Climate-related factors cause changes in the diversity of fish and invertebrates in subtropical coast of the Gulf of Mexico

Climate change impacts physical and chemical properties of the oceans, and these changes affect the ecology of marine organisms. One important ecological consequence of climate change is the distribution shift of marine species toward higher latitudes. Here, the prevalence of nearly 150 species of fish and invertebrates were investigated to find changes in their distributions over 35 years along a subtropical coast within the Gulf of Mexico. Our results show that 90 species increased their occupancy probability, while 33 decreased (remaining species neither increase or decrease), and the ranges of many species expanded. Using rarefaction analysis, which allows for the estimation of species diversity, we show that species diversity has increased across the coast of Texas. Climate-mediated environmental variables are related to the changes in the occupancy probability, suggesting the expansion of tropical species into the region is increasing diversity.

Energy policy as a social determinant of Australian health equity

Background

Intersectoral action on social determinants of health to reduce health inequities requires policy research beyond the usual social and human services. We ask how Australian energy policy affects health equity.

Methods

Document analysis and policy case studies on how goals, objectives and strategies of all Australian energy policies address equity.

Results

Energy policy affects health via risk from unreliable energy; difficult transitions to renewables; disproportionate effects on poorer people faced with high energy bills versus other basics; ecological degradation; cost pressures on businesses and governments; job losses and policy paralysis about renewable energy and climate change. Policy features subsidies for the disadvantaged; privatisation and artificial markets; differing geographical distribution of resources and high level political conflict about whether it can deliver on 3, or only 2, of the ’energy trilemma’ of reliability, affordability and ecological sustainability. Mining, industrial and political interests, powerful enough to orchestrate the downfall of Australian prime ministers, actively close policy links between health, climate change and energy. Bridging energy and health policy requires political support for market solutions involving renewables; community generation of renewable energy; solutions for rural and remote areas; and global treaties. Intergenerational equity is a strong policy lever.

Conclusions

Health in All Policies approaches can creatively engage with the language and concepts of energy policy via the daily conditions of living, inequity and climate change. When it is difficult to engage, researchers can connect with non-government organisations who bridge sectors through simultaneous advocacy for equitable health, climate and energy policies.

Key messages

Powerful interests burn bridges between health equity and energy policy. Local and global policy levers harmonising terminology differences build bridges between energy, climate change and health equity.

457. Cutibacterium (Propionibacterium) acnes Infection Rate and Optimization of Surgical Culture Duration

Background

Cutibacterium acnes is part of the normal skin and gastrointestinal tract flora that is increasingly recognized as a causative organism of surgical infections. Distinguishing between infection and contamination is difficult. The standard culture duration for C. acnes has not been determined. As a slow-growing organism, a prolonged incubation of 10–14 days is adopted in many laboratories. Ideally, only samples with high pretest probability for infection should be worked up this way, otherwise resources are overutilized with likely no benefits and potential harms to patients. We conduct a study to assess the optimal incubation duration for C. acnes.

Methods

We retrospectively reviewed microbiologic and clinical data of patients who underwent surgical procedures at the Veterans Affairs (VA) Hospital and the University of Utah Hospital in Salt Lake City, Utah, between 2015 and 2018 for which prolonged incubation of surgical samples was requested. Samples that grew C. acnes were divided into three groups (infection, contaminant, indeterminate) based on the quantity of growth and the number of positive samples (Figure 1). Samples in the “indeterminate” group were re-classified into the other two groups based on clinical criteria (Figure 2). Time to culture positivity (TTP) was calculated for each group.

Results

741 patients contributed to a total of 909 surgical cases. There were 2,401 samples collected resulting in 4,408 bacterial cultures. C. acnes grew in 131 cases (14.41%). Fifty-five cases (44%) fulfilled the criteria for true infections and 70 cases (56%) were contaminants. 6 cases were lost to follow-up. The mean TTP of the infection and the contamination groups were 5.60 + 0.76 days and 8.67 + 0.81 days, respectively. The TTP of C. acnes from specimens of true surgical infections was significantly shorter than that of contaminants by the mean of 3.07 days (95% CI: -4.22 to -1.92); P < 0.001.

Conclusion

Using our microbiological and clinical criteria to differentiate infections and contaminations, this study provides evidence that surgical sample cultures should be held no longer than 7 days to limit the effect of contaminated C. acnes on cultures and reduce unnecessary antimicrobial use.

Disclosures

All authors: No reported disclosures.

Effectiveness and safety of betrixaban extended prophylaxis for venous thromboembolism compared with standard-duration prophylaxis intervention in acute medically ill patients: a systematic literature review and network meta-analysis

Aims: To determine the clinical effectiveness and safety of venous thromboembolism (VTE) prophylaxis using US- and Europe-approved anticoagulants relative to extended-duration VTE prophylaxis with betrixaban. Low molecular weight heparins (LMWHs), unfractionated heparin (UFH), fondaparinux sodium and placebo were each compared to betrixaban, as standard-duration VTE prophylaxis for hospitalized, non-surgical patients with acute medical illness at risk of VTE. Materials and methods: A systematic literature review was conducted up to June 2019 to identify randomized controlled trials (RCTs) of VTE prophylaxis in hospitalized, non-surgical patients with acute medical illness at risk of VTE. Studies that reported the occurrence of VTE events (including death) and, where possible, major bleeding, from treatment initiation to 20-50 days thereafter were retrieved and extracted. A Bayesian fixed effect network meta-analysis was used to estimate efficacy and safety of betrixaban compared with standard-duration VTE prophylaxis. Results: Seven RCTs were analyzed which compared betrixaban, LMWHs, UFH, fondaparinux sodium, or placebo. There were significantly higher odds (median odds [95% credible interval]) of VTE with LMWHs (1.38 [1.12-1.70]), UFH (1.60 [1.05-2.46]), and placebo (2.37 [1.55-3.66]) compared with betrixaban. There were significantly higher odds of VTE-related death with placebo (7.76 [2.14-34.40]) compared with betrixaban. No significant differences were observed for the odds of major bleeding with all comparators, VTE-related death with any active standard-duration VTE prophylaxis, or of VTE with fondaparinux sodium, compared with betrixaban. Limitations and conclusions: In this indirect comparison, betrixaban was shown to be an effective regimen with relative benefits compared with LMWHs and UFH. This indicates that betrixaban could reduce the burden of VTE in at-risk hospitalized patients with acute medical illness who need extended prophylaxis, though without direct comparative evidence, stronger conclusions cannot be drawn.

Animal Research, Accountability, Openness and Public Engagement: Report from an International Expert Forum

In November 2013, a group of international experts in animal research policy (n = 11) gathered in Vancouver, Canada, to discuss openness and accountability in animal research. The primary objective was to bring together participants from various jurisdictions (United States, Sweden, Australia, New Zealand, Germany, Canada and the United Kingdom) to share practices regarding the governance of animals used in research, testing and education, with emphasis on the governance process followed, the methods of community engagement, and the balance of openness versus confidentiality. During the forum, participants came to a broad consensus on the need for: (a) evidence-based metrics to allow a "virtuous feedback" system for evaluation and quality assurance of animal research, (b) the need for increased public access to information, together with opportunities for stakeholder dialogue about animal research, (c) a greater diversity of views to be represented on decision-making committees to allow for greater balance and (d) a standardized and robust ethical decision-making process that incorporates some sort of societal input. These recommendations encourage aspirations beyond merely imparting information and towards a genuine dialogue that represents a shared agenda surrounding laboratory animal use.

Budget impact analysis of betrixaban for venous thromboembolism prophylaxis in nonsurgical patients with acute medical illness in the United Kingdom

OBJECTIVES

Venous thromboembolism (VTE) incurs substantial costs to the UK National Health Service (NHS). Betrixaban is approved in the US for VTE prophylaxis with a recommended 35-42 days of treatment. This analysis modeled the budget impact of introducing betrixaban for extended-duration VTE prophylaxis in nonsurgical patients with acute medical illness at risk of VTE in the UK, where it is not yet licensed.

