The Capio Prostate Cancer Center Model for Prostate Cancer Diagnostics-Real-world Evidence from 2018 to 2022

Background

The Capio Prostate Cancer Center (Capio PCC) in Stockholm, Sweden, adopts a comprehensive diagnostic approach, utilizing prostate-specific antigen (PSA), Stockholm3, and magnetic resonance imaging (MRI) for prostate cancer risk assessment, followed by targeted and systematic biopsies for high-risk cases.

Objective

This study aims to elucidate the clinical process and real-world outcomes of the Capio PCC model for prostate cancer diagnosis at Capio S:t Göran Hospital.

Design setting and participants

Between 2018 and 2022, a cohort of 12 406 men aged 45-75 yr underwent prostate cancer testing, adhering to Capio PCC's structured diagnostic protocol.

Outcome measurements and statistical analysis

We provide a comprehensive description of the Capio PCC model and present results from its implementation, including assessments of PSA, Stockholm3, MRI scans, and biopsies. A comparative analysis is conducted between the diagnostic outcomes obtained at Capio PCC and those obtained at other regions in Sweden.

Results and limitations

The median participant age was 61 yr (interquartile range [IQR]: 55-67), with PSA levels at 1.6 ng/ml (IQR: 0.8-3.3) and Stockholm3 scores at 4 (IQR: 3-11). Among 1064 men (8.6%) undergoing biopsies, 611 (57% of biopsied) were diagnosed with International Society of Urological Pathology grade ≥ 2 cancer. Notably, employing a Stockholm3 ≥ 15 cutoff for biopsy, in lieu of PSA ≥ 3 ng/ml, reduced biopsy recommendations by 43%. For men with PSA levels between 1.5 and 2.9 ng/ml, 360 (12%) exhibited Stockholm3 scores of ≥ 15, with 72 (56% of biopsied) diagnosed with clinically significant prostate cancer. A comparative analysis with national Swedish prostate cancer detection data indicated that the Capio PCC model (vs Sweden) revealed a distribution of 14% (vs 25%) low-risk, 59% (vs 42%) intermediate-risk, and 26% (vs 30%) high-risk and advanced cancers.

Conclusions

This study underscores the effectiveness of the protocol-driven diagnostic process at Capio PCC, enabling earlier detection of intermediate-risk prostate cancer and reducing the need for MRI assessments compared with standard prostate cancer care in Sweden.

Patient summary

At the Capio Prostate Cancer Center, a novel diagnostic approach incorporating prostate-specific antigen, Stockholm3, magnetic resonance imaging, and targeted biopsies has been implemented to enhance prostate cancer testing and diagnosis in Stockholm, Sweden.

One-Year Medication Adherence and Persistence in Rheumatoid Arthritis in Clinical Practice: A Retrospective Analysis of Upadacitinib, Adalimumab, Baricitinib, and Tofacitinib

INTRODUCTION

This study evaluated 12 months adherence and persistence among Janus kinase inhibitors (upadacitinib, baricitinib, tofacitinib) and adalimumab, a tumor necrosis factor inhibitor (TNFi), in patients with rheumatoid arthritis (RA).

METHODS

This retrospective analysis used administrative claims data from the Merative™ MarketScan® Research Databases (2018-2022). Eligible adults had ≥ 1 RA diagnosis before the index date, ≥ 1 pharmacy claim for index medication, and ≥ 12 months of continuous insurance enrollment pre- and post-index. Adherence to treatment [defined as proportion of days covered (PDC) ≥ 80%], risk of treatment discontinuation, and mean time to discontinuation were assessed during the 12 months follow-up. Adjusted odds ratios (aOR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI) were reported.

RESULTS

In total, 6317 patients were included (683 upadacitinib, 3732 adalimumab, 132 baricitinib, 1770 tofacitinib). Compared with upadacitinib, patients initiating adalimumab [aOR (95% CI): 0.82 (0.69, 0.96)], baricitinib [0.46 (0.31, 0.68)], and tofacitinib [0.74 (0.62, 0.88)] were significantly less likely to achieve PDC ≥ 80%. Risk of treatment discontinuation was significantly higher in patients treated with adalimumab [aHR (95% CI): 1.14 (1.01, 1.29)], baricitinib [1.48 (1.16, 1.90)], and tofacitinib [1.22 (1.07, 1.38)] compared with upadacitinib. Mean time to discontinuation was 256 (upadacitinib), 249 (adalimumab), 221 (baricitinib), and 239 (tofacitinib) days. Similar results were observed in patients with prior TNFi use.

CONCLUSIONS

Patients with RA, regardless of recent TNFi experience, initiating upadacitinib were significantly more likely to be adherent and less likely to discontinue therapy compared to adalimumab, baricitinib, and tofacitinib in the first 12 months of treatment.

[Improved prostate cancer diagnostics with a structured pathway including »Stockholm 3« test, MRI and targeted perineal biopsies]

The Prostate Cancer Center at Capio S:t Göran hospital is located in Stockholm and offers testing for prostate cancer. The pathway applies task shifting from doctors to nurses and new and innovative test methods, and leverages digitalization opportunities to enable a cost-efficient pathway with high specificity and sensitivity. In this article, we describe our experiences of the Capio S:t Göran Model.

1-h post-load plasma glucose for detecting early stages of prediabetes

Prediabetes is a very prevalent condition associated with an increased risk of developing diabetes and/or other chronic complications, in particular cardiovascular disorders. Early detection is therefore mandatory since therapeutic interventions may limit the development of these complications. Diagnosis of prediabetes is currently based on glycemic criteria (fasting plasma glucose (PG), and/or glycemia at 120 min during a 75 g oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c). Accumulating longitudinal evidence suggests that a 1-hour PG ≥155 mg/dl (8.6 mmol/l) during the OGTT is an earlier marker of prediabetes than fasting PG, 2-h post-load PG, or HbA1c. There is substantial evidence demonstrating that the 1-h post-load PG is a more sensitive predictor of type 2 diabetes, cardiovascular disease, microangiopathy and mortality compared with conventional glucose criteria. The aim of this review is to highlight the paramount importance of detecting prediabetes early in its pathophysiological course. Accordingly, as recommended by an international panel in a recent petition, 1-h post-load PG could replace current criteria for diagnosing early stages of "prediabetes" before prediabetes evolves as conventionally defined.

Bone mineral density, osteopenia and osteoporosis among US adults with cancer

BACKGROUND

Bone mineral deficits are one of the most common complications in cancer survivors. However, there are no studies evaluating bone mineral density (BMD) and the prevalence of osteopenia and osteoporosis among patients with different types of cancers.

AIM

The objective was to assess BMD and evaluate the prevalence of osteopenia and osteoporosis among US adults with cancer.

DESIGN

A cross-section propensity score matching study.

METHODS

We extracted data from National Health and Nutrition Examination Survey database from 2005 to 2018. We compared BMD in participants with and without cancer which was further analyzed according to cancer type. We conducted logistic regression to evaluate adjusted odds ratios of osteopenia and osteoporosis and determine risk factors for their development.

RESULTS

We found that BMD was significantly higher in participants without cancer than cancer patients. Furthermore, the median BMD of patients with breast cancer or skin cancer (including melanoma) was significantly lower than participants without cancer. People with breast, lung, genitourinary and skin cancers were more likely to incur osteopenia/osteoporosis than those without cancer.

CONCLUSIONS

BMD differs depending upon type in survivors. Individuals with a history of cancer have a poor understanding of osteoporosis and its risk factors. Understanding risk factors in patients with cancers identified in our study may be helpful for preventing osteoporosis and fractures and the development of screening guidelines.

Media use and trust during the COVID-19 pandemic: evidence from eight cross-sectional surveys in Sweden

BACKGROUND

While a lot has been written about Sweden's COVID-19 control strategy, less is known about Swedish residents' media use during the pandemic and trust in and perceived agreement among key stakeholders commenting in the media.

METHODS

Eight online, nationwide surveys were fielded between March and August 2020, during the first wave of the coronavirus pandemic in Sweden, with 8146 responses. Questions were asked on media usage, perceived tone of media, trust in key pandemic stakeholder groups commenting in the media (politicians, journalists, government officials, doctors/healthcare professionals and researchers) and perceived agreement among these key stakeholders about how the pandemic was handled in Sweden.

RESULTS

Using five or more information sources was associated with increased perceived alarmism in the media. Women and those with tertiary education were more likely to trust key pandemic actors. Trust in doctors/healthcare professionals and researchers remained high over the course of the study, trust in politicians and journalists was relatively low throughout the study period, with a slight increase in April 2020. Trust in key stakeholders was strongly associated with perceived agreement among the key stakeholders.

CONCLUSIONS

Our results show that trust in stakeholders was strongly associated with perceived consistency of messages from those stakeholders. The inverse also holds: perceived conflicting messages among stakeholders was associated with low trust in them. Taken together, this could point to the importance of building trust before a crisis. Trust-building efforts could be targeted to men and those with lower educational attainment, as they had lower trust in key stakeholders.

Routine Assessment of Patient Index Data 3 (RAPID3) in Patients with Rheumatoid Arthritis Treated with Long-Term Upadacitinib Therapy in Five Randomized Controlled Trials

Introduction

The Routine Assessment of Patient Index Data 3 (RAPID3) is a patient-reported outcome tool recommended for the assessment of disease activity in patients with rheumatoid arthritis (RA) in clinical practice. This analysis evaluated the long-term effect of upadacitinib vs. comparators on RAPID3 scores in patients with RA in the phase 3 SELECT clinical trial program.

Methods

This post hoc analysis included data from five randomized controlled trials (RCTs) in patients receiving upadacitinib 15 mg or 30 mg once daily (QD) as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). The proportions of patients reporting RAPID3 remission (scores ≤ 3) were assessed at week 60. Correlations between absolute scores for RAPID3 and Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and 28-joint Disease Activity Score with C-reactive protein (DAS28[CRP]) at week 60 were assessed using Spearman correlation coefficients.

Results

A total of 3117 patients were included from the SELECT-NEXT, -BEYOND, -MONOTHERAPY, -COMPARE, and -EARLY trials. By week 60, 32–52% of methotrexate-naïve and csDMARD inadequate responder (IR) patients treated with either upadacitinib 15 mg QD or upadacitinib 30 mg QD reported RAPID3 scores consistent with remission. The proportions were slightly lower in the biologic DMARD-IR SELECT-BEYOND population (19–28%). RAPID3 scores highly correlated (Spearman correlation values ≥ 0.58) with CDAI, SDAI, and DAS28(CRP) scores through week 60 (all p < 0.001).

Conclusions

Upadacitinib, as monotherapy or in combination with csDMARDs, was associated with patient-reported remission assessed by RAPID3 over 60 weeks across the SELECT RCTs in patients with RA.

Trial registration

SELECT-BEYOND (NCT02706847); SELECT-NEXT (NCT02675426); SELECT-MONOTHERAPY (NCT02706951); SELECT-EARLY (NCT02706873); SELECT-COMPARE (NCT02629159).

Supplementary Information

The online version contains supplementary material available at 10.1007/s40744-022-00483-4.

Rheumatoid arthritis (RA) is a disease that causes inflammation of the joints. Doctors have several ways of assessing how bad a patient’s disease is, and these often use a combination of signs and symptoms to develop a ‘score’. One method is called RAPID3, which is a score based on an overall assessment of the disease by the patient, the level of pain, and the amount of physical disability. An advantage of RAPID3 is that it is quick and easy to use, and since it uses only patient-reported symptoms, it can be measured easily via telemedicine, without the need for an in-person consultation. In this study, we decided to look into the effect of upadacitinib, a drug used for the treatment of RA, on RAPID3 score in patients with RA. We also investigated whether RAPID3 correlates with other ways of measuring RA severity, including scores that use physician-measured factors such as number of affected joints, as this can help show whether RAPID3 is a valid and useful tool. We found that upadacitinib led to long-term improvements in RAPID3 score, and that results were the same in different studies and patient groups, including patients who had not responded well to other treatments. We also found that RAPID3 correlated well with other measures, i.e., improvements in RAPID3 happened in parallel with improvements in other scores. Overall, these results suggest that RAPID3 can be a useful tool in patients with RA.

Baseline Disease Activity Predicts Achievement of cDAPSA Treatment Targets With Apremilast: Phase III Results in DMARD-naïve Patients With Psoriatic Arthritis

OBJECTIVE

The probability of achieving Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) treatment targets (remission [REM], low disease activity [LDA]) was evaluated following apremilast monotherapy in disease-modifying antirheumatic drug (DMARD)-naïve patients with psoriatic arthritis (PsA) based on baseline disease activity.

METHODS

This post hoc probability analysis of PALACE 4, a phase III, multicenter, randomized, placebo-controlled study, evaluated shifting across cDAPSA categories from baseline to week 52 and included DMARD-naïve patients receiving apremilast 30 mg BID with available baseline cDAPSA data. Changes in articular/extraarticular manifestations were evaluated in patients with week 52 cDAPSA components. cDAPSA treatment target achievement was assessed in a subgroup with baseline extraarticular PsA manifestations (skin involvement, enthesitis, dactylitis).

