Real-world outcomes of switching from adalimumab originator to adalimumab biosimilar in patients with inflammatory bowel disease: The ADA-SWITCH study

BACKGROUND AND AIMS

Data on the outcomes after switching from adalimumab (ADA) originator to ADA biosimilar are limited. The aim was to compare the treatment persistence, clinical efficacy, and safety outcomes in inflammatory bowel disease patients who maintained ADA originator vs. those who switched to ADA biosimilar.

METHODS

Patients receiving ADA originator who were in clinical remission at standard dose of ADA originator were included. Patients who maintained ADA originator formed the non-switch cohort (NSC), and those who switched to different ADA biosimilars constituted the switch cohort (SC). Clinical remission was defined as a Harvey-Bradshaw index ≤4 in Crohn's disease and a partial Mayo score ≤2 in ulcerative colitis. To control possible confounding effects on treatment discontinuation, an inverse probability treatment weighted proportional hazard Cox regression was performed.

RESULTS

Five hundred and twenty-four patients were included: 211 in the SC and 313 in the NSC. The median follow-up was 13 months in the SC and 24 months in the NSC (p < 0.001). The incidence rate of ADA discontinuation was 8% and 7% per patient-year in the SC and in the NSC, respectively (p > 0.05). In the multivariate analysis, switching from ADA originator to ADA biosimilar was not associated with therapy discontinuation. The incidence rate of relapse was 8% per patient-year in the SC and 6% per patient-year in the NSC (p > 0.05). Six percent of the patients had adverse events in the SC vs. 5% in the NSC (p > 0.05).

CONCLUSION

Switching to ADA biosimilar did not impair patients' outcomes in comparison with maintaining on the originator.

POS0940 FACTORS ASSOCIATED WITH LONG-TERM RETENTION OF TREATMENT WITH GOLIMUMAB IN A LARGE COHORT OF PATIENTS WITH RHEUMATIC DISEASES, WITH UP TO 8 YEARS OF FOLLOW-UP

Background

The long-term retention rate of a biological drug is a surrogate marker of its effectiveness and tolerability.

Objectives

We assessed the probability of golimumab retention (persistence or drug survival) and the associated factors in a large cohort of patients with rheumatic diseases, with up to 8 years of follow-up.

Methods

This was an analysis of the BIOBADASER database (Spanish registry of biological drugs of the Spanish Society of Rheumatology and the Spanish Medicines Agency) on all adult patients who had initiated golimumab for treating rheumatoid arthritis (RA), psoriatic arthritis (PsA) or axial spondyloarthritis (SpA). The probability of golimumab retention was assessed with the Kaplan-Meier method, differences between groups with the log-rank test, and factors related to retention with a Cox-regression model. Patients were right-censored if they were still treated with golimumab at the last observation for data analysis.

Results

A total of 885 patients were included, of whom 59 had received golimumab in 2 separate cycles (with a grace period of 3 months), totaling 944 cycles of treatment (286 RA, 396 axial SpA and 262 PsA). At golimumab initiation, mean (SD) age was 52 (13) years, 54% were women and median duration of disease was 7.6 (2.8-14.4) years. Golimumab was prescribed as first, second and third/subsequent biological drug in 313 (33%), 303 (32%) and 328 (35%) treatments. Concomitant medications at golimumab initiation included methotrexate (MTX) (32%), steroids (29%), leflunomide (13%) and sulphasalazine (6%). The probability of retention of golimumab since treatment initiation was 71% (95% confidence interval [CI]: 68 – 74) at year 1, 60% (95% CI: 57-63) at year 2, 54% (95% CI: 51-58) at year 3, 48% (95% CI: 44-51) at year 4, 44% (95% CI: 40-48) at year 5, 41% (95% CI: 37-45) at year 6 and 38% (95% CI: 33-42) at year 7 and at year 8. In bivariate analysis, the retention rate was higher when golimumab was used as first biological agent (p log-rank <0.001), in patients with axial SpA or PsA compared to RA (p <0.001, Figure 1) in men (p<0.001) and in those not using steroids (p<0.001). As first biological drug the probability of retention was 82% at year 1 and 50% at year 7. As second, it was 70% at year 1 and 35% at year 8, and at third/further, 62% (year 1) and 28% (year 8). Cox-regression analysis (Table 1) showed that golimumab retention was positively associated to use as first vs second or third biological, to axial SpA or PsA compared to RA and to use of methotrexate, and inversely to corticosteroid use and to disease activity over the median at golimumab initiation.

