Mortality and morbidity after combined heart and liver transplantation in the failing Fontan: An updated dual center retrospective study

INTRODUCTION

As the adult Fontan population with Fontan associated liver disease continues to increase, more patients are being referred for transplantation, including combined heart and liver transplantation.

METHODS

We report updated mortality and morbidity outcomes after combined heart and liver transplant in a retrospective cohort series of 40 patients (age 14 to 49 years) with Fontan circulation across two centers from 2006-2022.

RESULTS

The 30-day, 1-year, 5-year and 10-year survival rate was 90%, 80%, 73% and 73% respectively. Sixty percent of patients met a composite comorbidity of needing either post-transplant mechanical circulatory support, renal replacement therapy or tracheostomy. Cardiopulmonary bypass time > 283 min (4.7 h) and meeting the composite comorbidity were associated with mortality by Kaplan Meier analysis.

CONCLUSION

Further study to mitigate early mortality and the above comorbidities as well as the high risk of bleeding and vasoplegia in this patient population is warranted.

OP0049 COMPARISON OF BASELINE DISEASE ACTIVITY AND PATIENT (PT)-REPORTED OUTCOMES (PROS) BETWEEN PTS WITH PSORIATIC ARTHRITIS AND AXIAL INVOLVEMENT (AXIAL PSA) AND AXIAL SPONDYLOARTHRITIS (AXIAL SPA) FROM THE CORRONA PSA/SPA REGISTRY

Background:

Although pts with axial PsA and axial SpA share some common clinical characteristics, there are also potential differences that may influence disease assessment and treatment response. Identifying differences between the two pt populations is important for assessment of disease characteristics and severity as well as informing treatment decisions. There has been little comparative characterization of these conditions in a US population.

Objectives:

To compare characteristics of pts with axial PsA and axial SpA.

Methods:

Pts ≥18 years of age diagnosed with axial PsA or axial SpA at enrollment in the prospective, multicenter, observational Corrona PsA/SpA Registry between March 2013 and August 2020 were included. Enrollment visit demographics, clinical characteristics, treatment history, disease activity measures, and PROs were compared between disease groups. Continuous measures were reported using means and standard deviations; means for disease groups were compared using two-sample t tests or Wilcoxon rank sum tests. Categorical measures were reported as frequencies and percentages; frequencies in disease groups were compared using chi-square or Fisher exact tests.

Results:

A total of 1044 pts (470 with axial PsA and 574 with axial SpA) were identified (Table). Pts with axial PsA were older with a higher percentage being female vs pts with axial SpA. Time since symptom onset and diagnosis were shorter for pts with axial PsA vs axial SpA (12.0 vs 15.6 years [P<0.001] and 6.8 vs 8.3 years [P=0.01]). Pts with axial PsA were less likely than pts with axial SpA to have current or historical uveitis (4% vs 14% [P<0.001]) or inflammatory bowel disease (5% vs 10% [P=0.005]). Prior biologic synthetic disease-modifying antirheumatic drug (bDMARD) and conventional synthetic DMARD use was more prevalent in the axial PsA vs axial SpA groups (64% vs 52% [P<0.001]/59% vs 32% [P<0.001]), while mean dactylitis (measured by Dactylitis Count) and enthesitis (measured by Spondyloarthritis Research Consortium of Canada [SPARCC] Enthesitis Index) counts were higher (0.4 vs 0.1 [P<0.001]/1.7 vs 1.2 [P<0.001]). Mean pt-reported pain and spinal pain were lower in pts with axial PsA vs axial SpA (49.4 vs 53.9 [P=0.015]/40.8 vs 49.7 [P<0.001]) (Figure). The proportion of pts with morning stiffness along with mean fatigue and work impairment scores were similar between disease groups.

