.5%. Relative β-power and α-power are low in newborns (mean 3.2% and 4.6%; respectively), with a marked increase in the older infants (4-6 months) (mean 10.9% and 14.4%; respectively). EEG dynamic in newborns from baseline (relative δ-power of 88%) to the intraoperative situation (80.5%) are discrete. In contrast infants >6-months have a strong reduction of relative δ-power from baseline to the intraoperative situation, which corresponds to an increase of faster frequencies.

CONCLUSIONS

Age dependent perioperative EEG signatures can be demonstrated in infants younger than one year.

SIGNIFICANCE

We demonstrate significant differences in EEG readouts between newborns and infants which questions our monitoring systems in paediatric anaesthesia.

Right ventricular longitudinal strain on cardiovascular magnetic resonance imaging predicts outcome in patients undergoing transcatheter mitral valve repair

Background

The prognostic value of left and right ventricular global longitudinal strain (LV and RV GLS) derived from cardiovascular magnetic resonance (CMR) feature tracking in patients with severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) is unknown.

Methods

Consecutive patients scheduled for TMVR underwent pre-procedural and follow-up CMR imaging including feature tracking strain analysis. Kaplan-Meier estimates and multivariate Cox-regression analyses were used to identify the prognostic impact of LV and RV GLS on CMR using a composite of heart failure hospitalization and death.

Results

A total of 62 patients (78.3±7.0y/o, 45% female, EuroSCORE II: 9.7±7.2%) with severe MR underwent CMR prior to TMVR. 23 (37%) patients presented with right ventricular dysfunction (RVD) defined by RV GLS &gt;−20% on CMR. At baseline, RVD was associated with NT-proBNP levels (9510 vs. 4064pg/mL, p=0.030). On CMR, RVD was associated with reduced left and RV ejection fraction (LVEF: 39.2 vs. 48.7%, p=0.011, RVEF: 35.1 vs. 46.7%, p&lt;0.001), as well as increased LV GLS (−14.0 vs. −19.5%, p=0.003).

A total of 18 events (12 deaths, 6 hospitalizations for heart failure) occurred during follow-up (mean 11.4±9.1months). While LV GLS was not significantly associated with outcome (HR 0.95, 95% CI: 0.90–1.01, p=0.082), RV GLS showed a strong and independent association with event-free survival by multivariate Cox-regression analysis (adj.HR 0.91, 95% CI: 0.83–0.99, p=0.033) after adjustment for relevant baseline and procedural data (EuroSCORE II, post-procedural residual MR), imaging parameters (TAPSE, LV and RVEF on CMR), and cardiac biomarkers (NT-proBNP). When compared with the “gold standard” RVEF on CMR (RVEF &lt;45%: adj.HR 0.86, 95% CI: 0.23–3.20, p=0.825) and TAPSE on echo (TAPSE &lt;17mm: adj.HR: 2.77, 95% CI: 0.72–10.70, p=0.140), only RVD (RV GLS &gt;−20%: adj.HR 5.05, 95% CI: 1.23–20.63, p=0.024) was significantly associated with the composite endpoint (Figure 1). Follow-up CMR was performed in 21 (34%) patients. RV GLS significantly improved after TMVR (−20.6 to −25.2%, p=0.016, Figure 2).

Conclusions

RV rather than LV GLS, as determined on CMR, is an important predictor of outcome in patients undergoing TMVR. At 1 year follow-up, RV function significantly improved, and thus might add useful prognostic information on top of established risk factors.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Prevalence of cardiac amyloidosis in patients undergoing transcatheter edge-to edge mitral valve repair

Introduction

Cardiac amyloidosis (CA) is associated with severe aortic stenosis, however, its prevalence in patients with severe mitral regurgitation in elderly patients is unknown.

Methods

Patients scheduled for transcatheter edge-to edge mitral valve repair (TMVR) were prospectively screened for CA using 99m technetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy and subsequent serum as well as urine free light-chain quantification in case of a positive DPD scan, defined as visual cardiac update based on the Perugini grading scale.

