Descemet's membrane endothelial keratoplasty rejection after SARS-COV2 infection or vaccination: 2-year retrospective study

PURPOSE

To assess the incidence of Descemet's membrane endothelial keratoplasty (DMEK) rejection potentially associated with coronavirus disease 2019 (COVID-19) infection or vaccination, and its association with known rejection risk factors during the first two years of the pandemic.

METHODS

This retrospective study included patients with DMEK rejection between January 2020 and December 2021. Diagnostic criteria were based on symptoms, visual acuity, and other clinical assessments. Risk factors for graft rejection were considered, and a telephone survey was conducted to identify possible preceding COVID-19 infection or vaccination.

RESULTS

Of 58 patients, 44 were included. Six patients (14%) reported COVID-19 infection, with one immediate endothelial graft rejection (EGR) post-infection. After vaccine availability, 13 of 36 patients had EGR at an average of 2.7 months post-vaccination. Five (38%) had immediate EGR following vaccination, four of which had concomitant risk factors for rejection.

CONCLUSION

Although the risk of endothelial graft rejection (EGR) associated with COVID-19 infection or vaccination appears to be extremely low, there may be a causative relationship, especially in patients with pre-existing risk factors for EGR. A temporary increase in anti-rejection treatment following COVID-19 infection or vaccination is recommended, especially in patients with pre-existing risk factors, along with closer monitoring during the subsequent 4 to 8 weeks.

Sequential combination of Sonic Hedgehog inhibitors followed by consolidation radiotherapy in locally advanced basal cell carcinoma

BACKGROUND

Sonic Hedgehog inhibitors (SHHis) are an effective treatment in locally advanced basal cell carcinoma (laBCC), but the use of these drugs is limited by adverse events and relapse at discontinuation in around half of patients. A few cases of patients treated concomitantly by radiotherapy (RT) and SHHis have been reported in the literature, suggesting that the combination results in an improved overall response. Maintaining complete response after stopping treatment is a concern, especially since resuming treatment in the case of relapse does not guarantee a new therapeutic response. The optimal combination and sequence of treatment to improve local control of laBCCs are not yet defined.

OBJECTIVE

We hypothesized that consolidation RT after complete response to SHHis could reduce the risk of relapse at discontinuation.

METHODS

We present a case series of patients with laBCCs who achieved complete response (CR) after SHHi treatment and were treated with consolidation RT. Patients were evaluated by a skin cancer board. The closure RT technique and dosage were refined by a radiotherapist.

RESULTS

Eleven patients were included. SHHis were prescribed for 5 months (range 4-11). Consolidation RT was performed after CR to SHHis and discontinuation. RT was delivered at a median dose of 45 Gy (range 40.5-66) in 10 fractions (range 9-33). With a median follow-up of 23 months, all patients maintained complete clinical response. This strategy was well tolerated with no grade 3 adverse events.

CONCLUSION

SHHi treatment followed by RT consolidation after drug discontinuation seems effective and safe. Further studies are needed to develop a precise strategy for the management of laBCCs.

An Effective Primary Treatment Using Radiotherapy in Patients with Eyelid Merkel Cell Carcinoma

BACKGROUND

Merkel cell carcinoma (MCC) is a rare type of neuroendocrine tumor. Palpebral localization represents 2.5% of MCCs. Surgery is not always possible due to the localization or comorbidities of elderly patients. We hypothesized that radiotherapy (RT) alone could be a curative treatment in patients contraindicated for oncological surgery.

METHODS

We performed a retrospective monocentric study of patients with localized eyelid MCC treated with curative intent using curative radiotherapy.

RESULTS

Overall, 11 patients with histologically confirmed eyelid MCC were treated with curative radiotherapy. The median age was 77 years old (range: 53-94). Curative RT was decided mainly due to difficult localization and significant co-morbidities. The median lesion dose was 57 Gy (range: 47-70). Most patients had adjuvant lymph nodes irradiation with a median dose of 50 Gy (n = 9; 82%). The median follow-up was 62 months (6-152 months). None of the seven deaths were MCC-related. None of our patients relapsed during follow-up. Side effects related to radiotherapy were mild (no grade ≥ 2) and rare (n = 3, 21%).

