IL1R1+ cancer-associated fibroblasts drive tumor development and immunosuppression in colorectal cancer

Fibroblasts have a considerable functional and molecular heterogeneity and can play various roles in the tumor microenvironment. Here we identify a pro-tumorigenic IL1R1⁺, IL-1-high-signaling subtype of fibroblasts, using multiple colorectal cancer (CRC) patient single cell sequencing datasets. This subtype of fibroblasts is linked to T cell and macrophage suppression and leads to increased cancer cell growth in 3D co-culture assays. Furthermore, both a fibroblast-specific IL1R1 knockout and IL-1 receptor antagonist Anakinra administration reduce tumor growth in vivo. This is accompanied by reduced intratumoral Th17 cell infiltration. Accordingly, CRC patients who present with IL1R1-expressing cancer-associated-fibroblasts (CAFs), also display elevated levels of immune exhaustion markers, as well as an increased Th17 score and an overall worse survival. Altogether, this study underlines the therapeutic value of targeting IL1R1-expressing CAFs in the context of CRC.

POS1199 IS PSORIATIC ARTHRITIS A RISK FACTOR FOR SEVERE COVID -19 INFECTION? DATA FROM THE ARGENTINIAN REGISTRY SAR-COVID

Background

Comorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained.

Objectives

To describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confirmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA).

Methods

Cross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR / EULAR 2010 criteria), who had confirmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID)1 was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher’s test, Student’s test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed.

Results

A total of 129 PsA patients and 808 with RA were included. Clinical characteristics are shown in Table 1. Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. The frequency of NIAID≥5 was comparable between groups (PsA 19.5% vs RA 20.1%; p=0.976). (Figure 1).

Table 1.

Characteristics of patients with PsA and RA who presented COVID-19 in the SAR-COVID registry.

Psoriatic arthritis (n=129)Rheumatoid arthritis (n=808)P valueTotal (n=937)Age (years), mean (SD)51.7 (12.7)53.1 (12.9)0.23952.9 (12.9)Female72 (55.8)684 (84.7)<0.001756 (80.7)Comorbidities65 (50.4)355 (43.9)0.203420 (44.8) Obesity (BMI ≥30)19 (15.2)102 (13.4)0.692121 (13.7) Morbid obesity (BMI ≥40)1 (0.8)10 (1.3)111 (1.25) Hypertension35 (28.5)205 (26.8)0.783240 (27.0) Diabetes16 (13.0)67 (8.8)0.18883 (9.39) Dyslipidemia24 (19.5)102 (13.5)0.106126 (14.4) Cardiovascular or cerebrovascular disease5 (11.4)32 (3.9)0.03337 (4.2)Two or more comorbidities55 (42.6)219 (27.1)<0.001274 (29.2)Current smoking4 (3.6)60 (8.4)0.7964 (7.7)High disease activity0 (0)29 (3.8)0.02729 (3.23)Glucocorticoids treatment5 (20.0)95 (60.1)<0.001100 (54.6)Conventional DMARDs47 (36.4)443 (54.8)<0.001490 (52.3)Biologic DMARDs60 (46.5)193 (23.9)<0.001253 (27.0)JAK inhibitors4 (3.10)72 (8.9)0.03876 (8.1)Full recovery of COVID-19105 (84.0)644 (81.7)0.127749 (82.0)COVID-19 complications16 (12.5)68 (8.7)0.22784 (9.2)Death due to COVID-191 (0.8)34 (4.3)0.07435 (3.8)

Notes=values n (%) unless otherwise indicated; BMI: Body Mass Index; DMARDs: disease-modifying antirheumatic drugs; JAK inhibitors: Janus kinase inhibitors.

PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5; p=0.002), had more frequently hypertension (52.2% vs 23%; p=0.011) and dyslipidemia (39.1% vs 15%; p=0.017). In the multivariate analysis, age (OR 1.06; 95% CI 1.02–1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34; 95% CI 0.11–0.92) and biological DMARDs (OR 0.28; 95% CI 0.09–0.78) had a better outcome.

Conclusion

Although PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar. Most of the patients had mild SARS-CoV-2 infection and a low death rate.

References

[1]Beigel JH, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826.

Disclosure of Interests

None declared

POS1489-HPR ASSESSMENT OF TREATMENT ADHERENCE IN A COHORT OF RHEUMATOID ARTHRITIS PATIENTS TREATED WITH SUBCUTANEOUS ANTI-TNF WHO WERE EXPOSED TO A COMPREHENSIVE CARE MODEL

Background

Rheumatoid arthritis (RA) is an autoimmune, chronic, and inflammatory disease, which can be treated with effective medications, but requires a high level of adherence to treatment. Offering a comprehensive care model by a multidisciplinary team could increase the adherence levels of these patients and improves disease outcomes.