RESULTS

Of 175 apremilast-treated patients in the probability analysis, 66.3% were in high disease activity (HDA) and 31.4% in moderate disease activity (ModDA) at baseline. Approximately twice as many patients in ModDA at baseline reached REM/LDA at week 52 vs those in HDA (61.7% vs 28.2%). Achieving cDAPSA treatment targets was associated with reductions in articular (swollen/tender joints) and extraarticular (skin involvement, enthesitis, dactylitis, functional disability) disease activity. Similar treatment target achievement rates were observed in the subgroup with ≥ 1 extraarticular PsA manifestation (n = 126; ModDA: 66.7%, HDA: 32.2%).

CONCLUSION

Apremilast-treated patients with baseline ModDA had higher probability of achieving cDAPSA treatment targets than patients with HDA. Resolution and/or near resolution of articular and/or extraarticular PsA manifestations was achieved by patients in REM/LDA at week 52. Consistent treatment target achievement was observed in patients with 1 or multiple extraarticular manifestations of active PsA.

Patient-reported outcomes of upadacitinib versus abatacept in patients with rheumatoid arthritis and an inadequate response to biologic disease-modifying antirheumatic drugs: 12- and 24-week results of a phase 3 trial

Background

In previous clinical trials, patients with active rheumatoid arthritis (RA) treated with upadacitinib (UPA) have improved patient-reported outcomes (PROs). This post hoc analysis of SELECT-CHOICE, a phase 3 clinical trial, evaluated the impact of UPA vs abatacept (ABA) with background conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) on PROs in patients with RA with inadequate response or intolerance to biologic disease-modifying antirheumatic drugs (bDMARD-IR).

Methods

Patients in SELECT-CHOICE received UPA (oral 15 mg/day) or ABA (intravenous). PROs evaluated included Patient Global Assessment of Disease Activity (PtGA) by visual analog scale (VAS), patient’s assessment of pain by VAS, Health Assessment Questionnaire Disability Index (HAQ-DI), morning stiffness duration and severity, 36-Item Short Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Work Productivity and Activity Impairment (WPAI), and EQ-5D 5-Level (EQ-5D-5L) index score. Least squares mean (LSM) changes from baseline to weeks 12 and 24 were based on an analysis of covariance model. Proportions of patients reporting improvements ≥ minimal clinically important differences (MCID) were compared using chi-square tests.

Results

Data from 612 patients were analyzed (UPA, n=303; ABA, n=309). Mean age was 56 years and mean disease duration was 12 years. One-third received ≥2 prior bDMARDs and 72% received concomitant methotrexate at baseline. At week 12, UPA- vs ABA-treated patients had significantly greater improvements in PtGA, pain, HAQ-DI, morning stiffness severity, EQ-5D-5L, 2/4 WPAI domains, and 3/8 SF-36 domains and Physical Component Summary (PCS) scores (P<0.05); significant differences persisted at week 24 for HAQ-DI, morning stiffness severity, SF-36 PCS and bodily pain domain, and WPAI activity impairment domain. At week 12, significantly more UPA- vs ABA-treated patients reported improvements ≥MCID in HAQ-DI (74% vs 64%) and SF-36 PCS (79% vs 66%) and 4/8 domain scores (P<0.05).

Conclusions

At week 12, UPA vs ABA treatment elicited greater improvements in key domains of physical functioning, pain, and general health and earlier improvements in HAQ-DI. Overall, more UPA- vs ABA-treated patients achieved ≥MCID in most PROs at all timepoints; however, not all differences were statistically significant. These data, however, highlight the faster response to UPA treatment.

Trial registration

NCT03086343, March 22, 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-022-02813-x.

POS1064 CLINICAL AND ECONOMIC BURDEN OF PATIENTS WITH PSORIATIC ARTHRITIS WITH AND WITHOUT AXIAL INVOLVEMENT

Background

Axial involvement affects about 12% to 50% of patients (pts) with psoriatic arthritis (PsA),1,2 and these pts report worse pain and function than pts without axial involvement.3 Limited evidence exists quantifying the clinical and economic impact of axial involvement and pain in pts with PsA.

Objectives

To examine the clinical and economic burden of pts with PsA with and without axial involvement and assess the relationship between pain and frequency/costs of healthcare resource utilization (HCRU).

Methods

This cross-sectional study was conducted using de-identified linked electronic medical record and administrative claims data from the OM1 PsA Registry, a subset of the OM1 Real-World Data Cloud (OM1, Inc, Boston, MA, US). Adults aged ≥18 years with PsA (ICD-10 codes: L40.5x except for L40.53) were divided into two cohorts based on the presence or absence of the diagnosis code for axial involvement (ICD-10: L40.53) during 2019. Demographic and clinical characteristics between pts with and without axial involvement were compared with t-tests or Chi-square tests. Poisson regression models were used to assess the association of pain with HCRU. Mean costs per HCRU encounter (inpatient and emergency department [ED] visits) in 2019 were obtained from Optum’s de-identified Clinformatics Data Mart Database (2007-2019) and multiplied by the mean annual rate of HCRU encounters to generate per patient per year (PPPY) costs.

Results

Of 11,531 pts with PsA, 1,118 (10%) were diagnosed as having axial involvement. The two cohorts were similar in age, Charlson comorbidity score, and biologic disease-modifying antirheumatic drug (DMARD) use (Table 1). More pts with vs without axial involvement were commercially insured, had higher pain, and used opioids. Higher mean annual rates of inpatient (9 vs 5 per 100 pts) and ED (19 vs 14 per 100 pts) visits were seen in pts with vs without axial involvement, respectively, which translated to higher mean annual inpatient ($1,899 vs $1,055) and ED ($222 vs $164) visit costs PPPY (Figure 1). A 1-point higher pain score was associated with a higher likelihood of inpatient (52% vs 11%) and ED (20% vs 10%) visits (Table 1) and additional mean annual inpatient ($987 vs $116) and ED ($44 vs $16) visit costs PPPY (Figure 1) in pts with and without axial involvement, respectively.

Table 1.

Demographics, treatment utilization, and healthcare resource utilization

Mean (SD), unless otherwise specifiedPsA pts without axial involvement n=10,413PsA pts with axial involvement n=1,118p-valuesAge, years56.7 (13.0)56.8 (14.0)0.8948Female, n (%)6,401 (61%)653 (58%)0.0494Insurance, n (%)<0.0001 Commercial3,285 (62%)414 (73%) Medicaid110 (2%)18 (3%) Medicare1,618 (30%)103 (18%)Charlson comorbidity score0.4 (1.0)0.4 (1.0)0.9900Pain, VAS (0–10)4.2 (2.6)a4.5 (2.6)b0.0422bDMARD use, n (%)6,871 (66%)753 (67%)0.3762tsDMARD use, n (%)1,117 (11%)91 (8%)0.0072Opioid use, n (%)1,722 (17%)224 (20%)0.0034Inpatient visits/100 pts5 (32)9 (35)0.0021ED visits/100 pts14 (63)19 (72)0.0168Association of pain and HCRU, IRR (95% CI)cInpatient visits1.11 (1.08–1.15)*1.52 (1.13–2.03)**ED visits1.10 (1.07–1.13)*1.20 (1.05–1.38)**

bDMARD, biologic DMARD; CI, confidence interval; IRR, incidence rate ratio; MTX, methotrexate; NSAIDs, non-steroidal anti-inflammatory drugs; SD, standard deviation; tsDMARD, targeted synthetic DMARD; VAS, visual analog scale.

*p<0.0001 and **p<0.01 for association between 1-point increase in pain and HCRU.

an=9,981

bn=320

cBased on Poisson regression model adjusted for age, sex, race, insurance type, Charlson comorbidity score, and PsA treatments (b/tsDMARDs, MTX, and NSAIDs).

Conclusion

Axial involvement in PsA was associated with an increased clinical and economic burden. Higher pain was associated with higher HCRU and costs in pts with vs without axial involvement.

References

[1]Baraliakos X, et al. Clin Exp Rheumatic. 2015;33:S31–5.

[2]Ogdie A, et al. J Rheumatol. 2021;48:698–706.

[3]Mease PJ, et al. J Rheumatol. 2018;45:1389–96.

Acknowledgements

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Julia Zolotarjova, MSc, MWC, of AbbVie.

Disclosure of Interests

Martin Bergman Shareholder of: JNJ (parent of Janssen) and Merck, Speakers bureau: AbbVie, Amgen, BMS, Janssen, Merck, Novartis, Pfizer, Sanofi, and Sandoz, Consultant of: AbbVie, Amgen, BMS, Janssen, Merck, Novartis, Pfizer, Sanofi, and Sandoz, Jayeshkumar Patel Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Christopher Saffore Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Erin McDearmon-Blondell Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Ia Topuria Employee of: OM1, Cristi Cavanaugh Employee of: OM1

AB0905 Routine Assessment of Patient Index Data 3 (RAPID3) in Patients With Active Psoriatic Arthritis (PsA) After Inadequate Response or Intolerance to DMARDs: Pooled Results From the Phase 3, Randomized, Double-Blind KEEPsAKE 1 and 2 Trials

Background

PsA is a chronic, systemic inflammatory disease with diverse clinical manifestations that can impact a patients’ quality of life. Risankizumab (RZB), a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit, is approved for the treatment of active PsA in adults. In the phase 3 KEEPsAKE 1 and 2 studies, RZB treatment resulted in significantly greater improvements in signs and symptoms of active PsA compared with placebo (PBO).1,2 RAPID3 is frequently used in clinical practice to evaluate PsA disease activity and consists of 3 key patient-reported measures (physical function, pain, and patient’s global assessment of disease activity [PtGA]).3

Objectives

To evaluate short- (24 week) and long-term (52 week) improvements in RAPID3 scores and achievement of RAPID3 minimal clinically important difference (MCID) across the RZB KEEPsAKE 1 and 2 clinical program.

Methods

In KEEPsAKE 1 (NCT03675308) and KEEPsAKE 2 (NCT03671148), patients with active PsA who experienced inadequate response or intolerance to ≥ 1 csDMARD (KEEPsAKE 1) and/or ≤ 2 biological therapies (KEEPsAKE 2) were randomized to PBO or RZB 150 mg from baseline to week (W) 24; from W28–W52, all patients received open-label RZB 150 mg. At W16, nonresponders could add or modify rescue therapy. This post hoc analysis assessed the mean change from baseline to W24 and W52 in RAPID3 scores and the proportion of patients who achieved a RAPID3 MCID (defined as a decrease of ≥3.8 points4). Modified RAPID3 scores (range: 0–30) were calculated using pain scores, PtGA, and HAQ-DI, each rescaled to 0–10 and summed together.3

Results

A total of 961 and 443 patients were included from KEEPsAKE 1 and 2, respectively. At baseline, mean RAPID3 scores were 15.3 in both treatment arms of KEEPsAKE 1 (PBO n = 479, RZB n = 482) and 15.1 (PBO n = 219) and 14.8 (RZB n = 224) in KEEPsAKE 2. From W4 to W24, RAPID3 scores were significantly reduced with RZB treatment compared with PBO in both KEEPsAKE 1 (mean change from baseline at W24 of −5.3 vs −2.4, respectively, P <.001) and KEEPsAKE 2 (−3.8 vs −1.6, P <.001; Figure 1 A, B), and a significantly greater proportion of patients achieved MCID at W24 with RZB than with PBO in KEEPsAKE 1 (57.0% vs 36.4%, P <.001) and KEEPsAKE 2 (48.8% vs 32.8%, P <.001; Table 1). At W52 among patients who received RZB from W0–W52, mean change from baseline was −7.0 (KEEPsAKE 1) and −5.2 (KEEPsAKE 2; Figure 1 C, D), and MCID was achieved by 67.5% (KEEPsAKE 1) and 56.5% (KEEPsAKE 2) of patients. Patients who switched from PBO to RZB at W24 experienced similar and substantial improvements in RAPID3 scores by W52.

Table 1.

Proportion of Patients Achieving a Minimal Clinically Important Difference From Baseline in RAPID3 (AO).

Patients, % (n/N) [95% CI]KEEPsAKE 1KEEPsAKE 2PBORZB 150 mgPBORZB 150 mgW2436.4 (166/456) [32.0, 40.8]57.0 (262/460) [52.4, 61.5]***32.8 (64/195) [26.2, 39.4]48.8 (104/213) [42.1, 55.5]***PBO to RZB 150 mgaRZB 150 mgPBO to RZB 150 mgaRZB 150 mgW5259.8 (260/435) [55.2, 64.4]67.5 (297/440) [63.1, 71.9]57.4 (105/183) [50.2, 64.5]56.5 (109/193) [49.5, 63.5]

aPatients randomized to PBO at W0 switched to open-label RZB 150 mg at W24.

***, P < .001 vs PBO.

AO, as observed; PBO, placebo; RAPID3, Routine Assessment of Patient Index Data 3; RZB, risankizumab; W, week.

Figure 1.

Mean Change From Baseline in RAPID3 Scores During KEEPsAKE 1 and 2.

**, P < .01; ***, P < .001 vs PBO.

AO, as observed; LS, least squares; MMRM, mixed-effect model repeated measurement; PBO, placebo; RAPID3, Routine Assessment of Patient Index Data 3; RZB, risankizumab.

Conclusion

RZB 150 mg was associated with improvement in RAPID3 total scores over 24–52 weeks of treatment in patients with active PsA in KEEPsAKE 1 and 2.

References

[1]Kristensen LE, et al. Ann Rheum Dis. 2022;81:225–231.

[2]Östör A, et al. Ann Rheum Dis. 2021;annrheumdis-2021-221048.

[3]Coates LC, et al. Arthritis Care Res (Hoboken). 2018;70:1198–1205.

[4]Ward MM, et al. J Rheumatol. 2019;46:27–30.

Acknowledgements

AbbVie Inc. participated in the study design; study research; collection, analysis, and interpretation of data; and writing, reviewing, and approving of this abstract for submission. All authors had access to the data; participated in the development, review, and approval of and in the decision to submit this abstract to EULAR 2022 for consideration as a poster or oral presentation. No honoraria or payments were made for authorship. AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. AbbVie funded the research for this study and provided writing support for this abstract.

Medical writing assistance, funded by AbbVie, was provided by Callie A. S. Corsa, PhD, of JB Ashtin.

Disclosure of Interests

Alexis Ogdie Consultant of: AO has received consulting fees and/or honoraria from AbbVie, Amgen, Bristol Myers Squibb, Celgene, CorEvitas, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AO has received grants from AbbVie, Novartis, and Pfizer to the trustees of University of Pennsylvania, and from Amgen to Forward., Laura Coates Speakers bureau: LCC has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer and UCB., Consultant of: LCC has worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB, Grant/research support from: LCC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB, RICARDO ACAYABA DE TOLEDO Speakers bureau: RAT has received honoraria as a speaker/consultant for Abbvie, Celltrion, Janssen, Novartis, Pfizer, and UCB, Consultant of: RAT has received honoraria as a speaker/consultant for Abbvie, Celltrion, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: RAT has received grants as an investigator from Abbvie, GSK, Novartis, and Pfizer., Ana Biljan Shareholder of: AB may hold AbbVie stock or stock options., Employee of: AB is a full-time employee of AbbVie., Heather Jones Shareholder of: HJ may hold AbbVie stock or stock options., Employee of: HJ is a full-time employee of AbbVie., Kristin Tacelosky Shareholder of: KT may hold AbbVie stock or stock options., Employee of: KT is a full-time employee of AbbVie., Cuiyong Yue Shareholder of: CY may hold AbbVie stock or stock options., Employee of: CY is a full-time employee of AbbVie., Byron Padilla Shareholder of: BP may hold AbbVie stock or stock options., Employee of: BP is a full-time employee of AbbVie., Martin Bergman Shareholder of: MB is a stock holder of Johnson & Johnson and Merck., Speakers bureau: MB has received honoraria as a speaker/consultant for Abbvie, Amgen, GSK, Janssen, Novartis, Pfizer, Sanofi, and Scipher, Consultant of: MB has received honoraria as a speaker/consultant for Abbvie, Amgen, GSK, Janssen, Novartis, Pfizer, Sanofi, and Scipher

Economic Benefit from Improvements in Quality of Life with Upadacitinib: Comparisons with Tofacitinib and Methotrexate in Patients with Rheumatoid Arthritis

Introduction

To compare the economic benefit of upadacitinib combination therapy versus tofacitinib combination therapy and upadacitinib monotherapy versus methotrexate monotherapy from improvements in health-related quality of life (HRQOL) in patients with rheumatoid arthritis (RA).

Methods

Data were analyzed from two trials of upadacitinib (SELECT-NEXT and SELECT-MONOTHERAPY) and one trial of tofacitinib (ORAL-Standard) that collected HRQOL measurements using the Short Form 36 (SF-36) Health Survey in patients with RA. Direct medical costs per patient per month (PPPM) for patients receiving upadacitinib 15 mg once daily and methotrexate were derived from observed SF-36 Physical (PCS) and Mental Component Summary (MCS) scores in the SELECT trials using a regression algorithm. Direct medical costs PPPM for patients receiving tofacitinib 5 mg twice daily were obtained from a published analysis of SF-36 PCS and MCS scores observed in the ORAL-Standard trial. Short-term (12–14 weeks) and long-term (48 weeks) estimates of direct medical costs PPPM were compared between upadacitinib and tofacitinib and between upadacitinib and methotrexate.

Results

Over 12 weeks, direct medical costs PPPM were $252 lower (95% CI $72, $446) for upadacitinib-treated patients versus tofacitinib-treated patients. Medical costs PPPM at weeks 24 and 48 and cumulative costs over the entire 48-week period (difference $1759; 95% CI $1162, $2449) were significantly lower for upadacitinib than for tofacitinib. Over 14 weeks, direct medical costs PPPM were $399 lower (95% CI $158, $620) for patients treated with upadacitinib monotherapy compared with those treated with methotrexate alone. Direct medical costs at week 48 and cumulative costs over the entire 48-week period (difference $2044; 95% CI $1221, $2846) were significantly lower for upadacitinib monotherapy compared with methotrexate alone.

Conclusion

In the short and long term, upadacitinib combination therapy versus tofacitinib combination therapy and upadacitinib monotherapy versus methotrexate monotherapy were associated with significantly lower direct medical costs for patients with RA.

Trial Registration

ClinicalTrials.gov identifier, NCT02675426, NCT02706951, and NCT00853385.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01930-4.

Seeing the world through the eyes of a butterfly: visual ecology of the territorial males of Pararge aegeria (Lepidoptera: Nymphalidae)

Combining studies of animal visual systems with exact imaging of their visual environment can get us a step closer to understand how animals see their “Umwelt”. Here, we have combined both methods to better understand how males of the speckled wood butterfly, Pararge aegeria, see the surroundings of their perches. These males are well known to sit and wait for a chance to mate with a passing females, in sunspot territories in European forests. We provide a detailed description of the males' body and head posture, viewing direction, visual field and spatial resolution, as well as the visual environment. Pararge aegeria has sexually dimorphic eyes, the smallest interommatidial angles of males are around 1°, those of females 1.5°. Perching males face the antisolar direction with their retinal region of the highest resolution pointing at an angle of about 45° above the horizon; thus, looking at a rather even and dark background in front of which they likely have the best chance to detect a sunlit female passing through the sunspot.

Guided therapy selection in rheumatoid arthritis using a molecular signature response classifier: an assessment of budget impact and clinical utility

BACKGROUND: Patients with moderate to severe rheumatoid arthritis (RA) can be treated with a range of targeted therapies following inadequate response to conventional synthetic disease-modifying antirheumatic drugs such as methotrexate. Whereas clinical practice guidelines provide no formal recommendations for initial targeted therapies, the tumor necrosis factor alpha inhibitor (TNFi) class is the prevalent first-line selection based on clinician experience, its safety profile, and/or formulary requirements, while also being the costliest. Most patients do not achieve adequate clinical response with a first-line TNFi, however. A molecular signature response classifier (MSRC) test that assesses RA-related biomarkers can identify patients who are unlikely to achieve adequate response to TNFi-class therapies. OBJECTIVE: To model cost-effectiveness of MSRC-guided, first-line targeted therapy selection compared with current standard care. METHODS: This budget impact analysis used data sourced from August to September 2020. The prevalence of each first-line targeted therapy was obtained using market intelligence from Datamonitor/Informa PLC Rheumatology Dashboard Forecast 2020, and the average first-year cost of treatment for each class was calculated using wholesale acquisition costs from IBM Micromedex RED BOOK Online. Average effectiveness for each class was based on manufacturer-reported ACR50 response rates (American College of Rheumatology adequate response criteria of 50% improvement at 6 months after therapy initiation). The impact of MSRC testing on first therapy selection was predicted based on a third party-generated decision-impact study that analyzed potential alterations in rheumatologist prescribing patterns after receiving MSRC test reports. Sensitivity analysis evaluated potential impacts of variation in first-year medication cost, adherence to MSRC report, and test price on the first-year cost of treatment. Cost for response (first-year therapy cost therapy divided by probability of achieving ACR50) was compared between standard care and MSRC-guided care. RESULTS: The estimated cost for first-year, standard-care treatment was $65,117, with 80% of patients initiating treatment with a TNFi. Cost for achieving ACR50 response was $177,046. After applying MSRC-guided patient stratification and therapy selection, the first-year cost was $56,543, net of test price, with 49.0% of patients initiating with a TNFi. First-year MSRC-guided care cost, including test price, was estimated at $117,103, a 33.9% improvement over standard care. Sensitivity analysis showed a net cost improvement for guided care vs standard care across all scenarios. Patients predicted to be inadequate TNFi responders, when modeled with lower-priced alternatives, were predicted to show increased ACR50 response rates. Those with MSRC test results indicating a first-line TNFi were predicted to show an ACR50 response rate superior to that for any other class. In this model, if implemented clinically, MSRC-guided care might save the US health care system more than $850 million annually and improve ACR50 by up to 31.3%. CONCLUSIONS: Precision medicine using MSRC-guided patient stratification and therapy selection may both decrease cost and improve efficacy of targeted RA therapies. DISCLOSURES: This work was funded in full by Scipher Medicine Corporation, which participated in data analysis and interpretation and drafting, reviewing, and approving the publication. All authors contributed to data analysis and interpretation and publication preparation, maintaining control over the final content. Arnell, Withers, and Connolly-Strong are employees of and have stock ownership in Scipher Medicine Corporation. Bergman has received consulting fees from AbbVie, Gilead, GlaxoSmithKline, Novartis, Pfizer, Regeneron, Sanofi, and Scipher Medicine and owns stock or stock options in Johnson & Johnson. Kenney, Logan, and Lim-Harashima are consultants for Scipher Medicine Corporation. Basu has nothing to disclose.

Healthcare Resource Use in Patients with Immune-Mediated Conditions Treated with Targeted Immunomodulators During COVID-19 Pandemic: A Retrospective Claims Analysis

INTRODUCTION

The impact of the COVID-19 pandemic on routine medical care may result in altered healthcare resource use in patients with immune-mediated conditions. The aim of this study was to determine the impact of treatment interruptions in patients with and without COVID-19 infections who were treated with targeted immunomodulators (TIMs) in the USA.

METHODS

Data from the IBM^® MarketScan^® Research Databases were analyzed in patients with immune-mediated conditions from January 1, 2018, through December 31, 2020. Healthcare resource use (HCRU) including hospitalizations, emergency department (ED) visits, in-person outpatient visits, and respiratory outcomes was assessed in a cohort of patients without COVID-19 who had uninterrupted versus interrupted TIM use. The impact of treatment interruption on HCRU and respiratory outcomes was also evaluated in a cohort of patients with COVID-19. Results from adjusted logistic regression were reported as adjusted odds ratios (aORs) with 95% confidence intervals.

RESULTS

Approximately 25% of patients in both the COVID-19 (N = 787) and non-COVID-19 cohorts (N = 77,178) experienced interruptions in TIM therapy. In the non-COVID-19 cohort, the likelihood of being hospitalized was 20% less in patients with uninterrupted versus interrupted TIM use (aOR = 0.80, 95% CI 0.71-0.90). Patients with uninterrupted TIM use had a similar likelihood of an ED visit (aOR = 0.99, 95% CI 0.91-1.08) and respiratory outcome (aOR = 0.97, 95% CI 0.71-1.31) versus patients with interrupted TIM use. The likelihood of having an in-person outpatient visit was 87% greater in patients with uninterrupted versus interrupted TIM use (aOR = 1.87, 95% CI 1.81-1.94). Similar findings were observed in the COVID-19 cohort.

CONCLUSION

This analysis of real-world claims data showed that uninterrupted TIM use was not associated with an increased likelihood of hospitalizations, ED visits, or negative respiratory outcomes compared to interrupted TIM use among patients with immune-mediated conditions, regardless of COVID-19 diagnosis.

MRI-Targeted or Standard Biopsy in Prostate Cancer Screening

BACKGROUND

High rates of overdiagnosis are a critical barrier to organized prostate cancer screening. Magnetic resonance imaging (MRI) with targeted biopsy has shown the potential to address this challenge, but the implications of its use in the context of organized prostate cancer screening are unknown.

METHODS

We conducted a population-based noninferiority trial of prostate cancer screening in which men 50 to 74 years of age from the general population were invited by mail to participate; participants with prostate-specific antigen (PSA) levels of 3 ng per milliliter or higher were randomly assigned, in a 2:3 ratio, to undergo a standard biopsy (standard biopsy group) or to undergo MRI, with targeted and standard biopsy if the MRI results suggested prostate cancer (experimental biopsy group). The primary outcome was the proportion of men in the intention-to-treat population in whom clinically significant cancer (Gleason score ≥7) was diagnosed. A key secondary outcome was the detection of clinically insignificant cancers (Gleason score 6).