Table 1.

Cox-regression analysis. Hazard Ratio for discontinuation of golimumab

Hazard Ratio95% Confidence intervalpAge at golimumab initiation1.011.00-1.020.063Gender (women vs men)1.230.98-1.550.079Axial SpA vs RA0.590.44-0.80<0.001PsA vs RA0.670.51-0.890.005Second vs first biological drug1.521.17-1.970.002Third or further vs first biological drug1.791.38-2.32<0.001Corticosteroids1.461.16-1.850.001Methotrexate0.790.63-0.990.041Disease activity over the median*1.291.05-1.590.015

*DAS28 > 4.3 (RA, PsA) or BASDAI > 5.6 (axial SpA) at golimumab initiation

Figure 1.

Conclusion

This study provides new information on long-term golimumab effectiveness for the treatment or rheumatic diseases, with retention rates of 71% at year 1, 44% at year 5 and 38% at year 8. The probability of golimumab retention was higher as first biological drug, in patients with PsA or axial SpA and in those treated with methotrexate, and lower in those treated with steroids or with higher disease activity at golimumab initiation.

Acknowledgements

BIOBADASER is funded by the Spanish Society of Rheumatology, the Spanish Agency of Medicines and by different pharmaceutical companies. The present study was funded by MSD, Spain.have no acknowledgements to declare.

Disclosure of Interests

Manuel Pombo-Suarez: None declared, Daniel Seoane-Mato: None declared, Luis Cea-Calvo Employee of: Medical Affairs, MSD Spain, Federico Diaz-Gonzalez: None declared, Fernando Sánchez-Alonso: None declared, Marta Sánchez-Jareño Employee of: Medical Affairs, MSD Spain, Francisco Javier Manero Ruiz: None declared, Lucía Ruiz: None declared, Vega Jovani: None declared, Isabel Castrejon: None declared

Functional bacterial cultures for dairy applications: towards improving safety, quality, nutritional and health benefit aspects

Traditionally, fermentation was used to preserve the shelf life of food. Currently, in addition to favouring food preservation, well standardized and controlled industrial processes are also aimed at improving the functional characteristics of the final product. In this regard, starter cultures have become an essential cornerstone of food production. The selection of robust microorganisms, well adapted to the food environment, has been followed by the development of microbial consortia that provide some functional characteristics, beyond their acidifying capacity, achieving safer, high‐quality foods with improved nutritional and health‐promoting properties. In addition to starters, adjunct cultures and probiotics, which normally do not have a relevant role in fermentation, are added to the food in order to provide some beneficial characteristics. This review focuses on highlighting the functional characteristics of food starters, as well as adjunct and probiotic cultures (mainly lactic acid bacteria and bifidobacteria), with a specific focus on the synthesis of metabolites for preservation and safety aspects (e.g. bacteriocins), organoleptic properties (e.g. exopolysaccharides), nutritional (e.g. vitamins) and health improvement (e.g. neuroactive molecules). Literature reporting the application of these functional cultures in the manufacture of foods, mainly those related to dairy production, such as cheeses and fermented milks, has also been updated.

Clinical Characteristics of Juvenile Idiopathic Inflammatory Myopathy and Comparison With Adult Patients: Analysis From a Multicentric Cohort in Spain

METHODS

This study reviewed the medical records of patients from the REMICAM cohort, a multicentric longitudinal study carried out in patients with IIM, followed up between 1980 and 2014 in 12 hospitals in Madrid, Spain. Patients with definite or probable JPM, JDM, adult DM, and adult PM according to the modified Bohan and Peter criteria were selected. We compared the characteristics between JDM and JPM, and between JIIM and adult IIM.

RESULTS

Eighty-six juvenile patients (75 JDMs and 11 JPMs) and 283 adult patients (133 DMs and 150 PMs) were included. Compared with patients with JDM, patients with JPM were older at diagnosis, had more fever and arthritis, and were less frequently treated with disease-modifying antirheumatic drugs (these differences were not statistically significant). Compared with patients with adult DM, those with JDM presented more frequently with calcinosis (33.8% vs 6.9%, p < 0.0001) and had less severe infections (4.3% vs 23.4%, p < 0.0001), malignancies (1.3% vs 25.6%, p < 0.0001), and mortality (3.5% vs 33%, p < 0.0001). Patients with JDM were treated less frequently with azathioprine (10.8% vs 44.7%, p < 0.0001).

