Reproduction, seasonal morphology, and juvenile growth in three Malagasy fruit bats

The island nation of Madagascar is home to three endemic species of Old World fruit bat in the family Pteropodidae: Pteropus rufus, Eidolon dupreanum, and Rousettus madagascariensis, all three of which are IUCN Red Listed under some category of threat. Delineation of seasonal limits in the reproductive calendar for threatened mammals can inform conservation efforts by clarifying parameters used in population viability models, as well as elucidate understanding of the mechanisms underpinning pathogen persistence in host populations. Here, we define the seasonal limits of a staggered annual birth pulse across the three species of endemic Madagascar fruit bat, known reservoirs for viruses of high zoonotic potential. Our field studies indicate that this annual birth pulse takes place in September/October for P. rufus, November for E. dupreanum, and December for R. madagascariensis in central-eastern Madagascar where the bulk of our research was concentrated. Juvenile development periods vary across the three Malagasy pteropodids, resulting in near-synchronous weaning of pups for all species in late January-February at the height of the fruiting season for this region. We here document the size range in morphological traits for the three Malagasy fruit bat species, with P. rufus and E. dupreanum among the larger of pteropodids globally and R. madagascariensis among the smaller. All three species demonstrate subtle sexual dimorphism with males being larger than females. We explore seasonal variation in adult body condition by comparing observed body mass with body mass predicted by forearm length, demonstrating that pregnant females add weight during staggered gestation periods and males lose weight during the nutritionally deficit Malagasy winter. Finally, we quantify forearm, tibia, and ear length growth rates in juvenile bats, demonstrating both faster growth and more protracted development times for P. rufus as compared with E. dupreanum and R. madagascariensis. The longer development period for the already-threatened P. rufus further undermines the conservation status of this species as human hunting is particularly detrimental to population viability during reproductive periods. Our work highlights the importance of longitudinal field studies in collecting critical data for mammalian conservation efforts and human public health alike.

POS0666 A MULTINATIONAL, PROSPECTIVE, OBSERVATIONAL STUDY IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING BARICITINIB, TARGETED SYNTHETIC OR BIOLOGIC DISEASE-MODIFYING THERAPIES: 12 MONTH TIME TO DISCONTINUATION, EFFECTIVENESS AND PATIENT REPORTED OUTCOME DATA FROM THE EUROPEAN COHORT

Background

Baricitinib (BARI), an oral selective JAK 1/2 inhibitor, is approved for treating adults with moderate to severe active rheumatoid arthritis (RA). RA-BE-REAL is a 3-year, multinational, prospective, observational study of adult patients with RA evaluating time to discontinuation of initial RA treatment for all causes (excluding sustained clinical response) over 24 months (M).

Objectives

This analysis reports time to discontinuation in the European (France, Germany, Italy, Spain, UK) subgroup, treated with either BARI, biologic (b) disease-modifying anti-rheumatic drugs (DMARDs) or any other targeted synthetic (ts)DMARDs, as well as, the effectiveness of RA treatment, at 12M.

Methods

In the two cohorts, patients were initiated with BARI 2-mg or 4-mg (cohort A), or any bDMARD or tsDMARD (b/tsDMARDs; cohort B). Treatment initiation and changes are at the discretion of the patient or physician. Response rates for remission, low disease activity (LDA), moderate disease activity (MDA) or high disease activity (HDA) were determined using the Clinical Disease Activity Index (CDAI) at 12M. Quality of life using the EQ-5D-5L and patient reported outcome (PRO) measures for pain (pain visual analogue scale; VAS) and physical functioning (Health Assessment Questionnaire Disability Index; HAQ-DI) were also assessed at 12M. This pre-specified interim analysis reports descriptive 12M data using summary statistics, without any inferential testing.