Objectives

Compare the level of adherence to treatment before and after the implementation of a comprehensive care model in a cohort of patients with RA, treated with subcutaneous anti-TNF, in a reference center in Bogotá-Colombia.

Methods

An analytical study was conducted before and after the implementation of a comprehensive care model on a cohort of patients over 18 years of age, diagnosed with RA, who have been prescribed management with a subcutaneous anti-TNF by their doctor during the last 12 months. Convenience sequential sampling was performed to reach a defined sample size of 130 patients to estimate a baseline versus final adherence difference of 20%, at an alpha value of 5% and a beta value of 20%. The comprehensive care model (CCM) consisted of the approach by a multidisciplinary team, offering a comprehensive care not fragmented, based on evidence (guidelines and protocols) and proposing a treatment by objectives (T2T). Adherence was measured using the CQR-19 scale, with a cut-off point ≥80.7 to consider an adherent patient.

Results

The cohort consisted of 131 patients who were followed semiannually for 24 months, and who were incorporated into the CCM. 83.9% were women (n=110), in an age range between 30 and 84 years (Average: 62; DS: 9.9 years). 37.4% of patients were treated with etanercept (n=49), 29% with golimumab (n=38) and 33.6% with adalimumab (n=44). The median baseline of CQR-19 was 87.7 points (RIQ:84.2-91.2); while at month 24 it reached 91.2 points (RIQ: 87.7-94.7). The difference between the distributions was statistically significant (p<0.00). According to the cut-off point for CQR-19, the baseline percentage of adherent patients was 87.8% (n=115) and increased to a percentage of 96.2% at 24 months of follow-up (n=126). The difference between these two percentages of adherence was 8.39% (95% CI: 1.9-14.9%) (p: 0.012). The results of a generalized linear model binomial family, for the outcome of difference in proportions (PD) of basal and final adherence, are presented in Table 1. The estimator is adjusted for activity level (DAS28), disability level (HAQ) and anti-TNF. Golimumab appears to have an effect that increases adherence by 4.5% compared to adalimumab and etanercept, adjusting for the other predictors.

Table 1.

Model of the effect of MAI on adherence to treatment.

Dependent variable: Adhesion according to cut-off point CQR-19(≥80.7). Proportion Difference (DP) EstimatorVariableDPCI 95%P-valueIntervention: MAI9,4%3,2-15,5%0,003Golimumab vs. Etanercept-Adalimumab4,5%0,5-8,5%0,024DAS28(-)0,85%(-)3.2% to 14.9%0,47HAQ0,00(-)0.03% to 0.045%0,85

MLG-Binomial family. Identity function.

Conclusion

The CCM, after a follow-up of 24 months in patients with RA in treatment with subcutaneous anti-TNF increases the percentage of adherence by 9.4%, adjusting for treatment, activity level and degree of disability. Golimumab appears to have an effect that increases adherence by 4.5% compared to adalimumab and etanercept, adjusting for the other predictors.

Disclosure of Interests

Wilberto Rivero: None declared, GUILLERMO SÁNCHEZ: None declared, Fernando Rodriguez: None declared, Laura Villarreal: None declared, Diana Buitrago-Garcia: None declared, CARLOS CASTRO: None declared, Pedro Santos-Moreno Speakers bureau: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Consultant of: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Grant/research support from: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly

AB1101 PREVALENCE OF LONG COVID IN RHEUMATIC DISEASE PATIENTS: ANALYSIS OF SAR COVID REGISTRY

Background

Persistent symptoms after acute COVID have been described previously. Main symptoms reported are fatigue, arthralgias, myalgias and mental sickness. Definition and methods vary widely.1

Objectives

To asses prevalence and related factors to long COVID in a retrospective cohort of patients with rheumatic diseases from Argentina.

Methods

A total of 1915 patients were registered from August 18th, 2020 to July 29th, 2021. Patients > 18 years old, with rheumatic disease and confirmed infection by SARS-CoV-2 (antigen or RT-PCR) were included. Those dead, with unknown outcome, wrong date or missing data were excluded. Demographic data, comorbidities, rheumatic disease, and characteristics of SARS-CoV-2 infection were recorded.

Long COVID was defined according to NICE guidelines (persistent symptoms for more than 4 weeks, without alternative diagnosis). Long COVID symptoms were defined by rheumatologist. Severity of infection was classified according to WHO ordinal scale.

We used descriptive statistics, univariate model (Student’s test, chi square test, ANOVA) and multivariate logistic regression analysis.

Results

230 (12%) had long COVID. Median age was 51 (IQR 40-61]) years, 82% were females, 51% were not caucasian. Median of education was 13.3 years (IQR 12 – 16), 79 % had private health insurance and 55 % were employed. Nearly half (n=762, 46%) had comorbidities, the most prevalent was hypertension (n=396, 24%).

The most frequent rheumatic diseases were rheumatoid arthritis (n=719, 42%) and systemic lupus erythematosus (n=280, 16 %). Most were in low activity/remission (79%), used Conventional DMARD (n=773 patients, 45%) and steroids (n=588, 34%) at low dose (n=415, 71%).

Main laboratory findings were abnormal D-dimer (n=94, 28%) and leukopenia (n=93, 26%). Most patients had a WHO ordinal scale < 5 (n=1472, 86%). Median of hospitalization at intensive care unit (ICU) was 8 days [IQR 5, 13]. Treatment for SARS-CoV-2 infection (steroids, anticoagulation, azithromycin, convalescent plasma) was used in 461 (27%) patients.

Most of long COVID (n= 152, 69%) reported 1 symptom, the most frequent was fatigue (n= 55, 22%). Figure 1.

Univariate analysis is presented in Table 1. In multivariate logistic regression analysis non-caucasian ethnicity OR 1.44 (1.07-1.95), years of education OR 1.05 (1-1.09), treatment with cyclophosphamide OR 11.35 (1.56-112.97), symptoms of COVID – 19 OR 13.26 (2.75-242.08), severity scale WHO ≥ 5 OR 2.46 (1.68-3.57), and ICU hospitalization days OR 1.09 (1.05-1.14) were factors associated to long COVID.

Table 1.

Univariate analysis of long COVID syndrome in SAR – COVID registry

VariableAcute COVID n=1486Long COVID n=221P valueAge, years, median [IQR]51 [40, 60]54 [42, 62]0.032Caucasian, n (%)744 (48)132 (53)0.227Female sex, n (%)1242 (80)215 (86)0.066Education, years, median [IQR]12 [10, 17]13 [12, 16]-Private health insurance, n (%)1161 (79)181 (82)0.325Smoking, n (%)381 (25)71 (29)0.224Comorbidities, n (%)650 (45)108 (52)0.066Dyslipidemia, n (%)173 (12)39 (19)0.008Hypertension, n (%)332 (23)60 (29)0.053Low activity/remission disease, n (%)1140 (80)179 (77)1Rheumatoid arthritis, n (%)623 (42)96 (42)1Systemic lupus erythematosus, n (%)243 (16)37 (16)0.996DMARD, n (%)664 (45)109 (47)0.486Cyclophosphamide, n (%)3 (0.2)3 (1)0.035Rituximab, n (%)19 (1)9 (34)0.008Lymphocyte66 (23)19 (30)0.011<1.500 / mm3, n (%)Ferritin > 2000 ng/ml, n (%)32 (11)16 (25)0.011ICU hospitalization, days,7 [4, 10]10 [8, 24]<0.001median [IQR]Treatment for COVID-19, n (%)394 (27)91 (41)<0.001

Conclusion

Prevalence of long COVID was 12%. Non-caucasian ethnicity, higher education, treatment with cyclophosphamide, symptoms of COVID – 19, severe disease and ICU hospitalization days were related to long COVID.

References

[1]Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, Riera R. Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review. Int J Clin Pract.

Disclosure of Interests

None declared

POS1491-HPR THE USEFULNESS OF THE PATIENT ACTIVITY SCORE-PASS-II TO ASSESS DISEASE ACTIVITY DURING THE COVID-19 LOCKDOWN IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Many measurement tools are designed to assess disease activity for Rheumatoid Arthritis (RA) patients. One of the most used tools is the Disease Activity Score- DAS28 which assesses the number of painful joints, erythrocyte sedimentation, and a patient’s global assessment. The assessment is performed by a clinician and requires laboratory exams. Unfortunately, from March to August 2019, Colombia had one of the strictest responses to the COVID-19 pandemic according to the COVID-19 stringency Index(1). One of the main restrictions was the preventive isolation of older populations, especially those with comorbidities. These restrictions challenged the rheumatology practice because face-to-face consultations were not possible. Due to the above, measurements like the PAS-II score should be used to assess disease activity during the pandemic.

Objectives

To describe disease activity according to the Patient Activity Score- PAS-II score patients with RA and compare its results to the most recent DAS28 assessment before the COVID-19 pandemic.

Methods

We conducted a descriptive study; patients were followed during the COVID-19- lockdown in a video consultation. The PAS-II score was applied to assess disease activity as an alternative to the DAS28 assessment. The patients were part of an educational program, clinical charts were reviewed to collect the study variables. We collected demographic data and DAS28 before the pandemic started. We present a descriptive analysis of DAS28 severity and the results obtained by the PASS-II score.

Results

The educational program enrolled 250 participants; 196 patients had complete data. 93% of participants were women, mean age was 64 years IQR (54-67). 43% of participants were married or had a civil union, 26% were single, 20% divorced, and 11% were widowed. Regarding educational level, 25% had finished elementary school and 39% high school; the remaining 36% had higher education. When we compared the last DAS28 assessed by a rheumatologist between January, and March 2019, 67% of patients were in remission, while in July 2019, the PASS-II score reported that 7% of patients were in remission and 75% had low or minimal activity. Figure 1- Table 1.

Figure 1.

Table 1.DISEASE ACTIVITIYDAS28PASS-IIRemission67%6%Low (Minimal)14%75%Moderate15%18.5%High/Severe4%0.5%

Conclusion

The PASS score is a helpful tool to assess disease activity in patients with RA, especially in situations where the patient cannot see a rheumatologist in a face-to-face consultation; however, patients in severe disease activity should not delay the consultation with a clinician. As other studies have demonstrated, patient-reported outcome measures should be adopted in clinical practice as an alternative for treat- to- targe strategies(2). Further studies should be conducted to assess the impact of the pandemic in countries with high levels of restrictions in the course of RA.

References

[1]Hale T, Angrist N, Goldszmidt R, Kira B, Petherick A, Phillips T, et al. A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker). Nature Human Behaviour. 2021;5(4):529-38.

[2]Salaffi F, Di Carlo M, Farah S, Marotto D, Atzeni F, Sarzi-Puttini P. Rheumatoid Arthritis disease activity assessment in routine care: performance of the most widely used composite disease activity indices and patient-reported outcome measures: Comparison of disease activity indices in RA. Acta Biomedica Atenei Parmensis. 2021;92(4):e2021238.

Acknowledgements

This project was funded by the Ministry of Science, Technology and Innovation MINCIENCIAS. Grant number: 695180763684

Disclosure of Interests

Fernando Rodriguez: None declared, Diana Buitrago-Garcia: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Speakers bureau: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Consultant of: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Grant/research support from: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly

POS1459 THE IMPLEMENTATION OF AN EDUCATIONAL PROGRAM TO IMPROVE PHARMACOLOGICAL ADHERENCE IN PATIENTS WITH RHEUMATOID ARTHRITIS. RESULTS FROM A QUASI-EXPERIMENTAL STUDY

Background

Pharmacological therapy is the principal intervention in rheumatoid arthritis (RA) patients. Currently, adherence to DMARDs therapy is a challenge that needs to be addressed[1]. On the other hand, educational programs have shown an improvement in the health status of RA patients[2].

Objectives

This study aimed to determine if a 12-month educational program developed for patients with RA can improve medication adherence.

Methods

A quasi-experimental design was conducted. Patients who attend a specialized center in RA were invited to participate in an educational program. The program was called UNIVERSITAR: PATIENT UNIVERSITY. An interdisciplinary team provided educational workshops for the patients; we included coaching sessions and leisure activities such as yoga and art lessons to avoid a conventional classroom program and provide a dynamic program. A rheumatologist with experience in centers of excellence for RA led the team. Patients attended during a year. Follow-up was planned at 6 and 12 months after enrollment. Medication adherence was assessed using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8). Patients were considered adherent when they scored 8 points, moderately adherent with a score of 6 or 7, and non-adherent with less than 6 points. The Wilcoxon signed-rank test was used to evaluate differences in MMAS-8 scores between baseline and 16 and 12-months. We also assessed if there were changes in DAS 28 in the participants who improved the level of adherence.

Results

In total, 252 patients were enrolled in the study, and 206 completed the follow-up at 6 and 12 months (82%). The median age was 60 years IQR (54-67), 94% were female. In our study, 54% of patients received conventional and 46% Biological therapy. The proportion of patients with high adherence at baseline was 11%, at 6-months was 17% and at 12-month was 19%. At the end of the follow-up, 49% of the participants moved from being non-adherent to a moderate or high adherence level. When we compared the MMAS scores at baseline and follow-up, they showed a significant improvement (P<0.05) Figures 1-2. The majority of participants (65%) were in remission at baseline, according to DAS28. Therefore, we found no differences between the level of adherence and DAS28.

Conclusion

Our educational program improved medication adherence among patients with RA. Educational interventions are helpful to sustain remission in patients with RA. Further studies focused only on patients with moderate and high disease activity are necessary to assess the impact on clinical outcomes.

References

[1]Monchablon C, Gondé H, Pouplin S, Varin R, Vittecoq O, Lequerré T. Assessment of adherence to disease-modifying anti-rheumatic drugs in rheumatoid arthritis. Clin Rheumatol. 2020;39(1):207-16.