CONCLUSIONS

Our findings confirm that JIIMs are a heterogeneous group of diseases with relevant differences compared with adult IIMs.

Oleanolic acid protection against experimental autoimmune myocarditis modulates the microbiota and the intestinal barrier integrity

Background

Autoimmune myocarditis is a cause of dilated cardiomyopathy and heart failure. Recent studies have indicated that leaky gut may allow environmental factors to enter the body and trigger the initiation/development of autoimmune disease. Moreover, there is a growing literature supporting that, beside myocardial fibrosis, a leaky intestinal barrier and gut dysbiosis are pathogenic factors linked to heart failure. The natural triterpene oleanolic acid (OA) has been shown to beneficially influence the severity of the experimental autoimmune myocarditis (EAM), a preclinical model of human myocarditis, via anti-oxidant and immunomodulatory mechanisms. Herein, we investigate gastrointestinal (GI) disturbances and the gut microbiota composition associated with EAM as potential therapeutic target of OA.

Methods and results

BALB/c mice were α-myosin-inmunized to induce EAM and treated with OA (25 mg/kg/day, i.p). On day 21, heart fibrosis and parameters related to gut damage such as oxidative stress (O2- ions, lipid peroxidation), gut permeability (D-lactate; I-FABP), inflammation and mucins were determined in serum and/or colon. Fecal microbial profiles were identified by 16S rRNA gene sequencing analysis. Firstly, histological analysis of hearts showed presence of fibrosis (Sirius Red stain) in EAM mice, whereas these effects were not detectable in myocardium from healthy or OA-treated EAM mice. In addition, OA preserved the mucin-containing goblet cells along the colon (Alcian Blue/PAS stain). Consistently, serum levels of the epithelial gut damage markers, including D-lactate and iFABP were significantly reduced in OA treated-EAM mice. The beneficial OA effects also included a decrease in the pro-inflammatory mediators sPLA2-IIA and IL-1β and a protection from the oxidative stress response (DHE stain and TBARS) in serum and colonic tissue of EAM-mice. Furthermore, gut microbiota composition showed a lower bacterial diversity and different relative abundance of certain bacterial taxa in EAM-mice compared to control mice. The families of Muribaculaceae, Lachnospiraceae, and Ruminococcaceae were significantly affected in EAM mice, and only Muribaculaceae recovered levels similar to the healthy-control group, after treatment with OA.

Conclusion

Our data show that in addition to the heart, the intestinal barrier and gut microbiota are altered in myocarditis, and that OA treatment could ameliorate this profile. Our data contribute to the idea that gut dysbiosis and GI dysfunction influences myocarditis pathogenesis, and provides new findings regarding the beneficial activity of OA in EAM, suggesting that it may be an interesting candidate to be explored for the treatment of human patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): MINECO, ISCIII, CIBERCV-ISCIII

AB0035 TWO DIFFERENT ABNORMAL BEHAVIORS IN CD4+T LYMPHOCYTES IN FIBROMYALGIA PATIENTS AND FIBROMYALGIA ASSOCIATED TO SJÖGREN’S SYNDROME

Background:

Primary fibromyalgia syndrome is a prevalent rheumatic condition characterized by widespread pain and whose etiopathogenesis is not well understood. Fibromyalgia can also be secondary to other rheumatic diseases like Sjogren’s syndrome; however, its relation to this disease is unknown. It has been suggested that the immune system is involved in their pathogenesis. The role of activation stages and cytokines profiles of CD4+T lymphocytes in fibromyalgia or fibromyalgia secondary to Sjogren´s syndrome are completely unclear and could play a key role in the pathophysiology of these diseases.

Objectives:

The objective of this study is to investigate the counts and distribution of the CD4+T lymphocyte activation subsets and their pattern of cytokine production in women with primary fibromyalgia, fibromyalgia secondary to Sjogren´s, Sjogren´s syndrome and healthy controls (HC). The counts and distribution of naïve (TN), central memory (TCM), effector memory (TEM) and effector (TE) CD4+T lymphocyte subsets were analyzed in these diseases. Furthermore, we investigated their pattern of IL-4, IL-10, IL-17A, IFNγ, and TNFα production.

