POS1050 SECUKINUMAB LEADS TO IMPROVEMENT ACROSS PSORIATIC ARTHRITIS MANIFESTATIONS OVER 2 YEARS REGARDLESS OF PREVIOUS EXPOSURE TO A TNF INHIBITOR: A POST HOC ANALYSIS OF FUTURE 5

Background:

The goal of treating psoriatic arthritis (PsA) is to achieve very low disease activity or remission across disease manifestations. In the phase 3 FUTURE 5 study (NCT02404350), patients receiving secukinumab (SEC) demonstrated sustained clinical improvements across PsA manifestations through Week 104.1 However, the effect of previous tumor necrosis factor inhibitor (TNFi) exposure on achievement of remission across PsA manifestations was not explored.

Objectives:

To report exploratory efficacy analyses of SEC at Week 104 on stringent endpoints across PsA manifestations in patients who were TNFi naive or inadequate responders (TNF-IR).

Methods:

Patient data from FUTURE 5 were stratified by previous TNFi exposure and analyzed by treatment arm. At Week 104, patients received SEC 300 or 150 mg with subcutaneous loading dose (LD), SEC 150 mg without LD, or had received placebo up to Week 16 and were switched to SEC 300 or 150 mg between Weeks 16 or 24 based on tender and swollen joint count response. Patients with suboptimal clinical response to SEC 150 mg could escalate to SEC 300 mg after Week 52 per investigator judgment.2 Exploratory efficacy analyses at Week 104 included resolution of TJC/SJC (0 tender/swollen joints), resolution of enthesitis and dactylitis, 75% improvement in the modified Nail Psoriasis Severity index (mNAPSI75), 100% improvement in the Psoriasis Area and Severity Index (PASI100), very low disease activity (VLDA), and Disease Activity in Psoriatic Arthritis (DAPSA) remission. Descriptive statistics are provided for each endpoint using an observed-case approach.

Results:

Regardless of previous TNFi exposure, SEC-treated patients achieved several stringent endpoints across PsA domains, including TJC/SJC resolution, resolution of dactylitis/enthesitis, mNAPSI75, and PASI100 at Week 104 (Table 1). TNFi-naive patients generally experienced greater improvements than TNF-IR patients (Table 1 above). Similar trends were observed for achievement of VLDA and DAPSA remission at Week 104 (Figure 1).

Conclusion:

SEC treatment resulted in sustained achievement of stringent endpoints across key PsA manifestations through Week 104 in both TNFi-naive and TNF-IR patients, with generally greater clinical responses among TNFi-naive patients.

References:

[1]Mease P, et al. Ann Rheum Dis. 2018;77:890-897.

[2]Mease P, et al. Arthritis Rheumatol. 2019;71:(suppl 10) [abstract 1554].

Table 1.

Achievement of Key Outcomes Across PsA Manifestations at Week 104 Among TNF-IR and TNFi-Naive Patients Treated With SEC

SEC 300 mgSEC 150 mgaSEC 150 mg No LoadbPBO–SEC 300 mgPBO–SEC 150 mgcOutcomes, n/M (%)TNFi-naiven=154TNF-IRn=68TNFi-naiven=153TNF-IRn=67TNFi-naiven=157TNF-IRn=65TNFi-naiven=109TNF-IRn=44TNFi-naiven=114TNF-IRn=39TJC/SJC resolution51/140 (36.4)19/51 (37.3)46/136 (33.8)11/46 (23.9)53/125 (42.4)14/43 (32.6)40/90 (44.4)11/31 (35.5)32/96 (33.3)10/28 (35.7)Resolution of dactylitis42/48 (87.5)11/16 (68.8)37/43 (86.0)16/19 (84.2)56/62 (90.3)11/13 (84.6)35/41 (85.4)5/7 (71.4)30/33 (90.9)10/12 (83.3)Resolution of enthesitis70/88 (79.5)22/30 (73.3)70/85 (82.4)24/32 (75.0)50/69 (72.5)16/26 (61.5)37/50 (74.0)12/17 (70.6)39/56 (69.6)14/20 (70.0)mNAPSI7561/73 (83.6)15/26 (57.7)66/76 (86.8)16/23 (69.6)61/80 (76.3)13/18 (72.2)42/51 (82.4)13/17 (76.5)34/64 (53.1)7/14(50.0)PASI10034/68 (50.0)14/29 (48.3)41/85 (48.2)5/19(26.3)33/73 (45.2)4/18(22.2)23/45 (51.1)9/18(50.0)19/46 (41.3)6/13(46.2)

