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Suriany S, Liu H, Cheng AL, Wenby R, Patel N, Badran S, Meiselman HJ, Denton C, Coates TD, Wood JC, Detterich JA. Decreased erythrocyte aggregation in Glenn and Fontan: univentricular circulation as a rheologic disease model. Pediatr Res 2024; 95:1335-1345. [PMID: 38177250 DOI: 10.1038/s41390-023-02969-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/19/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND In the Fontan palliation for single ventricle heart disease (SVHD), pulmonary blood flow is non-pulsatile/passive, low velocity, and low shear, making viscous power loss a critical determinant of cardiac output. The rheologic properties of blood in SVHD patients are essential for understanding and modulating their limited cardiac output and they have not been systematically studied. We hypothesize that viscosity is decreased in single ventricle circulation. METHODS We evaluated whole blood viscosity, red blood cell (RBC) aggregation, and RBC deformability to evaluate changes in healthy children and SVHD patients. We altered suspending media to understand cellular and plasma differences contributing to rheologic differences. RESULTS Whole blood viscosity was similar between SVHD and healthy at their native hematocrits, while viscosity was lower at equivalent hematocrits for SVHD patients. RBC deformability is increased, and RBC aggregation is decreased in SVHD patients. Suspending SVHD RBCs in healthy plasma resulted in increased RBC aggregation and suspending healthy RBCs in SVHD plasma resulted in lower RBC aggregation. CONCLUSIONS Hematocrit corrected blood viscosity is lower in SVHD vs. healthy due to decreased RBC aggregation and higher RBC deformability, a viscous adaptation of blood in patients whose cardiac output is dependent on minimizing viscous power loss. IMPACT Patients with single ventricle circulation have decreased red blood cell aggregation and increased red blood cell deformability, both of which result in a decrease in blood viscosity across a large shear rate range. Since the unique Fontan circulation has very low-shear and low velocity flow in the pulmonary arteries, blood viscosity plays an increased role in vascular resistance, therefore this work is the first to describe a novel mechanism to target pulmonary vascular resistance as a modifiable risk factor. This is a novel, modifiable risk factor in this patient population.
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Affiliation(s)
- Silvie Suriany
- Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Honglei Liu
- Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Andrew L Cheng
- Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Rosalinda Wenby
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Neil Patel
- Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Sarah Badran
- Division of Pediatric and Congenital Cardiology, Helen Devos Children's Hospital at Spectrum Health, Grand Rapids, MI, USA
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Herbert J Meiselman
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher Denton
- Division of Hematology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Thomas D Coates
- Division of Hematology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - John C Wood
- Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Jon A Detterich
- Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Knobler R, Geroldinger-Simić M, Kreuter A, Hunzelmann N, Moinzadeh P, Rongioletti F, Denton C, Mouthon L, Cutolo M, Smith V, Gabrielli A, Bagot M, Olesen AB, Foeldvari I, Jalili A, Kähäri VM, Kárpáti S, Kofoed K, Olszewska M, Panelius J, Quaglino P, Seneschal J, Sticherling M, Sunderkötter C, Tanew A, Wolf P, Worm M, Skrok A, Rudnicka L, Krieg T. Consensus statement on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxoedema and scleroedema. J Eur Acad Dermatol Venereol 2024. [PMID: 38456518 DOI: 10.1111/jdv.19937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
The term 'sclerosing diseases of the skin' comprises specific dermatological entities, which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present consensus provides an update to the 2017 European Dermatology Forum Guidelines, focusing on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, updated strategies for the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 2 of this consensus provides clinicians with an overview of the diagnosis and treatment of scleromyxoedema and scleroedema (of Buschke).
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Affiliation(s)
- Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Marija Geroldinger-Simić
- Department of Dermatology, Ordensklinikum Linz Elisabethinen, Linz, Austria
- Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Klinik Oberhausen, University Witten-Herdecke, Oberhausen, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | | | - Christopher Denton
- Center for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Institut Cochin, Université de Paris Cité, Paris, France
| | - Maurizio Cutolo
- Laboratories for Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University Medical School of Genoa, IRCCS San Martino Genoa, Genova, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Armando Gabrielli
- Fondazione di Medicina Molecolare e Terapia Cellulare, Università Politecnica delle Marche, Ancona, Italy
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Anne B Olesen
- Department of Dermatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Ahmad Jalili
- Department of Dermatology, Dermatology & Skin Care Clinic, Buochs, Switzerland
| | - Veli Matti Kähäri
- Department of Dermatology and Venereology, University of Turku and Turku University Hospital, Turku, Finland
| | - Sarolta Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Kristian Kofoed
- The Skin Clinic, Department of Dermato-Allergology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jaana Panelius
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Saint-Andre, University of Bordeaux, CNRS, Immuno CencEpT UMR 5164, Bordeaux, France
| | | | - Cord Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), Germany
| | - Adrian Tanew
- Private Practice, Medical University of Vienna, Vienna, Austria
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergology, University Hospital Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Skrok
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Thomas Krieg
- Department of Dermatology and Venereology, and Translational Matrix Biology, University of Cologne, Cologne, Germany
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Deibel E, Carreira PE, Vonk M, Del Papa N, Bečvář R, Guillén-Del-Castillo A, Campochiaro C, Poormoghim H, Liem S, Lazzaroni MG, Giollo A, Mekinian A, de Vries-Bouwstra J, De Santis M, Balbir-Gurman A, Mihai C, De Luca G, Moiseev S, Zanatta E, Foti R, Rednic S, Denton C, Cutolo M, Belloli L, Airo P, Garzanova L, Moroncini G, İnanç M, Panopoulos S, Tandaipan JL, Chatelus E, Rosato E, Kuwana M, Yavuz S, Alegre-Sancho JJ, Smith V, Szűcs G, Henes J, Rodríguez-Pintó I, Atzeni F, Spierings J, Truchetet ME, Milchert M, Brito de Araujo D, Riemekasten G, Bernardino V, Martin T, Del Galdo F, Vacca A, Mendoza F, Midtvedt Ø, Murdaca G, Santiago T, Codullo V, Cacciapaglia F, Walker U, Brunborg C, Tirelli F, Allanore Y, Furst DE, Matucci M, Gabrielli A, Distler O, Hoffmann-Vold AM. Does the Impact of COVID-19 on Patients With Systemic Sclerosis Change Over Time? Arthritis Care Res (Hoboken) 2024; 76:88-97. [PMID: 37667424 DOI: 10.1002/acr.25226] [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: 03/31/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The outcome of patients with COVID-19 improved over the pandemic, including patients with systemic rheumatic diseases. However, data on patients with systemic sclerosis (SSc) are lacking. This study aimed to assess the outcome of patients with both SSc and COVID-19 over several waves. METHODS Patients with both SSc and COVID-19 who were registered in the European Scleroderma Trials and Research group (EUSTAR) were collected between April 2020 and April 2021. Patients were assigned to waves 1, 2, or 3 depending on the date of their COVID-19 diagnosis. Primary endpoints were death, intensive care unit stay, or ventilatory support (severe outcome). Subgroup analyses of patients who were hospitalized or died were conducted. General and SSc-specific characteristics and treatment were compared over the waves. Descriptive statistics and multivariate logistic regression were applied. RESULTS A total of 333 patients were included; 57 patients (17%) had a severe outcome, and 30 patients (9%) died. Compared to wave 1, significantly fewer patients with SSc suffered from severe COVID-19 in waves 2 and 3 (28.2% vs 9.8% and 12.7%; P < 0.001), fewer patients required hospitalization (46.7% vs 19.6% and 25.5%; P < 0.001) or ventilatory support (24.0% vs 8.7% and 10.9%; P = 0.001), and fewer patients died (15.7% vs 5.0% and 7.5%; P = 0.011). Patients were significantly younger, more often men, had less frequent arterial hypertension, and less SSc cardiac involvement over waves 1 to 3. Patients received significantly less medium to high doses of corticosteroids as they did SSc treatment. CONCLUSION The outcome of patients with both SSc and COVID-19 improved significantly over time because of intrinsic and extrinsic factors.
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Affiliation(s)
- Elisabeth Deibel
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Madelon Vonk
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Radim Bečvář
- 1st Medical School, Charles University, Praha, Czech Republic
| | | | | | | | - Sophie Liem
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Maria De Santis
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy, and Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carina Mihai
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Sergey Moiseev
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Rosario Foti
- A.O.U. Policlinico S. Marco Catania, Catania, Italy
| | - Simona Rednic
- University of Medicine & Pharmacy "Iuliu Hatieganu" Cluj, Cluj-Napoca, Romania
| | | | | | - Laura Belloli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paolo Airo
- ASST Spedali Civili of Brescia, University of Brescia, Italy
| | - Liudmila Garzanova
- VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Gianluca Moroncini
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | | | | | | | - Emmanuel Chatelus
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares Est/Sud-Ouest (RESO), Strasbourg, France
| | | | | | | | | | - Vanessa Smith
- Ghent University, Ghent University Hospital, and VIB Inflammation Research Center (IRC), Ghent, Belgium
| | | | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases (INDIRA), University Hospital Tuebingen, Tuebingen, Germany
| | | | | | | | | | | | | | - Gabriela Riemekasten
- University Clinic Schleswig Holstein Lübeck, University of Lübeck, Lübeck, Germany
| | - Vera Bernardino
- Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Thierry Martin
- Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Nouvel Hôpital Civil, Strasbourg, France
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds, UK
| | | | | | | | - Giuseppe Murdaca
- University of Genova and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tânia Santiago
- Centro Hospital e Universitário de Coimbra, University of Coimbra, Portugal
| | | | | | | | | | - Francesca Tirelli
- University Hospital Zurich, University of Zurich, Zurich, Switzerland, and University of Padova, Padova, Italy
| | | | | | - Marco Matucci
- University of Florence, Florence, Italy and IRCCS San Raffaele Hospital, Milan, Italy
| | - Armando Gabrielli
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | - Oliver Distler
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna-Maria Hoffmann-Vold
- University Hospital Zurich, University of Zurich, Zurich, Switzerland and Oslo University Hospital, Oslo, Norway
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4
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Foeldvari I, Torok KS, Anton J, Blakley M, Constantin T, Curran M, Cutolo M, Denton C, Fligelstone K, Ingegnoli F, Li SC, Němcová D, Orteu C, Pilkington C, Smith V, Stevens A, Klotsche J, Khanna D, Costa-Reis P, Del Galdo F, Hinrichs B, Kasapcopur O, Pain C, Ruperto N, Zheng A, Furst DE. Proposed Response Parameters for Twelve-Month Drug Trial in Juvenile Systemic Sclerosis: Results of the Hamburg International Consensus Meetings. Arthritis Care Res (Hoboken) 2023; 75:2453-2462. [PMID: 37332054 DOI: 10.1002/acr.25171] [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: 11/24/2022] [Revised: 04/03/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Juvenile systemic sclerosis (SSc) is an orphan disease, associated with high morbidity and mortality. New treatment strategies are much needed, but clearly defining appropriate outcomes is necessary if successful therapies are to be developed. Our objective here was to propose such outcomes. METHODS This proposal is the result of 4 face-to-face consensus meetings with a 27-member multidisciplinary team of pediatric rheumatologists, adult rheumatologists, dermatologists, pediatric cardiologists, pulmonologists, gastroenterologists, a statistician, and patients. Throughout the process, we reviewed the existing adult data in this field, the more limited pediatric literature for juvenile SSc outcomes, and data from 2 juvenile SSc patient cohorts to assist in making informed, data-driven decisions. The use of items for each domain as an outcome measure in an open label 12-month clinical trial of juvenile SSc was voted and agreed upon using a nominal group technique. RESULTS After voting, the domains agreed on were global disease activity, skin, Raynaud's phenomenon, digital ulcers, musculoskeletal, cardiac, pulmonary, renal, and gastrointestinal involvement, and quality of life. Fourteen outcome measures had 100% agreement, 1 item had 91% agreement, and 1 item had 86% agreement. The domains of biomarkers and growth/development were moved to the research agenda. CONCLUSION We reached consensus on multiple domains and items that should be assessed in an open label, 12-month clinical juvenile SSc trial as well as a research agenda for future development.
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Affiliation(s)
| | - Kathryn S Torok
- University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jordi Anton
- Hospital Sant Joan de Déu and Universitat de Barcelona, Barcelona, Spain
| | - Michael Blakley
- Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis
| | | | - Megan Curran
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Maurizio Cutolo
- University of Genoa and IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | | | | | | | - Suzanne C Li
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | | | - Vanessa Smith
- Ghent University, Ghent University Hospital, VIB Inflammation Research Center, and ERN ReCONNET, Ghent, Belgium
| | - Anne Stevens
- Children's Hospital Research Institute and University of Washington, Seattle, and Janssen Pharmaceutical Companies of Johnson & Johnson, Spring House, Pennsylvania
| | | | | | - Patrícia Costa-Reis
- Hospital de Santa Maria, Faculdade de Medicina, and Universidade de Lisboa, Lisbon, Portugal
| | | | | | - Ozgur Kasapcopur
- Cerrahpasa Medical School and Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Clare Pain
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | | | - Alison Zheng
- Chinese Organization for Scleroderma, Chengdu City, Sichuan Province, China
| | - Daniel E Furst
- University of California, Los Angeles, University of Washington, Seattle, and University of Florence, Florence, Italy
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5
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Rees CA, Brousseau DC, Cohen DM, Villella A, Dampier C, Brown K, Campbell A, Chumpitazi CE, Airewele G, Chang T, Denton C, Ellison A, Thompson A, Ahmad F, Bakshi N, Coleman KD, Leibovich S, Leake D, Hatabah D, Wilkinson H, Robinson M, Casper TC, Vichinsky E, Morris CR. Sickle Cell Disease Treatment with Arginine Therapy (STArT): study protocol for a phase 3 randomized controlled trial. Trials 2023; 24:538. [PMID: 37587492 PMCID: PMC10433602 DOI: 10.1186/s13063-023-07538-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Despite substantial illness burden and healthcare utilization conferred by pain from vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD), disease-modifying therapies to effectively treat SCD-VOE are lacking. The aim of the Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial is to provide definitive evidence regarding the efficacy of intravenous arginine as a treatment for acute SCD-VOE among children, adolescents, and young adults. METHODS STArT is a double-blind, placebo-controlled, randomized, phase 3, multicenter trial of intravenous arginine therapy in 360 children, adolescents, and young adults who present with SCD-VOE. The STArT Trial is being conducted at 10 sites in the USA through the Pediatric Emergency Care Applied Research Network (PECARN). Enrollment began in 2021 and will continue for 5 years. Within 12 h of receiving their first dose of intravenous opioids, enrolled participants are randomized 1:1 to receive either (1) a one-time loading dose of L-arginine (200 mg/kg with a maximum of 20 g) administered intravenously followed by a standard dose of 100 mg/kg (maximum 10 g) three times a day or (2) a one-time placebo loading dose of normal saline followed by normal saline three times per day at equivalent volumes and duration as the study drug. Participants, research staff, and investigators are blinded to the participant's randomization. All clinical care is provided in accordance with the institution-specific standard of care for SCD-VOE based on the 2014 National Heart, Lung, and Blood Institute guidelines. The primary outcome is time to SCD-VOE pain crisis resolution, defined as the time (in hours) from study drug delivery to the last dose of parenteral opioid delivery. Secondary outcomes include total parental opioid use and patient-reported outcomes. In addition, the trial will characterize alterations in the arginine metabolome and mitochondrial function in children with SCD-VOE. DISCUSSION Building on the foundation of established relationships between emergency medicine providers and hematologists in a multicenter research network to ensure adequate participant accrual, the STArT Trial will provide definitive information about the efficacy of intravenous arginine for the treatment of SCD-VOE for children. TRIAL REGISTRATION The STArT Trial was registered in ClinicalTrials.gov on April 9, 2021, and enrollment began on June 21, 2021 (NCT04839354).
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Affiliation(s)
- Chris A Rees
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David C Brousseau
- Department of Pediatrics, Nemours Children's Health Delaware and the Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA
| | | | | | - Carlton Dampier
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kathleen Brown
- Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Andrew Campbell
- Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Gladstone Airewele
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Todd Chang
- Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Christopher Denton
- Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Angela Ellison
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Fahd Ahmad
- Washington University in St. Louis, St. Louis, MO, USA
| | - Nitya Bakshi
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Keli D Coleman
- Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | | | | | - Dunia Hatabah
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA
| | | | | | | | - Elliott Vichinsky
- Center for Maternal-Fetal Precision Medicine, University of California, San Francisco, CA, USA
- Department of Pediatrics, UCSF-Benioff Children's Hospital-Oakland, Oakland, CA, USA
| | - Claudia R Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
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6
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Garces SL, Abdi BA, MacFadyen C, Smillie R, Nagib L, Ghani S, Shah S, Abraham D, Denton C, Stratton RJ. P231 Targeting the Rho/MRTF-A pathway inhibits growth factor and cytokine release but enhances efferocytosis in scleroderma macrophages. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.230] [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: 11/12/2022] Open
Abstract
Abstract
Background/Aims
In the systemic sclerosis (SSc) microenvironment, accumulation of extracellular matrix (ECM) components induces changes in the matrix's mechanical properties, which triggers Rho/MRTFF-A activation and the downstream signalling cascades, inducing the expression of fibrotic and inflammatory genes in fibroblasts. However, macrophages also play a key role in tissue homeostasis and wound repair. It is possible that these cells are also influenced by ECM stiffness and therefore we investigated the effects of altering substrate stiffness and tested the effects of an inhibitor of the mechano-sensing Rho/MRTF-A pathway on the activation state of SSc macrophages.
Methods
SSc and healthy control macrophages (both n = 4 donors) were derived by culture of blood monocytes in the presence of M-CSF (4ng/ml) for 7 days. Soft substrates (4kPa) or stiff ECM substrates (50kPa) were used to model the effect of soft healthy skin tissue and stiff fibrotic SSc skin (Softwell, Matrigen, polymer gels, collagen I coated). Morphology, gene expression (qPCR for CD86 for M1-like, CD206 for M2-like, MerTK for efferocytosis), Multiplex assay, labelled E. Coli uptake assay and Rho/MRTF/SRF pathway inhibition (small molecule CCG-257081) were used to assess the polarisation and activation state of these cells.
Results
Morphology and CD86 did not vary with matrix stiffness, but CD206 expression was significantly lower in stiff compared to soft gels (Mean+/- SEM; soft 38.2+/- 4.2 vs stiff 16.2+/-3.7 relative expression, p value 0.0167). CCG-257081 strongly inhibited secretion of cytokines, growth factors and chemokines. Factors present at > 50 pg/ml suppressed by CCG-257081 include TNFα, GM-CSF, IL-1RA, IP-10, RANTES, MIP-1α, MIP-1β, MCP-1, MCP-3, PDGF-BB (all p < 0.05). SSc macrophages secreted at high levels on soft, and were attenuated by culture on stiff, whereas healthy control macrophages showed the opposite trend inducing more secretion on stiff, inhibited by CCG-257081. Although polarisation markers CD206 and CD86 did not alter with the CCG-257081 treatment, there was a significant increase in MerTK with treatment (p < 0.0001). Endocytosis was moderately yet significantly suppressed by the CCG treatment (basal endocytosis 80.2+/- 4.0 vs CCG-257081 treated 62+/-2.5; % endocytosis; p < 0.01), whereas cell viability was not significantly altered.