[2]Tan YK, Teo P, Saffari SE, Xin X, Chakraborty B, Ng CT, et al. A musculoskeletal ultrasound program as an intervention to improve disease modifying anti-rheumatic drugs adherence in rheumatoid arthritis: a randomized controlled trial. Scand J Rheumatol. 2022;51(1):1-9.

Acknowledgements

This project was funded by the Ministry of Science, Technology and Innovation MINCIENCIAS. Grant number: 695180763684

Disclosure of Interests

Pedro Santos-Moreno Speakers bureau: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Consultant of: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Grant/research support from: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Diana Buitrago-Garcia: None declared, Fernando Rodriguez: None declared, GUILLERMO SÁNCHEZ: None declared

Learning to implement Smart Healthy Age-Friendly Environments

To develop trainings on the implementation of smart healthy age-friendly environments for people who aim to support, for example, their parents, their neighbours or local community, there are precautionary measures that have to be taken into account: the role of the facilitator (volunteer or self-employed), the level of skills, the needs of the end-users, training content and methodologies together with the sustainability of the learning. This article examines these aspects, based on desk research and expert interviews in the Smart Healthy Age-Friendly Environments (SHAFE) fields.

AB1305-HPR IS BETTER AND SAFER TOFACITINIB AS A FIRST LINE OF TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS? – A COHORT STUDY

Background:

Tofacitinib is the first oral Janus Kinasa inhibitor approved for the treatment of rheumatoid arthritis (RA); and although it is approved both after conventional treatment and after biological therapy, it is not well known its real-life effectiveness in both cases and if it is preferable to use it after cDMARDs or biologics.

Objectives:

We compare the effectiveness and safety of Tofacitinib in patients with RA analyzing if better and safer Tofacitinib after cDMARDs or biologics.

Methods:

A retrospective analysis of a real-world cohort of patients with RA, who were treated with Tofacitinib in last 3 years, as first line of treatment (T1) after failure with cDMARDS and second line of treatment after biologic drug failure (T2). The therapy was considered effective with the change from moderate-high disease activity to low disease activity or remission measured by DAS28, in those who met criteria of high adherence, without change or addition of other conventional DMARDs, without new dose or increase of dose of oral glucocorticoids. A logistic model of regression was performed to evaluate de differences between T1 and T2, using as covariates sex, age, comorbidities, time of disease evolution, adverse events and other causes of discontinuation. Medication survival time and the main causes of suspension were measured. Mixed model regression and least-squared means were used to estimate the baseline changes and a Kaplan-Meyer survival analysis to estimate time to remission and drug survival.

Results:

105 patients with RA were included (median age: 56.1 ± 11.7 years; 80.9% female, median disease duration 11.48 ± 10.1 years); 43% (45/105) of patients with positive rheumatoid factor and 73% (77/105) positive anti-citrulline antibodies. Regarding treatment 51% (54/105) used Tofacitinib as 1T, after failure to cDMARDs; on the other hand, Tofacitinib was used as 2T, after failure to biologics in 49% (51/105) of patients. DAS28 levels were reduced at 8, 16 and 24 weeks with statistical difference (p value 0.004, <0.0001, and <0.001, respectively). HAQ-DI also reported reduction but without statistical difference. The use of Tofacitinib was more effective after failure to cDMARDs (p value 0.014) and patients with more than 3 years of disease (p value 0.04), a statistically better response. Also, corticoids use, positive RF, extended release tablet of tofacitinib reported better changes of DAS28 but without statistical significance. Patients with high disease activity treated with Tofacitinib 1T decreased from 30% at baseline to 19% at the last follow-up; patients in 2T way were in moderate activity of the disease in 57% at baseline and went to 37% in the last follow-up. There was an increase in patients who achieved remission in both groups, but higher in 1T where they went from 9% to 41%, while in 2T they went from 22% to 33% (p < 0.05). The survival rate of the medication was 1.7 years in 1T and 2.1 in 2T; in terms of time to remission, the use of Tofacitinib monotherapy presented statistical difference (p value <0.001). The main cause of suspension of treatment was therapeutic failure 12% (13/105), 9% in 1T (5/54) and 16% (8/51) in 2T (p <0.005). 6% of patients (6/105) presented suspension due to the occurrence of adverse events, 4% (2/54) in 1T and 8% (4/51) in 2T (p <0.005).

Conclusion:

In patients with RA, the use of Tofacitinib as the first line of treatment (after failure to cDMARDs) is better in effectiveness and safer in comparison with its use as a second line of treatment (after biologics), with significant differences in the rates of therapeutic failure and occurrence of adverse events/reactions. On the other hand, concomitant corticoids use, positive RF, extended release tablet of Tofacitinib seem to increase the effectiveness of Tofacitinib in terms of DAS28 and HAQ-DI.