Table.Baseline demographics and clinical characteristicsAxial PsAN=470Axial SpAN=574P valueAge (years), mean ± SD51.6 ± 13.247.7 ± 14.0<0.001Female, n (%)265 (57)248 (44)<0.001White, n (%)428 (94)507 (91)0.089Years since symptom onset, mean ± SD12.0 ± 11.615.6 ± 12.1<0.001Years since diagnosis, mean ± SD6.8 ± 9.08.3 ± 10.50.010HLA-B27 positive status, n/n (%)52/189 (28)214/295 (73)<0.001Abnormal CRP, n (%)88 (19)140 (24)0.033Uveitis, n (%)20 (4)80 (14)<0.001IBD, n (%)25 (5)59 (10)0.005Dactylitis count, mean ± SD0.4 ± 1.50.1 ± 0.7<0.001SPARCC enthesitis count, mean ± SD1.7 ± 2.91.2 ± 2.4<0.001Morning stiffness, n (%)439 (95)537 (96)0.923BASDAI (0–10), mean ± SD4.8 ± 2.54.9 ± 2.40.463BASDAI Q2 (0–10): spinal pain, mean ± SD5.0 ± 2.95.7 ± 2.9<0.001BASDAI Q3 (0–10): peripheral pain/swelling, mean ± SD4.5 ± 2.94.0 ± 3.10.010Modified BASDAI (0–10), mean ± SD5.0 ± 2.55.4 ± 2.40.013Prior bDMARDs, n (%)300 (64)299 (52)<0.001Prior csDMARDs, n (%)275 (59)181 (32)<0.001Prior prednisone use, n (%)54 (12)73 (13)0.611Prior NSAID use, n (%)52 (11)46 (8)0.115

Conclusion:

Findings from this descriptive real-world analysis suggest there may be meaningful differences between pts with axial SpA and axial PsA but future studies are needed to better understand these differences.

Acknowledgements:

Medical writing services provided by Alan Saltzman of Fishawack Facilitate Ltd, part of Fishawack Health, and funded by AbbVie.

This study was sponsored by Corrona, LLC. Corrona has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Crescendo, Eli Lilly and Company, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Pfizer, Regeneron, Roche, Sun, UCB, and Valeant. The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship.

Disclosure of Interests:

Philip J Mease Speakers bureau: AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, BMS, Boehringer Ingelheim, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, Grant/research support from: AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun, and UCB, Maya Marchese Employee of: Corrona, Robert McLean Employee of: Corrona, Taylor Blachley Employee of: Corrona, Laura Anatale-Tardiff Employee of: Corrona, Christopher Saffore Shareholder of: AbbVie, Employee of: AbbVie, Elizabeth Lesser Shareholder of: AbbVie, Employee of: AbbVie, Alexis Ogdie Consultant of: Amgen, AbbVie, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, Grant/research support from: National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, National Psoriasis Foundation, Pfizer, and Novartis

OP0052 COMPARISON OF PATIENTS WITH PSORIATIC ARTHRITIS (PSA) AND INVESTIGATOR-DEFINED AXIAL PSA TO PATIENTS WITH PSA AND ELEVATED PATIENT-REPORTED SPINE PAIN: FINDINGS FROM THE CORRONA PSORIATIC ARTHRITIS/SPONDYLOARTHRITIS (PSA/SPA) REGISTRY

Background:

Efforts are underway by GRAPPA and ASAS to define axial disease in psoriatic arthritis (axPsA).1AxPsA is typically diagnosed based on clinical evaluation and judgement, imaging, and patient-defined axial symptoms. In the MAXIMISE trial, part of the inclusion criteria for axPsA required patients to have a BASDAI ≥ 4 and patient-reported spine pain ≥ 40 in addition to clinician judgement.2

Objectives:

To compare characteristics of patients with PsA and investigator-identified axPsA to patients with PsA with BASDAI ≥ 4 and patient-reported spine pain ≥ 40.

Methods:

Adult patients with PsA enrolled in the registry from March 2013–December 2019 were included. Investigators identified the subset of patients with axPsA based on clinical assessments, imaging, and laboratory workup. All patients completed a BASDAI questionnaire and spine pain VAS. Patients with investigator-identified axPsA were compared with those who had BASDAI ≥ 4 and spine pain VAS ≥ 40 (elevated spine symptoms; non-mutually exclusive groups). Presence of other manifestations at enrollment was also evaluated: enthesitis (SPARCC enthesitis count > 0), dactylitis (dactylitis count > 0), peripheral arthritis (PA; tender and/or swollen joint count > 0), nail psoriasis (VAS > 0), skin psoriasis (affected body surface area > 0%). The prevalence of investigator-defined axPsA and elevated spine symptoms, alone and with other manifestations, was summarized for all patients and those who initiated biologics at enrollment using frequency counts and percentages.