Conclusion
Although differences are observed amongst patients, this data indicates that stiffness of the matrices, as used in this study, did not greatly alter the morphology or polarisation of the macrophages. However, transfer to stiff matrices enhanced the secretion of certain cytokines by control macrophages. Strong effects were seen with the Rho/MRTF-A inhibitor, which appeared to block the secretion of multiple factors, including inflammatory cytokines, pro-fibrotic factors, as well as regulatory factors and to strongly induce MerTK, a marker of efferocytosis. One possibility is that the inhibitor converts these cells from secretory to resolving phenotype. Based on these findings, CCG-257081 has promising effects against activated macrophages, which could be utilised in inflammatory fibrotic diseases.
Disclosure
S. Lopez Garces: None. B. Ahmed Abdi: None. C. MacFadyen: None. R. Smillie: None. L. Nagib: None. S. Ghani: None. S. Shah: None. D. Abraham: None. C. Denton: None. R.J. Stratton: None.
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Affiliation(s)
- Sandra Lopez Garces
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Bahja Ahmed Abdi
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Claire MacFadyen
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Robert Smillie
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Lydia Nagib
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Shahi Ghani
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Shivani Shah
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - David Abraham
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Christopher Denton
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
| | - Richard J Stratton
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, UCL Division of Medicine, London, UNITED KINGDOM
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Murphy D, Orgel E, Koek W, Frei-Jones M, Denton C, Kamat D. A Meta-analysis of the Utility of Red Cell Distribution Width as a Biomarker to Predict Outcomes in Pediatric Illness (PROSPERO CRD42020208777). J Pediatr Intensive Care 2021. [DOI: 10.1055/s-0041-1735876] [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: 10/20/2022] Open
Abstract
AbstractRed cell distribution width (RDW) is an average of the variation in red blood cell (RBC) sizes reported on a complete blood count. An elevated RDW indicates a pathological process that is affecting erythropoiesis. Studies showed that as the severity of disease process increases, the RDW often increases as well. Particularly in resource-limited countries, RDW has been studied as an outcome predictor for conditions in a variety of disciplines and is offered as an adjunct monitoring tool that is cost effective, readily available, and indicative of pathological processes amenable to intervention. Particularly in pediatric critical care settings, RDW has been shown to be a reliable tool for surveillance of disease states such as sepsis. Despite the increased attention of RDW as a marker for disease outcome, collective evaluation on the utility of RDW as a marker for outcome in pediatric critical care settings is lacking. We offer a systematic review and meta-analysis of published studies to assess the ability of RDW to predict illness severity and mortality among pediatric critical care patients. Among eight studies of over 4,800 patients, we found over a two-fold increase in odds for mortality in critically ill children whose RDW was above 15.7%. This is the first systematic review of RDW being used to predict mortality in critically ill children and findings of this study may prompt early intervention in the pediatric critical care setting.
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Affiliation(s)
- Devin Murphy
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United Sates
| | - Etan Orgel
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California, United Sates
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California, United Sates
| | - Wouter Koek
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United Sates
| | - Melissa Frei-Jones
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United Sates
- Department of Pediatrics, Pediatric Hematology–Oncology, Long School of Medicine, University of Texas Health Science Center San Antonio, Texas, United Sates
| | - Christopher Denton
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California, United Sates
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California, United Sates
| | - Deepak Kamat
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United Sates
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Orlandi M, Landini N, Sambataro G, Nardi C, Bruni C, Bellando-Randone S, Denton C, Luppi F, Ruaro B, Tomassetti S, Cavigli E, Melchiorre F, Palmucci S, Guiducci S, Moggi Pignone A, Allanore Y, Bartoloni A, Confalonieri M, Cortese G, Dagna L, De Cobelli F, De Paulis A, Harari S, Khanna D, Kuwana M, Miele V, Taliani G, Hughes M, Vanchieri C, Colagrande S, Matucci-Cerinic M. POS1228 THE ROLE OF CHEST CT IN UNDERSTANDING INTERSTITIAL LUNG DISEASE (ILD): SYSTEMIC SCLEROSIS (SSc). VERSUS COVID-19. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2967] [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:COVID-19 pandemic is a global emergency which may overlap on the clinical and radiological scenario of ILD in SSc. In clinical practice, the striking similarities observed at computed tomography (CT) between the diseases make it difficult to distinguish a COVID-19 superinfection from a progression of SSc-ILD.Objectives:The aim of our study was to identify the main CT features that may help distinguishing SSc-ILD from COVID-19 pneumonia.Methods:22 international readers were included and divided in the radiologist group (RAD) and non-radiologist group (nRAD). The RAD group included non-chest RAD and chest-RAD. A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.Results:Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT parameters most frequently associated with SSc-ILD. The CT parameters most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p <0.0001) and signs of fibrosis in GGO in the lower lobes (p <0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. These two variables were combined in a predictive score which resulted positively associated with the COVID-19 diagnosis, with 96.1% sensitivity and 83.3% specificity: 3 different risk class for COVID-19 pneumonia may be identified: high risk for COVID-19 pneumonia (5-9 points); probable overlap COVID-19 pneumonia in SSc-ILD (4 points); low risk for COVID-19 pneumonia (0-3 points).Conclusion:The CT differential diagnosis between COVID-19 Pneumonia and SSc-ILD is possible and may be fostered in practice by the use of a radiological score. In the case where an overlap of both diseases is suspected, the presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.References:[1]Orlandi M, Landini N, Bruni C, et al. Infection or autoimmunity? The clinical challenge of interstitial lung disease in systemic sclerosis during COVID 19 pandemic. J Rheumatol. 2020 Dec 1: jrheum.200832[2]Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA [published online ahead of print, 2020 Apr 28]. J Thorac Imaging. 2020;10.1097/RTI.0000000000000524.[3]Cheng C, Li C, Zhao T, et al. COVID-19 with rheumatic diseases: a report of 5 cases. Clin Rheumatol. 2020;39(7):2025-2029.[4]Mariano RZ, Rio APTD, Reis F. Covid-19 overlapping with systemic sclerosis. Rev Soc Bras Med Trop. 2020 Sep 21;53:e20200450.Disclosure of Interests:None declared
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Kuster S, Jordan S, Elhai MD, Held U, Steigmiller K, Bruni C, Iannone F, Vettori S, Siegert E, Rednic S, Codullo V, Airò P, Braun-Moscovici Y, Hunzelmann N, Salvador MJ, Riccieri V, Gheorghiu AM, Alegre Sancho JJ, Romanowska-Prochnicka K, Castellví I, Koetter I, Truchetet ME, López-Longo FJ, Novikov P, Giollo A, Shirai Y, Belloli L, Zanatta E, Hachulla E, Smith V, Denton C, Ionescu R, Schmeiser T, Distler JHW, Gabrielli A, Hoffmann-Vold AM, Kuwana M, Allanore Y, Distler O. POS0861 EFFECTIVENESS AND SAFETY OF TOCILIZUMAB IN PATIENTS WITH SYSTEMIC SCLEROSIS: A PROPENSITY SCORE CONTROL MATCHED OBSERVATIONAL STUDY OF THE EUSTAR COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2392] [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:Tocilizumab (TCZ) showed trends for improving skin fibrosis and prevented progression of lung fibrosis in patients with systemic sclerosis (SSc) in placebo-controlled randomised clinical trials (RCTs). However, safety and effectiveness of TCZ beyond these selected and enriched clinical trial populations in SSc is still unknown.Objectives:To assess safety and effectiveness of TCZ treatment compared to standard of care in SSc patients from the large, multicentre, observational, real-life EUSTAR network/database using propensity score matching.Methods:SSc patients from the EUSTAR network/database, who fulfilled the ACR/EULAR 2013 classification criteria, with a baseline and a follow-up visit at 12±3 months, receiving TCZ or standard of care (controls), were selected. The following variables were used for the propensity score matching (1:1): age at diagnosis, gender, disease subtype, baseline modified Rodnan skin score (mRSS), forced vital capacity (FVC), and diffusing capacity for carbon monoxide (DLCO), co-therapy with immunosuppressives, disease duration, and year of treatment. Primary endpoints were mRSS and FVC at 12±3 months follow-up compared between the groups, using paired t-tests. Secondary endpoints were the percentage of progressive/regressive patients for skin and lung at 12±3 months follow-up according to standard definitions (1,2). Sensitivity analyses assessed pre-processing decisions (selection of most recent vs. random observation for control patients with multiple suitable time intervals), as well as the matching method (optimal vs. exact matching). Missing values were addressed with 100-fold multiple imputation using chained equations. Safety data were analysed in all patients. The study including the statistical analysis plan was pre-registered at www.drks.de (DRKS-ID: DRKS00015537).Results:We identified 93 SSc patients treated with TCZ and 2370 SSc patients with standard of care who fulfilled the inclusion criteria. Forty nine (57.7%) of the TCZ treated patients were diffuse, eight patients were not classified, disease duration was (mean±SD) 6.35±5.40 years, their baseline mRSS was 15.05±10.85, and 76 (81.7%) received immunosuppressive therapy in addition to TCZ.Through multiple imputation and propensity score matching, 100 imputed sets of 93 pairs of TCZ/controls were generated. Comparison between groups showed consistent effects of TCZ across all pre-defined primary and secondary endpoints: mRSS was lower in the TCZ group (mean difference (95% confidence interval (CI)) -1.8 (-4.79 to 1.19), p=0.24, Figure 1A). Similarly, FVC % predicted was higher in the TCZ group mean difference (2.25, 95% CI -4.57 to 9.06), p=0.51, Figure 1B). Considering secondary endpoints, the percentage of skin progressors as well as lung progressors at follow up was lower in the TCZ group (odds ratio OR 0.67 (95% CI 0.07 to 6.41), p=0.74 and OR 0.53 (95% CI 0.16 to 1.7); p=0.2, respectively. Consistently, the percentage of regressors for skin (OR 1.6 (95% CI 0.56 to 4.54), p=0.38) and for lung (OR 1.74 (95% CI 0.66 to 4.58), p=0.26) was higher in TCZ. These results were robust regarding the sensitivity analyses. Safety analysis confirmed previously reported adverse event profiles.Conclusion:In this large, observational, controlled, real-life EUSTAR study, effectiveness of TCZ did not reach statistical significance compared to standard of care treatment but showed consistent positive effects of TCZ on skin and lung fibrosis across all pre-defined primary and secondary endpoints confirming data from recent RCTs.References:[1]Prediction of improvement in skin fibrosis in diffuse cutaneous systemic sclerosis: a EUSTAR analysis. Ann Rheum Dis 2016:1743-8.[2]Progressive interstitial lung disease in patients with systemic sclerosis-associated interstitial lung disease in the EUSTAR database. Ann Rheum Dis 2021:219-227.Disclosure of Interests:Simon Kuster: None declared, Suzana Jordan: None declared, Muriel Daniele Elhai: None declared, Ulrike Held: None declared, Klaus Steigmiller: None declared, Cosimo Bruni: None declared, Florenzo Iannone: None declared, Serena Vettori: None declared, Elise Siegert: None declared, Simona Rednic: None declared, Veronica Codullo: None declared, Paolo Airò Consultant of: Dr. Airo’ reports personal fees (consultancies) from Bristol Myers Squibb, Bohringer Ingelheim, non-financial support from CSL Behring, SOBI, Janssen, Roche, Sanofi, Pfizer, Yolanda Braun-Moscovici: None declared, Nicolas Hunzelmann: None declared, Maria Joao Salvador: None declared, Valeria Riccieri: None declared, Ana Maria Gheorghiu: None declared, Juan Jose Alegre Sancho: None declared, Katarzyna Romanowska-Prochnicka: None declared, Ivan Castellví: None declared, Ina Koetter: None declared, Marie-Elise Truchetet Consultant of: Marie-Elise Truchetet has had consultancy relationships and/or has received research funding from Boehringer Ingelheim, Genentech/Roche, and Sanofi in the area of potential treatments of scleroderma and its complications., Grant/research support from: Marie-Elise Truchetet has had consultancy relationships and/or has received research funding from Boehringer Ingelheim, Genentech/Roche, and Sanofi in the area of potential treatments of scleroderma and its complications., Francisco J López-Longo: None declared, Pavel Novikov: None declared, Alessandro Giollo: None declared, Yuichiro Shirai: None declared, Laura Belloli: None declared, Elisabetta Zanatta: None declared, Eric Hachulla: None declared, Vanessa Smith: None declared, Christopher Denton: None declared, Ruxandra Ionescu: None declared, Tim Schmeiser: None declared, Jörg H.W. Distler: None declared, Armando Gabrielli: None declared, Anna-Maria Hoffmann-Vold Consultant of: AMHV has received research funding and/or consulting fees and/or other remuneration from Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp & Dohme, ARXX, Lilly and Medscape, Grant/research support from: AMHV has received research funding and/or consulting fees and/or other remuneration from Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp & Dohme, ARXX, Lilly and Medscape. Masataka Kuwana: None declared, Yannick Allanore: None declared, Oliver Distler Speakers bureau: Oliver Distler has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: Oliver Distler has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: The study was partially supported by a grant from Roche. Roche was not involved in analysis or interpretation of the results.
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Volkmann E, Kreuter M, Hoffmann-Vold AM, Wijsenbeek M, Smith V, Khanna D, Denton C, Wuyts W, Miede C, Alves M, Sambevski S, Allanore Y. OP0170 DECLINE IN FORCED VITAL CAPACITY (FVC) IN PATIENTS WITH SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE (SSC-ILD) WITH AND WITHOUT DYSPNOEA: DATA FROM THE SENSCIS TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.834] [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:Some patients with SSc-ILD develop dyspnoea secondary to parenchymal lung disease, while others do not report dyspnoea even when their lung function is impaired. It is unclear whether the presence of dyspnoea is associated with a worse course of SSc-ILD or with response to therapy.Objectives:To investigate the rate of decline in FVC in patients with SSc-ILD in the SENSCIS trial in subgroups by patient-reported dyspnoea at baseline.Methods:The SENSCIS trial enrolled patients with SSc-ILD with first non-Raynaud symptom within ≤7 years before screening, extent of fibrotic ILD ≥10% on HRCT and FVC ≥40% predicted. Patients were randomised to receive nintedanib or placebo until the last patient reached week 52. In post-hoc analyses, we analysed the rate of decline in FVC (mL/year) over 52 weeks in patients with and without dyspnoea at baseline based on the question about dyspnoea in the St. George’s Respiratory Questionnaire (SGRQ). Patients who reported having shortness of breath “most days a week”, “several days a week” or “a few days a month” (rather than “only with chest infection” or “not at all”) over the last month were considered to have dyspnoea at baseline. A random slope and intercept model was used to assess the rate of decline in FVC (mL/year) and an interaction test was applied to assess potential heterogeneity in the treatment effect of nintedanib between the subgroups.Results:Of 576 patients, 69.8% had dyspnoea at baseline. At baseline, in patients with and without dyspnoea, respectively, mean (SD) extent of fibrotic ILD on HRCT was 37.7 (21.7)% and 31.6 (19.4)%; mean (SD) FVC was 71.0 (16.3) and 76.5 (16.8) % predicted; 50.7% and 44.8% were taking mycophenolate; 53.5% and 41.9% were taking corticosteroids. In the placebo group, the rate of decline in FVC (mL/year) was similar in patients with and without dyspnoea at baseline (Figure). The effect of nintedanib versus placebo on reducing the rate of decline in FVC (mL/year) was numerically more pronounced in patients without dyspnoea (difference: 79.8 [95% CI: 9.8, 149.7]) than with dyspnoea (difference: 25.7 [-19.9, 71.3]), but the exploratory interaction p-value did not indicate heterogeneity in the treatment effect between subgroups (p=0.20).Conclusion:In the SENSCIS trial, patients with SSc-ILD who had dyspnoea at baseline had a numerically greater extent of fibrotic ILD on HRCT and numerically lower FVC % predicted at baseline. The rate of decline in FVC in the placebo group was similar in patients with and without dyspnoea. Nintedanib had a numerically greater treatment effect in patients without dyspnoea. These data suggest that the presence of dyspnoea should not be used as a criterion for starting nintedanib in patients with SSc-ILD.Acknowledgements:The SENSCIS trial was funded by Boehringer Ingelheim. Medical writing support was provided by Fleishman Hillard Fishburn, London, UK. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE).Disclosure of Interests:Elizabeth Volkmann Consultant of: Boehringer Ingelheim, Grant/research support from: Corbus and Forbius, Michael Kreuter Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim and Roche, Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme and Roche, Consultant of: Actelion, Arxx Therapeutics, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme and Roche, Grant/research support from: Boehringer Ingelheim, Marlies Wijsenbeek Speakers bureau: Boehringer Ingelheim (fees paid to institution) and Hoffmann-La Roche (fees paid to institution), Consultant of: Boehringer Ingelheim (fees paid to institution), Bristol-Myers Squibb (fees paid to institution), Galapagos NV (fees paid to institution), Hoffmann-La Roche (fees paid to institution), NeRRe Therapeutics (fees paid to institution), OncoArendi Therapeutics (fees paid to institution), Respivant Sciences (fees paid to institution) and Savara (fees paid to institution), Grant/research support from: Boehringer Ingelheim (fees paid to institution) and Hoffmann-La Roche (fees paid to institution), Vanessa Smith Speakers bureau: Boehringer Ingelheim and Janssen-Cilag NV, Consultant of: Boehringer Ingelheim, Grant/research support from: Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim, Janssen-Cilag NV and Research Foundation - Flanders (FWO), Dinesh Khanna Shareholder of: Eicos Sciences, Inc. (less than 5%), Consultant of: Acceleron Pharma, Actelion, AbbVie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead Sciences, Galapagos NV, Genentech/Roche, GlaxoSmithKline, Horizon Therapeutics, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Sanofi-Aventis and United Therapeutics, Grant/research support from: Bayer, Bristol-Myers Squibb, Horizon Therapeutics, Immune Tolerance Network, National Institutes of Health and Pfizer, Employee of: Chief Medical Officer- CiviBioPharma/Eicos Sciences, Inc., Christopher Denton Speakers bureau: Boehringer Ingelheim, Corbus, Janssen, and Mallinckrodt Pharmaceuticals, Consultant of: Acceleron Pharma, Arxx Therapeutics, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos NV, GlaxoSmithKline, Horizon Therapeutics, Janssen, Mallinckrodt Pharmaceuticals, Roche, Sanofi and UCB, Grant/research support from: Arxx Therapeutics, GlaxoSmithKline and Servier, Wim Wuyts: None declared, Corinna Miede Employee of: Currently an employee of mainanalytics GmbH, contracted by Boehringer Ingelheim, Margarida Alves Employee of: Currently an employee of Boehringer Ingelheim, Steven Sambevski Employee of: Currently an employee of Boehringer Ingelheim, Yannick Allanore Consultant of: Boehringer Ingelheim, Medsenic, Menarini and Sanofi, Grant/research support from: Alpine Pharmaceuticals
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Del Galdo F, Distler O, Denton C, Allanore Y, Wachtlin D, Alves M, Khanna D. AB0431 EXPLORING THE UTILITY OF THE AMERICAN COLLEGE OF RHEUMATOLOGY (ACR) CRISS IN PATIENTS WITH DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1760] [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:The ACR Composite Response Index in diffuse cutaneous Systemic Sclerosis (CRISS) was developed to measure the probability of improvement in response to treatment in patients with early diffuse cutaneous SSc (dcSSc), accounting for new/worsening cardiopulmonary involvement and/or renal crisis, and changes in modified Rodnan skin score, forced vital capacity, health assessment questionnaire disability index, and patient’s and physician’s global impressions. In patients with SSc-ILD, treatment response may be reflected as slower progression, stabilisation or improvement.Objectives:Using data from patients with dcSSc and ILD in the placebo group of the SENSCIS trial, we analysed the probability of improvement using the ACR CRISS score at week 52. We also evaluated whether the CRISS numerator could provide information on the spectrum of responses in this patient population.Methods:The SENSCIS trial enrolled subjects with SSc-ILD with onset of first non-Raynaud symptom ≤7 years before screening, FVC ≥40% predicted, and fibrotic ILD ≥10% extent on an HRCT scan. Subjects on prednisone ≤10 mg/day (or equivalent) and/or stable therapy with mycophenolate or methotrexate were allowed to participate. Subjects were randomised to receive nintedanib or placebo. Subjects were not randomised by use of mycophenolate. In patients randomised to receive placebo who had dcSSc and/or mRSS >15 at baseline, we analysed the ACR CRISS and its numerator at week 52 in subgroups by use of mycophenolate at baseline. Analyses were exploratory and descriptive.Results:Of 117 analysed subjects in the placebo group who had dcSSc and/or mRSS >15 at baseline, 60 (51.3%) were taking mycophenolate at baseline. Compared with patients not taking mycophenolate at baseline, those taking mycophenolate had a lower mean age (48.4 [SD 11.8] vs 53.1 [13.4] years), lower mean FVC % predicted (68.8 [17.0] vs 73.0 [14.6]), and a greater proportion were female (76.7% vs 71.9%); median time since first onset of non-Raynaud symptom was similar (3.9 vs 4.5 years, respectively) as was mean (SD) mRSS (16.5 [7.7] vs 15.9 [8.0], respectively). One patient (taking mycophenolate at baseline) had limited cutaneous SSc. At week 52, median (Q1, Q3) ACR CRISS score was 0.036 (0.001, 0.601) in subjects taking mycophenolate and 0.002 (0.000, 0.112) in subjects not taking mycophenolate at baseline, and mean (SD) ACR CRISS score was 0.28 (0.37) in subjects taking mycophenolate and 0.16 (0.31) in subjects not taking mycophenolate at baseline (Figure 1). In these groups, respectively, 25.0% and 14.0% of subjects had CRISS score >0.6 (considered improved) at week 52. The CRISS numerator provided a broader distribution of response values, but was not informative in this patient population.Conclusion:In exploratory analyses, among subjects with dcSSc and ILD who received placebo in the SENSCIS trial, the proportion considered improved at week 52 based on ACR CRISS score was numerically greater in patients taking than not taking mycophenolate at baseline. There remains a need for composite scores that provide better interpretation of the magnitude of response in patients with SSc.Acknowledgements:The SENSCIS trial was funded by Boehringer Ingelheim. Medical writing support was provided by FleishmanHillard Fishburn, London, UK. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE).Disclosure of Interests:Francesco Del Galdo Speakers bureau: Actelion and AstraZeneca, Consultant of: Actelion, AstraZeneca, Boehringer Ingelheim, Capella BioScience, ChemomAb and Mitsubishi Tanabe Pharma, Grant/research support from: Capella BioScience, Kymab and Mitsubishi Tanabe Pharma, Oliver Distler Consultant of: AbbVie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Bayer, Blade Therapeutics, Boehringer Ingelheim, ChemomAb, Corbus, CSL Behring, Galapagos NV, GlaxoSmithKline, Glenmark Pharmaceuticals, Horizon (Curzion) Pharmaceuticals, Inventiva, IQVIA, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Target Bioscience, Topadur Pharma and UCB, Grant/research support from: Kymera Therapeutics and Mitsubishi Tanabe Pharma, Christopher Denton Speakers bureau: Boehringer Ingelheim, Corbus, Janssen, and Mallinckrodt Pharmaceuticals, Consultant of: Acceleron Pharma, Arxx Therapeutics, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos NV, GlaxoSmithKline, Horizon Therapeutics, Janssen, Mallinckrodt Pharmaceuticals, Roche, Sanofi and UCB, Grant/research support from: Arxx Therapeutics, GlaxoSmithKline and Servier, Yannick Allanore Consultant of: Boehringer Ingelheim, Medsenic, Menarini and Sanofi, Grant/research support from: Alpine Pharmaceuticals, Daniel Wachtlin Employee of: Currently an employee of Boehringer Ingelheim, Margarida Alves Employee of: Currently an employee of Boehringer Ingelheim, Dinesh Khanna Shareholder of: Eicos Sciences, Inc. (less than 5%), Consultant of: Acceleron Pharma, Actelion, AbbVie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead Sciences, Galapagos NV, Genentech/Roche, GlaxoSmithKline, Horizon Therapeutics, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis and United Therapeutics, Grant/research support from: Bayer, Bristol-Myers Squibb, Horizon Therapeutics, Immune Tolerance Network, National Institutes of Health and Pfizer, Employee of: Chief Medical Officer- CiviBioPharma/Eicos Sciences, Inc.