RESULTS

Of 12,750 men enrolled, 1532 had PSA levels of 3 ng per milliliter or higher and were randomly assigned to undergo biopsy: 603 were assigned to the standard biopsy group and 929 to the experimental biopsy group. In the intention-to-treat analysis, clinically significant cancer was diagnosed in 192 men (21%) in the experimental biopsy group, as compared with 106 men (18%) in the standard biopsy group (difference, 3 percentage points; 95% confidence interval [CI], -1 to 7; P<0.001 for noninferiority). The percentage of clinically insignificant cancers was lower in the experimental biopsy group than in the standard biopsy group (4% [41 participants] vs. 12% [73 participants]; difference, -8 percentage points; 95% CI, -11 to -5).

CONCLUSIONS

MRI with targeted and standard biopsy in men with MRI results suggestive of prostate cancer was noninferior to standard biopsy for detecting clinically significant prostate cancer in a population-based screening-by-invitation trial and resulted in less detection of clinically insignificant cancer. (Funded by the Swedish Research Council and others; STHLM3-MRI ClinicalTrials.gov number, NCT03377881.).

Upadacitinib monotherapy improves patient-reported outcomes in rheumatoid arthritis: results from SELECT-EARLY and SELECT-MONOTHERAPY

OBJECTIVE

To evaluate the effect of upadacitinib (UPA) monotherapy vs MTX on patient-reported outcomes (PROs) in patients with RA who were MTX-naïve or who had an inadequate response to MTX (MTX-IR).

METHODS

PROs from the SELECT-EARLY and SELECT-MONOTHERAPY randomized controlled trials were evaluated at Weeks 2 and 12/14. Patients were ≥18 years of age with RA symptoms for ≥6 weeks (SELECT-EARLY, MTX-naïve) or diagnosed RA for ≥3 months (SELECT-MONOTHERAPY, MTX-IR) and received UPA monotherapy (15 or 30 mg) or MTX. PROs included Patient Global Assessment of Disease Activity (PtGA), pain visual analogue scale, HAQ Disability Index (HAQ-DI), morning stiffness duration/severity, Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue (SELECT-EARLY), health-related quality of life (HRQOL) by the 36-iem Short Form Health Survey and Work Productivity and Activity Impairment (WPAI; SELECT-EARLY). Least square mean (LSM) changes and proportions of patients reporting improvements greater than or equal to the minimum clinically important differences and normative values were determined.

RESULTS

In 945 MTX-naïve and 648 MTX-IR patients, UPA monotherapy (15 mg, 30 mg) vs MTX resulted in greater reported LSM changes from baseline at Weeks 12/14 in PtGA, pain, HAQ-DI, morning stiffness duration/severity, FACIT-F (SELECT-EARLY), HRQOL and WPAI (SELECT-EARLY). These changes were statistically significant with both doses of UPA vs MTX at Weeks 12/14 in both RCTs. Improvements were reported as early as week 2. Compared with MTX, more UPA-treated MTX-naïve and MTX-IR patients reported improvements greater than or equal to the minimum clinically important differences and scores greater than or equal to normative values.

CONCLUSION

Among MTX-naïve and MTX-IR patients with active RA, UPA monotherapy at 15 or 30 mg for 12/14 weeks resulted in statistically significant and clinically meaningful improvements in pain, physical function, morning stiffness, HRQOL and WPAI compared with MTX alone.

CLINICAL TRIAL REGISTRATION NUMBER

SELECT-EARLY (NCT02706873) and SELECT-MONOTHERAPY (NCT02706951) are registered with ClinicalTrials.gov.

Prostate cancer screening using a combination of risk-prediction, MRI, and targeted prostate biopsies (STHLM3-MRI): a prospective, population-based, randomised, open-label, non-inferiority trial

BACKGROUND

Screening for prostate cancer using prostate-specific antigen (PSA) reduces prostate cancer mortality but can lead to adverse outcomes. We aimed to compare a traditional screening approach with a diagnostic strategy of blood-based risk prediction combined with MRI-targeted biopsies.

METHODS

We did a prospective, population-based, randomised, open-label, non-inferiority trial (STHLM3-MRI) in Stockholm county, Sweden. Men aged 50-74 years were randomly selected by Statistics Sweden and invited by mail to participate in screening; those with an elevated risk of prostate cancer, defined as either a PSA of 3 ng/mL or higher or a Stockholm3 score of 0·11 or higher were eligible for randomisation. Men with a previous prostate cancer diagnosis, who had undergone a prostate biopsy within 60 days before the invitation to participate, with a contraindication for MRI, or with severe illness were excluded. Eligible participants were randomly assigned (2:3) using computer-generated blocks of five, stratified by clinically significant prostate cancer risk, to receive either systematic prostate biopsies (standard group) or biparametric MRI followed by MRI-targeted and systematic biopsy in MRI-positive participants (experimental group). The primary outcome was the detection of clinically significant prostate cancer at prostate biopsy, defined as a Gleason score of 3 + 4 or higher. We used a margin of 0·78 to assess non-inferiority for the primary outcome. Key secondary outcome measures included the proportion of men with clinically insignificant prostate cancer (defined as a Gleason score of 3 + 3), and the number of any prostate MRI and biopsy procedures done. We did two comparisons: Stockholm3 (using scores of 0·11 and 0·15 as cutoffs) versus PSA in the experimental group (paired analyses) and PSA plus standard biopsy versus Stockholm3 plus MRI-targeted and systematic biopsy (unpaired, randomised analyses). All analyses were intention to treat. This study is registered with ClinicalTrials.gov, NCT03377881.

FINDINGS

Between Feb 5, 2018, and March 4, 2020, 49 118 men were invited to participate, of whom 12 750 were enrolled and provided blood specimens, and 2293 with elevated risk were randomly assigned to the experimental group (n=1372) or the standard group (n=921). The area under the receiver-operating characteristic curve for detection of clinically significant prostate cancer was 0·76 (95% CI 0·72-0·80) for Stockholm3 and 0·60 (0·54-0·65) for PSA. In the experimental group, a Stockholm3 of 0·11 or higher was non-inferior to a PSA of 3 ng/mL or higher for detection of clinically significant prostate cancer (227 vs 192; relative proportion [RP] 1·18 [95% CI 1·09-1·28], p<0·0001 for non-inferiority), and also detected a similar number of low-grade prostate cancers (50 vs 41; 1·22 [0·96-1·55], p=0·053 for superiority) and was associated with more MRIs and biopsies. Compared with PSA of 3 ng/mL or higher, a Stockholm3 of 0·15 or higher provided identical sensitivity to detect clinically significant cancer, and led to fewer MRI procedures (545 vs 846; 0·64 [0·55-0·82]) and fewer biopsy procedures (311 vs 338; 0·92 (0·86-1·03). Compared with screening using PSA and systematic biopsies, a Stockholm3 of 0·11 or higher combined with MRI-targeted and systematic biopsies was associated with higher detection of clinically significant cancers (227 [3·0%] men tested vs 106 [2·1%] men tested; RP 1·44 [95% CI 1·15-1·81]), lower detection of low-grade cancers (50 [0·7%] vs 73 [1·4%]; 0·46 [0·32-0·66]), and led to fewer biopsy procedures. Patients randomly assigned to the experimental group had a lower incidence of prescription of antibiotics for infection (25 [1·8%] of 1372 vs 41 [4·4%] of 921; p=0·0002) and a lower incidence of admission to hospital (16 [1·2%] vs 31 [3·4%]; p=0·0003) than those in the standard group.

INTERPRETATION

The Stockholm3 test can inform risk stratification before MRI and targeted biopsies in prostate cancer screening. Combining the Stockholm3 test with an MRI-targeted biopsy approach for prostate cancer screening decreases overdetection while maintaining the ability to detect clinically significant cancer.

FUNDING

The Swedish Cancer Society, the Swedish Research Council, and Stockholm City Council.

POS0436 PATIENT CHARACTERISTICS AND OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH UPADACITINIB: THE OM1 RA REGISTRY

Background:

Upadacitinib (UPA) has demonstrated efficacy in the treatment of rheumatoid arthritis (RA) in randomized controlled trials,1-6 but there are limited data available on its real-world use and effectiveness in patients with RA.

Objectives:

To describe the characteristics and clinical outcomes at 3 months among real-world patients with RA initiating UPA.

Methods:

The data source for this study was the OM1 RA Registry, a subset of the OM1 Real-World Data Cloud (OM1, Inc, Boston, MA, US), a large, linked clinical and administrative dataset derived from medical and pharmacy claims, electronic medical record data, and death data. This analysis includes data collected in patients who initiated UPA during or after August 2019. Patients had ≥1 prescription for UPA (index date was first UPA prescription), were ≥18 years of age at index date, had ≥6 months of available data in the OM1 RA Registry prior to index date (ie, baseline period), ≥1 baseline disease activity measure, and ≥1 follow-up disease activity measure (3 or 6 months post-index). Disease activity was based on RAPID3 or CDAI. Multivariate analyses were conducted using a mixed-effects linear model adjusting for age, sex, and baseline scores. Outcomes were also assessed by therapy status (monotherapy or combination therapy) and targeted immunomodulator (TIM) use (naïve vs experienced).

Results:

Inclusion criteria were met by 1,102 patients, of whom 620 were on monotherapy and 482 were on combination therapy at index. Mean age was 57.7 years, 83% were female, 75% had prior treatment with a biologic, and 47% had prior treatment with a Janus kinase inhibitor. Of 651 patients with known disease activity category, 113 (17%) were in low disease activity (LDA)/remission. At baseline, overall mean±SD scores were 19.9±12.3 for CDAI, 4.5±2.4 for RAPID3, 5.7±2.8 for pain, 5.2±3.0 for fatigue, 3.1±2.7 for MDHAQ Physician Global Assessment (PGA), 5.2±2.8 for MDHAQ Patient Global Assessment (PtGA), and 3.1±2.3 for MDHAQ Functional Index. At 3 months post-UPA initiation, mean (95% CI) change in CDAI was –5.1 (–7.5 to –2.7) in the monotherapy group and –5.9 (–8.7 to –3.0) in the combination group. At 3 months, 29% (109/374) of patients were in LDA/remission and 32% (120/374) of patients showed improvement in disease activity. Of 94 patients with moderate disease at baseline, 34 (36%) were in LDA/remission at 3 months. Of 215 patients with high disease at baseline, 30 (14%) were in LDA/remission and 49 (23%) had moderate disease at 3 months. RAPID3 and other outcomes also improved at 3 months in the monotherapy and combination therapy groups (Figure 1). Improvements in disease activity were observed at 3 months and maintained at 6 months post-UPA initiation. Of 1,102 patients, 16% were TIM naïve and 84% TIM experienced. Both TIM-naïve and TIM-experienced patients achieved significant mean changes in CDAI (–5.7 [–10.8 to –0.6] and–5.0 [–7.0 to –3.0], respectively) and RAPID3 (–1.0 [–1.6 to –0.4] and –0.5 [–0.8 to –0.1]) at 3 months (Table 1). Improvements in clinical outcomes were maintained at 6 months in both TIM-naïve and TIM-experienced patients.

Conclusion:

Significant improvements in disease activity were consistently observed at 3 months and maintained at 6 months post-UPA initiation regardless of monotherapy, combination therapy, or prior TIM use.

References:

[1]Fleischmann R. Arthritis Rheumatol. 2019;71:1788–800.

[2]Smolen JS. Lancet. 2019;393:2303–11.

[3]Burmester GR. Lancet. 2018;382:2505–12.

[4]Genovese MC. Lancet. 2018;391:2513–24.

[5]van Vollenhoven R. Arthritis Rheumatol. 2020;72:1607–20.

[6]Rubbert-Roth A. N Engl J Med. 2020;383:1511–21.

Table 1.

Change in clinical outcomes from baseline at 3 months: TIM-naïve and TIM-experienced groups

TIM naïve(N=179)TIM experienced(N=923)nMean changenMean changeCDAI36–5.7*160–5.0*RAPID367–1.0*189–0.5*Pain (VAS)76–1.5*237–0.9*Fatigue46–0.7149–0.5MDHAQ PGA65–0.7*251–0.7*MDHAQ PtGA97–0.6*383–0.3MDHAQ Functional Index72–0.7*215–0.2

*Statistically significant change from baseline (P<0.05).

Acknowledgements:

Funding statement: Financial support for the study was provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract. All authors contributed to the development of the publication and maintained control over the final content.

Acknowledgment:

Medical writing services were provided by Joann Hettasch of Fishawack Facilitate Ltd, part of Fishawack Health, and funded by AbbVie.