Results

This analysis involved 1073 adult RA patients with a mean age (standard deviation; SD) of 59.1 (13.2) (cohort A) and 57.0 (13.9) yrs (cohort B), respectively, and a mean disease duration (SD) of 10.0 (9.1) (cohort A) and 8.9 (9.6) yrs (cohort B), respectively. At baseline, 50.9% of patients in cohort A and 31.2% in cohort B initiated treatment as a monotherapy. At 12M, 26.7% of patients in cohort A and 44.1% of patients in cohort B had discontinued treatment. The most common reason for discontinuation in both cohorts was primary non-response. At 12M, 24.1% of patients in cohort A and 16.6% in cohort B achieved CDAI remission (Figure 1). The mean CDAI reduction was -14.5 and -12.0, respectively in cohorts A and B. Mean reductions from baseline in physician global assessment (PhGA) and in patient global assessment (PGA) were -3.4 and -2.5, respectively in cohort A and -3.0 and -2.1, respectively in cohort B. Improvements from baseline in EQ-5D-5L, HAQ-DI, and pain (VAS) were reported in both cohorts at 12M. The mean pain (VAS) reduction from baseline was -24.6 and -19.3 in cohort A and cohort B, respectively.

Figure 1.

Percentage of pts in cohorts A and B achieving remission and LDA at 12M

Conclusion

The majority of BARI-treated patients were in remission or had low disease activity and continued treatment at 12M.

Table 1.

Disease activity and patient reported outcomes at baseline and 12M

Cohort A BaricitinibCohort B b/tsDMARDsBaseline12MCFBBaseline12MCFBCDAI24.0 (11.7)9.1 (8.2)-14.5 (12.4)23.8 (12.4)10.7 (9.8)-12.0 (12.6)SJC5.2 (4.8)1.3 (2.4)-3.9 (4.8)4.7 (4.9)1.3 (2.8)-3.0 (4.6)TJC7.3 (6.1)2.2 (3.6)-4.7 (6.0)7.8 (6.5)3.0 (4.8)-4.0 (6.1)PhGA5.6 (2.0)2.3 (2.1)-3.4 (2.5)5.5 (2.1)2.5 (2.1)-3.0 (2.6)PGA5.9 (2.3)3.4 (2.5)-2.5 (2.9)5.8 (2.4)3.8 (2.6)-2.1 (3.0)HAQ-DI1.4 (0.7)1.0 (0.8)-0.4 (0.6)1.3 (0.7)1.0 (0.8)-0.3 (0.6)Pain (VAS)59 (23.1)33.2 (26.2)-24.6 (28.7)56.5 (24.3)36.6 (26.5)-19.3 (30.4)EQ-5D-5L0.5 (0.3)0.7 (0.2)0.1 (0.3)0.5 (0.3)0.7 (0.2)0.1 (0.3)

Values represent observed mean (SD)

b/tsDMARDs; biologic/targeted synthetic disease-modifying anti-rheumatic drugs, CFB; change from baseline, CDAI; clinical disease activity index, SJC; swollen joint count, TJC; tender joint count, P(h)GA; patient (physician) global assessment of disease activity, HAQ-DI; health assessment questionnaire disability index, VAS; visual analogue scale (mm), EQ-5D-5L; European quality of life 5 dimensions 5 levels

Disclosure of Interests

Rieke Alten Speakers bureau: Eli Lilly and Company, Pfizer, Galapagos, Consultant of: Eli Lilly and Company, Pfizer, Galapagos, Grant/research support from: Eli Lilly and Company, Pfizer, Galapagos, Gerd Rüdiger Burmester Speakers bureau: Amgen, AbbVie, BMS, Galapagos, Eli Lilly and Company, MSD, Pfizer, Roche, Sanofi, Consultant of: Amgen, AbbVie, BMS, Galapagos, Eli Lilly and Company, MSD, Pfizer, Roche, Sanofi, Marco Matucci Cerinic Speakers bureau: Biogen, Eli Lilly and Company, Grant/research support from: Actelion, Biogen, Novartis, MSD, Andrew Ostor Consultant of: AbbVie, BMS, Roche, Janssen, Eli Lilly and Company, Novartis, Pfizer, UCB, Gilead, Paradigm, Liliana Zaremba-Pechmann: None declared, Marta Herrera Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kathy Gibson Speakers bureau: UCB, Consultant of: Janssen, Novartis, Grant/research support from: Novartis, Employee of: Eli Lilly and Company, Tamas Treuer Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jens Gerwien Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Bruno Fautrel Consultant of: AbbVie, Biogen, BMS, Celgene, Janssen, Eli Lilly and Company, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, SOBI, UCB, Grant/research support from: AbbVie, MSD, Pfizer, Eli Lilly and Company