Disclosure of Interests:

Omaira Valencia: None declared, Michael Cabrera: None declared, Fernando Rodriguez: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

AB1296-HPR PREVALENCE OF COMORBIDITIES IN A COHORT OF PATIENTS IN AN EDUCATIONAL MULTIDISCIPLINARY PROGRAM

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory and complex disease. Patients with RA face other diseases that might lead to increase morbidity. In patients with RA it has been stablished a high prevalence of comorbidities and their risk factors (1).

Objectives:

The aim of this study was to evaluate the prevalence of comorbidities in Colombian patients with RA enrolled in an educational multidisciplinary program and possible correlation with disease activity

Methods:

We performed a cross-sectional study; we included patients with confirmed diagnosis of rheumatoid arthritis in a specialized RA center. We collected sociodemographic data, and markers of disease activity DAS28. We collected data regarding the history of comorbidities such as hypertension, dyslipidemia, osteoporosis, type 2 diabetes mellitus, hypothyroidism, malignancies, among others. We performed a descriptive analysis, variables with a normal distribution were described using mean and standard deviation (SD), and non- normal distributed variables were described using median and interquartile range. Categorical variables were presented as rates. We evaluated the relationship between disease activity and comorbidities.

Results:

We included 251 patients; mean age was 59 ± 9.8 years old, with a high proportion of women 93%; median disease duration was 15 years RIQ (8-20); in this study, 145 (65%) of patients were in remission; 35 (11%) had low, 44 (20%) moderate and 10 (4%) high disease activity. Regarding pharmacological therapy, 55% were receiving conventional DMARDs. The prevalence of comorbidities was 85%, the most common were high blood pressure 25% followed by hypothyroidism 12% and diabetes 10%, 0.7% of patients had malignancies such as thyroid cancer or breast cancer, 1.29% of patients had renal comorbidities. Among comorbidities related to RA 30% had osteoporosis and 20% arthrosis. We did not find a statistical association between DAS28 and comorbidities.

Conclusion:

As other studies have shown, there is a high prevalence of comorbidities among RA patients, mainly high blood pressure. Due to the above, it is relevant to evaluate the risks factors of patients with RA, especially cardiovascular risks. We consider that a multidisciplinary program represents an opportunity not only to educate patients about healthy life styles and the management of RA, but also other diseases in order to increase the empowering of the health status in these poly pathological patients(2).

References:

[1]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best practice & research Clinical rheumatology. 2011;25(4):469-83.

[2]Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Wah-Suarez M, et al. Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis. Rheumatology international. 2017;37(9):1507-11.

Acknowledgments:

This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid Arthrtitis

Disclosure of Interests:

Michael Cabrera: None declared, Fernando Rodriguez: None declared, Diana Buitrago-Garcia: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

AB1279-HPR A DESCRIPTIVE STUDY RELATED TO THE ADHERENCE BEFORE AND AFTER ENROLLING IN A MULTIDISCIPLINARY EDUCATIONAL PROGRAM

Background:

Rheumatoid arthritis (RA) is an inflammatory, chronic disease. It leads to deformity and destruction of joints through the erosion of cartilage and bone. Patients with RA report to suffer symptoms in hands, joints, swelling, loss of motion, muscle weakness among others.(1).Centers of excellence in RA have proposed a multidisciplinary model of care with an initial diagnosis, treatment prescription and follow-up with a rheumatologist, periodic consultations with a physiatrist, psychologist, physiotherapist, occupational therapy, nutrition and a patient focused program(2). With this model of care, the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. However, if the patient does adhere the model becomes ineffective.

Objectives:

The aim of this to report the attendance to a multidisciplinary model of care for patients with RA that attend to a specialized center in Colombia, before and after enrolling in a educational program.

Methods:

We performed a descriptive study. Patients enrolled our educational program in July 2019. In our institution patients are followed-up under T2T standards and a multidisciplinary approach, as part of our model of care they have periodic consultations with a rheumatology, physiatrist, psychologist, physiotherapist, occupational therapy and nutrition. We collected sociodemographic data, DAS28, and compare the attendance to each specialty at the beginning and at 6-month follow-up. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We compared disease activity and adherence at the beginning of the program and after six months of attendance.

Results:

We included 229 patients; mean age was 59 years ±10; 93% were female. At the beginning of our program, mean DAS28 was 2.57 ± 1.19, from all patients 65% were at remission, 11% at low disease activity 19% at moderate disease activity and, 5% at severe disease activity. Regarding adherence to our model, the medical specialty with the highest attendance was rheumatology (30%) followed by, physical therapy (16%) physiatrist consultation (15%) psychology (13%) and, occupational therapy (11%); the specialty with the lowest attendance was nutrition (8%). After six months of attendance to the educational program, we found an increasing number of patients in remission 67%, low disease activity 15%, moderate disease activity 18%, we did not have patients with severe DA28. Regarding the medical specialties, we found a 3% rise in the attendance to the nutrition consultation and psychology consultation. We did not find statistical association between disease activity and adherence to the model.