CONCLUSION

Our data suggest that curative radiotherapy is an effective and safe treatment for Merkel cell carcinoma of the eyelid and periocular region. Radiotherapy alone allows limiting the aesthetic and functional sequelae in elderly and comorbid patients who are contraindicated for oncological surgery.

Enhanced directional extraction of very cold neutrons using a diamond nanoparticle powder reflector

For more than a decade, detonation nanodiamond (DND) powders have been actively studied as a material for efficient reflectors of very cold neutrons (VCNs) and cold neutrons. In this work, we experimentally demonstrate, for the first time, the possibility of enhanced directional extraction of a VCN beam using a reflector made of fluorinated DND powder. With respect to the theoretical flux calculated from an isotropic source at the bottom of the reflector cavity, the gain in the VCN flux density along the beam axis is ∼10 for the neutron velocities of ∼57 and ∼75 m/s. The use of such reflectors for enhanced directional extraction of VCN from neutron sources will make it possible to noticeably increase the neutron fluxes delivered to experiments and expand the scope of VCN applications.

Continuity of care during the COVID-19 pandemic: Qualitative results from a mixed-methods study

Background

Decreases in health service use were observed globally during the COVID-19 pandemic. In the quantitative part of this mixed-methods study, we documented similar trends in Switzerland, with a retrospective cohort study showing a 15-20% decrease in general practitioner (GP) consultations/chronic disease monitoring in spring 2020. These changes need to be understood, particularly for individuals at risk of COVID-19 complications, as many have conditions requiring regular monitoring.

Methods

With a mixed-methods design, we examine continuity of care for at-risk groups (people: ≥65-years-old, with cancer, diabetes, respiratory disease, etc.) between Mar-2020 and Apr-2021. Following quantitative analyses, we qualitatively studied changes in GP/patient practices thru semi-structured interviews with 23 GPs and 36 at-risk patients. We here focus on thematically analyzed qualitative results.

Results

Qualitative data helped explain observed reductions in consultations/monitoring: 1) some patients were discouraged to seek care by official recommendations and/or GPs during the first semi-shutdown; 2) some patients perceived GP offices as closed/overburdened; 3) some patients feared contracting coronavirus; 4) some patients sought alternatives to traditional primary care consultations (e.g., tele-consultations, consulting pharmacists/other professionals, self-reliance). Many patients did not feel that there was discontinuity of their cares. GPs commonly described feeling like an underutilized resource during the pandemic and explained how they could have been mobilized for population needs.

Conclusions

During the first wave, there was a mismatch between 1) GPs' reported availability/preparedness to adequately care for at-risk patients, and 2) some GPs discouraging at-risk patients to come for consultations, at-risk patients' perceptions that their care was not “urgent” in a pandemic setting, and patient perceptions that GPs were otherwise unavailable/overburdened.

Key messages

Qualitative data offer explanations for health service use reductions during the COVID-19 pandemic.

Results provide potential paths forward and highlight GP views of being an underutilized resource.

Evaluation of two RT-PCR screening assays for identifying SARS-CoV-2 variants

Background

The recent emergence of new SARS CoV-2 variants (variants of concern, VOC) that spread rapidly and may lead to immune escape has emphasized the urgent need to monitor and control their spread.

Methods

We analyzed 2018 SARS-CoV-2 positive specimens collected between February 9 and March 22, 2021 using the Thermofisher® TaqPath™ COVID-19 CE-IVD RT-PCR kit (TaqPath) and the ID solutions® ID™ SARS-CoV-2/UK/SA Variant Triplex RT-PCR (ID triplex) assay to screen for VOCs.

Results

The ID triplex assay identified 62.8% of them as VOCs: 61.8% B.1.1.7 and 0.9% B.1.351/P.1. The agreement between the ID triplex results for B.1.1.7 and the TaqPath S gene target failure (SGTF)/ S gene target late detection (SGTL) profile for this variant agreed very well (k = 0.86). A low virus load was the main cause of discrepancies. Sequencing discordant results with both assays indicated that the TaqPath assay detected the B.1.1.7 lineage slightly better. Both assays suggested that the virus loads of B.1.1.7 variants were significantly higher than those of non-B.1.1.7 strains. Only 10/20 B1.351/P.1 strains detected with the ID triplex assay were confirmed by sequencing.

