Structural, Electrical and Corrosion Properties of Bulk Ti-Cu Alloys Produced by Mechanical Alloying and Powder Metallurgy

Binary Ti100-x-Cux (x = 1.6 and 3.0 wt.%) alloys were produced by the application of mechanical alloying and powder metallurgy processes. The influence of the copper concentration in titanium on the microstructure and properties of bulk alloys was investigated. The synthesized materials were characterized by an X-ray diffraction technique, scanning electron microscopy, and chemical composition determination. The electrochemical and corrosion properties were also investigated. Cold compaction and sintering reduced the content of α-Ti content in Ti98.4-Cu1.6 and Ti97-Cu3 alloys to 92.4% and 83.7%, respectively. Open Circuit Potential measurements showed a positive shift after the addition of copper, suggesting a potential deterioration in the corrosion resistance of the Ti-Cu alloys compared to pure Ti. Electrochemical Impedance Spectroscopy analysis revealed significant improvement in electrical conductivity after the addition of copper. Corrosion testing results demonstrated compromised corrosion resistance of Ti-Cu alloys compared to pure Ti. In summary, the comprehensive investigation of Ti100-x-Cux alloys provides valuable insights for potential applications in biosensing.

A dynamical measure of the black hole mass in a quasar 11 billion years ago

Tight relationships exist in the local Universe between the central stellar properties of galaxies and the mass of their supermassive black hole (SMBH)1-3. These suggest that galaxies and black holes co-evolve, with the main regulation mechanism being energetic feedback from accretion onto the black hole during its quasar phase4-6. A crucial question is how the relationship between black holes and galaxies evolves with time; a key epoch to examine this relationship is at the peaks of star formation and black hole growth 8-12 billion years ago (redshifts 1-3)7. Here we report a dynamical measurement of the mass of the black hole in a luminous quasar at a redshift of 2, with a look back in time of 11 billion years, by spatially resolving the broad-line region (BLR). We detect a 40-μas (0.31-pc) spatial offset between the red and blue photocentres of the Hα line that traces the velocity gradient of a rotating BLR. The flux and differential phase spectra are well reproduced by a thick, moderately inclined disk of gas clouds within the sphere of influence of a central black hole with a mass of 3.2 × 108 solar masses. Molecular gas data reveal a dynamical mass for the host galaxy of 6 × 1011 solar masses, which indicates an undermassive black hole accreting at a super-Eddington rate. This suggests a host galaxy that grew faster than the SMBH, indicating a delay between galaxy and black hole formation for some systems.

Microstructure, Mechanical and Corrosion Properties of Copper-Nickel 90/10 Alloy Produced by CMT-WAAM Method

In the case of copper and its alloys, Wire Arc Additive Manufacturing (WAAM) 3D printing technology is mainly used to produce elements for the maritime industry and research has focused on the use of Cu-Al alloys. There is little information devoted to the use of Cu-Ni alloys in this technology, which are also widely used in the maritime industry. In this work, tests were carried out on the microstructure, mechanical properties, and corrosion properties in a 1M NaCl solution of Cu-Ni 90/10 alloy 3D walls printed using the WAAM method. The obtained objects are characterized by a microstructure with elongated column grains and particles of the Ni-Ti phase, hardness in the range of 138-160 HV10, ultimate tensile strength of 495-520 MPa, yield strength of 342-358 MPa, elongation of 16.6-17.9%, and a low average corrosion rate of 7.4 × 10-5 mm/year. The work shows that it is possible to obtain higher mechanical properties of Cu-Ni 90/10 alloy 3D objects produced using the WAAM method compared to cast materials, which opens up the possibility of using this alloy to produce objects with more complex shapes and for use in corrosive working conditions.

Rapidly growing uterine myoma - should we be afraid of it?

During a year, myomas may undergo radical changes in their dimensions - from decreasing by 90% to growing by 200%. On average, myomas of the uterus increase in volume by 20-30% annually in the premenopausal period. On the other hand, myomas regress spontaneously in about 20% of women. After menopause uterine fibroids stabilize or regress. Every new or growing lesion of the uterus after menopause has to be diagnosed. There is no general definition of fast growing uterine myoma. The presence of fast growing uterine myoma, regardless of its definition, is associated with some clinical issues: it may become symptomatic (pain, bleeding, bulk symptoms), may be responsible for infertility, and a malignant process (leiomyosarcoma) may be present. Regardless of common belief, the risk of sarcoma is not related to the size of the uterus or its fast enlargement. The prevalence of sarcoma in myomas is 0.26%, and in rapidly growing myomas is 0.27%. Treatment should be individualized, selected for the age of the woman and her expectations (preservation of fertility, uterus), symptoms, size and localization of the myomas. The methods of surgical treatment of unsuspected "rapidly growing myomas" are the same as those of common uterine fibroids. Minimally invasive surgery is optimal, but a decision has to be made after evaluation of the risk factors of sarcoma.

The use of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosing of ovarian tumors

OBJECTIVES

To compare utility of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosis of ovarian tumors.

MATERIAL AND METHODS

Research was conducted among 456 patients qualified for surgery due to ovarian tumor. Preoperatively, CA125 and HE4 serum levels were estimated, and transvaginal ultrasound was performed. ROMA and RMI values and SA qualifications were obtained. Results were compared with pathomorphological findings.

RESULTS

Receiver Operating Characteristic (ROC)-Area Under Curve (AUC) values for CA125, HE4, ROMA, RMI and SA in preoperative diagnosis of malignant lesions were 0.819, 0.909, 0.911, 0.895 and 0.895, respectively. Combinations of biochemical and sonographic methods increased sensitivity in diagnosis of ovarian tumors. Combinations utilizing serum HE4 concentrations were most useful.

CONCLUSIONS

CA125, HE4, ROMA, RMI and SA proved to be useful in preoperative diagnosis of ovarian tumors. HE4 and ROMA occurred to be the most useful. Ultrasonographic methods are considerably useful in diagnosis of ovarian tumors. RMI and SA present similar overall diagnostic value.

The use of PLANS and NetworkX in modeling power grid system failures

The theoretical and practical aspects and results of simulations based on a specialized tool that is used in the energy industry were adressed. The previously discussed cases in the literature by taking into account the worst case and critical states of networks in terms of complex networks were extended. Using the Monte-Carlo method, the vulnerability of the power grid to node failures was investigated, both in terms of the use of specialized software, which is used in the power industry, and a tool for the analysis of complex networks graphs. We present the results obtained and the observed analogy between the results of the analysis performed in specialized software and the complex network graph analysis tool. It has been shown that the results obtained coincide for both software packages, even though their application focuses on slightly different aspects of system operation. Moreover, further possibilities of extending the research in this direction are proposed, taking into account not only the improvement of the method used, but also a significant increase in the size of the tested structure model.

Suspicion of bovine tuberculosis in sheep in the Małopolskie Voivodeship (southern Poland)

Bovine tuberculosis (BTB) in sheep (Ovis aries) is caused by Mycobacterium bovis and Mycobacterium caprae. Even though sheep have been considered less sensitive to BTB than other ruminants, they have been subject to increasing numbers of tuberculosis cases and it has been suggested that they may act as a disease reservoir in some regions. Aim of the study: Following a report of tuberculous-like gross lesions (repeated cases of purulent or caseous lymphadenitis and a single case of serosal tubercles on the peritoneum) from veterinarians working in a slaughterhouse in the Małopolskie Voivodeship, southern Poland, the aim of this study was to conduct ante-mortem BTB diagnostics in three flocks with suspected BTB. The animals for testing were selected randomly from the flocks; a blood sample for interferon-γ release assay (IGRA) and a single tuberculin skin test (TST) was performed on each sheep. All TST results were negative. The IGRA result was positive in two ewes from the same flock (four and five years of age); these two sheep were tested microbiologically using Stonebrink and Löwenstein-Jensen media. No gross lesions suggesting BTB were observed, and the culture results were negative. Based on the positive IGRA results, together with its high specificity in sheep, and the potential risk to humans posed by consuming local unpasteurized dairy products, we recommend introducing serological BTB screening in sheep from this area, and subjecting the positive results to confirmation by culture.

POS0672 ASSESSMENT OF THE DRUG-DRUG INTERACTION POTENTIAL OF BRANEBRUTINIB (BMS-986195), A HIGHLY POTENT AND SELECTIVE IRREVERSIBLE COVALENT INHIBITOR OF BRUTON’S TYROSINE KINASE, IN HEALTHY PARTICIPANTS

Background

Branebrutinib (BMS-986195) is a highly potent and selective irreversible small-molecule covalent inhibitor of Bruton’s tyrosine kinase (BTK),1 a non-receptor tyrosine kinase involved in the pathophysiology of immune-mediated diseases. Branebrutinib has the potential to be best in its class, as it achieves ~100% BTK occupancy in humans, sustained over a 24-hour dosing interval at low doses (≤ 10 mg once daily [QD]) despite its short half-life (≤ 2 hours),2 and demonstrates potent efficacy in murine models of immune-mediated diseases.1 Branebrutinib is under clinical study in multiple autoimmune inflammatory disorders such as RA, systemic lupus erythematosus, primary Sjögren’s syndrome, and atopic dermatitis. In vitro drug-drug interaction (DDI) studies with branebrutinib predicted pharmacokinetic DDI potential with substrates of cytochrome P450 (CYP)3A4 and the breast cancer resistant protein drug transporter.

Objectives

To assess the DDI potential of branebrutinib when co-administered with potential concomitant medications and probe substrates of major drug-metabolizing enzymes (DMEs) and drug transporters.

Methods

DDI risk with branebrutinib was assessed in 3 single-sequence, cross-over clinical studies in healthy participants. In the first 2-part study, MTX was administered alone or with steady-state (SS) branebrutinib (10 mg QD) in part 1; in part 2, caffeine, montelukast, flurbiprofen, omeprazole, midazolam, digoxin, and pravastatin were taken with or without SS branebrutinib (9 mg QD). In the second study, rosuvastatin was taken alone or with SS branebrutinib (9 mg QD). In cycle 1 of the third study, the oral contraceptive (OC) loestrin (1.5 mg norethindrone/30 μg ethinyl estradiol) was taken alone; in cycle 2, SS branebrutinib (9 mg QD) was taken alone or with the OC.

Results

Weak DDI with montelukast (CYP2C8) was observed, leading to a mild increase in montelukast exposure (max concentration [Cmax], 56%; area under the curve [AUC], 27%). A mild increase in digoxin exposure (P-glycoprotein [P-gp] substrates; Cmax, 57%; AUC, 21%) was also observed. There was no potential DDI with MTX (Table 1). No other clinically relevant DDIs with branebrutinib were observed. No serious AEs or other significant AEs occurred during these studies. All AEs were mild to moderate in intensity.