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Bellando Randone S, Wilhalme H, Bruni C, Siegert E, Airò P, Irace R, Distler O, Doria A, Ananieva LP, Czirják L, Denton C, Allanore Y, Riccieri V, Vacca A, Foeldvari I, Hoffmann-Vold AM, Gabrielli A, Matucci-Cerinic M, Furst D. POS0321 USE OF HYDROXYCHLOROQUINE AND SYSTEMIC SCLEROSIS: RESULTS FROM A PROSPECTIVE OBSERVATIONAL STUDY ON THE EUSTAR COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3725] [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:Hydroxychloroquine (HCQ) is a well-tolerated drug that contributes to downregulating the immune response against autoantigens and it has been used in several autoimmune diseases. In systemic sclerosis (SSc) it is used to treat inflammatory arthritis without proof of efficacy.Objectives:Our aim was to evaluate the use of HCQ and its impact on Health Assessment Questionnaire disability index (HAQ-DI) and the Cochin Hand Function Status (CHFS). in a large SSc cohort compared to a propensity matched group of SSc patients not using HCQ.Methods:SSc patients from the European Scleroderma Trials and Research (EUSTAR) data base treated with HCQ for at least 6 months were evaluated. Demographic and clinical data, concomitant drugs, duration of HCQ treatment and reasons for its discontinuation, HAQ-DI and CHFS (at least 2 evaluation) were recorded and were the outcome variables of interest. Statistical analysis was performed using propensity score matching for age, gender, disease duration, corticosteroids, immunosuppressives, vasoactive drugs, DMARDs in a 3:1 control:HCQ ratio. Standard descriptive statistics and Student’s t-test and Chi-square test were used to assess the propensity-matched groups.Results:1,636 of 17,805 SSc patients (9.2%) were treated with HCQ for at least 6 months; out of these 3% (50/1636). had at least a baseline and follow-up HAQ-DI evaluation, (and 44/1636 (2.7%) had at least a baseline and follow-up CHFS evaluation. Propensity matching assured that pts were matched for demographic variables such as gender (mean on HCQ vs no HCQ:femals:92.0 vs 85.3), age(49.8 vs 49.97yrs) disease duration(8.3 vs 9.1 yrs), limited disease(55.3 vs 62.6%) as well as background medications (P>0.1-0.9). We did not find any significant changes in HAQ or CHFS (difference in slope) over 365 days of treatment, comparing the HCQ-treated group to the non-HCQ treated patients (p=0.240 for both (Figure 1).Conclusion:Results from the EUSTAR registry showed that HCQ was used by 9.2% of SSc patients. HCQ use did not improve the HAQ or CHFS, comparing HCQ users to non-HCQ users.Disclosure of Interests:Silvia Bellando Randone: None declared, Holly Wilhalme: None declared, Cosimo Bruni: None declared, Elise Siegert: None declared, Paolo Airò: None declared, Rosaria Irace: None declared, Oliver Distler: None declared, Andrea Doria: None declared, Lidia P. Ananieva: None declared, László Czirják: None declared, Christopher Denton: None declared, Yannick Allanore: None declared, Valeria Riccieri: None declared, ALESSANDRA VACCA: None declared, Ivan Foeldvari Consultant of: Gilead, Novartis, Pfizer, Hexal, BMS, Sanofi, MEDAC, Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Roche, Merck Sharp & Dohme, Lilly and Medscape, Consultant of: Actelion, Boehringer Ingelheim, Roche, Bayer, ARXX, and Medscape, Grant/research support from: Boehringer Ingelheim, Armando Gabrielli: None declared, Marco Matucci-Cerinic: None declared, Daniel Furst: None declared
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Spiera R, Kuwana M, Khanna D, Hummers L, Frech T, Stevens W, Gordon J, Kafaja S, Matucci-Cerinic M, Distler O, Lee EB, Levy Y, Jun JB, Constantine S, Dgetluck N, White B, Furst D, Denton C. OP0171 PHASE 3 TRIAL OF LENABASUM, A CB2 AGONIST, FOR THE TREATMENT OF DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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:Lenabasum is an oral CB2 agonist that attenuates inflammation and fibrosis in SSc animal models and showed clinical benefit with acceptable safety in a Phase 2 trial in dcSSc.Objectives:Test efficacy and safety of lenabasum in a Phase 3 trial in dcSSc.Methods:Subjects ≥18 years old with disease duration ≤ 6 years were randomized 1:1:1 to lenabasum 5 mg, 20 mg, or placebo (PBO), all BID, with stable background immunosuppressant therapy (IST) allowed. The primary efficacy endpoint was ACR CRISS score, and secondary endpoints were ΔmRSS, ΔHAQ-DI, and ΔFVC, all at Week 52 for lenabasum 20 mg vs PBO.Results:363 adults were dosed; 37 (10%) stopped study drug early, with only 1 subject (PBO cohort) stopping due to adverse event (AE). Baseline demographics were similar among groups. Disease duration was ≤ 3 years in 60% and 66%, mean mRSS score was 22.0 and 23.3, and background IST was used by 89% and 84% of lenabasum 20 mg and PBO groups, respectively.Safety results showed serious AEs and severe AEs occurred in 9.2% and 5.8% vs 14.6% and 13.0%, respectively, of lenabasum 20 mg and PBO groups.Efficacy results (Table) demonstrated:Table 1.Primary and secondary efficacy endpoints and post-hoc analyses, Week 52Group, by IST treatmentCohortNΔmRSS, mean (SD)ΔFVC% mean (SD)ΔFVC, mL mean (SD)ΔHAQ-DI mean (SD)ACR CRISS medianmITT population, MMRM primary analysis methodAllPlacebo123-8.1 (7.72)-1.0 (8.68)-51 (317)-0.13 (0.468)0.887Lenabasum 20 mg120-6.7 (6.59)-1.6 (6.91)-78 (265)-0.13 (0.436)0.888Placebo subjects, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417All ISTPlacebo97-8.9 (7.07)-1.0 (9.2)-43 (330)-0.17 (0.474)0.936MMF, no other ISTPlacebo29-10.7 (8.1)-0.58 (7.1)-37 (235)-0.12 (0.456)0.935MMF ≤ 2 years, no other ISTPlacebo23-11.7 (8.1)-0.3 (6.0)-41 (197)-0.13 (0.495)0.935Non-MMF ≤ 2 yearsPlacebo24-6.7 (6.2)-1.4 (7.87)-52 (281)-0.15 (0.357)0.931Post-hoc comparisons, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417Lenabasum 20 mg10-6.3 (6.02)-2.3 (5.58)-99 (209)-0.06 (0.498)0.811Established IST1Placebo26-6.1 (5.35)-4.6 (10.11)-170 (350)-0.17 (0.445)0.619Lenabasum 20 mg38-7.4 (5.08)-0.4 (5.70)2-21 (233)3-0.07 (0.357)0.941Established IST, subjects with ILDPlacebo22-5.9 (5.28)-3.7 (5.43)-133 (206)-0.10 (0.372)0.553Lenabasum 20 mg33-7.2 (5.70)-1.0 (10.5)-47 (365)-0.06 (0.391)0.8192 P = 0.0386 two-sample t-test; 3 P = 0.0481 two-sample t-test; other comparisons were not significant• No significant differences were seen in primary and secondary efficacy endpoints. Primary MMRM analyses with treatment-by-time-by-subgroup interactions showed that background mycophenolate (MMF) significantly influenced the outcome•oSubjects on no IST with disease duration ≤3 years were only 7% of PBO subjects and showed little improvement on PBO, in line with other dcSSc trials in which IST was restricted. Post-hoc subgroup analyses of these subjects on no IST suggested improvement in ΔmRSS and ΔHAQ-DI, for lenabasum 20 mg vs PBO•uUnexpectedly high improvement occurred in PBO subjects receiving IST, notably those on MMF started within 2 years of baseline•nPost-hoc analyses of subjects on established IST (MMF or, if no MMF, ≥ 1 non-MMF IST started > 2 years before baseline) suggested improvement in ΔFVC% (nominal P = 0.0386) and ΔFVC mL (nominal P = 0.0481) for lenabasum 20 mg vs PBO. Improvement in FVC was also seen in subjects on established IST who had ILD at baseline, lenabasum 20 mg vs PBO•mACR CRISS score demonstrated a ceiling effect and correlated most highly with ΔmRSS (r = -0.739) and moderately with MDGA (-0.432), HAQ-DI (-0.362), FVC% (0.366), and PtGA (-0.288)Conclusion:Lenabasum was safely used in this study. Unexpectedly high improvement on background IST, especially MMF, has not been previously reported at this level. The primary endpoint was not met. Post-hoc analyses showed greater improvement in lenabasum- vs PBO-treated subjects who were not on background IST and those on established IST, including subjects with ILD.Disclosure of Interests:Robert Spiera Consultant of: Abbvie, Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Formation Biologics, Mitsubishi Tanabe, Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Formation Biologics, Sanofi, Inflarx, Astra Zeneca, Kadmon, Masataka Kuwana Speakers bureau: Boehringer-Ingelheim, Chugai, Janssen, Consultant of: Boehringer-Ingelheim, Chugai, Corbus, Grant/research support from: Boehringer-Ingelheim, Chugai, MBL, Ono Pharmaceuticals, Tanabe-Mitsubishi, Dinesh Khanna Shareholder of: Eicos Sciences, Inc (less than 5%). Leadership/Equity position – Chief Medical Officer, CiviBioPharma/Eicos Sciences, Inc, Consultant of: Acceleron, Actelion, Abbvie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead, Galapagos, Genentech/Roche, GSK, Horizon, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis, and United Therapeutics, Grant/research support from: NIH, Immune Tolerance Network, Bayer, BMS, Horizon, Pfizer, Laura Hummers Consultant of: CSL Behring, Boehringer Ingelheim, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Corbus, Boehringer Ingelheim, Medpace, Kadmon, Cumberland, CSL Behring, Tracy Frech Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Wendy Stevens Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jessica Gordon Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Research funding for EICOS Pharmaceuticals and Cumberland Pharmaceuticals., Suzanne Kafaja Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Marco Matucci-Cerinic Consultant of: Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Oliver Distler Consultant of: Consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB., Eun Bong Lee Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Yair Levy Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jae-Bum Jun Consultant of: Consultant to Boehringer Ingelheim Korea, Jeil Pharma, Dae Woong Pharma, Kwangdong Pharma, and Sama Pharma., Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals, Daniel Furst Consultant of: Corbus, Galapagos, Pfizer, CSL Behring, Mitsubishi Tanabi, Actelion, Amgen, Novartis, Roche/Genentech, Gilead, Talaris, and Boehringer Ingelheim., Grant/research support from: grants from Corbus, Galapagos, GSK, Pfizer, Talaris, CSL Behring, Mitsubishi Tanabi, Christopher Denton Consultant of: Consultancy fees and/or honoraria from Corbus, Actelion, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, Acceleron, Horizon, Arxx Therapeutics
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Hutchinson M, Abignano G, Blagojevic J, Bosello SL, Allanore Y, Denton C, Distler O, Emery P, Matucci-Cerinic M, Del Galdo F. OP0269 A COMBINED CLINICAL AND BIOMARKER ALGORITHM TO PREDICT FVC DECLINE IN SYSTEMIC SCLEROSIS ASSOCIATED INTERSTITIAL LUNG DISEASE: RESULTS FROM AN INTERNATIONAL MULTICENTRE OBSERVATIONAL COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:Interstitial lung disease (ILD) is the leading cause of mortality in patients with Systemic Sclerosis (SSc). Forced Vital Capacity (FVC) is a major indicator of severity in SSc ILD. The ELF serum test and its constituent biomarkers (HA, PIIINP and TIMP-1) have shown to correlate with FVC in two large, independent multicentre cohorts of 457 patients, but also showed a correlation with age.Objectives:Here we aimed to investigate the relationship of the ELF biomarkers and age in a large population of healthy controls and to identify a combined clinical and biomarkers model to stratify for risk of ILD progression in a multicentre longitudinal cohort of patients with SSc.Methods:ELF score was measured in sera from 925 healthy controls in one centre and 869 longitudinal samples from 254 SSc patients from 6 centres across 4 European countries. Clinical data were recorded according to EUSTAR Minimal Essential dataset. FVC% change over time was estimated by Mixed-effects modelling. Patients were then divided in two groups: progressors, with a %FVC drop > 3%/year (according to published MCID) and a group of patients with stable or improving FVC. Lasso penalised regression was carried out with biomarkers and the available clinical and demographic variables at patient’s first visit as potential predictors. The resulting linear predictor was used to derive two thresholds, one for optimal sensitivity (rule-out) and one for optimal specificity (rule-in). Patients within thresholds were further selected according to the ratio of TIMP-1: PIIINP (Figure 1).Results:HA was the only ELF biomarker that correlated significantly with age in the healthy control cohort. Therefore, we defined by linear regression a “residual HA” which accounted for age. TIMP1, PIIINP and residual HA were then considered as distinct biomarkers in the analysis of the SSc cohort. 189 SSc patients with 785 time-points had complete datasets and were included in the analysis. Median follow up was 33 months (IQR 18-48). One-hundred and forty patients (74%) were classified as non progressors, 94 (50%) with no change or improving FVC and 46 (24%) with FVC drop <3% year. 49 patients (26%) were classed as progressors (drop of 3%/year or more in FVC, median slope -4.7%/year). Variable selection via Lasso penalised logistic regression resulted in a model with a c-index of 0.69 (95% CI: 0.60-0.78)) and contained age, disease duration (from first non-Raynaud’s symptom), residual HA, anti-centromere antibodies (ACA) status, previous diagnosis of ILD, joint synovitis and history of protein pump inhibitor use. A two-step process was developed using the linear predictor from the model and the ratio of TIMP-1 and PIIINP (Figure 1). The stratification tool increased by nearly two-fold the ability to predict progressors in any 12 months interval (46 to 49% predictive value vs 26% probability) identifying an 82 to 91% negative predictive value for progression.Conclusion:Building on the face and content validity of the biomarkers included in the ELF score, here we identify an easy to assess combined clinical and biomarker model to stratify patients for their risk of ILD progression. Despite its derivation from a large multicentre cohort, independent validation will determine the clinical value of Scleroscore as a stratification tool for risk of progression of SSc ILD.Disclosure of Interests:Michelle Hutchinson: None declared, Giuseppina Abignano: None declared, Jelena Blagojevic: None declared, Silvia Laura Bosello: None declared, Yannick Allanore Grant/research support from: Alpine, Boehringer Ingelheim, Genentech/Roche, Medsenic, and Sanofi, Christopher Denton Consultant of: Corbus, Actelion, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, Acceleron, Horizon, Arxx Therapeutics, Grant/research support from: Corbus, Actelion, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, Acceleron, Horizon, Arxx Therapeutics, Oliver Distler Consultant of: Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB, Grant/research support from: Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB, Paul Emery Consultant of: Lilly, Abbvie, Roche, Grant/research support from: Lilly, Marco Matucci-Cerinic Consultant of: Chemomab, Lilly, Abbvie, Actelion, Francesco Del Galdo Speakers bureau: Astra-Zeneca, Boehringer Ingelheim, Actelion, Consultant of: Astra-Zeneca, Mitsubishi-Tanabe, Capella Biosciences, Chemomab, Actelion, Boehringer-Ingelheim, Grant/research support from: Capella Biosciences, Chemomab, Kymab, Mitsubishi-Tanabe
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Romana M, Reminy K, Moeckesch B, Charlot K, Hardy‐Dessources M, Doumdo L, Tressieres B, Etienne‐Julan M, Lemonne N, Denton C, Coates T, Petras M, Antoine‐Jonville S, Connes P. Loss of alpha globin genes is associated with improved microvascular function in patients with sickle cell anemia. Am J Hematol 2021; 96:E165-E168. [PMID: 33580983 DOI: 10.1002/ajh.26126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Marc Romana
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex), PRES Sorbonne Paris France
- Université des Antilles, UMR_S1134, BIGR Inserm Pointe‐à‐Pitre France
- Université de Paris, UMR_S1134, BIGR, INSERM Paris France
| | - Karen Reminy
- EA 3596 'ACTES': Adaptation, Climat Tropical, Exercice et Santé Université des Antilles Pointe‐à‐Pitre France
| | - Berenike Moeckesch
- EA 3596 'ACTES': Adaptation, Climat Tropical, Exercice et Santé Université des Antilles Pointe‐à‐Pitre France
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels Institut de Recherche Biomédicale des Armées Bretigny‐Sur‐Orge France
| | - Marie‐Dominique Hardy‐Dessources
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex), PRES Sorbonne Paris France
- Université des Antilles, UMR_S1134, BIGR Inserm Pointe‐à‐Pitre France
- Université de Paris, UMR_S1134, BIGR, INSERM Paris France
| | - Lydia Doumdo
- Unité Transversale de la Drépanocytose, CHU de la Guadeloupe Pointe‐à‐Pitre France
| | - Benoit Tressieres
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424 Pointe‐à‐Pitre France
| | - Maryse Etienne‐Julan
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex), PRES Sorbonne Paris France
- Université des Antilles, UMR_S1134, BIGR Inserm Pointe‐à‐Pitre France
- Université de Paris, UMR_S1134, BIGR, INSERM Paris France
- Unité Transversale de la Drépanocytose, CHU de la Guadeloupe Pointe‐à‐Pitre France
| | - Nathalie Lemonne
- Unité Transversale de la Drépanocytose, CHU de la Guadeloupe Pointe‐à‐Pitre France
| | - Christopher Denton
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles University of Southern California Keck School of Medicine Los Angeles California USA
| | - Thomas Coates
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles University of Southern California Keck School of Medicine Los Angeles California USA
| | - Marie Petras
- Unité Transversale de la Drépanocytose, CHU de la Guadeloupe Pointe‐à‐Pitre France
| | - Sophie Antoine‐Jonville
- EA 3596 'ACTES': Adaptation, Climat Tropical, Exercice et Santé Université des Antilles Pointe‐à‐Pitre France
- Université d'Avignon, LAPEC EA4278 Avignon France
| | - Philippe Connes
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex), PRES Sorbonne Paris France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424 Université Lyon 1 (COMUE Lyon), Equipe « Biologie Vasculaire et du Globule Rouge » Lyon France
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Coumbe BGT, Ahmad SN, Thomas G, Borukhson L, Abdi BA, Lopez H, Garvin C, Jaynes J, Yates C, Martin G, Denton C, Abraham D, Stratton RJ. P155 Modelling calcinosis in systemic sclerosis through disease microenvironment-stem cell interactions: effect of novel therapeutic peptide RP832c. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.151] [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: 11/12/2022] Open
Abstract
Abstract
Background/Aims
Systemic sclerosis (SSc) is a rare and progressive connective tissue disease that is more common in women in the third to fifth decades of life and is rare in children. Calcinosis cutis, the deposition of calcium deposits within the subcutaneous tissue, remains a challenging non-lethal complication of SSc. The development of calcinosis cutis is a poorly understood area and there are no functional mouse models or laboratory models for calcinosis in SSc. In this study we present clinical database analysis plus two potential in vitro models for examining calcinosis in the setting of SSc.