Results

Out of 100 patients undergoing TMVR, 28 patients (28.0%) had a positive DPD-scan (DPD+). 14 patients (14.0%) showed Perugini grade I enhancement, 9 patients (9.0%) grade II enhancement, and in 5 patients (5.0%), grade III enhancement was present. 28 patients suffered from TTR and two from AL- amyloidosis (one patient had a combination of TTR and AL-amyloidosis). When compared to patients with a negative scan (DPD-), DPD+ patients presented with similar baseline characteristics such as age (DPD- vs DPD+ 76y/o vs 77y/o, p=0.44), gender (female; 62.7% vs 50.0%, p=0.25), coronary artery disease (59.7% vs 42.9%, p=0.13), previous valve surgery (25.4% vs 14.3%, p=0.24) and atrial fibrillation (68.7% vs 78.6%, p=0.33). Also, NYHA functional class and EuroScore II were similar (NYHA ≥ III; 85.1% vs 82.1%, p=0.72, and EuroScore II 9.9±9.8% vs 7.0±4.8%, p=0.21, respectively). On echocardiography, DPD+ patients presented with more pronounced left and right ventricular hypertrophy (interventricular septum: 15mm vs 13mm, p&lt;0.01) but similar left ventricular ejection fraction (44.9% vs 42.3%, p=0.34). At 3-months after TMVR, DPD+ patients showed significant improvement in BNP serum levels when compared to DPD- patients (DPD+ vs DPD-: +315±2569pg/ml vs −2404±8696pg/ml, p=0.03), while NYHA functional class remained unchanged (NYHA improvement ≥1 class: 57.6% vs 50.0%, p=0.52)

Conclusions

In this single centre experience, CA was highly prevalent among elderly patients with severe mitral regurgitation scheduled for TMVR. TMVR in CA patients resulted in significant improvement of NT-pro BNP levels. Future studies need to clarify the prognostic relevance of CA in this specific patient population.

Funding Acknowledgement

Type of funding sources: None.

Transcatheter versus surgical valve repair in patients with severe mitral regurgitation

Background

Transcatheter edge-to-edge mitral valve repair (TMVR) is increasingly performed, however, its efficacy in comparison with surgical MV treatment (SMV) is unknown.

Methods

Consecutive patients with severe mitral regurgitation (MR) undergoing TMVR (68% functional, 32% degenerative) or SMV (9% functional, 91% degenerative; 23% MV replacement) were enrolled. To account for differences in baseline characteristics, propensity score-matching including age, EuroSCORE-II, left ventricular ejection fraction, and NT-proBNP was performed. A composite of heart failure (HF) hospitalization/death was defined as primary endpoint. Kaplan-Meier curves and Cox-regression analyses were used to investigate associations between baseline, imaging, and procedural parameters and outcome.

Results

Between July 2017 and April 2020, 245 patients were enrolled, of which 102 patients could be adequately matched (73y/o, 61% females, EuroSCORE-II: 5.7%, p&gt;0.05 for all). Despite matching, TMVR patients were sicker at baseline (higher rates of prior myocardial infarction, coronary revascularization, pacemakers/defibrillators, and diabetes mellitus, p&lt;0.009 for all).

Patients were followed for 28.3±27.2 months, during which 27 events (17 deaths, 10 HF hospitalizations) occurred.Postprocedural MR reduction (MR grade &lt;2: TMVR vs. SMV: 88% vs. 94%, p=0.487) and freedom from HF hospitalization/death (log-rank: p=0.221) were similar at two years. By multivariable Cox analyses, EuroSCORE-II (adj.HR 1.07 [95% CI: 1.00–1.13], p=0.027) and postprocedural MR severity (adj.HR 1.85 [95% CI: 1.17–2.92], p=0.009) emerged as independent predictors of outcome.

Conclusions

In this propensity matched, all-comers cohort, 2-year outcomes after TMVR versus SMV were similar. Given the reported favorable long-term durability of TMVR, the interventional approach emerges as valuable alternative for a substantial number of patients with functional and degenerative MR at high/prohibitive surgical risk.

Funding Acknowledgement

Type of funding sources: None.