AB0899 A 24-month Prospective Psoriatic Arthritis Observational Study of Persistence of Treatment (PRO-SPIRIT) - Interim Analysis of Baseline Characteristics

Background

Ixekizumab (ixe), a highly selective interleukin (IL)-17A monoclonal antibody, has been approved for treatment of psoriatic arthritis (PsA). However, there is limited real-world evidence (RWE) available for ixe. PRO-SPIRIT is the first large-sample prospective observational study to provide RWE for ixe in patients (pts) with PsA.

Objectives

PRO-SPIRIT’s primary objective is to describe treatment persistence at 24 months (M) among pts with PsA who initiate or switch to a new biologic Disease Modifying Arthritis Rheumatic Drugs (bDMARDs) or targeted synthetic (tsDMARDs), including ixe. This abstract describes the interim baseline (BL) characteristics.

Methods

PRO-SPIRIT is a prospective observational study, conducted in FR, ES, IT, DE, UK, and CA, enrolling adults with PsA (≥6M) to be initiated or switched to a new b/tsDMARD, locally approved for PsA. Treatment groups include ixe, secukinumab, IL-12/IL-23 inhibitors (i) (ustekinumab) or IL-23i (guselkumab), tumour necrosis factor (TNFi) (adalimumab, etanercept, infliximab or biosimilar), Janus kinase (JAKi) (tofacitinib or upadacitinib). Pt demographic, disease activity and therapy characteristics are collected at BL; clinical and patient-reported outcomes measures are collected at BL and at a routine post-BL visit. BL descriptive statistics are reported.

Results

From December 2019 until this interim data cut (June 2021), a total of 477 pts (305 female; mean age 52) were enrolled. Mean age ranged from 48 (IL-12/23i and IL-23i) to 55 (JAKi), with a majority of female pts in each group (Table 1). Pts in the IL-12/23i and IL-23i and TNFi groups showed the shortest time since PsA diagnosis (5.2±4.5; 6.5±7.9), while pts in the JAKi group showed the longest time (10.6±9.4). The lowest proportion of pts with a prior b/tsDMARDs use was observed in the TNFi group (31%), the highest in the IL-12/23i and IL-23i group (71%). Pts in the ixe and IL-12/23i and IL-23i groups were more likely to be on monotherapy. Tender Joint Count (9.1-11.3) and Swollen Joint Count (3.3-5.8) were comparable across groups, with the highest values in the ixe and JAKi groups, respectively. Pt proportion with enthesitis and dactylitis was higher in the ixe, secukinumab and JAKi groups. Percentage of Body Surface Area affected by psoriasis was higher in the ixe, secukinumab and IL-12/23i and IL-23i groups. Pt proportion with nail psoriasis was higher in the ixe and secukinumab groups. Physician’s Global Assessment Visual Analog Scale (VAS), Patient’s Global Assessment VAS and Patient’s Assessment of Joint Pain VAS reflected a high burden of illness.

Table 1.

