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Tavakkol E, Kihira S, McArthur M, Polson J, Zhang H, Arnold CW, Yoo B, Linetsky M, Salehi B, Ledbetter L, Kim C, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. Automated Assessment of the DWI-FLAIR Mismatch in Patients with Acute Ischemic Stroke: Added Value to Routine Clinical Practice. AJNR Am J Neuroradiol 2024; 45:562-567. [PMID: 38290738 DOI: 10.3174/ajnr.a8170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND PURPOSE The DWI-FLAIR mismatch is used to determine thrombolytic eligibility in patients with acute ischemic stroke when the time since stroke onset is unknown. Commercial software packages have been developed for automated DWI-FLAIR classification. We aimed to use e-Stroke software for automated classification of the DWI-FLAIR mismatch in a cohort of patients with acute ischemic stroke and in a comparative analysis with 2 expert neuroradiologists. MATERIALS AND METHODS In this retrospective study, patients with acute ischemic stroke who had MR imaging and known time since stroke onset were included. The DWI-FLAIR mismatch was evaluated by 2 neuroradiologists blinded to the time since stroke onset and automatically by the e-Stroke software. After 4 weeks, the neuroradiologists re-evaluated the MR images, this time equipped with automated predicted e-Stroke results as a computer-assisted tool. Diagnostic performances of e-Stroke software and the neuroradiologists were evaluated for prediction of DWI-FLAIR mismatch status. RESULTS A total of 157 patients met the inclusion criteria. A total of 82 patients (52%) had a time since stroke onset of ≤4.5 hours. By means of consensus reads, 81 patients (51.5%) had a DWI-FLAIR mismatch. The diagnostic accuracy (area under the curve/sensitivity/specificity) of e-Stroke software for the determination of the DWI-FLAIR mismatch was 0.72/90.0/53.9. The diagnostic accuracy (area under the curve/sensitivity/specificity) for neuroradiologists 1 and 2 was 0.76/69.1/84.2 and 0.82/91.4/73.7, respectively; both significantly (P < .05) improved to 0.83/79.0/86.8 and 0.89/92.6/85.5, respectively, following the use of e-Stroke predictions as a computer-assisted tool. The interrater agreement (κ) for determination of DWI-FLAIR status was improved from 0.49 to 0.57 following the use of the computer-assisted tool. CONCLUSIONS This automated quantitative approach for DWI-FLAIR mismatch provides results comparable with those of human experts and can improve the diagnostic accuracies of expert neuroradiologists in the determination of DWI-FLAIR status.
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Affiliation(s)
- E Tavakkol
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - S Kihira
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - M McArthur
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - J Polson
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - H Zhang
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - C W Arnold
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - B Yoo
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - M Linetsky
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - B Salehi
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - L Ledbetter
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - C Kim
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - R Jahan
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - G Duckwiler
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
| | - J L Saver
- Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles, Los Angeles, California
| | - D S Liebeskind
- Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles, Los Angeles, California
| | - K Nael
- From the Department of Radiological Sciences (E.T., S.K., M.M. J.P., H.Z., C.W.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), University of California, Los Angeles, Los Angeles, California
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Yoon SJ, Bak J, Yoo B. Rheological and tribological properties of native potato starch agglomerated by fluidized bed granulator. Int J Biol Macromol 2024; 264:130600. [PMID: 38442829 DOI: 10.1016/j.ijbiomac.2024.130600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/07/2024]
Abstract
We explored the rheological and tribological properties of potato starch agglomerated with a sugar binder (maltodextrin or lactose) at various concentrations by using a fluidized bed granulator. The magnitudes of consistency index and apparent viscosity of agglomerated potato starch (APS) decreased as the binder concentration was increased. Moreover, APS with a sugar binder showed lower viscoelastic moduli and higher tan δ values compared to APS with water as the binder (the control). The gel strength of all agglomerates decreased as the sugar concentration was increased. All samples showed anti-thixotropic behavior, and especially, APS with 20 % lactose showed a small anti-thixotropic area. Utilizing the Arrhenius equation clearly elucidated the effect of temperature on the apparent viscosity of all the samples. Although the maltodextrin concentration had little influence on the activation energy of APS, it increased as the lactose concentration was increased. APS samples with a sugar binder showed greater friction coefficient values compared to the control, with maltodextrin having a significant impact. The findings indicate that the rheological and tribological properties of APS rely on the type and concentration of sugar binder.
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Affiliation(s)
- S J Yoon
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang, Gyeonggi 10326, Republic of Korea
| | - J Bak
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang, Gyeonggi 10326, Republic of Korea.
| | - B Yoo
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang, Gyeonggi 10326, Republic of Korea.
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Bak J, Yoo B. Rheological characteristics of concentrated ternary gum mixtures with xanthan gum, guar gum, and carboxymethyl cellulose: Effect of NaCl, sucrose, pH, and temperature. Int J Biol Macromol 2023; 253:126559. [PMID: 37657581 DOI: 10.1016/j.ijbiomac.2023.126559] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
Our goal was to investigate the effects of various conditions of media (NaCl, sucrose, pH, and temperature) on the steady and dynamic shear rheological properties of a concentrated ternary gum mixture system (1.0 wt%) containing xanthan gum (XG), guar gum (GG), and carboxymethyl cellulose (CMC). Regardless of the media conditions, all gum mixtures exhibited a high shear-thinning behavior with a low flow behavior index (<0.30). NaCl addition resulted in a decrease in the consistency index (K, 32.8-16.1 Pa·sn) and apparent viscosity at 50 s-1 (ηa,50, 1.00-0.75 Pa·s), as well as the elastic modulus (G') and viscous modulus (G″) due to the charge screening effect. Similar result was observed with an increase in acidity of media. The presence of sucrose also induced the decrease in the ηa,50, K, G', and G″ values of the ternary gum, but tan δ (G″/G') decreased, indicative of higher weak gel-like properties. No effect of NaCl or sucrose addition on the temperature dependence of G' values was observed, whereas pH adjustment was impacted. These results demonstrated that the presence of co-solute, the acidity of media, and temperature influenced the rheological properties of ternary gum, and in particular acid condition gave a great impact.
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Affiliation(s)
- J Bak
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang, Gyeonggi 410-820, Republic of Korea
| | - B Yoo
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang, Gyeonggi 410-820, Republic of Korea.
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Kang E, Kim YG, Oh JS, Hong S, Lee CK, Yoo B, Ahn SM. POS1247 THE EFFECT OF IMMUNOSUPPRESSIVE AGENTS ON ANTIBODY FORMATION AFTER COVID-19 VACCINATION IN RHEUMATOID ARTHRITIS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere is still controversy about the efficacy of COVID-19 vaccination and its extent in lowering immunogenicity of Rheumatoid Arthritis (RA) patients. The guideline in whether immunosuppressive agents need to be discontinued before the vaccination is continuously updated because it is considered to lower immunogenicity. Furthermore, there is great discussion on the effectiveness of the COVID-19 booster vaccine and interest in antibody generation in different types of vaccine, as in South Korea there are many patients who were prescribed the mRNA booster vaccine after two doses of ChAdOx1-S nCoV-19 vaccine.ObjectivesThus, we investigated the differences of antibody production between patients who received only two doses of ChAdOx1-S nCoV-19 and those who received the mRNA booster vaccine. Also, antibody production under different types of immunosuppressive agents was analyzed.MethodsFrom October 14, 2021 to January 21, 2022 at a tertiary referral center, two patient groups diagnosed with RA were studied prospectively; one group that completed 1st and 2nd doses of ChAdOx1-S nCoV-19 vaccine, second group that completed mRNA booster vaccine as well as two doses of ChAdOx1-S nCoV-19 vaccine. SARS-CoV-2 antibody testing on the semiquantitative anti-SARS-CoV-2 S enzyme immunoassay was done, and differences in antibody titers were analyzed in patients who received different immunosuppressive agents such as csDMARD, TNF inhibitor, JAK inhibitor, Tocilizumab, Abatacept and Corticosteroid. Statistical analysis with a multivariate logistic regression model was performed.ResultsIn a total of 261 patients, 153 patients had completed two doses of ChAdOx1-S nCoV-19, 108 patients had completed third mRNA booster vaccine. Anti-SARS-CoV-2 RBD antibody positive rate (titer>0.8U/mL) was 97%(149/153) and 99%(107/108) respectively, and only 5 patients showed negative result. In the aspect of high antibody titer(>250U/mL), which is the upper limit of the RBD antibody immunoassay, the result showed rate of 31% (47/153) in the non-booster group and 94%(102/108) in the booster group respectively.Among the different immunosuppressive agents and other clinical aspects, multivariate analysis revealed that corticosteroid use (OR 0.91; 95% CI: 0.86-0.98), older age(OR 4.33; 95% CI: 1.34-13.91), and male gender(OR 0.35; 95% CI 0.16-0.75) were significantly associated with low rate of high antibody titer.Furthermore, out of 14 patients who underwent antibody test twice before and after the mRNA booster vaccine, other than four patients who already showed high titer of >250U/mL before the mRNA booster vaccine, 10 patients showed an increase in titer after the booster vaccine and 7 patients were acquired high titer of >250U/mL.Figure 1.Anti-SARS-CoV RBD antibody titer of two groupsTable 1.Analysis of immunosuppressive agents and other clinical aspects for high antibody titer(>250U/mL) after two doses of ChAdOx1-S nCoV-19Univariate analysisMultivariate analysisParameterOR95% CIp valueOR95% CIp valueClinical features Age0.9170.860-0.9780.0080.9170.857-0.9810.012 Sex3.6741.206-11.1910.0224.3301.348-13.9120.014 DAS 281.1440.670-1.9500.622 Duration0.9300.830-1.0430.214Medications csDMARD1.2730.639-2.5331.273 TNF inhibitor2.2110.795-6.1450.128 JAK inhibitor0.6650.275-1.6070.365 Abatacept0.3680.038-3.6020.391 Tocilizumab1.2640.438-3.6480.665 Corticosteroid0.4720.235-0.9490.0350.3490.163-0.7480.007Medication dose Methotrexate0.9930.919-1.0720.855 Corticosteroid0.8490.719-1.0030.054ConclusionAnti-SARS-CoV-2 RBD antibody positive rate was 97% or more regardless of the mRNA booster vaccination. However, patients who received the mRNA booster vaccine after two doses of ChAdOx1-S nCoV-19 vaccine showed high antibody titer (>250U/mL) three times more than those who did not receive the booster shot.Our findings also showed that corticosteroid use, old age, and male gender is significantly associated with low rate of acquiring high antibody titer.Disclosure of InterestsNone declared