Table 1.

Results from clinical DDI studies of branebrutinib

Adjusted geometric mean ratios with (test) and without (reference) branebrutinibConcomitant medication or probe substrateDME or drug transporter testedCmax ratio (90% CI)AUC ratio (90% CI)Digoxin (0.25 mg)P-gp1.57 (1.36–1.80)1.21 (1.11–1.32)MTX (7.5 mg)BCRP, OATP1B1, OATP1B3, OAT1, OAT3, MRP2, MRP41.00 (0.92–1.09)0.94 (0.90–0.99)Pravastatin (40 mg)OATP1B1, OATP1B31.25 (1.00–1.57)1.06 (0.90–1.25)Rosuvastatin (10 mg)BCRP, OATP1B1, OATP1B30.81 (0.71–0.93)0.96 (0.88–1.04)Montelukast (10 mg)CYP2C81.56 (1.24–1.95)1.27 (1.10–1.47)Caffeine (200 mg)CYP1A20.98 (0.94–1.01)1.16 (1.08–1.24)Flurbiprofen (50 mg)CYP2C91.06 (0.97–1.16)1.12 (1.09–1.15)Omeprazole (50 mg)CYP2C191.05 (0.85–1.30)0.97 (0.84–1.13)Midazolam (5 mg)CYP3A40.95 (0.82–1.11)1.00 (0.84–1.19)Ethinyl estradiol (30 μg)CYP3A, CYP2C9, UGAT1A1, SULT1E11.16 (1.09–1.23)1.17 (1.12–1.22)Norethindrone (1.5 mg)CYP3A4, CYP2C191.10 (1.04–1.15)1.06 (1.01–1.12)

BCRP, breast cancer resistant protein; MRP, multidrug resistance-associated protein; OAT, organic anion transporting polypeptide; SULT, estrogen sulfotransferase; UGAT, uridine diphosphate glucuronosyltransferase.

Conclusion

In all 3 studies, co-administration of SS branebrutinib was generally well tolerated. The only potentially significant DDIs with substrates of major DMEs or transporters were mild increases in montelukast (CYP2C8) and digoxin (P-gp) exposures.

References

[1]Watterson SH, et al. J Med Chem 2019;62:3228–50.

[2]Catlett IM, et al. Br J Clin Pharmacol 2020;86:1849–59.

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Editorial assistance was provided by Candice Judith Dcosta, MSc, of Caudex, and was funded by Bristol Myers Squibb.

Disclosure of Interests

Aberra Fura Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Ihab Girgis Shareholder of: Bristol Myers Squibb, Johnson & Johnson, Employee of: Bristol Myers Squibb, Johnson & Johnson, CSL Behring, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Leon Carayannopoulos Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Celgene, Merck Sharp & Dohme, Dennis Grasela Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Wenying Li Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Bindu Murthy Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Urvi Aras Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

Current trends in the use of psychodrama and drama therapy in the treatment of mental disorders

Introduction

Psychodrama and Drama therapy enable patients to establish contact with the threat of stepping into a given role. This gives the opportunity to learn how to control it, which leads to better expression of oneself and better communication with the environment. Those qualities are crucial in the treatment of mental disorders. Despite the variety of literature describing the methodology, clinical trials using these forms of therapy are relatively rare.

Objectives

To describe the current trends in psychodrama (PD) and drama (DT) research over the last 6 years.

Methods

We have implemented a systematic approach to literature review, consistent with the PRISMA declaration. We searched through major medical databases: PubMed, Web of Science, Scopus by Elsevier and Science Direct for peer-reviewed articles published between 2015 and 2020. We have included studies using all types of methodology: mixed, quantitative and qualitative and also case studies. The risk of bias was assessed for randomized clinical trials, consistent with the PRISMA declaration.

Results

Using our search strategy we have identified 24 publications with 454 participants. Most of the subjects were adults, only four studies focused on children. Overall, these studies looked at the effects of PD i DT on more than 25 different outcomes. Therefore theatre - based therapies research reports promising results across all methodologies. Although, most of the interventions have small groups of clients and are not randomized.

Conclusions

Current reports on the effectiveness of PD and DT still need to be verified on a larger group of patients.

Disclosure

No significant relationships.

AB0891 Deucravacitinib Efficacy in Psoriatic Arthritis by Baseline DMARD Use: Exploratory Analysis From a Phase 2 Study

Background

Psoriatic arthritis (PsA) treatment guidelines recommend that patients (pts) inadequately responding to conventional synthetic DMARDs (csDMARDs) can be treated with targeted synthetic DMARDs with or without background use of csDMARDs. Deucravacitinib (DEUC) is a novel, oral, selective, allosteric inhibitor of tyrosine kinase 2 (TYK2) that binds to the unique TYK2 regulatory domain, thereby suppressing signaling of key cytokines (eg, IL-23) involved in PsA pathogenesis. In a Phase 2 trial in pts with active PsA, DEUC was well tolerated and significantly more efficacious than placebo (PBO) after 16 weeks of treatment.1

Objectives

This analysis further evaluated the effect of DEUC in this Phase 2 trial in pts treated with and without background csDMARDs for 16 weeks.

Methods

This double-blind trial (NCT03881059) enrolled pts with active PsA who had either failed or were intolerant to ≥1 nonsteroidal anti-inflammatory drug, corticosteroid, csDMARD, and/or 1 TNF inhibitor (TNFi; up to 30%). Pts were randomised 1:1:1 to DEUC 6 mg once daily (QD) or 12 mg QD, or PBO. A post hoc subgroup analysis in pts with and without background csDMARD use assessed improvements in select clinical outcomes (ACR 20 response, and change from baseline in ACR components, Psoriasis Area and Severity Index total score, and Psoriatic Arthritis Disease Activity Score) at Week 16.

Results

Baseline (BL) demographics, clinical characteristics, and disease activity were generally similar among pts with and without background csDMARD use. At BL, background csDMARD use was 64.3%, 64.2%, and 66.7% and methotrexate use was 50.0%, 55.2%, and 59.1% in the DEUC 6 mg QD, 12 mg QD, and PBO groups, respectively. Pts with and without background csDMARD use showed similar improvements at Week 16 with DEUC treatment versus PBO on most clinical measures, pt-reported outcomes, and composite measures (Table 1 and Figure 1). No clinically meaningful differences in adverse events (AEs) were observed in pts with or without background csDMARD use.

Table 1.

Adjusted mean (SE) change from baseline at Week 16 in clinical outcomes by csDMARD use

PBO w/o csDMARD (n=22)PBO w csDMARD (n=44)DEUC 6 mg QD w/o csDMARD (n=25)DEUC 6 mg QD w csDMARD (n=45)DEUC 12 mg QD w/o csDMARD (n=24)DEUC 12 mg QD w csDMARD (n=43)Swollen joint count-4.7 (1.4)-5.0 (0.9)-7.4 (1.4)-6.8 (0.9)-8.4 (1.3)-7.7 (1.0)Tender joint count-5.3 (2.2)-6.6 (1.3)-6.4 (2.2)-11.3 (1.3)-11.5 (2.0)-11.6 (1.4)Physician’s Global Assessment of Disease Activity-20.6 (5.6)-20.6 (3.7)-29.1 (5.8)-32.6 (3.5)-30.1 (5.3)-32.1 (3.9)Patients’ Global Assessment of Disease Activity-14.9 (5.8)-13.4 (3.9)-23.0 (5.9)-28.4 (3.8)-28.2 (5.4)-24.9 (4.2)Pain-14.7 (5.6)-14.6 (3.9)-22.7 (5.7)-26.2 (3.7)-25.5 (5.3)-25.5 (4.2)HAQ-DI-0.23 (0.11)-0.04 (0.09)-0.31 (0.11)-0.38 (0.08)-0.48 (0.10)-0.34 (0.09)hsCRP12.0 (5.3)-4.4 (2.1)-10.1 (5.3)-13.3 (2.0)-4.9 (4.9)-10.0 (2.2)PASI total score2.5 (1.4)-2.3 (0.7)-3.7 (1.4)-4.0 (0.6)-4.0 (1.3)-4.9 (0.7)PASDAS-0.9 (0.4)-1.2 (0.3)-1.8 (0.4)-2.1 (0.2)-2.2 (0.3)-2.1 (0.3)

The number of patients with data available for individual endpoints may vary.

csDMARD, conventional synthetic disease-modifying antirheumatic drug; DEUC, deucravacitinib; HAQ-DI, Health Assessment Questionnaire-Disability Index; hsCRP, high-sensitivity C-reactive protein; PASDAS, Psoriatic Arthritis Disease Activity Score; PASI, Psoriasis Area and Severity Index; PBO, placebo; QD, once daily; SE, standard error; w, with; w/o, without.

Conclusion

These analyses demonstrate that the efficacy of DEUC for the treatment of PsA was similar in pts with and without background csDMARD use. The AE profile of DEUC treatment with and without csDMARD use was consistent with findings from the overall Phase 2 PsA trial population.

References

[1]Mease PJ et al. Efficacy and Safety of Selective TYK2 Inhibitor, Deucravacitinib, in a Phase 2 Trial in Psoriatic Arthritis. Ann Rheum Dis. (In Press)

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Julianne Hatfield, PhD at Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb.

Disclosure of Interests

Atul Deodhar Consultant of: Consulting and/or advisory boards: AbbVie, Amgen, Aurinia, Bristol Myers Squibb, Celgene, Eli Lilly, GlaxoSmithKline, Janssen, MoonLake, Novartis, Pfizer, UCB;, Grant/research support from: Research grants: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, UCB., Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, June Ye Shareholder of: Employees and shareholders of Bristol Myers Squibb, Employee of: Employees and shareholders of Bristol Myers Squibb, Thomas Lehman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Lan Wei Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Subhashis Banerjee Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Philip J Mease Consultant of: Consulting and/or speaker fees: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB., Grant/research support from: Research grants: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB;

POS1039 DEUCRAVACITINIB, AN ORAL, SELECTIVE TYROSINE KINASE 2 INHIBITOR, IN A PHASE 2 TRIAL IN PSORIATIC ARTHRITIS: ACHIEVEMENT OF MINIMAL DISEASE ACTIVITY AND ITS COMPONENTS

Background

Tyrosine kinase 2 (TYK2) is an intracellular kinase in the Janus kinase (JAK) family that mediates the signalling of multiple cytokines, including those central to the immunopathogenesis of psoriatic arthritis (PsA), such as IL-23. Deucravacitinib (DEUC) is a novel, oral, selective, allosteric inhibitor of TYK2 that acts by binding to the unique regulatory domain on the enzyme. In a Phase 2 trial in patients with active PsA, DEUC was significantly more efficacious than placebo (PBO) after 16 weeks of treatment and was well tolerated.1

Objectives

This analysis further evaluated the effect of DEUC in this trial on achievement of individual components of minimal disease activity (MDA).