Conclusions

We conclude that the SGTF/SGTL profiles identified using the TaqPath assay and ID triplex results are suitable for detecting the B.1.1.7 lineage. The ID triplex assay, which rapidly determines all three current VOCs simultaneously, could be a valuable tool for limiting virus spread by supporting contact-tracing and isolation.

P13.10 Chemoattraction of glioma cells in a local hydrogel trap and immune control associated with improved survival and cognitive functions in a mouse model of glioblastoma resection

BACKGROUND

Glioblastoma (GB) is the most aggressive brain primary tumor. The prognosis remains poor mainly due to the invasiveness of glioma cells, radio and/or chemoresistance and GB-induced immunosuppressive environment. Here, we propose to use a local delivery system based on a biocompatible hydrogel containing the chemopeptide urotensin II (hUII) or a biased synthetic analog DAB8-hUII, to “trap” GB cells, and/or to control immune cells expressing its G protein-coupled receptor UT, leading to tumor regression and neurological benefit, in a mouse model of GB resection.

MATERIAL AND METHODS

In vitro, invasion towards UII/analog across different hydrogels or glue of human or murine GB-GFP cell lines was evaluated in Boyden chamber and cloning ring assays. In vivo GB cells were intrastriatally xenografted, then resected while hydrogel- or glue-containing UII/analog was injected in the cavity resection. Behavioral tests, brain immunohistochemical analyses and mouse survival were then investigated.

RESULTS

In vitro, invasive capacity of human U87 and 42MG or murine GL261 and CT2A GB cells was stimulated by UII loaded into hydrogel-based hyaluronic acid supplemented with collagen or other chemicals, PNIPAAm-PEG, or thrombin-fibrin glue. In vivo, injection of UII- or DAB8-hUII-loaded glue into the cavity resection of GL261 and CT2A GB in C57BL/6 mice significantly improved survival compared with tumor and resected experimental conditions. Neurological status was also tested before and after GB resection. We found that GL261 and CT2A cell-bearing mice expressed altered spontaneous activity, emotion and cognitive functions. Intracavity injection of the glue improved resignation and anxiety and increased motor activity and cognition with a best cognitive recovery with hUII and DAB-8-hUII-loaded glue groups. Ex vivo brain analyses revealed high expression of UT and UII in some GB GFP-positive cells and macrophages within GB core and at the interface with the normal brain, GB cells expressing UT migrating along tortuous podocalyxin+ vascular components. In brains bearing hydrogel/hUII glue, vascularization appears modified and GFAP+ astrocytes and F4/80+ macrophages were highly recruited in the border of the cavity, compared with the other conditions.

CONCLUSION

A local glue containing UII may trap GB cells and remodel the tumor microenvironment responsible for survival and cognitive improvements, providing new option in the therapeutic arsenal of GB.

POS1190 EXPECTATIONS AND POTENTIAL CONCERNS OF PATIENTS WITH AUTOIMMUNE AND RHEUMATIC DISEASES REGARDING VACCINATION AGAINST SARS-CoV-2 (COVID-19): THE WORLDWIDE ONLINE VAXICOV STUDY

Background:

Vaccination is an important and effective tool to prevent infections in the general population as well as in patients with systemic autoimmune or inflammatory rheumatic diseases (AIIRDs) who may be at increased risk of serious infection. While the global race for vaccines against COVID-19 has already lead to first authorizations and vaccinations in some countries, multiple questions arise for access and provisions as well as for the acceptance of vaccine policies by immunocompromised patients.

Objectives:

We conducted an international survey about expectations and potential concerns regarding SARS-CoV-2 vaccine in patients with AIIRDs and healthcare professionals.

Methods:

The online study consisted of 57 questions which addressed determinants associated with SARS-2-CoV-2 vaccine willingness. Dissemination was ensured through social media and patient associations between December 12 and December 21, 2020.

Results:

The study included 1266 patients with AIIRDs and 265 healthcare professionals from 56 countries. SARS-CoV-2 vaccine willingness was reported by 54.2% of AIIRD patients (uncertainty in 32.2% and unwillingness in 13.6%) and 74.0% of healthcare professionals. In patients, the willingness to get vaccinated increased significantly with age (p<0.0001) and was strongly associated with the fear to be infected by SARS-CoV-2 (p<0.0001) or to develop severe COVID19 (p<0.0001) but not with presence of additional comorbidities (p=0.71) or immunocompromised status (p=0.94). The most trusted healthcare professional regarding the recommendation to get vaccinated against COVID-19 was their specialist (rheumatologist, internist, etc.) for 69.9%. Vaccine unwillingness was low (7.9%) among healthcare professionals and willingness was significantly increased in those who had been vaccinated against influenza in the last 3 years (p=0.01).