Results:

Of 3393 patients with PsA, 391 (11.5%) had investigator-defined axPsA and 863 (25.4%) had elevated spine symptoms (Figure 1A); 127 (3.7%) patients met both criteria. In the total population with PsA, 2982 patients had ≥ 1 PsA manifestation when axPsA was investigator defined, of whom 2235 (74.9%) had multiple manifestations. Among those with ≥ 1 manifestation, the most common presentations were PA + skin (14.6%), skin (13.1%), and PA + nail + skin (11.3%). When using the criteria for elevated spine symptoms, 2996 patients had ≥ 1 PsA manifestation, of whom 2299 (76.7%) had multiple manifestations. Among those with ≥ 1 manifestation, the most common presentations were skin (12.3%), PA + skin (11.2%), and PA + nail + skin (8.8%). Of 769 patients who initiated a biologic at enrollment, 109 (14.2%) had investigator-defined axPsA and 270 (35.1%) had elevated spine symptoms (Figure 2A). Among all biologic initiators with PsA, 733 had ≥ 1 PsA manifestation when axPsA was investigator defined, of whom 630 (85.9%) had multiple manifestations; the most common presentations were PA + skin (16.2%), PA + skin + nail (12.8%), and enthesitis + PA + nail + skin (7.8%). When using the criteria for elevated spine symptoms, 732 biologic initiators had ≥ 1 disease manifestation, of whom 650 (88.8%) had multiple manifestations; the most common presentations were PA + skin (11.7%), PA + skin + nail (8.5%), and PA + axPsA + skin (6.3%). The prevalence of skin, PA, and dactylitis was higher in those with elevated spine symptoms vs investigator-defined axPsA, whereas the prevalence of enthesitis was higher in those with investigator-defined axPsA (Figure 1B and 2B).

Conclusion:

In the Corrona PsA/SpA Registry, there was a higher number of patients with elevated spine symptoms than with investigator-defined axPsA; these patients also had more coexisting manifestations. Although they may have had other reasons for back pain (ie, degenerative spine disease or central sensitization), it is possible that axPsA could be present in some and this warrants further evaluation.

References:

[1]Goel N, et al.J Rheumatol. 2019;95(Suppl):54-7.

[2]Baraliakos X, et al.Ann Rheum Dis. 2019;78:195-6.

Disclosure of Interests:

Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer, Taylor Blachley Employee of: Corrona, LLC, Meghan Glynn Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Employee of: Corrona, LLC – employment, Sabrina Rebello Employee of: Corrona, LLC, Blessing Dube Employee of: Corrona, LLC, Robert McLean Employee of: Corrona, LLC, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, 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

FRI0100 COMPARISON OF PATIENTS (PTS) WITH RHEUMATOID ARTHRITIS (RA) AMONG DISEASE ACTIVITY CATEGORIES AFTER 6 MONTHS OF TREATMENT WITH A TUMOUR NECROSIS FACTOR INHIBITOR (TNFI): RESULTS FROM THE CORRONA® RA REGISTRY

Background:

Targeting remission (REM) or low disease activity (LDA) is a widely accepted treatment strategy for RA. However, there are limited data on the proportion of pts who achieve these targets, or remain in moderate (MDA) or high disease activity (HDA) following advanced therapy.

Objectives:

To estimate the proportion of RA pts in disease activity states (REM, LDA, MDA, and HDA) who were biologic-naïve at initiation and had continuous treatment with a TNFi for 6–12 months in the Corrona RA registry.

Methods:

Eligible pts were aged ≥18 years, biologic-naïve, initiated TNFi treatment between January 1, 2010 and July 31, 2019, and had continuous use of a TNFi for 6–12 months. Disease activity was defined based on Clinical Disease Activity Index (CDAI) at the visit closest to 6-month follow-up: REM, ≤2.8; LDA, >2.8–10; MDA, >10–22; and HDA, >22. Disease characteristics, disease activity measures, and pt-reported outcomes (PROs) were reported at TNFi initiation and at the 6-month follow-up visit.