Methods:

Counts and distribution of CD4+T subsets (TN, TCM, TEM, TE)and their cytokine producing capacity were measured using multiparametric flow cytometry in peripheral blood mononuclear cells (PBMC) from 20 primary fibromyalgia, 15 fibromyalgia associated to Sjögren and 15 primary Sjögren patients and 15 female controls. Fibromyalgia and/or Sjögren’s syndrome were diagnosed based on ACR criteria. CD4+T cell activation stages were analyzed by the expression of the CD3, CD4, CD45RA, CD27 and CCR7 antigens. Cytokine CD4+T producing cells subsets were assayed stimulating PBMC during 6 hours, fixed, permeabilized and simultaneously stained with IL-4, IL-10, IL-17A, IFNγ, and TNFα intracellular cytokines.

Results:

Fibromyalgia patients showed a significant increase in the CD4+T, TNand TCMcells counts with compared to fibromyalgia secondary to Sjogren, Sjogren´s syndrome and HC. The counts of IL-17A, IL-4 and IFNγ producing CD4+T cells were increased in fibromyalgia patients with respect to HC. However, only IL17A and IFNγ, but not IL-4 producing CD4+T lymphocytes were increased with respect fibromyalgia secondary to Sjogren. These alterations were due to an increment of TEMIL-17A, TCMand TEMIL-4 and TNTCMand TEMIFNγ producing CD4+T cell subsets in fibromyalgia patients. Furthermore, IFNγ producing CD4+T cells were decreased in fibromyalgia secondary to Sjogren´s with respect to fibromyalgia patients and HC. Counts of TNTNFα producing CD4+ T cells were increased in fibromyalgia with respect fibromyalgia secondary to Sjogren. IL-10 producing CD4+T cells were normal in fibromyalgia but decreased in fibromyalgia secondary to Sjogren.

Conclusion:

Fibromyalgia patients show an abnormal circulating activation stages of CD4+T cells, as well as, express unusual elevated counts of CD4+T cells producing IL-17A, IL-4 and IFNγ. These alterations could differentiate two different pathologic and inflammatory behaviors of the T cell compartment between fibromyalgia and fibromyalgia secondary to Sjogren patients.

References:

[1]T helper 1 response is correlated with widespread pain, fatigue, sleeping disorders and the quality of life in patients with fibromyalgia.. Guggino G et al, Clin Exp Rheumatol. 2019.

[2]A Comparative Study of Fibromyalgia, Rheumatoid Arthritis, Spondyloarthritis, and Sjögren’s Syndrome. Bucourt E et al, Pain Med. 2019

Disclosure of Interests:

None declared

P867 Mitral stenosis: from mild to severe in less than a year

We report the case of an 82-year-old woman, with personal history of hypertension, diabetes mellitus, dyslipemia and permanent atrial fibrillation. In 2013 aortic valve substitution surgery was performed with a mechanic prosthetic valve. In her last echocardiogram in May 2018 a mild double mitral lesion was detected, with a normal aortic valve functioning.

In March of 2019 she was admitted in hospital with symptoms of heart failure and 38ºC fever.

A transthoracic echocardiogram was performed, which revealed a vegetation in the native mitral valve that caused a severe mitral stenosis (area 0.64 cm2). In blood cultures Streptococcus gallolyticycus was isolated.

In this situation, a tranesophagical echocardiogram was performed, which confirmed the diagnosis of an infective endocarditis in the native mitral valve. It also showed spontaneous echocontrast as well as a thrombus in the left atrial appendage, despite anticoagulant medication.

Given these findings, antibiotic therapy was initiated and surgery programmed. Substitution of the native mitral valve for a biological prosthesis was made. In the transthoracic echocardiographic control the prosthesis was normal functioning. A colonoscopy was performed taking into account the strong association between Streptococcus gallolyticus and colonic lesions, which showed no abnormal findings. At the discharge the patient had no signs or symptoms suggestive of heart failure or infection.

Streptococcus gallolytycus is included in the D group of Streptococci. Among hospitalized patients, this group accounts for approximately 5% of streptococcal bloodstream isolates. For humans, the gastrointestinal tract is the most frequent entry point, other potential sources include the hepatobiliary tree and the urinary tract. Clinical manifestations include bacteremia and endocarditis, which is usually highly destructive and frequently bivalvular. Bone infection, meningitis or peritonitis can also be present. Due to the frequent association between this microorganism and colonic neoplasm, colonoscopy is necessary to dismiss pathological findings. Typically D Streptococci can be treated with penicillins, ceftriaxone, carbapenems, vancomycin, daptomycin, and linezolid. The preferred regimen for streptococcal prosthetic valve endocarditis includes a beta-lactam combined with an aminoglycoside, to achieve synergistic effect.