Methods

This double-blind, multicenter Phase 2 trial (NCT03881059) enrolled patients (n=203) with a PsA diagnosis ≥6 months who fulfilled Classification Criteria for Psoriatic Arthritis at screening and had active joint disease (≥3 tender and ≥3 swollen joints), high-sensitivity C-reactive protein ≥3 mg/L, and ≥1 plaque psoriasis lesion (≥2 cm). Eligible patients had failed or were intolerant to ≥1 nonsteroidal anti-inflammatory, conventional synthetic DMARD, and/or 1 tumour necrosis factor inhibitor (≤30%). Patients were randomized 1:1:1 to receive PBO, DEUC 6 mg once daily (QD), or 12 mg QD. The percentage of patients achieving MDA (5/7: tender joint count [TJC] ≤1, swollen joint count [SJC] ≤1, tender entheseal points [TEP] ≤1, Patient Global Assessment of disease activity [PtGA] ≤20, Patient Global Assessment of pain [Pain] ≤15, Health Assessment Questionnaire-Disability Index [HAQ-DI] ≤0.5, and Psoriasis Area and Severity Index [PASI] ≤1 or body surface area [BSA] ≤3%) as well as proportions of patients achieving each of the MDA components in all patients, MDA responders, and nonresponders were assessed through Week 16.

Results

Of 203 patients randomized, 180 (89%) completed 16 weeks of treatment (PBO, 58/66 [88%]; DEUC 6 mg QD, 63/70 [90%]; DEUC 12 mg QD, 59/67 [88%]). Demographic and baseline disease characteristics were generally similar across groups. Although no patient had met 5 of 7 criteria required for achieving MDA at baseline, several individual components of MDA were met at baseline, most frequently TEP ≤1 (PBO, 57.6%; DEUC 6 mg QD, 64.3%; DEUC 12 mg QD, 65.7%). After 16 weeks of treatment, 7.6%, 22.9%, and 23.9% of patients in the PBO, DEUC 6 mg QD, and DEUC 12 mg QD groups, respectively, achieved MDA response. Treatment with DEUC was associated with a numerically greater mean reduction from baseline in all MDA components versus PBO over 16 weeks of treatment in all patients. At Week 16, more patients receiving DEUC versus PBO achieved the threshold for each of the MDA components (Figure 1).

Conclusion

In this study, patients treated with DEUC achieved a higher rate of MDA response compared with patients treated with PBO after 16 weeks of treatment. More patients receiving DEUC treatment achieved each of the MDA components compared with patients receiving PBO.

References

[1]Mease PJ et al. Efficacy and Safety of Selective TYK2 Inhibitor, Deucravacitinib, in a Phase 2 Trial in Psoriatic Arthritis. Ann Rheum Dis. (In Press).

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Julianne Hatfield, PhD at Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb.

Disclosure of Interests

Arthur Kavanaugh Grant/research support from: Clinical research sponsored by Abbott, Amgen, Janssen, and UCB, Laura Coates Speakers bureau: Has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB., Consultant of: Worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB., Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis, Joseph F. Merola Consultant of: Consultant and/or investigator: Amgen, AbbVie, Biogen, Bristol-Myers Squibb, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB., Philip J Mease Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB., Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Subhashis Banerjee Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Lauren Hippeli Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Thomas Lehman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

AB0883 Real-World Treatment Patterns In Patients With Psoriatic Arthritis

Background

Psoriatic arthritis (PsA) is a complex inflammatory disease with manifestations that play an important role in treatment selection.1 Treatments include oral agents, biologic therapies (inhibitors of tumor necrosis factor [TNFi], interleukin [IL-17Ai, IL-12/23i], cytotoxic T lymphocyte–associated antigen 4 inhibitor [CTLA-4i]), and new targeted oral agents (inhibitors of phosphodiesterase-4 [PDE-4i] and Janus kinase [JAKi]).1 Few studies have examined real-world treatment patterns of recently approved therapies.

Objectives

Evaluate real-world treatment patterns for branded systemic therapy in patients with PsA.

Methods

In this retrospective study, medical and pharmacy claims from the US IBM MarketScan Commercial and Medicare databases (1/1/2012–12/31/2019) were used to identify patients with PsA who initiated treatment with a TNFi (adalimumab, etanercept, infliximab, golimumab, or certolizumab), IL-17Ai (secukinumab, ixekizumab), IL-12/23p40i (ustekinumab), IL-23p19i (guselkumab), CTLA-4i (abatacept), JAKi (tofacitinib), or PDE-4i (apremilast). Patients (≥18 years) with ≥1 prescription, ≥2 PsA claims separated by ≥1 day on or before the index date (first prescription date [1/1/13–12/31/2018]), and 1-year continuous enrollment before and after the index date were eligible. Treatment patterns were grouped into continuers, discontinuers, and patients with treatment modification (switchers [without a treatment gap], reinitiators [same drug with a treatment gap], and restarters [different drug with a treatment gap]) (Table 1). Patients were followed for 1 year or until treatment modification, whichever came first. Descriptive statistics were used.

Table 1.

Terminology

CohortDefinitionn/N (%)ContinuersOn index treatment during 1-year follow-up with no treatment gaps*1910/6455 (29.6)DiscontinuersNo prescription claims for any therapy during 1-year follow-up1614/6455 (25.0)Patients with treatment modificationsAll patients with a change in treatment during 1-year follow-up2908/6455 (45.1)SwitchersPrescription claims for treatments different than index therapy before permissible treatment gaps*794/6455 (12.3)ReinitiatorsPrescription claims for treatments SAME as index therapy AFTER treatment gaps*1686/6455 (26.1)RestartersPrescription claims for DIFFERENT therapy AFTER treatment gap*428/6455 (6.6)

Note: All terminology applies to cohorts within the first year of treatment.

*Treatment gap: gap of 200% of recommended dosing schedule from end of previous prescription’s days’ supply.

Results

A total of 6455 patients were included (mean age, 50.5 years; 55.5% female; mean Charlson Comorbidity Index score, 0.54). At baseline, the most commonly used therapies were immunosuppressants (58.5%), corticosteroids (52.2%), and nonsteroidal anti-inflammatory drugs (45.9%). Treatments most used at index were TNFi (72.5%; including adalimumab [41.6%] and etanercept [23.8%]) and the PDE-4i apremilast (21.1%). During the 1-year study period, 29.6% of patients maintained their index therapy and 25.0% discontinued. Treatment modification was observed in 45.1% of patients; 12.3% switched to a new therapy without a treatment gap, 26.1% restarted their index therapy, and 6.6% started a new therapy after a treatment gap.

Conclusion

Among patients with PsA, there is substantial variability, including high rates of discontinuation within the first year and after index therapy. Further studies are warranted to understand reasons for these treatment patterns.

References

[1]Ogdie A et al. Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford). 2020;59(Suppl 1):i37-i46.

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Statistical analysis support was provided by Arindom Borkakoti, formerly of Mu Sigma. Professional medical writing assistance was provided by LeeAnn Braun, MPH, MEd, of Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb.

Disclosure of Interests

Jiyoon Choi Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Antoine Sreih Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Thomas Lehman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Manasi Suryavanshi Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Qian Xia Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

AB0886 The Impact of Deucravacitinib on Health-Related Quality of Life Measured by the Short Form Health Survey 36-Item Questionnaire: Analysis of a Phase 2 Trial in Patients With Active Psoriatic Arthritis

Background

Patients (pts) with psoriatic arthritis (PsA) experience pain, loss of physical function, joint damage, and significant impairments in social and emotional well-being. The Short Form Health Survey 36-item questionnaire (SF-36v2), a generic measure of pt-reported health-related quality of life (HRQOL), includes 36 items and measures 8 domains—physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health (MH)—that contribute to both physical component summary (PCS) and mental component summary (MCS) scores. Deucravacitinib (DEUC) is a novel, oral, selective, allosteric inhibitor of tyrosine kinase 2 (TYK2), an intracellular kinase that mediates cytokine signalling pathways implicated in PsA pathogenesis. In a Phase 2 trial in pts with active PsA, DEUC was well tolerated and significantly more efficacious than placebo (PBO) after 16 weeks (wks) of treatment.1

Objectives

To further evaluate the effect of DEUC treatment on SF-36 scores.

Methods

This double-blind Phase 2 trial (NCT03881059) enrolled pts with a PsA diagnosis ≥6 months who fulfilled Classification Criteria for Psoriatic Arthritis at screening and had active joint disease (≥3 tender and ≥3 swollen joints), high-sensitivity CRP ≥3 mg/L, and ≥1 plaque psoriasis lesion (≥2 cm). Pts failed or were intolerant to ≥1 nonsteroidal anti-inflammatory, conventional synthetic DMARD, and/or 1 TNF inhibitor (≤30%). Pts were randomised 1:1:1 to DEUC 6 mg once daily (QD) or 12 mg QD, or PBO. Changes from baseline (BL) in SF-36 PCS and MCS scores at Wk 16 were prespecified key secondary and additional endpoints, respectively. The 8 SF-36 domain scores were evaluated at Wk 16. The proportions of pts reporting improvements ≥2.5 and ≥5 points (the minimum clinically important difference [MCID]) in SF-36 summary and domain scores, respectively, were evaluated.

Results

Of 203 pts randomised, 180 (89%) completed 16 wks of treatment (DEUC 6 mg QD, 63/70 [90%]; DEUC 12 mg QD, 59/67 [88%]; PBO, 58/66 [88%]). Demographic and BL disease characteristics were similar across groups. BL mean SF-36 PCS and MCS scores were similar among DEUC 6 mg QD, 12 mg QD, and PBO groups (PCS: 34.0, 34.5, and 33.4; MCS: 45.4, 46.9, and 47.5, respectively). At Wk 16, adjusted mean changes from BL in SF-36 PCS and MCS scores were significantly improved with DEUC 6 and 12 mg QD treatment vs PBO (PCS: 5.6, 5.8, and 2.3; MCS: 3.6, 3.5, and 0.7, respectively; P<0.05). Reported improvements in domain scores with both doses exceeded MCID and were significant in 5 of 8 domains with DEUC 6 mg QD (PF, RP, BP, VT, and SF) and 6 of 8 domains with DEUC 12 mg QD (RE in addition; Figure 1 and Table 1).