Results:

2586 biologic-naïve pts who initiated a TNFi and had continuous use for 6–12 months were included. At TNFi initiation, 167 (6%) were in REM, 479 (19%) had LDA, 907 (35%) had MDA, and 1033 (40%) had HDA. After 6–12 months of treatment, 563 (21.8%) were in REM, 923 (35.7%) had LDA, 674 (26.1%) had MDA, and 426 (16.5%) had HDA. Pts with HDA/MDA at 6–12 months were more likely to have a history of hypertension (32.7% HDA; 34.0% MDA; vs 23.6% REM) and had higher mean body mass index (BMI) (30.9 HDA; 31.1 MDA; vs 29.0 REM) at baseline compared with pts in REM. Disease activity measures and PROs were worse in pts with MDA and HDA vs LDA and REM after 6–12 months (Table). Pt Global Assessment was higher than Physician Global Assessment across all groups.

Conclusion:

While 57.4% of pts who initiated a TNFi experienced a favorable outcome, >40% required additional or alternative intervention to achieve REM/LDA. Pts who remained in MDA/HDA continued to have an inadequate response to TNFi (as measured by disease activity measures and PROs) after 6–12 months of treatment compared with those who achieved REM/LDA.

Table

Summary of disease activity measures and PROs in previously biologic-naïve pts at the 6–12-month follow-up visit, stratified by disease activity category at the 6–12-month follow-up visit

Characteristics at 6–12 months, mean (standard deviation)Disease activity category at 6–12 monthsREM (n=563)LDA (n=923)MDA (n=674)HDA (n=426)CDAI1.2 (0.8)6.2 (2.1)15.4 (3.4)32.7 (9.2)Tender joint count (28)0.1 (0.3)1.0 (1.3)4.3 (3.3)13.4 (7.0)Swollen joint count (28)0.1 (0.3)1.1 (1.6)4.0 (3.6)9.1 (5.9)C-reactive protein6.4 (22.7)7.0 (10.6)11.1 (19.9)12.6 (22.1)Modified health assessment questionnaire0.1 (0.2)0.3 (0.4)0.5 (0.5)0.8 (0.5)Pt global assessment6.6 (6.8)28.6 (20.9)43.7 (25.7)58.0 (22.7)Physician global assessment3.6 (4.3)12.1 (10.4)27.4 (15.9)44.9 (19.8)Pt pain assessment8.7 (11.0)30.3 (23.5)46.1 (27.0)59.9 (24.4)Pt fatigue assessment15.7 (19.2)34.5 (26.6)48.3 (28.0)59.4 (27.5)Morning stiffness (min)16.5 (36.5)55.4 (146.3)96.9 (197.5)143.6 (260.0)

Disclosure of Interests:

Joel M Kremer Shareholder of: May own stocks and opinions, Grant/research support from: Research and consulting fees from AbbVie Inc., Consultant of: AbbVie, Amgen, BMS, Genentech, Inc., Gilead, GSK, Lilly, Pfizer, Regeneron and Sanofi, Employee of: Corrona, LLC employee, Anne Winkler Consultant of: AbbVie, Pfizer, and Novratis, Speakers bureau: AbbVie, Janssen, Sanofi, Genentech, Celgene, Eli Lilly, and Novartis., Laura Anatale-Tardiff Employee of: Corrona, LLC employee, Robert McLean Employee of: Corrona, LLC, Ying Shan Employee of: Corrona, LLC employee, Page Moore Employee of: Corrona, LLC employee, Namita Tundia Shareholder of: May own stocks and options, Employee of: AbbVie employee, Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., John Tesser Consultant of: Sanofi/Regeneron, Speakers bureau: Sanofi/Regeneron

SAT0429 SECUKINUMAB IMPROVES CLINICAL AND PATIENT-REPORTED OUTCOMES AT 6 MONTHS AMONG PATIENTS WITH PSORIATIC ARTHRITIS IN THE US-BASED CORRONA PSORIATIC ARTHRITIS/SPONDYLOARTHRITIS (PsA/SpA) REGISTRY

Background:

Secukinumab, an interleukin-17 antagonist approved for the treatment of PsA, improves all PsA manifestations in the GRAPPA-OMERACT core domain set.1Few US-based studies have evaluated the real-world effectiveness of secukinumab in patients with PsA.