Subject groupsPatientsHealthcare professionalsN1266265Age (years), median [IQR25-75]50 [40-61]40 [32.5-53]Female, n (%)1141 (90.1%)150 (56.6%)Male, n (%)115 (9.9%)115 (43.4%)Country, n (%) France320 (25.3%)159 (60%) UK345(27.3%)4 (1.5%) Chile123 (9.7%)4 (1.5%) USA114 (9.0%)7 (2.6%) Venezuela43 (3.4%)26 (9.8%) Spain57 (4.5%)3 (1.1%) Mexico53 (4.2%)3 (1.1%) Argentina45 (3.6%)8 (3.0%) Other*166 (13.1%)51 (19.2%)Rheumatic diagnosis, n (%)1266- Systemic lupus erythematosus492 (38.9%)- Spondyloarthritis176 (13.9%)- Rheumatoid arthritis160 (12.6%)- Giant cell arteritis / Polymyalgia rheumatica144 (11.4%)- Primary anti-phospholipid syndrome64 (5.1%)- Inflammatory myositis62 (4.9%)- Relapsing polychondritis45 (3.6%)- Other**123 (9.7%)--Health professionals, n (%)-265 Doctor-203 (76.6%) Nurse (or equivalent)-23 (8.7%) Nursing assistant-11 (4.2%) Other***-28 (10.6%)Associated comorbidities, n (%) Diabetes69 (5.5%)6 (2.3%) Hypertension267 (21.1%)24 (9.1%) Myocardial infarction, stroke, transient stroke60 (4.7%)1 (0.4%) Respiratory disease (asthma, chronic bronchitis, emphysema, etc.)169 (13.3%)13 (4.9%)Renal failure47 (3.7%)1 (0.4%)Obesity (BMI > 30)228 (18.0%)18 (6.8%)At least one associated comorbidity, n (%)588 (46.4%)50 (18.9%)Smoker, n (%)128 (10.2%)22 (8.3%) Current411 (32.7%)51 (19.2%) Past719 (57.1%)192 (72.5%) NeverUse of oral glucocorticoids, n (%)551 (56.1%)3 (1.1%)Immunocompromised$, n (%)770 (60.8%)0On a 0 to 10 scale, median8 (6-10)5 (3-8)[IQR25-75]9 (7-10)5 (1-8)−Afraid to get infected by SARS-CoV-2−Afraid to get a severe COVID-19Willing to get vaccinated (Yes / uncertain / No), %54.2 / 32.2 / 13.674.0 / 18.1 / 7.9Vaccine hesitancy, n (%)357 (28.2%)59 (22.3%)

Conclusion:

Data from this study are crucial to understand the main expectations and concerns regarding SARS-CoV-2 vaccination in patients with AIIRDs and healthcare workers and allow the identification of valuable strategies to increase vaccine coverage in those populations.

Acknowledgements:

We wish to acknowledge the crucial role of the following patient associations: LupusEurope (tweeter: @LupusEurope), Agrupacion Lupus Chile (@Lupus_Chile), RarasNoInvisibles (@Noinvisibles), Lupus UK, Lupus France, SPONDYL’ASSO, Spondyl(O)action, AFL+, in the dissemination of the survey. We are indebted to Gonzalo Tobar Carrizo (@pinkycito) for the Spanish translation of the survey, all patients, families, and health professionals for their kind participation in our study. We wish to thank Ms. Sylvie Thuong for her invaluable assistance.

Disclosure of Interests:

Renaud FELTEN Speakers bureau: Pfizer, Maxime Dubois: None declared, Manuel F. Ugarte-Gil Speakers bureau: Janssen and Pfizer, Jérémy Fort: None declared, Luc PIJNENBURG: None declared, Aurore Chaudier: None declared, Lou Kawka: None declared, Charlotte Costecalde: None declared, Hugo Bergier: None declared, Emmanuel Chatelus: None declared, Rose-Marie Javier: None declared, Christelle Sordet: None declared, Jacques-Eric Gottenberg Speakers bureau: Pfizer and Astra-Zeneca, Jean Sibilia Speakers bureau: Pfizer, Yurilis Fuentes-Silva: None declared, Laurent Arnaud Speakers bureau: Pfizer and Astra-Zeneca.

Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

Purpose

Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date.

Methods

All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant.

Results

Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0–43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3–56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98).

Conclusion

Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13014-021-01815-4.

[The revolution of immuno-oncology therapy: specificities for the physicians]

The use of immune checkpoint inhibitors has revolutionized the treatment and prognosis of many cancer patients. Associated with the raise of these new treatments, new side effects have been observed, requiring specific management. In addition, the tumor evolution and its monitoring under immunotherapy differ from conventional treatments, and require an adaptation of the radiological criteria for tumor lesions monitoring. Many other therapeutic targets exist and could potentially be associated with immune checkpoint inhibitors. Many challenges still need to be overcome in order to better understand and optimize the use of these new molecules.

[The revolution of immuno-oncology therapy: review of immune checkpoint inhibitors efficacy]

Immunotherapy represents a major paradigm shift, as the treatment no longer directly targets tumor cells, but the patient him/herself, in order to restore an effective anti-tumor immunity. This article illustrates the growing place of immune checkpoint inhibitors in the available therapeutic options, by focusing on two cancers with poor outcome: metastatic melanoma and metastatic non-small cell lung cancer (NSCLC), against which Immune checkpoints inhibitors now occupy a central place. Many questions remain unresolved, such as the search for markers predicting a good response to treatment, which would allow the selection of responder patients. Numerous trials are in progress, evaluating the relevance of these new molecules at earlier stages of the disease (adjuvant and neoadjuvant strategies) and their place in combined strategies (associated with chemotherapy, targeted therapies, and other types of immunotherapy).

Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors

BACKGROUND

Advances in diagnostic and therapeutic strategies in oncology have significantly increased the chance of survival of cancer patients, even those with metastatic disease. However, cancer-related cognitive impairment (CRCI) is frequently reported in patients treated for non-central nervous system cancers, particularly during and after chemotherapy.

DESIGN

This review provides an update of the state of the art based on PubMed searches between 2012 and March 2019 on 'cognition', 'cancer', 'antineoplastic agents' or 'chemotherapy'. It includes the most recent clinical, imaging and pre-clinical data and reports management strategies of CRCI.

RESULTS

Evidence obtained primarily from studies on breast cancer patients highlight memory, processing speed, attention and executive functions as the most cognitive domains impaired post-chemotherapy. Recent investigations established that other cancer treatments, such as hormone therapies and targeted therapies, can also induce cognitive deficits. Knowledge regarding predisposing factors, biological markers or brain functions associated with CRCI has improved. Factors such as age and genetic polymorphisms of apolipoprotein E, catechol-O-methyltransferase and BDNF may predispose individuals to a higher risk of cognitive impairment. Poor performance on neuropsychological tests were associated with volume reduction in grey matter, less connectivity and activation after chemotherapy. In animals, hippocampus-based memory and executive functions, mediated by the frontal lobes, were shown to be particularly susceptible to the effects of chemotherapy. It involves altered neurogenesis, mitochondrial dysfunction or brain cytokine response. An important next step is to identify strategies for managing cognitive difficulties, with primary studies to assess cognitive training and physical exercise regimens.

CONCLUSIONS

CRCI is not limited to chemotherapy. A multidisciplinary approach has improved our knowledge of the complex mechanisms involved. Nowadays, studies evaluating cognitive rehabilitation programmes are encouraged to help patients cope with cognitive difficulties and improve quality of life during and after cancer.