Abstract P867 Figure. Mitral stenosis

Clinical Characteristics, Associated Malignancies and Management of Primary Sclerosing Cholangitis in Inflammatory Bowel Disease Patients: A Multicentre Retrospective Cohort Study

BACKGROUND AND AIMS

Primary sclerosing cholangitis [PSC] is usually associated with inflammatory bowel disease [IBD]. An increased risk of malignancies, mainly colorectal cancer [CRC] and cholangiocarcinoma [CCA], has been reported in PSC-IBD patients. Our aim was to determine the clinical characteristics and management of PSC in IBD patients, and the factors associated with malignancies.

METHODS

PSC-IBD patients were identified from the Spanish ENEIDA registry of GETECCU. Additional data were collected using the AEG-REDCap electronic data capture tool.

RESULTS

In total, 277 PSC-IBD patients were included, with an incidence rate of 61 PSC cases per 100 000 IBD patient-years, 69.7% men, 67.5% ulcerative colitis and mean age at PSC diagnosis of 40 ± 16 years. Most patients [85.2%] were treated with ursodeoxycholic acid. Liver transplantation was required in 35 patients [12.6%] after 79 months (interquartile range [IQR] 50-139). It was more common in intra- and extrahepatic PSC compared with small-duct PSC (16.3% vs 3.3%; odds ratio [OR] 5.7: 95% confidence interval [CI] = 1.7-19.3). The incidence rate of CRC since PSC diagnosis was 3.3 cases per 1000 patient-years [95% CI = 1.9-5.6]. Having symptoms of PSC at PSC diagnosis was the only factor related to an increased risk of CRC after IBD diagnosis [hazard ratio= 3.3: 95% CI = 1.1-9.9]. CCA was detected in seven patients [2.5%] with intra- and extrahepatic PSC, with median age of 42 years [IQR 39-53], and presented a lower life expectancy compared with patients without CCA and patients with or without CRC.

CONCLUSIONS

PSC-IBD patients with symptoms of PSC at PSC diagnosis have an increased risk of CRC. CCA was only diagnosed in patients with intra- and extrahepatic PSC and was associated with poor survival.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Endoscopic recommendations for colorectal cancer screening and surveillance in patients with inflammatory bowel disease: Review of general recommendations

Screening for colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) is recommended by all scientific societies. However, there are differences in the recommendations they make regarding screening and surveillance. We address a series of questions that come up in the daily clinical practice of a physician. The first two questions that are raised are: (1) Who should be offered screening for CRC? and (2) When should the first colonoscopy be performed? The next step is to decide who should undergo endoscopic surveillance and at what intervals they should be performed. Chromoendoscopy is emerging as the recommended endoscopic technique for screening and surveillance. The terminology for describing lesions detected with endoscopy is also changing. The management of visible lesions or non-visible dysplasia is also a motive for the review. We end the review by addressing the follow-up for endoscopically resected lesions. These questions often cannot be answered easily due to the varying degrees of evidence available; therefore, we have made some general recommendations based on those made by the various guidelines and consensuses. The first screening colonoscopy should be offered 8 years after a IBD diagnosis and we recommend that patients be stratified according to the individual risk for each for endoscopic surveillance intervals.

Selection by mating competitiveness improves the performance of Anastrepha ludens males of the genetic sexing strain Tapachula-7

The sexual performance of Anastrepha ludens males of the Tapachula-7 genetic sexing strain, produced via selection based on mating success, was compared with that of males produced without selection in competition with wild males. Mating competition, development time, survival, mass-rearing quality parameters and pheromone production were compared. The results showed that selection based on mating competitiveness significantly improved the sexual performance of offspring. Development time, survival of larvae, pupae and adults, and weights of larvae and pupae increased with each selection cycle. Differences in the relative quantity of the pheromone compounds (Z)-3-nonenol and anastrephin were observed when comparing the parental males with the F4 and wild males. The implications of this colony management method on the sterile insect technique are discussed.

Personality traits in patients with cluster headache: a comparison with migraine patients

Background

Cluster headache (CH) has been associated with certain personality traits and lifestyle features, but there are few studies assessing personality profiles in CH. We aimed to analyze personality traits in patients with CH, and to compare them with those found in migraine.

Methods

We included all consecutive patients with CH attending 5 outpatient offices between January and December 2013. Personality traits were evaluated using the Salamanca screening test, a validated inventory assessing 11 personality traits grouped in 3 clusters. We analyzed the test results in this population, and compared them with those of a migraine population previously assessed with the same test.

Results

Eighty patients with CH (75 men, 5 women; mean age, 43.2 ± 9.9 years) were recruited. The reference population consisted of 164 migraine patients (30 men, 134 women; mean age 36.4 ± 12.7 years). In CH patients, the most frequent personality traits were anancastic (52.5 %), anxious (47.5 %), histrionic (45 %), schizoid (42.5 %), impulsive (32.5 %) and paranoid (30 %). When compared to migraine patients, paranoid (p < 0.001; χ2 test), and schizoid traits (p = 0.007; χ2 test) were significantly more prevalent in CH patients. In logistic regression analysis the paranoid trait was significantly associated with CH (p = 0.001; OR: 3.27, 95 % CI [1.66–6.43]).

Conclusion

According to the Salamanca screening test, personality traits included in cluster A (odd or eccentric disorders) are more prevalent in CH patients than in a population of migraineurs. Larger studies are needed to determine whether certain personality traits are related to CH.

Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe

Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors.

Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001.

Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0.

Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones.

Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.

Improving effect of chronic resveratrol treatment on central monoamine synthesis and cognition in aged rats

Resveratrol is a polyphenol exhibiting antioxidant and neuroprotective effects in neurodegenerative diseases. However, neuroprotective properties during normal aging have not been clearly demonstrated. We analyzed the in vivo effects of chronic administration of resveratrol (20 mg/kg/day for 4 weeks) in old male rats (Wistar, 20 months), on tryptophan hydroxylase (TPH) and tyrosine hydroxylase (TH) activities which mediate central monoaminergic neurotransmitters synthesis, and besides, on hippocampal-dependent working memory test (radial maze). Our results show an age-related decline in neurochemical parameters that were reversed by resveratrol administration. The resveratrol treatment enhances serotonin (5-HT) levels in pineal gland, in hippocampus, and in striatum, and those of noradrenaline (NA) in hippocampus and also dopamine (DA) in striatum. These changes were largely due to an increased activity of TPH-1 (463 % in pineal gland), TPH-2 (70-51 % in hippocampus and striatum), and TH (150-36 % in hippocampus and striatum). Additionally, the observed hippocampal effects correlate with a resveratrol-induced restorative effect on working memory (radial maze). In conclusion, this study suggests resveratrol treatment as a restoring therapy for the impaired cognitive functions occurring along normal aging process, by preventing 5-HT, DA, and NA neurotransmission decline.

Thermodynamics versus Kinetics Dichotomy in the Linear Self-Assembly of Mixed Nanoblocks

We report classical and replica exchange molecular dynamics simulations that establish the mechanisms underpinning the growth kinetics of a binary mix of nanorings that form striped nanotubes via self-assembly. A step-growth coalescence model captures the growth process of the nanotubes, which suggests that high aspect ratio nanostructures can grow by obeying the universal laws of self-similar coarsening, contrary to systems that grow through nucleation and elongation. Notably, striped patterns do not depend on specific growth mechanisms, but are governed by tempering conditions that control the likelihood of depropagation and fragmentation.

Preparing for rectal microbicides: sociocultural factors affecting product uptake among potential South American users

OBJECTIVES

We examined views on rectal microbicides (RMs), a potential HIV prevention option, among men who have sex with men and transgender women in 3 South American cities.

METHODS

During September 2009 to September 2010, we conducted 10 focus groups and 36 in-depth interviews (n = 140) in Lima and Iquitos, Peru, and Guayaquil, Ecuador, to examine 5 RM domains: knowledge, thoughts and opinions about RM as an HIV prevention tool, use, condoms, and social concerns. We coded emergent themes in recorded and transcribed data sets and extracted representative quotes. We collected sociodemographic information with a self-administered questionnaire.

RESULTS

RM issues identified included limited knowledge; concerns regarding plausibility, side effects, and efficacy; impact on condom use; target users (insertive vs receptive partners); and access concerns.

CONCLUSIONS

Understanding the sociocultural issues affecting RMs is critical to their uptake and should be addressed prior to product launch.

Antimicrobial resistance in Shigella spp. causing traveller's diarrhoea (1995-2010): a retrospective analysis

BACKGROUND

Shigellosis is a global human health problem causing an important morbidity among travellers returning from tropical areas. This study was aimed to describe the evolution of antimicrobial resistance profile in Shigella spp. isolated between the years 1995-2010 in patients with traveller's diarrhoea (TD) returning from tropical areas.