Curating the Digital Mental Health Landscape With a Guide to Behavioral Health Apps: A County-Driven Resource

With more than 10,000 mental health apps available, consumers and clinicians who want to adopt such tools can be overwhelmed by the multitude of options and lack of clear evaluative standards. Despite the increasing prevalence of curated lists, or app guides, challenges remain. Organizations providing mental health services to consumers have an opportunity to address these challenges by producing guides that meet relevant standards of quality and are tailored to local needs. This column summarizes an example of the collaborative process of app guide development in a publicly funded mental health service context and highlights opportunities and barriers identified through the process.

Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study

Background

Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population.

Objective

This study aimed to understand facilitators of and barriers to mental health app use among community college students.

Methods

A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps.

Results

Of the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect.

Conclusions

These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps.

Quantitative characterization of AEB pulses across the modern fleet

OBJECTIVE

Characteristics of specific Automatic Emergency Braking (AEB) pulses can result in increased motion of the occupant, which can lead to the occupant being out-of-position such that when a crash occurs protection may be compromised. Quantifying these variations across the modern fleet is crucial to understand the loading environment to which vehicle occupants are exposed. Therefore, we categorized the AEB pulses based on acceleration pulse features such as deceleration magnitude, jerk, and ramp time.

METHODS

A total of 2278 AEB vehicle tests (years 2013-2019) were extracted from the Insurance Institute for Highway Safety (IIHS) database and analyzed. The following pulse characteristics were extracted: Jerk (g/s), Ramp-time (s), and Maximum deceleration (g). A subset of tests in which the tested vehicle did not contact the foam target (n = 1665) was analyzed further, with the following additional variables extracted: Deceleration time (s), Steady-state deceleration (g), and Duration (s). Other non-pulse related features were also considered: Test speed (20 and 40 km/h), Curb weight (Kg), and Vehicle Model Year. Using machine learning methods, the pulses were categorized into clusters. One-way ANOVAs for continuous variables and X² for categorical features were used to assess differences between clusters (p ≤ 0.05).

RESULTS

Using the entirety of the AEB vehicle tests extracted (n = 2278), a total of 3 clusters were selected. The three clusters showed significantly different Jerk, Ramp-time, and Maximum deceleration (p < 0.001). Target contact decreased in AEB tests with more recent vehicle model years (rate of contact 66% in 2014 vs 1.7% in 2019). In one cluster, Jerk and Maximum deceleration increased with vehicle model year. Using the subset of tests in which there was no contact with the foam target (n = 1665), 4 categories of pulses were selected. In both sets of clusters, Ramp-time and Jerk showed moderate inverse correlation (r = -0.7), while all other features showed a low correlation.

CONCLUSIONS

These results show that AEB technology improved over the years in obstacle avoidance. The identification of AEB pulse clusters is important in order to describe distinct approaches to achieving AEB and to be able to reproduce representative AEB pulses in the laboratory and understand the influences of those pulses on occupants' motion.

AB0341 SLE PREGNANCIES AT HIGH RISK FOR PRE-ECLAMPSIA BENEFIT MOST FROM COMBINATION OF LOW DOSE ASPIRIN AND HYDROXYCHLOROQUINE

Background:

Women with SLE face a high risk of preeclampsia (PE). Low dose Aspirin (LDA) is known to protect against PE in non-autoimmune patients and is recommended for SLE patients1. Besides, a beneficial effect of hydroxychloroquine (HCQ) on the occurrence of PE has recently been discussed2.

Objectives:

To investigate the influence of LDA and HCQ on the occurrence of PE in SLE patients.

Methods:

Pregnancies of women with SLE from an outpatient pregnancy clinic were prospectively evaluated. Clinical characteristics, medication use and pregnancy outcomes were analysed. Association of LDA use (latest from gestational week 16 on) and HCQ use (from 1st trimester on) with PE were analysed using a multiple logistic regression model (adjustment for age, BMI, hypertension, disease activity in 1st trimester, lupus nephritis, nulliparity, history of PE and high-risk aPL profile3).

Results:

We enrolled 190 lupus pregnancies (148 women, 1995-2019). Additional risk factors for PE were present in 83.7%: 55.8% showed a high-risk profile (HRP) for PE according to ACOG4 (history of PE, hypertension, lupus nephritis or aPL), another 27.9% had at least one moderate risk factor (nulliparous, BMI>30 or age>35) (see table 1).