Baseline characteristics

bDMARDstsDMARDsIxekizumabSecukinumabIL-12/23 and IL-23 inhibitorsTNF inhibitorsJAK InhibitorsN=137N=46N=24N=211N=40Age52.8±12.252.8±13.147.6±13.450.3±11.755.3±9.9Female, n (%)86 (62.8)31 (67.4)16 (66.7)135 (64.0)25 (62.5)Years since diagnosis8.4±7.57.6±8.05.2±4.56.5±7.910.6±9.4Prior b/tsDMARD, n (%)87 (63.5)27 (58.7)17 (70.8)66 (31.3)26 (65.0)Concomitant csDMARD, n (%)47 (34.3)19 (41.3)5 (20.8)108 (51.2)19 (47.5)Tender Joint Count11.3±10.29.1±10.89.1±9.310.9±10.611.1±8.8Swollen Joint Count5.7±6.63.3±3.83.4±6.44.8±5.65.8±6.6Body Surface Area % affected by psoriasis6.1±10.57.6±14.27.0±9.74.6±11.02.2±3.1Presence of enthesitis, n (%)58 (42.3)16 (34.8)4 (16.7)67 (31.8)16 (40.0)Presence of dactylitis, n (%)33 (24.1)10 (21.7)3 (12.5)26 (12.3)10 (25.0)Presence of nail psoriasis, n (%)57 (41.6)20 (43.5)7 (29.2)71 (33.6)11 (27.5)Physician’s Global assessment VAS62.6±18.159.5±20.555.7±24.661.7±18.063.0±20.5Patient’s Global Assessment VAS60.5±20.456.8±25.156.2±25.757.5±22.955.4±22.5Patient’s Assessment of Joint Pain VAS62.7±21.358.4±27.155.7±28.359.4±22.957.5±24.0

Mean±SD, unless otherwise stated

Conclusion

The reported BL characteristics offer preliminary information about which pts initiate or switch to a b/tsDMARD in a real life-setting. Future disclosures (at 12 and 24M) will provide RWE regarding persistence, effectiveness, and health care resource use of available treatments for PsA, which will help pts and physicians to make better informed treatment decisions.

Disclosure of Interests

Jacques Morel Speakers bureau: Abbvie, Amgen, Biogen, Biogen, Bristol Myer Squib, Fresenius, Galapagos, Eli Lilly and Company, Médac, Novartis, Sandoz, Sanofi, Consultant of: Abbvie, Galapagos, Eli Lilly and Company, Médac, Novartis, Glaxo Smith Kline, Grant/research support from: Bristol Myer Squib, Biogen, Eli Lilly and Company, Novartis, Pfizer, Lorenzo Dagna Speakers bureau: Abbvie, Amgen, BMS, Eli Lilly and Company, Galapagos, GSK, Pfizer, Sobi, Consultant of: Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly and Company, Galapagos, GSK, Janssen, Kiniksa, Pfizer, Roche, Sobi, Sanofi, Beatriz Joven-Ibáñez Speakers bureau: Eli Lilly and Company, Grant/research support from: (institutional grant) Eli Lilly and Company, Thorsten Holzkaemper Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Celine El Baou Consultant of: Eli Lilly and Company, Leonore Unger Speakers bureau: Eli Lilly and Company, Angelo Semeraro: None declared, Nicola Gullick Speakers bureau: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, UCB, Consultant of: AbbVie, Janssen, Eli Lilly and Company, Novartis, UCB, Grant/research support from: (institutional grants) Eli Lilly and Company, AbbVie, Astra Zeneca, Izana, Novartis, Tamas Treuer Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company

AB0428 TREATMENT PATTERNS OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN TAIWAN – A POPULATION-BASED ANALYSIS

Background

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease of an unknown etiology with a broad spectrum of organ manifestations, and patients with SLE have limited treatment options to NSAIDS, glucocorticoids, hydroxychloroquine and immunosuppressants. There is a lack of real-world evidence related to treatment patterns of SLE patients in Taiwan.

Objectives

To describe the real-world patient demographics, clinical characteristics, and treatment patterns of patients with SLE in Taiwan.

Methods

A retrospective observational study using Taiwan’s National Health Insurance Research Database (NHIRD) from 1/1/2014 to 12/31/2019 was undertaken. Patients holding catastrophic illness certificates for SLE in 2015-2017 were identified. Enrolled patients aged ≥ 18 years were then divided into three groups (mild, moderate, and severe) based on the highest severity patients experienced in the one year following the enrollment date using a published claims-based algorithm (Garris et al 2013) that incorporates the Systemic Lupus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure, British Isles Lupus Assessment Group Index and expert clinical opinion, and indexed upon the first date of entering the severity group. Baseline patient characteristics and treatment patterns during the follow-up period were measured. The types of treatment considered were NSAIDs, glucocorticoids, hydroxychloroquine and immunosuppressants.