Table 1.

Improvements reported in SF-36 domains with deucravacitinib 6 mg QD and 12 mg QD vs placebo at Week 16

PFRPBPGHVTSFREMHDeucravacitinib 6 mg – BL41.942.932.539.639.057.069.558.4Deucravacitinib 12 mg – BL44.146.033.438.543.065.571.559.2Placebo – BL42.442.831.740.338.863.875.159.9Deucravacitinib 6 mg – LSM Wk 1614.612.315.99.511.713.26.98.1Deucravacitinib 12 mg – LSM Wk 1613.313.519.58.412.110.58.78.2Placebo – LSM Wk 163.35.37.06.24.2-0.21.63.6Protocol A/G norms81.181.972.570.259.185.188.076.2

Domain scores range from 0-100, with higher scores indicating better health status.

A/G, age/gender; BL, baseline; BP, bodily pain; GH, general health; LSM, least square mean change; MH, mental health; PF, physical functioning; QD, once daily; RE, role-emotional; RP-role-physical; SF, social functioning; SF-36, Short Form-36; VT, vitality; Wk, week.

Conclusion

Pts with PsA treated with DEUC reported clinically meaningful and significant improvements in HRQOL, including fatigue, social functioning and role emotional in addition to physical functioning, role physical and pain, at Wk 16.

References

[1]Mease PJ et al. Efficacy and Safety of Selective TYK2 Inhibitor, Deucravacitinib, in a Phase 2 Trial in Psoriatic Arthritis. Ann Rheum Dis. (In Press)

Acknowledgements

The study was sponsored by Bristol Myers Squibb. Professional medical writing assistance from Julianne Hatfield, PhD was provided by Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb.

Disclosure of Interests

Vibeke Strand Consultant of: AbbVie, Amgen, BMS, Boehringer Ingelheim, Celltrion, Galapagos, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Rheos, Samsung, Sandoz, Sun Pharma, UCB., Philip J Mease Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Atul Deodhar Consultant of: Consulting and/or advisory boards: AbbVie, Amgen, Aurinia, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, MoonLake, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, UCB, June Ye Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Jiyoon Choi Shareholder of: Employee of Bristol Myers Squibb at time of study conduct, Employee of: Employee of Bristol Myers Squibb at time of study conduct, Brandon Becker Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

POS0005 BASELINE BIOMARKERS PREDICT BETTER RESPONSES TO DEUCRAVACITINIB, AN ORAL, SELECTIVE TYROSINE KINASE 2 (TYK2) INHIBITOR, IN A PHASE 2 TRIAL IN PSORIATIC ARTHRITIS

Background

Deucravacitinib (DEUC) is a novel, oral, selective TYK2 inhibitor with a unique allosteric mechanism of action that has demonstrated efficacy in patients with psoriasis (PsO)1 and psoriatic arthritis (PsA).2 TYK2 mediates signalling of select immune cytokines, eg, interleukin (IL) 23, IL-12, and Type I interferons, whereas the related Janus kinases (JAK) 1/2/3 mediate signalling of a wider array of cytokines and mediators involved in inflammatory, developmental, metabolic, and hematopoietic pathways. DEUC reduced inflammatory markers associated with skin and joint manifestations but did not result in laboratory abnormalities associated with inhibition of JAK1/2/3 in a PsA trial.3

Objectives

To identify baseline biomarkers that predict response to DEUC in patients with PsA.

Methods

The double-blind Phase 2 trial (NCT03881059) enrolled 203 patients with PsA randomised 1:1:1 to placebo (PBO), DEUC 6 mg once daily (QD), or 12 mg QD.2 Molecular profiling of baseline serum samples was performed by immunoassays. Clinical response at Week 16 was measured by ≥20% improvement from baseline in American College of Rheumatology Improvement Criteria (ACR 20) and ≥75% improvement from baseline in Psoriasis Area and Severity Index (PASI 75) scores.

Results

Biomarkers of the IL-23/T helper cell type 17 pathway, including IL-17A, IL-17‒induced β-defensin 2 (BD2), and IL-19, were associated with higher PASI but not Psoriatic Arthritis Disease Activity Scores overall at baseline. PASI 75 responders in DEUC-treated groups had higher baseline levels of IL-17A compared with nonresponders. In contrast, PASI 75 responders in PBO-treated patients had lower baseline expression of IL-17A, BD2, and IL-19 compared with nonresponders. In patients treated with DEUC 12 mg QD, greater reductions in BD2 were observed in the PASI 75 responder group compared with nonresponder group. When patients were dichotomised by median baseline biomarker level, higher clinical responses in both PASI 75 and ACR 20 were achieved in those with higher baseline overall biomarker levels in the DEUC-treated groups compared with the PBO group. Higher baseline expression of IL-23 biomarkers IL-17A, IL-19, and BD2 enriched ACR 20 response in patients treated with DEUC compared with PBO (OR=5.64, 6.68, and 4.99, respectively). While greater benefit was observed in high-biomarker groups, the low-biomarker populations still manifested clinical responses although not significant (Figure 1).

Conclusion

Patients who had higher expression of IL-23 pathway biomarkers were more likely to benefit from DEUC compared with placebo in skin and joint manifestations of PsA. These results reinforce the value of TYK2 inhibition in patients with IL-23‒mediated diseases. The potential value of IL-23-pathway markers in predicting higher responses to DEUC should be further explored in larger trials.

References

[1]Armstrong A et al. Presented at American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021.

[2]Mease PJ et al. Efficacy and Safety of Selective TYK2 Inhibitor, Deucravacitinib, in a Phase 2 Trial in Psoriatic Arthritis. Ann Rheum Dis. (In Press).

[3]FitzGerald O et al. Presented at the 2021 ACR Convergence, American College of Rheumatology; Nov 3-9, 2021.

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Julianne Hatfield, PhD at Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb.

Disclosure of Interests

Oliver FitzGerald Consultant of: Consulting and/or speaker fees: Biogen, and Novartis., Grant/research support from: Research grants: BMS, Novartis, Pfizer, UCB, Lilly., Dafna D Gladman Consultant of: Consulting fees: AbbVie, Amgen, BMS, Galapagos, Gilead, Eli Lilly, Janssen, Novartis, Pfizer, and UCB., Grant/research support from: Research grants: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Philip J Mease Consultant of: Consulting and/or speaker fees: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, and UCB., Grant/research support from: Research grants: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Christopher T. Ritchlin Consultant of: Consultant: AbbVie, Amgen, Janssen, Lily, Novartis, Pfizer, Regeneron, Sun, UCB;, Grant/research support from: Grants / Research Support: AbbVie, Amgen, UCB, Josef S. Smolen Consultant of: Consulting and/or speaker fees: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos-Gilead, Janssen, Merck-Sharp-Dohme, Novartis-Sandoz, Pfizer, Roche-Chugai, Samsung, and UCB., Grant/research support from: Research grants: AbbVie, AstraZeneca, Eli Lilly, Novartis, Lu Gao Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Sarah Hu Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Miroslawa Nowak Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Subhashis Banerjee Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Ian Catlett Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb.

POS1048 SAFETY AND EFFICACY OF DEUCRAVACITINIB, AN ORAL, SELECTIVE TYROSINE KINASE 2 INHIBITOR, IN PATIENTS WITH PSORIATIC ARTHRITIS: 52-WEEK RESULTS FROM A RANDOMISED PHASE 2 TRIAL

Background

Deucravacitinib (DEUC) is a novel, oral, selective, allosteric inhibitor of tyrosine kinase 2 (TYK2) that acts by binding to the unique TYK2 regulatory domain, thereby suppressing signalling of key cytokines (eg, IL-23) involved in skin psoriasis and psoriatic arthritis (PsA) pathogenesis. Results from the initial 16-week (wk), placebo (PBO)-controlled period (Part A) of a 52-wk, blinded Phase 2 trial in PsA showed that DEUC was significantly more efficacious than PBO.1 The Psoriatic Arthritis Disease Activity Score (PASDAS), a validated comprehensive measure assessing a variety of PsA clinical domains, was used to assess efficacy of DEUC up to 52 wks.

Objectives

Evaluate the safety and efficacy of DEUC in Part B (Wks 16-52) in the Phase 2 PsA trial.

Methods

Patients (pts) with PsA were randomised 1:1:1 to PBO, DEUC 6 mg once daily (QD), or 12 mg QD. After Wk 16 (Part A), pts could enrol in an optional, double-blind period until Wk 52 (Part B). In Part B, pts receiving DEUC who had achieved minimal disease activity (MDA) at Wk 16 continued DEUC treatment and those who had not achieved MDA were switched to ustekinumab (UST) at the approved PsA dose. All pts treated with PBO in Part A switched to UST in Part B. Pts were assessed up to 52 wks for adverse events (AEs) and exploratory efficacy endpoints including change in PASDAS. Analyses were descriptive using data as observed.

Results

Of 203 pts randomised in Part A, 180 (89%) completed 16 wks of treatment and 173 (96%) of these pts chose to enrol in Part B. Of 118 pts initially randomised to DEUC, 25% (29/118; 6 mg QD, 22% [13/60]; 12 mg QD, 28% [16/58]) achieved MDA at Wk 16 and continued at the same dose. All other pts switched to UST in Part B: PBO, 100% (55/55; including 5 pts who had achieved MDA at Wk 16); DEUC 6 mg QD, 78% (47/60); DEUC 12 mg QD, 72% (42/58). The safety profile of DEUC in Part B (Table 1) was consistent with that in Part A, and all AEs were mild or moderate except 2 AEs in 1 pt with severe cataract/macular fibrosis. There were no opportunistic infections, herpes zoster, malignancy, thrombotic events, or treatment-related serious AEs reported in pts who remained on DEUC. Decreases in mean PASDAS score observed at Wk 16 were maintained at Wk 52 in pts who continued on DEUC (Figure 1). Improvements in other outcomes, including ACR components, PASI, and FACIT-Fatigue, were also sustained at Wk 52 in pts who continued DEUC treatment. Pts who had not achieved MDA on DEUC at Wk 16 showed a decrease in mean PASDAS score at Wk 52 after switching to UST.

Table 1.

Overall summary of safety in Part B (Weeks 16 to 52)

AE, n (%)aDEUC 6 mg QD n = 13DEUC 12 mg QD n = 16DEUC 6 mg QD →UST n = 47DEUC 12 mg QD → UST n = 42PBO → UST n = 55Total AEs11 (84.6)8 (50.0)26 (55.3)26 (61.9)30 (54.5)Deaths001 (2.1)d1 (2.4)d0SAE1 (7.7)b03 (6.4)4 (9.5)0Treatment-related SAE00000Discontinued due to AE01 (6.3)c02 (4.8)c,e0

Includes all treated patients in Part B. Medical Dictionary for Regulatory Activities version 23.0 was used. an is the number of patients who experienced an event. bOne patient had SAEs of psoriatic arthropathy in 1 joint and peripheral neuropathy. cPatient had an AE of COVID-19 infection leading to discontinuation. dDeaths in UST arms were due to car accident and sudden death in a 71-year-old patient with hypertension. ePatient had an AE of urinary tract infection leading to discontinuation.

AE, adverse event; DEUC, deucravacitinib; PBO, placebo; QD, once daily; SAE, serious adverse event; UST, ustekinumab.

Conclusion

In the 16- to 52-wk blinded Part B of a Phase 2 study in pts with PsA, no new safety signals were observed with continuous DEUC treatment vs the earlier Part A period. Efficacy in PASDAS, as well as other key efficacy measures, was maintained with continued DEUC treatment through Wk 52.

References

[1]Mease PJ et al. Efficacy and Safety of Selective TYK2 Inhibitor, Deucravacitinib, in a Phase 2 Trial in Psoriatic Arthritis. Ann Rheum Dis. (In Press).

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Julianne Hatfield, PhD at Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb. The authors acknowledge Jonghyeon Kim, PhD, who was employed by Bristol Myers Squibb at the time the study was conducted, for his statistical assistance.

Disclosure of Interests

Philip J Mease Consultant of: Consulting and/or speaker fees: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, and UCB., Grant/research support from: Research grants: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, and UCB;, Atul Deodhar Consultant of: Consulting and/or advisory boards: AbbVie, Amgen, Aurinia, Bristol Myers Squibb, Celgene, Eli Lilly, GlaxoSmithKline, Janssen, MoonLake, Novartis, Pfizer, UCB, Grant/research support from: Research grants: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, and UCB., Désirée van der Heijde Consultant of: Consulting fees: AbbVie, Bayer, Bristol Myers Squibb, Cyxone, Eisai, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB Pharma; Director: Imaging Rheumatology BV., Frank Behrens Consultant of: Consultancies/speaker fees: AbbVie, Amgen, Boehringer, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly, Boehringer, Sandoz, and Sanofi., Grant/research support from: Research Support: AbbVie, Pfizer, Roche, Chugai, Prophylix, Novartis, and Amgen, Alan Kivitz Shareholder of: Shareholder: Pfizer, Sanofi, GlaxoSmithKline, Gilead Sciences, Inc., Novartis, Consultant of: Paid Consultant: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc., Speakers bureau: Celgene, Merck, Lilly, Novartis, Pfizer, Sanofi, Genzyme, Flexion, AbbVie., Jeffrey Neal Grant/research support from: Research grants to foundation: AbbVie, Amgen, Eli Lilly, Genentech, Novartis, UCB, Pfizer, Gilead, and Bristol Myers Squibb., Marleen Nys Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Thomas Lehman Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Nikolay Delev Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Shimon Korish Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Miroslawa Nowak Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb., Subhashis Banerjee Shareholder of: Bristol Myers Squibb., Employee of: Bristol Myers Squibb.

Cancer Immunoediting: Elimination, Equilibrium, and Immune Escape in Solid Tumors

Emphasizing the dynamic processes between cancer and host immune system, the initially discovered concept of cancer immunosurveillance has been replaced by the current concept of cancer immunoediting consisting of three phases: elimination, equilibrium, and escape. Solid tumors composed of both cancer and host stromal cells are an example how the three phases of cancer immunoediting functionally evolve and how tumor shaped by the host immune system gets finally resistant phenotype. The elimination, equilibrium, and escape have been described in this chapter in details, including the role of immune surveillance, cancer dormancy, disruption of the antigen-presenting machinery, tumor-infiltrating immune cells, resistance to apoptosis, as well as the function of tumor stroma, microvesicles, exosomes, and inflammation.

Seeking relationships between Internet addiction and depressiveness, daytime sleepiness, as well as perceived social support in young adults

OBJECTIVE

An assessment of the scale of Internet addiction among young adults and seeking relationships between Internet addiction and chosen sociodemographic variables, perceived social support, prevalence of depressiveness, and excessive daytime sleepiness.

PATIENTS AND METHODS

The study was carried out using a diagnostic poll method with author's own questionnaire as well as standardized diagnostic tools: The Internet Addiction Test (IAT), the Beck Depression Inventory (BDI), The Epworth Sleepiness Scale (ESS), as well as The Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

The study was conducted on 567 individuals. Pathological Internet use was identified in 1.41% of the surveyed. Perceived social support was significantly lower in the group of respondents who pathologically used Internet in comparison with ones who used Internet in the proper way. Severity of depressiveness symptoms and daytime sleepiness was significantly higher in respondents who were addicted to Internet in comparison with not addicted individuals.

CONCLUSIONS

The scale of pathological Internet use among surveyed was low. Problematic Internet use refers to women and men to the same degree, as well as to single people and individuals in relationships. Persons who work and do not study as well as residents of large and medium cities more frequently use Internet in a more pathological way than individuals who study and live-in small cities and in the countryside. Internet addiction creates a significant relationship with the prevalence of more severe symptoms of depressiveness and excessive daytime sleepiness, whereas pathological pattern of Internet use more often concerns individuals whose perception of social support is low.

Chemokine expression in patients with ovarian cancer or benign ovarian tumors

INTRODUCTION

Chemokines play a crucial role in tumor growth and progression according to proangiogenic and immunosuppressive action. The aim of this study was to investigate the serum levels of selected chemokines in patients with ovarian cancer or benign ovarian tumors to assess their role in tumorigenesis and their potential use in preoperative diagnosis of an adnexal mass.

MATERIAL AND METHODS

The study group consisted of 59 women with ovarian cancer: 17 epithelial ovarian cancer (EOC) patients and 42 women with benign ovarian tumors. We measured in sera obtained preoperatively the level of CA125 and a panel of 5 chemokines - CX3CL1/fractalkine, CXCL1/GRO-α, CXCL12/SDF-1, CCL20/MIP-3α and IL-17F - using the chemiluminescence method with multiplexed bead based immunoassay.

RESULTS

CX3CL1 was significantly elevated in sera of advanced ovarian cancer patients compared to women with benign ovarian tumors. The significant elevation of CXCL1 was also observed (both early and advanced stages). A similar pattern was present with the standard ovarian cancer marker CA125. In our patients with endometriotic cysts CA125 levels were significantly higher than in women with other benign tumors, whereas all analyzed chemokines had similar serum titers in patients with endometriotic vs. other benign ovarian cysts.

CONCLUSIONS

CX3CL1 and CXCL1 are elevated in sera of EOC patients, which indicates their role in cancer development. Moreover, they might be useful in preoperative differential diagnosis of ovarian tumors, especially as they were not elevated in cases of endometriosis.

A novel method to assess the spatiotemporal image quality in fluoroscopy

Objectives. The planar formulation of the noise equivalent quanta (NEQ) and detective quantum efficiency (DQE) used to assess the image quality of projection images does not deal with the influence of temporal resolution on signal blurring and image noise. These metrics require correction factors based on temporal resolution when used for dynamic imaging systems such as fluoroscopy. Additionally, the standard NEQ and detector DQE are determined on pre-processed images in scatter-free conditions for effective energies produced by additional aluminium or copper filters that are not representative of clinical fluoroscopic procedures. In this work, we developed a method to measure 'frame NEQ' and 'frame system DQE' which include the temporal frequency bandwidth and consider the anti-scatter grid, the detector and the image processing procedures for beam qualities with scatter fractions representative of clinical use.Approach. We used a solid water phantom to simulate a patient and a thin copper disc to measure the spatial resolution. The copper disc, set in uniform rectilinear motion in the image plane, assessed the temporal resolution. These new metrics were tested on two fluoroscopy systems, a C-arm and a floor-mounted cardiology, for multiple parameters: phantom thicknesses from 5 to 20 cm, frame rates from 3 to 30 fps, spatial and temporal image processing of different weights.Main results.The frame NEQ correctly described the image quality for different scatter conditions, temporal resolutions and image processing techniques. The frame system DQE varied between 0.38 and 0.65 within the different beam and scatter conditions, and correctly mitigated the influence of spatial and temporal image processing.Significance.This study introduces and validates an unbiased formulation of in-plane NEQ and system DQE to assess the spatiotemporal image quality of fluoroscopy systems.

The implication of IL-6 in the invasiveness and chemoresistance of ovarian cancer cells. Systematic review of its potential role as a biomarker in ovarian cancer patients

Interleukin 6 (IL-6) is a pleiotropic cytokine that is strongly implicated in the development and progression of ovarian cancer. The most recognized actions of IL-6 in ovarian cancer (OC) cells are the induction of cell proliferation and inhibition of cell apoptosis. Equally important is its ability to enhance the migratory and invasive potential of OC cells. Moreover, the increased expression and secretion of this cytokine positively correlates with OC cell chemoresistance. Elevated concentrations of IL-6 are observed in the serum and ascites of ovarian cancer patients. Thus, its level is discussed in the literature as a potential biomarker that can help to discriminate malignant and nonmalignant ovarian tumors and allow for the prediction of the chemotherapy response. The importance of IL-6 in ovarian cancer is proved by the fact that this cytokine is a potential target to anti-cancer therapy. This review is divided into two parts. The first summarizes the general biological activity of IL-6, and overviews its impact on OC cells, as well as discusses the current proposition of IL-6 inclusion in combination of anti-OC therapy. The second part is a systematic review of IL-6 as a possible biomarker in ovarian cancer patients.

Performance and automation of ancient DNA capture with RNA hyRAD probes

DNA hybridization-capture techniques allow researchers to focus their sequencing efforts on preselected genomic regions. This feature is especially useful when analysing ancient DNA (aDNA) extracts, which are often dominated by exogenous environmental sources. Here, we assessed, for the first time, the performance of hyRAD as an inexpensive and design-free alternative to commercial capture protocols to obtain authentic aDNA data from osseous remains. HyRAD relies on double enzymatic restriction of fresh DNA extracts to produce RNA probes that cover only a fraction of the genome and can serve as baits for capturing homologous fragments from aDNA libraries. We found that this approach could retrieve sequence data from horse remains coming from a range of preservation environments, including beyond radiocarbon range, yielding up to 146.5-fold on-target enrichment for aDNA extracts showing extremely low endogenous content (<1%). Performance was, however, more limited for those samples already characterized by good DNA preservation (>20%-30%), while the fraction of endogenous reads mapping on- and off-target was relatively insensitive to the original endogenous DNA content. Procedures based on two instead of a single round of capture increased on-target coverage up to 3.6-fold. Additionally, we used methylation-sensitive restriction enzymes to produce probes targeting hypomethylated regions, which improved data quality by reducing post-mortem DNA damage and mapping within multicopy regions. Finally, we developed a fully automated hyRAD protocol utilizing inexpensive robotic platforms to facilitate capture processing. Overall, our work establishes hyRAD as a cost-effective strategy to recover a set of shared orthologous variants across multiple ancient samples.

OP0227 EFFICACY OF DEUCRAVACITINIB, AN ORAL, SELECTIVE TYROSINE KINASE 2 INHIBITOR, IN MUSCULOSKELETAL MANIFESTATIONS OF ACTIVE PSORIATIC ARTHRITIS IN A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Background:

Tyrosine kinase 2 (TYK2) is an intracellular kinase that mediates IL-23, IL-12, and IFNα/β signaling. Deucravacitinib is a novel, oral selective inhibitor of TYK2 acting via the TYK2 regulatory domain. Phase 2 results showed deucravacitinib was efficacious and well tolerated versus placebo (PBO) in patients with active psoriatic arthritis (PsA).

Objectives:

This analysis further evaluated improvements in musculoskeletal disease manifestations in patients in the Phase 2 PsA trial.

Methods:

The ongoing Phase 2 trial (NCT03881059) enrolled patients who had a PsA diagnosis for ≥6 months, met CASPAR criteria, had active disease (≥3 tender joints, ≥3 swollen joints, C-reactive protein [CRP] ≥3 mg/L), and had at least 1 active skin lesion. Patients either failed or were intolerant to at least 1 nonsteroidal anti-inflammatory drug, corticosteroid, conventional synthetic disease-modifying antirheumatic drug, and/or 1 TNF inhibitor (TNFi; ≤30%). Patients were randomized 1:1:1 to deucravacitinib 6 mg QD or 12 mg QD or PBO, and stratified by TNFi status (experienced vs naive) and body weight (<90 vs ≥90 kg). The primary endpoint, ACR20 response at Week 16, was met and significant improvements in enthesitis vs PBO were observed. The current prespecified subgroup analysis assessed the likelihood of achieving ACR20 response at Week 16 based on study stratification factors. A post hoc analysis evaluated mean change from baseline to Week 16 in ACR components (tender joint count, swollen joint count, Physician’s Global Assessment of PsA, Patients’ Global Assessment of disease activity, Patients’ Global Assessment of pain, high-sensitivity CRP [hCRP], and HAQ-DI score). Analyses were descriptive using data as observed.

Results:

Patients treated with deucravacitinib were numerically more likely to achieve ACR20 response at Week 16 compared with PBO-treated patients regardless of TNFi experience or body weight, although some of these groups were small (Figure). Improvements for deucravacitinib 6 mg and 12 mg QD versus PBO were observed in all ACR components, with apparent separation occurring as early as Week 4 on, for example, HAQ-DI (mean change from baseline, -0.2 vs -0.2 vs -0.1, respectively) and hCRP (mean change from baseline, -7.4 vs -5.2 vs 0.3, respectively) and maintained through Week 16 (Table).

Table 1.

Mean (SD) change from baseline for ACR components

TJCSJCPtGAPainPGAHAQ-DIhCRPBaselineaPBO16.9 (9.8)10.5 (7.7)66.2 (15.8)64.9 (18.2)63.8 (14.8)1.3 (0.6)20.4 (39.1)DEUC 618.1 (10.3)11.9 (7.0)68.2 (16.8)63.6 (21.7)68.2 (14.7)1.3 (0.6)17.6 (23.6)DEUC1219.4 (11.8)11.3 (9.0)63.6 (15.6)63.8 (15.9)63.3 (16.1)1.3 (0.6)16.5 (21.7)Week 16bPBO-4.6 (9.7)-4.3 (8.0)-13.4 (23.5)-13.8 (21.5)-19.9 (21.8)-0.1 (0.4)-3.3 (22.6)DEUC 6-9.3 (9.7)-7.7 (5.8)-28.7 (23.1)-25.3 (26.1)-33.6 (23.0)-0.4 (0.5)-14.2 (24.5)DEUC 12-12.2 (10.2)-8.5 (9.1)-27.6 (25.8)-27.5 (25.0)-32.2 (25.0)-0.4 (0.6)-10.9 (22.8)

PBO, n/N=58/66; DEUC 6, n/N=63/70; DEUC 12, n/N=59/67; n/N = number of patients who completed treatment/number of patients randomized; the number of patients with data available for individual components at each time point may vary.

aMean (SD). bMean (SD) change from baseline.

ACR, American College of Rheumatology; DEUC 6, deucravacitinib 6 mg QD; DEUC 12, deucravacitinib 12 mg QD; HAQ-DI, Health Assessment Questionnaire-Disability Index total score; hCRP, high-sensitivity C-reactive protein; PBO, placebo; PGA, Physician’s Global Assessment of psoriatic arthritis; PtGA, Patients’ Global Assessment of disease activity; QD, once daily; SJC, swollen joint count; TJC, tender joint count.

Conclusion:

Analyses confirmed the efficacy of deucravacitinib versus PBO across TNFi and body weight subgroups. With deucravacitinib treatment, improvements were displayed in all ACR components.

Acknowledgements:

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Peloton Advantage, LLC, an OPEN Health company, and funded by Bristol Myers Squibb.

Disclosure of Interests:

Philip J Mease Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, UCB, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma. Director of Imaging Rheumatology BV, Frank Behrens Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche, Chugai, Bristol Myers Squibb, UCB Pharma, Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Roche, Alan Kivitz Shareholder of: Pfizer, Sanofi, GlaxoSmithKline, Gilead Sciences, Inc., Novartis; Paid consultant: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc, Speakers bureau: Amgen, Horizon, Lilly, Novartis, Pfizer, Sanofi, Genzyme, Flexion, AbbVie, Thomas Lehman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Lan Wei Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Marleen Nys Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Subhashis Banerjee Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

AB0560 EFFECT OF DEUCRAVACITINIB ON THE PSORIATIC ARTHRITIS IMPACT OF DISEASE (PsAID) QUESTIONNAIRES 12 AND 9: ANALYSIS OF A PHASE 2 STUDY OF ACTIVE PSORIATIC ARTHRITIS

Background:

Tyrosine kinase 2 (TYK2) is an intracellular kinase that mediates IL-23, IL-12, and IFNα/β signaling. Deucravacitinib is a novel, oral selective inhibitor of TYK2 via the TYK2 regulatory domain. Phase 2 results showed deucravacitinib was efficacious and well tolerated versus placebo (PBO) in patients (pts) with active psoriatic arthritis (PsA). The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire is a EULAR-developed, validated instrument designed to specifically assess the impact of PsA on health-related quality of life (HRQoL) from the pt’s perspective and is available as separate versions for clinical practice (PsAID-12) and clinical trials (PsAID-9).1

Objectives:

To compare the effect of deucravacitinib vs PBO on PsAID-12 and PsAID-9 responses and to assess relationships between PsAID scores and clinical and pt-reported outcome (PRO) measures.

Methods:

This is an ongoing, 1-year, double-blind, Phase 2 trial (NCT03881059). Pts with active PsA were randomized 1:1:1 to deucravacitinib 6 mg or 12 mg once daily, or PBO for 16 weeks (wk). PsAID-12 and PsAID-9, other PROs, and clinical response outcomes were assessed at baseline (BL) and Wk 16. Mean changes from BL in PsAID-12 and PsAID-9 total scores at Wk 16 were determined for each treatment group as well as by response outcomes (ie, achievement of response at Wk 16 for PROs and select clinical response outcomes; Table 1). Spearman correlations between PsAID-12 and PsAID-9 scores and clinical and PRO measures were also assessed.

Results:

203 pts were randomized and BL characteristics were similar across groups. Adjusted mean changes from BL in PsAID-12 and PsAID-9 scores at Wk 16 were significantly greater in the deucravacitinib groups vs PBO (Figure 1). Adjusted mean changes from BL in PsAID-12 and PsAID-9 scores at Wk 16 were significantly improved with deucravacitinib vs PBO in pts who achieved response for PROs, as well as PASDAS low disease activity and PASI 75 response (Table 1). Adjusted mean changes from BL were generally similar with deucravacitinib vs PBO in nonresponders. Spearman correlation analysis revealed significant correlations at BL and Wk 16 between PsAID-12 and PsAID-9 scores and clinical and PRO measures (P<0.0001).

Conclusion:

With deucravacitinib vs PBO, PsAID-12 and PsAID-9 scores were significantly improved vs BL at Wk 16. PsAID detected additional improvements among pts achieving response for multiple other PROs and select clinical outcome measures.

References:

[1]Gossec L et al. Ann Rheum Dis. 2014;73:1012-9.

Table 1.

Adjusted mean change from BL in PsAID-12 total scores at Wk 16 in patients who achieved PRO or clinical response

Mean change from BL in PsAID-12 total scoreResponse DefinitionPBOn=66Deucravacitinib6 mg QDn=70P valuevs PBODeucravacitinib12 mg QDn=67P valuevs PBOPROsPatient global VAS(≤ -10.0)-1.6 (n=40)-2.8 (n=54)0.0008-2.9 (n=48)0.0003Patient pain VAS(≤ -10.0)-2.3 (n=32)-3.4 (n=44)0.004-3.3 (n=45)0.004HAQ-DI(≤ -0.35)-2.8 (n=10)-3.8 (n=27)0.09-3.8 (n=27)0.11FACIT-Fatigue(≥ 4.0)-2.4 (n=27)-3.3 (n=36)0.02-3.6 (n=41)0.002SF-36 PCS(≥ 2.5)-1.7 (n=35)-2.7 (n=44)0.02-3.1 (n=43)0.001SF-36 MCS(≥ 2.5)-2.1 (n=21)-3.5 (n=33)0.005-3.8 (n=31)0.0009Clinician assessmentsPASDAS(≤ 3.2)-3.1 (n=6)-4.2 (n=14)0.004-4.5 (n=15)0.0006PASI 75(≥75% improvementfrom BL)-2.4 (n=11)-3.7 (n=25)0.05-3.9 (n=31)0.02

PsAID-9 results were generally consistent with PsAID-12 (data not shown).