Conclusion:

These results are a clear example of how an educational program is capable of increasing awareness and improving the clinical outcomes and adherence to a multidisciplinary model for approaching RA. As other studies have shown(3), patient education interventions improve adherence to medication and to attendance to health care specialists.

References:

[1]Santos-Moreno P, Castaneda O, Garro B, Flores D, Sanchez G, Castro C. From the model of integral attention to the creation of centers of excellence in rheumatoid arthritis. Clinical rheumatology. 2015;34 Suppl 1:S71-7.

[2]Taibanguay N, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient preference and adherence. 2019;13:119-29.

Acknowledgments:

This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid Arthritis

Disclosure of Interests:

Diana Buitrago-Garcia: None declared, Fernando Rodriguez: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

AB1340-HPR PATIENTS’ OUT-OF-POCKET EXPENSES ANALYSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS ENROLLED IN A EDUCATIONAL PROGRAM

Background:

The increasing health and economic burdens of deaths and disabilities from non-communicable diseases (NCDs) are emerging as major concerns worldwide, particularly for low- and middle-income countries (LMICs)(1). Rheumatoid arthritis (RA) NCD is considered as one of the most common causes of disability. RA affects from 0.5% to 1% of the worldwide population. Little is known about the out-of-pocket (OOP) expenditures for prescription of pharmacological treatment for patients with RA, including drugs, diagnostic tests, mobility aids among others.

Objectives:

To describe the out of pocket costs in patients with rheumatoid arthritis

Methods:

We performed a cross-sectional study among patients who are participating in an educational program in a specialized center for RA. We collected sociodemographic variables; in addition, we collected data related to the expenditures in drugs, diagnostic tests and mobility aids that were not covered by the health system. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. The costs are presented in the US dollars with the average exchange rate for 2019

Results:

We included 181 patients, 92% were female. Mean age was 59 years ±9.5. Regarding occupation, 24% were employees, 40% were economically inactive, and 36% were pensioners. Most of patients 45% had a low income, 43 % middle income and only 12% high income according to the Colombian socioeconomic classification. Most of out of pocket expenses (47%) were associated to the acquisition of medical devices such as reading glasses or orthopedic braces. Secondly, the OOP expenses were related to medications (38%) such as antibiotics prednisone or pain control medications. Finally, 25% of patients reported that they had pay for their diagnostic tests such as x rays or laboratory tests. When assessed the costs patients expended between 30-100 USD purchasing aid devices, medications or laboratory tests.

Conclusion:

In the Colombian context OPP are relevant and represent an important expenditure for patients with RA especially for those who have low or middle income. Due to the above, it is important to find alternatives in order to help vulnerable segments of the population. Additionally, OPP needed to be taken into account due to its association with treatment adherence(2).

References:

Datta BK, Husain MJ, Fatehin S. The crowding out effect of out-of-pocket medication expenses of two major non-communicable diseases in Pakistan. International health. 2020;12(1):50-9.

Acknowledgments:

This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid Arthritis

Disclosure of Interests:

Diana Buitrago-Garcia: None declared, Fernando Rodriguez: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

Oviductal Proteins Effect in Rooster Spermatic Cryopreservation

BACKGROUND

Cryopreservation induces spermatic cryo capacitation, which can decrease thawed sperm fertilizing capability.

OBJECTIVE

To evaluate the effect of uterus-vaginal union protein factors to inhibit sperm cryo capacitation and maintain viability and fertilizing capability of rooster spermatozoa.

MATERIALS AND METHODS

Rooster spermatozoa was cryopreserved using Lake extender supplemented with different hen's uterus-vaginal junction protein concentrations, to determine spermatic viability, sperm physiological condition and fertilizing capability in vivo.

RESULTS

It was possible to induce spermatic decapacitation in vitro, inhibiting cryo capacitation and allowing fertility results comparable to those obtained with fresh semen.

CONCLUSION

Uterus-vaginal protein extracts induce spermatic decapacitation in vitro.

3D Strain in 2D Materials: To What Extent is Monolayer Graphene Graphite?

This work addresses a fundamental question: To what extent is graphene graphite? In particular does 2D graphene have many of the same 3D mechanical properties as graphite, such as the bulk modulus and elastic constant c_{33}? We have obtained, for the first time, unambiguous Raman spectra from unsupported monolayer graphene under pressure. We have used these data to quantify the out-of-plane stiffness of monolayer graphene, which is hard to define due to its 2D nature. Our data indicate a first physically meaningful out-of-plane stiffness of monolayer graphene, and find it to be consistent with that of graphite. We also report a shift rate of the in-plane phonon frequency of unsupported monolayer graphene to be 5.4  cm^{-1} GPa^{-1}, very close to that of graphite (4.7  cm^{-1} GPa^{-1}), contrary to the previous value for supported graphene. Our results imply that monolayer graphene has similar in-plane and out-of-plane stiffnesses, and anharmonicities to graphite.