IR, inadequate responder; M, number of evaluable patients; mNAPSI, modified Nail Psoriasis Severity Index; PASI, Psoriasis Area and Severity Index; PBO, placebo; SEC, secukinumab; TJC/SJC resolution, 0 tender/swollen joints; TNFi, tumor necrosis factor inhibitor.

a Includes 53 TNFi-naive and 23 TNF-IR patients with dose escalation.

b Includes 58 TNFi-naive and 19 TNF-IR patients with dose escalation.

c Includes 40 TNFi-naive and 12 TNF-IR patients with dose escalation.

Figure 1.

Acknowledgements:

This study was funded by Novartis Pharma AG. The authors thank Prasanthi Mandalay, PhD, of ArticulateScience LLC, for providing medical writing support/editorial support, which was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Ana-Maria Orbai Consultant of: Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Celgene, Horizon, Janssen, Eli Lilly, and Novartis, M Elaine Husni Consultant of: AbbVie, Amgen, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Regeneron, and UCB, Grant/research support from: Pfizer, Dafna D Gladman Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Galapagos, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Pfizer, and UCB, Bhumik Parikh Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Xiangyi Meng Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Corine Gaillez Employee of: Novartis Pharma AG, Basel, Switzerland, Philip J Mease Speakers bureau: AbbVie, Amgen, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB.

POS0194 ENTHESITIS IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH SECUKINUMAB OR ADALIMUMAB: A POST HOC ANALYSIS OF EXCEED

Background:

Enthesitis is a key musculoskeletal manifestation of psoriatic arthritis (PsA). EULAR guidelines recommend biologics for patients with enthesitis and an inadequate response to or intolerance of nonsteroidal anti-inflammatory drugs, although no guidance on specific biologics is offered. In the EXCEED head-to-head, double-blind study (NCT02745080), secukinumab (SEC) and adalimumab (ADA) showed a similar efficacy in joints and in resolution of enthesitis at Week 52 for patients with PsA,1 although a detailed analysis of enthesitis was not conducted.

Objectives:

To explore detailed enthesitis treatment response, including temporal and additional enthesitis assessment data, in patients with PsA treated with SEC or ADA over 52 weeks.

Methods:

In this post hoc analysis, patient data from EXCEED were grouped by presence or absence of baseline enthesitis based on the Leeds Enthesitis Index (LEI) and the Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Baseline characteristics of these groups were summarized. Median time to resolution of LEI/SPARCC enthesitis score in patients receiving SEC or ADA was assessed using Kaplan-Meier analysis. Efficacy was further assessed among the enthesitis subset by LEI and SPARCC change from baseline, resolution of enthesitis (LEI/SPARCC) at Weeks 24 and 52, and resolution of enthesitis at Week 52 by baseline enthesitis severity. Relapse of enthesitis after a first resolution was evaluated at Weeks 24 and 52. Missing data were imputed by nonresponder imputation.

Results:

Baseline demographics were well balanced in the LEI/SPARCC enthesitis subsets, although a higher proportion of all patients with enthesitis were women vs those with no enthesitis (LEI: 54.6% vs 40.5%; SPARCC: 53.2% vs 36.2%). Patients with baseline enthesitis had higher disease activity vs patients without enthesitis (LEI/SPARCC enthesitis vs no LEI/SPARCC enthesitis: tender joint count of 78 joints [22.8/22.1 vs 15.8/13.8], Health Assessment Questionnaire-Disability Index [1.3/1.3 vs 1.1/1.1], and mean Psoriasis Area and Severity Index [6.4/6.1 vs 5.1/5.3]). Median time to resolution of LEI and SPARCC enthesitis was similar between patients receiving either SEC or ADA (Table 1). Both treatment groups experienced a similar mean change from baseline in LEI and SPARCC enthesitis counts and a similar resolution of LEI and SPARCC at Weeks 24 and 52 (Table 1). Achievement of enthesitis resolution was similar between treatment groups irrespective of disease severity (Figure 1). The proportion of patients who experienced relapse after achieving resolution was low across both treatments (Table 1).