Methods
Clinical modelling through database analysis of n = 79 SSc patients with and without calcinosis was attempted. In tissue culture studies, the first model system utilised adipose-derived mesencyhmal stem cells (MSCs) stimulated with interstitial fluid from healthy controls or SSc patients (both n = 4). In a second model, macrophages from patients with SSc (n = 4 lines) were used to stimulate MSCs in co-culture. We examined the impact that this has on the deposition of calcium hydroxyapatite production after prolonged culture in osteogenic media, measured using a scale (scored 0-4) to describe the degree of alizarin red uptake. We also investigated the role of an inhibitor of TGFβ signalling, SB432542 (10µM), and RP832c,(10µM), a peptide therapy which targets and repolarises activated SSc macrophages via CD206, in reducing calcium hydroxyapatite production.
Results
Clinical database analysis demonstrated that 35% of patients had evidence of calcinosis, but the only significant factor between the calcinosis and non-calcinosis group was the presence of digital ulcerations (p = 0.0008). The tissue fluid based model of calcinosis demonstrated that on day 21 the blister fluid obtained from SSc patients induced a significant increase in calcium deposition as compared to the culture media alone (3.9 vs 2.5, p = 0.00071), whereas SB431542, reduced calcium production by SSc fluid treated cells (3.9 vs 3.0, p = 0.2147). In the cell based model, macrophages derived from SSc patients induced the production of mineralised deposits. Both the TGFβ inhibitor SB432542 and the RP832c peptide reduced calcinosis in this model (SB431542 0.5 vs 1.3 p = 0.0547, RP832c 0.2 vs 1.3 p = 0.0147).
Conclusion
Our understanding of the underlying pathogenesis of calcinosis within SSc remains poor leading to therapeutic challenges for clinicians. From this analysis, it appears that presence of digital ulceration is associated clinically with calcinosis, possibly implicating aberrant tissue repair or ischaemia. Both tissue culture models presented here may recreate certain aspects of calcinosis in patients with SSc and may provide a basis for further evaluation of therapeutic inhibitors. At present there are no therapies that have been consistently found to be effective but our data support a possible role for macrophage - mesenchymal stem cell interactions and for TGFβ.
Disclosure
B.G.T. Coumbe: None. S.N. Ahmad: None. G. Thomas: None. L. Borukhson: None. B. Ahmed Abdi: None. H. Lopez: None. C. Garvin: None. J. Jaynes: None. C. Yates: None. G. Martin: None. C. Denton: None. D. Abraham: None. R.J. Stratton: None.
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Affiliation(s)
- Ben G T Coumbe
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Sonia N Ahmad
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Gemma Thomas
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Liubov Borukhson
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Bahja Ahmed Abdi
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Henry Lopez
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Charles Garvin
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Jesse Jaynes
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - Clayton Yates
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | - George Martin
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
| | | | - David Abraham
- Royal Free Hospital, Department of Rheumatology, London, UNITED KINGDOM
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Affiliation(s)
- Carine J Moezinia
- Centre for Rheumatology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK
| | - Antonio Ji-Xu
- Centre for Rheumatology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK
| | - Arianna Azari
- Centre for Rheumatology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK
| | - Serena Horlick
- Centre for Rheumatology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK
| | - Christopher Denton
- Centre for Rheumatology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK
| | - Richard Stratton
- Centre for Rheumatology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK
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Khanna D, Pope J, Matucci-Cerinic M, Kuwana M, Denton C, Allanore Y, Wosnitza M, Truchetet ME, Szücs G, Stevens W, Steen V, Stagnaro C, Smith V, Silver R, Schiopu E, Riccieri V, Kramer F, Johnson S, Ishikawa O, Ishii T, Hachlla E, De Langhe E, Czirják L, Bečvář R, Atsumi T, Distler O. OP0249 LONG-TERM EXTENSION RESULTS OF RISE-SSC, A RANDOMIZED TRIAL OF RIOCIGUAT IN PATIENTS WITH EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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:RISE-SSc (NCT02283762) was a multicenter Phase IIb trial of riociguat in pts with early (duration ≤18 months) dcSSc and modified Rodnan skin score (mRSS) 10−22 units. Pts were randomized double-blind to placebo or riociguat 0.5–2.5 mg t.i.d. for 52 weeks. The primary endpoint, mRSS change from baseline to Week (Wk) 52, did not reach statistical significance (p=0.08, riociguat vs placebo), but there were favorable trends in some other outcomes.Objectives:To present open-label long-term extension (LTE) results of RISE-SSc.Methods:Pts who completed Wk 52 of double-blind therapy could enter LTE on riociguat. Endpoints included mRSS, adverse events (AEs), and serious AEs (SAEs).Results:Of 60 pts randomized to riociguat and 61 to placebo, 42 (riociguat−riociguat group) and 45 (former placebo group), respectively, entered LTE. At LTE start, mean±SD mRSS was 16.4±3.2 and 16.3±4.2 units, and mean disease duration was 8.9±7.8 and 8.9±5.8 months, in the riociguat−riociguat and former placebo groups, respectively. Other demographics/disease characteristics were also comparable. Median duration of riociguat treatment was 1092 d in riociguat−riociguat pts and 649 d in former placebo pts. Throughout the study, mRSS decreased in both groups (Figure 1). From Wk 52 to last visit, mRSS fell by −3.02±5.51 in riociguat−riociguat patients and −3.96±5.43 in former placebo pts. Rates of mRSS regression (decrease by >5 units and ≥25% from Wk 52 to last visit) and of % declines in mRSS were similar in the two groups (Figure 2). mRSS progression (increase by >5 units and ≥25% from Wk 52 to last visit) occurred in 1 pt (2%) in each group. During the entire study, rescue therapy agents were used in 15 (36%) riociguat−riociguat pts and 17 (38%) former placebo pts. AEs were reported from Wk 52 to last visit in 82 pts (94%): 40 (95%) riociguat−riociguat and 42 (93%) former placebo. Most common AEs overall: nasopharyngitis (24%), gastroesophageal reflux disease (17%), diarrhea (15%), and hypotension (14%). AEs of special interest (dizziness, postural dizziness, or hypotension) occurred in 5 riociguat−riociguat pts (12%) and 4 former placebo pts (9%). SAEs were reported in 21 (24%) pts: 10 (24%) riociguat−riociguat pts and 11 (24%) former placebo pts, with no SAE reported in >1 patient, no SAEs of special interest, and no deaths.Conclusion:During LTE riociguat treatment, mRSS decreased in both groups from Wk 52 onwards and mRSS progression was uncommon. Riociguat had acceptable safety, similar to the main study, with no new safety signal.Acknowledgments:RISE-SSc was jointly funded by Bayer AG and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.Disclosure of Interests:Dinesh Khanna Shareholder of: Eicos, Grant/research support from: NIH NIAID, NIH NIAMS, Consultant of: Acceleron, Actelion, Bayer, BMS, Boehringer-Ingelheim, Corbus, Galapagos, Genentech/Roche, GSK, Mitsubishi Tanabi, Sanofi-Aventis/Genzyme, UCB Pharma, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Masataka Kuwana Grant/research support from: Acetelion, Consultant of: Acetelion, Bayer, Chugai, Corbus Pharmaceuticals, CSL Behring and Reata Pharmaceuticals. He was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Melanie Wosnitza Employee of: Bayer AG, Marie-Elise Truchetet: None declared, Gabriella Szücs: None declared, Wendy Stevens: None declared, Viginia Steen Grant/research support from: The associated affiliation has received grants/research from Boehringer Ingelheim, Corbus Pharmaceuticals, CSL Behring, Eicos, Galapagos, Immune Tolerance Network, Reata, Consultant of: Virginia Steen has acted as a consultant for Boehringer Ingelheim, Corbus, CSL Behring, Eicos, Forbius, Chiara Stagnaro: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Richard Silver: None declared, Elena Schiopu: None declared, Valeria Riccieri: None declared, Frank Kramer Employee of: Bayer AG, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Osamu Ishikawa: None declared, Tomonori Ishii: None declared, Eric Hachlla: None declared, Ellen De Langhe Consultant of: member of advisory board for Boehringer, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Radim Bečvář Consultant of: Actelion, Roche, Tatsuya Atsumi Grant/research support from: Eli Lily Japan K.K., Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb Co., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., Consultant of: Gilead Sciences, Inc., Eli Lilly Japan K.K., UCB Japan Co. Ltd., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Speakers bureau: Eli Lilly Japan K.K., UCB Japan Co. Ltd., Bristol-Myers Squibb Co., AbbVie Inc., Eisai Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche
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Allanore Y, Steen V, Kuwana M, Denton C, Matucci-Cerinic M, Volkmann E, Khanna D, Wachtlin D, Gahlemann M, Quaresma M, Alves M, Distler O. THU0330 EFFECTS OF NINTEDANIB IN PATIENTS WITH SYSTEMIC SCLEROSIS-ASSOCIATED ILD (SSC-ILD) AND DIFFERING EXTENTS OF SKIN FIBROSIS: FURTHER ANALYSES OF THE SENSCIS TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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:In the SENSCIS trial, nintedanib reduced the progression of SSc-ILD compared with placebo, as shown by a significantly lower rate of decline in forced vital capacity (FVC) over 52 weeks. There was no significant difference between treatment groups in change in modified Rodnan skin score (mRSS) at week 52. An mRSS of 18–25 has been proposed as an upper cut-off to enrich a cohort for skin-progressive patients. Progression of skin fibrosis has been associated with later progression of ILD.Objectives:To assess the effects of nintedanib on the rate of FVC decline and change in mRSS in the SENSCIS trial in subgroups by mRSS <18 and ≥18 at baseline.Methods:Patients with SSc-ILD with onset of first non-Raynaud symptom <7 years before screening and ≥10% fibrosis of the lungs on a high-resolution computed tomography scan were randomised to receive nintedanib or placebo. We analysed the rate of decline in FVC (ml/year) over 52 weeks and the change from baseline in mRSS at week 52 in subgroups by mRSS (<18; ≥18) at baseline.Results:In the nintedanib and placebo groups, respectively, 219/288 (76.0%) and 226/288 (78.5%) patients had mRSS <18 at baseline. Compared with those with mRSS <18, patients with mRSS ≥18 had a lower mean FVC % predicted (68.3% vs 73.7%) and greater proportions were taking mycophenolate at baseline (58.1% vs 45.6%), were anti-topoisomerase I antibody positive (67.4% vs 58.7%) and had diffuse cutaneous SSc (100% vs 37.8%). The mean (SE) annual rate of decline in FVC in the placebo group was numerically greater in patients who had mRSS ≥18 than mRSS <18 at baseline (-131.7 [29.2] mL/year vs -81.4 [15.4] mL/year). The effect of nintedanib vs placebo on reducing the annual rate of decline in FVC was numerically more pronounced in patients with mRSS ≥18 (difference: 88.7 mL/year [95% CI 7.7, 169.8]) than mRSS <18 (difference: 26.4 mL/year (95% CI -16.8, 69.6) at baseline, but statistical testing did not indicate heterogeneity in the treatment effect of nintedanib between subgroups (p=0.18 for treatment-by-time-by-subgroup interaction) (Figure). In the nintedanib and placebo groups, respectively, changes in mRSS at week 52 were -2.2 (0.3) and -2.1 (0.3) (difference -0.1 [95% CI -1.0, 0.7]) in patients with mRSS <18 at baseline and -2.1 (0.7) and -1.6 (0.7) (difference -0.6 [95% CI -2.1, 1.0]) in patients with mRSS ≥18 at baseline (p=0.62 for treatment-by-visit-by-subgroup interaction).Conclusion:In the placebo group of the SENSCIS trial, the rate of decline in FVC over 52 weeks was numerically greater in patients with mRSS ≥18 than <18 at baseline, while reductions in mRSS were similar. A lower rate of FVC decline was observed in patients treated with nintedanib than placebo both in patients with mRSS ≥18 and <18 at baseline.Acknowledgments:The SENSCIS trial was funded by Boehringer IngelheimDisclosure of Interests:Yannick Allanore Grant/research support from: Yannick Allanore has received grants from Inventiva, Roche and Sanofi, Consultant of: Yannick Allanore has received fees from Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Curzion, Inventiva, Roche, Sanofi, Viginia Steen Grant/research support from: The associated affiliation has received grants/research from Boehringer Ingelheim, Corbus Pharmaceuticals, CSL Behring, Eicos, Galapagos, Immune Tolerance Network, Reata, Consultant of: Virginia Steen has acted as a consultant for Boehringer Ingelheim, Corbus, CSL Behring, Eicos, Forbius, Masataka Kuwana Grant/research support from: Acetelion, Consultant of: Acetelion, Bayer, Chugai, Corbus Pharmaceuticals, CSL Behring and Reata Pharmaceuticals. He was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Elizabeth Volkmann Grant/research support from: Forbius, Corbus Pharmaceuticals, Consultant of: Boehringer Ingelheim, Forbius, Speakers bureau: Boehringer Ingelheim, Dinesh Khanna Shareholder of: Eicos Sciences, Inc./Civi Biopharma, Inc., Grant/research support from: Dr Khanna was supported by NIH/NIAMS K24AR063120, Consultant of: Acceleron, Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Corbus Pharmaceuticals, Horizon Therapeutic, Galapagos, Roche/Genentech, GlaxoSmithKline, Mitsubishi Tanabe, Sanofi-Aventis/Genzyme, UCB, Daniel Wachtlin Employee of: Employee of Boehringer Ingelheim, Martina Gahlemann Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Margarida Alves Employee of: Employee of Boehringer Ingelheim, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche
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Ross R, Georgiou I, Carriero A, Abignano G, Wasson C, Migneco G, Herrick A, Denton C, Del Galdo F. SAT0281 BIOSAMPLES FROM AT RISK SSC PATIENTS SHOW CLASSIC PATHOLOGICAL SIGNS OF SCLERODERMA: OPPORTUNITY FOR DIAGNOSIS OF PRE-CLINICAL SSC. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:The VEDOSS study has recently indicated that more than 80% of patients affected by Raynaud’s phenomenon (RP) with specific SSc auto-antibodies and capillaroscopy changes satisfied ACR/EULAR 2013 criteria within 5 years. These data suggest that there is a window of opportunity for early detection of SSc in these patients.Objectives:Here we aimed to determine whether sera, skin biopsies and skin fibroblasts cultured from these patients showed any biomarker sign of SSc.Methods:Fifty-nine at risk patients identified by having RP and SSc auto-antibodies or capillaroscopy pattern (or both) were enrolled in the Kennedy national inception cohort. Sera were tested for IFN inducible chemokines (CXCL-9,10 and 11 and CCL2, 8 and 19) and biomarker of extracellular matrix turnover (ELF test), all previously shown to be increased in SSc. Further, two 3mm skin biopsies were taken from the forearms from 3 ACA+ve (anti-centromere antibodies), 3 SCL70+ve patients. One biopsy was subjected to histology analysis, including haematoxylin and eosin staining and immunohistological staining for Collagen Type 1, alpha-SMA, Caveolin 1 and CD31 as endothelial marker. The other biopsy was used to explant fibroblasts cultures. mRNA and protein were isolated from primary fibroblasts and processed for RT-qPCR and western blotting analyses.Results:Sera from at risk patients showed overall higher IFN inducible chemokines and ELF test (P<0.05) with bimodal distribution among patients. Skin biopsies from both ACA or SCL70+ve patients showed decreased number of CD31+ cells, increased number of myofibroblasts and increased collagen bundles within the dermis, as usually seen in SSc, compared to healthy controls. In vitro, fibroblasts from both ACA or SCL70+ve patients showed average 10-fold higher collagen mRNA levels and 31-fold increased collagen protein levelscompared to healthy control fibroblasts. Furthermore, fibroblasts from ACA or SCL70+ve patients showed limited TGF-beta induced increase in collagen and SMA expression, similar to SSc fibroblasts.Conclusion:Although pilot in nature, this study suggests that patients “at risk” already show biomarker signs of SSc both in their sera, at skin biopsy and fibroblast level. Longitudinal studies on patients at this stage of pre-clinical disease may inform on the stratification strategies for imminent progression to clinical manifestations, and offer both insights on pathogenesis of clinical signs and a window of opportunity for delaying the onset clinical intervention trials.Disclosure of Interests:rebecca ross: None declared, Ioanna Georgiou: None declared, Antonio Carriero: None declared, Giuseppina Abignano: None declared, Chris Wasson: None declared, Gemma Migneco: None declared, Ariane Herrick: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Francesco Del Galdo: None declared
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Denton C, Bloom B, Dgetluck N, White B, Spiera R. AB0568 BASELINE EUROPEAN PATIENT DEMOGRAPHICS AND DISEASE CHARACTERISTICS IN A PHASE 3 STUDY OF SAFETY AND EFFICACY OF LENABASUM, A CB2 AGONIST, IN DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:We previously presented on the baseline characteristics of a large cohort of diffuse cutaneous systemic sclerosis (dcSSc) patients enrolled in a Phase 3 trial of lenabasum, a selective cannabinoid receptor type 2 (CB2) agonist. Lenabasum, was safe and well-tolerated in a prior Phase 2 study in dcSSc patients and associated with improvements in ACR Combined Response Index Systemic Sclerosis (CRISS) score and multiple secondary efficacy outcomes.Objectives:We now report on the background standard of care and baseline disease characteristics of European (EU) patients in order to assess variability by geographic regions.Methods:The RESOLVE-1 Phase 3 study was designed with input from study investigators and regulatory authorities. An important intent of the design was to have eligibility criteria that allow testing of efficacy and safety of lenabasum in an inclusive group of dcSSc subjects to maximize relevance to patients in current practice. The study is ongoing and remains blinded.Results:Primary efficacy outcome is the ACR CRISS score at 12 months, comparing lenabasum 20 mg BID to placebo. Key inclusion criteria are males and females ≥ 18 years of age with dcSSc and disease duration ≤ 6 years who are on stable standard of care medicines, with background stable immunosuppressive mediations allowed. Baseline mRSS needed to be ≥ 15 if disease duration was > 3 to ≤ 6 years at enrollment. The study enrolled 110 EU subjects over 15 months who received ≥ 1 dose of study drug at 20 sites in 7 countries. Baseline characteristics as shown in Table 1. The majority were middle-aged, female, and white, and 80% were on immunosuppressive drugs in EU region; methotrexate (MTX) used in 30% of subjects, mycophenolate/mycophenolic acid (MMF) used in 46% of subjects, and 43% of subjects took ≥ 2 concurrent immunosuppressive drugs. There were regional differences in background immunosuppressive with use of MTX, MMF and corticosteroids highest in EU, NA and Asia, respectively.Table 1.Patient Baseline Demographics and Disease Characteristics by Regions (Blinded)Characteristic at First DoseMean (SD) or %RegionEuropeUS, CA, AU, ILAsiaN =110 (30.1%)N = 189 (51.8%)N = 66 (18.1%)Years of age51 ± 11.751 ± 13.549 ± 13.2Female75%78%71%ILD55%40%58%Caucasian101 (91.8%)148 (78.3%)0 (0.0%)Asian2 (1.8%)10 (5.3%)66 (100.0%)Black2 (1.8%)16 (8.5%)0 (0.0%)Other5 (4.6%)15 (7.9%)0 (0.0%)Any immunosuppressive drug80%89%79%≥ 2 immunosuppressive drugs43%48%38%Mycophenolate46%70%26%Corticosteroids31%31%53%Methotrexate30%22%23%Other31%41%26%Modified Rodnan Skin Score21.9 ± 7.7523.8 ± 8.4120.0 ± 7.72Physician Global Assessment5.9 ± 1.575.3 ± 1.565.0 ± 1.50Patient Global Assessment4.9 ± 2.025.0 ± 2.254.8 ± 1.89HAQ-DI with aids/devices1.0 ± 0.691.3 ± 0.760.7 ± 0.77Forced vital capacity % predicted83.2 ± 18.9277.5 ± 16.4182.5 ± 14.73Conclusion:This is the first Phase 3 study to use ACR CRISS as the primary efficacy outcome, a composite outcome of multiple clinically relevant measures of SSc, and the largest interventional study to date in diffuse cutaneous SSc. While the use of background immunosuppressive therapies is significant irrespective of geographic regions, MTX use is highest in the EU. Benefits of having inclusive eligibility criteria are that they facilitated timely full enrollment and will make the study more relevant to real-world practice. This study provides a model for future Phase 3 trials in dcSSc and will afford valuable information regarding scleroderma care in practice as well as evaluating the efficacy and safety of lenabasum.Disclosure of Interests:Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Bradley Bloom Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Nancy Dgetluck Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Barbara White Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Robert Spiera Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Forbius, Sanofi, Inflarx, Consultant of: Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Forbius, Mistubishi Tanabe