A Raman study of the pressure-induced densification of SiO2-based glass-ceramics

Here we report a structural characterization study of glass-ceramics as a function of pressure by Raman spectroscopy. We selected a glass-ceramics of Li₂O-Al₂O₃-nSiO₂ (n  ≈  8) doped with ZrO₂ and TiO₂. This composition induces slight structural modification in Si-O and Si-O-Si bonds in the glass matrix that are crucial to stabilize metastable hexagonal SiO₂ (β-quartz) solid-solution nano crystals corresponding to γ-LiAlSi₂O₆. This structure yields a more compact β-quartz-type phase that eventually stabilizes it in wider pressure range than pure SiO₂. Raman spectroscopy allows to unravel at least two pressure-induced structural phase transitions at about 6 and 15 GPa that could not be previously revealed by x-ray diffraction. We show that the phase-transition sequence can tentatively be described in terms of SiO₂-type structure as: β-quartz  →  Coesite I  →  Coesite II. The measured transition pressures are consistent with the larger cell volume attained in the γ-LiAlSi₂O₆ yielding a wider metastability pressure range of the β-quartz-type phase.

Omega-3 fatty acids increase the unfolded protein response and improve amyloid-β phagocytosis by macrophages of patients with mild cognitive impairment

Macrophages (Mϕs) of patients with Alzheimer's disease and mild cognitive impairment (MCI) are defective in amyloid-β1-42 (Aβ) phagocytosis and have low resistance to apoptosis by Aβ. Omega-3 fatty acids (ω-3s) in vitro and in vivo and the ω-3 mediator, resolvin D1, in vitro increase Aβ phagocytosis by Mϕs of patients with MCI. We have investigated the unfolded protein response (UPR) to endoplasmic reticulum (ER) stress by Mϕs in a longitudinal study of fish-derived, ω-3-supplemented patients with MCI. Patients in the apolipoprotein E (ApoE)e3/e3 subgroup over time exhibited an increase of protein kinase RNA-like ER kinase (PERK) expression, Aβ phagocytosis, intermediate M1-M2 Mϕ type, and a Mini-Mental State Examination (MMSE) rate of change of +1.8 points per year, whereas patients in the ApoEe3/e4 subgroup showed individually divergent results with an MMSE rate of change of -3.2 points per year. In vitro treatment of Mϕs by fish-derived ω-3 emulsion increased Aβ phagocytosis, PERK expression, and UPR RNA signature, and decreased ER stress signature. Augmented genes in the UPR signature included chaperones, lectins, foldases, and N-linked glycosylation enzymes. In summary, fish-derived ω-3s increase cytoprotective genes and decrease proapoptotic genes, improve immune clearance of Aβ, and are associated with an improved MMSE rate of change in ApoEe3/e3 vs. ApoEe3/e4 patients.-Olivera-Perez, H. M., Lam, L., Dang, J., Jiang, W., Rodriguez, F., Rigali, E., Weitzman, S., Porter, V., Rubbi, L., Morselli, M., Pellegrini, M., Fiala, M. Omega-3 fatty acids increase the unfolded protein response and improve amyloid-β phagocytosis by macrophages of patients with mild cognitive impairment.

Viability and Functionality of Bovine Chromaffin Cells Encapsulated into Alginate-PLL Microcapsules with a Liquefied Inner Core

Implantation of adrenal medullary bovine chromaffin cells (BCC), which synthesize and secrete a combination of pain-reducing neuroactive compounds including catecholamines and opioid peptides, has been proposed for the treatment of intractable cancer pain. Macro- or microencapsulation of such cells within semi-permeable membranes is expected to protect the transplant from the host's immune system. In the present study, we report the viability and functionality of BCC encapsulated into microcapsules of alginate-poly-L-lysine (PLL) with a liquefied inner core. The experiment was carried out during 44 days. Empty microcapsules were characterized in terms of morphology, permeability, and mechanical resistance. At the same time, the viability and functionality of both encapsulated and nonencapsulated BCC were evaluated in vitro. We obtained viable BCC with excellent functionality: immunocytochemical analysis revealed robust survival of chromaffin cells 30 days after isolation and microencapsulation. HPLC assay showed that encapsulated BCC released catecholamines basally during the time course study. Taken together, these results demonstrate that viable BCC can be successfully encapsulated into alginate-PLL microcapsules with a liquefied inner core.