Each 20.5% of pregnancies received HCQ only or LDA only, while 22.6% were prescribed both drugs. 36.3% took neither HCQ nor LDA. Women with HRP were more likely to take LDA alone or in combination with HCQ (28.3% and 35.8%, respectively).

PE occurred in 13.2% of pregnancies (7.7% in HCQ only, 15.4% in LDA only, 14.0% in HCQ and LDA, 14.5% in no HCQ or LDA). Most pregnancies affected by PE carried a HRP (88.0%).

Use of LDA was significantly associated with a lower risk for PE [aOR 0.21 (95%-CI 0.05-0.99), p<0.05]. HCQ use also had a moderating effect on the incidence of PE, but this effect did not reach significance [aOR 0.47 (95%-CI 0.15-1.52), p=0.21]. If only pregnancies with HRP were considered, the effect size increased for HCQ (LDA [aOR 0.18 (95%-CI 0.04-0.96), p<0.05], HCQ [aOR 0.28 (95%-CI 0.07-1.14), p=0.075]).

Conclusion:

In this prospective real-life cohort, timely LDA medication was associated with a lower risk of PE in SLE pregnancies. In a multiple regression model taking LDA and HCQ into account, the favourable effect on the occurrence of PE was partially explained by HCQ. In particular, SLE patients at high risk for PE seem to benefit from HCQ during pregnancy. Future research may reveal mechanisms by which HCQ might lower the incidence of PE.

References:

[1]doi: 10.1136/annrheumdis-2016-209770

[2]doi: 10.1111/bcp.14131

[3]doi: 10.1136/annrheumdis-2019-215213

[4]doi: 10.1097/AOG.0000000000002708

Table 1.

Patient characteristics and risk profile

HCQ only (n=39)LDA only (n=39)HCQ + LDA (n=43)no HCQor LDA(n=69)Patient characteriticsAge (years), median (IQR)29 (25-33)32 (30-33)30 (28.5-33.5)31 (28-35)BMI, median (IQR)23.5 (22-25)23 (22-24)22 (22-24)23 (22-24)Chronic Hypertension, n (%)7 (17.9%)9 (23.1%)6 (14.0%)9 (13.0%)Preconception counselling, n (%)23 (59.0%)28 (71.8%)35 (81.4%)41 (59.4 %)Obstetrical historyNulliparous, n (%)20 (51.3%)26 (66.7%)33 (76.7%)36 (52.2%)Previous fetal loss, n (%)1 (2.6%)10 (25.6%)14 (32.6%)10 (14.5%)Previous PE, n (%)2 (5.1%)4 (10.3%)4 (9.3%)5 (7.2%)SLE characteristicsand therapyDisease duration (years), median (IQR)7.0 (2.0-11.0)7.5 (3.0-11.5)6.7 (3.4-10.0)6.0 (3.0-9.2)SLEDAI, median (IQR)2.0 (1.0-4.3)2.0 (0-2.5)4.0 (2.0-4.0)2.0 (0-4.0)Lupus nephritis, n (%)9 (23.1%)13 (33.3%)18 (41.9%)14 (20.3%)Anti-dsDNA antibodies, n (%)22 (56.4%)15 (38.5%)36 (83.7%)33 (47.8%)Prednisolone therapy, n (%)26 (66.7%)15 (38.5%)25 (58.1%)29 (42.0%)Prednisolone (mg/d), median (IQR)5.0 (5.0-8.0)5.0 (5.0-7.5)5.0 (4.0-5.0)5.0 (5.0-8.0)aPL statusAPS, n (%)-12 (30.8%)14 (32.6%)2 (2.9%)Any positive aPL, n (%)-20 (51.3%)19 (44.2%)5 (7.2%)LAC, n (%)-15 (38.5%)13 (30.2%)3 (4.3%)ACL, n (%)-14 (35.9%)13 (30.2%)4 (5.8%)β2-GP1, n (%)-12 (30.8%)12 (27.9%)2 (2.9%)

LAC = Lupus anticoagulant, ACL = Anticardiolipin antibody, β2-GP1 = β2-Glycoprotein I antibody

Disclosure of Interests:

None declared