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Khanna D, Lin CJF, Spotswood H, Siegel J, Furst D, Denton C. THU0328 SAFETY AND EFFICACY OF SUBCUTANEOUS TOCILIZUMAB IN SYSTEMIC SCLEROSIS: RESULTS FROM THE OPEN-LABEL PERIOD OF THE PHASE 3 FOCUSSCED TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1535] [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:The anti–interleukin-6 (IL-6) receptor-α antibody tocilizumab (TCZ) demonstrated skin score improvement and forced vital capacity (FVC) preservation in patients with systemic sclerosis (SSc) in a phase 2 randomized controlled trial.1,2Data from the 48-week, double-blind (DB), placebo (PBO)-controlled period of the focuSSced phase 3 trial were previously presented,3and open-label (OL) data up to week 96 are presented herein.Objectives:To assess the long-term safety and efficacy of TCZ in SSc patients.Methods:Adult patients with active SSc (≤60-month duration, modified Rodnan skin score [mRSS] 10-35, and elevated acute-phase reactants) treated with PBO or TCZ in the DB period received OL TCZ 162 mg SC weekly from weeks 48 to 96 in the OL period (PBO→OL TCZ and TCZ→OL TCZ, respectively). Exploratory analysis of data up to week 96 included no formal statistical analyses. Changes in mRSS and percent predicted FVC (ppFVC) were assessed.Results:Overall, 92/105 TCZ (88%) and 89/107 PBO (83%) patients entered the OL TCZ treatment period at week 48, and 85/105 TCZ→OL TCZ (81%) and 82/107 PBO→OL TCZ (77%) patients completed treatment up to week 96. Continued decline in mRSS was observed in the OL period for PBO→OL TCZ and TCZ→OL TCZ patients (Table). Change in ppFVC for patients who switched from PBO to TCZ (PBO→OL TCZ) was comparable between weeks 48 and 96 (OL period) to the change in patients who received TCZ from BL to week 48 in the DB period (Table). Rates (95% CI) of serious adverse events from weeks 48 to 96 were 15.8 (8.6, 26.5) per 100 PY for TCZ→OL TCZ patients, 14.8 (7.9, 25.3) per 100 PY for PBO→OL TCZ patients, and 15.4 (11.0, 20.9) for all TCZ exposure over 96 weeks (n = 193). Rates (95% CI) of serious infections were 2.3 (0.3, 8.1) per 100 PY for TCZ→OL TCZ patients, 3.4 (0.7, 10.0) per 100 PY for PBO→OL TCZ patients, and 3.0 (1.3, 5.9) for all TCZ exposure over 96 weeks. One death occurred during the OL period in each arm.Conclusion:Although OL data have to be interpreted with caution, results from OL TCZ treatment show numeric improvements in mRSS and FVC preservation similar to those of the DB period, with a beneficial effect on trajectory of FVC decline in patients who switched from PBO to TCZ. Long-term safety results were consistent with the known safety profile of TCZ, and no new or unexpected events were observed.References:[1]Khanna D et al.Lancet2016;387:2630-40.[2]Khanna D et al.Ann Rheum Dis.2018;77:212-20.[3]Khanna D et al.Arthritis Rheumatol2018;70(suppl 10):abst 898.Table.Change in Efficacy From BaselineBaseline to Week 48Baseline to Week 96Week 48 to Week 96PBOTCZPBO→OL TCZTCZ→OL TCZPBO→OL TCZTCZ→OL TCZmRSS, mean (95% CI)a–5.3 (–6.9, –3.7)n = 92–6.7 (–8.0, –5.4)n = 97–8.4 (–10.0, –6.8)n = 83–9.6 (–10.9, –8.4)n = 85–2.5(–3.3, –1.6)n = 82–2.3(–3.2, –1.5)n = 85ppFVC, mean (95% CI) [median]–4.1 (–5.8, –2.4) [–3.9]n = 92–0.2 (–1.6, 1.2) [–0.7]n = 94–3.3 (–5.1, –1.5) [–3.1]n = 79–0.5 (–2.4, 1.3) [–1.4]n = 840.6 (–0.7, 1.9) [0.3]n = 78–0.3 (–1.7, 1.1) [0.0]n = 82Decline in ppFVC ≥10%, n/N (%)a15/91(16.5)5/93(5.4)14/79 (17.7)11/84 (13.1)NANAImprovement in ppFVC, n/N (%)a26/91(28.6)43/93(46.2)22/79(27.8)35/84(41.7)NANAaObserved data. NA, not assessed.Disclosure of Interests:Dinesh Khanna Shareholder of: Eicos, Grant/research support from: NIH NIAID, NIH NIAMS, Consultant of: Acceleron, Actelion, Bayer, BMS, Boehringer-Ingelheim, Corbus, Galapagos, Genentech/Roche, GSK, Mitsubishi Tanabi, Sanofi-Aventis/Genzyme, UCB Pharma, Celia J. F. Lin Employee of: Genentech, Helen Spotswood Shareholder of: Roche Products Ltd, Employee of: Roche Products Ltd, Jeff Siegel Employee of: Genentech, Daniel Furst Grant/research support from: AbbVie, Actelion, Amgen, BMS, Corbus Pharmaceuticals, the National Institutes of Health, Novartis, Pfizer, and Roche/Genentech, Consultant of: AbbVie, Actelion, Amgen, BMS, Cytori Therapeutics, Corbus Pharmaceuticals, the National Institutes of Health, Novartis, Pfizer, and Roche/Genentech, Speakers bureau: CMC Connect (McCann Health Company), Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer
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Distler O, Kramer F, Höfler J, Ghadessi M, Sandner P, Allanore Y, Denton C, Kuwana M, Matucci-Cerinic M, Pope J, Atsumi T, Bečvář R, Czirják L, De Langhe E, Hachlla E, Ishii T, Ishikawa O, Johnson S, Laapas K, Riccieri V, Schiopu E, Silver R, Smith V, Stagnaro C, Steen V, Stevens W, Szücs G, Truchetet ME, Wosnitza M, Khanna D. FRI0575 BIOMARKER ANALYSIS FROM THE RISE-SSC STUDY OF RIOCIGUAT IN EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:RISE-SSc (NCT02283762) was a multicenter, double-blind, Phase IIb study of riociguat in early dcSSc. Primary endpoint was change in mRSS from baseline to Wk 52.Objectives:Exploratory, descriptive analyses of riociguat target engagement and effects on disease biomarkers in RISE-SSc and their relationship with effects on the primary endpoint. All biomarker p-values are for information only.Methods:Pts with dcSSc (duration ≤18 mo; modified Rodnan skin score [mRSS] 10–22 units) were randomized to riociguat 0.5−2.5 mg tid (n=60) or placebo (n=61). Biomarkers of target engagement (cGMP), inflammation and/or vascular/endothelial function (e.g. high-sensitivity C-reactive protein [hsCRP], soluble platelet endothelial cell adhesion molecule 1 [sPECAM-1], soluble E-selectin, chemokine ligand 4 [CXCL-4]), and fibrosis (e.g. alpha-smooth muscle cell actin [alphaSMA], pro-collagen mRNA expression) were measured in plasma, serum, and skin biopsies at baseline and Wk 14.Results:Mean±SD change from baseline in mRSS was –2.09±5.66 (n=57) with riociguat and –0.77±8.24 (n=52) with placebo (p=0.08). From baseline to Wk 14, plasma cGMP rose by mean (SD) 94% (78%) (n=52) with riociguat and 10% (39%) (n=52) with placebo (nominal p<0.001). Serum sPECAM-1 and CXCL-4 fell with riociguat vs placebo; changes in hsCRP or E-selectin differed little between groups (Fig 1). Pts with higher baseline sPECAM-1 showed larger mRSS reductions with riociguat vs placebo than pts with lower levels (nominal interaction p=0.004). In baseline skin biopsies, 34% and 31% of pts in the riociguat and placebo groups, respectively, had no alphaSMA-positive cells; other pts had +ve cells (alphaSMA counts 0.1–99.5, median 2.5), a potential indicator of higher disease activity. Pts with +ve baseline alphaSMA counts showed a reduction of mRSS with riociguat vs placebo (Fig 2). Skin collagen mRNA expression biomarkers in skin biopsies showed no differences between groups.Conclusion:Primary study endpoint (change in mRSS) was not met. Plasma cGMP rose with riociguat, confirming engagement with the NO-sGC-cGMP pathway. Serum sPECAM-1 (marker of endothelial activation) and CXCL-4 (marker of progressive SSc) fell with riociguat; hsCRP and E-selectin did not. Some serum and skin biomarkers of higher disease activity at baseline were associated with a greater effect of riociguat on skin fibrosis.Acknowledgments:RISE-SSc was jointly funded by Bayer AG and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.Disclosure of Interests:Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Frank Kramer Employee of: Bayer AG, Josef Höfler Employee of: Josef Höfler is an employee of Staburo GmbH, Munich, Germany, contracted by Bayer AG to perform the biomarker analyses, Mercedeh Ghadessi Employee of: Bayer AG, Peter Sandner Employee of: Bayer AG, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Masataka Kuwana Grant/research support from: Acetelion, Consultant of: Acetelion, Bayer, Chugai, Corbus Pharmaceuticals, CSL Behring and Reata Pharmaceuticals. He was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Tatsuya Atsumi Grant/research support from: Eli Lily Japan K.K., Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb Co., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., Consultant of: Gilead Sciences, Inc., Eli Lilly Japan K.K., UCB Japan Co. Ltd., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Speakers bureau: Eli Lilly Japan K.K., UCB Japan Co. Ltd., Bristol-Myers Squibb Co., AbbVie Inc., Eisai Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Radim Bečvář Consultant of: Actelion, Roche, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Ellen De Langhe Consultant of: member of advisory board for Boehringer, Eric Hachlla: None declared, Tomonori Ishii: None declared, Osamu Ishikawa: None declared, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Kaisa Laapas Employee of: Partly in-sourced to Bayer, Valeria Riccieri: None declared, Elena Schiopu: None declared, Richard Silver: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Chiara Stagnaro: None declared, Viginia Steen Grant/research support from: The associated affiliation has received grants/research from Boehringer Ingelheim, Corbus Pharmaceuticals, CSL Behring, Eicos, Galapagos, Immune Tolerance Network, Reata, Consultant of: Virginia Steen has acted as a consultant for Boehringer Ingelheim, Corbus, CSL Behring, Eicos, Forbius, Wendy Stevens: None declared, Gabriella Szücs: None declared, Marie-Elise Truchetet: None declared, Melanie Wosnitza Employee of: Bayer AG, Dinesh Khanna Shareholder of: Eicos Sciences, Inc./Civi Biopharma, Inc., Grant/research support from: Dr Khanna was supported by NIH/NIAMS K24AR063120, Consultant of: Acceleron, Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Corbus Pharmaceuticals, Horizon Therapeutic, Galapagos, Roche/Genentech, GlaxoSmithKline, Mitsubishi Tanabe, Sanofi-Aventis/Genzyme, UCB
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Campochiaro C, Clark K, Host L, Sari A, Nihtyanova S, Denton C, Ong V. AB0557 CO-EXISTENCE OF SYSTEMIC SCLEROSIS HALLMARK AUTOANTIBODIES ASSOCIATES WITH DISTINCT CLINICAL PHENOTYPE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3500] [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:Systemic sclerosis (SSc) is typically manifests with distinct SSc-specific antibodies (SSc-Abs): anti-topoisomerase I (ATA), anti-centromere (ACA), anti-RNA polymerase III (ARA), anti-U3RNP (u3RNP), anti-U1RNP (U1RNP), anti-PmScl (PmScl), anti-Ku (Ku) and anti-Th/T0 (Th/T0), each being characterised by different clinical features and prognosis. The presence of >1 SSc-Abs is rare with minimum data about these patients’ clinical phenotype.Objectives:To describe and compare the clinical features of SSc patients with >1 SSc-AbMethods:The autoantibody profiles of 2799 SSc patients from February 2001 to June 2017 were retrospectively reviewed. Patients with >1 SSc-Abs were identified. Clinical features were collected and compared to historical cohorts of SSc patients with single SSc-Ab positivity. Patients were excluded if treated prior to their immunology test with rituximab, iv immunoglobulins or stem cell transplantation. Statistical analysis was performed using Fisher exact test.Results:72 patients (2.6%) with >1 SSc-Ab were identified. Full clinical data were available for 63 patients. 60 patients (2.1%) had double Ab positivity and 3 patients had triple Ab positivity (0.1%). 13 Ab combinations were present. U1RNP and ATA was the most frequent combination (35%), patients were significantly younger (51.38 years) than both U1RNP (58.64 years, p=0.050) and ATA (62.03 years, p=0.002) patients and more commonly of diffuse subset (dcSSc) (p=0.001 and p=0.041 respectively). Compared to ATA patients overlap features were more frequent (43% vs 15%, p=0.004) including inflammatory arthritis (p=0.025) and myositis (p=0.013) (Table 1). U1RNP and ACA had a significantly higher prevalence of pulmonary arterial hypertension compared to U1RNP (p=0.039) and ACA (p=0.022) patients, and compared to ACA patients they were younger (57.88 vs 68.75, p=0.015) with a higher incidence of myositis (p=0.001). U1RNP and ARA patients were more frequently dcSSc subtype compared to U1RNP patients (75% vs 21%, p=0.040). U1RNP and PmScl patients had a higher prevalence of myositis compared to U1RNP patients (p=0.006). ATA and ACA patients behaved similarly to ATA patients with a significantly higher prevalence of lung fibrosis (p=0.006) and myositis (p=0.041) compared to ACA. ACA and PmScl (7%) had higher prevalence of myositis compared to ACA patients (p=0.04).Table 1. Frequency of clinical features in some of the double antibody group combinations, compared to our cohort of patients with only one of the SSc specific antibody. Significant p values (<0.05) highlighted in bold. ILD (interstitial lung disease), PAH (pulmonary arterial hypertension), SRC (scleroderma renal crisis).Conclusion:Coexistence of hallmark autoantibodies is exceedingly rare in SSc patients. When combined, both SSc-Abs have the potential to synergistically interact and modify the clinical phenotype.Disclosure of Interests:Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Kristina Clark: None declared, Lauren Host: None declared, Alper Sari: None declared, Svetlana Nihtyanova: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Voon Ong: None declared
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Lescoat A, Jouneau S, Crestani B, Riemekasten G, Kondoh Y, Smith V, Patel N, Huggins J, Stock C, Gahlemann M, Alves M, Denton C. SAT0329 IS THE RATE OF LUNG FUNCTION DECLINE THE SAME IN PATIENTS WITH SYSTEMIC SCLEROSIS-ASSOCIATED ILD (SSC-ILD) WHO EXPERIENCE WEIGHT LOSS? DATA FROM THE SENSCIS TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:In the SENSCIS trial, nintedanib reduced the progression of SSc-ILD vs placebo, as shown by a lower rate of decline in forced vital capacity (FVC). The adverse event (AE) profile of nintedanib was characterised mainly by gastrointestinal (GI) events, including weight loss.Objectives:Assess FVC decline and AEs in subgroups by weight loss ≤5% vs >5% over 52 weeks in the SENSCIS trial.Methods:Patients with SSc-ILD with first non-Raynaud symptom <7 years before screening and ≥10% fibrosis of the lungs on an HRCT scan were randomised to nintedanib or placebo. In a non-randomised comparison, we analysed the rate of decline in FVC (mL/year) and AEs over 52 weeks in subgroups by weight loss (≤5% vs >5%) over 52 weeks.Results:In the nintedanib (n=288) and placebo (n=288) groups, respectively, 112 (38.9%) and 43 (14.9%) patients had weight loss >5% over 52 weeks. At baseline, patients with weight loss >5% over 52 weeks had a higher mean age (57.0 vs 52.9 years), greater proportion of females (81.3% vs 72.9%), and similar mean BMI (26.5 vs 25.7 kg/m2, respectively) and FVC % predicted (71.0% vs 73.1%, respectively) vs patients with weight loss ≤5%. In the placebo group, the mean (SE) annual rate of decline in FVC was similar between patients who had weight loss ≤5% and >5% over 52 weeks (-92.7 [14.7] mL/year and -96.4 [34.9] mL/year, respectively). The estimated annual rate of decline in FVC was lower in patients treated with nintedanib than placebo, with between-group differences in patients who had weight loss ≤5% and >5% of 49.9 mL/year [95% CI 4.2, 95.6]) and 30.2 mL/year [95% CI -50.5, 110.9]), respectively, with no evidence of heterogeneity between subgroups by weight loss (p=0.68 for interaction). Standardised differences in baseline values of potential confounders were <0.2 (indicating negligible differences). The most frequent AEs in patients treated with nintedanib were diarrhoea (74.4% and 77.7% of patients with weight loss ≤5% and >5%, respectively), nausea (30.1% and 33.9%, respectively) and vomiting (19.3% and 33.3%, respectively). In the nintedanib and placebo groups, respectively, AEs leading to discontinuation of study drug occurred in 17.0% and 8.6% of patients with weight loss ≤5%, and 14.3% and 9.3% of patients with weight loss >5% over 52 weeks.Conclusion:In the SENSCIS trial in patients with SSc-ILD, a greater proportion of patients treated with nintedanib than placebo had weight loss >5% over 52 weeks. The rate of decline in FVC was numerically lower in the nintedanib group than in the placebo group both in patients with weight loss ≤5% and >5% over 52 weeks. AEs leading to discontinuation of nintedanib were not more frequent in patients with weight loss >5% vs ≤5%.References:Disclosure of Interests: :Alain LESCOAT: None declared, Stéphane Jouneau Grant/research support from: AIRB, Boehringer Ingelheim, LVL Medical, Novartis, Roche, Bellorophon Therapeutics, Biogen, Fibrogen, Galecto Biotech, Gilead Sciences, Pharm-Olam, Pliant Therapeutics, Savara Pharmaceuticals/Serendex Pharmaceuticals, Consultant of: Actelion, AIRB, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Chiesi, Genzyme, GlazoSmithKline, LVL Medical, Mundipharma, Novartis, Pfizer, Roche, Sanofi, Bruno Crestani Grant/research support from: AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Novartis, Roche, Sanofi, Consultant of: AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Roche, Sanofi, Speakers bureau: AstraZeneca, Boehringer Ingelheim, Roche, Sanofi, Gabriela Riemekasten Consultant of: Cell Trend GmbH, Janssen, Actelion, Boehringer Ingelheim, Speakers bureau: Actelion, Novartis, Janssen, Roche, GlaxoSmithKline, Boehringer Ingelheim, Pfizer, Yasuhiro Kondoh Consultant of: Boehringer Ingelheim, Asahi Kasei Pharma, Janssen, Shionogi, Speakers bureau: Boehringer Ingelheim, Asahi Kasei Pharma, Janssen, Eisai, KYORIN, Mitsubishi Tanabe Pharma, Novartis, Shionogi, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Nina Patel Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Speakers bureau: Genentech, John Huggins Consultant of: I was a site PI for the SENSCIS trial for Boehringer Ingelheim, Christian Stock Employee of: Employee of Boehringer Ingelheim, Martina Gahlemann Employee of: Employee of Boehringer Ingelheim, Margarida Alves Employee of: Employee of Boehringer Ingelheim, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer
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Allanore Y, Wung P, Soubrane C, Esperet C, Frederic M, Bejuit R, Lahmar A, Khanna D, Denton C. OP0250 EFFICACY AND SAFETY OF ROMILKIMAB IN DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC): RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, 24-WEEK, PROOF OF CONCEPT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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:Systemic sclerosis (SSc) is a progressive, multi-organ disease with limited treatment options. Interleukin-4 (IL-4) and IL-13 have been implicated in the fibrotic pathway and pathogenesis of SSc and are promising targets. Romilkimab (RKB) is an engineered humanized bispecific Ig-G4 antibody that binds and neutralizes both IL-4/IL-13. We report a Phase IIa randomized, double-blind, placebo-controlled trial (NCT02921971, Sanofi funded) employing RKB in SSc.Objectives:To evaluate the efficacy and safety of RKB in dcSSc.Methods:Patients with dcSSc duration ≤36 months, mRSS 10-35, with or without immunosuppressive background therapy were randomized (1:1) to subcutaneous RKB 200mg or placebo (PBO) for 24 weeks and stratified on history of SSc-ILD. Primary endpoint was mean change in mRSS at Week 24 and FVC/DLco and HAQ-DI were secondary endpoints. All analyses used a 1-sided p-value <0.05 as reaching statistical significance.Results:Ninety-seven patients with similar baseline characteristics between arms, including use of background therapy (RKB 59.2% vs. PBO 52.1%) were randomized. Six (12.2%) and 4 (8.3%) patients discontinued study treatment early in the PBO and RKB arms, respectively. Primary endpoint showed an absolute change in mRSS of -2.45 (0.85) and -4.76 (0.86) for PBO and RKB groups, respectively with a difference of -2.31 (1.21) favoring RKB (p=0.029). Subgroup analysis based on background therapy showed a similar treatment effect with a PBO subtracted difference in mRSS of -2.69 (1.83) and -2.38 (1.59), suggesting an additive effect between background therapy and RKB. Secondary endpoints did not show a statistically significant difference between RKB vs. PBO arms, although there was numerically less decline in FVC with RKB with a PBO subtracted difference of 70ml (p=0.06). Exploratory endpoints suggested possible effect of RKB on overall pain, Raynaud’s, digital ulcers, and EQ-5D-5L. Post-hoc analysis was undertaken to determine time to progression (first event defined as death, ≥10% relative decline in % predicted FVC, ≥15% relative decline in % predicted DLCO, ≥20% increase or +5 in mRSS, or other events: cardiac, SRC, PAH development) and showed a benefit for RKB (HR: 0.47 p=0.04). Adverse events were balanced between the two groups (RKB 83.3% vs. PBO 83.7%). There were 5 and 4 SAEs in the PBO and RKB arms, respectively. One death occurred in each arm (SRC – RKB, cardiomyopathy – PBO).Conclusion:Patients with dcSSc who were treated with RKB showed a statistically significant reduction in mRSS compared to those receiving PBO. Secondary outcomes were not met, although RKB was associated with a smaller decline in FVC than PBO. Post-hoc analysis showed a possible reduction on time to progression with RKB. RKB was well tolerated with no major safety concerns.References:None.Disclosure of Interests:Yannick Allanore Grant/research support from: Yannick Allanore has received grants from Inventiva, Roche and Sanofi, Consultant of: Yannick Allanore has received fees from Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Curzion, Inventiva, Roche, Sanofi, Peter Wung Shareholder of: I own Sanofi stock, Employee of: I work for Sanofi, Christina Soubrane Employee of: I work for Sanofi., Corinne Esperet Employee of: I work for Sanofi., MARRACHE Frederic Employee of: I work for Sanofi, Raphael Bejuit Employee of: I work for Sanofi., Amel Lahmar Employee of: I work for Sanofi., Dinesh Khanna Shareholder of: Eicos Sciences, Inc./Civi Biopharma, Inc., Grant/research support from: Dr Khanna was supported by NIH/NIAMS K24AR063120, Consultant of: Acceleron, Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Corbus Pharmaceuticals, Horizon Therapeutic, Galapagos, Roche/Genentech, GlaxoSmithKline, Mitsubishi Tanabe, Sanofi-Aventis/Genzyme, UCB, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer
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Lazzaroni MG, Campochiaro C, Marasco E, De Vries-Bouwstra J, Franceschini F, Del Galdo F, Denton C, Cavagna L, Distler O, Allanore Y, Airò P. SAT0328 OUTCOME OF INTERSTITIAL LUNG DISEASE (ILD) IN ANTI-PM/SCL PATIENTS WITH SYSTEMIC SCLEROSIS: RESULTS FROM AN EUSTAR CASE-CONTROL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4890] [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:The main clinical associations of anti-PM/Scl in Systemic Sclerosis (SSc) so far reported include calcinosis, myositis and interstitial lung disease (ILD). Nevertheless, data regarding the long-term outcome of ILD in these patients are lacking. A single centre Spanish cohort reported a better functional outcome in 14 SSc-ILD patients anti-Pm/Scl+ as compared to 49 anti-Topo I after a mean follow-up of 7 years (1).Objectives:To analyze the long-term outcome of ILD in a large multicentre EUSTAR study dedicated to anti-Pm/Scl SSc patients.Methods:A case-control study within the EUSTAR cohort collected 165 anti-PM/Scl+ SSc cases and 257 anti-PM/Scl- SSc controls, matched for sex, cutaneous subset, disease duration, and age at onset. Data for ILD at HRCT were available for 162/165 cases and 249/257 controls. Data for pulmonary function tests (PFT) at the baseline (T0), 1 year after diagnosis (T1) and at the last visit (LV) were analyzed.Results:A significantly higher frequency of ILD was reported in anti-Pm/Scl+ cases vs anti-Pm/Scl- controls (62.3% vs 39.4%, p:<0.0001, OR 95%, CI 2.55, 1.70-3.83). Complete PFTs data were available for 81/101 ILD anti-Pm/Scl+ cases and 78/98 anti-Pm/Scl- ILD controls, with similar age at onset and female/male ratio and disease duration at LV (112±81 months vs. 115±64 months, p:0.77). Diffuse cutaneous involvement was less frequent in cases than in controls (27.2% vs. 44.9%, p:0.03).In ILD cases, %pFVC tended to improve from T0 (85.1±18.3) to T1 (89.5±16.5, p:0.045) and to LV (87.9±16.9, p:0.057), while in ILD controls remained stable from T0 (90.4±18.5) to T1 (91.1±16.5, p:0.38) and significantly declined to LV (85.0±18.0, p:0.0002). %pDLCO remained stable from T0 (60.5±16.8) to T1 (60.1±17.6, p:0.87) and to LV (60.4±16.9, p:0.77) in ILD cases, while significantly declined from T0 (67.0±18.9) to T1 (62.7±18.2, p:0.0016) and to LV (59.6±18.4, p<0.0001) in the control group. Mean %pFVC and %pDLCO at the 3 time points were not significantly different between the two groups.Delta %pFVC (LV-T0) was 2.85±11.3 for the anti-Pm/Scl+ group vs -5.42±13.4 in the control group (p:0.0004) with a significant smaller proportion of patients with FVC loss ≥10% from T0 to LV in the anti-PM/Scl group (12.3% vs. 39.7%, p:0.0001). Delta %pDLCO (LV-T0) was -0.13±10.8 for the anti-PM/Scl+ group vs -7.38±14.6 in the control group (p:0.0015), with a significant smaller proportion of patients with DLCO loss ≥10% from T0 to LV in the anti-PM/Scl+ group (13.6% vs. 42.3%, p<0.0001).Conclusion:In this multicenter real-life study, the long-term pulmonary functional outcome in SSc-ILD patients with anti-Pm/Scl positivity seems to be more favorable than in patients without anti-Pm/Scl antibodies.References:[1]Guillen-Del Castillo A, Semin Arthritis Rheum 2014, 44 (3), 331-7.Disclosure of Interests: :Maria Grazia Lazzaroni: None declared, Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Emiliano Marasco: None declared, Jeska de Vries-Bouwstra: None declared, Franco Franceschini: None declared, Francesco Del Galdo: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Lorenzo Cavagna: None declared, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Paolo Airò: None declared
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Rohani-Montez C, Calle M, Allen C, Denton C. THU0584 CASE-BASED ONLINE EDUCATION SIGNIFICANTLY INCREASES CLINICIAN COMPETENCE IN ASSESSING SSC-ILD DISEASE PROGRESSION AND IMPLEMENTING APPROPRIATE THERAPY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:Due to the heterogeneity in both the initial manifestations of systemic sclerosis (SSc) and progression with SSc-associated interstitial lung disease (SSc-ILD), diagnosis and prognosis can be challenging in clinical practice. Clinicians need expert case-based guidance on how best to monitor patients with SSc and the treatment implications.Objectives:This study was conducted to determine whether online case-based independent medical education could improve rheumatologists’ and pulmonologists’ competence in evaluating and monitoring SSc-ILD progression and initiating the right treatments when progression is identified.Methods:Rheumatologists and pulmonologists participated in two comprehensive online case studies, using a ‘test then teach’ approach and completed all pre- and post-questions.1The effects of the education on knowledge and competence were assessed using a 3-question, repeated pairs, pre-assessment/post-assessment study design. For all questions combined, the chi-square test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. The activity launched on September 24, 2019, and data were collected through December 9, 2019.Results:Overall significant improvements were seen after participation for both rheumatologists (average correct response rate of 65% at pre-assessment vs 97% at post-assessment; P<.001, N=89), and pulmonologists (average correct response rate of 64% at pre-assessment vs 95% at post-assessment; P<.001, N=71). Specifically, significant improvements were observed in clinicians’ competence in assessing response to therapy and monitoring for disease progression; and managing evidence of disease worsening (figure).Figure.After participating in the activity, 54% of rheumatologists and 51% of pulmonologists had measurable improved confidence related to communicating with patients with SSc-ILD about the possibility of disease progression.Given that only around half of clinicians provided correct responses at baseline, it will be important to continue to reinforce these learnings in ongoing education.Conclusion:This study demonstrates the success of online, case-based education in improving rheumatologists’ and pulmonologists’ competence in managing patients with SSc-ILD. This could lead to earlier changes in therapeutic approach for those with signs of progression and result in improved overall outcomes for these patients.References:[1]Denton C. When SSc-ILD Starts Progressing: Monitoring and Managing Those at Risk for Poor Prognosis. Launched: 9/24/2019. Data as of 12/9/2019. Available atwww.medscape.org/viewarticle/918465Disclosure of Interests:Christy Rohani-Montez: None declared, Marinella Calle: None declared, Chris Allen: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer
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Becker MO, Dobrota R, Fligelstone K, Roennow A, Allanore Y, Carreira P, Czirják L, Denton C, Hesselstrand R, Sandqvist G, Kowal-Bielecka O, Bruni C, Matucci Cerinic M, Mihai C, Gheorghiu AM, Müller-Ladner U, Sexton J, Heiberg T, Distler O. OP0251 THE EULAR SYSTEMIC SCLEROSIS IMPACT OF DISEASE (SCLEROID) SCORE – A NEW PATIENT-REPORTED OUTCOME MEASURE FOR PATIENTS WITH SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5612] [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:Patient reported outcome measures (PROM) are important for clinical practice and research. Given the unmet need for a comprehensive PROM for systemic sclerosis (SSc), the ScleroID questionnaire was developed by a joint team of patients with SSc and medical experts. This is intended as a brief, specific, patient-derived, disease impact score for research and clinical use in SSc.Objectives:Here, we present the validation and final version of the ScleroID.Methods:This EULAR-endorsed project involves 9 European expert SSc centers. Patients fulfilling the ACR/EULAR 2013 criteria were prospectively included since 05/16 in a large observational cohort study. Patients completed the ScleroID and comparators SHAQ, EQ5D, SF36. They also weighted the 10 dimensions of the ScleroID by distributing 100 points according to the perceived impact on their health. The final score calculation is based on the ranking of the weights. The validation study included a reliability arm and a longitudinal arm, looking at sensitivity to change at follow-up.Results:Of the 472 patients included at baseline, 109 patients also had a reliability visit and 113 patients a follow-up visit. 84.5% of patients were female, 29.8% had diffuse SSc, mean age was 54.6 years, and mean disease duration 9.5 years. The highest weights were assigned by the patients to Raynaud`s phenomenon, fatigue, hand function and pain, confirming our previous results. The total ScleroID score showed good Spearman correlation coefficients with the comparators (SHAQ, 0.73; EQ5D -0.48; Patient’s global assessment, VAS 0.77; HAQ-DI 0.62; SF36 physical score -0.62; each p<0.001). The internal consistency was good: Crohnbach’s alpha 0.866, similar to SS-HAQ (0.88) and higher than EQ5D (0.77). The ScleroID had a very good reliability: intra-class correlation coefficient 0.839 (ranging 0.608 to 0.788 for the individual items), superior to all comparators. Twenty of 113 patients reported a change in their disease status at follow up. Sensitivity to change: the standardized response mean was 0.34 for the total ScleroID score and highest for lower GI (0.633) and life choices domains (0.521), superior to all other PROM. Figure 1 shows the final ScleroID.Figure 1.Conclusion:The EULAR ScleroID is a novel PROM designed for use in clinical practice and clinical trials to reflect the disease impact of SSc, showing good performance in the validation study. Importantly, Raynaud syndrome, impaired hand function, pain and fatigue were the main patient reported drivers of disease impact.Disclosure of Interests:Mike O. Becker: None declared, Rucsandra Dobrota: None declared, Kim Fligelstone: None declared, Annelise Roennow: None declared, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Roger Hesselstrand: None declared, Gunnel Sandqvist: None declared, Otylia Kowal-Bielecka Consultant of: Bayer, Boehringer Ingelheim, Inventiva, MSD, Medac, Novartis, Roche and Sandoz, Speakers bureau: Bayer, Boehringer Ingelheim, Inventiva, MSD, Medac, Novartis, Roche and Sandoz, Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Marco Matucci Cerinic: None declared, Carina Mihai: None declared, Ana Maria Gheorghiu: None declared, Ulf Müller-Ladner Speakers bureau: Biogen, Joe Sexton: None declared, Turid Heiberg: None declared, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche
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Galloway M, Hunter E, Akoulitchev A, Vigneswaran S, Abdi B, Denton C, Abraham D, Stratton R. OP0254 CHROMATIN CONFORMATION SIGNATURE ANALYSIS IN EARLY VS LATE SCLERODERMA PHENOTYPES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6323] [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:Systemic sclerosis (scleroderma, SSc) is a heterogeneous disease in which clinical outcomes vary widely. Predicting outcomes on an individual basis remains challenging despite progress made through autoantibody analysis and gene expression profiling. Effective targeted therapies are evolving and accurately predicting outcomes is important to enable patient stratification for therapy.Chromatin Conformation Signature (CCS) profiling of peripheral blood for systemic epigenetic deregulations could be used for such a purpose. The EpiSwitch platform offering high throughput and resolution chromosome conformation (3C) capture detects significant regulatory changes in 3D genome architecture and maps long range interaction between distant genomic locations. This then reveals the spatial disposition and physical properties of the chromosome, such as chromatin loops and inter-chromosomal connections, which have a role in network organization and genetic epistasis controlling gene expression. EpiSwitch automated platform has been successfully utilised in patient stratification in RA, MS and other indications.This methodology could be applied to patients with SSc to identify CCS associated with different phenotypes and may ultimately be used to stratify and identify patients into pathogenic subtypes.Objectives:We aimed to determine significant CCSs associated with early and late phenotypes of SSc.Methods:The EpiSwitch-based chromosome conformation capture (3C) method was applied to blood samples from early phenotype, and late phenotype SSc patients. Intact nuclei were isolated from peripheral blood mononuclear cells and subjected to formaldehyde fixation resulting in crosslinking between physically touching segments of the genome via contacts between their DNA bound proteins. For quantification of cross-linking frequencies, the cross linked DNA was digested and then subjected to ligation. Cross-linking was then reversed and individual ligation products detected and quantified by EpiSwitch custom oligo array annotated across the whole genome to the anchoring sites of 3D genome architecture.Results:7 significant CCSs were found over the HLA-C, HLA-B and TNF regions on Chromosome 6 in the early phenotype. The top 8 pathways for genetic locations associated to the CCSs are shown in Table 1.Table 1.Top 8 pathways for genetic locations associated to significant CCS for the early phenotype.GeneSet1Natural Killer cell mediated cytotoxicity2Immunoregulatory interations between a lymphoid cell and a non-lymphoid cell3Antigen Processing & presentation4Phagosome5Graft versus host disease6Type 1 diabetes mellitus7Osteoclast differentiation8Class 1 MHC mediated antigen processing & presentation2 significant CCSs were found centred around the IFNG region of chromosome 12 in the late phenotype. The top 8 pathways for genetic locations associated to significant CCSs are shown in Table 2.Table 2.Top 8 pathways for genetic locations associated to significant CCS for the late phenotype.GeneSet1Surfactant metabolism2IL12 signalling mediated by STAT43Protein digestion & absorption4Calcineruin regulated NFAT dependent transcription in lymphocytes5Transcriptional misregulation in cancer6Kaposi’s sarcoma associated herpes virus infection7IL2 mediated signalling events8Inflammatory bowel diseaseConclusion:Significant CCSs, as part of 3D genomic regulatory control, and their associated pathways for the genetic locations, were identified in both late and early phenotypes. There were distinct CCSs in the early phenotype compared to the late suggesting the CCSs change as the disease progresses and varies between phenotypes. If CCSs could be linked to each clinically defined subgroup across a SSc cohort they could be used as a biomarker tool to predict outcome and progression in patients.Disclosure of Interests:Megan Galloway: None declared, Ewan Hunter: None declared, Alexandre Akoulitchev: None declared, Shivanee Vigneswaran: None declared, Bahja Abdi: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, Inventiva, CSF Behring, Consultant of: Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Bayer, David Abraham: None declared, Richard Stratton: None declared
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Oláh C, Schwartz N, Denton C, Kardos Z, Putterman C, Szekanecz Z. Cognitive dysfunction in autoimmune rheumatic diseases. Arthritis Res Ther 2020; 22:78. [PMID: 32293528 PMCID: PMC7158026 DOI: 10.1186/s13075-020-02180-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/01/2020] [Indexed: 02/08/2023] Open
Abstract
For people with chronic autoimmune rheumatic diseases (AIRD), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or systemic sclerosis (SSc), normal cognitive functions are essential for performing daily activities. These diseases may be associated with cognitive dysfunction (CD). In RA, CD has been associated with age, lower education and disease duration and activity. Great advances have been achieved in neuropsychiatric SLE in the identification of pathogenic pathways, assessment and possible treatment strategies. SSc rarely exerts direct effects on the brain and cognitive function. However, the psychological burden that includes depression, anxiety and social impact may be high. AIRD patients with sustained disease activity, organ damage or lower education should be evaluated for CD. The control of systemic inflammation together with tailored behavioural cognitive therapies may benefit these patients.
