AB0289 PATIENT REPORTED PHYSICAL HEALTH COMPARED TO CLINICIAN RECORDED BILAG-2004 MUSCULOSKELETAL SYSTEM SCORES – DISCORDANCE BETWEEN PATIENTS AND CLINICIANS

Background:

The musculoskeletal organ system BILAG-2004 (MSK BILAG) assessment is of critical importance in SLE clinical trials. Severe active polyarthritis, MSK BILAG A, by definition includes significant impairment of basic activities of daily living (ADLs), as opposed to MSK BILAG C, D, or E where ability to perform ADLs is expected to be preserved. In clinical trials, BILAG is scored by clinicians without formal review of patient reported outcomes (PROs). The Physical Health domain of the LupusQoL (LQol PH) (range 0 – 100) can be used to assess the patient’s physical function and ADLs. LQoL PH score thresholds defining impairment severity have not been established; however, a transformed LQoL PH score ≤50 suggests more impaired function, which would not be expected in MSK BILAG C, D, or E. Conversely, a score >50 implies no major issues with ADLs, which would be contradictory to the definition of MSK BILAG A.

Objectives:

To assess correlation of patient reported LQoL PH with MSK BILAG scores recorded by clinicians at various timepoints using data from the phase 3 TULIP studies 1,2 and to investigate the percent of discordance between patients and clinicians.

Methods:

Data from TULIP 1 and 2 studies (anifrolumab 300 mg and placebo arms) were pooled to evaluate the relationship between LQoL PH and MSK BILAG scores at baseline, weeks 24 and 52 using Spearman correlations as post-hoc analysis. Mean LQoL PH scores were assessed for each MSK BILAG category at the three timepoints using one-way ANOVA. Percent of patients with MSK BILAG A and LQoL PH scores >50 and patients with MSK BILAG C, D, or E and LQoL PH scores ≤50 was calculated at baseline, week 24 and 52. MSK BILAG B was excluded from the analysis because discordance could not be easily defined for this category compared with the more extreme MSK BILAG categories.

Results:

Total of 690 patients were included in the pooled analysis (Table 1). Significant correlations between LQoL PH and MSK BILAG scores were found at each time point (nominal p<0.0001); this relationship became stronger over time. Mean LQoL PH scores were different in each MSK BILAG category, with the highest in MSK BILAG D/E and the lowest in the MSK BILAG A category, thus confirming the discriminatory ability of the LQoL PH (Table 1).

Table 1.

Correlation coefficients (CC) between LQoL PH and MSK BILAG scores, and mean LQoL PH scores with standard deviations (SD) per each MSK BILAG category at baseline, weeks 24 and 52.

BaselineWeek 24Week 52CCNCCNCCNTotal Population-0.25690-0.36626-0.41552MSK BILAGMean LQoL PH Score (SD)Mean LQoL PH Score (SD)Mean LQoL PH Score (SD)0 (D/E)69.3 (24.7)1774.2 (22.1)18674.5 (21.3)2371 (C)62.3 (25.4)6064.0 (23.9)23360.6 (22.5)1848 (B)56.6 (24.4)39855.1 (24.2)16351.3 (24.3)10512 (A)44.9 (25.8)21543.9 (25.9)4444.2 (26.2)26

At baseline, 40% of patients who were assessed by clinicians as having MSK BILAG A reported minimal impairment in physical function and ADLs (LQoL PH >50) and 24.1% who had MSK BILAG C, D, or E reported difficulties with ADLs (LQoL HP ≤50), suggesting discordance between patients and clinicians. This discordance slightly decreased over time (Figure 1).

Figure 1.

Percent of patients with MSK BILAG A and LQoL PH scores >50 and patients with MSK BILAG C, D, or E and LQoL PH scores ≤50 at baseline, weeks 24 and 52.

Conclusion:

Patient reported LQoL PH scores correlated with MSK BILAG scores and showed discriminant validity for MSK BILAG scores. Greater discordance was seen between LQoL PH and MSK BILAG A compared with C, D, or E. These findings suggest a need for further investigation of a role for PROs in MSK BILAG scoring. Formal review of PROs by clinicians during MSK BILAG assessment could be considered in future SLE clinical trials.

References:

[1]Furie R et al. Lancet 2019

[2]Morand EF et al. N Engl J Med 2020

Acknowledgements:

This study was sponsored by AstraZeneca.

Disclosure of Interests:

Ewa Olech Speakers bureau: Abbvie, Amgen, Merck, Pfizer, and UCB, Grant/research support from: BMS, Donald Stull: None declared, Betsy Williams: None declared, Stephanie Bean: None declared, Gabriel Abreu Employee of: AstraZeneca, Erik Schwetje Employee of: AstraZeneca, Raj Tummala Employee of: AstraZeneca, Sean O’Quinn Shareholder of: AstraZeneca, Employee of: AstraZeneca

Clinical Trial Implications for Study Participants Accessing Medical Assistance in Dying

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Bioethics consultation practices and procedures: a survey of a large Canadian community of practice

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Evaluation and characterization of forage Sorghum as feedstock for fermentable sugar production

Sorghum is a tropical grass grown primarily in semiarid and drier parts of the world, especially areas too dry for corn. Sorghum production also leaves about 58 million tons of by-products composed mainly of cellulose, hemicellulose, and lignin. The low lignin content of some forage sorghums such as brown midrib makes them more digestible for ethanol production. Successful use of biomass for biofuel production depends on not only pretreatment methods and efficient processing conditions but also physical and chemical properties of the biomass. In this study, four varieties of forage sorghum (stems and leaves) were characterized and evaluated as feedstock for fermentable sugar production. Fourier transform infrared spectroscopy and X-ray diffraction were used to determine changes in structure and chemical composition of forage sorghum before and after pretreatment and the enzymatic hydrolysis process. Forage sorghums with a low syringyl/guaiacyl ratio in their lignin structure were easy to hydrolyze after pretreatment despite the initial lignin content. Enzymatic hydrolysis was also more effective for forage sorghums with a low crystallinity index and easily transformed crystalline cellulose to amorphous cellulose, despite initial cellulose content. Up to 72% hexose yield and 94% pentose yield were obtained using modified steam explosion with 2% sulfuric acid at 140 degrees C for 30 min and enzymatic hydrolysis with cellulase (15 filter per unit (FPU)/g cellulose) and beta-glucosidase (50 cellobiose units (CBU)/g cellulose).

Grain sorghum is a viable feedstock for ethanol production

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pGreen: a versatile and flexible binary Ti vector for Agrobacterium-mediated plant transformation

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Accommodation to stationary and moving targets

PURPOSE

To test the hypothesis that the contrast of spectral components of the retinal image specifies ocular focus and controls reflex accommodation.

METHODS

Eight subjects viewed a stationary target at 0, 2.5, and 5 D in a Badal optometer, with longitudinal chromatic aberration (LCA) normal and reversed and in monochromatic (550 nm) light. Accommodation was monitored continuously during 40-s trials. Subjects also viewed the grating target as it moved sinusoidally (1.5 to 2.5 D) at 0.2 Hz under the same three conditions.

RESULTS

Subjects accommodated relatively accurately at all distances in the normal condition; three subjects had difficulty accommodating in monochromatic light at 5 or 0 D, and seven subjects could not maintain focus with LCA reversed. The accommodative response differed significantly in the three chromatic conditions both for stationary and moving targets.

CONCLUSIONS

Relative contrast of long-, middle-, and short-wavelength components of the retinal image specifies ocular focus and drives reflex accommodation.