Results

A total of 20,181 patients with catastrophic illness certificates for SLE were included in this study. The mean age of all SLE patients was 46.5 years and patients were mostly female (89.1%). The mean Charlson Comorbidity Index (CCI) score of all SLE patients was 1.5 (SD 1.3). Of these patients, 29.3% (n=5,918) had mild SLE activity, 60.7% (n=12,253) moderate and 10.0% (n=2,010) severe. During the one-year follow-up period, moderate to severe patients had numerically higher utilization rate of all types of treatment compared with mild patients (Table 1). Of all oral glucocorticoid users,27.8% of severe patients used high-dose glucocorticoids (> 15 mg/day) compared to <0.1% for mild and 9.7% for moderate patients. More than 70.0% of moderate to severe patients were prescribed 2 or more types of treatment at the same point of time. Of these patients having concomitant treatment of glucocorticoids with immunosuppressants, glucocorticoid dosage increased with the number of immunosuppressant used, especially in severe patients. 80.4% of moderate to severe patients received glucocorticoid-based therapy as the first-line treatment and the median treatment duration was 3.1 months. The median treatment duration of each first-line immunosuppressant ranged from 0.9 to 4.8 months in moderate to severe patients.

Table 1.

SLE treatment utilization during the 1-year follow-up period

Total (n=20,181)`Mild (n=5,918)Moderate (n=12,253)Severe (n=2,010)n%n%n%n%NSAID7,21235.71,40523.74,98340.782441.0Glucocorticoid14,01969.52,01534.110,29784.01,70784.9Hydroxychloroquine13,27865.82,86748.58,97073.21,44171.7Immunosuppressant7,63037.800.06,31951.61,31165.2Methotrexate8984.500.07866.41125.6Azathioprine5,64228.000.04,84339.579939.8Leflunomide1320.700.01171.0150.8Cyclosporin8544.200.07155.81396.9Mycophenolate9594.800.07746.31859.2Cyclophosphamide7903.900.0170.177338.5

Conclusion

The complexity and intensity of therapeutic approaches in SLE were associated with increased disease severity and patients were often resistant to treatment. These findings reflect the disease burden in SLE patients and suggest there is a substantial unmet need in the SLE treatment paradigm for moderate to severe SLE patients.

References

[1]Garris C, et al. J Med Econ. 2013;16:667–677.

Disclosure of Interests

Yu Sheng Chang: None declared, Wen-Nan Huang: None declared, Chao-Hsiun Tang: None declared, Khai Ng Shareholder of: I am a minor shareholder of Eli Lilly & Company, Employee of: I am an employee of Eli Lilly & Company, Po-Ya Chuang Consultant of: I am a paid consultant for Eli Lilly &Company, Wesley Furnback Consultant of: I am a paid consultant for Eli Lilly & Company, Bruce Wang Consultant of: I am a paid consultant for Eli Lilly & Company, Ching-Yun Wei Shareholder of: I am a minor shareholder of Eli Lilly & Company, Employee of: I am an employee of Eli Lilly & Company, Bradley Wang Shareholder of: I am a minor shareholder of Eli Lilly & Company, Employee of: I am an employee of Eli Lilly & Company

, Tamas Treuer Shareholder of: I am a minor shareholder of Eli Lilly & Company, Employee of: I am an employee of Eli Lilly & Company

The spatial and temporal domains of modern ecology

To understand ecological phenomena, it is necessary to observe their behaviour across multiple spatial and temporal scales. Since this need was first highlighted in the 1980s, technology has opened previously inaccessible scales to observation. To help to determine whether there have been corresponding changes in the scales observed by modern ecologists, we analysed the resolution, extent, interval and duration of observations (excluding experiments) in 348 studies that have been published between 2004 and 2014. We found that observational scales were generally narrow, because ecologists still primarily use conventional field techniques. In the spatial domain, most observations had resolutions ≤1 m² and extents ≤10,000 ha. In the temporal domain, most observations were either unreplicated or infrequently repeated (>1 month interval) and ≤1 year in duration. Compared with studies conducted before 2004, observational durations and resolutions appear largely unchanged, but intervals have become finer and extents larger. We also found a large gulf between the scales at which phenomena are actually observed and the scales those observations ostensibly represent, raising concerns about observational comprehensiveness. Furthermore, most studies did not clearly report scale, suggesting that it remains a minor concern. Ecologists can better understand the scales represented by observations by incorporating autocorrelation measures, while journals can promote attentiveness to scale by implementing scale-reporting standards.

Upstream watershed condition predicts rural children's health across 35 developing countries

Diarrheal disease (DD) due to contaminated water is a major cause of child mortality globally. Forests and wetlands can provide ecosystem services that help maintain water quality. To understand the connections between land cover and childhood DD, we compiled a database of 293,362 children in 35 countries with information on health, socioeconomic factors, climate, and watershed condition. Using hierarchical models, here we find that higher upstream tree cover is associated with lower probability of DD downstream. This effect is significant for rural households but not for urban households, suggesting differing dependence on watershed conditions. In rural areas, the effect of a 30% increase in upstream tree cover is similar to the effect of improved sanitation, but smaller than the effect of improved water source, wealth or education. We conclude that maintaining natural capital within watersheds can be an important public health investment, especially for populations with low levels of built capital.Globally diarrheal disease through contaminated water sources is a major cause of child mortality. Here, the authors compile a database of 293,362 children in 35 countries and find that upstream tree cover is linked to a lower probability of diarrheal disease and that increasing tree cover may lower mortality.

Predictive factors and clinical biomarkers for treatment in patients with chronic pain caused by osteoarthritis with a central sensitisation component

AIMS

The aim of this non-systematic review was to provide a practical guide for clinicians on the evidence for central sensitisation in chronic osteoarthritis (OA) pain and how this pain mechanism can be addressed in terms of clinical diagnosis, investigation and treatment.

METHODS

The authors undertook a non-systematic review of the literature including a MEDLINE search (search terms included central sensitisation, osteoarthritis, osteoarthrosis) for relevant and current clinical studies, systematic reviews and narrative reviews. Case reports, letters to the editor and similar literature sources were excluded. Information was organised to allow a pragmatic approach to the discussion of the evidence and generation of practical recommendations.

RESULTS

There is good evidence for a role of central sensitisation in chronic OA pain in a subgroup of patients. Clinically, a central sensitisation component in chronic OA pain can be suspected based on characteristic pain features and non-pain features seen in other conditions involving central sensitisation. However, there are currently no diagnostic inventories for central sensitisation specific to OA. Biomarkers may be helpful for confirming the presence of central sensitisation, especially when there is diagnostic uncertainty. Several non-pharmacological and pharmacological treatments may be effective in OA patients with central sensitisation features. Multimodal therapy may be required to achieve control of symptoms.

DISCUSSION

Clinicians should be aware of central sensitisation in patients with chronic OA pain, especially in patients presenting with severe pain with unusual features.

Predictors of pharmacological treatment outcomes with atomoxetine or methylphenidate in patients with attention-deficit/hyperactivity disorder from China, Egypt, Lebanon, Russian Federation, Taiwan, and United Arab Emirates

BACKGROUND

The reduced availability of data from non-Western countries limits our ability to understand attention-deficit/hyperactivity disorder (ADHD) treatment outcomes, specifically, adherence and persistence of ADHD in children and adolescents. This analysis assessed predictors of treatment outcomes in a non-Western cohort of patients with ADHD treated with atomoxetine or methylphenidate.

METHODS

Data from a 12-month, prospective, observational study in outpatients aged 6-17 years treated with atomoxetine (N = 234) or methylphenidate (N = 221) were analysed post hoc to determine potential predictors of treatment outcomes. Participating countries included the Russian Federation, China, Taiwan, Egypt, United Arab Emirates and Lebanon. Factors associated with remission were analysed with stepwise multiple logistic regression and classification and regression trees (CART). Cox proportional hazards models with propensity score adjustment assessed differences in atomoxetine persistence among initial-dose cohorts.

RESULTS

In patients treated with atomoxetine who had available dosing information (N = 134), Cox proportional hazards revealed lower (< 0.5 mg/kg) initial dose was significantly associated with shorter medication persistence (p < 0.01). multiple logistic regression analysis revealed greater rates of remission for atomoxetine-treated patients were associated with age (older), country (United Arab Emirates) and gender (female) (all p < 0.05). CART analysis confirmed older age and lack of specific phobias were associated with greater remission rates. For methylphenidate, greater baseline weight (highly correlated with the age factor found for atomoxetine) and prior atomoxetine use were associated with greater remission rates.

CONCLUSIONS

These findings may help clinicians assess factors upon initiation of ADHD treatment to improve course prediction, proper dosing and treatment adherence and persistence.

TRIAL REGISTRATION

Observational study, therefore no registration.

A prospective observational study of attention-deficit hyperactivity disorder in Asia: baseline characteristics of symptom severity and treatment options in a paediatric population

OBJECTIVES

To better understand the burden and management of attention-deficit hyperactivity disorder in East Asia, this subanalysis of the baseline characteristics of a large prospective, observational, nonrandomized study investigating the relationships between symptom severity, treatments, co-morbidities, and health outcomes provides information about the diagnosis of, and treatment patterns for, attention-deficit hyperactivity disorder in this region.

METHODS

Outpatients with attention-deficit hyperactivity disorder symptoms participated in this 12-month study performed in China, Korea, and Taiwan. Patients were grouped according to whether they received conventional treatment or no or other treatment. Attention-deficit hyperactivity disorder symptom severity and co-morbidities were assessed using the Clinical Global Impressions-Attention-deficit Hyperactivity Disorder-Severity scale and Child Symptom Inventory-4: Parent Checklist (categories B to J) / Adolescent Symptom Inventory-4: Parent Checklist (categories L and O), respectively.

RESULTS

A total of 502 patients aged 6 to 18 years were enrolled. Investigators were psychiatrists (69%) and paediatricians (31%), who used the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (86%), the 10th revision of the International Classification of Diseases (6%), and other attention-deficit hyperactivity disorder diagnostic criteria (8%) for diagnosis. Pharmacotherapy was the most commonly prescribed treatment (n = 251; 50%), and treated patients were older (9.1 vs. 8.2 years; p < 0.001) and more severely ill (Clinical Global Impressions-Attention-deficit Hyperactivity Disorder- Severity scale, 4.6 vs. 4.2; p < 0.001) than those who were not treated. Anxiety and oppositional co-morbidities were commonly reported.

CONCLUSIONS

These data provide an insight into the demographics, diagnosis, and treatment of paediatric patients with attention-deficit hyperactivity disorder in East Asia, and provide a baseline for assessing changes in treatment practices in this population.

Predicting the course and outcome of bipolar disorder: a review

Despite of advances in pharmacological and non-pharmacological treatments, bipolar disorder often entails multiple relapses and impaired psychological functioning. The extent to which modern treatments have influenced the natural course of a mental disorder is uncertain. Prediction of the course and outcome of bipolar disorders continues to be challenging, despite the multiple research efforts worldwide. Due to a lack of laboratory diagnostic tests and biomarkers, psychiatric interview and examination provide the basis for outcome prediction. While considered to have more favorable prognosis than schizophrenia, it is not uncommon for bipolar disorder to include persisting alterations of psychosocial functioning. Although long-term symptomatic remission does not guarantee functional recovery, it may have a favorable impact on long-term overall prognosis. The high degree of treatment resistance in patients with bipolar disorder highlights the need to develop better identification of outcome predictors, prognosis and treatment intervention, designed to reverse or prevent this illness burden. This review summarizes the main factors involved in predicting the course and outcome of bipolar disorder.

Factors associated with achieving minimally symptomatic status by patients with schizophrenia: results from the 3-year intercontinental schizophrenia outpatients health outcomes study

OBJECTIVE

The aim of this study was to describe factors associated with achieving a minimally symptomatic status outcome in outpatients with schizophrenia.

METHODS

Data were analysed from a 3-year, prospective observational study that examined outcomes in 7658 patients with schizophrenia. Minimally symptomatic status was defined as a postbaseline score of 1 or 2 on the Clinical Global Impressions Severity Scale-Schizophrenia version (CGI-SCH).

RESULTS

Baseline CGI-SCH score had the strongest association with minimally symptomatic status followed by age, geographical region and hospitalisation status. The probability of becoming minimally symptomatic was consistently higher in the olanzapine and risperidone monotherapy groups compared with the clozapine, quetiapine or haloperidol groups [corrected]. The olanzapine group achieved the minimally symptomatic status in a shorter period of time than the other treatment groups (p < or = 0.016).

CONCLUSION

The likelihood of patients achieving a minimally symptomatic status was greater in younger patients with lower baseline clinical severity and in patients whose treatment included olanzapine.

Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients

OBJECTIVE

To describe the Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO) patient population at study entry, focusing on illness burden and prescribing practices across regions.

METHODS

The SOHO study was a 3-year, prospective, observational study designed to assess costs and outcomes associated with antipsychotic use in outpatients initiating or changing antipsychotic (with an emphasis on olanzapine compared with other antipsychotics). SOHO was conducted in 10 European countries and 27 other countries as Intercontinental SOHO (IC-SOHO). Data from all countries have been pooled to produce the W-SOHO dataset.

MAIN OUTCOMES MEASURES

Clinical Global Impression-Schizophrenia (CGI-SCH) severity scores, psychotropic medication use, adverse events, social interaction, housing and employment status, self-perceived health state (EuroQoL EQ-5D scale and Visual Analogue Scale, EQ-VAS), and reasons for initiation/change of antipsychotic.

RESULTS

The W-SOHO database comprises 17,384 patients from six regions; East Asia (n = 1223), Central and Eastern Europe (n = 2175), Northern Europe (n = 4291), Southern Europe (n = 5788), Latin America (n = 2566), North Africa and the Middle East (n = 1341). Overall, patients were 38 +/- 13 years old (mean +/- SD), moderately ill (mean CGI-SCH overall score of 4.4 +/- 1.0) with a median duration of illness of 7 years (interquartile range 1-16 years); 43% were female, 10% were receiving antipsychotic medication for the first time. Adverse events were prevalent across all regions; on average, 50% (range 41-59%) of patients taking antipsychotics exhibited extrapyramidal symptoms at baseline, and 62% (34-67%) of patients reported sexual dysfunction in the previous month. On average, only 19% (16-23%) of patients were in paid employment and as many as 69% were living in dependent housing.

CONCLUSIONS

Despite inherent diversity in these patients and the health care systems supporting them, there are striking cross-regional similarities in baseline characteristics for most measures. Not all countries are represented; regional comparisons may not be valid outside of the countries studied.

Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania

BACKGROUND

This study compared the safety, tolerability and switch to oral medication in patients with bipolar disorder or schizophrenia who received intramuscular (IM) olanzapine or other IM antipsychotics for the treatment of acute agitation.

METHODS

Patients (N = 2011) from 15 countries participated in this prospective, observational, non-interventional study. Inpatients requiring treatment with at least one IM injection of a short-acting antipsychotic were assessed at baseline and within 7 days after the first IM injection. Treatment groups comprised: (i) patients prescribed IM olanzapine at baseline; and (ii) patients prescribed any other IM antipsychotic medication at baseline. Outcome measures included: treatment-emergent adverse events, concomitant psychotropic medication and the time taken to switch to oral medication.

RESULTS

Fewer patients in the IM olanzapine group experienced an adverse event than patients in the other IM antipsychotic group (34.4% vs. 46.2%, p < 0.001). The most frequently reported adverse events in both groups were: sedation, Parkinsonism, disturbance in attention, akathisia, dystonia and orthostatic hypotension. Fewer patients in the IM olanzapine group used anticholinergics (13.9% vs. 42.5%, p < 0.001) or anxiolytics/hypnotics (47.6% vs. 51.6%, p = 0.023). Patients in the IM olanzapine group switched to oral medication earlier than patients in the other IM antipsychotic group (median time = 46.5 vs. 48.0 h, p = 0.009).

CONCLUSIONS

These findings suggest that IM olanzapine may have a favourable impact on individual patients. However, the high rate of oral concomitant medication used throughout the study limits these findings from being associated with IM olanzapine alone.