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Affiliation(s)
- Csaba Oláh
- Departments of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Noa Schwartz
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Christopher Denton
- Centre for Rheumatology, Royal Free Campus, University College London, London, UK
| | - Zsófia Kardos
- Departments of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Chaim Putterman
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.,Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.,Azrieli Faculty of Medicine of Bar Ilan University, Zefat, Israel.,Research Institute, Galilee Medical Center, Nahariya, Israel
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, Debrecen, 4032, Hungary.
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Brown J, Norrington K, Kotecha T, Martinez-Naharro A, Fayed H, Teresi L, Denton C, Schreiber B, Fontana M, Kellman P, Coghlan J, Knight DS. P5262Subclinical myocardial abnormalities in systemic sclerosis-associated versus non-connective tissue disease pulmonary hypertension by CMR multiparametric mapping. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Scleroderma (SSc)-associated pulmonary arterial hypertension (PAH) has the worst prognosis of all PAH subtypes despite having relatively more favourable haemodynamic and cardiac functional profiles. Myocardial abnormalities in SSc have been demonstrated by cardiovascular magnetic resonance (CMR) multiparametric tissue mapping. However, myocardial tissue characterisation studies across distinct PAH subtypes including SSc are limited.
Purpose
We compared indices of tissue characterisation by CMR multiparametric mapping between patients with SSc with and without PAH, non-connective tissue disease pulmonary hypertension (non-CTD PH) and healthy volunteers.
Methods
One-hundred and thirty-six patients underwent a CMR study over a 30-month period: 104 patients with systemic sclerosis, of whom 39 had SSc-PAH and 65 had no PH; 32 patients with idiopathic PAH, chronic thromboembolic PH or portopulmonary PH (non-CTD PH group). Patients underwent comprehensive CMR tissue characterisation including quantification of native myocardial T1 (MOLLI), myocardial T2 and ECV from automatically generated tissue maps along with conventional late gadolinium enhancement (LGE) imaging. Twenty age-matched controls underwent the same CMR study protocol. Patients were assessed for PH by right heart catheterisation.
Results
Native myocardial T1 and myocardial T2 and myocardial ECV are significantly elevated in SSc-PAH versus non-CTD PH (all p<0.05, Figure 1) despite no differences in LV systolic function between these patient cohorts. Patients with SSc have similar degrees of elevated T1, T2 and ECV irrespective of the presence or absence of PAH, suggesting a diffuse myocardial process due to SSc itself. Both SSc sub-groups have significantly higher T1, T2 and ECV compared with controls (all p<0.05).
All patients with SSc were subdivided by the presence or absence of ventricular insertion point LGE. Even in the absence of LGE, T1, T2 and ECV were significantly higher in SSc patients versus controls (all p<0.001). However, the presence of focal insertional LGE in SSc was not associated with different burdens of interstitial disease, as defined by median ECV. This highlights the unique role of multiparametric tissue maps in assessing diffuse myocardial involvement beyond the identification of focal LGE.
Conclusion
Subclinical abnormalities of the myocardium can be detected by CMR multiparametric tissue mapping in patients with SSc. The higher native myocardial T1 and T2 along with the elevated ECV in SSc-PAH are likely to be accounted for by SSc involvement itself. Abnormalities of the myocardial architecture could be a potential contributory reason for the poorer outcomes in SSc-PAH versus non-CTD PH despite the more favourable haemodynamics and right heart function observed in the former patient sub-group. Further work should be directed at determining the prognostic capacity of these metrics in SSc-PAH.
Acknowledgement/Funding
British Heart Foundation, Action Pharmaceuticals Ltd
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Affiliation(s)
- J Brown
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - K Norrington
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - T Kotecha
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - A Martinez-Naharro
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - H Fayed
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - L Teresi
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - C Denton
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - B Schreiber
- Royal Free Hospital, Pulmonary Hypertension Service, London, United Kingdom
| | - M Fontana
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - J Coghlan
- Royal Free Hospital, Pulmonary Hypertension Service, London, United Kingdom
| | - D S Knight
- University College London, Department of Cardiac MRI, Royal Free Campus, London, United Kingdom
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Santos Cade J, Papaioannou I, Siddiqui Y, Holmes A, Loizidou M, Schatzlein A, Denton C, Abraham D, Ponticos M. P6011NKX2-5 contributes to EndoMT and endothelial dysfunction in pulmonary arterial hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0731] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The onset of inflammation, hypoxia or shear stress within blood vessels can result in endothelial-to-mesenchymal transition (EndoMT), a disease-associated process where endothelial cells (ECs) downregulate endothelial markers and acquire mesenchymal features. EndoMT is observed in patients with scleroderma-associated pulmonary hypertension (SSc-PAH), which have the highest mortality amongst all the scleroderma patient subgroups. The homeobox transcriptional factor NKX2-5 is fundamental for cardiovascular development. However, NKX2-5 expression has not been reported yet in ECs of adult pulmonary blood vessels.
Purpose
To investigate the role of NKX2-5 in the pulmonary endothelium of SSc-PAH.
Methods
Human pulmonary artery endothelial cells (HPAECs) were treated with a cocktail of TGF-β (5 ng/mL), TNF-α (5 ng/mL), and IL-1β (0.1 ng/mL) for 5 days. Immunofluorescence was used to detect NKX2-5 and other markers in ECs. Western blotting and qPCR evaluated, respectively, protein and gene expression. Lentiviral transduction forced NKX2-5 expression in the cells. Transendothelial electrical resistance (TEER) measurements evaluated endothelial barrier function. Pharmacological inhibition was performed to determine the pathways that lead to NKX2-5 activation. Casein kinase 2 (CK2)-inhibition (CX4945) of a chronic hypoxia mouse model of PAH was used to assess right ventricular systolic pressure (RVSP).
Results
Immunofluorescence showed a strong expression of NKX2-5 in the endothelium of SSc-PAH human lungs (p<0.0001). Western blot analysis demonstrated a 5.3-fold downregulation of CD31 (p<0.001), and an increased production of NKX2-5 (5.6-fold, p<0.0001) and of Procollagen I (12-fold, p=0.0009) after 5 days of cytokine stimulation on HPAECs. Relative mRNA expression has shown a 3-fold gene downregulation of CD31 (p=0.0002) and a reduction of VE-Cadherin (2.3-fold, p=0.0008) and of vWF (10.4-fold, p=0.003) in EndoMT, whereas gene expression of COL1α2 (8.5-fold, p<0.0001) and of NKX2-5 (1.5-fold, p=0.003) were upregulated. Immunofluorescence of cells has revealed a decreased VE-Cadherin expression concomitant with upregulation of NKX2-5 in EndoMT cells. Forced expression of NKX2-5 downregulated endothelial markers and endothelial barrier function was impaired whereas proliferation rate of cells was increased. Inhibition of PI3K, ERK5, ALK5 and CK2 reduced NKX2-5 protein expression within cells. CK2-inhibited mice under hypoxia conditions resembled the normoxia mice group by normalising RVSP.
Conclusion
HPAECs undergoing EndoMT express NKX2-5 in vitro and in vivo, via mediation of CK2, TGF-β, ERK5 and PI3K signalling. NKX2-5 downregulates key adherence junctional proteins, disrupting endothelial barrier function. This study highlights the involvement of NKX2-5 in EndoMT and in endothelial dysfunction, leading to vascular disease progression in SSc-PAH.
Acknowledgement/Funding
British Heart Foundation, Arthritis Research UK, Scleroderma Research UK and Royal Free Hospital Charity
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Affiliation(s)
- J Santos Cade
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - I Papaioannou
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - Y Siddiqui
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - A Holmes
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - M Loizidou
- University College London, Department of Surgical Biotechnology, London, United Kingdom
| | - A Schatzlein
- University College London, School of Pharmacy, London, United Kingdom
| | - C Denton
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - D Abraham
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - M Ponticos
- University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
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Sobanski V, Giovannelli J, Allanore Y, Riemekasten G, Airò P, Vettori S, Cozzi F, Distler O, Matucci-Cerinic M, Denton C, Launay D, Hachulla E. Phenotypes Determined by Cluster Analysis and Their Survival in the Prospective European Scleroderma Trials and Research Cohort of Patients With Systemic Sclerosis. Arthritis Rheumatol 2019; 71:1553-1570. [PMID: 30969034 PMCID: PMC6771590 DOI: 10.1002/art.40906] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/04/2019] [Indexed: 01/26/2023]
Abstract
Objective Systemic sclerosis (SSc) is a heterogeneous connective tissue disease that is typically subdivided into limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) depending on the extent of skin involvement. This subclassification may not capture the entire variability of clinical phenotypes. The European Scleroderma Trials and Research (EUSTAR) database includes data on a prospective cohort of SSc patients from 122 European referral centers. This study was undertaken to perform a cluster analysis of EUSTAR data to distinguish and characterize homogeneous phenotypes without any a priori assumptions, and to examine survival among the clusters obtained. Methods A total of 11,318 patients were registered in the EUSTAR database, and 6,927 were included in the study. Twenty‐four clinical and serologic variables were used for clustering. Results Clustering analyses provided a first delineation of 2 clusters showing moderate stability. In an exploratory attempt, we further characterized 6 homogeneous groups that differed with regard to their clinical features, autoantibody profile, and mortality. Some groups resembled usual dcSSc or lcSSc prototypes, but others exhibited unique features, such as a majority of lcSSc patients with a high rate of visceral damage and antitopoisomerase antibodies. Prognosis varied among groups and the presence of organ damage markedly impacted survival regardless of cutaneous involvement. Conclusion Our findings suggest that restricting subsets of SSc patients to only those based on cutaneous involvement may not capture the complete heterogeneity of the disease. Organ damage and antibody profile should be taken into consideration when individuating homogeneous groups of patients with a distinct prognosis.
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Affiliation(s)
- Vincent Sobanski
- Université Lille, INSERM U995 LIRIC, CHU Lille, and Referral Center for Rare Systemic Autoimmune Diseases North and North-West of France, Lille, France
| | | | - Yannick Allanore
- Hôpital Cochin, APHP, and Université Paris Descartes, Paris, France
| | | | - Paolo Airò
- Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | | | - David Launay
- Université Lille, INSERM U995 LIRIC, CHU Lille, and Referral Center for Rare Systemic Autoimmune Diseases North and North-West of France, Lille, France
| | - Eric Hachulla
- Université Lille, INSERM U995 LIRIC, CHU Lille, and Referral Center for Rare Systemic Autoimmune Diseases North and North-West of France, Lille, France
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Chisholm KM, Denton C, Keel S, Geddis AE, Xu M, Appel BE, Cantor AB, Fleming MD, Shimamura A. Bone Marrow Morphology Associated With Germline RUNX1 Mutations in Patients With Familial Platelet Disorder With Associated Myeloid Malignancy. Pediatr Dev Pathol 2019; 22:315-328. [PMID: 30600763 DOI: 10.1177/1093526618822108] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Germline mutations in RUNX1 result in autosomal dominant familial platelet disorder with associated myeloid malignancy (FPDMM). To characterize the hematopathologic features associated with a germline RUNX1 mutation, we reviewed a total of 42 bone marrow aspirates from 14 FPDMM patients, including 24 cases with no cytogenetic clonal abnormalities, and 18 with clonal karyotypes or leukemia. We found that all aspirate smears had ≥10% atypical megakaryocytes, predominantly characterized by small forms with hypolobated and eccentric nuclei, and forms with high nuclear-to-cytoplasmic ratios. Core biopsies showed variable cellularity and variable numbers of megakaryocytes with similar features to those in the aspirates. Granulocytic and/or erythroid dysplasia (≥10% cells per lineage) were present infrequently. Megakaryocytes with separate nuclear lobes were increased in patients with myelodysplastic syndrome (MDS) and acute leukemia. Comparison to an immune thrombocytopenic purpura cohort confirms increased megakaryocytes with hypolobated eccentric nuclei in FPDMM patients. As such, patients with FPDMM often have atypical megakaryocytes with small hypolobated and eccentric nuclei even in the absence of clonal cytogenetic abnormalities; these findings are related to the underlying RUNX1 germline mutation and not diagnostic of MDS. Isolated megakaryocytic dysplasia in patients with unexplained thrombocytopenia should raise the possibility of an underlying germline RUNX1 mutation.
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Affiliation(s)
- Karen M Chisholm
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Laboratory Medicine, University of Washington, Seattle, Washington.,3 Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Christopher Denton
- 4 Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Sioban Keel
- 5 Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | - Amy E Geddis
- 6 Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington.,7 Division of Hematology & Oncology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Min Xu
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Burton E Appel
- 8 Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Children's Cancer Institute, Hackensack, New Jersey
| | - Alan B Cantor
- 9 Division of Hematology Oncology, Boston Children's Hospital, Boston, Massachusetts.,10 Department of Hematology Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Mark D Fleming
- 3 Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Akiko Shimamura
- 9 Division of Hematology Oncology, Boston Children's Hospital, Boston, Massachusetts.,10 Department of Hematology Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
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Butler EA, Baron M, Fogo AB, Frech T, Ghossein C, Hachulla E, Hoa S, Johnson SR, Khanna D, Mouthon L, Nikpour M, Proudman S, Steen V, Stern E, Varga J, Denton C, Hudson M. Generation of a Core Set of Items to Develop Classification Criteria for Scleroderma Renal Crisis Using Consensus Methodology. Arthritis Rheumatol 2019; 71:964-971. [PMID: 30614663 DOI: 10.1002/art.40809] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/13/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To generate a core set of items to develop classification criteria for scleroderma renal crisis (SRC) using consensus methodology. METHODS An international, multidisciplinary panel of experts was invited to participate in a 3-round Delphi exercise developed using a survey based on items identified by a scoping review. In round 1, participants were asked to identify omissions and clarify ambiguities regarding the items in the survey. In round 2, participants were asked to rate the validity and feasibility of the items using Likert-type scales ranging from 1 to 9 (where 1 = very invalid/unfeasible, 5 = uncertain, and 9 = very valid/feasible). In round 3, participants reviewed the results and comments from round 2 and were asked to provide final ratings. Items rated as highly valid and feasible (median scores ≥7 for each) in round 3 were selected as the provisional core set of items. A consensus meeting using a nominal group technique was conducted to further reduce the core set of items. RESULTS Ninety-nine experts from 16 countries participated in the Delphi exercise. Of the 31 items in the survey, consensus was achieved on 13, in the categories hypertension, renal insufficiency, proteinuria, and hemolysis. Eleven experts took part in the nominal group technique discussion, where consensus was achieved in 5 domains: blood pressure, acute kidney injury, microangiopathic hemolytic anemia, target organ dysfunction, and renal histopathology. CONCLUSION A core set of items that characterize SRC was identified using consensus methodology. This core set will be used in future data-driven phases of this project to develop classification criteria for SRC.
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Affiliation(s)
| | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Agnes B Fogo
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Cybele Ghossein
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric Hachulla
- University of Lille and Hôpital Claude Huriez, Lille, France
| | - Sabrina Hoa
- McGill University and Lady Davis Institute, Montreal, Quebec, Canada
| | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Luc Mouthon
- Cochin Hospital, Paris-Descartes University, Paris, France
| | - Mandana Nikpour
- University of Melbourne at St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - John Varga
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Marie Hudson
- Jewish General Hospital, McGill University and Lady Davis Institute, Montreal, Quebec, Canada
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Leslie A, Shiwen X, Abraham D, Ong V, Denton C. 017 Systemic sclerosis fibroblasts show defective activation by coagulation factor XIII in vitro: implications for impaired wound healing in SSc. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Leslie
- Centre for Rheumatology, University College London, London, UNITED KINGDOM
| | - Xu Shiwen
- Centre for Rheumatology, University College London, London, UNITED KINGDOM
| | - David Abraham
- Centre for Rheumatology, University College London, London, UNITED KINGDOM
| | - Voon Ong
- Centre for Rheumatology, University College London, London, UNITED KINGDOM
| | - Christopher Denton
- Centre for Rheumatology, University College London, London, UNITED KINGDOM
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Denton C. I163 Analysis of the DUO Registry UK data: the effect of NHS England’s sildenafil and bosentan clinical commissioning policy. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez109.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Davies EJ, Ong V, Morris E, Kyriakou C, Denton C. E080 Two cases of rapidly progressive diffuse cutaneous systemic sclerosis treated with autologous haematopoietic stem cell transplant. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez110.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Voon Ong
- Rheumatology, Royal Free Hospital, London, UNITED KINGDOM
| | - Emma Morris
- Haematology, University College London Hospital, London, UNITED KINGDOM
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Abdi BA, Shiwen X, Arumalla N, Denton C, Abraham D, Stratton R. O06 Prolyl 3-hydroxylase 2 is a candidate gene in scleroderma involved in collagen synthesis and fibrosis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez105.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bahja Ahmed Abdi
- Rheumatology & Connective Tissue Diseases, University College London, London, United Kingdom
| | - Xu Shiwen
- Rheumatology & Connective Tissue Diseases, University College London, London, United Kingdom
| | - Nikita Arumalla
- Rheumatology & Connective Tissue Diseases, University College London, London, United Kingdom
| | - Christopher Denton
- Rheumatology & Connective Tissue Diseases, University College London, London, United Kingdom
| | - David Abraham
- Rheumatology & Connective Tissue Diseases, University College London, London, United Kingdom
| | - Richard Stratton
- Rheumatology & Connective Tissue Diseases, University College London, London, United Kingdom
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Dougherty DH, Kwakkenbos L, Carrier ME, Salazar G, Assassi S, Baron M, Bartlett SJ, Furst DE, Gottesman K, van den Hoogen F, Malcarne VL, Mouthon L, Nielson WR, Poiraudeau S, Sauvé M, Boire G, Bruns A, Chung L, Denton C, Dunne JV, Fortin P, Frech T, Gill A, Gordon J, Herrick AL, Hinchcliff M, Hudson M, Johnson SR, Jones N, Kafaja S, Larché M, Manning J, Pope J, Spiera R, Steen V, Sutton E, Thorne C, Wilcox P, Thombs BD, Mayes MD. The Scleroderma Patient-Centered Intervention Network Cohort: baseline clinical features and comparison with other large scleroderma cohorts. Rheumatology (Oxford) 2018; 57:1623-1631. [PMID: 29868924 DOI: 10.1093/rheumatology/key139] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives The Scleroderma Patient-centered Intervention Network (SPIN) Cohort is a web-based cohort designed to collect patient-reported outcomes at regular intervals as a framework for conducting trials of psychosocial, educational, self-management and rehabilitation interventions for patients with SSc. The aim of this study was to present baseline demographic, medical and patient-reported outcome data of the SPIN Cohort and to compare it with other large SSc cohorts. Methods Descriptive statistics were used to summarize SPIN Cohort characteristics; these were compared with published data of the European Scleroderma Trials and Research (EUSTAR) and Canadian Scleroderma Research Group (CSRG) cohorts. Results Demographic, organ involvement and antibody profile data for SPIN (N = 1125) were generally comparable with that of the EUSTAR (N = 7319) and CSRG (N = 1390) cohorts. There was a high proportion of women and White patients in all cohorts, though relative proportions differed. Scl70 antibody frequency was highest in EUSTAR, somewhat lower in SPIN, and lowest in CSRG, consistent with the higher proportion of interstitial lung disease among dcSSc patients in SPIN compared with in CSRG (48.5 vs 40.3%). RNA polymerase III antibody frequency was highest in SPIN and remarkably lower in EUSTAR (21.1 vs 2.4%), in line with the higher prevalence of SSc renal crisis (4.5 vs 2.1%) in SPIN. Conclusion Although there are some differences, the SPIN Cohort is broadly comparable with other large prevalent SSc cohorts, increasing confidence that insights gained from the SPIN Cohort should be generalizable, although it should be noted that all three cohorts include primarily White participants.
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Affiliation(s)
- Dane H Dougherty
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Linda Kwakkenbos
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Gloria Salazar
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Shervin Assassi
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Murray Baron
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, QC, Canada.,Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,McGill University Health Center, Montréal, QC, Canada
| | - Daniel E Furst
- Division of Rheumatology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Medicine, University of Washington, Seattle, WA, USA.,Medicine, University of Florence, Florence, Italy
| | | | - Frank van den Hoogen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Luc Mouthon
- Médecine interne, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, France.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares, vascularites nécrosantes et sclérodermie systémique, Hôpital Cochin, Paris, France
| | - Warren R Nielson
- Beryl & Richard Ivey Rheumatology Day Programs, St Joseph's Health Care, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Serge Poiraudeau
- Médecine interne, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, France.,Service de Médecine Physique et Réadaptation, Hôpital Cochin, France.,IFR Handicap INSERM, Paris, France
| | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton.,Scleroderma Society of Canada, Ottawa, ON, Canada
| | - Gilles Boire
- Département de médecine, Sherbrooke University, Sherbrooke, QC, Canada
| | - Alessandra Bruns
- Département de médecine, Sherbrooke University, Sherbrooke, QC, Canada
| | - Lorinda Chung
- Medicine - Med/Immunology & Rheumatology, Stanford University, Stanford, CA, USA
| | | | - James V Dunne
- Rheumatology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul Fortin
- Département de médecine, Université Laval, Québec, QC, Canada
| | - Tracy Frech
- Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Anna Gill
- Rheumatology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Gordon
- Department of Rheumatology, Hospital for Special Surgery, New York City, NY, USA
| | - Ariane L Herrick
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Manchester, UK
| | | | - Marie Hudson
- Department of Medicine, McGill University, Montreal, QC, Canada.,Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC, Canada
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Niall Jones
- Division of Rheumatology, University of Alberta, Edmonton, AB, Canada
| | - Suzanne Kafaja
- Division of Rheumatology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maggie Larché
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Joanne Manning
- Clinical and Research Vascular Laboratories, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janet Pope
- Bone & Joint Institute, University of Western Ontario, London, ON, Canada
| | - Robert Spiera
- Department of Rheumatology, Hospital for Special Surgery, New York City, NY, USA
| | - Virginia Steen
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Evelyn Sutton
- Division of Rheumatology, Dalhousie University, Halifax, NS
| | | | - Pearce Wilcox
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Département de médecine, Université Laval, Québec, QC, Canada
| | - Brett D Thombs
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada.,Department of Psychology, McGill University, Montréal, QC, Canada.,School of Nursing, McGill University, Montréal, QC, Canada
| | - Maureen D Mayes
- Department of Internal Medicine, Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, USA
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Baron M, Kahaleh B, Bernstein EJ, Chung L, Clements PJ, Denton C, Domsic RT, Ferdowsi N, Foeldvari I, Frech T, Gordon JK, Hudson M, Johnson SR, Khanna D, McMahan Z, Merkel PA, Narain S, Nikpour M, Pauling JD, Ross L, Valenzuela Vergara AM, Vacca A. An Interim Report of the Scleroderma Clinical Trials Consortium Working Groups. J Scleroderma Relat Disord 2018; 4:17-27. [PMID: 30906878 DOI: 10.1177/2397198318783926] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Scleroderma Clinical Trials Consortium (SCTC) represents many of the clinical researchers in the world who are interested in improving the efficiency of clinical trials in Systemic Sclerosis (SSc). The SCTC has established 11 working groups (WGs) to develop and validate better ways of measuring and recording multiple aspects of this heterogeneous disease. These include groups working on arthritis, disease damage, disease activity, cardiac disease, juvenile SSc, the gastrointestinal tract, vascular component, calcinosis, scleroderma renal crisis, interstitial lung disease, and skin measurement. Members of the SCTC may join any one or more of these groups. Some of the WGs have only recently started their work, some are nearing completion of their mandated tasks and others are in the midst of their projects. All these projects, which are described in this paper, will help to improve clinical trials and observational studies by improving or developing better, more sensitive ways of measuring various aspects of the disease. As Lord Kelvin stated, "To measure is to know. If you cannot measure it you cannot improve it." The SCTC is dedicated to improving the lives of patients with SSc and it is our hope that the contributions of the WGs will be one important step in this process.
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Affiliation(s)
- Murray Baron
- Division of Rheumatology, Jewish General Hospital, Montreal, Canada
| | - Bashar Kahaleh
- Faculty of Rheumatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Elana J Bernstein
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Lorinda Chung
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Philip J Clements
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; University College London, London, United Kingdom
| | - Christopher Denton
- Insitute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Robyn T Domsic
- Arthritis and Autoimmunity Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nava Ferdowsi
- Division of Rheumatology, St. Vincent's Hospital, Melbourne, Australia
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric Rheumatology, Hamburg, Germany
| | - Tracy Frech
- Department of Rheumatology, University of Utah, UT, USA
| | - Jessica K Gordon
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Montreal, Canada
| | - Sindhu R Johnson
- Department of Rheumatology, Toronto Western Hospital, Toronto, Canada
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, MI, USA
| | | | - Peter A Merkel
- Department of Medicine, University of Pennsylvania, PA, USA
| | - Sonali Narain
- Department of Rheumatology, Hosfra Northwell School of Medicine
| | - Mandana Nikpour
- Division of Rheumatology, St. Vincent's Hospital, Melbourne, Australia
| | - John D Pauling
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases University of Bath
| | - Laura Ross
- Division of Rheumatology, St. Vincent's Hospital, Melbourne, Australia
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Jaeger VK, Distler O, Maurer B, Czirják L, Lóránd V, Valentini G, Vettori S, Del Galdo F, Abignano G, Denton C, Nihtyanova S, Allanore Y, Avouac J, Riemekasten G, Siegert E, Huscher D, Matucci-Cerinic M, Guiducci S, Frerix M, Tarner IH, Garay Toth B, Fankhauser B, Umbricht J, Zakharova A, Mihai C, Cozzi F, Yavuz S, Hunzelmann N, Rednic S, Vacca A, Schmeiser T, Riccieri V, García de la Peña Lefebvre P, Gabrielli A, Krummel-Lorenz B, Martinovic D, Ancuta C, Smith V, Müller-Ladner U, Walker UA. Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group. Rheumatology (Oxford) 2018; 57:441-450. [PMID: 28499034 DOI: 10.1093/rheumatology/kex182] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives The multisystem manifestations of SSc can greatly impact patients' quality of life. The aim of this study was to identify factors associated with disability in SSc. Methods SSc patients from the prospective DeSScipher cohort who had completed the scleroderma health assessment questionnaire (SHAQ), a disability score that combines the health assessment questionnaire and five visual analogue scales, were included in this analysis. The effect of factors possibly associated with disability was analysed with multiple linear regressions. Results The mean SHAQ and HAQ scores of the 944 patients included were 0.87 (s.d. = 0.66) and 0.92 (s.d. = 0.78); 59% of the patients were in the mild to moderate difficulty SHAQ category (0 ⩽ SHAQ < 1), 34% in the moderate to severe disability category (1 ⩽ SHAQ < 2) and 7% in the severe to very severe disability category (2 ⩽ SHAQ ⩽ 3). The means of the visual analogue scales scores were in order of magnitude: overall disease severity (37 mm), RP (31 mm), pulmonary symptoms (24 mm), gastrointestinal symptoms (20 mm) and digital ulcers (19 mm). In multiple regression, the main factors associated with high SHAQ scores were the presence of dyspnoea [modified New York Heart Association (NYHA) class IV (regression coefficient B = 0.62), modified NYHA class III (B = 0.53) and modified NYHA class II (B = 0.21; all vs modified NYHA class I)], FM (B = 0.37), muscle weakness (B = 0.27), digital ulcers (B = 0.20) and gastrointestinal symptoms (oesophageal symptoms, B = 0.16; stomach symptoms, B = 0.15; intestinal symptoms, B = 0.15). Conclusion SSc patients perceive dyspnoea, pain, digital ulcers, muscle weakness and gastrointestinal symptoms as the main factors driving their level of disability, unlike physicians who emphasize objective measures of disability.
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Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Laszlo Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | - Veronika Lóránd
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | | | - Serena Vettori
- Department of Rheumatology, Second University of Naples, Naples, Italy
| | - Francesco Del Galdo
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Giuseppina Abignano
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Christopher Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Svetlana Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Yannick Allanore
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | - Jerome Avouac
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | | | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, University Hospital Charité
| | | | | | - Serena Guiducci
- Department of Rheumatology, University of Florence, Florence, Italy
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ingo H Tarner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Beata Garay Toth
- Federation of European Scleroderma Associations Aisbl, Budapest, Hungary
| | | | | | | | - Carina Mihai
- Department of Internal Medicine and Rheumatology, Dr Ion Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Sule Yavuz
- Department of Rheumatology, University of Marmara, Altunizade-Istanbul, Turkey
| | | | - Simona Rednic
- Clinica Reumatologie, University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Vacca
- II Chair of Rheumatology, University of Cagliari-Policlinico Universitario, Monserrato, Italy
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Krankenhaus St Josef, Wuppertal, Germany
| | - Valeria Riccieri
- Divisione di Reumatologia, Università di Roma La Sapienza, Roma, Italy
| | | | - Armando Gabrielli
- Istituto di Clinica Medica Generale, Ematologia ed Immunologia Clinica, Università Politecnica delle Marche, Ancona, Italy
| | | | - Duska Martinovic
- Division of Rheumatology, University Hospital of Split, Split, Croatia
| | - Codrina Ancuta
- Rheumatology 2 Department, Clinical Rehabilitation Hospital, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania
| | - Vanessa Smith
- Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel
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Ahmed BA, Shiwen X, Denton C, Martin G, Fraser J, Lopez H, Stratton R. 198 Critical role of the prolyl 3-hydroxylase LEPREL1 in scleroderma-related fibrosis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bahja Abdi Ahmed
- Centre for Rheumatology, Royal Free Hospital, London, UNITED KINGDOM
| | - Xu Shiwen
- Centre for Rheumatology, Royal Free Hospital, London, UNITED KINGDOM
| | | | | | - Jess Fraser
- Centre for Rheumatology, Royal Free Hospital, London, UNITED KINGDOM
| | | | - Richard Stratton
- Centre for Rheumatology, Royal Free Hospital, London, UNITED KINGDOM
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Campochiaro C, Clark K, Host L, Sari A, Nihtyanova S, Harvey J, Fonseca C, Ong V, Denton C. 199 Frequency and clinical association of rare antibodies in a large connective tissue disease cohort. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Corrado Campochiaro
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Kristina Clark
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Lauren Host
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Alper Sari
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Svetlana Nihtyanova
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Jenny Harvey
- Immunology Department, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Carmen Fonseca
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Voon Ong
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Christopher Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
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46
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Denton C. i067 Evaluation and management of skin fibrosis in systemic sclerosis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher Denton
- Centre for Rheumatology, University College London, London, UNITED KINGDOM
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47
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Sari A, Campochiaro C, Nihtyanova S, Harvey J, Fonseca C, Ong V, Denton C. 197 Clinical features and prevalence of double antibody positivity in a large cohort of systemic sclerosis patients. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alper Sari
- Rheumatology, Royal Free Hospital Centre for Rheumatology and Connective Tissue Diseases - UCL, London, UNITED KINGDOM
| | - Corrado Campochiaro
- Rheumatology, Royal Free Hospital Centre for Rheumatology and Connective Tissue Diseases - UCL, London, UNITED KINGDOM
| | - Svetlana Nihtyanova
- Rheumatology, Royal Free Hospital Centre for Rheumatology and Connective Tissue Diseases - UCL, London, UNITED KINGDOM
| | - Jenny Harvey
- Clinical Immunology, Royal Free Hospital Centre for Immunology- UCL, London, UNITED KINGDOM
| | - Carmen Fonseca
- Rheumatology, Royal Free Hospital Centre for Rheumatology and Connective Tissue Diseases - UCL, London, UNITED KINGDOM
| | - Voon Ong
- Rheumatology, Royal Free Hospital Centre for Rheumatology and Connective Tissue Diseases - UCL, London, UNITED KINGDOM
| | - Christopher Denton
- Rheumatology, Royal Free Hospital Centre for Rheumatology and Connective Tissue Diseases - UCL, London, UNITED KINGDOM
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48
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Campochiaro C, Lytton S, Nihtyanova S, Fuchs D, Ong V, Denton C. 205 Serum tryptophan and kynurenine levels are altered in systemic sclerosis patients and show distinct clinical and autoantibody associations suggesting potential role in pathogenesis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Corrado Campochiaro
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Simon Lytton
- SeraDiaLogistics, Benediktenwandstr, Munchen, GERMANY
| | - Svetlana Nihtyanova
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Dietmar Fuchs
- Center for Chemistry and Biomedicine, Innsbruck Medical University, Innsbruck, AUSTRIA
| | - Voon Ong
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
| | - Christopher Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital - UCL, London, UNITED KINGDOM
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Ho CH, Nihtyanova S, Abdi BA, Coghlan G, Denton C, Schreiber B, Ong VH. 193 Correlating plasma cytokine levels with right heart catheterisation parameters in systemic sclerosis-related pulmonary arterial hypertension. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chup Hei Ho
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, HONG KONG
| | - Svetlana Nihtyanova
- Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, University College London, London, UNITED KINGDOM
| | - Bahja Ahmed Abdi
- Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, University College London, London, UNITED KINGDOM
| | - Gerry Coghlan
- Department of Cardiology, Royal Free Hospital, London, UNITED KINGDOM
| | - Christopher Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, University College London, London, UNITED KINGDOM
| | | | - Voon Hong Ong
- Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, University College London, London, UNITED KINGDOM
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Cade JS, Papaioannou I, Denton C, Abraham D, Ponticos M. 191 NKX2-5 is associated to endothelial-to-mesenchymal transition in scleroderma-PAH. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - David Abraham
- Inflammation, University College London, London, UNITED KINGDOM
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