Two-year abatacept retention rate in clinical practice in the French ACTION cohort

OBJECTIVES

Abatacept retention rates were evaluated in the French cohort in the prospective ACTION study (2010-2013), which included patients with moderate-to-severe rheumatoid arthritis managed in everyday clinical practice and started on intravenous abatacept therapy.

METHODS

Two-year abatacept retention rates were evaluated in 455 patients classified according to treatment line, body mass index (BMI), and status for rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA).

RESULTS

After 2 years, the overall abatacept retention rate was 44%. The retention rate was non-significantly higher in the patients with vs. without a history of unresponsiveness to at least one biologic (48.1% vs. 41.8%, respectively). No significant retention rate differences were found across BMI categories (444 patients; <25, 45.5%; ≥25 to <30, 48.9%; and ≥30, 36.6%). Neither were any significant differences demonstrated according to RF and ACPA status (RF+ and ACPA+, 45.7%; RF+ or ACPA+, 43.8%; and FR- and ACPA-, 39.1%).

CONCLUSION

The 44% 2-year retention rate in the French ACTION cohort supports the usefulness of abatacept therapy. In this study, retention was not associated with treatment line, BMI, or antibody status.

Correction to: Predictors of abatacept retention over 2 years in patients with rheumatoid arthritis: results from the real-world ACTION study

The article listed above was initially published with incorrect copyright information. Upon publication of this Correction, the copyright of this article changed to "The Author(s)". The original article has been corrected.

Body mass index and clinical response to intravenous or subcutaneous abatacept in patients with rheumatoid arthritis

This post hoc analysis of ACQUIRE (NCT00559585) explored the effect of baseline body mass index (BMI) on the pharmacokinetics of and clinical response to subcutaneous (SC) or intravenous (IV) abatacept in patients with rheumatoid arthritis (RA). ACQUIRE was a phase 3b, 6-month, double-blind, double-dummy study in which patients with RA were randomized (1:1) to SC (fixed - dose; 125 mg/week) or IV (weight-tiered; ~ 10 mg/kg/month) abatacept plus methotrexate. In this analysis, minimum abatacept plasma concentration (Cmin) was measured at 3 and 6 months, and clinical remission over 6 months was assessed by Disease Activity Score 28 (C-reactive protein; DAS28 [CRP], < 2.6), Simplified Disease Activity Index (SDAI, ≤ 3.3), and Clinical Disease Activity Index (CDAI, ≤ 2.8). Data were stratified by baseline BMI (underweight/normal, < 25 kg/m2; overweight, 25 to < 30 kg/m2; obese, ≥ 30 kg/m2) and administration route. Of the 1456/1457 patients for whom baseline BMIs were available, 526 (36%; SC 265, IV 261) patients were underweight/normal, 497 (34%; SC 249, IV 248) were overweight, and 433 (30%; SC 221, IV 212) were obese. Median Cmin abatacept concentration was ≥ 10 μg/mL (efficacy threshold) at 3 and 6 months in > 90% of patients across BMI groups with both administration routes. DAS28 (CRP), SDAI, and CDAI remission rates at 6 months were similar across BMI groups and 95% confidence intervals overlapped at all time points in both separate and pooled SC/IV analyses. Therapeutic concentrations of abatacept and clinical remission rates using stringent criteria were similar across patient BMIs and administration routes.

Impact of early cART on HIV blood and semen compartments at the time of primary infection

BACKGROUND

HIV-infected cells in semen facilitate viral transmission. We studied the establishment of HIV reservoirs in semen and blood during PHI, along with systemic immune activation and the impact of early cART.

METHODS

Patients in the ANRS-147-OPTIPRIM trial received two years of early cART. Nineteen patients of the trial were analyzed, out of which 8 had acute PHI (WB ≤1 Ab). We quantified total cell-associated (ca) HIV-DNA in blood and semen and HIV-RNA in blood and semen plasma samples, collected during PHI and at 24 months of treatment.

RESULTS

At enrollment, HIV-RNA load was higher in blood than in semen (median 5.66 vs 4.22 log10 cp/mL, p<0.0001). Semen HIV-RNA load correlated strongly with blood HIV-RNA load (r = 0.81, p = 0.02, the CD4 cell count (r = -0.98, p<0.0001), and the CD4/CD8 ratio (r = -0.85, p<0.01) in acute infection but not in later stages of PHI. Median blood and seminal cellular HIV-DNA levels were 3.59 and 0.31 log10cp/106 cells, respectively. HIV-DNA load peaked in semen later than in blood and then correlated with blood IP10 level (r = 0.62, p = 0.04). HIV-RNA was undetectable in blood and semen after two years of effective cART. Semen HIV-DNA load declined similarly, except in one patient who had persistently high IP-10 and IL-6 levels and used recreational drugs.

CONCLUSIONS

HIV reservoir cells are found in semen during PHI, with gradual compartmentalization. Its size was linked to the plasma IP-10 level. Early treatment purges both the virus and infected cells, reducing the high risk of transmission during PHI.

CLINICAL TRIALS REGISTRATION

NCT01033760.

A comparison between different prediction models for invasive breast cancer occurrence in the French E3N cohort

Breast cancer remains a global health concern with a lack of high discriminating prediction models. The k-nearest-neighbor algorithm (kNN) estimates individual risks using an intuitive tool. This study compares the performances of this approach with the Cox and the Gail models for the 5-year breast cancer risk prediction. The study included 64,995 women from the French E3N prospective cohort. The sample was divided into a learning (N = 51,821) series to learn the models using fivefold cross-validation and a validation (N = 13,174) series to evaluate them. The area under the receiver operating characteristic curve (AUC) and the expected over observed number of cases (E/O) ratio were estimated. In the two series, 393 and 78 premenopausal and 537 and 98 postmenopausal breast cancers were diagnosed. The discrimination values of the best combinations of predictors obtained from cross-validation ranged from 0.59 to 0.60. In the validation series, the AUC values in premenopausal and postmenopausal women were 0.583 [0.520; 0.646] and 0.621 [0.563; 0.679] using the kNN and 0.565 [0.500; 0.631] and 0.617 [0.561; 0.673] using the Cox model. The E/O ratios were 1.26 and 1.28 in premenopausal women and 1.44 and 1.40 in postmenopausal women. The applied Gail model provided AUC values of 0.614 [0.554; 0.675] and 0.549 [0.495; 0.604] and E/O ratios of 0.78 and 1.12. This study shows that the prediction performances differed according to menopausal status when using parametric statistical tools. The k-nearest-neighbor approach performed well, and discrimination was improved in postmenopausal women compared with the Gail model.

Excimer laser effects on human corneal endothelium. Modulation by serum factor(s)

OBJECTIVE

To determine the possibility of endothelial cell damage after excimer laser ablation.

METHODS

Endothelial cell densities and morphology of human corneas after photoablations or mechanical keratectomy were compared with those of the untreated mates after 1 week of culture with or without serum.

RESULTS

Corneas cultured in serum-free medium after ablation to a depth of 150 microns showed endothelial cell densities reduced to 60% of untreated, mate corneas; ultrastructural analysis showed endothelial cell damage not seen in untreated mates. Corneas ablated to the same depth and cultured in serum-enriched medium showed no endothelial cell density loss, nor did corneas cultured in serum-free medium after an ablation to a depth of 50 microns or mechanical keratectomies averaging 95 microns.

CONCLUSIONS

Endothelial cell loss in deep laser resections may be prevented by factor(s) in fetal bovine serum. The apparent lack of cell loss in clinical studies may be related to the protective action of similar factors in aqueous humor.

[New technique for implanting Bomirski melanoma into the anterior chamber of Syrian hamster eyes]

PURPOSE

To describe a newly elaborated ocular tumor model, obtained by implanting Bomirski melanoma into the anterior chamber of the eye in Syrian hamsters (Mesocricetus auratus).

MATERIAL AND METHODS

The experiments were carried out using pigmented and non-pigmented lines of the tumor. Attempted injections of suspension of malignant melanoma cells in physiological salt solution to the anterior chamber with an infusion pump did not give the expected results. The growth of the tumor occurred only in 8% of eyes. The research material contained 132 adult pigmented hamsters. Tumor fragments of the size of 0,4-1,0 mm were implanted to the anterior chamber of the eyes. Melanotic cells were implanted in 71 hamsters, amelanotic ones in 61 hamsters. Hamsters were anesthetized with intravisceral vetbutal. The examination was carried out in 24 hour intervals.

RESULTS

During the first 2 to 3 days the disappearance of the cells were observed, and then iris tumors appeared, in the cases of amelanotic cells after 4-6 days, and in the cases of melanotic cells after 8-10 days. Enucleated eye-balls were examined histopathologically. In all cases confirmation of the growth of melanoma in the iris was obtained.