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Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. AB0476 PREDICTIVE FACTORS FOR THE DEVELOPMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS WITH IMMUNE THROMBOCYTOPENIA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with immune thrombocytopenia (ITP) have a risk of developing systemic lupus erythematosus (SLE). We sought to examine the clinical characteristics of patients with primary ITP who later developed SLE, and identified the risk factors for the development of SLE.ObjectivesWe retrospectively examined patients who were diagnosed with primary ITP at a tertiary hospital between August 2001 and November 2019. We compared the clinical characteristics according to the development of SLE. Logistic regression analysis was performed to identify the factors associated with the development of SLE.MethodsOf 130 patients with primary ITP, 10 (7.7%) were later diagnosed with SLE during follow-up (median, 30 months [IQR, 15.5–105]). The presence of skin bleeding, organ bleeding, lymphopenia, anemia, and positive antinuclear antibody (ANA) titer (> 1:160) were more common among patients who later developed SLE than did those who did not develop SLE. Multivariate analysis showed that young age (< 40 years; odds ratio [OR], 8.359 [95% confidence interval (CI), 1.230–56.793]; p = 0.033), organ bleeding (OR, 18.349 [95% CI, 2.771–121.517]; p = 0.003), and ANA positivity (>1:160; OR, 7.692 [95% CI, 1.482–39.910]; p = 0.015) were significantly associated with the development of SLE.ResultsYoung age (< 40 years), organ bleeding, and ANA positivity (> 1:160) were risk factors for the development of SLE in patients with primary ITP.ConclusionThese results suggest that continued follow-up for the detection of SLE development is needed for patients with ITP, particularly those with young age, ANA positivity, or organ bleeding.References[1]Zhu, Fang-Xiao, et al. “Risk of systemic lupus erythematosus in patients with idiopathic thrombocytopenic purpura: a population-based cohort study.” Annals of the rheumatic diseases 79.6 (2020): 793-799.Table 1.Factors associated with the development of SLE in patients with primary ITPUnivariateMultivariateOR95% CIP valueOR95% CIP valueYoung agea5.4441.332–22.2500.0188.3591.230–56.7930.033Female4.3330.530–35.4220.17BMI0.8730.717–1.0700.20Skin bleeding8.4191.034–68.5330.046Mucosa bleeding1.2500.247–6.3300.79Organ bleeding14.8643.633–60.815< 0.00118.3492.771–121.5170.003Platelet counts0.9110.828–1.0020.06ANA positivityb16.5003.984–68.341< 0.0017.6921.482–39.9100.015Neutropeniac2.1110.229–19.4990.51Lymphopeniad4.8461.189–19.7590.028Anemiae10.1182.044–50.0910.005SLE: systemic lupus erythematosus, ITP: immune thrombocytopenia, BMI: body mass index, ANA: antinuclear antibody, OR: odds ratio, CI: confidence interval.aYoung age = age < 40 yearsbANA positivity ≥ 1:160cNeutropenia = Absolute neutrophil count < 1500 μLdLymphopenia = Absolute lymphocyte count < 1500 μLeAnemia = Hemoglobin < 12 g/dLDisclosure of InterestsNone declared
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Kim YE, Choi SJ, Lim DH, Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. AB0456 DISEASE FLARE OF SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS WITH END-STAGE RENAL DISEASE ON DIALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe systemic lupus erythematosus (SLE) disease activity in patients with lupus nephritis (LN) generally declines after the initiation of renal replacement therapy (RRT); this is known as the “burn out” phenomenon that possibly occurs due to the suppression of cellular and humoral immunity in the end-stage renal disease (ESRD) state and elimination of disease pathogenic factor by dialysis [1-4]. However, several studies showed that SLE flares could occur even during RRT [5-8]. Nevertheless, the details of disease flares of SLE in patients under dialysis have not been studied yet.ObjectivesThis study aimed to investigate the clinical features, risk factors, and treatment details of SLE patients experiencing disease flare under RRT.MethodsThe medical records of SLE patients who received dialysis at two tertiary referral hospitals in Seoul and Ulsan, South Korea were reviewed. All patients in this study were either clinically or histologically diagnosed with LNResultsOf a total of 121 patients with SLE on dialysis, 96 (79.3%) were on hemodialysis (HD) and 25 (20.6%) were on peritoneal dialysis (PD). During a median follow-up of 45 months (IQR, 23–120) after the initiation of dialysis, 32 (26.4%) patients experienced SLE flare (HD, n = 25; PD, n = 7). The most common features of SLE flare were hematologic (40.6%) and constitutional manifestations (40.6%). Treatments for disease flares were based on corticosteroids, and 11 (34.3%) patients required additional immunosuppressants including cyclophosphamide and mycophenolate mofetil. There was no case of severe adverse events related to medication. non-renal SLE Disease Activity Index (SLEDAI) score before dialysis initiation (HR 1.235; 95% CI, 1.122–1.359; P = 0.001) was a significant risk factor for disease flare during dialysis.Table 1.Multivariable analysis of factors associated with SLE flare under dialysisHazard ratio95% CIP-valueNon-renal SLEDAI at the initiation of dialysis1.2351.122–1.3590.001Hematologic manifestation prior to dialysis1.2560.690–2.8260.150Cumulative amount of steroid during 1 year prior to the initiation of dialysis1.0400.995–1.0870.086Dialysis modality: hemodialysis0.7660.262–2.2430.630ConclusionMore than one-quarter of SLE patients experienced disease flare during dialysis, which most commonly had hematologic manifestations. Continued follow-up and appropriate treatments including immunosuppressants should be considered for patients with SLE under dialysis.References[1]Coplon NS, Diskin CJ, Petersen J, Swenson RS. The Long-Term Clinical Course of Systemic Lupus Erythematosus in End-Stage Renal Disease. New England Journal of Medicine 1983;308:186-90.[2]Lee P-T, Fang H-C, Chen C-L, Chiou Y-H, Chou K-J, Chung H-M. Poor prognosis of end-stage renal disease in systemic lupus erythematosus: a cohort of Chinese patients. Lupus 2003;12:827-32.[3]Pahl MV, Gollapudi S, Sepassi L, Gollapudi P, Elahimehr R, Vaziri ND. Effect of end-stage renal disease on B-lymphocyte subpopulations, IL-7, BAFF and BAFF receptor expression. Nephrology Dialysis Transplantation 2010;25:205-12.[4]Ribeiro FM, Fabris CL, Bendet I, Lugon JR. Survival of lupus patients on dialysis: a Brazilian cohort. Rheumatology 2013;52:494-500.[5]Okano K, Yumura W, Nitta K et al. Analysis of Lupus Activity in End-Stage Renal Disease Treated by Hemodialysis. Internal Medicine 2001;40:598-602.[6]Barrera-Vargas A, Quintanar-Martínez M, Merayo-Chalico J, Alcocer-Varela J, Gómez-Martín D. Risk factors for systemic lupus erythematosus flares in patients with end-stage renal disease: a case–control study. Rheumatology 2015:kev349.[7]Cucchiari D, Graziani G, Ponticelli C. The dialysis scenario in patients with systemic lupus erythematosus. Nephrology Dialysis Transplantation 2014;29:1507-13.[8]Kang S-H, Chung B-H, Choi S-R et al. Comparison of Clinical Outcomes by Different Renal Replacement Therapy in Patients with End-Stage Renal Disease Secondary to Lupus Nephritis. The Korean Journal of Internal Medicine 2011;26:60.Disclosure of InterestsNone declared
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Ghang B, Yoo B, Nam SJ. POS0389 MUSCULAR EXPRESSION OF CD163 AND MAJOR HISTOCOMPATIBILITY COMPLEX CLASS I AS DIAGNOSTIC MARKERS IN IDIOPATHIC INFLAMMATORY MYOPATHIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundVarious inflammatory markers have been suggested for detecting idiopathic inflammatory myopathies (IIMs); however, their diagnostic utility remains inconclusive.ObjectivesMuscle tissues from patients diagnosed with IIMs from January 2001 to March 2017 in a tertiary hospital were investigated. Muscular expression of CD3, CD4, CD8, CD20, CD68, CD163, MX1, MHC class I, MHC class II, and HLA-DR in muscle biopsy specimens from patients with IIMs and controls were evaluated using immunohistochemical staining. Classification and regression tree analyses were used to classify patients with IIMs who met the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies (2017 EULAR/ACR criteria for IIMs) using various staining results as predictor variables.MethodsMuscle tissues from patients diagnosed with IIMs from January 2001 to March 2017 in a tertiary hospital were investigated. Muscular expression of CD3, CD4, CD8, CD20, CD68, CD163, MX1, MHC class I, MHC class II, and HLA-DR in muscle biopsy specimens from patients with IIMs and controls were evaluated using immunohistochemical staining. Classification and regression tree analyses were used to classify patients with IIMs who met the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies (2017 EULAR/ACR criteria for IIMs) using various staining results as predictor variables.ResultsAmong the total 146 patients diagnosed with IIMs by expert neurologist or rheumatologist, 129 patients with IIMs met the 2017 EULAR/ACR criteria for IIMs. Histopathologic features consistent with IIMs using HE staining was observed in 104 of 129 (80.6%) patients who met the 2017 EULAR/ACR criteria for IIMs (dermatomyositis, n = 46/66, 69.7%; polymyositis n = 58/63, 92.1%; sensitivity 80.6%, specificity 100.0%). Muscular expression of CD163 (99.2% vs. 20.8%, p < 0.001) and MHC class I (87.6% vs. 23.1%, p < 0.001) were significantly higher in patients with IIMs who met the 2017 EULAR/ACR criteria for IIMs than in controls. Combined CD163 and MHC class I expression provided the most significant stratification for the control group (sensitivity 96.1%, specificity 94.5%). This combination was able to classify 16 of 17 (94.1%) patients who were diagnosed with IIMs by an expert physician but did not meet the 2017 EUALR/ACR criteria for IIMs.ConclusionCombined CD163 and MHC class I muscular expression may be useful in diagnosing IIMs.Table 1.Sensitivity, specificity, and predictive values of various inflammatory marker expressions and their optimal combinations for the diagnosis of idiopathic inflammatory myopathies.SensitivitySpecificityPPVNPVPatients who were diagnosed by an expert physician but did not meet the 2017 EULAR/ACR classification criteria for IIMs are classified by each combinationMuscle biopsy features consistent with IIMs on H/E staining80.6%100.0%100.0%74.5%7/17 (41.2%)CD3 expression91.5%51.4%77.6%76.6%7/17 (41.2%)CD163 expression99.2%79.2%89.5%98.3%16/17 (94.1%)MHC class I on myofibers87.6%76.9%88.3%75.8%12/17 (70.6%)HLA-DR on myofibers69.8%81.5%88.2%57.6%8/17 (47.1%)MHC class II on myofibers13.2%72.3%45.6%29.6%6/17 (35.3%)Combination of CD163 pattern and MHC class I on myofibers96.1%94.5%96.9%93.2%16/17 (94.1%)Combination of histopathologic examination using HE staining, CD163 pattern, and MHC class I on myofibers97.7%94.5%95.8%96.5%16/17 (94.1%)AcknowledgementsThis work was supported by a research grant from the Jeju National University HospitalDisclosure of InterestsNone declared
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Nam SH, Ahn SM, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. AB1273 MACROPHAGE ACTIVATION SYNDROME IN RHEUMATIC DISEASE: CLINICAL CHARACTERISTICS AND PROGNOSIS OF 20 PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMacrophage activation syndrome (MAS) is a hyperinflammatory condition that is known to be secondary hemophagocytic lymphohistiocytosis (HLH) in patients with rheumatic disease.ObjectivesThe aim of study was to evaluate the clinical manifestations and outcomes in patients with MAS with rheumatic disease.MethodsWe performed a retrospective study of 20 adult patients who were diagnosed with MAS from 2012 to 2020. MAS was classified according to the HLH-2004 criteria. Patients’ information, including clinical features, laboratory findings, and treatment regimens, was collected, and the overall survival rate was estimated by the Kaplan–Meier method.ResultsTwenty patients (18 women, 35.6 ± 18.3 years) who met the HLH-2004 criteria also fulfilled the 2016 EULAR/ACR/PRINTO classification criteria for MAS, and HScore was higher than 169 (median, 238.5). Fourteen patients with systemic lupus erythematosus and 6 patients with adult-onset Still’s disease were included. All patients were treated initially with corticosteroids, and 16 patients required additional immunosuppressants. The overall survival at 3 and 6 months was 75.2% and 64.3%. In survivors, renal impairment was less common (23.1% versus 42.9%, p = 0.007), the levels of AST (202.0 versus 72.0 IU/L, p = 0.006) and LDH (1144.0 versus 343.0IU/L, p = 0.001), and platelet count (90.0 versus 46.0 × 109/L, p = 0.016) were higher in compared to non-survivors. Nine patients had opportunistic infections, five of whom died during admission.ConclusionThe mortality of patients with MAS remains high. Renal impairment, levels of AST and LDH, and platelet count might be associated with prognosis.Table 1.Treatments and management characteristics of patients with MASNo.Age/sexDiseaseDisease duration (months)1st Treatment (corticosteroids)2nd Treatment3rd TreatmentCombined infectionAlive/dead119/FSLE11 mg/kgIVIG + PPTCZ, RTXBacteremiaDead220/MSLE01 mg/kg---Alive320/FAOSD11 mg/kgVP16--Alive422/FSLE1100 mgIVIG + PP-PneumoniaDead522/FAOSD0500 mgIVIG--Alive623/FSLE1821 mg/kg---Alive723/FSLE411 mg/kg---Alive830/FSLE1461 mg/kgIVIGCsA-Alive932/FSLE1271 mg/kgIVIG + PPCsA, TCZPneumoniaAlive1035/FAOSD01 mg/kgCsA-Viral infectionAlive1137/FSLE651 mg/kgCsA, VP16-BacteremiaAlive1238/FSLE01 mg/kgIVIG + PPRTX-Dead1340/FAOSD00.5 mg/kgCsA--Alive1443/FSLE601 mg/kgIVIG + PPTCZ, RTX, CsA,PCP,DeadVP16, IFXViral infection1549/FSLE01 mg/kgCYC-BacteremiaAlive1651/FAOSD01 mg/kg---Alive1757/FSLE01 mg/kgIVIG + PPCsA, VP16Fungal infectionDead1861/FSLE21 mg/kgIVIG + PPTCZ-Dead1968/FSLE21 mg/kgIVIG + PPCsAFungal infectionAlive2070/MAOSD01 mg/kgIVIG + PPCsA, VP16Fungal infectionDeadSLE: Systemic lupus erythematosus, IVIG: Intravenous immunoglobulin, PP: Plasmapheresis, TCZ: Tocilizumab, RTX: Rituximab, AOSD: Adult-onset still’s disease, VP16: Etoposide, PCP: Pneumocystis pneumonia, CsA: Cyclosporin, IFX: Infliximab, MCTD: Mixed connective tissue disease.Disclosure of InterestsNone declared