Disclosure of Interests:

Martin Bergman Shareholder of: JNJ (parent of Janssen), Speakers bureau: AbbVie, Amgen, BMS, Genentech, Gilead, Janssen, Merck, Novartis, Pfizer, Regeneron, Sanofi, Sandoz, Consultant of: AbbVie, Amgen, BMS, Genentech, Gilead, Janssen, Merck, Novartis, Pfizer, Regeneron, Sanofi, Sandoz, Namita Tundia Shareholder of: AbbVie, Employee of: AbbVie, Allison Bryant: None declared, Ia Topuria: None declared, Tom Brecht: None declared, Kendall Dunlap Shareholder of: AbbVie, Employee of: AbbVie, Allan Gibofsky Shareholder of: AbbVie, Amgen, Horizon, J&J, Pfizer, Regeneron, Speakers bureau: AbbVie, Acquist, Amgen, Lilly, Merck, Pfizer, Sandoz, Samumed, Consultant of: AbbVie, Acquist, Amgen, Lilly, Merck, Pfizer, Sandoz, Samumed

POS0670 ROUTINE ASSESSMENT OF PATIENT INDEX DATA 3 (RAPID3) IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH LONG-TERM UPADACITINIB THERAPY

Background:

Routine Assessment of Patient Index Data 3 (RAPID3) is a pooled index of 3 patient-reported measures: patient global assessment, pain, and physical function. RAPID3 was shown to correlate with other composite measures of disease activity1 and is recommended by the American College of Rheumatology for use in clinical practice.2

Objectives:

To evaluate the impact of upadacitinib (UPA) versus comparators on RAPID3 over 60 weeks, as well as the correlation of RAPID3 scores with other disease measures in the UPA phase 3 SELECT clinical program.

Methods:

This post hoc analysis included placebo-controlled (SELECT-NEXT, -BEYOND, and -COMPARE) and active comparator-controlled (SELECT-EARLY, -MONOTHERAPY, and -COMPARE) trials. Patients received UPA as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Mean change from baseline in RAPID3 and the proportion of patients reporting RAPID3 remission (≤3), low (LDA, >3 to ≤6), moderate (MDA, >6 to ≤12), and high disease activity (HDA, >12) were assessed. Correlations between absolute scores for RAPID3 and Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and 28-joint Disease Activity Score with C-reactive protein (DAS28[CRP]) were assessed using Spearman correlation coefficients. All data are as observed.

Results:

A total of 661, 498, 648, 1629, and 945 patients were included from SELECT-NEXT, -BEYOND, -MONOTHERAPY, -COMPARE, and -EARLY. At baseline, the majority of patients across all studies were in RAPID3 HDA (mean baseline RAPID3 [across all studies], 17.2–19.2) (Table 1 and Figure 1). Improvements from baseline in RAPID3 were observed with UPA 15 mg and 30 mg through Week 60, with numerically greater improvements observed with UPA compared with active comparators (Table 1). Across studies, mean improvements in RAPID3 exceeded the minimal clinically important difference (MCID) with UPA and adalimumab (ADA) treatment (MCID=3.83). By Week 60, approximately one-half of UPA-treated patients were in RAPID3 remission or LDA, with only 10–25% remaining in HDA, except for the more refractory population in SELECT-BEYOND, in which ~38% of patients remained in HDA (Figure 1). RAPID3 scores moderately to strongly correlated with CDAI (ρ=0.69–0.83), SDAI (ρ=0.69–0.82), and DAS28(CRP) (ρ=0.58–0.77), across all studies, at Week 60 (all p<0.001).

Conclusion:

UPA, as monotherapy or in combination with csDMARDs, was associated with improvements in patient-reported disease activity, pain, and physical function, as assessed by RAPID3 over 60 weeks in the phase 3 SELECT clinical program. RAPID3 continues to be an important tool in clinical practice to assess disease activity, as it was shown to correlate to other disease activity measures and allows for rapid scoring.

References:

[1]Pincus T, et al. Arthritis Care Res (Hoboken) 2010;62:181–9.

[2]England BR, et al. Arthritis Care Res (Hoboken) 2019;71:1540–55.

[3]Ward MM, et al. J Rheumatol 2019;46:27–30.

Table 1.

Change from BL in RAPID3 at Week 60 (as observed)

Phase 3 studyGroupnaMean (SD) BL scoreMean (SD) change from BLbSELECT-EARLYc(MTX-naïve)MTX23618.5 (5.6)−9.6 (7.5)UPA 15 mg QD26918.9 (5.6)−12.0 (7.6)UPA 30 mg QD25318.2 (5.6)−13.4 (7.2)SELECT-NEXT(csDMARD-IR)UPA 15 mg QD17217.7 (5.1)−11.1 (7.3)UPA 30 mg QD17217.6 (5.3)−10.4 (6.8)SELECT-MONOTHERAPY(MTX-IR)UPA 15 mg QD17217.4 (5.8)−9.6 (7.4)UPA 30 mg QD18017.2 (5.9)−10.6 (7.2)SELECT-COMPAREc(MTX-IR)UPA 15 mg QD55218.5 (5.5)−10.2 (7.1)ADA 40 mg EOW26418.7 (5.4)−8.8 (6.7)SELECT-BEYOND(bDMARD-IR)UPA 15 mg QD13319.2 (5.1)−8.6 (6.8)UPA 30 mg QD11818.5 (5.3)−9.3 (7.3)

b, biologic; BL, baseline; EOW, every other week; IR, inadequate response; MTX, methotrexate; QD, once daily; SD, standard deviation

aNumber of patients with RAPID3 values at both BL and Week 60. bNegative values indicate improvement from BL. cObserved data include patients rescued to UPA and/or ADA; treatment effect may include both the randomized and switch treatments in these patients

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Grant Kirkpatrick, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Martin Bergman Shareholder of: Johnson & Johnson, Speakers bureau: AbbVie, Celgene, GSK, MSD, Novartis, Pfizer, and Sanofi/Regeneron, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Genentech/Roche, Gilead, Horizon, Janssen, MSD, Novartis, Pfizer, Sandoz, Sanofi/Regeneron, and Scipher, Maya H Buch Consultant of: AbbVie, Eli Lilly, Merck-Serono, Pfizer, Sandoz, and Sanofi, Grant/research support from: Pfizer, Roche, and UCB, Yoshiya Tanaka Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, GSK, Janssen, Mitsubishi Tanabe, Novartis, Pfizer, Sanofi, Takeda, UCB, and YL Biologics, Grant/research support from: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, MSD, Ono, Taisho Toyama, and Takeda, Gustavo Citera Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Genzyme, Pfizer, and Roche, Sami Bahlas: None declared, Ernest Wong Consultant of: AbbVie, Chugai, Eli Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Chugai, Novartis, and UCB, Yanna Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Namita Tundia Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Jessica Suboticki Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Vibeke Strand Consultant of: AbbVie, Amgen, Arena, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Gilead, Ichnos, Inmedix, Janssen, Kiniksa, MSD, Myriad Genetics, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, Scipher, Setpoint, and UCB.

AB0553 BASELINE DISEASE ACTIVITY AS A PREDICTOR FOR ACHIEVING cDAPSA TREATMENT TARGETS WITH APREMILAST IN DMARD-NAIVE PATIENTS WITH MANIFESTATIONS OF ACTIVE PSORIATIC ARTHRITIS

Background:

In PALACE 4, DMARD-naive patients (pts) with moderately active (ModDA) psoriatic arthritis (PsA) at baseline (BL) were more likely to achieve Clinical Disease Activity Index for PsA (cDAPSA) treatment targets (cDAPSA remission [REM] or low disease activity [LDA]) at Week 52 with continued apremilast 30 mg BID (APR) treatment than pts with high disease activity (HDA) at BL. Pts who achieved cDAPSA treatment targets also had no or mild articular and extra-articular disease activity by Week 52. Whether specific PsA manifestations other than arthritis impact the achievement of cDAPSA treatment targets in this population is unknown.

Objectives:

To assess the predictive value of BL clinical disease status on achieving cDAPSA treatment targets in DMARD-naive pts in PALACE 4 with PsA in ModDA or HDA who exhibited manifestations of skin involvement, enthesitis, and/or dactylitis at BL.

Methods:

This post hoc analysis included APR-treated pts in ModDA or HDA with available cDAPSA data at BL and Week 52 who exhibited any of the PsA manifestations at BL, including skin-involved body surface area (BSA) ≥3%, Maastricht Ankylosing Spondylitis Entheses Score (MASES) >0, or dactylitis count >0. Pts were divided into 4 subgroups based on number of manifestations: ≥1, only 1, any 2, or all 3. The proportions of pts who shifted across ModDA (>13 to ≤27) and HDA (>27) cDAPSA categories at BL to REM (≤4) and LDA (>4 to ≤13) treatment targets at Week 52 were calculated (data as observed).

Results:

In 176 PALACE 4 pts with PsA receiving APR, 165 had involvement in ≥1 PsA manifestation in addition to peripheral arthritis (ie, skin/enthesitis/dactylitis) at BL. This population had a mean age of 48.8 years, PsA duration of 3.6 years, Psoriasis Area and Severity Index (PASI) score of 6.6, MASES of 3.8, and dactylitis count of 3.5 (Table 1). Within this subgroup, 32.7% had only 1 of these non-arthritic PsA manifestations, 50.9% had any 2, and 16.4% had all 3. In pts with ≥1 manifestation, a greater proportion in ModDA achieved REM/LDA at Week 52 than those in HDA (66.7% vs 32.2%; risk difference: 0.34) (Figure 1). Similarly, greater rates of treatment target achievement were observed in subgroups of pts in ModDA vs HDA and only 1 (72.2% vs 39.1%; risk difference: 0.33), any 2 (57.1% vs 28.6%; risk difference: 0.29), or all 3 (75.0% vs 33.3%; risk difference: 0.42) PsA manifestations (Figure 1).

Conclusion:

In DMARD-naive pts exhibiting various non-arthritic manifestations of active PsA (ie, skin/enthesitis/dactylitis), those in ModDA at BL were more likely to achieve cDAPSA REM or LDA at Week 52 of APR treatment than pts in HDA. This observation was consistent whether pts had only 1 or multiple manifestations. These findings are consistent with the probability of achieving treatment targets demonstrated in the overall population in PALACE 4 (61.7% ModDA vs 28.2% HDA).

Table 1.

BL Demographics and Disease Characteristics in Pts With ≥1 Manifestations of PsA (Skin Involvement, Enthesitis, and/or Dactylitis) Treated With APR (N = 165)

Age*, years48.8 (12.5)Women, n (%)87 (52.7)BMI*, kg/m229.9 (6.5)Duration of PsA*, years3.6 (5.0)Duration of psoriasis*, years15.5 (13.3)cDAPSA (0-154)*39.4 (19.7)Swollen joint count (0-66)*10.3 (7.7)Tender joint count (0-68)*18.5 (12.9)Pt’s Assessment of Pain (VAS 0-100 mm)*52.8 (21.5)Pt’s Global Assessment (VAS 0-100 mm)*53.8 (20.1)Physician’s Global Assessment (VAS 0-100 mm)*52.2 (17.6)PASI score (0-72)*,†6.6 (5.1)MASES (0-13)*,‡3.8 (3.0)Dactylitis count (0-20)*,§3.5 (3.3)Corticosteroid use, n (%)13 (7.9)NSAID use, n (%)126 (76.4)

*Mean (SD).†In pts with BSA ≥3% at BL.‡In pts with enthesitis at BL.§In pts with dactylitis at BL.

Acknowledgements:

This study was funded by Celgene. Additional analyses were funded by Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, RPh, MBA, of Peloton Advantage, LLC, an OPEN Health company.

Figure 1.

Disclosure of Interests:

Philip J Mease Speakers bureau: AbbVie, Amgen Inc., Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen Inc., Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Galapagos, GSK, Novartis, Pfizer, Sun, and UCB, Grant/research support from: AbbVie, Amgen Inc., Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Galapagos, GSK, Novartis, Pfizer, Sun, and UCB, Arthur Kavanaugh Grant/research support from: AbbVie, Amgen Inc., AstraZeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Alexis Ogdie Consultant of: AbbVie, Amgen Inc., BMS, Celgene, Corrona, Eli Lilly, Gilead, Novartis, Pfizer, and UCB, Grant/research support from: Novartis and Pfizer, Alvin F. Wells Speakers bureau: AbbVie, Alexion, Amgen Inc., BMS, Celgene, Horizon, Lilly, Novartis, and UCB, Consultant of: AbbVie, Alexion, Amgen Inc., BMS, Celgene, Horizon, Lilly, Novartis, and UCB, Grant/research support from: AbbVie, Celgene, and Lilly, Martin Bergman Shareholder of: Johnson & Johnson, Speakers bureau: AbbVie, Amgen Inc., Novartis, Pfizer, and Sanofi, Consultant of: AbbVie, BMS, Celgene, Genentech, Janssen, Merck, Novartis, Pfizer, and Sanofi, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, Frank Behrens Speakers bureau: AbbVie, Biotest, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Genzyme, Janssen, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Chugai, Janssen, Roche, and Pfizer, Yuri Klyachkin Employee of: Amgen Inc., Sven Richter Employee of: Amgen Inc., Lichen Teng Employee of: Amgen Inc., Josef S. Smolen Speakers bureau: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, MSD, Novartis, Pfizer, Roche, Samsung, Sanofi, and UCB, Consultant of: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, MSD, Novartis, Pfizer, Roche, Samsung, Sanofi, and UCB, Grant/research support from: AbbVie, Eli Lilly, Janssen, MSD, Medimmune, Pfizer, and Roche.