METHODS

The levels of antimicrobial resistance were tested in a total of 191 Shigella spp. isolated during the period from 1995 to 2010.

RESULTS

A decrease of cases of diarrhoea caused by Shigella has been observed in recent years. A wide spectrum of antibiotic resistance was observed among Shigella spp. These isolates showed high levels of resistance to tetracycline (84%), co-trimoxazole (75.5%), and ampicillin (45.5%). The resistance was low to ciprofloxacin (2.1%), azithromycin (3.9%) and furazolidone (8.4%). According to the period, in the case of ampicillin, amoxicillin plus clavulanic acid, chloramphenicol, values of resistance were significantly decreasing from 1995-2000 to 2001-2010, (62.5% vs. 28.4%, 19.8% vs. 6.6%, 23.4 vs. 10.4%, respectively). Meanwhile in nalidixic acid and tetracycline the evolution of resistance has increased over time.

CONCLUSIONS

A decrease in the isolation number of Shigella spp. causing TD has been observed. Differential trends in the evolution of the levels of resistance to the tested antibacterial agents have been observed.

Postnatal Transplantation of Interneuronal Precursor Cells Decreases Anxiety-Like Behavior in Adult Mice

The GABAergic system is critically involved in the modulation of anxiety levels, and dysfunction of GABAergic neurotransmission appears to be involved in the development of generalized anxiety disorder. Precursor cells from the medial ganglionic eminence (MGE) have the ability to migrate and differentiate into inhibitory GABAergic interneurons after being transplanted into the mouse brain. Thus, transplantation of interneuronal precursor cells derived from the MGE into a postnatal brain could modify the neuronal circuitry, increasing GABAergic tone and decreasing anxiety-like behavior in animals. Our aim was to verify the in vivo effects of transplanted MGE cells by evaluating anxiety-like behavior in mice. MGE cells from 14-day green fluorescent protein (GFP) embryos were transplanted into newborn mice. At 15, 30, and 60 days posttransplant, the animals were tested for anxiety behavior with the elevated plus maze (EPM) test. Our results show that transplanted cells from MGE were able to migrate to different regions of the brain parenchyma and to differentiate into inhibitory interneurons. The neuronal precursor cell transplanted animals had decreased levels of anxiety, indicating a specific function of these cells in vivo. We suggested that transplantation of MGE-derived neuronal precursors into neonate brain could strengthen the inhibitory function of the GABAergic neuronal circuitry related to anxiety-like behavior in mice.

Persistence length and stochastic fragmentation of supramolecular nanotubes under mechanical force

Cyclic peptide nanotubes (CPNs) exhibit impressive structural, mechanical and chemical properties in resemblance to beta-sheet proteins found in silks and amyloids, and show potential as supramolecular nanotubes that can be utilized to generate novel nanocomposites and nanoporous thin films. Quantifying the persistence length and thermomechanical fragmentation of CPNs is of great importance for establishing a theoretical basis of how to generate rectilinear nanostructures with controlled aspect ratio and rigidity. However, factors governing the elasticity and dynamical breaking of these supramolecular nanostructures remain to be fully understood. Here we present a statistical analysis of the Young's modulus and persistence length of CPNs using fully-atomistic molecular dynamic simulations in explicit solvent. We show that the measured properties exhibit a dependence on the magnitude of the shear force applied, and extrapolation to the quasi-static deformation case yields 0.46 μm for the persistence length and 7.8 GPa for the Young's modulus, in agreement with our experimental observations from TEM images. We establish a theoretical model for the spatial and temporal distribution of stochastic fracture, which we use to explain the simulation-based observations of spontaneous fragmentation under an applied shear force. Our methodology, blending theory, simulation and experiments provide a framework that can be utilized to investigate the mechanical behavior of self-assembling protein materials, paving the way for their design towards biological and industrial applications.

An economic evaluation of pregabalin versus usual care in the management of community-treated patients with refractory painful diabetic peripheral neuropathy in primary care settings

OBJECTIVE

To estimate the cost-effectiveness of pregabalin versus usual care (UC) in the management of community-treated patients with refractory painful diabetic peripheral neuropathy (pDPN) in primary care settings (PCS) in Spain.