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Ghang B, Kim J, Yoo B. POS0284 CHANGES OF ESTIMATED GLOMERULAR FILTRATION RATE AFTER LONG-TERM FEBUXOSTAT OR ALLOPURINOL TREATMENT IN GOUT PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundUnder the hypothesis that hyperuricemia is a potentially modifiable risk factor for progression of CKD, there has been numerous small, single-center studies that have shown that use of urate-lowering therapy (ULT) delayed CKD progression in patients with hyperuricemia or CKD. However, recent three multicenter, randomized controlled trials have not shown beneficial effect of ULT on the progression of CKD among CKD patients without gout and in DM patients with albuminuria.ObjectivesWe investigated whether ULT may have a beneficial effect on the progression of CKD in gout patients.MethodsGout patients who took the study medication for more than 1 year were identified from the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES) trial, which is a large, multicenter, randomized controlled trial. We analyzed the estimated glomerular filtration rate (eGFR) slope (mL/min/1.73 m2 per year) using the CKD-EPI equation. Using logistic regression, we investigated risk factors for CKD progression, defined as eGFR slope of lower than 0 mL/min/1.73 m2 per year.ResultsDuring the study period [median (interquartile range, IQR) 3.1 (2.0-4.8) year], 4,144 patients performed median (IQR) 12 (9~15) creatinine tests, the GFR slope was analyzed as median (IQR) 0.5 (-0.8-1.6). The median (IQR) values of the GFR slope were -1.2 (-2.3--0.5) in the CKD progression group (n=1,590) and 1.3 (0.7-2.2) in the CKD progression delayed group (n=2,554). After adjusting well known factors associated with CKD progression, average level of serum uric acid ≥ 6 mg/dL during study period was significantly associated with CKD progression (adjusted odds ratio 1.73; 95% confidence interval 1.49-2.01, p < 0.0001).ConclusionThis study showed that eGFR did not decrease in more than half of gout patients after long term febuxostat or allopurinol administration. ULT may have a beneficial effect on slowing the progression of CKD in gout patients.Figure 1.Changes of estimated glomerular filtration rate during febuxostat or allupurinol administration.AcknowledgementsWe were able to access the CARES trial data through the Vivli company, and re-analyzed data of the CARES trial without financial support from any company.Disclosure of InterestsNone declared
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Kang E, Hong S, Kim YG, Lee CK, Oh JS, Yoo B, Ahn SM. POS0762 LONG-TERM RENAL OUTCOMES OF PATIENTS WITH NON-PROLIFERATIVE LUPUS NEPHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAlthough proliferative (class III or IV) lupus nephritis (LN) is the most common finding in the classification of LN, pure membranous (class V) or mesangial (class I or II) LN can occur as a form of LN. Even though non-proliferative LN (class I, II, or V) is a less severe form with good outcomes, data on long-term renal prognosis are limited.ObjectivesThis study investigated the long-term outcomes and prognostic factors in non-proliferative LN.MethodsWe retrospectively reviewed the medical records of patients with systemic lupus erythematosus who were diagnosed with LN class I, II, V or II+IV by kidney biopsy between 1997 and 2021 at a tertiary referral center. Clinical and laboratory data were compared between patients with and without poor renal outcomes. Poor renal outcome was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 or death due to renal cause. Univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the factors associated with poor renal outcomes.ResultsWe included 71 patients with non-proliferative LN (4: class I; 17: class II; 48: class V, 17; 2: class II+V). Median follow-up duration was 103 months (interquartile range 27–185) and the overall rate of poor renal outcomes at last follow-up was 29% (21/71), including end-stage renal disease (n=2) and renal death (n=1).Univariate analysis indicated that older age (HR 1.05; 95% CI: 1.00–1.09), low eGFR (HR 0.97; 95% CI: 0.95–0.99) and failure to reach complete remission at 6 months (HR 0.332; 95% CI: 0.12–0.92) were significantly associated with poor renal outcomes. Multivariate analysis revealed that low eGFR at 6 months (HR 0.97; 95% CI: 0.95–0.99) was significantly associated with poor renal outcomes.Figure 1.Renal outcomes at last follow upeGFR, estimated glomerular filtration rate (ml/min/1.73m2)Table 1.Univariate and multivariate Cox proportional hazard regression analyses of the factor associated with poor renal outcomesParameterUnivariate analysisMultivariate analysisHR95% CIp valueHR95% CIp valueClinical features Age1.0461.003-1.0910.0361.0020.960-1.0470.921 Sex1.6540.375-7.2980.506 SLEDAI1.0360.965-1.1120.327 Extra renal SLEDAI1.0380.971-1.110.272Renal profiles eGFR at LN diagnosis0.9930.976-1.0110.456 Proteinuria at LN diagnosis1.0001.000-1.0000.444 > 1g/24 hours0.6690.243-1.8410.437 > 3g/24 hours0.6240.229-1.6990.356 eGFR at 6M0.9670.948-0.9860.0010.9680.948-0.9880.002 eGFR at 12M0.9640.947-0.9810.000 Complete remission at 6M0.3320.119-0.9240.0350.5530.179-1.7070.303 Complete remission at 12M0.6670.232-1.9140.451 Transformation1.2460.423-0.7010.692Laboratory data Anti-dsDNA1.0010.999-1.0030.196 C31.0201.000-1.0410.051 C41.0270.969-1.0890.367 Albumin1.1800.661-2.1090.576ClassificationaClass I0.8020.102-6.3030.834Class II1.2980.412-4.0880.656Class V0.8870.308-2.5570.824Class II+V0.0480.000-16850.837Medicationsb ACEi/ARB1.6520.603-4.5280.329 Hydroxychloroquine1.3260.414-4.2420.635 Corticosteroid1.1860.154-9.1080.870 CNI2.4390.464-12.8240.292 MMF3.7880.959-14.9650.057 AZA0.5890.133-2.6110.486a LN classifications were based on the International Society of Pathology/Renal Pathology Society (ISN/RPS) classification.b Medications maintained at least one year since Lupus Nephritis diagnosis.HR, hazard ratio; 95% CI, 95% confidence interval; SLEDAI, systemic lupus erythematosus disease activity index; eGFR, estimated glomerular filtration rate; LN, lupus nephritis; anti-dsDNA, anti-double strand DNA; C3/C4; complement 3/4; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CNI, carcineurin inhibitor; MMF, mycophenolate mofetil; AZA, azathioprine.ConclusionPoor renal outcomes occurred in approximately 30% of patients with non-proliferative LN (class I, II or V) after long-term follow-up.Our findings suggest that more active management may be needed for non-proliferative LN, particularly in patients with low eGFR at 6 months.Disclosure of InterestsNone declared
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Yadalam A, Yoo B, Bhatia-Patel S, Patel P, Laskar S, Bhatt K, Gupta D. Successful Pregnancy with HeartMate 3 (Abbott) Left Ventricular Assist Device. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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BhatiaPatel S, Raj L, Yoo B, Patel P, Nicholson W, Daneshmand M, Abdou M, Gupta D. Cardiogenic Shock Following Successful CTO Revascularization. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee D, Yoo B. Cellulose derivatives agglomerated in a fluidized bed: Physical, rheological, and structural properties. Int J Biol Macromol 2021; 181:232-240. [PMID: 33775758 DOI: 10.1016/j.ijbiomac.2021.03.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
Understanding the agglomeration of cellulose derivatives is crucial for the production of instant gum-based food thickeners. In the present study, physical, rheological, and structural properties of agglomerated water-soluble cellulose gums (CGs), such as carboxymethylcellulose (CMC), hydroxypropylmethylcellulose (HPMC), and methylcellulose (MC), were investigated at different concentrations of maltodextrin (MD) as a binder for fluidized-bed agglomeration. Among the CG agglomerates in the presence of MD, CMC exhibited better flowability and lower cohesiveness, showing lower Carr index and Hausner ratio values. The MC agglomerates with 20% MD exhibited higher porosity than the other CGs due to the size enlargement of MC particles, which was confirmed via scanning electron microscopy images and size distribution profiles. The dynamic moduli of the CG agglomerates were significantly decreased by the addition of MD and also decreased with increasing MD concentration. The tan δ values of the agglomerates increased with increasing MD concentration, indicating the enhancement of their viscous properties. These results suggest that the physical, rheological, and structural properties of cellulose derivatives with different types of CG can be greatly influenced by their agglomerate growths during fluidized-bed agglomeration of particles with the different concentrations of MD binder.
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Affiliation(s)
- D Lee
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang, Gyeonggi 410-820, Republic of Korea
| | - B Yoo
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang, Gyeonggi 410-820, Republic of Korea.
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Damask C, Yoo B, Zhao R, Saenz R, Millette L, Rajput Y, Franzese C. P508 IMPACT OF OMALIZUMAB ON QUALITY OF LIFE IN PATIENTS WITH CHRONIC RHINOSINUSITIS WITH NASAL POLYPS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Park CS, Cho HJ, Choi EK, Lee SE, Kim MS, Kim JJ, Choi JO, Jeon ES, Hwang KK, Chae SC, Baek SH, Kang SM, Yoo B, Choi DJ, Ahn Y, Kim KH, Cho MC, Oh BH, Lee HY. J-curve relationship between corrected QT interval and mortality in acute heart failure patients. Korean J Intern Med 2020; 35:1371-1384. [PMID: 32380800 PMCID: PMC7652667 DOI: 10.3904/kjim.2019.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/03/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIMS This study investigated the prognostic power of corrected QT (QTc) interval in patients with acute heart failure (AHF) according to sex. METHODS We analyzed multicenter Korean Acute Heart Failure registry with patients with AHF admitted from 2011 to 2014. Among them, we analyzed 4,990 patients who were followed up to 5 years. Regarding QTc interval based on 12 lead electrocardiogram, patients were classified into quartiles according to sex. RESULTS During follow-up with median 43.7 months, 2,243 (44.9%) patients died. The relationship between corrected QT interval and all-cause mortality followed a J-curve relationship. In Kaplan-Meier analysis, both sex had lowest mortality in the second QTc quartile. There were significant prognostic differences between the second and the fourth quartiles in male (log-rank p = 0.002), but not in female (log-rank p = 0.338). After adjusting covariates, the third (hazard ratio [HR], 1.185; 95% confidence interval [CI], 1.001 to 1.404; p = 0.049) and the fourth (HR, 1.404; 95% CI, 1.091 to 1.535; p = 0.003) quartiles demonstrated increased risk of mortality compared to the second quartile in male. In female, however, there was no significant difference across quartiles. QTc interval was associated with 5-year all-cause mortality in J-shape with nadir of 440 to 450 ms in male and 470 to 480 ms in female. CONCLUSION QTc interval was an independent predictor of overall death in male, but its significance decreased in female. The relationship between QTc interval and all-cause mortality was J-shaped in both sex.