METHODS

The 5-year budget impact of introducing betrixaban into current prophylaxis (low molecular weight heparin and fondaparinux) was estimated for the UK NHS. The Phase 3 APEX study provided primary event (VTE, myocardial infarction, ischemic stroke, and death; all-cause or VTE-related) and treatment complications data. Literature informed risk of recurrent events and long-term complications, population, market share, and costs for treatment and management of events. Network meta-analyses informed symptomatic DVT, pulmonary embolism and VTE-related death rates in fondaparinux patients. Deterministic sensitivity analyses explored uncertainty.

RESULTS

Introducing betrixaban accrued savings of £1,290,000-£23,000,000 in years 1-5. Savings were from reduced primary VTE events, which reduced recurrent events and future complications. All sensitivity analyses showed savings.

CONCLUSION

Introducing extended-duration VTE prophylaxis with betrixaban in the UK would accrue substantial savings annually over the next 5 years compared to current prophylaxis. Clinical trial registration: www.clinicaltrials.gov identifier is NCT01583218.

Cost-Effectiveness of Betrixaban Compared with Enoxaparin for Venous Thromboembolism Prophylaxis in Nonsurgical Patients with Acute Medical Illness in the United States

BACKGROUND

Studies show that the risk of venous thromboembolism (VTE) continues post-discharge in nonsurgical patients with acute medical illness. Betrixaban is the first anticoagulant approved in the United States (US) for VTE prophylaxis extending beyond hospitalization.

OBJECTIVE

The aim was to establish whether betrixaban for VTE prophylaxis in nonsurgical patients with acute medical illness at risk of VTE in the US is cost-effective compared with enoxaparin.

METHODS

A cost-effectiveness analysis was conducted, estimating the cost per quality-adjusted life-year (QALY) gained with betrixaban (35-42 days) compared with enoxaparin (6-14 days) from a US payer perspective over a lifetime horizon. A decision tree (DT) estimated primary VTE events, thrombotic events, and treatment complications in the first 3 months based on data from the phase III Acute Medically Ill VTE Prevention with Extended Duration Betrixaban study. A Markov model estimated recurrent events and long-term complication risks from published literature. EuroQoL-5 Dimensions utility data and costs inflated to 2017 US dollars (US$) were from published literature. Results were discounted at 3.0% per annum. Deterministic and probabilistic sensitivity analyses explored uncertainty.

RESULTS

Betrixaban dominated enoxaparin, with savings of US$784 and increased QALYs of 0.017 per patient. In addition, betrixaban dominated enoxaparin across all sensitivity analyses, but was most sensitive to utilities and DT probabilities. Furthermore, probabilistic sensitivity analysis found that betrixaban was more cost-effective than enoxaparin at all willingness-to-pay thresholds.

CONCLUSION

Betrixaban can be considered cost-effective for nonsurgical patients with acute medical illness at risk of VTE, requiring longer VTE prophylaxis from hospitalization through post-discharge.

Comparison of creatinine and cystatin C for estimation of glomerular filtration rate in pediatric patients after Fontan operation

BACKGROUND

There are several limitations when using creatinine to estimate glomerular filtration rate, especially in children with chronic medical conditions who are at high risk of kidney dysfunction. Cystatin C has been the recent focus of research as a replacement biomarker for creatinine. Our objective was to compare the 2 biomarkers in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. We hypothesized that there would be poor correlation and agreement between the 2 estimates of renal function.

METHODS

This was a single center retrospective chart review of 20 patients who had previously undergone Fontan operation. Demographic and clinical data were collected from medical records. Blood samples were collected as part of routine clinical care and simultaneously measured for serum creatinine and cystatin C. Glomerular filtration rate was calculated using the creatinine-based bedside Schwartz formula and cystatin C-based Zapatelli equation. Spearman correlation and Bland-Altman analysis were used to assess correlation and agreement.

RESULTS

The median Schwartz-derived estimated glomerular filtration rate was 98.94 mL/min/1.73 m² while the median Zappitelli-derived estimated glomerular filtration rate was 84.76 mL/min/1.73 m² . The mean difference was -19.27 suggesting poor agreement. There was weak to moderate correlation between the Schwartz and cystatin C estimated glomerular filtration rate.

CONCLUSION

The bedside Schwartz formula may be an overestimate of glomerular filtration rate in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. While larger studies are necessary, cystatin C is a promising biomarker to replace creatinine and better estimate kidney function in this population.

Cost-Effectiveness of Niraparib Versus Routine Surveillance, Olaparib and Rucaparib for the Maintenance Treatment of Patients with Ovarian Cancer in the United States

OBJECTIVES

The aim was to evaluate the cost-effectiveness of niraparib compared with routine surveillance (RS), olaparib and rucaparib for the maintenance treatment of patients with recurrent ovarian cancer (OC).

METHODS

A decision-analytic model estimated the cost per quality-adjusted life-year (QALY) gained for niraparib versus RS, olaparib, and rucaparib from a US payer perspective. The model considered recurrent OC patients with or without germline BRCA mutations (gBRCAmut and non-gBRCAmut), who were responsive to their last platinum-based chemotherapy regimen. Model health states were: progression-free disease, progressed disease and dead. Mean progression-free survival (PFS) was estimated using parametric survival distributions based on ENGOT-OV16/NOVA (niraparib phase III trial), ARIEL3 (rucaparib phase III trial) and Study 19 (olaparib phase II trial). Mean overall survival (OS) benefit was estimated as double the mean PFS benefit based on the relationship between PFS and OS observed in Study 19. Costs included: drug, chemotherapy, monitoring, adverse events, and terminal care. EQ-5D utilities were estimated from trial data.

RESULTS

Compared to RS, niraparib was associated with an incremental cost-effectiveness ratio (ICER) of US$68,287/QALY and US$108,287/QALY for gBRCAmut and non-gBRCAmut, respectively. Compared to olaparib and rucaparib, niraparib decreased costs and increased QALYs, with a cost saving of US$8799 and US$22,236 versus olaparib and US$198,708 and US$73,561 versus rucaparib for gBRCAmut and non-gBRCAmut, respectively.

CONCLUSIONS

Niraparib was estimated to be less costly and more effective compared to olaparib and rucaparib, and the ICER fell within an acceptable range compared to RS. Therefore, niraparib may be considered a cost-effective maintenance treatment for patients with recurrent OC.

Abstract TP422: Mechanisms of Cerebral Microbleeds

Cerebral microbleeds are a common MRI finding in the aging population, and reflect an underlying microscopic pathology of cerebral microhemorrhage. Pathogenesis of cerebral microbleeds remains obscure. We conducted a mechanistic investigation of the neuropathology of cerebral microhemorrhage, combining standard and immunohistochemistry analyses, and focusing on microvascular changes concurrent with microhemorrhage. We conducted a postmortem study of participants from the UCI Alzheimer’s Disease Research Center and The 90+ Study. We analyzed five brain regions (middle frontal gyrus, occipital pole, rostral cingulate cortex, caudal cingulate cortex, and basal ganglia) of 77 brain bank subjects (aged 90±10.8 years, mean±SEM ). Prussian blue-positivity, used as an index of cerebral microhemorrhage, was subjected to quantitative analysis for all five brain regions and compared with quantitative immunohistological findings of smooth muscle actin, claudin-5, fibrinogen, and platelet-derived growth factor receptor-beta (PDGFRβ), along with the sclerosis index, a measure of arteriolar injury. The top and bottom quartiles (n=19 each) for Prussian blue-positivity were compared for immunohistological findings and for sclerosis index. Subjects from the top quartile (ie, with most extensive cerebral microhemorrhage) had significantly higher sclerosis index in all five brain regions collectively (0.355±0.008 vs 0.379±0.007; p<0.05). In addition, PDGFRβ, an index of pericyte presence, was significantly lower in the top versus bottom quartiles in caudal cingulate cortex (82±7 vs 136±15 um 2 , p<0.01). The top and bottom quartiles did not differ significantly for smooth muscle actin, fibrinogen, or claudin-5 immunoreactivity. These findings indicate significant coexistence of arteriolar injury and cerebral microhemorrhage, as well as suggesting pericyte loss concurrent with cerebral microhemorrhage. Further studies are needed to determine the presence of causal roles for arteriolar injury and pericyte loss in the pathogenesis of cerebral microbleeds.

Abstract TP443: Effects of Dabigatran in Mouse Models of Aging and Cerebral Amyloid Angiopathy

Background: Oral anticoagulants are a critical component of stroke prevention, but carry a risk of brain hemorrhage. These hemorrhagic complications tend to occur in elderly individuals, especially those with predisposing conditions such as cerebral amyloid angiopathy. Clinical evidence suggests that newer oral anticoagulants (NOACs) are safer than traditional oral anticoagulants.

Objectives: We analyzed whether the NOAC dabigatran produces cerebral microhemorrhage (the pathological substrate of MRI-demonstrable cerebral microbleeds) or intracerebral hemorrhage in aged mice with and without hemorrhage-predisposing angiopathy.

Methods: We studied aged (22 months old) Tg2576 (a model of cerebral amyloid angiopathy) and wild-type (WT) littermate mice. Mice received either dabigatran etexilate (DE) (Tg N=7; WT N=10) or vehicle (Tg N=9; WT N=7) by gavage for four weeks. Anticoagulation effects of dabigatran were confirmed using diluted thrombin time assay.

Results: No mice experienced intracerebral hemorrhage. Cerebral microhemorrhage analysis, performed using Prussian-blue and H&E staining, showed no significant change in either number or size of cerebral microhemorrhage in DE-treated animals. Analysis of biochemical parameters for endothelial activation (ICAM-1), blood-brain barrier disruption (IgG, claudin-5, fibrinogen), microglial activation (Iba-1) or astrocyte activation (GFAP) showed neither exacerbation nor protective effects of DE in either Tg2576 or WT mice.

Conclusion: Our study provides histological and biochemical evidence that aged mice, with or without predisposing factors for brain hemorrhage, tolerate anticoagulation with dabigatran. Dabigatran did not induce intracerebral hemorrhage, and neither induced nor enlarged spontaneous cerebral microhemorrhage. These findings may provide some reassurance for the use of dabigatran in high-risk patient populations.

Reducing peak pressures under the saddle at thoracic vertebrae 10-13 is associated with alteration in jump kinematics

There is little information about horse-saddle interaction at take-off for a fence, although there is potential that this could have an influence on performance. It was hypothesised that (1) maximum peak pressure under the saddle would occur in the phase of maximum thoracolumbar flexion prior to hindlimb take-off; and (2) limb and trunk kinematics at take-off over the fence would be affected by reducing peak pressure at Thoracic vertebrae (T)10-13 at the point in the stride where peak pressures occur. The peak pressures under the usual saddle (Saddle S) and a saddle modified to reduce peak pressures at T10-13 (Saddle F) were measured during approach and take-off over a 1.30 m upright fence in 12 elite jumping horses. The timing of peak pressures was determined by comparison with simultaneous video data. Shoulder, carpal flexion angle and trunk angle to the horizontal at hindlimb take-off, take-off distance from the fence and fetlock height above the fence were determined using high speed motion analysis. Peak pressures under the saddle at T10-13 and kinematic data were compared between Saddles S and F. Maximum peak pressures occurred at forelimb vertical, during hindlimb protraction, consistent with thoracolumbar ventroflexion. Saddle F was associated with significantly lower peak pressures at T10-13, greater shoulder and carpal flexion, a steeper trunk angle, and higher fetlock height above the fence than Saddle S. Forelimb take-off distance from the fence was not different between saddles, but hindlimbs were significantly closer to the fence with Saddle F, indicating potential increase in ventroflexion through the thoracolumbosacral region. These findings suggest that reducing peak pressures under the saddle at T10-13 are associated with altered kinematics during the approach and take-off over a fence, which may have a positive effect on jumping performance.

Driving Change: Do Nurse-Led Clinics Make a Difference for the Patient?

Background and context: The number of people living with breast cancer and beyond is increasing. The nurse led clinics prioritise the patient as the center of care, providing the opportunity to address the serious medical, functional and psychosocial consequences of cancer and its treatments. Aim: To evaluate a model of survivorship care from the patient´s perspective. Strategy/Tactics: Eligible patients were identified through the multidisciplinary team breast meeting. Consultation with the breast care nurse at approximately 10 months postdiagnosis. Prior to this appointment, validated screening tools were sent to attendees and completed. Through assessment and discussion, issues were identified and addressed, with onward referral to internal and community based organizations. Resource packs provided together with a care plan. Program/Policy process: Having offered the nurse led clinics for 18 months Western Health conducted a patient satisfaction survey. Data were collected in the form of a questionnaire to ascertain the effect of the clinic in providing optimal and supportive survivorship care. Outcomes: 208 patients seen, 134 were born in a country other than Australia. 208 surveys sent to both English and non-English speaking patients. 91 respondents. 72% made changes to their lifestyles and relationships following the nurse led clinic. 93% of respondents felt they had more time to talk about their concerns and ask questions. 92% felt the BCN provided helpful information about support services and programs that they would otherwise not be aware of. What was learned: Patients may experience significant burden of symptoms following definitive treatment of early breast cancer. The nurse led clinic allows patients space to reflect and explore their disease experience to date, which for many has resulted in positive lifestyle changes.

Bridge of Support: A Collaborative Approach to a Peer Support Program

Background and context: The Bridge of Support Program (BOS) is adapting a successful community based model of peer support to an acute setting, at the Sunshine Hospital Breast Clinic, to meet the cultural and socioeconomic diverse needs of women with breast cancer. This two year project was funded by LUCRF Community Partnership Trust. Aim: To improve the experience of women undergoing treatment of breast cancer at Western Health. To improve access to psych-social, emotional and practical support for women by extending the reach of CounterPart- a state-wide service of women´s Health Victoria, funded by the Victorian Department of Health and Human Services to provide peer support and information to people affected by breast or a gynecologic cancer. Program/Policy process: Peer support volunteers actively guided women to current and credible evidence-based information, support decision making and provide emotional support. Peer support volunteers are rostered once a week at Sunshine Hospital to coincide with breast clinic and include access to the day oncology unit and radiotherapy center. Detailed contact information is recorded and women receive follow-up contact (with consent) from the peer support volunteers at the CounterPart Resource Centre in Melbourne. A CounterPart staff member oversees the project and provides direct support and supervision to the volunteers on site at the hospital. Women can self refer. Outcomes: Between February and December 2016 the BOS program had 159 separate contacts with patients and their families. 82 contacts were with men and women who were new to CounterPart and 77 were follow-up contacts. 90 individuals treated for breast cancer at Western Health accessed the program, which represent 53% of the women seen by the breast service. 48% of the contacts were follow-up contacts with the CounterPart volunteers indicating that once engaged with the service many men and women continue to make contact. 38% of contacts were with women diagnosed with metastatic disease, a group who often have higher levels of unmet or more complex needs. 49% were born in a nonmain English speaking country (compared with the overall state of Victoria average of 19.6%) thus reflecting an accessible service to the non-English speaking community. What was learned: At a time when peer support is being increasingly recognized as a key part of effective supportive care in cancer services, the BOS program offers a model of integrated peer support that is respected, reliable, well supported and safe within the acute setting. This acute-community sector partnership demonstrates how the medical and social models of health care can work together to provide a connected and quality service for men and women diagnosed with breast cancer. An active research approach is enabling the project to be responsive to issues and challenges as they arise including the ongoing recruitment of women as volunteers from the local community to work within the acute setting.

The Impact of a Breast Cancer Diagnosis on Women´s Work Status

Background: Many women diagnosed with breast cancer are of working age at the time of diagnosis, so the impact of a diagnosis and treatment regimen on their lives can cause financial stress-partly by impacting on their ability to continue in paid employment. The financial fallout from not working, changes in employment status and the hidden costs associated with cancer treatment can add to financial toxicity. Aim: Our aim was to identify changes in work status after a diagnosis of breast cancer. Our secondary aim was to determine if there was a correlation between different treatment modalities and work status at 12 month follow-up. Finally, we wanted to consider the role of treatment and change in work status on the financial stress experienced by patients after their diagnosis and treatment. Methods: An audit of the medical record of women who present to Western Health with a diagnosis of early breast cancer and consequently attended the nurse led breast cancer survivorship clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at review in SC 12 months later. Results: 114 patients attended the SC in a 1 year period- 2 were males and both retired at diagnosis. The records of 111 women were reviewed. 46 of the 84 women < 65 years, were in paid employment at diagnosis. 38 of these 46 women were working in some capacity at 12 month review though only 28 were working the same, having decreased hours since diagnosis. 17 of the 111 (15%) women reported financial stress at the 12 month review. 9 of the 19 (42%) women with changed work status reported financial stress. 2 of the 28 (7%) women working the same hours reported financial stress. 14 of the 19 (74%) women who had changed work status had chemotherapy. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. 10/19 (53%) had changed or stop working since axillary dissection. Conclusion: Our data suggest that 83% of women returned to work in some capacity- most at the same level, and these women were unlikely to report financial stress. Women who returned to work at reduced hours, increased hours, or did not return to work at all were more likely to report significant financial concerns at one year postdiagnosis. Health care professionals as part of ongoing care should be aware of the financial impact a cancer diagnosis and its treatments, and should aim to refer appropriately.

Data on items of AKUSSI in Alkaptonuria collected over three years from the United Kingdom National Alkaptonuria Centre and the impact of nitisinone

Alkaptonuria is a rare genetic disorder characterized by a high level of circulating (and urine) homogentisic acid (HGA), which contributes to ochronosis when it is deposited in connective tissue as a pigmented polymer. In an observational study carried out by National AKU Centre (NAC) in Liverpool, a total of thirty-nine AKU patients attended yearly visits in varying numbers. At each visit a mixture of clinical, joint and spinal assessments were carried out and the results calculated to yield an AKUSSI (Alkaptonuria Severity Score Index), see "Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre" (Ranganath at el., 2018). The aim of this data article is to produce visual representation of the change in the components of AKUSSI over 3 years, through radar charts. The metabolic effect of nitisinone is shown through box plots.

Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: Evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre

QUESTION

Does Nitisinone prevent the clinical progression of the Alkaptonuria?

FINDINGS

In this observational study on 39 patients, 2 mg of daily nitisinone inhibited ochronosis and significantly slowed the progression of AKU over a three-year period.

MEANING

Nitisinone is a beneficial therapy in Alkaptonuria.

BACKGROUND

Nitisinone decreases homogentisic acid (HGA), but has not been shown to modify progression of Alkaptonuria (AKU).

METHODS

Thirty-nine AKU patients attended the National AKU Centre (NAC) in Liverpool for assessments and treatment. Nitisinone was commenced at V1 or baseline. Thirty nine, 34 and 22 AKU patients completed 1, 2 and 3 years of monitoring respectively (V2, V3 and V4) in the VAR group. Seventeen patients also attended a pre-baseline visit (V0) in the VAR group. Within the 39 patients, a subgroup of the same ten patients attended V0, V1, V2, V3 and V4 visits constituting the SAME Group. Severity of AKU was assessed by calculation of the AKU Severity Score Index (AKUSSI) allowing comparison between the pre-nitisinone and the nitisinone treatment phases.

RESULTS

The ALL (sum of clinical, joint and spine AKUSSI features) AKUSSI rate of change of scores/patient/month, in the SAME group, was significantly lower at two (0.32 ± 0.19) and three (0.15 ± 0.13) years post-nitisinone when compared to pre-nitisinone (0.65 ± 0.15) (p < .01 for both comparisons). Similarly, the ALL AKUSSI rate of change of scores/patient/month, in the VAR group, was significantly lower at one (0.16 ± 0.08) and three (0.19 ± 0.06) years post-nitisinone when compared to pre-nitisinone (0.59 ± 0.13) (p < .01 for both comparisons). Combined ear and ocular ochronosis rate of change of scores/patient/month was significantly lower at one, two and three year's post-nitisinone in both VAR and SAME groups compared with pre-nitisinone (p < .05).

CONCLUSION

This is the first indication that a 2 mg dose of nitisinone slows down the clinical progression of AKU. Combined ocular and ear ochronosis progression was arrested by nitisinone.