METHODS

Data was extracted from a 12-week registry study assessing costs of neuropathic pain in Spain. Pregabalin-naïve outpatients treated with UC or newly prescribed pregabalin were selected for inclusion in the cost-effectiveness analysis. Effectiveness was expressed as quality-adjusted life years (QALY) gain. Perspectives of the Spanish National Health System (NHS) and society (2006) were applied for cost calculations. Results were expressed as incremental cost-effectiveness ratio (ICER). Bootstrapping techniques (10,000 re-samples) were used to obtain the probabilistic ICER and the cost-effectiveness acceptability curve.

RESULTS

A total of 189 patients were included in the economic analysis. Compared with UC, pregabalin was associated with higher QALY gain in a period of 12-weeks; 0.0406±0.0343 versus 0.0285±0.0350 (p=0.167). Overall total costs (€1368±1229 vs. €1258±1474; p=0.587) and healthcare costs (€628±590 vs. €469±420; p=0.134) were similar for both pregabalin and UC, respectively. ICERs for pregabalin varied from €5302 (95% CI: dominant; €144,105) for total costs to €14,381 (dominant; €115,648) for healthcare costs. Probabilistic sensitivity analyses showed that 79-84% of ICERs were below the threshold of €30,000/QALY.

CONCLUSION

This study suggests that pregabalin may be cost-effective in the management of community-treated refractory outpatients, with pDPN when compared with usual care in the primary care setting in Spain. These findings may help policy makers when making health decision in the management of diabetes in the community.

Modeling the potential benefits of catch-crop introduction in fodder crop rotations in a Western Europe landscape

Among possible mitigation options to reduce agricultural-borne nitrate fluxes to water bodies, introduction of catch crop before spring crops is acknowledged as a cost-efficient solution at the plot scale, but it was rarely assessed at the catchment level. This study aims to evaluate a set of catch crop implantation scenarios and their consequences in a coastal catchment prone to eutrophication. The objectives are (i) to discuss the potential benefits of catch crop introduction taking into account the limitations due to the physiographic and agricultural context of the area (ii) to propose a multicriteria classification of these scenarios as a basis for discussion with stakeholders. We used the distributed agro-hydrological model TNT2 to simulate 25 scenarios of catch crop management, differing in length of catch crop growing period, place in the crop rotation and residue management. The scenarios were classified considering the variations in main crop yields and either nitrogen fluxes in stream or the global nitrogen mass balance at the catchment level. The simulations showed that in the catchment studied, little improvement can be expected from increasing the catch crop surface. Catch crop cultivation was always beneficial to reduce nitrogen losses, but led to adverse effects on main crop yields in some cases. Among the scenarios involving additional catch crop surface, introducing catch crop between two winter cereals appeared as the most promising. The classification of scenarios depended on the chosen criteria: when considering only the reduction of nitrogen fluxes in streams, exporting catch crop residues was the most efficient while when considering the global nitrogen mass balance, soil incorporation of catch crop residues was the most beneficial. This work highlights the interest, while using integrated models, of assessing simulated scenarios with multicriteria approach to provide stakeholder with a picture as complete as possible of the consequences of prospective policies.

Nitrate dynamics in agricultural catchments deduced from groundwater dating and long-term nitrate monitoring in surface- and groundwaters

Although nitrate export in agricultural catchments has been simulated using various types of models, the role of groundwater in nitrate dynamics has rarely been fully taken into account. We used groundwater dating methods (CFC analyses) to reconstruct the original nitrate concentrations in the groundwater recharge in Brittany (Western France) from 1950 to 2009. This revealed a sharp increase in nitrate concentrations from 1977 to 1990 followed by a slight decrease. The recharge concentration curve was then compared with past chronicles of groundwater concentration. Groundwater can be interpreted as resulting from the annual dilution of recharge water in an uncontaminated aquifer. Two aquifers were considered: the weathered aquifer and the deeper fractured aquifer. The nitrate concentrations observed in the upper part of the weathered aquifer implied an annual renewal rate of 27 to 33% of the reservoir volume while those in the lower part indicated an annual renewal rate of 2-3%. The concentrations in the deep fractured aquifer showed an annual renewal rate of 0.1%. The river concentration can be simulated by combining these various groundwater reservoirs with the recharge. Winter and summer waters contain i) recharge water, or water from the variably saturated zone with rapid transfer and high nitrate concentrations, and ii) a large contribution (from 35 to 80% in winter and summer, respectively) from the lower part of the aquifer (lower weathered aquifer and deep fractured aquifer). This induces not only a relatively rapid response of the catchment to variations in agricultural pressure, but also a potential inertia which has to be taken into account.