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Affiliation(s)
- Chan Soon Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Eun Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Hong Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byungsu Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong-Ju Choi
- Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngkeun Ahn
- Heart Research Center, Chonnam National University, Gwangju, Korea
| | - Kye-Hoon Kim
- Heart Research Center, Chonnam National University, Gwangju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Byung-Hee Oh
- Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence to Hae Young Lee, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0698, Fax: +82-2-3674-0805, E-mail:
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Nam SH, Lee JS, Choi SJ, Seo WJ, Oh JS, Hong S, Kim YG, Lee CK, Yoo B. AB0212 FLARE RISK AFTER DISCONTINUING LONG-TERM METHOTREXATE TREATMENT IN PATIENTS HAVING RHEUMATOID ARTHRITIS WITH LOW DISEASE ACTIVITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Several recent studies have reported that MTX could be discontinued in patients with low disease activity who are taking biologic DMARDs or tofacitinib. However, there are limited studies on whether MTX could be discontinued in patients with low disease activity who have taken MTX for a long term.Objectives:We investigated the disease flare rate in patients with rheumatoid arthritis (RA) who achieved low disease activity following long-term methotrexate (MTX) treatment and the factors related to flare.Methods:This retrospective longitudinal cohort study included patients with RA and low disease activity who were exposed to MTX for >10 years. Disease flare was defined as an increase in DAS28 of >1.2 within 6 months of discontinuation of MTX. Logistic regression analysis was performed to identify the factors associated with flare.Results:In total, 97 patients with RA were included in the study. The mean baseline DAS28 was 1.96 ± 0.56. The median cumulative MTX dose was 11.7g; the median duration of exposure to MTX was 19 years. Following MTX discontinuation, flare occurred in 43 (44.3%) patients; the mean time to flare was 98 ± 37.7 days. According to univariable logistic regression analysis, C-reactive protein, erythrocyte sedimentation rate (ESR) at discontinuation, the average ESR in the 6 months before discontinuation of MTX, a weekly dose of MTX before discontinuation, and use of other conventional synthetic DMARDs were associated with a higher risk of disease flare. In multivariable analysis, a weekly dose of MTX before discontinuation (OR, 1.014; 95% CI, 1.014–1.342; p = 0.031) was significantly associated with flare risk.Conclusion:Among patients with RA who achieved low disease activity with long-term treatment with MTX, more than half of the patients remained flare free after MTX discontinuation. A higher MTX dose before discontinuation was associated with a high flare risk.Disclosure of Interests:None declared
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Choi SJ, Lee JS, Nam SH, Seo WJ, Oh JS, Hong S, Kim YG, Lee CK, Yoo B. FRI0118 RISK OF LIVER FIBROSIS ON TRANSIENT ELASTOGRAPHY IN PATIENTS WITH RHEUMATIC DISEASE UNDER LONG-TERM METHOTREXATE TREATMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Methotrexate (MTX) is a cornerstone drug for the treatment of rheumatic disease and low doses of MTX are both tolerable and safe, with monitored toxicity, assessed via the liver function test. However, there is still controversy regarding the risk of liver fibrosis with long-term use of MTX. Transient elastography is commonly used to assess and monitor fibrosis progression in patients with chronic liver disease.Objectives:The present study aims to investigate liver fibrosis using transient elastography and related factors in patients with rheumatic disease receiving long-term MTX.Methods:The present retrospective, longitudinal, cross-sectional study included patients with an autoimmune disease who are taking cumulative MTX dosed over 7 g, and who had liver fibrosis upon examination using transient elastography. Liver fibrosis was defined as liver stiffness, valued over 7.2 kPa. Logistic regression analysis was performed to identify factors associated with liver fibrosis, and receiver operating characteristics analysis was used to determine the predictive value of each factor.Results:We included 83 patients with autoimmune disease, with a median MTX cumulative dose of 11.6 (range 7.3-16.0) g. Sixty-eight patients (81.9%) had rheumatoid arthritis (RA), and 13 patients (15.7%) had Takayasu arteritis. The median MTX exposure duration was 18 (range 9-31) years. The median liver stiffness value was 4 (range 1.8-10.2) kPa. Five patients (6%) showed liver fibrosis (3 patients; RA, 2 patients; Takayasu arteritis). In the linear regression analysis, cumulative MTX dose showed a tendency towards a positive correlation with increasing liver stiffness value (r2 =0.039, p = 0.074). In the logistic regression analysis, cumulative MTX dose was associated with a higher risk of liver fibrosis (OR: 1.734, 95% CI: 1.060–2.837, p = 0.029). In addition, cumulative MTX dose had an area under the curve (AUC) of 0.813 (95% CI 0.695-0.930) and a sensitivity of 80% and specificity of 71.8% at a cut-off value of 12.7 g.Conclusion:Liver fibrosis was observed in 6% of patients with long-term MTX use and higher cumulative MTX doses increased the risk of liver fibrosis. Thus, transient elastography should be considered in patients exposed to high cumulative doses of MTX.Disclosure of Interests:None declared
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Nam SH, Choi SJ, Lee JS, Oh JS, Hong S, Seo WJ, Lee CK, Yoo B, Kim YG. THU0210 EARLY DISCONTINUATION OF TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS CO-TREATED WITH RIFAMPIN FOR LATENT TUBERCULOSIS: RESULTS FROM THE REAL-WORLD DATA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) patients need to undergo screening and receive treatment for latent tuberculosis infection (LTBI) before starting tofacitinib, which is primarily metabolized by cytochrome P450 (CYP) 3A4. Among chemoprophylactic agents, rifampin is known to be a potent CYP3A4 inducer; therefore, it is expected to decrease the efficacy of tofacitinib. However, tofacitinib and rifampin have been co-administered practically because of the short duration of chemoprophylaxis.Objectives:The aim of this study was to determine the efficacy of tofacitinib on co-administration with rifampin.Methods:Biologic-naïve RA patients treated with tofacitinib were selected, and electronic medical reports were reviewed retrospectively. All patients underwent screening for LTBI before starting tofacitinib, and patients with positive results were treated to prevent progression to active tuberculosis. To evaluate the efficacy of tofacitinib with or without rifampin, the discontinuation rates of tofacitinib were examined during the first 6 months. Kaplan–Meier analysis was used to construct cumulative discontinuation curves, and comparisons were performed using the log-rank test.Results:Among 81 patients who started tofacitinib, 21 (25.9%) were LTBI-positive and 18 (22.2%) were administered rifampin concomitantly with tofacitinib. The median follow-up time was 6 months in both patients who received rifampin (interquartile range [IQR] 2.21, 6.00) and those who did not receive rifampin (IQR 5.97, 6.00) (p = 0.083). There were no significant differences between patients who received rifampin and those who did not receive rifampin in all baseline characteristics, except the swollen joint count (3.00 [1.75, 5.25] vs. 5.00 [4.00, 7.00]; p = 0.025), at the time of starting tofacitinib. In patients who received rifampin at the time of starting tofacitinib, the mean duration of co-administration was 47.00 ± 23.54 days (median 56; IQR 28.75, 59.00). During follow-up, 14 of the 81 patients (17.3%) discontinued tofacitinib. As shown in the Figures 1 and 2, the discontinuation rate of tofacitinib within the first 6 months was significantly higher among patients who received rifampin for LTBI than among those who did not receive rifampin (lack of efficacy: 24.7% vs. 5.1%, p = 0.008; all causes: 38.9% vs. 11.2%, p = 0.002). Seven patients discontinued tofacitinib because of uncontrolled RA activity, and rifampin had been administered concomitantly in four of these seven patients. Of the four patients, three stopped taking tofacitinib in the middle of LTBI treatment, and the DAS28-ESR scores of these patients were higher at discontinuation than at baseline.Conclusion:Discontinuation rates were higher in RA patients who started tofacitinib during chemoprophylaxis involving rifampin than in those who did not receive rifampin. Physicians should be aware that the efficacy of tofacitinib could be decreased by the chemoprophylactic regimen for tuberculosis.Disclosure of Interests:None declared
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Ghang B, Nam SH, Kim YG, Yoo B, Lee CK. FRI0485 RISK OF PROGRESSION OF IDIOPATHIC PULMONARY FIBROSIS TO CONNECTIVE TISSUE DISEASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Connective tissue disease (CTD) may be observed during the course of idiopathic pulmonary fibrosis (IPF). However, clinical factors associated with the development of CTD in patients with IPF have not yet been identified. These factors might be valuable clues for determining the pathogenesis of pulmonary fibrosis in patients with CTD. We hypothesize that some IPF patients have a clinically significant association with autoimmunity, and that autoantibodies are important biomarkers for identifying these patients.Objectives:Based on this hypothesis, we investigated whether the serology criteria (anti-neutrophil cytoplasmic antibody (ANCA) or autoantibodies that met the serology criteria for interstitial pneumonitis with autoimmune features (IPAF)) were associated with the development of CTD during the clinical course of IPF in the patients from our previous study(1), with a particular focus on which antibodies have a significant association with the development of CTD.Methods:We retrospectively reviewed the records of 527 patients with a first diagnosis of IPF between January 2007 and March 2014, and investigated the length of time from first visit to the clinic for IPF diagnosis (baseline) to CTD diagnosis by an expert rheumatologist in patients with IPF. Multivariable Cox proportional-hazards models with backward elimination were used to investigate the risk factors for the development of CTD.Results:CTD developed in 15 patients at a median of 2.1 years (range 1.2 to 4.8) after IPF diagnosis. All these patients had ANCA or autoantibodies that met the serology criteria for IPAF. A significant number of IPF patients with high titers of RF, ACPA or MPO-ANCA tested at first visit to the clinic progressed to CTD(Figure 1). Survival duration for IPF patients with progression to CTD was 5.3 [3.8; 6.7] years, which was significantly longer than for the IPF patients without progression to CTD (2.9 [1.7; 4.8], p = 0.001). Independent risk factors for development of CTD in IPF patients included female gender (adjusted hazard ratio (HR) 5.319, p = 0.0082), titer of rheumatoid factor (RF) (adjusted HR 1.006, p = 0.022), titer of anti-citrullinated protein antibody (ACPA) (adjusted HR 1.009, p = 0.0011), and titer of myeloperoxidase (MPO) ANCA (adjusted HR 1.02, p < 0.0001).Figure 1.Connective tissue disease development in each autoantibody positive IPF patient. ACPA = anti–citrullinated protein antibody; ANA = antinuclear antibody; CTD = connective tissue disease; MPA = microscopic polyangiitis; PAN = polyarteritis nodosa; RA = rheumatoid arthritis; RF = rheumatoid factor; UCTD = Undifferentiated connective tissue disease; SjS = Sjögren’s syndrome.Conclusion:We observed development of CTD in IPF patients with ANCA or autoantibodies that met the IPAF serology criteria. Among these autoantibodies, RF, ACPA, and MPO-ANCA were significantly associated with the development of CTD in IPF patients. Progression to CTD is uncommon in IPF patients, but a significant number of IPF patients with high titers of RF, ACPA or MPO-ANCA progressed to connective tissue disease. IPF with high titers of RF, ACPA or MPO-ANCA might be the initial clinical manifestation of connective tissue disease. Further studies are needed to investigate the role of RF, ACPA, and MPO-ANCA in development of pulmonary fibrosis.References:[1]Ghang B, Lee J, Chan Kwon O, Ahn SM, Oh JS, Hong S, et al. Clinical significance of autoantibody positivity in idiopathic pulmonary fibrosis. Respir Med. 2019;155:43-8.Disclosure of Interests:None declared
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Lee EJ, Kim DH, Lee JH, Choi SJ, Nam SH, Oh JS, Chang EJ, Hong S, Lee CK, Yoo B, Kim YG. SAT0009 ROLE OF EC-18 IN AUTOIMMUNE ARTHRITIS AND INTERSTITIAL LUNG DISEASE IN CURDLAN-ADMINISTERED SKG MICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Although the mortality of patients with rheumatoid arthritis (RA), for which interstitial lung disease (ILD) is one of the major contributors, has still not decreased, new target therapies for RA have shown good response in peripheral arthritis. EC-18 (acetylated diacylglycerol 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol) is a mono-acetyl-diglyceride that has been isolated from the antlers of sika deer and can be chemically synthesized from glycerol, palmitic acid, and linoleic acid. Research using LPS-induced acute lung injury murine model has reported that EC-18 stimulates a more rapid resolution of LPS-induced lung Inflammation. In addition, it has been reported that in a murine model of collagen-induced arthritis, EC-18 treatment ameliorated arthritis, with down-regulation of IL-6 level by regulating the activity of STAT3 in the synovium. Curdlan-administered SKG mice develop ILD spontaneously followed by peripheral arthritis, which resembles RA-ILD.Objectives:We evaluated the modulatory effect of the EC-18 on arthritis and ILD in autoimmune arthritis animal model.Methods:Male SKG mice were obtained from Dr. S. Sakaguchi. We injected curdlan (3 mg/mice) in 8-week-old SKG mice and identified the presence of ILD by histological analysis at 20 weeks post-injection. Arthritis score was measured every week for up to 20 weeks. EC-18 (250 mg/kg body weight/day, Enzychem Lifesciences Co., Daejeon, Korea) was administered every day orally. At 20 weeks post-injection, lung sections were stained with H&E and Masson’s trichrome. Using the Opal method, multiplexed immunofluorescent staining of lung tissue was performed. According to the scale by Ashcroft et al., fibrosis severity of lung sections was assessed by a system of eight grades. Analysis of serum cytokines by the luminex multiplex cytokine assay was performed at 20 weeks post-injection.Results:Oral administration of EC-18 decreased arthritis score significantly until 8 weeks post-injection and remained unchanged thereafter. At 20 weeks post-injection, histological analysis showed severe pulmonary destruction, including bronchial alveolar tissue damage and massive leukocyte infiltration, and fibrosis in the curdlan-administered mice, which was attenuated in EC-18 treated mice. In particular, 67% of curdlan-administered mice showed ILD-like phenotype, whereas the incidence rate in EC-18-treated mice was 17%. Furthermore, immunofluorescent-staining showed both IL-17A and neutrophil accumulation in lung in curdlan-administered mice; these were decreased in EC-18-treated mice. Interestingly, at 20weeks post-injection, EC-18 treatment down-regulated serum levels of IL-6 and TNF-α and up-regulated sIL-7Rα (anti-fibrotic molecule).Conclusion:Taken together, EC-18 exerts an anti-arthritic effect in early phase, but a long-term effect was not indicated. We emphasize the effect on ILD prevention of EC-18 via up-regulation of sIL-7Rα and inhibition of neutrophil accumulation, suggesting a therapeutic agent potentially for RA-ILD.Disclosure of Interests:None declared
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Koo BS, Eun S, Shin K, Yoon H, Hong CL, Kim DH, Hong S, Kim YG, Lee CK, Yoo B, Oh JS. OP0023 PREDICTION OF REMISSION FOR EACH BIOLOGICS BASED ON PATIENT’S CLINICAL INFORMATION BEFORE STARTING BIOLOGICS USING EXPLAINABLE ARTIFICIAL INTELLIGENCE: DATA FROM THE KOREAN COLLEGE OF RHEUMATOLOGY BIOLOGICS REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Many studies have identified predictive factors of response to biologics in patients wirh rheumatoid arthritis (RA). However, there is still a lack in using them in daily clinical practice. Therefore, it is necessary to develop a method that can assist the physician in selecting effective biologics.Objectives:The purpose of this study is to establish machine learning model that predicts remission in patients treated with biologics using data of RA patients from the Korean College of Rheumatology Biologics (KOBIO) registry, and to identify the important features that have the most influence on the response to biologics using explainable artificial intelligence (AI).Methods:A total of 1,527 patients who started with biologics such as etanercept, adalimumab, golimumab, infliximab, abatacept, and tocilizumab from December 2012 to June 2019 were enrolled. Remission was predicted using 46 variables corresponding to baseline profiles at the starting of each biologics. We used five machine learning methods such as lasso, ridge, SVM, random forest, and XGBoost. For explainability of those models, we used Shapley plot to interpret the feature importance for each biologics.Results:In all machine learning methods, the accuracy and the area under the receiver operating characteristic (AUROC) were 57.2%~74.5%, 0.547~0.747, respectively (Table 1). The accuracy and AUROC of each biologics were similar between machine learning methods. Figure 2 showed interpretation of feature importance with the Shapley plot for remission. The most important feature was age in adalimumab (younger were closer to remission), daily corticosteroid dose in etanercept, golimumab, and all TNF inhibitors (using fewer doses daily were closer to remission), baseline erythrocyte sedimentation rate in infliximab (lower ESR were closer to remission), disease duration in abatacept (longer disease durations showed difficulty determining remission), baseline c-reactive protein in tocilizumab (higher CRP were closer to remission).Table.Predicting remission for all biologics in various machine learning method.MeasureLassoRidgeSVMRandom ForestXGBoostNo info rateSampleAbataceptAccuracy74.1%74.1%70.6%71.8%68.8%70.6%216AUROC0.7250.7420.7070.6770.6470.500AdalimumabAccuracy73.6%72.0%70.4%72.0%70.4%68.8%315AUROC0.7100.7290.7000.6750.6630.500EtanerceptAccuracy72.0%72.0%70.0%71.5%70.0%68.0%250AUROC0.7410.7470.7260.7190.7040.500GolimumabAccuracy71.3%68.5%66.7%68.5%68.5%68.5%138AUROC0.7460.7270.7010.6900.6550.500InfliximabAccuracy72.8%73.5%67.6%73.5%69.1%72.5%172AUROC0.6630.6830.6160.5970.5270.500TNF inhibitorsAccuracy73.9%74.5%73.9%74.2%73.6%70.3%875AUROC0.7390.7410.7260.7470.7240.500TocilizumabAccuracy62.4%63.6%62.4%59.5%57.2%59.5%436AUROC0.6330.6400.6330.6150.5470.500Figure 2.Shapley plots and SHAP values for the feature importance from clinical information in patients with RA.Conclusion:We developed machine learning models for predicting remission as a response to each biologics in active RA patients based on their clinical profiles, and found important clinical features using explainable AI. This approach may support clinical decisions to improve treatment outcomes in patients with RA.Disclosure of Interests:None declared
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Choi SJ, Nam SH, Lee JS, Seo WJ, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. AB1018 TREATMENT RESPONSE OF HYDRONEPHROSIS ASSOCIATED WITH IDIOPATHIC RETROPERITONEAL FIBROSIS, FOCUSING ON RATIO OF IgG4/IgG3 SERUM CONCENTRATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Hydronephrosis, a common complication of idiopathic retroperitoneal fibrosis (iRPF), may lead to poor renal outcomes unless it is resolved. Pathological confirmation can help to identify the aetiology of the disease and determine the treatment strategy. But, in most cases, it is difficult to obtain sufficient tissue due to the location of fibrosis. In a recent study, parts of iRPF are correlated with IgG4-related disease characterised by elevated serum IgG4 levels (>135 mg/dL). Normal serum IgG3 level (21–176 mg/dL) has been known to be higher than normal serum IgG4 level (4–86 mg/dL). The reverse IgG4/IgG3 ratio has been suggested to be an IgG4-related disease component that distinguishes it from primary sclerosing cholangitis [1]. However, the ratio of IgG3 and IgG4 may be reversed in iRPF patients with hydronephrosis.Objectives:We aimed to investigate the ratio of IgG subclasses as a predictive factor associated with treatment response of hydronephrosis in patients with iRPF.Methods:We retrospectively recruited 19 iRPF patients with hydronephrosis who evaluated serum IgG subclasses in a tertiary hospital between 2004 and 2019. Hydronephrosis was evaluated on the basis of imaging findings. Medications and clinical and laboratory findings, including IgG subclasses, were reviewed following the diagnosis of hydronephrosis. Hydronephrosis improvement on subsequent images was evaluated to assess treatment response. Categorised data were compared using chi-square or Fisher’s exact test. Continuous variables were compared using Mann–Whitney U test.Results:At baseline, median serum IgG3 and IgG4 levels were 64 (IQR 37–82) mg/dL and 71 (IQR 40–171) mg/dL. Five patients had serum IgG4 levels > 135 mg/dL and 11 patients had the reverse serum level of IgG4/IgG3. On subsequent images (median follow-up at 3.2 [IQR 1.7–4.0] months), 11 patients showed hydronephrosis improvement. The proportions of positive ratio of serum IgG4/IgG3 (81.8% vs. 25%, p = 0.024), periaortic involvement (81.8% vs. 25%, p = 0.024) and high-dose glucocorticoid treatment (45.5% vs. 0%, p = 0.045) were significantly higher in patients with improvement than in those without improvement (Table 1). Interestingly, even in cases with normal serum IgG4 levels, patients with improvement showed a higher serum IgG4/IgG3 ratio than in those without improvement (median 1.5 vs. 0.7, p = 0.038).Table 1.Clinical characteristics and treatment according to the shortterm outcome of hydronephrosisImprovement(n = 11)No improvement(n = 8)p-valueTime to subsequent imaging (months)a2.2 (1.3–4.2)3.2 (2.0–3.8)0.778Males (n, %)8 (72.7%)7 (87.5%)0.603Periaortic involvement (n, %)9 (81.8%)2 (25%)0.024Impaired renal function (n, %)b5 (45.5%)2 (25%)0.633Serum IgG4 (mg/dL)a114 (59–172)43 (35–109)0.152Elevated serum IgG4 (n, %)4 (36.4%)1 (12.5%)0.338Serum IgG4/IgG3 ratioa2.1 (1.2–4.9)0.8 (0.4–1.0)0.041Positive ratio of serum IgG4/IgG3 (n, %)9 (81.8%)2 (25%)0.024Medical treatment (n, %)7 (63.6%)1 (12.5%)0.059High-dose glucocorticoid treatment (n, %)5 (45.5%)0 (0%)0.045Surgical intervention (n, %)8 (72.7%)4 (50%)0.377aValues are median and interquartile range (25th–75thpercentile)bDefined as serum creatinine level > 1.24 mg/dLConclusion:The reverse ratio of serum IgG4/IgG3 was associated with hydronephrosis treatment response, thus suggesting favourable responses to high-dose corticosteroid.References:[1]Boonstra K, Culver EL, de Buy Wenniger LM, et al. Serum immunoglobulin G4 and immunoglobulin G1 for distinguishing immunoglobulin G4-associated cholangitis from primary sclerosing cholangitis. Hepatology 2014;59:1954-63.Disclosure of Interests:None declared
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Choi SJ, Nam SH, Lee JS, Seo WJ, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. FRI0088 CHANGE IN SERUM BILIRUBIN SUGGESTS TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH MOLECULAR-TARGETED AGENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Bilirubin is an antioxidant with anti-inflammatory properties. In previous reports, serum bilirubin levels were correlated with disease activity of autoimmune diseases including rheumatoid arthritis (RA). Various molecular-targeted agents have been developed for RA, and targets, such as IL-6 and TNFα, are associated with liver function. However, the association between serum bilirubin and treatment response in RA patients treated with molecular-targeted agents is still unknown.Objectives:We aimed to evaluate the role of serum bilirubin in the prediction of the early treatment response in RA patients who initiated molecular-targeted agents.Methods:We retrospectively recruited biologic naïve RA patients (n=292) with moderate-to-high disease activity from a tertiary hospital between Jan 2013 and Dec 2019. Patients with viral hepatitis, drug-induced hepatitis, or alcoholic liver disease were excluded. Molecular-targeted agents included tocilizumab (TCZ, n=40), adalimumab (ADA, n=59), etanercept (ETN, n=66), golimumab (GOL, n=60), abatacept (ABA, n=31), and tofacitinib (TOF, n=36). Clinical and laboratory data were collected from electronic medical records. Patients were categorised into an increased bilirubin group (higher serum bilirubin at 3 months than at baseline) and decreased bilirubin group (equal or lower serum bilirubin at 3 months than at baseline). At 6 months of treatment, good response (defined as a DAS28 score ≤3.2) was evaluated. Multivariate logistic regression analysis and multiple linear regression analysis were used to evaluate the association between serum bilirubin and treatment response. The variables included in the multiple logistic and linear regression analyses were age, female sex, rheumatoid factor, prednisolone, DMARDs, baseline liver enzymes, baseline DAS28 score, and components.Results:The mean serum bilirubin level at baseline was 4.7±1.8 mg/L. After 6 months of treatment, 180 (61.6%) patients achieved good responses. The mean serum bilirubin levels at 3 and 6 months were 5.3±2.3 and 5.5±2.2 mg/L, respectively. At 6 months, a good response was more frequent in the increased bilirubin group than in the decreased bilirubin group (71.2% [99/139] vs. 52.9% [81/153], p=0.001). In multivariate logistic regression analysis, the ORs among good responders at 6 months were 1.221 (95% CI 1.014–1.471, p=0.036) for baseline serum bilirubin and 1.377 (95% CI 1.146–1.654, p=0.001) for the change in serum bilirubin at 3 months. According to target agents, the mean changes in serum bilirubin from baseline to 6 months were 1.9±2.5 for TCZ, 1.0±1.5 for ADA, 0.7±1.9 for ETN, 0.6±2.2 for GOL, 0.3±1.2 for ABA, and 0.4±2.2 for TOF (Figure 1). Among the target agents, TCZ showed a significant increase in the mean serum bilirubin level at 3 and 6 months from baseline. In multiple linear regression analysis performed on TCZ, the change in bilirubin at 3 months was associated with the DAS28 score at 6 months (β=−0.349, p=0.020).Figure 1.Change in serum bilirubin during treatment with molecular-targeted agents in rheumatoid arthritis patientsConclusion:High baseline serum bilirubin and an increase in serum bilirubin during treatment are helpful to predict a good response to molecular-targeted agents, especially TCZ.Disclosure of Interests:None declared
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Lee JS, Nam SH, Choi SJ, Seo WJ, Hong S, Lee CK, Yoo B, Oh JS, Kim YG. FRI0248 PROGNOSTIC FACTORS FOR STEROID-FREE REMISSION IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: IMPORTANCE OF ANTHROPOMETRIC MEASUREMENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Several studies have been conducted on factors associated with mortality in idiopathic inflammatory myopathies (IIM), but few studies have assessed prognostic factors for steroid-free remission in IIM.Objectives:We investigated the various clinical factors, including body measurements, that affect IIM treatment outcomes.Methods:Patients who were newly diagnosed with IIM between 2000 and 2018 were included. Steroid-free remission was defined as at least three months of normalisation of muscle enzymes and no detectable clinical disease activity. The factors associated with steroid-free remission were evaluated by a Cox regression analysis.Results:Of the 106 IIM patients, 35 displayed steroid-free remission during follow-up periods. In the multivariable Cox regression analyses, immunosuppressants’ early use within one month after diagnosis [hazard ratio (HR) 6.21, 95% confidence interval (CI) 2.61–14.74, p < 0.001] and sex-specific height quartiles (second and third quartiles versus first quartile, HR 3.65, 95% CI 1.40–9.51, p = 0.008 and HR 2.88, 95% CI 1.13–7.32, p = 0.027, respectively) were positively associated with steroid-free remission. Polymyositis versus dermatomyositis (HR 0.21, 95% CI 0.09–0.53, p = 0.001), presence of dysphagia (HR 0.15, CI 0.05–0.50, p = 0.002) and highest versus lowest quartile of waist circumference (WC) (HR 0.24, 95% CI 0.07–0.85, p = 0.027) were negatively associated with steroid-free remission.Conclusion:The early initiation of immunosuppressant therapy, type of myositis and presence of dysphagia are strong predictors of steroid-free remission in IIM; moreover, height and WC measurements at baseline may provide additional important prognostic value.Disclosure of Interests:None declared
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Abstract
Cardiac impalement injuries may be fatal. We report a patient with cardiac injury due to penetration by a steel rebar. The patient also sustained pulmonary injuries. The steel rebar was pulled out gradually during cardiopulmonary bypass (CPB). CPB is an effective surgical treatment even if there is a risk of bleeding.
Introduction Penetrating cardiac injury often occurs in South Korea. However, impalement injury of the heart with other organs is rare and fatal. We present a case of cardiac impalement injury by a steel rebar. Presentation of case A 38-year-old man was brought to the emergency room with a steel rebar of 45.5 cm in length in situ. Chest tomography revealed that the rebar had entered the thorax to the right diaphragm via the left shoulder while piercing the heart. The patient was immediately taken to the operating room for surgery without removing the bar. We were able to rescue the patient with an emergency operation wherein the bleeding site was treated by pulling the steel rebar out step-by-step while performing cardiopulmonary bypass. Discussion Early diagnosis and rapid surgery are important factors for patients with cardiac impalement injury. Haemostasis must be achieved patiently step- by- step without removing the foreign object at once. CPB is an appropriate treatment, even if there is a risk of bleeding. Conclusion This case highlights the importance of immediate surgical treatment for the survival of severe thoracic impalemant injury patients.
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Affiliation(s)
- Byungsu Yoo
- Department of Thoracic and Cardiovascular Surgery, Inje University Ilsan Paik Hospital, Republic of Korea.
| | - Yoon Cheol Shin
- Department of Thoracic and Cardiovascular Surgery, Inje University Ilsan Paik Hospital, Republic of Korea.
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Lee JS, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Recovery of renal function in patients with lupus nephritis and reduced renal function: the beneficial effect of hydroxychloroquine. Lupus 2019; 29:52-57. [DOI: 10.1177/0961203319890007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Reduced renal function is associated with worse renal outcome in patients with lupus nephritis (LN). However, there is insufficient knowledge regarding renal function recovery in patients with LN with reduced baseline renal function. Therefore, the present study aimed to investigate renal function recovery and related factors in patients with reduced baseline renal function. Methods The present retrospective longitudinal cohort study included patients with LN and reduced renal function. Reduced renal function was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Recovery of renal function was determined by an eGFR of >60 mL/min/1.73 m2 at six months after baseline, and factors associated with it were evaluated using logistic regression analysis. Results We included 90 patients with LN, with a mean eGFR value of 37.2 ± 13.9 mL/min/1.73 m2. Forty-six (51.1%) patients recovered their renal function after six months. On multivariate analysis, hydroxychloroquine use (odds ratio (OR) = 3.891, 95% confidence interval (CI) 1.196–12.653, p = 0.024), prolonged LN (OR = 0.926, 95% CI 0.874–0.981, p = 0.009) and high-grade tubular atrophy (OR = 0.451, 95% CI 0.208–0.829, p = 0.013) were associated with renal function recovery. During follow up, 25 patients were on end-stage renal disease (ESRD). Kaplan–Meier analysis revealed that renal function recovery after six months and lower probability of ESRD are associated. Conclusions In patients with LN and reduced renal function, renal function recovery at six months was associated with use of hydroxychloroquine and inversely related to longer duration of LN and higher grade of tubular atrophy.
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Affiliation(s)
- J S Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J S Oh
- Department of Biomedical Informatics, Asan Medical Center, Seoul, Korea
| | - Y-G Kim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - C-K Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - B Yoo
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - S Hong
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Yoo B, Lee SH, Kim SY, Leem AY, Chung KS, Kim EY, Jung JY, Kang YA, Park MS, Chang J, Kim YS, Park Y. Relationship between airway obstruction and C-reactive protein levels in a community-based population of Korea. Int J Tuberc Lung Dis 2019; 23:1228-1234. [DOI: 10.5588/ijtld.18.0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To examine the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and lung function in a community-based cohort of South Korea.DESIGN: The Ansung-Ansan cohort database (an ongoing prospective study of a community-based population) was
used in the analysis. We defined airway obstruction as the ratio between forced expiratory volume in 1 sec:forced vital capacity ratio (FEV1:FVC) of <95% of the predicted value for a healthy person. We also used the serum level of hs-CRP as a marker of inflammation. Multivariate
analysis was performed with adjustment for the clinical characteristics of the participants.RESULTS: A total of 5528 individuals were eligible for the study. The average age was 55.1 years, and 47.8% were males. The prevalence of airway obstruction was 9.0%, and the mean hs-CRP
level was 1.51 mg/dl. Serum hs-CRP levels increased with the severity of airway obstruction, and the latter worsened with an increase in the hs-CRP level. In multivariate analysis, as the hs-CRP level increased, FEV1 and FVC decreased. A higher FEV1:FVC ratio was associated
with lower hs-CRP levels in males.CONCLUSION: Higher hs-CRP levels were associated with decreased FEV1 and FVC in a general population of Korea. The FEV1:FVC ratio decreased with an increase in the hs-CRP level in males.
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Affiliation(s)
- B. Yoo
- Yonsei University College of Medicine, Seoul
| | - S. H. Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S. Y. Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - A. Y. Leem
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K. S. Chung
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - E. Y. Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J. Y. Jung
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y. A. Kang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M. S. Park
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J. Chang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y. S. Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y. Park
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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DeLeon S, Barsanti F, Haselkorn T, Yoo B, Creasy B, Wechsler M. P227 ASTHMA EXACERBATION REDUCTION IN ADULTS WITH HIGH/LOW AIRWAY REVERSIBILITY FOLLOWING OMALIZUMAB TREATMENT: RESULTS FROM PROSPERO. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soong W, Yoo B, Pazwash H, Holweg C, Casale T. P208 RESPONSE TO OMALIZUMAB IN ALLERGIC ASTHMA PATIENTS BY NUMBER AND TYPE OF ALLERGENS IN PROSPERO. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Won J, Lee JS, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis. Lupus 2019; 28:1294-1301. [DOI: 10.1177/0961203319876695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives Favourable long-term prognosis in proliferative lupus nephritis (LN) is associated with the achievement of complete renal response (CR), which is defined as a urine protein/creatinine ratio (UPCR) of < 0.5. However, it is unclear whether a more stringent cut-off for proteinuria (normal value of proteinuria; UPCR < 0.15) is better than CR. We aimed to evaluate the effect of stringent CR, defined as a UPCR of <0.15, on long-term renal outcomes in proliferative LN. Methods We included 87 patients with class III or IV LN who achieved CR at one year after induction therapy. Clinical and laboratory data were compared between the stringent and non-stringent CR groups. Logistic regression analysis was performed to identify factors associated with achievement of stringent CR. Cox analysis was performed to analyse the risk factors for renal flare and development of chronic kidney disease (CKD). Results The stringent and non-stringent CR groups included 58 and 29 patients, respectively. The two groups showed no significant baseline differences in terms of the clinical, laboratory and pathological classification. The sustained CR rates during five years were 91.3% and 50.0% ( p = 0.014) in the stringent and non-stringent CR groups, respectively. In Cox analyses, the achievement of stringent CR was associated with a lower risk of five-year renal flare rate (hazard ratio (HR) = 0.161, 95% confidence interval (CI) 0.063–0.411, p < 0.01) and development of CKD (HR = 0.189, 95% CI 0.047–0.752, p = 0.018). Mycophenolate mofetil induction therapy was associated with achievement of stringent CR at a borderline level of significance (HR = 7.268, 95% CI 0.894–59.089, p = 0.064). Conclusion Achievement of stringent CR predicted lower risk of renal flare and development of CKD in proliferative LN. These findings suggest that stringent CR is a valuable treatment target in proliferative LN.
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Affiliation(s)
- J Won
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J S Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J S Oh
- Clinical Research Centre, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - Y-G Kim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - C-K Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - B Yoo
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - S Hong
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
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Swain S, Schneeweiss A, Gianni L, Gao J, Stein A, Waldron-Lynch M, Heeson S, Beattie M, Yoo B, Cortes J, Baselga J. Correction to: Incidence and management of diarrhea in patients with HER2-positive breast cancer treated with pertuzumab. Ann Oncol 2019; 30:1404. [DOI: 10.1093/annonc/mdy538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jeong G, Bak J, Yoo B. Physical and rheological properties of xanthan gum agglomerated in fluidized bed: Effect of HPMC as a binder. Int J Biol Macromol 2019; 121:424-428. [DOI: 10.1016/j.ijbiomac.2018.10.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/02/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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Rosen K, Khan I, Yoo B. PO-060 ErbB2/Her2-dependent downregulation of a transcription factor IRF6 in breast cancer cells is required for their three-dimensional growth. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Yoo B, Ma K, Wiesner U, Bradbury M. Correction: Expanding analytical tools for characterizing ultrasmall silica-based nanoparticles. RSC Adv 2018; 8:34161. [PMID: 35548834 PMCID: PMC9087286 DOI: 10.1039/c8ra90077a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 11/29/2022] Open
Abstract
Correction for ‘Expanding analytical tools for characterizing ultrasmall silica-based nanoparticles’ by B. Yoo et al., RSC Adv., 2017, 7, 16861–16865.
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Affiliation(s)
- B. Yoo
- Department of Radiology
- Sloan Kettering Institute for Cancer Research
- New York
- USA
- Department of Chemistry
| | - K. Ma
- Department of Materials Science & Engineering
- Cornell University
- Ithaca
- USA
| | - U. Wiesner
- Department of Materials Science & Engineering
- Cornell University
- Ithaca
- USA
| | - M. Bradbury
- Department of Radiology
- Sloan Kettering Institute for Cancer Research
- New York
- USA
- Molecular Pharmacology Program
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Miles D, Im YH, Fung A, Yoo B, Knott A, Heeson S, Beattie MS, Swain SM. Effect of docetaxel duration on clinical outcomes: exploratory analysis of CLEOPATRA, a phase III randomized controlled trial. Ann Oncol 2017; 28:2761-2767. [PMID: 29112701 DOI: 10.1093/annonc/mdx406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Combination pertuzumab, trastuzumab, and docetaxel (D) is considered standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. This post hoc, exploratory analysis of CLEOPATRA study data evaluated the clinical effects of D treatment duration within this regimen. The clinical benefits of pertuzumab and trastuzumab by different durations of D treatment were also evaluated. Patients and methods Patients with HER2-positive metastatic breast cancer received trastuzumab and D plus pertuzumab or placebo. Clinical outcomes were analyzed by the number of D cycles that patients received (<6D, 6D, or >6D). Progression-free survival (PFS) and overall survival (OS) for each treatment arm within each D cycle group were estimated using the Kaplan-Meier approach. Time-dependent, multivariate Cox regression was applied to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for HER2-targeted therapy and D cycle groups. Results Overall, 804 patients received <6D (n = 119), 6D (n = 210), or >6D (n = 475) cycles. After adjusting for pertuzumab benefits versus placebo (PFS HR = 0.61, 95% CI 0.51-0.74, P < 0.0001; OS HR = 0.60, 95% CI, 0.49-0.74, P < 0.0001), >6D versus 6D cycles was not associated with statistically significant improvements in PFS (HR = 0.80, 95% CI 0.63-1.01, P = 0.0640) or OS (HR = 0.88, 95% CI 0.69-1.12, P = 0.3073). Consistent improvements in PFS and OS were observed with pertuzumab versus placebo, irrespective of D duration. The HRs for PFS were 0.395, 0.615, and 0.633 for <6D, 6D, and >6D cycles, respectively (P < 0.05 for all D cycle groups). Corresponding HRs for OS were 0.577, 0.700, and 0.612, respectively (P < 0.05 for <6D and >6D). Conclusions After accounting for pertuzumab benefits, more than six cycles of D treatment was not associated with significant improvements in either PFS or OS compared with six cycles. The addition of pertuzumab to trastuzumab improved clinical outcomes versus trastuzumab plus placebo, regardless of D treatment duration. ClinicalTrials.gov identifier NCT00567190.
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Affiliation(s)
- D Miles
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK;.
| | - Y-H Im
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - B Yoo
- Biostatistics, Genentech Inc., South San Francisco, USA
| | - A Knott
- Clinical Development, Roche Products Ltd, Welwyn Garden City, UK
| | - S Heeson
- Clinical Development, Roche Products Ltd, Welwyn Garden City, UK
| | | | - S M Swain
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, USA
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Kaufman P, Hurvitz S, O'Shaughnessy J, Mason G, Yardley D, Brufsky A, Rugo H, Cobleigh M, Swain S, Tripathy D, Chu L, Antao V, Yoo B, Jahanzeb M. Baseline characteristics and first-line (1L) treatment of patients with HER2+ metastatic breast cancer (MBC) from the SystHERs registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jahanzeb M, Tripathy D, Hurvitz S, O'Shaughnessy J, Mason G, Yardley D, Brufsky A, Rugo H, Cobleigh M, Swain S, Chu L, Antao V, Yoo B, Kaufman P. First-line treatment patterns by age for patients (pts) with HER2+ metastatic breast cancer (MBC) in the SystHERs registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Swain SM, Schneeweiss A, Gianni L, Gao JJ, Stein A, Waldron-Lynch M, Heeson S, Beattie MS, Yoo B, Cortes J, Baselga J. Incidence and management of diarrhea in patients with HER2-positive breast cancer treated with pertuzumab. Ann Oncol 2017; 28:761-768. [PMID: 28057664 DOI: 10.1093/annonc/mdw695] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Indexed: 11/13/2022] Open
Abstract
Background Pertuzumab disrupts heterodimerization between human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR), HER3, and HER4. Thus, pertuzumab could result in adverse events similar to those observed with EGFR antagonists, such as diarrhea. We report the incidence and severity of diarrhea observed with pertuzumab in the CLEOPATRA, NeoSphere, and TRYPHAENA studies. Patients and methods Patients (n = 1443) had metastatic [CLEOPATRA (n = 804)] or early-stage breast cancer [NeoSphere (n = 416) and TRYPHAENA (n = 223)]. The incidence and severity of diarrhea were analyzed by treatment received. The incidence of febrile neutropenia concurrent with diarrhea and the effect of pre-existing gastrointestinal comorbidities were also evaluated. Subgroup analyses were carried out using CLEOPATRA data. Results The incidence of all-grade diarrhea across studies was generally greater for pertuzumab-based treatment, ranging from 28% to 72% (grade 1, 21%-54%; grade 2, 8%-37%; grade 3, 0%-12%; grade 4, 0%). Incidence was highest during the first pertuzumab-containing cycle, decreasing with subsequent cycles. Dose delays or discontinuations due to diarrhea were infrequent, ranging from 0% to 8%. Among pertuzumab-treated patients with diarrhea, 47%-67% received pharmacological intervention, most commonly with loperamide. Overlap between diarrhea and febrile neutropenia was uncommon, ranging from 0% to 11%. No relationship was observed between pre-existing gastrointestinal comorbidities and diarrhea. In CLEOPATRA, patients ≥65 years treated with pertuzumab had a higher incidence of grade 3 diarrhea than patients <65 years (19% versus 8%). All-grade diarrhea occurred at greater frequency among pertuzumab-treated Asian versus white patients with metastatic breast cancer (74% versus 63%); the corresponding rates in the control arm were 53% and 45%, respectively. Conclusions In both the metastatic and early-stage breast cancer settings, diarrhea was common but manageable for all pertuzumab-containing regimens. Diarrheal episodes were mainly low grade and occurred most often during the first treatment cycle. Diarrheal-related drug delays or discontinuations were uncommon. ClinicalTrials.gov identifiers NCT00567190 (CLEOPATRA), NCT00545688 (NeoSphere), NCT00976989 (TRYPHAENA).
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Affiliation(s)
- S M Swain
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Germany.,Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - L Gianni
- Department of Medical Oncology, San Raffaele Hospital, Milan, Italy
| | - J J Gao
- Medical Oncology Service, National Cancer Institute, National Institutes of Health, Bethesda, MA, USA
| | - A Stein
- BioOncology, Genentech, Inc., South San Francisco, CA, USA
| | - M Waldron-Lynch
- Clinical Development, Roche Products Ltd, Welwyn Garden City, UK
| | - S Heeson
- Clinical Development, Roche Products Ltd, Welwyn Garden City, UK
| | - M S Beattie
- BioOncology, Genentech, Inc., South San Francisco, CA, USA
| | - B Yoo
- Biostatistics, Genentech, Inc., South San Francisco, CA, USA
| | - J Cortes
- Ramon y Cajal University Hospital, Madrid, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - J Baselga
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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Gwak H, Park H, Lin W, Shin S, Yoo H, Kwon J, Lee J, Kim K, Yoo B. OS03.2 CSF metabolomic profiles can discriminate patients with leptomeningeal carcinomatosis from patients having high risk for leptomeningeal metastasis from brain metastasis or brain tumors. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
C' dots are fluorescent inorganic-organic hybrid nanoparticles synthesized in water comprised of a silica core with a covalently embedded near infrared dye, and a polyethylene glycol (PEG) outer layer. C' dots containing the integrin specific ligand, cycloRGDyC, are the first of their kind particles approved for human clinical trials. In the continued clinical development of these nanoparticles, high-resolution analytical approaches are needed. Here we investigate the use of reversed phase high performance liquid chromatography (RP-HPLC) to analyze cycloRGDyC-Cy5-C' dots. Given the stability and protein-like size, we reasoned that these nanoparticles would be compatible under RP-HPLC conditions typically used to characterize peptides and proteins. Our results show that RP-HPLC provides excellent resolution, showing significant heterogeneity of these nanoparticles. C' dots also exhibit unusual peak profiles where RP-HPLC chromatogram peak shapes change from run to run, possibly due to the conformational heterogeneity or charge distribution of the particle surface due to the PEG groups. In addition we describe a novel thiol-mediated release of C' dot ligands to directly estimate cycloRGDyC by exposing the particles to organic thiols. Ligand release is presumably afforded by a reverse Michael reaction mechanism.
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Affiliation(s)
- B Yoo
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065.,Department of Chemistry, Hunter College, New York, New York 10065
| | - K Ma
- Department of Materials Science & Engineering, Cornell University, Ithaca, New York 14853
| | - U Wiesner
- Department of Materials Science & Engineering, Cornell University, Ithaca, New York 14853
| | - M Bradbury
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065.,Molecular Pharmacology Program, Sloan Kettering Institute for Cancer Research, New York, NY 10065
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Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Abstract P5-08-27: Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-08-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction In 2010, the cutoff for HR positivity in breast cancer was established as ≥1% of cells staining HR+, previously having varied from 1% to 10%. The impact of this change on treatment patterns and outcomes is poorly understood. SystHERs is a prospective, observational cohort registry of patients (pts) with HER2+ metastatic breast cancer (MBC) that commenced enrollment in 2012. To our knowledge, SystHERs is the largest registry to collect and analyze data for the HER2+ subgroup. We report baseline characteristics, treatment patterns, and early outcomes by %HR+ (1–9% vs 10–100%).
Methods SystHERs enrolled pts aged ≥18 years and within 6 months of HER2+ MBC diagnosis. For pts with locally-determined HR+ disease, defined as HR+ in primary or metastatic tissue, %HR+ is the highest percentage of ER+ or PR+ tissue in early breast cancer or MBC. The percentage of ER+ or PR+ cells was not reported for pts considered HR– by the investigator. Median overall survival (OS; Kaplan–Meier) and hazard ratios (Cox regression) were estimated.
Results As of Feb 1, 2016, data were available for 872 eligible pts with known HR status, of whom 608 (70%) had HR+ disease. Of the 608 pts, 53 (9%) had 1–9%HR+ and 496 (82%) had 10–100%HR+; %HR+ was not reported for 59 pts. Baseline characteristics were similar between %HR+ subgroups (Table 1).
As shown in Table 2, the 1–9%HR+ subgroup was less likely to receive first-line hormonal therapy (26%) than the 10–100%HR+ subgroup (56%). 87% and 79% of pts received chemotherapy, respectively.
Median time from MBC diagnosis was 16.5 months (range, 0.4–49.4 months). Median OS was not reached at the data cutoff. The number of deaths was 13 (25%) in the 1–9%HR+ subgroup, and 68 (14%) in the 10–100%HR+ subgroup (log-rank P=0.025). The OS hazard ratio (0.514, 95% CI 0.283–0.931) favored the 10–100%HR+ subgroup. OS did not differ significantly between pts with 1–9%HR+ vs HR– disease (log-rank P=0.582, hazard ratio 1.185, 95% CI 0.647–2.169).
Table 1. Baseline characteristics 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)Age at MBC diagnosis, median yrs (range)54 (30–86)57 (21–86)55 (28–88)Race, % White838372Black151320Premenopausal, %282522ECOG performance status, % 04654441463942≥2878MBC diagnosis type, % De novo404958Recurrent605142Visceral, %*686275*Non-hepatic abdominal, ascites, CNS, liver, lung, or pleural effusion sites of metastasis
Table 2. First-line treatment 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)HER2-targeted therapy, %969391Chemotherapy, %877989Hormonal therapy, %26564
Conclusions These preliminary observational data suggest potential differences in treatment patterns and survival outcomes in low vs moderate/high HR+ expressers, with the former being less likely to receive hormonal therapy (26% vs 56%). Furthermore, low HR positivity was associated with poorer OS and was similar to OS observed in pts with HR– disease.
Citation Format: Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-27.
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Affiliation(s)
- M Jahanzeb
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - D Tripathy
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - H Rugo
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - S Swain
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - PA Kaufman
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - M Mayer
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - S Hurvitz
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - J O'Shaughnessy
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - G Mason
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - DA Yardley
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - A Brufsky
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - L Chu
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - V Antao
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - M Beattie
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - B Yoo
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - M Cobleigh
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
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Chu L, Yoo B, Carrigan G, Lai C, Beattie M, Reyes C. Abstract P5-08-24: How do real-world treatment patterns compare to guideline recommendations for first-line metastatic breast cancer patients in US community clinics? Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-08-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Treatment (txt) guidelines are based on trial data from a small minority of patients (pts). Linked electronic health records (EHRs) are a novel approach to examine txt patterns and outcomes in larger and more generalizable populations. Given the increasing importance of real world data and real world outcomes, we utilized linked EHRs from a network of US community clinics to examine how real world txt patterns compare to metastatic breast cancer (mBC) txt guideline recommendations.
Methods:
The Flatiron database provides real world clinical data collected from EHRs used by US cancer care providers. The Flatiron network comprises ~15% of US cancer pts and is geographically and demographically diverse.
Using EHR from Jan 2016 mBC database, we evaluated first-line (1L) txt patterns in mBC by molecular subtype. Pts were selected if they received mBC txt within 60 days of mBC diagnosis between 01Jan2011-31Dec2015, had ≥2 visits within the Flatiron Network on or after 01Jan2013, and were ≥18 years (yrs). Analyses were conducted to describe pt and clinical characteristics and 1L txt by HER2 and/or hormone receptor (HR) status.
Results:
Among 2509 mBC pts identified, 58.9% were HR+/HER2-, 17.7% HER2+, 11.6% HR-/HER2- (triple negative, TNBC), 7.4% HER2 equivocal, and 4.3% 'not done/unknown HER2 status'. Txt patterns in the latter two groups were not analyzed. Selected pt and disease characteristics by subtype are shown in Table 1. Median follow-up since mBC diagnosis was 1.1 yrs (range 0-5 yrs). The 1L mBC txts by subtype are shown in Table 2. Pts with HR+/HER2- subtype were treated primarily with hormonal therapy (68%) and/or chemotherapy (chemo) (35%). Among HER2+ pts, the 1L mBC txt patterns include trastuzumab+pertuzumab with chemo (31%), trastuzumab with chemo (22%), trastuzumab with hormonal therapy (9%), ado-trastuzumab (4%), lapatinib with chemo (3%), and lapatinib with hormonal therapy (1%). For TNBC, the majority received chemo (95%), such as paclitaxel (21%), nab-paclitaxel (13%) and docetaxel (12%).
Conclusion:
This study advances our current understanding of real world 1L patterns of care by molecular subtype among mBC pts and how these compare to guideline recommendations. While the majority of pts are receiving therapy per guidelines, up to 22% of HER2+ of pts are not receiving targeted therapy in 1L mBC
Table 1. Patient and disease characteristics by subtypeN (%)HR+/HER2- (N=1479)HER2+ (N=445)TNBC (N=291)Age at mBC diagnosis (yrs), median (range)66 (24-85)60 (27-85)60 (33-85)Sex Female1459 (99)441 (99)289 (99)Race White995 (67)274 (62)168 (58)Black112 (8)44 (10)42 (14)Asian19 (1)14 (3)5 (2)Other179 (12)50 (11)36 (12)Missing173 (12)63 (14)40 (14)MBC type De novo418 (28)172 (39)94 (32)Recurrent881 (60)225 (51)178 (61)Unknown180 (12)48 (11)19 (7)HR Status Positive1479 (100)300 (67)--Negative--145 (33)291 (100)
Table 2. 1L mBC treatments by subtypeN (%)HR+/HER2- (N=1479)HER2+ (N=445)TNBC (N=291)Any Targeted Therapy*77 (5)346 (78)12 (4)Any Chemotherapy521 (35)283 (64)276 (95)Any Hormonal Therapy1010 (68)115 (26)16 (6)*Targeted therapy includes trastuzumab, pertuzumab, ado-trastuzumab emtansine, lapatinib and bevacizumab
Citation Format: Chu L, Yoo B, Carrigan G, Lai C, Beattie M, Reyes C. How do real-world treatment patterns compare to guideline recommendations for first-line metastatic breast cancer patients in US community clinics? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-24.
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Affiliation(s)
- L Chu
- Genentech, Inc, South San Francisco, CA
| | - B Yoo
- Genentech, Inc, South San Francisco, CA
| | | | - C Lai
- Genentech, Inc, South San Francisco, CA
| | - M Beattie
- Genentech, Inc, South San Francisco, CA
| | - C Reyes
- Genentech, Inc, South San Francisco, CA
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Yoo B, Woo J, Khanam SSS, Lee JW, Youn YJ, Ahn MS, Ahn SG, Kim JY, Lee SH, Yoon J. Prognostic Impact of Central Arterial Stiffness in Patients with Acute Heart Failure. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.07.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park HS, Kim JE, You HJ, Gu J, Yoo B, Lee S, Lee HJ, Hwang HY, Hwang Y, Kim HK, Kim YT. Beneficial effect of a nitric oxide donor in an ex vivo model of pig-to-human pulmonary xenotransplantation. Xenotransplantation 2016; 22:391-8. [PMID: 26381495 DOI: 10.1111/xen.12195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 08/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Nitric oxide (NO) can reduce platelet adhesion and vascular resistance. Tempol can scavenge the reactive oxygen species (ROS) that induce tissue injury. As xenograft rejection attenuates endogenous NO production and generates ROS, we evaluated the potential effect of an NO donor (SIN-1, 3-morpholinosydnonimine) and tempol on hyperacute xenograft dysfunction using an ex vivo porcine lung perfusion model. METHODS For the evaluation of von Willebrand factor (vWF) secretion, human endothelial cells were stimulated with thrombin. Porcine lungs were perfused with either fresh human whole blood (unmodified control group [n = 4]), SIN-1 (n = 4), or SIN and tempol (n = 4). RESULTS SIN-1 and tempol significantly inhibited vWF secretion from endothelial cells in vitro. However, they did not suppress xenogeneic complement activation. In an ex vivo pulmonary perfusion model, SIN-1 improved pulmonary xenograft function by reducing pulmonary vascular resistance (PVR), inhibiting complement activation, and inhibiting thrombin generation. Combined treatment with tempol and SIN-1 potentiated PVR reduction, but slightly enhanced complement activation. CONCLUSIONS An NO donor is expected to improve pulmonary xenograft function through inhibition of vWF secretion, vasoconstriction, thrombin generation, and indirectly through inhibition of complement activation. The additional effects of tempol on an NO donor were not considered significant in an ex vivo xenograft system.
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Affiliation(s)
- Hee Sue Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Eun Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.,Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Ju You
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.,Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jayoon Gu
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.,Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Byungsu Yoo
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Saebom Lee
- Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Joo Lee
- Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yoohwa Hwang
- Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.,Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Xenotransplantation Research Center and Transplantation Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
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Lim DH, Ahn S, Hong S, Kim YG, Lee CK, Yoo B, Kim TH. THU0381 The Incidence of Herpes Zoster Infection in Patients with Ankylosing Spondylitis: Analysis from Korean National Health Insurance Service–Cohort Sample Database: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lim DH, Ahn S, Hong S, Seo W, Kim YG, Lee CK, Yoo B. FRI0124 Nontuberculous Mycobacterial Infection in Rheumatoid Arthritis Patients: A Single-Center Experience in South Korea: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lim DH, Oh J, Ahn S, Hong S, Seo W, Kim YG, Lee CK, Choi S, Yoo B. AB0804 The Efficacy and Tolerability of Febuxostat in Hyperuricemic Patients Undergoing Dialysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Lee EJ, Ghang B, Lim DH, Hong S, Lee CK, Yoo B, Kim YG. AB0185 Undercarboxylated Osteocalcin as A Marker for Metabolic Dysfunction in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Miles D, Fung A, Yoo B, Knott A, Heeson S, Portera C, Swain S. Abstract P4-14-27: Effect of docetaxel duration on clinical outcomes: Results from the phase III trial CLEOPATRA. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-14-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
In the CLEOPATRA study, pertuzumab (P) plus trastuzumab (T) and docetaxel (D) significantly improved median progression-free survival (PFS) and overall survival (OS) compared with placebo (Pla) plus T and D in pts with HER2-positive metastatic breast cancer. Study treatment was given every 3 weeks until disease progression (PD) or unacceptable toxicity. D starting dose was 75 mg/m2 and could be escalated or reduced per protocol. A minimum of 6 cycles of D was recommended. If D was discontinued, patients could continue P+T or Pla+T. To evaluate the potential association between D duration and clinical outcomes, we conducted post hoc exploratory analyses of the CLEOPATRA study.
Methods:
As of 11 Feb 2014 data cutoff, the safety population analyzed included 804 pts (396 Pla+T+D; 408 P+T+D) who received at least one dose of any study medication. Exposure and clinical outcomes of study treatment groups are presented by dichotomized subgroup of pts who received <6 cycles of D and those who received more than 6 cycles. Median PFS and OS were estimated using Kaplan-Meier methods. Cox regression analyses were used to estimate hazard ratios (HRs).
Results:
The median number of D cycles received was 8 for both arms. Forty-one % of pts received <6 (14% <6; 27% exactly 6) and 59% received >6 cycles.
Docetaxel Duration and Clinical Outcomes D <6 cycles (n=329, 41%)D >6 cycles (n=475, 59%) Pla+T+D (n=159)aP+T+D (n=170)aPla+T+D (n=237)P+T+D (n=238)Treatment Exposure#D Cycle, median (range)6 (1,6)6 (1,6)10 (7,42)10 (7,52)# Study Treatment Cycle, median (range)7 (1,78)14 (1,90)19 (7,92)28 (7,96)Duration of Study Treatment in month, median (range)6 (1,54)10 (1,63)14 (5,67)19 (5,68)Clinical OutcomesPFS in month, median (range)8.2 (6.2,9.0)12.5 (10.5,20.7)14.5 (12.6,17.2)22.8 (17.7,N/A)95% CIHR=0.59 (0.44,0.79)HR=0.65 (0.50,0.84)OS in month, median (range)29.8 (22.2,39.2)48.9 (36.8,N/A)46.7 (39.4,53.0)N/A (56.4,N/A)95% CIHR=0.67 (0.45,0.90)HR=0.62 (0.47,0.81)N/A=not available aTwo pts in each group had missing D cycle
Treatment Discontinuation Summary D <6 cyclesD >6 cycles Pla+T+D (n=159)P+T+D (n=170)Pla+T+D (n=237)P+T+D (n=238)D discontinuation before stopping anti-HER2 agents (n,%)90 (57)118 (69)180 (76)196 (82)Reason (n,%) AE/intercurrent illness34 (38)27 (23)60 (33)72 (37)Patient reasonb3 (3)5 (4)5 (3)8 (4)Standard practice36 (40)59 (50)65 (36)41 (21)Adequate therapy12 (13)22 (19)36 (20)59 (30)Other1 (1)1 (1)9 (5)11 (6)Missing4 (4)4 (3)5 (3)5 (3)Discontinuation of all study treatment (T+D+Pla or P), n159170237238Reason (n,%) AE/intercurrent illness15 (9)22 (13)25 (11)32 (13)Death10 (6)5 (3)4 (2)2 (1)Disease progression111 (70)110 (65)182 (77)154 (65)Patient reasonb17 (11)16 (9)12 (5)14 (6)Other6 (4)16 (9)12 (5)35 (15)Missing0 (0)1 (1)2 (1)1 (1)bIncluded failure to return, refused treatment, withdrawal, protocol violation
Conclusions:
Consistent with the overall study results, addition of P to T+D showed significant improvement in clinical outcomes regardless of whether <6 or >6 cycles of D were received. In the poster, three subgroup (<6, 6 and >6 D cycles) analyses and time-dependent Cox regression analysis to capture the dynamic variations in D exposure will be presented.
Citation Format: Miles D, Fung A, Yoo B, Knott A, Heeson S, Portera C, Swain S. Effect of docetaxel duration on clinical outcomes: Results from the phase III trial CLEOPATRA. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-27.
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Affiliation(s)
- D Miles
- Mount Vernon Cancer Center, Northwood, United Kingdom; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
| | - A Fung
- Mount Vernon Cancer Center, Northwood, United Kingdom; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
| | - B Yoo
- Mount Vernon Cancer Center, Northwood, United Kingdom; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
| | - A Knott
- Mount Vernon Cancer Center, Northwood, United Kingdom; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
| | - S Heeson
- Mount Vernon Cancer Center, Northwood, United Kingdom; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
| | - C Portera
- Mount Vernon Cancer Center, Northwood, United Kingdom; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
| | - S Swain
- Mount Vernon Cancer Center, Northwood, United Kingdom; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
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Robert N, Goertz HP, Asmar L, Tseng WY, Jiao X, Portera C, Yoo B, Patt D, Antao V. Abstract P4-14-13: Pertuzumab (P) use in first-line HER2-positive metastatic breast cancer (mBC) in US community oncology practices: Treatment patterns and outcomes. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-14-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pertuzumab was FDA-approved in 6/2012 for use in first-line in combination with trastuzumab (H) and docetaxel for patients (pts) with HER2-positive mBC. This retrospective study investigated the clinical characteristics, treatment patterns, safety, and outcomes for pts with HER2-positive mBC who received a P-containing regimen in first-line in US community oncology practices.
Methods: This study utilized iKnowMed electronic health records, Claims Data Warehouse, and Social Security Death Index. Pts with HER2-positive mBC, who received a P-containing regimen between 6/2012 and 6/2014 and were followed through 12/2014, had ≥2 visits within the McKesson Specialty Health/US Oncology Network, and were not on clinical trials during the study period, were eligible.
Results: Of the 322 pts who received a P-containing regimen in the first-line setting, 25% were ≥65 years of age, 63% were post-menopausal, 61% had hormone receptor-positive mBC, 84% had a performance status of 0 or 1, and 76% had a Charlson Comorbidities Index of 0. Twenty-one percent of pts had 1 site of metastasis noted, 32% had 2 sites, and 47% had 3 or more sites. Pts with de novo mBC made up 40% of this cohort. Of the pts with recurrent mBC, over 60% received H in the early-stage BC setting. In the first-line mBC setting, 93% of the 322 pts received H+P+taxane, and 7% received H+P with other chemotherapy agent(s). Common adverse events reported included: fatigue (49%), diarrhea (44%), nausea (33%), peripheral neuropathy (33%), neutropenia (24%), and rash (22%). Further analyses including outcomes of these 322 pts will be presented.
Conclusions: First-line P was given in combination with H and chemotherapy agent(s) (93% taxane). No new safety signals were observed. More details on the clinical characteristics, specific treatment patterns, and safety will be presented, along with the progression-free survival of these pts receiving first-line P-containing therapy in a real-world setting.
Citation Format: Robert N, Goertz H-P, Asmar L, Tseng W-Y, Jiao X, Portera C, Yoo B, Patt D, Antao V. Pertuzumab (P) use in first-line HER2-positive metastatic breast cancer (mBC) in US community oncology practices: Treatment patterns and outcomes. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-13.
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Affiliation(s)
- N Robert
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - H-P Goertz
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - L Asmar
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - W-Y Tseng
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - X Jiao
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - C Portera
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - B Yoo
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - D Patt
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
| | - V Antao
- US Oncology Research Inc., Houston, TX; Genentech, Inc., South San Francisco, CA
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