PlaScope: a targeted approach to assess the plasmidome from genome assemblies at the species level

Plasmid prediction may be of great interest when studying bacteria of medical importance such as Enterobacteriaceae as well as Staphylococcus aureus or Enterococcus. Indeed, many resistance and virulence genes are located on such replicons with major impact in terms of pathogenicity and spreading capacities. Beyond strain outbreak, plasmid outbreaks have been reported in particular for some extended-spectrum beta-lactamase- or carbapenemase-producing Enterobacteriaceae. Several tools are now available to explore the ‘plasmidome’ from whole-genome sequences with various approaches, but none of them are able to combine high sensitivity and specificity. With this in mind, we developed PlaScope, a targeted approach to recover plasmidic sequences in genome assemblies at the species or genus level. Based on Centrifuge, a metagenomic classifier, and a custom database containing complete sequences of chromosomes and plasmids from various curated databases, PlaScope classifies contigs from an assembly according to their predicted location. Compared to other plasmid classifiers, PlasFlow and cBar, it achieves better recall (0.87), specificity (0.99), precision (0.96) and accuracy (0.98) on a dataset of 70 genomes of Escherichia coli containing plasmids. In a second part, we identified 20 of the 21 chromosomal integrations of the extended-spectrum beta-lactamase coding gene in a clinical dataset of E. coli strains. In addition, we predicted virulence gene and operon locations in agreement with the literature. We also built a database for Klebsiella and correctly assigned the location for the majority of resistance genes from a collection of 12 Klebsiella pneumoniae strains. Similar approaches could also be developed for other well-characterized bacteria.

Charge breeder for the SPIRAL1 upgrade: Preliminary results

In the framework of the SPIRAL1 upgrade under progress at the GANIL lab, the charge breeder based on a LPSC Phoenix ECRIS, first tested at ISOLDE has been modified to benefit of the last enhancements of this device from the 1+/n+ community. The modifications mainly concern the 1 + optics, vacuum techniques, and the RF-buffer gas injection into the charge breeder. Prior to its installation in the midst of the low energy beam line of the SPIRAL1 facility, it has been decided to qualify its performances and several operation modes at the test bench of LPSC lab. This contribution shall present preliminary results of experiments conducted at LPSC concerning the 1 + to n+ conversion efficiencies for noble gases as well as for alkali elements and the corresponding transformation times.

How do cumulative live birth rates and cumulative multiple live birth rates over complete courses of assisted reproductive technology treatment per woman compare among registries?

STUDY QUESTION

How do the national cumulative (multiple) live birth rates over complete assisted reproduction technology (ART) courses of treatment per woman in Belgium compare to those in other registries?

SUMMARY ANSWER

Cumulative live birth rates (CLBRs) remain high with a low cumulative multiple live birth rate when compared with other registries and publications.

WHAT IS KNOWN ALREADY

In ART, a reduction in the multiple live birth rate could be achieved by reducing the number of embryos transferred. It has been shown that by doing so, live birth rates per cycle were maintained, particularly when the augmentation effect of attached frozen-thawed cycles was considered.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study included all patients with a Belgian national insurance number who were registered in the national ART registry (Belrap) and who started a first fresh ART cycle between 1 July 2009 until 31 December 2011 with follow up until 31 December 2012. We analysed 12 869 patients and 38 008 cycles (both fresh and attached frozen cycles).

PARTICIPANTS, MATERIALS, SETTINGS, METHODS

CLBRs per patient who started a first ART cycle including fresh and consecutive frozen cycles leading to a live birth. Conservative estimates of cumulative live birth assumed that patients who did not return for treatment had no chance of achieving an ART-related live birth, whereas optimal estimates assumed that women discontinuing treatment would have the same chance of achieving a live birth as those continuing treatment. A maximum of six fresh ART cycles with corresponding frozen cycles was investigated and compared with other registries and publications.

MAIN RESULTS AND ROLE OF CHANCE

The CLBR was age dependent and declined from 62.9% for women <35 years, to 51.4% for women 35-37 years, to 34.1% for women 38-40 years and 17.7% for women 41-42 years in the conservative analysis after six cycles. In the optimal estimate, the CLBR declined from 85.9% for women <35 years, to 72.0% for women 35-37 years, to 50.4% for women 38-40 years and 36.4% for women 41-42 years. The cumulative multiple live birth rates for the whole population were 5.1 and 8.6% for the conservative and optimal estimate, respectively.

LIMITATIONS, REASONS FOR CAUTION

Conservative and optimal estimates use assumptions for the whole ART population and do not take the individual patient into account.

WIDER IMPLICATIONS OF THE FINDINGS

These data reinforce the validity of the Belgian model of coupling reimbursement of ART costs to a restriction in the number of embryos transferred. Our data can improve decision-making in medical ART practice both on the patient level and for society at large and could provide health care takers and insurance companies with a valid model.

STUDY FUNDING COMPETING INTERESTS

none.