Response definitions based on published literature.

Higher FACIT-Fatigue scores indicate less fatigue.

Higher SF-36 PCS and SF-36 MCS scores indicate less disability.

BL, baseline: FACIT, Functional Assessment of Chronic Illness Therapy; HAQ-DI, Health Assessment Questionnaire-Disability Index; MCS, Mental Component Summary; NA, not applicable; PASDAS, Psoriatic Arthritis Disease Activity Score; PASI, Psoriasis Area and Severity Index; PCS, Physical Component Summary; PRO, patient-reported outcome; QD, once daily; SF-36, 36-item Short Form Health Survey; VAS, visual analog scale.

Acknowledgements:

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Peloton Advantage, LLC, an OPEN Health company, and funded by Bristol Myers Squibb.

Disclosure of Interests:

Laure Gossec Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz, Sanofi, Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis, Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB; Grants: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB; Royalties: Novartis to husband, Philip J Mease Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Thomas Lehman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Lan Wei Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, June Ye Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Jiyoon Choi Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Joe Zhuo Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Brandon Becker Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb.

POS0198 EFFICACY AND SAFETY OF DEUCRAVACITINIB, AN ORAL, SELECTIVE TYROSINE KINASE 2 INHIBITOR, IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: RESULTS FROM A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Background:

Tyrosine kinase 2 (TYK2) is an intracellular kinase that mediates signaling by key cytokines involved in psoriatic arthritis (PsA) and plaque psoriasis (PsO) pathogenesis. Deucravacitinib is a novel oral agent that selectively inhibits TYK2 via an allosteric mechanism by binding to the nonconserved regulatory domain of the kinase. A previous Phase 2 trial in PsO had demonstrated that deucravacitinib was efficacious and well tolerated, with no laboratory abnormalities observed.

Objectives:

To evaluate the efficacy and safety of deucravacitinib in active PsA.

Methods:

This is an ongoing, 1-year, randomized, double-blind, placebo (PBO)-controlled (initial 16 weeks), multiregional, Phase 2 trial (NCT03881059). Eligible patients had a PsA diagnosis for ≥6 months, met CASPAR criteria, and had active disease with ≥3 tender and ≥3 swollen joints, C-reactive protein ≥3 mg/L (ULN, 5 mg/L), and ≥1 psoriatic lesion (≥2 cm). Patients had failed or were intolerant to ≥1 nonsteroidal anti-inflammatory drug, corticosteroid, conventional synthetic disease-modifying antirheumatic drug (csDMARD), and/or 1 TNF inhibitor (TNFi; ≤30%). Patients were randomized 1:1:1 to deucravacitinib 6 mg once daily (QD) or 12 mg QD, or PBO. The primary endpoint was achievement of ACR 20 response at Week 16. Additional endpoints included the proportion of patients achieving ACR 50/70 response, Health Assessment Questionnaire-Disability Index (HAQ-DI) response (≥0.35 improvement from baseline), enthesitis resolution (Leeds Index score of 0), minimal disease activity, change from baseline in SF-36 physical component score (SF-36 PCS) and mental component score (SF-36 MCS), Psoriasis Area and Severity Index (PASI) 75 response, adverse events (AEs), and laboratory parameters.

Results:

Of 203 patients randomized, 180 (89%) completed 16 weeks of treatment (deucravacitinib 6 mg QD, 63/70 [90%]; deucravacitinib 12 mg QD, 59/67 [88%]; PBO, 58/66 [88%]). Demographic and baseline disease characteristics were similar across groups. Mean age was 49.8 years, 51% of patients were female, median PsA duration was 4.5 years, 66% of patients used csDMARDs at baseline and throughout the study, and 15% had used a TNFi. This study met its primary endpoint, with deucravacitinib 6 mg and 12 mg QD demonstrating significantly higher ACR 20 responses versus PBO at Week 16 (Figure 1). Additional endpoints were also met with deucravacitinib versus PBO (Figure 1). Adjusted mean changes from baseline in SF-36 PCS and SF-36 MCS at Week 16, respectively, were significantly higher in the deucravacitinib 6 mg QD group (5.6 vs 2.3, P=0.0062; 3.6 vs 0.7, P=0.0211) and 12 mg QD group (5.8 vs 2.3, P=0.0042; 3.5 vs 0.7, P=0.0263) compared with PBO. PASI 75 responses were also significantly higher in the deucravacitinib groups (P≤0.0136 vs PBO). The most common AEs in the deucravacitinib 6 mg/12 mg/PBO groups, respectively, during the 16-week treatment period were nasopharyngitis (5.7%/17.9%/7.6%), sinusitis (0%/7.5%/0%), headache (7.1%/1.5%/4.5%), and rash (4.3%/6.0%/0%). No serious AEs, herpes zoster infections, opportunistic infections, or thrombotic events were reported in deucravacitinib-treated patients during this period. Additionally, no significant changes from baseline in hematologic parameters (lymphocytes, neutrophils, platelets, and hemoglobin) or serum lipids were observed with deucravacitinib treatment.

Conclusion:

Deucravacitinib was efficacious versus PBO over 16 weeks in patients with active PsA. Treatment was generally well tolerated and the safety and laboratory parameter profile of deucravacitinib was consistent with that observed in an earlier Phase 2 PsO trial.

Acknowledgements:

This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Peloton Advantage, LLC, an OPEN Health company, and funded by Bristol Myers Squibb.

Disclosure of Interests:

Philip J Mease Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, UCB, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma, Frank Behrens Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche, Chugai, Bristol Myers Squibb, UCB Pharma, Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Roche, Alan Kivitz Shareholder of: Pfizer, Sanofi, GlaxoSmithKline, Gilead Sciences, Inc., Novartis, Paid Consultant: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc., Speakers bureau: Celgene, Merck, Lilly, Novartis, Pfizer, Sanofi, Genzyme, Flexion, AbbVie, Jonghyeon Kim Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Shalabh Singhal Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Subhashis Banerjee Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

Mapping past human land use using archaeological data: A new classification for global land use synthesis and data harmonization

In the 12,000 years preceding the Industrial Revolution, human activities led to significant changes in land cover, plant and animal distributions, surface hydrology, and biochemical cycles. Earth system models suggest that this anthropogenic land cover change influenced regional and global climate. However, the representation of past land use in earth system models is currently oversimplified. As a result, there are large uncertainties in the current understanding of the past and current state of the earth system. In order to improve representation of the variety and scale of impacts that past land use had on the earth system, a global effort is underway to aggregate and synthesize archaeological and historical evidence of land use systems. Here we present a simple, hierarchical classification of land use systems designed to be used with archaeological and historical data at a global scale and a schema of codes that identify land use practices common to a range of systems, both implemented in a geospatial database. The classification scheme and database resulted from an extensive process of consultation with researchers worldwide. Our scheme is designed to deliver consistent, empirically robust data for the improvement of land use models, while simultaneously allowing for a comparative, detailed mapping of land use relevant to the needs of historical scholars. To illustrate the benefits of the classification scheme and methods for mapping historical land use, we apply it to Mesopotamia and Arabia at 6 kya (c. 4000 BCE). The scheme will be used to describe land use by the Past Global Changes (PAGES) LandCover6k working group, an international project comprised of archaeologists, historians, geographers, paleoecologists, and modelers. Beyond this, the scheme has a wide utility for creating a common language between research and policy communities, linking archaeologists with climate modelers, biodiversity conservation workers and initiatives.

The origins and spread of domestic horses from the Western Eurasian steppes

Domestication of horses fundamentally transformed long-range mobility and warfare¹. However, modern domesticated breeds do not descend from the earliest domestic horse lineage associated with archaeological evidence of bridling, milking and corralling^2-4 at Botai, Central Asia around 3500 BC³. Other longstanding candidate regions for horse domestication, such as Iberia⁵ and Anatolia⁶, have also recently been challenged. Thus, the genetic, geographic and temporal origins of modern domestic horses have remained unknown. Here we pinpoint the Western Eurasian steppes, especially the lower Volga-Don region, as the homeland of modern domestic horses. Furthermore, we map the population changes accompanying domestication from 273 ancient horse genomes. This reveals that modern domestic horses ultimately replaced almost all other local populations as they expanded rapidly across Eurasia from about 2000 BC, synchronously with equestrian material culture, including Sintashta spoke-wheeled chariots. We find that equestrianism involved strong selection for critical locomotor and behavioural adaptations at the GSDMC and ZFPM1 genes. Our results reject the commonly held association⁷ between horseback riding and the massive expansion of Yamnaya steppe pastoralists into Europe around 3000 BC^8,9 driving the spread of Indo-European languages¹⁰. This contrasts with the scenario in Asia where Indo-Iranian languages, chariots and horses spread together, following the early second millennium BC Sintashta culture^11,12.

Characterisation and mapping of scattered radiation fields in interventional radiology theatres

We used the Timepix3 hybrid pixel detector technology in order to determine the exposure of medical personnel to ionizing radiation in an interventional radiology room. We measured the energy spectra of the scattered radiation generated by the patient during X-ray image-guided interventional procedures. We performed measurements at different positions and heights within the theatre. We first observed a difference in fluence for each staff member. As expected, we found that the person closest to the X-ray tube is the most exposed while the least exposed staff member is positioned at the patient’s feet. Additionally, we observed a shift in energy from head to toe for practitioners, clearly indicating a non-homogenous energy exposure. The photon counting Timepix3 detector provides a new tool for radiation field characterisation that is easier-to-use and more compact than conventional X-ray spectrometers. The spectral information is particularly valuable for optimising the use of radiation protection gear and improving dosimetry surveillance programs. We also found the device very useful for training purposes to provide awareness and understanding about radiation protection principles among interventional radiology staff.

Adenosine Analogues as Opposite Modulators of the Cisplatin Resistance of Ovarian Cancer Cells

BACKGROUND

Adenosine released by cancer cells in high amounts in the tumour microenvironment is one of the main immunosuppressive agents responsible for the escape of cancer cells from immunological control. Blocking adenosine receptors with adenosine analogues and restoring immune cell activity is one of the methods considered to increase the effectiveness of anticancer therapy. However, their direct effects on cancer cell biology remain unclear. Here, we determined the effect of adenosine analogues on the response of cisplatinsensitive and cisplatin-resistant ovarian cancer cells to cisplatin treatment.