Conclusion:

In EXCEED, patients with baseline enthesitis presented with higher disease burden, consistent with the FUTURE trials.2 SEC and ADA showed similar kinetics of response and efficacy on enthesitis, irrespective of baseline enthesitis severity.

References:

[1]McInnes IB, et al. Lancet. 2020;395(10235):1496-1505.

[2]Coates LC, et al. Arthritis Res Ther. 2019;21(1):266.

Table 1.

Clinical Improvements Among Patients With Baseline LEI or SPARCC Enthesitis Treated with Secukinumab or Adalimumab (nonresponder imputation)

Secukinumab300 mgAdalimumab40 mgOutcomesaLEI(n=234)SPARCC(n=301)LEI(n=264)SPARCC(n=331)Baseline enthesitis count, mean (SD)2.6 (1.5)5.0 (3.8)2.8 (1.6)5.4 (4.0)Median time to enthesitis resolution, days (95% CI)85 (57–113)113 (85–169)85 (57–86)88 (85–114)Enthesitis count, mean improvement from baseline (SD) Week 24−1.6 (1.6)−3.3 (3.5)−1.6 (1.6)−3.1 (3.5) Week 52−1.8 (1.6)−3.6 (3.2)−2.1 (1.7)−3.9 (3.8)Resolution of enthesitis, n (%) Week 24116 (49.6)138 (45.8)115 (43.6)144 (43.5) Week 52142 (60.7)160 (53.2)146 (55.3)170 (51.4)Enthesitis relapse, n/M (%) Week 2437/210 (17.6)38/274 (13.9)49/232 (21.1)47/293 (16.0) Week 5240/208 (19.2)56/267 (21.0)32/208 (15.4)41/263 (15.6)

LEI, Leeds Enthesitis Index; M, number of evaluable patients; SPARCC; Spondyloarthritis Research Consortium of Canada Enthesitis Index.

a Based on respective enthesitis measures.

Figure 1.

Acknowledgements:

This study was funded by Novartis Pharma AG. The authors thank Richard Karpowicz, PhD, of Health Interactions, Inc, for providing medical writing support/editorial support, which was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Gurjit S. Kaeley Consultant of: Novartis Pharmaceuticals Corporation, Georg Schett Speakers bureau: AbbVie, Bristol Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, and Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, and UCB, Grant/research support from: Bristol Myers Squibb, Celgene, GSK, Eli Lilly, and Novartis, Philip G Conaghan Consultant of: or Speakers bureau: AbbVie, AstraZeneca, Bristol Myers Squibb, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, and Pfizer, Grant/research support from: UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Dennis McGonagle Speakers bureau: Roche, Sobi, and Novartis, Grant/research support from: Novartis, Frank Behrens Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, Merck Sharp & Dohme, Celgene, Roche, and Chugai, Grant/research support from: Pfizer, Janssen, Chugai, Celgene, and Roche, and has received investigator fees from Eli Lilly, Philippe Goupille Grant/research support from: and/or Consultant of/Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Celgene, Chugai, Janssen, Lilly, Medac, Merck Sharp & Dohme, Nordic Pharma, Novartis, Pfizer, Sanofi, and UCB, Corine Gaillez Employee of: Novartis Pharma AG, Bhumik Parikh Employee of: Novartis Pharmaceuticals Corporation, Xiangyi Meng Employee of: Novartis Pharmaceuticals Corporation, Catherine Bakewell Consultant of: and/or Speakers bureau: AbbVie, Novartis, Pfizer, Janssen, UCB, and Sanofi Genzyme/Regeneron

The protective effect of hesperidin against renal ischemia-reperfusion injury involves the TLR-4/NF-κB/iNOS pathway in rats

Renal injury is reported to have a high mortality rate. Additionally, there are several limitations to current conventional treatments that are used to manage it. This study evaluated the protective effect of hesperidin against ischemia/reperfusion (I/R)-induced kidney injury in rats. Renal injury was induced by generating I/R in kidney tissues. Rats were then treated with hesperidin at a dose of 10 or 20 mg/kg intravenously 1 day after surgery for a period of 14 days. The effect of hesperidin on renal function, serum mediators of inflammation, and levels of oxidative stress in renal tissues were observed in rat kidney tissues after I/R-induced kidney injury. Moreover, protein expression and mRNA expression in kidney tissues were determined using Western blotting and RT-PCR. Hematoxylin and eosin (H&E) staining was done for histopathological observation of kidney tissues. The data suggest that the levels of blood urea nitrogen (BUN) and creatinine in the serum of hesperidin-treated rats were lower than in the I/R group. Treatment with hesperidin also ameliorated the altered level of inflammatory mediators and oxidative stress in I/R-induced renal-injured rats. The expression of p-IκBα, caspase-3, NF-κB p65, Toll-like receptor 4 (TLR-4) protein, TLR-4 mRNA, and inducible nitric oxide synthase (iNOS) was significantly reduced in the renal tissues of hesperidin-treated rats. Histopathological findings also revealed that treatment with hesperidin attenuated the renal injury in I/R kidney-injured rats. In conclusion, our results suggest that hesperidin protects against renal injury induced by I/R by involving TLR-4/NF-κB/iNOS signaling.

Rapid Qualitative and Quantitative Analysis of Caffeine and Sodium Benzoate in Annaca by Infrared Spectroscopy

Objective To establish an infrared spectroscopic method for the rapid qualitative and quantitative analysis of caffeine and sodium benzoate in Annaka samples. Methods Qualitative and quantitative modeling samples were prepared by mixing high-purity caffeine and sodium benzoate. The characteristic absorption peaks of caffeine and sodium benzoate in Annaka samples were determined by analyzing the infrared spectra of the mixed samples. The quantitative model of infrared spectra was established by partial least squares （PLS）. Results By analyzing the infrared spectra of 17 mixed samples of caffeine and sodium benzoate （the purity of caffeine ranges from 10% to 80%）, the characteristic absorption peaks for caffeine were determined to be 1 698, 1 650, 1 237, 972, 743, and 609 cm^-1. The characteristic absorption peaks for sodium benzoate were 1 596, 1 548, 1 406, 845, 708 and 679 cm^-1. When the detection of all characteristic absorption peaks was the positive identification criteria, the positive detection rate of caffeine and sodium benzoate in 48 seized Annaka samples was 100%. The linear range of PLS quantitative model for caffeine was 10%-80%, the coefficient of determination （ R²） was 99.9%, the root mean square error of cross validation （RMSECV） was 0.68%, and the root mean square error of prediction （RMSEP） was 0.91%; the linear range of PLS quantitative model for sodium benzoate was 20%-90%, the R² was 99.9%, the RMSECV was 0.91% and the RMSEP was 1.11%. The results of paired sample t test showed that the differences between the results of high performance liquid chromatography method and infrared spectroscopy method had no statistical significance. The established infrared quantitative method was used to analyze 48 seized Annaka samples, the purity of caffeine was 27.6%-63.1%, and that of sodium benzoate was 36.9%-72.3%. Conclusion The rapid qualitative and quantitative analysis of caffeine and sodium benzoate in Annaka samples by infrared spectroscopy method could improve identification efficiency and reduce determination cost.

Influence of the Internet of Things management system on hand hygiene compliance in an emergency intensive care unit

BACKGROUND

Hand hygiene is a critical strategy for infection prevention in all healthcare settings. Automated electronic monitoring systems are expected to improve hand hygiene performance.

AIM

To investigate the impact of the Internet of Things (IoT) management system on hand hygiene compliance among medical staff in an emergency intensive care unit (EICU).

METHODS

This retrospective observational study was conducted between July 1^st, 2017 and February 28^th, 2018 in a 19-bed EICU. The changes in hand hygiene compliance among 54 members of medical staff and the incidence of hospital infections were compared, counted, and analysed before and after implementing the IoT management system in the EICU that was initiated on November 1^st, 2017.

FINDINGS

After the application of the IoT management system, the hand hygiene compliance rates among the members of the medical staff before (29.5% (3347/11,338) vs 57.9% (4690/8094), P < 0.001) and after (59.9% (9915/16,556) vs 73.8% (17,194/23 286), P < 0.001) the contact with patients and surrounding environment significantly improved. However, hand hygiene compliance among three cleaning staff did not significantly improve after the application. Moreover, there was no significant difference in healthcare-acquired infection rates (2.535% (9/355) vs 2.047% (7/342), P = 0.667) nor in the detection rates of the four major multidrug-resistant bacteria in the EICU before and after the application of the IoT management system (P > 0.05).

CONCLUSION

The IoT management system significantly improved hand hygiene compliance among medical staff, except cleaners, in the EICU of one provincial hospital; however, the rates of nosocomial infection did not significantly decrease. The quality of hand hygiene implementation needs to be improved.

[Research on the spread of the book Shiyi Xinjian in ancient and modern times]

Three volumes of Shiyi Xinjian, written by Zan Yin of Tang Dynasty, contains the theories and prescriptions of food treatment in various branches, which have far-reaching influence on food treatment and clinical treatment. The book was written in the 9th century A. D. as a dietary therapy prescription. In the Northern Song Dynasty, the book of Shiyi Xinjian was still surviving. It has been cited in Taiping Shenghuifang: Shizhi, Yanglao Fengqinshu, Zhenglei Bencao(, Classified Materia Medica from Historical Classics for Emergency) and Shengji Zonglu: Shizhimen. After the Jingkang Incident, the book was rare, and even may have been lost. Until the Ming Dynasty, the book was completely disappeared in China. However, there are some Quotes in the book Zhenglei Bencao and other books, and the contents of this book are still often cited by later medical books. After that, the Japanese collected 211 prescriptions of Shiyi Xinjian from Euibangyoochui in Korea. Luo Zhenyu brought them back to China and published them in the Dongfang Xuehui in 1924, which made the Shiyi Xinjian appear in a separate volume in China for the first time since it was lost, which promoted the spread of the book in China. After the founding of the People's Republic of China, some of the scholars collected it again, which improved the content of the book.

Time-dependent Microhardness Gradients of Self-adhesive Resin Cements Under Dual- and Self-curing Modes

CLINICAL RELEVANCE

Acid-functional monomers in self-adhesive resin cements may decrease their self-curing polymerization ability. Light irradiation optimizes polymerization performance.

SUMMARY

Purpose: The aim of this study was to investigate Knoop microhardness of self-adhesive resin cements under dual- and self-curing modes in simulated canals for describing the polymerization behavior.Methods and Materials: Slots in lightproof silicone cylinders with one open end were filled with the following eight materials: a traditional resin cement (Duolink), a core build-up resin material (MultiCore Flow), and six self-adhesive resin cements (RelyX Unicem 2, G-Cem Automix, Maxcem, Biscem, Multilink Speed, and PermaCem 2.0). The resins were exposed to light through the open end and then stored in a lightproof box. The Knoop hardness gradient for each resin was measured after 1 hour and 120 hours. Surface readings were obtained at 1-mm intervals from 1 mm to 10 mm away from the open ends. The data were analyzed by two-way analysis of variance and the Student-Newman-Keuls test (α=0.05).Results: All the resin materials had stable Knoop hardness numbers (KHNs) at a certain depth; their KHNs in the self-curing mode did not change (p>0.05). The region above this certain depth was regarded as having undergone the dual-curing mode, and the KHN decreased gradually with depth (p<0.05). Between 1 and 120 hours postexposure, the ratio of the KHN at a 5-mm depth (self-cured) to that at a 1-mm depth (dual-cured) increased in Duolink and MultiCore Flow. However, the ratios of the six adhesive resin cements varied.Conclusion: Without light, most self-adhesive resin cements differed from traditional dual-cured resin materials in terms of Knoop micro-hardness, and they had a lesser capacity for chemical-induced curing.

Gut dysbacteriosis and intestinal disease: mechanism and treatment

The gut microbiome functions like an endocrine organ, generating bioactive metabolites, enzymes or small molecules that can impact host physiology. Gut dysbacteriosis is associated with many intestinal diseases including (but not limited to) inflammatory bowel disease, primary sclerosing cholangitis-IBD, irritable bowel syndrome, chronic constipation, osmotic diarrhoea and colorectal cancer. The potential pathogenic mechanism of gut dysbacteriosis associated with intestinal diseases includes the alteration of composition of gut microbiota as well as the gut microbiota-derived signalling molecules. The many correlations between the latter and the susceptibility for intestinal diseases has placed a spotlight on the gut microbiome as a potential novel target for therapeutics. Currently, faecal microbial transplantation, dietary interventions, use of probiotics, prebiotics and drugs are the major therapeutic tools utilized to impact dysbacteriosis and associated intestinal diseases. In this review, we systematically summarized the role of intestinal microbiome in the occurrence and development of intestinal diseases. The potential mechanism of the complex interplay between gut dysbacteriosis and intestinal diseases, and the treatment methods are also highlighted.