Safety and efficacy of anakinra as first-line or second-line therapy for systemic onset juvenile idiopathic arthritis - data from the German BIKER registry

Background: The IL-1 receptor-antagonist anakinra is recommended for the treatment of systemic juvenile idiopathic arthritis (sJIA) and was recently approved for first-line treatment. Long-term data from clinical practise are scarce. Methods: SJIA patients from the German biologics in pediatric rheumatology (BIKER) registry starting anakinra were grouped into two cohorts: Patients in the first-line cohort received no prior sJIA treatment except NSAID and a maximum of 3 days of steroids. Second-line cohort patients were pre-treated with steroids; DMARDs or biologics. Patient characteristics, disease-activity parameters, efficacy, and safety-parameters were compared. Results: Until December 2018, 51 anakinra patients were documented, representing 117.96 patient-years. Mean disease duration was 3.5 (± 3.8) years. At baseline, all anakinra first-line users had active systemic disease compared to 82% in the second-line users. Significant JADAS-10 improvement at last follow-up was observed in both cohorts (p = 0.02, p = 0.0014). Substantial numbers of patients in both groups reached JADAS-MDA/JADAS-remission/inactive disease (66.7%50%50% in first-liners and 60%45%70% in second-liners). Rates of serious adverse events were comparable and consistent with the overall AE profile of anakinra in patients. Conclusion: This analysis adds to the established safety profile of anakinra and demonstrates that anakinra is effective as first-line or second-line treatment.

Contemporary predictors of readmission outcomes in patients with infective endocarditis: analysis from a national readmission database

Background/Introduction

Infective endocarditis (IE) remains a serious illness that is associated with remarkable morbidity and mortality in the United States (US). There are limited studies that investigated predictors of 30-day readmission risk in this population.

Purpose

We aimed to perform a contemporary analysis to investigate predictors of 30-day readmission in IE patients in the US.

Methods

We used the 2017 national readmission database to identify index admissions among adults (age ≥18) with the diagnosis of IE. Appropriate International Statistical Classification (ICD-10) codes were used to identify patients with IE. Primary outcome of interest was 30-day readmission, and hospital cost was the secondary outcome.

Results

Out of 49,692 admissions for IE, 5,743 (11.6%) patients were readmitted within 30 days. Patients who had 30-day readmission were younger (55±20 vs 61±19 years, P<0.001), 44.8% were females (P=0.08), 27.9% had diabetes mellitus (DM), 56.8% had hypertension, 37.9% had heart failure (HF), 31.3% had chronic kidney disease (CKD), 12.2% had end stage renal disease, and 47.8% had Medicare insurance. Patients who had readmissions within 30 days were more likely to have non-elective index admission (96.9% vs 93.4%, P<0.001), more likely to have hepatitis C (19.5% vs 12.2%, P<0.001), human immunodeficiency virus (HIV) (1.7% vs 1.2%, P<0.001), substance abuse (8.6% vs 5.4%, P<0.001), opioid abuse (24% vs 14.7%, P<0.001), and cocaine use (7.4% vs 4.3%, P<0.001). Overall, 5,393 (10.9%) patients died during index admission. Median cost for readmissions within 30 days was $83,217 [$41,457-$165,487], compared to the index admission cost of $90,257 [$41,945- $208,851] (P<0.001). After adjusting for age, DM, HF, and CKD, substance abuse (odds ratio (OR): 1.19 [1.07–1.33]; P 0.001), opioid abuse (OR: 1.37, [1.26- 1.48]; P<0.001), cocaine use (OR: 1.33 [1.18- 1.48]; P<0.001), HIV (OR: 1.25 [1.01–1.56]; P=0.04), and hepatitis C (OR: 1.34 [1.24–1.45]; P<0.001) correlated with higher odds of readmissions within 30 days (Figure 1).

Conclusion

Approximately 1 in 4 patients admitted for IE in the US had a history of opioid abuse and almost one fifth had hepatitis C. The 30-day readmission rate remains significant in IE with high financial burden on the health system. Both opioid abuse and hepatitis C were among the highest predictors of readmission within 30 days. Identifying modifiable predictors of readmission in this population may reduce readmission risk and healthcare cost.

Figure 1

Funding Acknowledgement

Type of funding source: None

Long-term natural history of transient constrictive pericarditis

Background

In recent years, there has been increasing recognition of a potentially-reversible, transient/ subacute form of constrictive pericarditis (CP). To date, studies have been small with lack of long-term longitudinal follow-up.

Purpose

We aimed to elucidate the causes and natural history of subacute CP.

Methods

Patients were included if (1) they had a diagnosis of CP, (2) had cardiac magnetic resonance (CMR) within 12 months of symptom onset with evidence of pericardial delayed enhancement/ inflammation (Figure) (3) received anti-inflammatory medications.

Results

A total of 78 individuals were included, comprising 61 men (78%) with a mean age of 59±14 years. Causes of subacute CP included idiopathic/ viral pericarditis (58%), post-pericardiotomy (29%), autoimmune (6%), radiation therapy (3%) and others (4%). After median follow-up of 4.4 years, 31 (40%) required pericardiectomy. There were no deaths.

Patients who underwent pericardiectomy had longer duration of symptoms at presentation [6 (4–9) vs. 3 (2–5) months, P<0.01], were more likely to be on diuretic therapy (87 vs. 45%, P<0.001), had lower ultra-sensitive C-reactive protein [4.4 (2.6–13.1) vs. 11.95 (1.8–61.55) mg/dl, P<0.001] and lower erythrocyte sedimentation rate [5 (2–10) vs. 25 (6–43 mm/hr), P=0.031] compared to those who were managed medically. There were no other significant differences in clinical characteristics or baseline anti-inflammatory therapy. The presence of elevated inflammatory markers (HR: 0.18; 95% CI: 0.06–0.58, P<0.01) was an independent predictor of freedom from pericardiectomy after adjustment for relevant clinical and imaging parameters.

Conclusions

We present the original observations of the largest cohort of patients with transient CP to date and demonstrate that increased inflammatory markers were independently associated with long-term freedom from pericardiectomy. Our results suggest that a trial of anti-inflammatory therapy in the setting of elevated inflammatory markers may be appropriate prior to referral for surgery given the possible reversibility.

Pericardial delayed enhancement

Funding Acknowledgement

Type of funding source: None

A new whole-cell biocatalyst for sulfur dioxide filtering and degradation

In this study, the interaction of the magnetotactic bacterium with sulfite compounds and their potential to degrade SO₂ was investigated using cyclic voltammetry (CV), molecular emission cavity analysis (MECA) and ion-exchange chromatography (IEC). This biofilter was able to degrade SO₂ up to 22281 mg m^-3 by disproportionation reaction and the formation of S^2- and SO₄^2- with ≥99% efficiency. Designed biofilter was able to restart the initial performance at least after seven cycles if it was used at 14-day intervals. According to theoretical studies, the value of mean free energy (E) obtained using the Dubinin-Radushkevich isotherm model was 0.02 kJ mol^-1, which is in the range expected for physical adsorption. Designed biofilter can be considered as a powerful tool to degrade SO₂ in diverse urban and industrial centers.

Tetrel Bonding and Other Non-Covalent Interactions Assisted Supramolecular Aggregation in a New Pb(II) Complex of an Isonicotinohydrazide

A new supramolecular Pb(II) complex [PbL(NO₂)]_n was synthesized from Pb(NO₃)₂, N’-(1-(pyridin-2-yl)ethylidene)isonicotinohydrazide (HL) and NaNO₂. [PbL(NO₂)]_n is constructed from discrete [PbL(NO₂)] units with an almost ideal N₂O₃ square pyramidal coordination environment around Pb(II). The ligand L⁻ is coordinated through the 2-pyridyl N-atom, one aza N-atom, and the carbonyl O-atom. The nitrite ligand binds in a κ²-O,O coordination mode through both O-atoms. The Pb(II) center exhibits a hemidirected coordination geometry with a pronounced coordination gap, which allows a close approach of two additional N-atoms arising from the N=C(O) N-atom of an adjacent molecule and from the 4-pyridyl N-atom from the another adjacent molecule, yielding a N₄O₃ coordination, constructed from two Pb–N and three Pb–O covalent bonds, and two Pb⋯N tetrel bonds. Dimeric units in the structure of [PbL(NO₂)]_n are formed by the Pb⋯N=C(O) tetrel bonds and intermolecular electrostatically enforced π⁺⋯π⁻ stacking interactions between the 2- and 4-pyridyl rings and further stabilized by C–H⋯π intermolecular interactions, formed by one of the methyl H-atoms and the 4-pyridyl ring. These dimers are embedded in a 2D network representing a simplified uninodal 3-connected fes (Shubnikov plane net) topology defined by the point symbol (4∙8²). The Hirshfeld surface analysis of [PbL(NO₂)] revealed that the intermolecular H⋯X (X = H, C, N, O) contacts occupy an overwhelming majority of the molecular surface of the [PbL(NO₂)] coordination unit. Furthermore, the structure is characterized by intermolecular C⋯C and C⋯N interactions, corresponding to the intermolecular π⋯π stacking interactions. Notably, intermolecular Pb⋯N and, most interestingly, Pb⋯H interactions are remarkable contributors to the molecular surface of [PbL(NO₂)]. While the former contacts are due to the Pb⋯N tetrel bonds, the latter contacts are mainly due to the interaction with the methyl H-atoms in the π⋯π stacked [PbL(NO₂)] molecules. Molecular electrostatic potential (MEP) surface calculations showed marked electrostatic contributions to both the Pb⋯N tetrel bonds and the dimer forming π⁺⋯π⁻ stacking interactions. Quantum theory of atoms in molecules (QTAIM) analyses underlined the tetrel bonding character of the Pb⋯N interactions. The manifold non-covalent interactions found in this supramolecular assembly are the result of the proper combination of the polyfunctional multidentate pyridine-hydrazide ligand and the small nitrito auxiliary ligand.

Goodbye Nicky hello Goldie – exploring the opportunities for transitioning tobacco farmers into cannabis production in Malawi

Purpose

The purpose of this paper is to illustrate the opportunities for tobacco farmers in Malawi from diversifying to cannabis, and the potential benefits for reducing deforestation by producing a cannabis based alternative fuel. It further argues that there are tensions between the conflicting objectives of the Framework Convention on Tobacco Control and the Single Convention on Narcotic Drugs.

Design/methodology/approach

Field interviews were conducted with cannabis farmers, traders and sellers in different parts of Malawi.

Findings

The findings of this study show that there are opportunities for cannabis farmers but they have been blocked by legal impediments. Now that legislative reform have made cannabis cultivation possible, farmers need support in developing products.

Research limitations/implications

Any attempt to provide a precise assessment of the cannabis market in Malawi is constrained by the criminalised status of the product. The suitability of cannabis briquettes as an fuel has yet to be trialled in Malawi.

Social implications

There is an urgent need to revise the drug control conventions to address environmental degradation and deforestation.

Originality/value

The linkage between tobacco farming, deforestation and desertification in Malawi has not been made. This is the first time that hemp has been suggested as an alternative crop for farmers and as a solution to deforestation.

[The first COVID-19 hotspot in a retirement home in Hamburg]

Background

Coronavirus disease 2019 (COVID-19), a disease caused by the new coronavirus (SARS-CoV-2), is a particular threat to old people. At the end of March 2020, the first and so far largest outbreak of the disease occurred in a retirement home in Hamburg.

Methods

Analysis of procedures in dealing with a residential unit affected by SARS-CoV‑2, accommodating a risk group of 60 seniors with dementia is presented as well as a detailed presentation of post-mortem examination results of all 8 deceased tested positive for SARS-CoV‑2.

Results

Out of 60 residents, 39 were infected by SARS-CoV‑2. Due to preventive procedures it was possible to stop further spreading of the infection to other residential areas. In all 8 fatal cases, the autopsy diagnosis was death due to COVID-19. Autopsies revealed all COVID-19 patients to have a fatal (broncho)pneumonia and signs of relevant pre-existing cardiac, renal and pulmonary conditions in all cases. In 75% (n = 6) of the cases a fresh venous thrombosis was found. In 66.7% (n = 4) of the cases thrombotic events were combined with peripheral pulmonary artery thromboembolisms.

Conclusion

The cohort of SARS-CoV‑2 infected residents of a nursing home is characteristic for clinical and epidemiological features of the new coronavirus disease. Due to a centralized evaluation of all fatalities at the Institute of Legal Medicine in Hamburg, a detailed examination of all deceased positive for SARS-CoV‑2 was possible. Thereby, increased case fatality rates of approximately 20% could in all cases be assigned to a relevant number of pre-existing comorbidities of multiple organ systems, which was consistent with the clinical data available.

Characterization and Release Behavior of a Thiosemicarbazone from Electrospun Polyvinyl Alcohol Core-Shell Nanofibers

Mats of polyvinyl alcohol (PVA) core-shell nanofibers were produced using coaxial electrospinning in the presence of a thiosemicarbazone (TSC) N4-(S)-1-phenylethyl)-2-(pyridin-2-yl-ethylidene)hydrazine-1-carbothioamide (HapyTSCmB). Monolithic fibers with 0% or 5% TSC and core-shell fibers with 10% TSC in the spinning solution were studied to compare stability and release rates. SEM showed the formation of uniform, bead-free, cylindrical, and smooth fibers. NMR spectroscopy and thermal analysis (TG/DTA) gave proof for the chemical integrity of the TSC in the fiber mats after the electrospinning process. Attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy showed no TSC on the surface of the PVA/TSC-PVA fibers confirming the core-shell character. The TSC release profiles of the fibers as studied using UV-vis absorption spectroscopy showed a slower release from the PVA/TSC-PVA core-shell structure compared with the monolithic PVA/TSC fibers as well as lower cumulative release percentage (17%). Out of several release models, the Korsmeyer-Peppas model gave the best fit to the experimental data. The main release phase can be described with a Fick-type diffusion mechanism. Antibacterial properties were tested against the Gram-positive Staphylococcus aureus bacterium and gave a minimal inhibitory concentration of 12.5 μg/mL. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazoliumbromide (MTT)-based cytotoxicity experiments showed that the cell viability of fibroblast at different contents of TSC was slightly decreased from 1.5% up to 3.5% when compared to control cells.

Anti-inflammatory and immune properties of the peltatoside, isolated from the leaves of Annona crassiflora Mart., in a new experimental model zebrafish

Establishing new animal models for the study of inflammation is very important in the process of discovering new drugs, since the inflammatory event is the basis of many pathological processes. Whereas rodent models have been the primary focus of inflammation research, we defend the zebrafish (Danio rerio) test as a feasible alternative for preclinical studies. Moreover, despite all the technological development already achieved by humanity, nature can still be considered a relevant source of new medicines. In this context, the aim of this work was to evaluate the anti-inflammatory effect of a substance isolated from the medicinal plant Annona crassilfora Mart, the peltatoside, in an inflammatory model of zebrafish. It was determined: (i) total leukocyte count in the coelomate exudate; (ii) N-acetyl-β-d-glucuronidase (NAG); (iii) myeloperoxidase (MPO); (iv) and the histology of liver, intestine and mesentery. Peltotoside (25, 50 and 100 μg) and dexamethasone (25 μg) were administered intracelomatically (i.c.) 30 min before carrageenan (i.c.). Pretreatment with peltatoside at three doses significantly inhibited leukocyte recruitment in the coelomic cavity, and inhibited NAG and MPO activity against the action of Cg, in a similar manner as dexamethasone. However, some microlesions in the evaluated organs were detected. The dose of 25 μg showed an anti-inflammatory effect with lower undesirable effects in the tissues. Our results suggest that the zebrafish test was satisfactory in performing our analyzes and that the peltotoside has a modulatory action in reducing leukocyte migration.

SAT0502 LONG-TERM OBSERVATIONAL SAFETY SURVEILLANCE OF GOLIMUMAB TREATMENT FOR POLYARTICULAR JUVENILE IDIOPATHIC ARTHIRTIS—AN INTERIM ANALYSIS

Background:

Golimumab (GOL) is approved for treatment of polyarticular juvenile idiopathic arthritis (pJIA) in patients 2 years and older. Data on long-term safety in this indication are limited.

Objectives:

Prospective monitoring of long-term safety and effectiveness of GOL in routine care using the German BIKER registry.

Methods:

In this non-interventional study baseline and safety parameters were compared between patients initiating GOL and contemporary matched control cohorts starting either an alternative TNF inhibitor (TNFi) or methotrexate (MTX) without exposure to a biologic. Efficacy outcomes were JADAS10, JIA ACR scores, joint counts and Childhood Health Assessment Questionnaire disability-index (CHAQ-DI). Safety assessments were based on adverse event (AE) reports.

Results:

From 2016 to 2019, 55 patients initiating GOL have been recruited and matched to 110 patients starting alternative TNFi and 47 biologic-naïve patients. Patients starting GOL had a longer disease duration (6.8y vs. 4.1 y and 1.0y; p<0.0001) and use of GOL was significantly more often second-line (85% vs 31% and 0%, p<0.0001). Disease activity was lower at baseline compared to MTX patients as indicated by active joint counts, JADAS10 and concomitant steroid use. Otherwise they were comparable with patients treated with other TNFi (Table 1).

Table 1

Comparison of GOL cohort with (1) other TNFi cohort and (2) MTX cohort.

GOLN=55Other TNFiN=110MTXN=47p-value #GOL vs TNFi/MTXGender female, n (%)44 (80)86 (78)34 (72)0.8/0.5Age at baseline, mean (SD), years13.6 (2.8)13.6 (3.0)13.1 (3.4)1.0/0.4Disease duration, mean (SD), years6.8 (4.5)4.1 (3.8)1.0 (1.6)<0.0001RF neg. polyarthritis, n (%)28 (51)53 (48)29 (62)0.7/0.3RF pos. polyarthritis, n (%)6 (11)18 (16.4)11 (23.4)0.5/0.1Extended oligoarthritis, n (%)20 (36.4)37 (33.6)6 (12.8)0.7/0.007Psoriatic arthritis1 (1.8)2 (1.8)1 (2.1)1.0/1.0Pretreatment bDMARD n(%)47 (85.5)34 (30.9)0<0.0001Concomitant steroids, n (%)9 (16.4)26 (23.6)25 (53.2)0.3/0.0001Active joint count, mean (SD)4.6 (4.0)5.4 (6.1)9.7 (6.5)0.4/<0.0001CHAQ DI, mean (SD)0.4 (0.4)0.5 (0.6)0.6 (0.7)0.3/0.07ESR, mm/h, mean (SD)20.4 (27.6)15.4 (18.6)21.4 (18.6)0.2/0.8JADAS10, mean (SD)11.3 (6.0)12.4 (5.8)16.9 (5.4)0.3/<0.0001AE, n (rate/100PY; 95%CI)45 (96; 72-128)106 (114; 94-138)39 (107; 78-146)0.3/0.6SAE, n (rate/100PY; 95%CI)2 (4.2; 1.1-17)5 (5.4; 2-13)1 (2.7; 0.4-19)0.8/0.7Infectious AE, n (rate/100PY; 95%CI)6 (12.8; 5.7-28)11 (11.8; 6.5-21)9 (24.5; 13-47)0.9/0.2Serious infections, n (rate/100PY; 95%CI)02 (2.2; 0.5-8.6)0n.a.Uveitis new manifestation1 (2.1; 0.3-15)2 (2.2; 0.5-8.6)01.0/n.a.

In GOL treated patients a marked clinical response was noted at 6 months and beyond demonstrated by a significant decrease of the mean JADAS 10 from 11.3 to 6.4 (p=0.0008), as well as JIA ACR 30/50/70/90 response rates of 56/56/35/21%. JADAS remission and minimal disease activity was observed in 18% and 47% after 6 months and in 29% and 43% of patients after 12 months.

Rates of AE, SAE and infectious AE were comparable between the GOL cohort (96, 4.2 and 12.8/100PY), the alternative TNFi cohort (114, 5.4 and 11.8/100PY) and the MTX cohort (107, 2.7 and 24.5/100PY). SAE reported in the GOL cohort were uveitis and JIA flare (each 1). Two serious infections, both influenza, were reported in the alternative TNFi cohort, none in the GOL cohort. No case of pregnancy, malignancy or death was reported.

Conclusion:

Interim results from this ongoing safety surveillance study indicate acceptable safety and tolerability of GOL in pJIA that is comparable to treatment with alternative TNFi or MTX. The long-term effectiveness data reinforce the established efficacy of GOL in pJIA treatment.

Disclosure of Interests:

Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Angela Zimmer: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche, Toni Hospach: None declared, Frank Weller-Heinemann: None declared, Sandra Hansmann Consultant of: Advisory board Novartis Pharma, Jasmin Kuemmerle-Deschner Grant/research support from: Novartis, Sobi, Consultant of: Novartis, Sobi, Speakers bureau: Novartis, Sobi, Maria Fasshauer Consultant of: Shire, CSL Behring, Nadja Hofmann: None declared, Hans Koessel: None declared, Ivan Foeldvari Consultant of: Novartis, Sonja Mrusek: None declared, Daniel Windschall Speakers bureau: Abbvie, Nils Onken: None declared, Markus Hufnagel: None declared, Dirk Foell Grant/research support from: Novartis, Sobi, Pfizer, Speakers bureau: Novartis, Sobi, Normi Brueck: None declared, Prasad Oommen Consultant of: Novartis, Frank Dressler: None declared, Astrid Helling-Bakki: None declared, Ariane Klein Consultant of: Celgene

SAT0490 MATCHED CONTROLLED SURVEILLANCE OF TOCILIZUMAB TREATMENT FOR POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS–AN INTERIM ANALYSIS

Background:

Tocilizumab (TOC) is approved for treatment of polyarticular juvenile idiopathic arthritis (pJIA). Data out of clinical practice are limited.

Objectives:

Long-term surveillance of patients initiating TOC treatment compared to a cohort of patients initiating a comparator biologic using the BIKER-registry.

Methods:

Baseline parameters, efficacy and safety parameters were compared. Efficacy outcomes were JADAS10 and joint counts. Functional status was determined with the Childhood Health Assessment Questionnaire disability-index (CHAQ-DI). Safety was assessed by adverse events (AE) reports.

Results:

Until January 2020, 152 patients have been recruited to each cohort. Patients starting on TOC were older at treatment start (12.1 vs. 10.1 years (y); p<0.0001) and had a longer disease duration (5.4y vs. 3.0y; p<0.0001). TOC was significantly more often a second-line biologic (84% vs 13%, p< 0.0001). Otherwise patients were comparable (Table 1).

Table 1.

Comparison of TOC patients and matched controls.

TocilizumabN=152Matched controlsN=152pGender female, n (%)128 (84)124 (81)0.65Disease duration, mean (SD), years5.4 (4.1)3.0 (2.9)<0.0001RF neg. polyarthritis, n (%)104 (68.4)92 (60.5)0.19RF pos. polyarthritis, n (%)14 (9.2)19 (12.5)0.46Extended oligoarthritis, n (%)34 (22.4)41 (27)0.42Pretreatment with biologics, n(%)127 (83.5)20 (13.2)<0.0001Active joint count, mean (SD)6.7 (7.1)6.1 (5.1)0.4CHAQ DI, mean (SD)0.63 (0.63)0.65 (0.64)0.8ESR, mm/h, mean (SD)17.5 (14.9)20.9 (20.6)0.1JADAS10, mean (SD)16.8 (9.8)15.1 (5.8)0.067Efficacy Month 12N=87N=105JADAS MDA, n (%)50 (57.5)63 (60.0)0.77JADAS REM, n (%)32 (36.8)39 (37.1)1.0JIA ACR 30/50/70/90, %80/75/61/5386/84/70/560.34/0.15/0.17/0.66Adverse eventsN (rate/100PY; 95%CI)248,65 PY290.4 PYRR (95%CI); pAE145 (58.3; 50-69)157 (54.1; 46-63)1.1 (0.9-1.4); 0.5SAE12 (4.8; 2.7-8.5)4 (1.4; 0.5-3.7)3.5 (1.1-10.9); 0.03Medically important infection2 (0.8; 0.2-3.2)12 (4.1; 2.3-7.3)0.2 (0.04-0.9); 0.03Uveitis event2 (0.8; 0.2-3.2)12 (4.1; 2.3-7.3)0.2 (0.04-0.9); 0.03

Upon TOC a substantial response to treatment with a significant reduction in JADAS 10 from 16.8 to 3.4 (p<0.0001) after 12 months was observed. There were no significant differences between patients from the TOC cohort and their matched controls regarding JIA ACR 30/50/70/90 criteria and active joint counts. JADAS 10, JADAS remission (REM) and minimal disease activity (MDA) was reached by comparable numbers in the TOC (37% and 58%) and the control cohort (37% and 60%).

While the total number of AE was comparable between the TOC cohort (58/100PY) and in the control cohort (54/100PY; RR 1.1; 95%CI 0.9-1.4), more serious AE (SAE) were reported with TOC (4.8/100PY compared to 1.4/100PY; RR 3.5; 95% CI 1-10.9). Medically important infections and uveitis events were documented at significantly lower frequency in the TOC- (0.8/100PY) than in the control cohort (4.1/100PY; RR 0.2; 95% CI 0.04-0.9). SAE with TOC were suicidal intent (n=3), depression (n=2), exacerbation of JIA, abscess, gastrointestinal infection, abdominal pain, colitis, bone surgery and fracture (n=1). SAE in the control cohort were depression, osteomyelitis, gastrointestinal infection and superinfected eczema (n=1). No significant differences regarding cytopenia and elevated transaminases were observed. No gastrointestinal perforation, no vascular event, no malignancy and no death occurred.

Conclusion:

The efficacy of tocilizumab is comparable to that of alternative biologics. Tolerability was acceptable. As Tocilizumab was given as a second-line biologic in the vast majority of patients, comparisons between the cohorts have to be interpreted carefully. Observation in the registry is ongoing.

Disclosure of Interests:

Ariane Klein Consultant of: Celgene, Toni Hospach: None declared, Frank Weller-Heinemann: None declared, Sandra Hansmann Consultant of: Advisory board Novartis Pharma, Jasmin Kuemmerle-Deschner Grant/research support from: Novartis, Sobi, Consultant of: Novartis, Sobi, Speakers bureau: Novartis, Sobi, Maria Fasshauer Consultant of: Shire, CSL Behring, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche, Ivan Foeldvari Consultant of: Novartis, Christoph Rietschel Consultant of: Pfizer, Abbvie, Novartis, Chugai, and Sobi, Tobias Schwarz: None declared, Ralf Trauzeddel: None declared, Markus Hufnagel: None declared, Dirk Foell Grant/research support from: Novartis, Sobi, Pfizer, Speakers bureau: Novartis, Sobi, Rainer Berendes: None declared, Gundula Boeschow: None declared, Prasad Oommen Consultant of: Novartis, Frank Dressler: None declared, Astrid Helling-Bakki: None declared, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche

SAT0491 PSORIASIS ASSOCIATED WITH MONOCLONAL-ANTIBODY-TNF-Α INHIBITORS VS. FUSION PROTEIN ETANERCEPT IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS - ANALYSIS OF THE BIKER REGISTRY

Background:

Although efficacy of Tumor necrosis factor inhibitors (TNFi) for treatment of psoriasis is well established, patients may develop psoriasis for the first time while on TNFi as a paradoxical effect. Few data are available in patients with juvenile idiopathic arthritis (JIA).

Objectives:

To analyze the incidence of psoriasis in TNFi – treated JIA patients and to identify associated factors.

Methods:

Safety data from patients registered in the German Biologics registry (BIKeR) were analyzed. Cohorts of patients were grouped by treatment: any or multiple TNFi, single TNFi, biologics other than TNFi and no biologics (control group on methotrexate (MTX) only). TNFi-associated psoriasis was defined as incident diagnosis of psoriasis after starting a TNFi. Patients with personal history of psoriasis prior to TNFi therapy were excluded. Rates and events per 100 patient-years (PY) of exposure were calculated using AEs reported after first dose under therapy and under the age of 18 years. Rates were compared by X2-test, event rates by Wald test.

Results:

A total of 4149 treatment episodes with TNFi (Etanercept, Adalimumab, Golimumab, Infliximab), with a total exposure time of 8437 PY, were identified. There were 676 treatments with a non-TNFi- biologic (Tocilizumab, Abatacept, Anakinra, Canakinumab) with a total exposure time of 1112 PY. MTX monotherapy was conducted in 1692 patients with a total exposure time of 3971 PY. In total, 31 patients were diagnosed with incident psoriasis on JIA-treatment (Table 1). The mean duration of therapy until incident psoriasis was 2.2 (± 1.8) years. Multiple psoriatic skin manifestations were observed.

Psoriasis events were significantly more frequent in any or multiple TNFi compared to MTX-monotherapy, and specifically in the subgroup of TNF-antibody treatment (all) or Adalimumab compared to MTX or Etanercept (Table 2). Interestingly, psoriasis events were also observed with non-TNFi at high frequency. At occurrence of the event, patients exposed to biologics received MTX or steroids less frequently compared to the total patient cohort and had a higher JADAS10.

Table 1.N/PYTotalCohort*4792/13519All TNFi4149/8437ADA1105/1859ETA2824/6307GOL144/145INF76/126Non-TNFi676/1112MTX only1692/3971Psoriasis events/rate(%)31/0.623/0.613/1.27/0.22/1.41/1.37/0.61/0.1Pso**/100 PY (95%CI)0.2(0.2-0.3)0.3(0.2-0.4)0.7(0.4-1.2)0.1(0.1-0.2)1.4(0.3-5.5)0.8(0.1-5.6)1.0(0.5-2.1)0.03(0.004-0.2)Age at eventMean ± SD13.9(±3.1)13.9(± 3.2)14.0(±3.0)13.0(±4.0)15.1(±3.4)16.413.4(±3.1)17.3Female24(77%)18(78%)10(77%)5(71%)2(100%)1(100%)5(71%)1(100%)ANA positive22(71%)16(70%)10(77%)4(57%)1(50%)1(100%)5(71)1(100%)Treatment duration until event (years) Mean ±SD2.2±1.82.4±2.32.2±1.42.8±2.20.6±0.53.81.4±2.05.6ConcomitantMTX11(36%)6(26%)3(23%)2(29%)1(50%)04(57%)1(100%)ConcomitantSteroids4(13%)2(9%)01(14%)01(100%)2(29%)0JADAS10 Median [IQR]***2.5(0.6-8.8)4.2(1.0-11.0)2.0(0.6-10.1)5.8(1.5-11.4)18.06.61.3(0.8-3.4)1.7

*individual therapy numbers add to a sum > the total cohort number, because some patients switched between multiple drugs; ** Pso= Psoriasis event; *** at time of event

Table 2.ReferencePsoriasis eventn/100 PYComparatorPsoriasis eventn/100 PYRisk ratioP-valueNon-TNFi0.63TNFi0.270.4 (0.2 -1.0)0.052MTX0.03TNFi0.2710.8 (1.5-80.1)0.019MTX0.03ETA0.114.4 (0.5-35.8)0.165MTX0.03TNF-antibodies0.7542.9 (5.8-317)0.0002ETA0.11TNF-antibodies0.756.8 (2.8-16.5)0.00002MTX0.03ADA0.6927.4 (3.6-2209)0.001Non-TNFi0.63ADA0.691.1 (0.4-2.7)0.847Non-TNFi0.63ETA0.110.2(0.1-0.5)0.0012ETA0.11ADA0.696.2 (0.5-15.6)0.0001

Conclusion:

Our findings demonstrate a higher incidence of psoriasis in monoclonal-antibody-TNFi-treated JIA-patients, whereas in Etanercept-treated JIA patients no significant increase was detected. On average, psoriasis-manifestation occurred more than two years after treatment-initiation. Teenage females with ANA-positivity were most often affected.

Disclosure of Interests:

Angela Zimmer: None declared, Ariane Klein Consultant of: Celgene, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche

THU0515 SYSTEMIC LUPUS ERYTHEMATOSUS IN CHILDHOOD AND ADOLESCENCE - UPDATE FROM THE NATIONAL PEDIATRIC RHEUMATOLOGY DATABASE

Background:

Systemic lupus erythematosus (SLE) is a clinically heterogeneous disease, which begins in childhood and adolescence in 15 - 20% of cases. Since 2004, data on SLE have been collected by means of a disease-specific questionnaire as part of the National pediatric rheumatology database (NPRD) in Germany. Since 2014, kidney biopsy results have been recorded to further specify kidney involvement.

Objectives:

Evaluation of clinical signs and symptoms, outcome and laboratory data of patients with juvenile systemic lupus erythematosus from a large database in Germany.

Methods:

Data from patients with SLE recorded in the NPRD in 2017 were considered for the analysis. In addition to age, sex, onset of disease, the criteria that led to the diagnosis, various laboratory parameters, organ involvement (current, ever) and therapy (current, last 12 months), current disease activity (numerical rating scale 0-10, NRS) and ECLAM (score 0-10) were recorded. Patient-reported outcomes included global assessments of overall-wellbeing and fatigue (NRS 0-10) and functional ability (CHAQ).

Results:

196 patients (86% female) with a median age of 16 years were documented. Criteria most frequently met at diagnosis included “antinuclear antibodies” (88%), followed by “anti-ds-DNA-Ab” (66%), “butterfly erythema” (42%) and “arthritis” (41%). A positive family history was found in 10% of patients.

At documentation, 85% of patients received disease-modifying anti-rheumatic drugs, most frequently hydroxychloroquine (73%), followed by mycophenolate mofetil (32%) and azathioprine (17%). Systemic glucocorticoids obtained 52% of patients, 12% ≥ 0.2 mg/kg/day. Biologics (rituximab 2%) and cyclophosphamide i.v. (3%) were rarely administered during the last 12 months. Disease activity was reported as 1.0 (NRS, median, IQR 0 - 9), ECLAM as 1.0 (median, range 0 - 10). In the laboratory, leukopenia < 3500/µl was found in 9% of patients, lymphopenia < 1500/µl in 47% and erythrocyte sedimentation rate (ESR) > 25 mm in 15% of patients. Mean CHAQ was 0.24, and 86% of patients had a CHAQ score < 0.5. Mean patient`s global assessment of overall-wellbeing was 1.5, while the mean fatigue score was 2.86 (18% NRS score 7-10).

The following organ involvement was ever present: general symptoms 84%, skin/mucosa 72%, joints 73%, thyroid 15%, muscle 25%, lungs 17% and CNS 30%. In 45/190 (24%) patients, a kidney involvement was stated. In 34 patients (75%) a kidney biopsy was performed and histology yielded the following results: Class 1: 6.7%, Class 2: 16.7%, Class 3: 40.0%, Class 4: 23.3%, Class 5: 13.3%.

Conclusion:

The most common clinical symptoms documented in juvenile SLE patients were skin and joint involvement. In the course of the disease, a quarter of the patients developed kidney involvement, mostly proliferative nephritis. Apparently, azathioprine is increasingly being replaced by mycophenolate mofetil, biologicals have hardly been used so far. Although functional outcome and overall-wellbeing of jSLE patients was good, fatigue was a concern for some patients.

Disclosure of Interests:

Claudia Sengler: None declared, Martina Niewerth: None declared, Nils Geisemeyer: None declared, Hermann Girschick: None declared, Ariane Klein Consultant of: Celgene, Annette Friederike Jansson: None declared, Markus Hufnagel: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche

The effect of bleaching agents on the DNA analysis of bloodstains on different floor coverings

Blood at crime scenes is one of the most significant traces of evidence in investigation proceedings. Cleaning up these traces with household cleaning products, often containing bleaching agents, inhibits or complicates the detection of DNA. In this study, human blood was applied onto different floor coverings (carpet, laminate, parquet, PVC, tile) and subsequently cleaned with water and bleaching agents (hydrogen peroxide, sodium hypochlorite, DanKlorix®, Vanish Oxi Action®) at different times. Samples have been collected afterwards from the floors. The samples underwent a quantitative and qualitative DNA analysis. Cleaning smooth surfaces with water is usually sufficed to prohibit retrieving a DNA profile in most of the cases. Cleaning carpets was more difficult due to their absorbent surface whereas the use of bleaching agents caused an additional reduction of verifiable DNA concentrations. Retrieving partial or complete profiles after the use of bleaching agents was only possible when cleaning with low concentrations of 3% hydrogen peroxide.

Dynamics of the efficient cyclometalation of the undercoordinated organoplatinum complex [Pt(COD)(neoPh)]+ (neoPh = 2-methyl-2-phenylpropyl)

The cyclometalation reaction of [Pt(COD)(κ¹-neoPh)]⁺ (neoPh = 2-methyl-2-phenylpropyl) to [Pt(COD)(κ²-neoPh)] was studied experimentally and mechanistically using DFT and MD simulations.

Correction: Zn capped Al2O3 and TiO2 nanoporous arrays as pH sensitive drug delivery systems: a combined experimental and simulation study

Correction for ‘Zn capped Al₂O₃ and TiO₂ nanoporous arrays as pH sensitive drug delivery systems: a combined experimental and simulation study’ by Rokhsareh Khodabandeh et al., New J. Chem., 2020, 44, 16602–16612, DOI: 10.1039/D0NJ02840A.