METHODS

The effects of PSB 36, DPCPX, SCH58261, ZM 241385, PSB603 and PSB 36 on cisplatin cytotoxicity were determined against A2780 and A2780cis cell lines. Quantification of the synergism/ antagonism of the compounds cytotoxicity was performed and their effects on the cell cycle, apoptosis/necrosis events and cisplatin incorporation in cancer cells were determined.

RESULTS

PSB 36, an A1 receptor antagonist, sensitized cisplatin-resistant ovarian cancer cells to cisplatin from low to high micromolar concentrations. In contrast to PSB 36, the A2AR antagonist ZM 241385 had the opposite effect and reduced the influence of cisplatin on cancer cells, increasing their resistance to cisplatin cytotoxicity, decreasing cisplatin uptake, inhibiting cisplatin-induced cell cycle arrest, and partly restoring mitochondrial and plasma membrane potentials that were disturbed by cisplatin.

CONCLUSION

Adenosine analogues can modulate considerable sensitivity to cisplatin of ovarian cancer cells resistant to cisplatin. The possible direct beneficial or adverse effects of adenosine analogues on cancer cell biology should be considered in the context of supportive chemotherapy for ovarian cancer.

Vesicle shrinkage in hydrous phonolitic melt during cooling

The ascent of hydrous magma prior to volcanic eruptions is largely driven by the formation of H₂O vesicles and their subsequent growth upon further decompression. Porosity controls buoyancy as well as vesicle coalescence and percolation, and is important when identifying the differences between equilibrium or disequilibrium degassing from textural analysis of eruptive products. Decompression experiments are routinely used to simulate magma ascent. Samples exposed to high temperature (T) and pressure (P) are decompressed and rapidly cooled to ambient T for analysis. During cooling, fluid vesicles may shrink due to decrease of the molar volume of H₂O and by resorption of H₂O back into the melt driven by solubility increase with decreasing T at P < 300 MPa. Here, we quantify the extent to which vesicles shrink during cooling, using a series of decompression experiments with hydrous phonolitic melt (5.3-3.3 wt% H₂O, T between 1323 and 1373 K, decompressed from 200 to 110-20 MPa). Most samples degassed at near-equilibrium conditions during decompression. However, the porosities of quenched samples are significantly lower than expected equilibrium porosities prior to cooling. At a cooling rate of 44 K·s^-1, the fictive temperature T _f, where vesicle shrinkage stops, is up to 200 K above the glass transition temperature (T _g), Furthermore, decreasing cooling rate enhances vesicles shrinkage. We assess the implications of these findings on previous experimental degassing studies using phonolitic melt, and highlight the importance of correctly interpreting experimental porosity data, before any comparison to natural volcanic ejecta can be attempted.

P200 The impact of left venticule ejection fraction on long-term outcome in patients with high- and low-gradient severe aortic stenosis - data from ASRegistry

Background

Aortic stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention with a growing prevalence due to the ageing population. Severe aortic stenosis with reduced transaortic flow and gradient although it is a common finding still remains diagnostic challenge.

Purpose

The aim of study was to analyse the outcomes of patients with high- and low-gradient aortic stenosis depending on the ejection fraction.

Methods

621 patients hospitalized in the First Department of Cardiology, with severe aortic stenosis defined as aortic valve area &lt;1cm2 were enrolled to the Aortic Stenosis Registry (ASRegistry). The high-gradient aortic stenosis (HG-AS) [mean transvalvular pressure gradient (PGmean) ≥40mmHg and peak transvalvular velocity (Vmax) ≥ 4 m/s] and low-gradient aortic stenosis (LG-AS) [mean transvalvular pressure gradient (PGmean) &lt;40mmHg and peak transvalvular velocity (Vmax) &lt;4 m/s] were observed in 54%(n = 340) and 45% (n = 281) patients, respectively. In the subgroup of HG-AS were 80% (n = 275) and in the subgroup of LG-AS were 61%(n = 174) of patients with preserved left ventricle ejection fraction (LVEF &gt; 50%). The patients were observed for a period of 6 years (2012-2018). The primary end-point, all-cause mortality, was obtained from Nation Health Registry.

Results

Patients with LG-AS had a significantly higher risk of mortality compared to patients with HG-AS: 35% (n = 101) vs 26% (n = 87), p &lt; 0,05. Mortality in both group with HG-AS and LG-AS was significantly higher in the subgroup with diminished left ventricle dysfunction than in the subgroup with preserved ejection fraction: HG-AS: 44%(n = 29) vs 21%(n = 58), p &lt; 0,05 and LG-AS: 53%(n = 57) vs 25%(n = 44), p &lt; 0,05. The highest mortality rates was observed in the LG-AS group with left ventricule dysfunction, p &lt; 0,001.

Conclusions

The study shows the negative impact of left ventricle dysfunction in both groups of patients: high- and low-gradient severe aortic stenosis. The worst prognosis is in patients with LG-AS and low LVEF.

P761 Clinical manifestation of bicuspid aortic valve in single center registry

INTRODUCTION

Bicuspid aortic valve (BAV) is a congenital cardiac defect which may contribute to aortic stenosis (AS) and regurgitation (AR), aortopathy, endocarditis or in some group of patients remains without echocardiographic deviations. Prognosis of BAV population is hardly predictable. Nevertheless, the population of BAV requires regular medical control.

PURPOSE

The aim of our study was to assess the BAV appearance and characteristics in the Single Center Registry.

METHODS

All patients with recognition of BAV admitted to First Department of Cardiology at Medical University of Gdansk in years 2012-2018 were enrolled to analysis. Echocardiographic data were collected. Anthropometrics and comorbidities were recorded. Patents were categorized depending on BAV phenotype: coronary cusps fusion (Type 1), right-noncoronary cusps fusion (Type 2), left-noncornary cusps fusion (Type 3) and BAV without raphe (True Type).

RESULTS

323 (25,7% female) patients were enrolled into the Registry. Average age of studied group was 55 ± 16.0. 190 (58.8%) patients were characterized by Type 1 BAV, 75 (23.2%) by Type 2 and 8 (2.4%) by Type 3. There were only 3 patients with True Type. In 14.5% of patients we were unable to clearly identify BAV phenotype. For the further analysis there were included Type 1 and Type 2 groups due to low prevalence of other types. Patients with Type 2 were slightly younger (51.3 ± 16.2 years vs 57.5 ± 13.4 years in Type 1 group; p &lt; 0.01). The aortopathy appeared in 221 patients (68.4% of studied group). Type 1 was associated with larger diameter of aortic root comparing with Type 2 (40.7 ± 6.0 mm vs 38.7 ± 10.6 mm, respectively; p &lt; 0.001), without significant difference in ascending aorta diameter (42.3 ± 7.1 mm in Type 1 and 40.9 ± 6.7 mm in Type 2; p = 0.19). In contrary, Type 2 was correlating with the higher prevalence of severe AR (16% vs 5.7% in Type 1; p &lt; 0.01). Prevalence of AS was similar in both groups (48.4% in Type 1 and 37.85 in Type 2; p = 0.1). In the subgroup with severe AS (75 patients), there was no significant differences in the hemodynamic profile of AS between Type 1 and Type 2 group (respectively; peak transvalvular velocity- 4.5 ± 0.5 m/s2 vs 4.3 ± 0.6 m/s2, p = 0.2; mean transvalvular pressure- 54.2 ± 13.6 mmHg vs 46.6 ± 13.8 mmHg, p = 0.08; aortic valve area- 0.7 ± 0.1 cm2 vs 0.8 ± 0.1 cm2, p = 0.5). 4.3% of studied group were hospitalized due to endocarditis. Average age in that subgroup was 42.3 ± 12.0 years. There was no correlation between BAV phenotype and endocarditis prevalence.

CONCLUSION

Despite higher prevalence of severe AR in patients with Type 2 BAV, Type 1 is more predisposing to aortic root abnormalities. That discrepancy may confirm complex pathophysiology of BAV complications. Prevalence of AS and hemodynamic profile of severe AS does not present correlation with the type of BAV phenotype.

Dramatic slowing down of the conformational equilibrium in the silyl derivative of glucose in the vicinity of the glass transition temperature

The vitrification process is usually preceded by a significant change (around 6-8 decades) in the viscosity, structural relaxation times, or diffusion that occurs in a relatively small range of temperatures in fragile liquids. Along with this phenomenon, conformations of the molecules vary as well. In fact, this process is studied in bulk polymers and high molecular weight materials deposited in the form of thin films. On the other hand, spatial rearrangement of small glass formers in the supercooled liquid state has not been intensively investigated, so far. Herein, data obtained from measurements carried out using various experimental techniques on supercooled 1,2,3,4,6-penta-O-(trimethylsilyl)-d-glucopyranose (S-GLU) have revealed that rotations of silyl moieties along with the deformation in the saccharide ring are significantly slowed down in the vicinity of the glass transition temperature (Tg). These intramolecular reorganizations affect the structural relaxation time, atomic pair distribution function, integrated intensity, as well as a number of bands and signals observed, respectively, in the Raman and NMR spectra. Data reported herein offer a better understanding of the conformational variation and time scale of this process in the complex and flexible molecules around the Tg.

MULTIDIRECTIONAL ASSESSMENT OF BONE STRUCTURE INCLUDING RADIOISOTOPIC ANALYSIS IN PERIMENOPAUSAL WOMEN

OBJECTIVE

In postmenopausal period, changes in bone turnover markers (BTM), vitamin D3, cytokines and parathyroid hormone (PTH) are frequently observed. The study was to assess bone mineral density (BMD) and bone metabolism index (IBM) in the perimenopausal women.

DESIGN YEARS

2013-2014.

SUBJECTS AND METHODS

One hundred and thirteen women were divided into four groups: group I (35 not menstruating 50 - 60 years old with osteoporosis), II (23 not menstruating 50 - 60 years old without osteoporosis), III (30 menstruating 40 - 49 years old with osteoporosis), IV (25 menstruating 40 - 49 years old without osteoporosis). The following parameters were measured: IL-1β, IL-6, TNF-α, hormone oestradiol (E2), PTH, FSH, TSH, calcium (Ca2+), phosphates (P), alkaline phosphatase (bALP), C-terminal telopeptide of type I collagen alpha 1 chain (α1CTX), osteocalcin (OC), BMD, IBM.

RESULTS

IBM and BMD were significantly lower in premenopausal than in postmenopausal women. The concentration of OC, CTX, 25OH D3 and PTH levels differed significantly between group I vs. II, group I vs. III and group II vs. IV.

CONCLUSIONS

The levels of BTM, D3, PTH differed significantly between groups. This study demonstrated that bone metabolism depended mainly on processes related with menopause state and changes in D3, PTH and cytokines levels.