Photorefractive keratectomy to treat myopia and astigmatism after radial keratotomy and penetrating keratoplasty

Fifteen eyes with an initial myopia between -5.00 diopters (D) and -12.00 D were treated with radial keratotomy (RK) followed by photorefractive keratectomy (PRK) at least 6 months later and observed for 6 months to 24 months. Five eyes that had penetrating keratoplasty (PKP) were treated for residual ametropia by PRK and followed for up to two years. For the RK-treated eyes, mean pre-PRK refraction was -4.00 D sphere and + 1.25 D cylinder, which improved to -0.52 D sphere and + 0.73 D cylinder. Incidence of complications, including corneal haze, was extremely low in both the RK and PKP groups. In summary, PRK is a valuable method for correcting ametropia following RK and PKP, with risks similar to that for eyes having PRK as the initial refractive procedure.

The correction of high myopia using the excimer laser

OBJECTIVE

To determine the safety and efficacy of excimer laser photoablation as a treatment to correct high myopia that is defined as a spherical equivalent refractive error greater than -8.00 diopters (D).

DESIGN

Using a multizone (4.0-, 5.0-, and 6.0-mm) photorefractive keratectomy protocol for correction of high myopia, 23 eyes in 18 patients were treated at one clinical center with an excimer laser (VISX Inc, Santa Clara, Calif). Preoperative spherical equivalent refractions ranged from -8.00 to -19.50 D (mean +/- SD, -11.83 +/- 2.92 D); the mean attempted ablation depth was 93.0 +/- 20.2 microns.

RESULTS

At the last postoperative examination (mean +/- SD, 7.5 +/- 3.7 months), the mean +/- SD spherical equivalent refraction was -1.09 +/- 2.08 D, including results from two repeated procedures; visual acuity in 52% of the eyes was 20/40 or better uncorrected; 65% of the eyes improved or did not change best corrected acuity, whereas two eyes lost 2 Snellen lines; 39% of the eyes were +/- 1.00 D; and 65% were +/- 2.00 D of attempted correction. Corneal haze (corneal clarity score of > or = 1.5) was observed in 47% of the eyes at some time postoperatively.

CONCLUSIONS

Photorefractive keratectomy for high myopia was found to be not nearly as efficient or predictable as it is for low myopia. A greater incidence of regression of refractive effect and corneal haze were noted in these cases compared with reported studies of low to moderate myopia. A multizone approach to reduce ablation depth during photorefractive keratectomy for myopia that is greater than 8.00 D does not appear to prevent subsequent haze or refractive regression.

Immunological identification of cerebellar cell lines

Spleen cells from BALB/c mice, previously immunized with rat cerebellar tissue, were fused to the mouse myeloma cell line SP2/0-Ag14 and the cerebellar cell type specificity of the resultant hybridomas determined. In this report we describe the specificity of one hybridoma, C4/12. Monoclonal antibodies secreted by this hybridoma recognize granule cell neurons in adult cerebellar frozen sections, and in primary cultures started from 3 to 5-day-old newborn rats. In addition, C4/12 recognizes a subclass of astrocytes when screened on primary cultures but not adult cerebellar tissue. Two temperature sensitive Rous sarcoma virus transformed cerebellar cell lines, previously shown to be either neuronal or glial, were screened for the presence of the antigen. Both cell lines are positive at the temperature permissive for transformation, whereas the glial line but not the neuronal line exhibits the antigen at the nonpermissive temperature. These results are discussed in light of the cell lines being representative of precursor cells.

Properties of two temperature-sensitive Rous sarcoma virus transformed cerebellar cell lines

Cells from the cerebellum of 3-day-old BD-IX rats were obtained as permanent lines by transforming them with temperature-sensitive Rous sarcoma virus. The presence or absence of veratridine-stimulated Na+-uptake (voltage-dependent channels) was used to operationally classify them as neuronal or glial. When incubated at 34 degrees C, the permissive temperature for transformation, the cerebellar cells exhibit a transformed phenotype determined by anchorage independence, rounded morphology, high growth rate and absence of density-dependent inhibition of growth. In contrast, when the transformed cerebellar cell lines are kept at a temperature (38 degrees C) non-permissive for transformation, they exhibit a normal cellular phenotype with respect to the above properties. Moreover, changes toward neuronal morphology, increase in veratridine-stimulated Na+-uptake, decreased growth rate and the expression of the astrocyte specific protein, glial fibrillary acidic protein, suggest that a degree of differentiation is expressed at the non-permissive temperature.