Healthcare Costs of Not Achieving Remission in Patients with Rheumatoid Arthritis in the United States: A Retrospective Cohort Study

Introduction

To compare all-cause and rheumatoid arthritis (RA)-related healthcare costs and resource use in patients with RA who do not achieve remission versus those who achieve remission, using clinical practice data.

Methods

Data were derived from Optum electronic health records linked to claims from commercial and Medicare Advantage health plans. Two cohorts were created: remission and non-remission. Remission was defined as Disease Activity Score 28-joint count with the C-reactive protein level or erythrocyte sedimentation rate (DAS28-CRP/ESR) < 2.6 or Routine Assessment of Patient Index Data 3 (RAPID3 ≤ 3.0). Outcomes were all-cause and RA-related costs and resource use during a 1-year follow-up period. A weighted generalized linear regression and negative binomial regression were used to estimate adjusted annual costs and resource use, respectively, controlling for confounding factors, including patient and socio-demographic characteristics.

Results

Data from 335 patients (remission: 125; non-remission: 210) were analyzed. Annual all-cause total costs were significantly less in the remission versus non-remission cohort ($30,427 vs. $38,645, respectively; cost ratio [CR] = 0.79; 95% CI 0.63, 0.99). All-cause resource use (mean number of visits) was less in the remission versus non-remission cohort: inpatient (0.23 vs. 0.63; visit ratio [VR] = 0.36; 95% CI 0.19, 0.70), emergency department (0.36 vs. 0.77; VR = 0.47; 95% CI 0.30, 0.74), and outpatient visits (20.7 vs. 28.5; VR = 0.73; 95% CI 0.62, 0.86). Annual RA-related total costs were similar in both cohorts; however, RA-related medical costs were numerically lower in the remission versus non-remission cohort ($8,594 vs. $10,002, respectively; CR = 0.86; 95% CI 0.59, 1.25). RA-related resource use was less in the remission versus non-remission cohort.

Conclusions

Significant economic burden was associated with patients who did not achieve remission compared with those who did achieve remission.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01730-w.

Technique for modified transantral orbital decompression for improved cosmesis in stable thyroid eye disease

Functional and aesthetic rehabilitation of exophthalmos in stable thyroid eye disease (TED) can be achieved with a variety of surgical approaches. This article illustrates modifications of the classic transantral technique to provide a graded orbital decompression and achieve improved cosmesis. A retrospective chart review was performed of stable TED patients who elected to undergo the modified transantral decompression; illustrative cases are described. This modified transantral orbital decompression allows for graded orbital decompression surgery, adding to the range of treatment options for stable TED patients.

Upadacitinib improves patient-reported outcomes vs placebo or adalimumab in patients with rheumatoid arthritis: results from SELECT-COMPARE

Objective

To evaluate the impact of upadacitinib vs placebo and adalimumab treatment, on patient-reported outcomes (PROs) in SELECT-COMPARE in an active RA population with inadequate responses to MTX (MTX-IR).

Methods

PROs in patients receiving upadacitinib (15 mg QD), placebo, or adalimumab (40 mg EOW) while on background MTX were evaluated over 48 weeks. PROs included Patient Global Assessment of Disease Activity (PtGA) and pain by visual analogue scale (VAS), the HAQ Disability Index (HAQ-DI), the 36-Item Short Form Survey (SF-36), morning (AM) stiffness duration and severity, the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F), and work instability. Least squares mean (LSM) changes and proportions of patients reporting improvements ≥ minimal clinically important differences (MCIDs) and scores ≥ normative values were evaluated.

Results

Upadacitinib and adalimumab resulted in greater LSM changes from baseline vs placebo across all PROs (P < 0.05) at week 12, and pain and AM stiffness severity (P < 0.05) at week 2. More upadacitinib- vs placebo-treated (P < 0.05) and similar percentages of upadacitinib- vs adalimumab-treated patients reported improvements ≥ MCID across all PROs at week 12. Upadacitinib vs adalimumab resulted in greater LSM changes from baseline in PtGA, pain, HAQ-DI, stiffness severity, FACIT-F, and the SF-36 Physical Component Summary (PCS) (all P < 0.05) at week 12. More upadacitinib- vs adalimumab-treated patients reported scores ≥ normative values in HAQ-DI and SF-36 PCS (P < 0.05) at week 12. More upadacitinib- vs adalimumab-treated patients maintained clinically meaningful improvements in PtGA, pain, HAQ-DI, FACIT-F, and AM stiffness through 48 weeks.

Conclusion

In MTX-IR patients with RA, treatment with upadacitinib resulted in statistically significant and clinically meaningful improvements in PROs equivalent to or greater than with adalimumab.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT02629159.

Identifying Prostate Cancer Among Men with Lower Urinary Tract Symptoms

Background

In men aged above 50 yr, lower urinary tract symptoms (LUTS), benign prostate hyperplasia, and prostate cancer are common urological conditions. Current guidelines for general practitioners frequently recommend prostate-specific antigen (PSA) testing in patients with LUTS for the detection of prostate cancer.

Objective

To assess the performance of PSA, PSA density, and the Stockholm3 blood test for identification of prostate cancer among men with LUTS.

Design, setting, and participants

In this post hoc analysis of a population-based diagnostic trial (STHLM3, n = 58 588), 4588 men aged 50–69 yr, without previous prostate cancer, with International Prostate Symptom Score (IPSS) data, and having PSA ≥ 3 ng/mL were identified. Men with at least moderate LUTS, defined as an IPSS score of ≥8, were included. PSA density and Stockholm3 scores were calculated.

Intervention

Participants underwent 10–12-core systematic prostate biopsies.

Outcome measurements and statistical analysis

The primary outcome was significant prostate cancer (sPCa) defined as International Society of Urological Pathology (ISUP) grade ≥2. Logistic regression analysis adjusted for age and previous biopsy status was performed. The area under the receiver operating characteristic curve (AUC) was calculated, and decision curve analysis was performed.

Results and limitations

Out of 4588 men, 1544 (34%) reported at least moderate LUTS. The median age was 64 yr, and 11% had undergone a previous prostate biopsy. The Stockholm3 test showed superior discrimination for sPCa to PSA density, which in turn showed superior discrimination to PSA (AUC 0.77 vs 0.70 vs 0.61, p <  0.02). Calibration of the Stockholm3 test was adequate. Performing biopsy only in men with PSA ≥5 ng/mL saved 64% of biopsies, but resulted in missing 52% of detectable sPCa. Recommending biopsy for men with PSA density ≥0.07 resulted in sparing 26% of biopsy procedures and delaying the diagnosis of 12% of sPCa cases, with a 6.1% risk of sPCa among unbiopsied men. Recommending men with Stockholm3 ≥ 0.11 for biopsy resulted in sparing 53% of biopsy procedures and delaying the diagnosis of 20% of sPCa cases, with a 5.1% risk of finding sPCa in unbiopsied men.

Conclusions

PSA density and the Stockholm3 blood test were superior to PSA for the identification of prostate cancer among men with LUTS.

Patient summary

In this analysis of a large Swedish study, we find that the use of prostate-specific antigen (PSA) density or the Stockholm3 blood test instead of only PSA might improve the detection of prostate cancer among men with lower urinary tract symptoms.

High Burden of Burnout on Rheumatology Practitioners

OBJECTIVE

Burnout among physicians is common and has important implications. We assessed the extent of burnout among rheumatology practitioners and its associations.

METHODS

One hundred twenty-eight attendees at the 2019 Rheumatology Winter Clinical Symposium were surveyed using the Maslach Burnout Index (MBI) and a demographics questionnaire. Scores for emotional exhaustion (EE) ≥ 27, depersonalization (DP) ≥ 10, and personal accomplishment (PA) ≤ 33 were considered positive for burnout. Data regarding practitioner characteristics including age, sex, years in practice, and other demographics of interest were also collected. These data were used to determine prevalence and interactions of interest between practitioner characteristics and the risk of burnout.

RESULTS

Of the 128 respondents, 50.8% demonstrated burnout in at least 1 MBI domain. Dissatisfaction with electronic health records was associated with a 2.86-times increased likelihood of burnout (OR 2.86, 95% CI 1.23-6.65, P = 0.015). Similar results were found for lack of exercise (OR 5.00, 95% CI 1.3-18.5, P = 0.016) and work hours > 60 per week (OR 2.6, 95% CI 1.16-5.6, P = 0.019). Practitioners in group practice were 57% less likely to burn out (OR 0.43, 95% CI 0.20-0.92, P = 0.029), as were those who spend > 20% of their time in personally satisfying work (OR 0.32, 95% CI 0.15-0.71, P = 0.005).

CONCLUSION

In what we believe to be one of the largest studies regarding burnout among rheumatology practitioners, we found a substantial prevalence of burnout, with 51% of all respondents meeting criteria in at least 1 domain defined by the MBI and 54% of physicians meeting these same criteria.

Evaluation of Adherence and Persistence Differences Between Adalimumab Citrate-Free and Citrate Formulations for Patients with Immune-Mediated Diseases in the United States

INTRODUCTION

Our aim was to evaluate patient adherence and persistence with citrate-free adalimumab (ADA-CF), introduced in 2018 to reduce injection-site pain, compared with citrate-containing adalimumab (ADA-C).

METHODS

This was a retrospective cohort study using a US claims database (IBM^® MarketScan^® Commercial and Medicare Supplemental Claims Database) from February 2018 to January 2020. Patients at least 18 years of age who were naïve to adalimumab 6 months before the index date (date of first adalimumab claim) and with at least 12 months of continuous medical and pharmacy coverage were eligible for the study. Adherence was assessed by determining the proportion of days covered (PDC) and the percentage of patients with PDC ≥ 80% during the 12-month follow-up period. Persistence was evaluated by measuring the rate of discontinuation and days to discontinuation (i.e., time on treatment) from the index date over the 12-month follow-up period. Continuous adherence outcomes (PDC) were evaluated using linear regression models. Binary adherence outcomes (PDC ≥ 80%) were assessed using logistic regression models. Kaplan-Meier analysis and Cox proportional hazards models were used to assess persistence outcomes.

RESULTS

There were 2195 and 1005 patients in the ADA-CF and ADA-C cohorts, respectively, with most using adalimumab for rheumatoid arthritis (ADA-CF 29.7%, ADA-C 27.2%) and psoriasis (ADA-CF 24.5%, ADA-C 31.9%). Significantly greater adherence was achieved with ADA-CF compared with ADA-C (mean PDC [standard deviation] 0.68 [0.30] vs 0.61 [0.32], P < 0.0001). A significantly greater percentage of patients receiving ADA-CF (47.2%) vs ADA-C (39.6%) had PDC ≥ 80% (P < 0.0001). The discontinuation rate was significantly lower for the ADA-CF cohort (46.4%) compared with ADA-C (55.9%, P < 0.0001), resulting in a 27% lower likelihood of discontinuation during the 12-month follow-up period (hazard ratio 0.73; 95% confidence interval 0.66, 0.82; P < 0.0001) and longer time on treatment (260 vs 232 days, P < 0.0001).

CONCLUSION

Adherence and persistence are significantly improved with ADA-CF compared with ADA-C.

Invasiveness and Metastatic Aggressiveness in Small Differentiated Thyroid Cancers: Demography of Small Papillary Thyroid Carcinomas in the Swedish Population

BACKGROUND

The western world is seeing a rising incidence of thyroid cancer. Improved diagnostic methods do not entirely explain this increase. Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid cancer. Small PTC (≤20 mm) and especially papillary thyroid microcarcinomas (PTMC ≤10 mm) are considered to be low-risk tumors but some cases are considerably more aggressive. Sufficient understanding of these mechanisms is a long-term goal for more efficient and safer treatment of these tumors.

METHODS

We identified 959 cases of small PTCs in the validated Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery, grouped according to lymph node metastasis. These were analyzed according to age, gender, tumor size and geographic region.

RESULTS

Patients with N1b disease (lateral lymph nodes metastases) had a smaller tumor size compared to patients with N1a disease (8.6 mm vs 10.1 mm respectively, p < 0.05). Patients and specifically females with N1b disease were younger than those with N0 or N1a disease. Patients with N1b disease had a lower proportion of females (60%) compared to N0 and N1a groups (81% and 78%, respectively). The incidence of operated small PTCs and of lymph node engagement differs between geographic regions in Sweden.

CONCLUSIONS

Small PTC and especially PTMC seem to show different patterns of aggressiveness and demography regarding lateral lymph node metastases and 7% had N1b disease and tumor <1 cm, underscoring the importance of lymph node evaluation in PTMC patients. More understanding of predictive factors, mechanisms for metastatic disease and causes of regional differences, is needed.

Data-Driven Patient Clustering and Differential Clinical Outcomes in the Brigham and Women's Rheumatoid Arthritis Sequential Study Registry

Objective

To use unbiased, data‐driven, principal component (PC) and cluster analysis to identify patient phenotypes of rheumatoid arthritis (RA) that might exhibit distinct trajectories of disease progression, response to treatment, and risk for adverse events.

Methods

Patient demographic, socioeconomic, health, and disease characteristics recorded at entry into a large, single‐center, prospective observational registry cohort, the Brigham and Women’s Rheumatoid Arthritis Sequential Study (BRASS), were harmonized using PC analysis to reduce dimensionality and collinearity. The number of PCs was established by eigenvalue >1, cumulative variance, and interpretability. The resulting PCs were used to cluster patients using a K‐means approach. Longitudinal clinical outcomes were compared between the clusters over 2 years.

Results

Analysis of 142 variables from 1,443 patients identified 41 PCs that accounted for 77% of the cumulative variance in the data set. Cluster analysis distinguished 5 patient clusters: 1) less RA disease activity/multimorbidity, shorter RA duration, lower incidence of comorbidities; 2) less RA disease activity/multimorbidity, longer RA duration, more infections, psychiatric comorbidities, health care utilization; 3) moderate RA disease activity/multimorbidity, more neurologic comorbidity; 4) more RA disease activity/multimorbidity, shorter RA duration, more metabolic comorbidity, higher body mass index; 5) more RA disease activity/multimorbidity, longer RA duration, more hepatic, orthopedic comorbidity and RA‐related surgeries. The clusters exhibited differences in clinical outcomes over 2 years of follow‐up.

Conclusion

Data‐driven analysis of the BRASS registry identified 5 distinct phenotypes of RA. These results illustrate the potential of data‐driven patient profiling as a tool to support personalized medicine in RA. Validation in an independent data set is ongoing.

Brief Report: Adaptation of American College of Rheumatology Rheumatoid Arthritis Disease Activity and Functional Status Measures for Telehealth Visits

Objective

To provide guidance on the implementation of recommended American College of Rheumatology (ACR) rheumatoid arthritis (RA) disease activity and functional status assessment measures in telehealth settings.

Methods

An expert panel was assembled from the recently convened ACR RA disease activity and functional status measures working groups to summarize strategies for implementation of ACR‐recommended RA disease activity (the Clinical Disease Activity Index [CDAI], Disease Activity Score in 28 joints using the erythrocyte sedimentation rate or the C‐reactive protein level [DAS28‐ESR/CRP], Patient Activity Scale II [PAS‐II], Simplified Disease Activity Index [SDAI], and Routine Assessment of Patient Index Data 3 [RAPID3]) and functional status (the Health Assessment Questionnaire II [HAQ‐II], Multidimensional Health Assessment Questionnaire [MDHAQ], and PROMIS physical function 10‐item short form [PROMIS PF‐10]) measures in telehealth settings.

Results

Measures composed of patient‐reported items (disease activity: PAS‐II, RAPID3; functional status: HAQ‐II, MDHAQ, PROMIS PF‐10) require minimal modification for use in telehealth settings. Measures requiring formal joint counts (the CDAI, DAS28‐ESR/CRP, and SDAI) can be calculated using patient‐reported swollen and tender joint counts. When the feasibility of laboratory testing is limited, the CDAI can be used in place of the SDAI, and scoring modifications of the DAS28‐ESR/CRP without the acute‐phase reactant are available. Assessment of the validity of these modifications is limited. Implementation of these measures can be facilitated by electronic health record collection, mobile applications, and provider/staff administration during telehealth visits.

Conclusion

The ACR‐recommended RA disease activity and functional status measures can be adapted for use in telehealth settings to support high‐quality clinical care. Research is needed to better understand how telehealth settings may impact the validity of these measures.

THU0546 HEALTHCARE COSTS OF NOT ACHIEVING REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Guidelines recommend sustained remission as a treatment goal for patients with rheumatoid arthritis (RA). However, only one-third of patients are known to achieve this goal with current treatments. A few studies have evaluated the impact of remission in a real-world setting, but evidence is limited to the elderly population.

Objectives:

To understand the impact of remission on healthcare costs by comparing overall and RA-related direct healthcare costs and resource use in patients with RA who maintain vs those who do not maintain remission using a real-world database.

Methods:

Data for this retrospective cohort study were derived from Optum electronic health records linked to claims from commercial and Medicare Advantage health plans in the United States. Patients with ≥2 diagnoses for RA, ≥1 Disease Activity Score 28 (DAS28-CRP/ESR) or Routine Assessment of Patient Index Data 3 (RAPID3) measurement, and continuous medical and pharmacy coverage 6 months before and 1 year after the index date were included. Two cohorts were created: remission and non-remission. Remission was defined as DAS28 <2.6 or RAPID3 ≤3.0. In the remission cohort, the index date was defined as the first date remission was achieved. In the non-remission cohort, the index date was defined as the first date of DAS28 or RAPID3 measurement. Outcomes were all-cause and RA-related total, medical, and prescription costs; healthcare resource use (number of inpatient, emergency department [ED], outpatient, and other visits); and number of prescriptions within 1 year of index date. A weighted generalized linear model and binomial regression were used to estimate adjusted annual direct costs and healthcare resource use, respectively. Confounding between cohorts due to age, sex, race and comorbidities using the Elixhauser index was controlled for in the models.

Results:

A total of 335 patients with RA (remission cohort: 125; non-remission cohort: 210) met the study inclusion criteria. Annual all-cause total direct costs in the remission cohort were significantly less than in the non-remission cohort ($30,427 vs $38,645, respectively; cost ratio (CR)=0.79; 95% CI: 0.63, 0.99). All-cause medical costs were significantly lower in the remission cohort than in the non-remission cohort (Figure 1); furthermore, among all-cause medical costs, outpatient visit costs were significantly lower in the remission than in the non-remission cohort. All-cause resource use (mean number of visits) was less in the remission vs non-remission cohort: inpatient (0.23 vs 0.63; visit ratio (VR)=0.36; 95% CI: 0.19, 0.70), ED (0.36 vs 0.77; VR=0.47; 95% CI: 0.30, 0.74), and outpatient visits (20.7 vs 28.5; VR=0.73; 95% CI: 0.62, 0.86). Annual RA-related total direct costs were similar in both cohorts (Figure 2); however, RA-related medical costs were numerically lower in the remission vs non-remission cohort ($8,594 vs $10,002, respectively; CR=0.86; 95% CI: 0.59, 1.25). RA-related resource use (mean number of visits) was less in the remission vs non-remission cohort: inpatient (0.15 vs 0.22; VR=0.67; 95% CI: 0.35, 1.30), ED (0.04 vs 0.13; VR=0.31; 95% CI: 0.10, 0.95), and outpatient visits (5.4 vs 7.4; VR=0.72; 95% CI: 0.58, 0.91).

Conclusion:

Significant economic burden was associated with patients who did not maintain remission compared with those who maintained remission. Although outpatient visits were the driver of medical costs in both groups studied in this analysis, the contribution of outpatient visits was greater among those who did not maintain remission.

Acknowledgments:

Financial support for the study was provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract. All authors contributed to the development of the publication and maintained control over the final content. Medical writing services were provided by Joann Hettasch of JK Associates Inc., a member of the Fishawack Group of Companies, and funded by AbbVie.

Disclosure of Interests:

Martin Bergman Shareholder of: Johnson & Johnson – stockholder, Consultant of: AbbVie, BMS, Celgene Corporation, Genentech, Janssen, Merck, Novartis, Pfizer, Sanofi – consultant, Speakers bureau: AbbVie, Celgene Corporation, Novartis, Pfizer, Sanofi – speakers bureau, Lili Zhou Shareholder of: AbbVie, Employee of: AbbVie, Pankaj Patel Shareholder of: AbbVie, Employee of: AbbVie, Ruta Sawant Shareholder of: AbbVie, Employee of: AbbVie, Jerry Clewell Shareholder of: AbbVie, Employee of: AbbVie, Namita Tundia Shareholder of: AbbVie, Employee of: AbbVie

AB1194 STRIKING DIFFERENCES IN THE COURSE OF OSTEOARTHRITIS (OA) COMPARED TO RHEUMATOID ARTHRITIS (RA) OVER THE FIRST 24 MONTHS OF RHEUMATOLOGY CARE AT ONE PRIVATE PRACTICE SETTING

Background:

Recent reports indicate that disease burden in osteoarthritis (OA) is similar to or greater than in rheumatoid arthritis (RA) when an identical measure is used to assess patients with either disease, generally an MDHAQ/RAPID3 (multidimensional health assessment questionnaire/routine assessment of patient index data). The data suggest that a traditional view that RA is more severe than OA no longer is valid at this time. One concern is that similar disease burdens in OA vs RA may result entirely from superior treatments for RA, and RA may be considerably more severe than OA at initial presentation.

Objectives:

To analyze MDHAQ disease burden in patients with OA vs RA at initial visit and at 24-month follow-up in routine care at a single solo-rheumatologist private practice setting.

Methods:

All patients at this setting complete an MDHAQ at each visit in the waiting area, prior to seeing the rheumatologist. The MDHAQ includes three 0-10 scores for physical function, pain visual numeric scale (VNS), and patient global VNS, which may be compiled into a 0–30 RAPID3, as well as a 0-10 fatigue VNS, and 0-16 rheumatoid arthritis disease activity index (RADAI) self-report painful joint count. Mean MDHAQ scores were analyzed for all 73 OA and 116 RA patients seen for an initial visit between 2011 and 2017. Mean scores at initial and 24-month visits were compared for all 25 OA and 63 RA patients seen at 24 month (21-27 month) follow-up visits, using paired t tests.

Results:

Mean MDHAQ scores at first visit were similar for all 73 OA and 116 RA patients, and also for 25 OA and 63 RA patients who were also seen 24 months later, e.g., mean RAPID3 was 12.0-14.2. However, mean changes over 2 years were strikingly different in OA versus RA patients (Table). Almost all mean scores in OA were somewhat higher, while all mean scores in RA were clinically and statistically significantly improved at 24 months, e.g., mean RAPID3 worsened from 13.0 to 15.2 (+2.2 units, 17%) in OA patients, compared to improvement from 12.5 to 8.2 (-4.3 units, -34%) in RA patients. The smallest mean change in RA patients involved the joint count (7.7 to 6.1, -21%) (Table), suggesting possible control of inflammation, but continued damage to specific joints. An important limitation is that the data do not include follow-up on patients not seen over the 24 month “window,” because of substantially better or poorer status, joint surgery, or other reasons, although the data present an accurate characterization of one rheumatology practice setting.

Mean values of patient MDHAQ scores in patients with OA or RA at first visit and 24-month follow-up

MDHAQ score:OA first visit of those seen at 24 months(n=25)OA 24- month visit (n=25)% change, over 24 monthsRA first visit of those seen at 24 months(n=63)RA 24- month visit (n=63)% change, over 24 monthsRAPID313.015.2+2.2, +17%12.58.2-4.3, -34%Function0.810.77-0.04, -5%0.710.50-0.21, -29%Pain5.26.4+1.2, +23%5.13.2-1.9, -37%Patient global5.15.9+0.8, +16%5.13.3-1.8, -35%Fatigue4.14.4+0.3, +7%4.83.5-1.3, -27%Pt joint count7.57.8+0.3, +4%7.76.1-1.6, -21%

Abbreviations: MDHAQ=multidimensional health assessment questionnaire, OA=osteoarthritis, RA=rheumatoid arthritis, RAPID3=routine assessment of patient index data.

In change data, negative numbers indicate improvement, positive numbers indicate worsening.

Conclusion:

Mean MDHAQ/RAPID3 scores were similar in RA or OA at the initial visit. Over 24 months, scores worsened slightly in OA and improved considerably in RA, resulting in considerably poorer status in OA versus RA, likely reflecting superior treatments for RA vs OA. At an individual level, patients with primary OA may have better or poorer status than patients with primary RA. Nonetheless, at a group level, the severity of disease burden in OA appears similar to RA, and becomes greater over the next 24 months, likely as a result of better treatments. The severity of OA is underrated, suggesting a need for increased resources for research toward better treatments for OA.

Disclosure of Interests:

Kyle Schroeder: None declared, Theodore Pincus Shareholder of:

Dr. Pincus holds a copyright and trademark on MDHAQ and RAPID3 for which he receives royalties and license fees from profit-making organizations, all of which are used to support further development of quantitative clinical measures for patients and health professionals., Martin Bergman Shareholder of: Johnson & Johnson – stockholder, Consultant of: AbbVie, BMS, Celgene Corporation, Genentech, Janssen, Merck, Novartis, Pfizer, Sanofi – consultant, Speakers bureau: AbbVie, Celgene Corporation, Novartis, Pfizer, Sanofi – speakers bureau

FRI0352 PROBABILITY OF ACHIEVING LOW DISEASE ACTIVITY OR REMISSION WITH APREMILAST TREATMENT AMONG DMARD-NAIVE SUBJECTS WITH ACTIVE PSORIATIC ARTHRITIS

Background:

Apremilast (APR) is associated with comparable ACR response rates in DMARD-naive vs DMARD-experienced patients (pts) with psoriatic arthritis (PsA).1,2A question that remains is if DMARD-naive pts treated with APR have greater chances of achieving treatment targets than DMARD-experienced pts. cDAPSA is a commonly used treatment target.

Objectives:

To assess the predictive value of baseline (BL) clinical disease status on achieving long-term cDAPSA treatment targets at Wk 52 among DMARD-naive subjects in PALACE 4; to compare these findings vs those recently reported from the PALACE 1-3 studies in subjects with prior exposure to DMARDs; and to provide further evidence that at a group level, achievement of cDAPSA disease targets with APR is associated with no or mild articular and extra-articular disease activity by Wk 52.

Methods:

This post hoc analysis included subjects assigned to APR 30 mg twice daily at BL who had available cDAPSA data at BL. We calculated the probabilities of shifting across different cDAPSA categories (remission [REM]: ≤4; low disease activity [LDA]: >4 to ≤13; moderate disease activity [Mod]: >13 to ≤27; high disease activity [HDA]: >273) from BL to Wk 52. Mean values of articular and non-articular variables (e.g., PASI, SJC/TJC, MASES, dactylitis) from BL to Wk 52 were assessed by cDAPSA category achieved at Wk 52 to determine the association between achievement of targets and control of articular and non-articular manifestations. Results from the current analyses were compared with the previously reported results from PALACE 1-3.

Results:

A total of 175 subjects receiving APR were included; at BL, 66.3% were in HDA, 31.4% in Mod, and 2.3% were in LDA. Overall, subjects who achieved treatment targets (LDA or REM) by Wk 52 had lower levels of disease activity at BL, as shown by a lower number of swollen and tender joints and lower presence of enthesitis and dactylitis. Higher prevalence of psoriasis-involved body surface area ≥3% at BL was observed. Subjects in Mod at BL were estimated to be more than twice as likely to achieve REM or LDA at Wk 52 vs subjects in HDA at BL; for subjects in LDA at BL, the estimated probability of achieving cDAPSA treatment targets was 100% (Figure). PALACE 4 subjects with LDA and Mod at BL exhibited higher estimated probabilities of achieving treatment targets (100.0% and 61.7%, respectively) than those observed in the DMARD-experienced population of PALACE 1-3 (71.1% and 46.9%). Subjects in PALACE 4 who achieved REM or LDA by Wk 52 showed no or mild articular and extra-articular disease activity by Wk 52, similar to what was observed in the PALACE 1-3 population.4

Conclusion:

DMARD-naive subjects in PALACE 4 who had LDA or Mod at BL had the highest likelihood of achieving treatment targets (cDAPSA REM or LDA) by Wk 52 with continued APR treatment. Results from the current probability analyses revealed higher probability rates than those observed in the DMARD-experienced PALACE 1-3 population; control of articular and extra-articular manifestations was observed in the DMARD-naive and DMARD-experienced populations.

References:

[1]Wells AF, et al. Rheumatology. 2018;57:1253-63. 2. Kavanaugh A, et al. Arthritis Res Ther. 2019;21:118. 3. Machado PM. Ann Rheum Dis. 2016;75:787-90. 4. Mease PJ, et al. Arthritis Care Res. 2020 Jan 7.

Disclosure of Interests:

Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Arthur Kavanaugh Grant/research support from: Abbott, Amgen, AstraZeneca, BMS, Celgene Corporation, Centocor-Janssen, Pfizer, Roche, UCB – grant/research support, Alexis Ogdie Grant/research support from: Novartis, Pfizer – grant/research support, Consultant of: AbbVie, BMS, Eli Lilly, Novartis, Pfizer, Takeda – consultant, Alvin F. Wells Grant/research support from: AbbVie, Celgene Corporation, Lilly – grant/research support, Consultant of: AbbVie, Alexion, Amgen, BMS, Celgene Corporation, Horizon, Lilly, Novartis, UCB – consultant, Speakers bureau: AbbVie, Alexion, Amgen, BMS, Celgene Corporation, Horizon, Lilly, Novartis, UCB – speakers bureau, Martin Bergman Shareholder of: Johnson & Johnson – stockholder, Consultant of: AbbVie, BMS, Celgene Corporation, Genentech, Janssen, Merck, Novartis, Pfizer, Sanofi – consultant, Speakers bureau: AbbVie, Celgene Corporation, Novartis, Pfizer, Sanofi – speakers bureau, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Frank Behrens Grant/research support from: AbbVie, Chugai, Janssen, Roche, Pfizer – grant/research support, Consultant of: AbbVie Biotest, Boehringer Ingelheim, Celgene Corporation, Chugai, Eli Lilly, Genzyme, Janssen, Novartis, Pfizer, Roche, UCB – consultant, Speakers bureau: AbbVie, Biotest, BMS, Celgene Corporation, Chugai, Eli Lilly, Genzyme, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sandoz, UCB - speaker, Sven Richter Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Michele Brunori Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Lichen Teng Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Benoit Guerette Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, Merck Sharp & Dohme, Pfizer, Roche – grant/research support, Consultant of: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Sanofi, UCB – consultant, Speakers bureau: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Sanofi, UCB – speaker

[Improved prostate cancer diagnostics with a struc-tured pathway including the Stockholm3 test and MRI--targeted biopsies - experiences from Capio S:t Göran Prostate Cancer Center]

Capio S:t Göran Prostate Cancer Center is located in Stockholm and offers testing for prostate cancer using a structured pathway including the blood-test Stockholm3 and MRI-targeted prostate biopsies. The diagnostic pathway is organized by dedicated nurses, offering information, testing, test results, as well as organizing further workup with MRI and biopsies for men with elevated risk. In this article, we describe initial experiences and introduces the Capio S:t Göran Model.

Managing morbidity and treatment-related toxicity in patients with ankylosing spondylitis

AS is the prototypical member of the family of spondyloarthropathies, and is characterized by seronegativity, axial predominance and new bone formation, which underlie symptoms of inflammatory back pain, enthesopathy and extra-articular manifestations, including anterior uveitis, psoriasis and colitis. Patients with AS typically experience a wide variety of morbidities. These include both morbidities related to the disease itself—most prominently progressive, irreversible, structural damage to the axial or peripheral skeleton—and morbidities stemming from treatments for the disease, including toxicities from NSAID use, and increased risk of infections and immunogenicity concerns with biologics. AS is also associated with a number of comorbidities. We review the risks associated with AS, its comorbidities and its treatments, as well as strategies that can be used to mitigate these risks in patients with AS.

Mitigation of disease- and treatment-related risks in patients with psoriatic arthritis

Psoriatic arthritis is a part of the family of diseases referred to as spondyloarthropathies, a diverse group of chronic inflammatory disorders with common clinical, radiographic, and genetic features. Peripheral arthritis is the most common symptom of psoriatic arthritis and patients also frequently experience involvement of the entheses, spine, skin, and nails. Due to the diverse clinical spectrum of disease severity, tissues affected, and associated comorbidities, the treatment of psoriatic arthritis can be challenging and it is necessary to mitigate risks associated with both the disease and its treatment. These risks include disease-specific, treatment-related, and psychological risks. Disease-specific risks include those associated with disease progression that can limit functional status and be mitigated through early diagnosis and initiation of treatment. Risks also arise from comorbidities that are associated with psoriatic arthritis such as cardiovascular disease, obesity, diabetes mellitus, and gastrointestinal inflammation. Patient outcomes can be affected by the treatment strategy employed and the pharmacologic agents administered. Additionally, it is important for physicians to be aware of risks specific to each therapeutic option. The impact of psoriatic arthritis is not limited to the skin and joints and it is common for patients to experience quality-of-life impairment. Patients are also more likely to have depression, anxiety, and alcoholism. This article reviews the many risks associated with psoriatic arthritis and provides guidance on mitigating these risks.

One-hour post-load plasma glucose level during the OGTT predicts mortality: observations from the Israel Study of Glucose Intolerance, Obesity and Hypertension

AIMS

The relationship between 1- and 2-h glucose levels following an oral glucose tolerance test (OGTT) and long-term mortality was evaluated.

METHODS

Over a 33-year period, 2138 individuals were followed for all-cause mortality. Fasting and post-OGTT glucose parameters categorized the cohort according to baseline glycaemic status. Four categories were established according to 1- and 2-h glucose levels (in mmol/l): group A = 1 h ≤ 8.8 and 2 h < 7.8; group B = 1 h > 8.6 and 2 h < 7.8; group C = 1 h ≤ 8.6 and 2 h = 7.8-11.1 (impaired glucose tolerance); group D = 1 h > 8.6 and 2 h = 7.8-11.1 (impaired glucose tolerance). Individuals with diabetes at baseline were excluded from the cohort.

RESULTS

By August 2013, 51% of the study cohort had died. The worst prognosis occurred in group D (73.8% mortality), followed by groups C (67.5%), B and A (57.9% and 41.6%, respectively). When the 2-h glucose value is 'normal' (< 7.8 mmol/l), the 1-h glucose value > 8.6 mmol/l is an important predictor of mortality (28% increased risk) compared with group A, controlling for sex, age, smoking, BMI, systolic and diastolic blood pressures. A gradual increased hazard for mortality was seen by study group (hazard ratio = 1.28, 1.60 and 1.76, for groups B, C and D, respectively; group A = reference).

CONCLUSIONS

A 1-h glucose value > 8.6 mmol/l predicts mortality even when the 2-h level is < 7.8 mmol/l. However, when the 2-h level is in the impaired glucose tolerance range, the hazard for mortality rises significantly independent of the 1-h value. Individuals at risk for developing diabetes could be identified earlier using the 1-h threshold value of 8.6 mmol/l, which could avert progression to diabetes and increased mortality.‬.

Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

BACKGROUND

Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights.

OBJECTIVE

To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion.

METHODS

A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived.

RESULTS

The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10).

CONCLUSIONS

The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.

Ion transport in polycarbonate based solid polymer electrolytes: experimental and computational investigations

Among the alternative host materials for solid polymer electrolytes (SPEs), polycarbonates have recently shown promising functionality in all-solid-state lithium batteries from ambient to elevated temperatures.

Comparison of Simulated Workplace Protection Factors Offered by N95 and P100 Filtering Facepiece and Elastomeric Half-Mask Respirators against Particles of 10 to 400 nm

This study compared the simulated workplace protection factors (SWPFs) between NIOSH-approved N95 respirators and P100 respirators, including two models of filtering facepiece respirator (FFR) and two models of elastomeric half-mask respirator (EHR), against sodium chloride particles (NaCl) in a range of 10 to 400 nm. Twenty-five human test subjects performed modified OSHA fit test exercises in a controlled laboratory environment with the N95 respirators (two FFR models and two EHR models) and the P100 respirators (two FFRs and two EHRs). Two Scanning Mobility Particle Sizers (SMPS) were used to measure aerosol concentrations (in the 10-400 nm size range) inside (Cin) and outside (Cout) of the respirator, simultaneously. SWPF was calculated as the ratio of Cout to Cin. The SWPF values obtained from the N95 respirators were then compared to those of the P100 respirators. SWPFs were found to be significantly different (P<0.05) between N95 and P100 class respirators. The 10th, 25th, 50th, 75th and 90th percentiles of the SWPFs for the N95 respirators were much lower than those for the P100 models. The N95 respirators had 5th percentiles of the SWPFs > 10. In contrast, the P100 class was able to generate 5th percentiles SWPFs > 100. No significant difference was found in the SWPFs when tested against nano-size (10 to 100 nm) and large-size (100 to 400 nm) particles. Overall, the findings suggest that the two FFRs and two EHRs with P100 class filters provide better performance than those with N95 filters against particles from 10 to 400 nm, supporting current OSHA and NIOSH recommendations.

The ReactorAFM: non-contact atomic force microscope operating under high-pressure and high-temperature catalytic conditions

An Atomic Force Microscope (AFM) has been integrated in a miniature high-pressure flow reactor for in-situ observations of heterogeneous catalytic reactions under conditions similar to those of industrial processes. The AFM can image model catalysts such as those consisting of metal nanoparticles on flat oxide supports in a gas atmosphere up to 6 bar and at a temperature up to 600 K, while the catalytic activity can be measured using mass spectrometry. The high-pressure reactor is placed inside an Ultrahigh Vacuum (UHV) system to supplement it with standard UHV sample preparation and characterization techniques. To demonstrate that this instrument successfully bridges both the pressure gap and the materials gap, images have been recorded of supported palladium nanoparticles catalyzing the oxidation of carbon monoxide under high-pressure, high-temperature conditions.