Objectives:

To examine clinical and patient-reported outcomes (PROs) in patients with PsA enrolled in the Corrona PsA/SpA registry initiating secukinumab with ≥ 1 follow-up visit.

Methods:

Included were adult patients with PsA in the Corrona registry who initiated secukinumab after April 1, 2017 and remained on secukinumab at their 6-month (window, 5-8 months) follow-up visit. The primary outcome was achievement of minimal disease activity (MDA) at 6 months among patients not in MDA at secukinumab initiation. MDA was defined as meeting 5 of the 7 following criteria: tender joint count (TJC) ≤ 1, swollen joint count (SJC) ≤ 1, psoriasis affected body surface area (BSA) < 3%, patient assessment of pain on visual analog scale (VAS) ≤ 15, patient global assessment VAS ≤ 20, HAQ-DI ≤ 0.5, and tender entheseal points ≤ 1 using the Leeds Enthesitis Index (LEI). Secondary outcomes included the proportion of patients who achieved resolution (0 sites) of TJC, SJC, enthesitis (using the LEI), and dactylitis among those with ≥ 1 site at initiation and improvement from baseline in clinical outcomes (BSA, nail psoriasis, physician global assessment, TJC, SJC, and DAPSA) and PROs (patient-reported pain, patient global assessment, HAQ-DI, and Work Productivity and Activity Impairment questionnaire) at 6 months. Outcomes were evaluated in the overall population and in potentially recalcitrant patients with failure of or intolerance to ≥ 3 previous biologics to examine if the later line biologic could be adequately effective.

Results:

A total of 100 patients with PsA who initiated and maintained secukinumab after 6 months were included. The mean (SD) age was 51.6 (11.6) years, 54.3% were male, and 96.8% were white. The mean (SD) symptom and disease duration were 10.8 (9.7) and 7.0 (7.0) years, respectively. Thirty patients (30.0%) initiated secukinumab 150 mg and 70 (70.0%) initiated secukinumab 300 mg. Most (83.0%) were biologic experienced; 17 patients initiated secukinumab as a 1st biologic, 34 as 2nd, 26 as 3rd, and 23 as ≥ 4th. At initiation, 75/90 patients (83.3%) were not in MDA; 26/71 (36.6%) of those with follow-up data available achieved MDA at 6 months (Figure 1). In the overall population, 28 patients (41.2%) with TJC ≥ 1, 24 (44.4%) with SJC ≥ 1, 17 (60.7%) with enthesitis, and 9 (75.0%) with dactylitis at initiation achieved resolution at 6 months (Table 1). Improvement was observed at 6 months in clinical outcomes and PROs in the overall population (Figures 1 and 2) and in patients who initiated secukinumab as a ≥ 4th-line biologic.

Table 1.

Resolution of Peripheral Arthritis, Enthesitis, and Dactylitis at 6 Months Among Patients With ≥ 1 Site at Initiation

Secondary OutcomesInitiation,Mean (SD) [n]6-Month Follow-Up,Resolution (Count = 0), n (%)TJC (1-68)9.0 (9.7) [68]28 (41.2)SJC (1-66)4.7 (4.2) [54]24 (44.4)Enthesitis (1-6)1.9 (1.1) [28]17 (60.7)Dactylitis (1-20)2.1 (1.3) [12]9 (75.0)

Conclusion:

In the Corrona registry, most secukinumab initiators with PsA were biologic experienced and were not in MDA at time of initiation. Consistent with clinical trials, real-world patients treated with secukinumab achieved MDA as well as improvement in clinical manifestations, PROs, and work productivity.

References:

[1]Orbai AM, et al.J Rheumatol.2019 Oct 15. [Epub ahead of print].

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, Taylor Blachley Employee of: Corrona, LLC, Meghan Glynn Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Employee of: Corrona, LLC – employment, Blessing Dube Employee of: Corrona, LLC, Robert McLean Employee of: Corrona, LLC, Nina Kim Employee of: Postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer