POS1024 EFFICACY AND SAFETY OF RISANKIZUMAB (RZB) FOR ACTIVE PSORIATIC ARTHRITIS (PsA): 52-WEEK RESULTS FROM KEEPsAKE 1

Background

RZB, a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits the p19 subunit of the human cytokine IL-23, is being investigated as a treatment for PsA.

Objectives

To compare efficacy and safety of RZB vs. placebo (PBO) in patients with PsA who had an inadequate response or intolerance to conventional synthetic disease modifying antirheumatic drug (csDMARD-IR).

Methods

KEEPsAKE 1 (NCT03675308) is an ongoing, phase 3 study that includes a screening period; a 24-week double-blinded, placebo-controlled, parallel-group period (period 1); and an open-label extension period (period 2). Eligible patients aged ≥18 years with active PsA (symptom onset ≥6 months prior to screening, meeting the Classification Criteria for PsA [CASPAR], and ≥5 swollen and ≥5 tender joints) and who had an inadequate response or intolerance to ≥1 csDMARD-IR, were randomized 1:1 to receive RZB 150 mg or placebo (PBO) at weeks 0, 4, and 16. The primary endpoint was the proportion of patients achieving ≥20% improvement in American College of Rheumatology (ACR20) response at week 24. Period 2 started at week 24, and patients were switched to receive open-label RZB 150 mg every 12 weeks through week 208. Mixed-effect model repeated measures and nonresponder imputation methods were used to assess continuous and binary variables, respectively. Efficacy and safety were analyzed in all patients who received ≥1 dose of study drug through week 52. Treatment-emergent adverse events (TEAE) were summarized using exposure-adjusted event rates (EAERs, events/100 patient-years [PY]).

Results

At week 24, a greater proportion of RZB-treated (N=483) vs PBO-treated (N=481) patients achieved ACR20 (55.3% and 32.8%, respectively). At week 52, 70% of patients who were randomized to receive RZB and 63% of patients who were randomized to receive PBO and switch to RZB at week 24 achieved ACR20. In patients with ≥3% of body surface area affected at baseline, 52.7% of RZB-treated patients (N=273) and 9.9% of PBO-treated patients (N=272) achieved ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at week 24; 67.8% who were randomized to receive RZB and 59.9% who were randomized to receive PBO and switch to RZB at week 24 achieved PASI 90 at week 52. Similar results were observed for other efficacy measures. RZB was well tolerated through 52 weeks of treatment. EAERs of adverse events were stable between weeks 24 and 52. At the week 52 data cut-off (19 April 2021), the total EAER of any TEAE in patients receiving RZB was 143.1/100 PY.

Conclusion

Continuous RZB treatment provided durable efficacy and a consistent safety profile through 52 weeks of treatment in patients with active PsA who were csDMARD-IR.

Acknowledgements

AbbVie, Inc. participated in the study design; study research; collection, analysis, and interpretation of data. AbbVie funded the research for this study. Medical writing assistance, funded by AbbVie, was provided by Jay Parekh, PharmD, of JB Ashtin.

Disclosure of Interests

Lars Erik Kristensen Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Biogen, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, MAURO KEISERMAN Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Kim Papp Speakers bureau: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Dermavant, Dermira, Incyte, Janssen, LEO Pharma, Lilly, Novartis, Pfizer, Sandoz, Sanofi Genzyme, and UCB, Consultant of: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermavant, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, Gilead, Incyte, Janssen, LEO Pharma, Lilly, Meiji Seika Pharma, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Regeneron, Sandoz, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, Grant/research support from: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermavant, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, Gilead, Incyte, Janssen, LEO Pharma, Lilly, Merck, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB, Leslie McCasland Consultant of: Lilly, Douglas White Speakers bureau: AbbVie and Novartis, Consultant of: AbbVie and Novartis, Wenjing Lu Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Frank Behrens Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi

POS1042 IMPACT OF RISANKIZUMAB ON IMPROVING HEALTH-RELATED QUALITY OF LIFE, WORK PRODUCTIVITY, AND REDUCING FATIGUE AMONG PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: A POOLED ANALYSIS OF TWO PHASE 3 CLINICAL TRIALS

Background

Risankizumab (RZB) has been approved in the UK and Europe for the treatment of adults with active PsA. Patient-reported outcomes (PROs) are important tools for understanding a therapy’s efficacy from the patient’s perspective.

Objectives

This study evaluated the impact of RZB versus placebo on health-related quality of life (HRQoL), fatigue, and work productivity in patients with psoriatic arthritis (PsA) and inadequate response to 1 or 2 biologics and/or ≥1 conventional synthetic DMARDs in two Phase 3 trials (KEEPsAKE 1&2).

Methods

Eligible patients with active PsA (n=1402) were randomized (1:1) to receive risankizumab 150 mg (n=706) or placebo (n=696). Patient-reported outcomes assessed were 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue), EQ-5D-5L, and Work Productivity and Activity Impairment–PsA questionnaire. Least squares (LS) mean changes from baseline at Week 24 were compared between risankizumab versus placebo by mixed-effects repeated regression modeling.

Results

At Week 24, risankizumab- versus placebo-treated patients reported greater improvements in LS mean changes with between-group differences (all nominal P<0.001) in SF-36 physical component score (mean difference=3.5, 95% confidence interval [CI] 2.7, 4.2) and mental component score (mean difference=1.8, 95% CI 0.9, 2.6), FACIT-Fatigue (mean difference=2.5, 95% CI 1.5, 3.4), EQ-5D-5L index score (mean=0.07, 95% CI 0.05, 0.09), and EQ-5D-5L visual analogue scale score (mean difference=5.8, 95% CI 3.6, 8.0). In addition, risankizumab- versus placebo-treated patients reported greater reductions with between-group differences (all nominal P<0.001) in overall work impairment (mean difference= −8.9%, 95% CI −13.1, −4.7), activity impairment (mean difference= −7.7%, 95% CI −10.3, −5.2), and presenteeism (mean difference= −9.8%, 95% CI −13.3, −6.3).

Conclusion

Compared to placebo, risankizumab resulted in greater improvements in HRQoL, fatigue, and work productivity among patients with PsA.

Acknowledgements

This work/study was funded by AbbVie Inc. AbbVie participated in the study design, research, data collection, analysis and interpretation of data. No honoraria or payments were made for authorship. Medical writing services provided by Natalie Mitchell of Fishawack Facilitate Ltd, part of Fishawack Health, and funded by AbbVie.

Disclosure of Interests

Lars Erik Kristensen Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, and UCB; and received research grants from AbbVie, Biogen, Eli Lilly, Janssen Pharmaceutical, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, and UCB; and received research grants from AbbVie, Biogen, Eli Lilly, Janssen Pharmaceutical, Novartis, Pfizer, and UCB., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kim Papp Speakers bureau: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Consultant of: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Grant/research support from: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Douglas White Speakers bureau: AbbVie, Novartis, and Roche., Consultant of: AbbVie, Novartis, and Roche., Frank Behrens Speakers bureau: AbbVie, Amgen, BMS, Boehringer, Celgene, Chugai, Genzyme, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, Consultant of: AbbVie, Amgen, BMS, Boehringer, Celgene, Chugai, Genzyme, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, Grant/research support from: AbbVie, Chugai, Janssen, Pfizer, and Roche

AB0897 Impact of risankizumab on improving symptoms and health-related quality of life and reducing fatigue and pain among psoriatic arthritis patients with moderate-to-severe skin involvement: Evidence from two Phase III trials

Background

Psoriatic arthritis (PsA) greatly affects patient-reported health-related quality of life (HRQoL).

Objectives

To assess the impact of risankizumab (RZB) on patient-reported outcomes (PROs) in patients with high skin burden using integrated efficacy data from two Phase III clinical trials (KEEPsAKE-1 and KEEPsAKE-2).

Methods

Adult patients with PsA with inadequate response or intolerance to disease-modifying antirheumatic drugs were randomized 1:1 to receive RZB (150 mg) or placebo (PBO). Improvement from baseline in PROs (Patient’s Global Assessment of Disease Activity [PtGA] by visual analog scale [VAS], Short-Form 36 Health Questionnaire physical and mental component summary scores [SF-36 PCS and MCS], Health Assessment Questionnaire – Disability Index [HAQ-DI], EQ-5D 5-Level questionnaire [EQ-5D-5L] index and by VAS, Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-Fatigue], and pain by VAS) were assessed at Week 24 in patients with high skin burden (body surface area involvement ≥3% and Psoriasis Area Severity Index >10). Least squares mean (LSM) difference (95% confidence interval [CI]) between RZB and PBO groups based on mixed-model repeated measures regression is reported.

Results

RZB- vs PBO-treated patients demonstrated greater improvements in PROs with notable LSM differences (95% CI) between groups (P<0.01) in PtGA (-18.7 [-25.1, -12.2]), SF-36 PCS (6.3 [4.2, 8.4]) and MCS (4.4 [2.3, 6.6]), HAQ-DI (-0.4 [-0.5, -0.3]), EQ-5D-5L index (0.1 [0.1, 0.2]) and VAS (8.2 [2.5,13.9]), FACIT-Fatigue (4.9 [2.7, 7.2]), and pain (-18.9 [-25.1, -12.7]).

Conclusion

In patients with PsA with high skin burden, 24 weeks of RZB treatment, as compared with PBO, improved patients’ HRQoL, including fatigue and pain.

Acknowledgements

AbbVie funded the study and participated in interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing services were provided by Samantha Francis Stuart (Fishawack Facilitate Ltd) and funded by AbbVie.

Disclosure of Interests

Kim Papp Speakers bureau: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Consultant of: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Grant/research support from: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Christian Kaufmann Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Douglas White Speakers bureau: AbbVie and Novartis., Consultant of: AbbVie and Novartis., Andrew Ostor Speakers bureau: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Consultant of: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Grant/research support from: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Consultant of: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Grant/research support from: UCB, Novartis, Pfizer, Eli Lilly, Biogen, AbbVie, and Janssen Pharmaceuticals and UCB.

POS1036 EFFICACY AND SAFETY OF RISANKIZUMAB (RZB) FOR ACTIVE PSORIATIC ARTHRITIS (PsA): 52-WEEK RESULTS FROM KEEPsAKE 2

Background

RZB, a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits the p19 subunit of the human cytokine interleukin-23, is being investigated as a treatment for PsA.

Objectives

Evaluate longer-term safety and efficacy of RZB in patients with active PsA who experienced inadequate response or intolerance to 1 or 2 biologic therapies and/or to at least 1 csDMARD therapy.

Methods

KEEPsAKE 2 (NCT03671148) is an ongoing, phase 3, multicenter study that includes a screening period; a 24-week double-blinded, randomized, placebo-controlled, parallel-group period (period 1); and an open-label extension period (period 2). Eligible patients were ≥18 years of age with active PsA (symptom onset ≥6 months before screening, meeting Classification Criteria for PsA [CASPAR], and ≥5 tender and ≥5 swollen joints) and had inadequate response or intolerance to 1 or 2 biologic therapies (Bio-IR) and/or ≥1 conventional synthetic disease modifying antirheumatic drug (csDMARD-IR). Patients received RZB 150 mg or placebo (PBO) at weeks 0, 4, and 16 (1:1). The primary endpoint was the proportion of patients achieving ACR20 response at week 24. Period 2 started at week 24, and patients were switched to receive open-label RZB 150 mg every 12 weeks through week 208. Efficacy and safety were analyzed in patients who received ≥1 dose of study drug through week 52. Mixed-effect model with repeated measures and nonresponder imputation methods were used to assess continuous and binary variables, respectively. Treatment-emergent adverse events (TEAEs) were summarized using exposure-adjusted event rates (EAERs, events/100 patient-years [PY]).

Results

At week 24, 51,3% of RZB-treated (N=224) and 26.5% of PBO-treated (N=219) patients achieved ACR20. At week 52, 58.5% of patients who were randomized to RZB and 55.7% of patients who were randomized to PBO and then switched to RZB at week 24 achieved ACR20. In patients with ≥3% of body surface area affected at baseline, 55.0% of RZB-treated patients (N=123) and 10.2% of PBO-treated patients (N=119) achieved PASI 90 at week 24. At week 52, 64.2% of patients randomized to RZB and 59.7% of patients who were randomized to PBO and then switched to RZB at week 24 achieved PASI 90. For other efficacy measures, similar trends were observed. RZB was well tolerated through 52 weeks of treatment, and EAERs of adverse events were stable between weeks 24 and 52. At the week 52 data cutoff (19 April 2021), the total EAER of any TEAE in patients receiving RZB was 184.2/100 PY.

Conclusion

Continuous RZB treatment resulted in maintained efficacy responses with a consistent safety profile through 52 weeks of treatment in patients with active PsA who were Bio-IR and/or csDMARD-IR.

Acknowledgements

AbbVie, Inc. participated in the study design; study research; collection, analysis, and interpretation of data. AbbVie funded the research for this study and provided writing support for this abstract. Medical writing assistance, funded by AbbVie, was provided by Jay Parekh, PharmD, of JB Ashtin.

Disclosure of Interests

Andrew Ostor Speakers bureau: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Filip van den Bosch Speakers bureau: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Kim Papp Speakers bureau: AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, Lilly, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, Consultant of: AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, Lilly, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, Grant/research support from: AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, Lilly, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, CECILIA ASNAL Speakers bureau: AbbVie, Amgen, Genentech, Janssen, Lilly, Pfizer, Roche, and R-Pharm., Consultant of: AbbVie, Amgen, Genentech, Janssen, Lilly, Pfizer, Roche, and R-Pharm., Grant/research support from: AbbVie, Amgen, Genentech, Janssen, Lilly, Pfizer, Roche, and R-Pharm., Ricardo Blanco Speakers bureau: AbbVie, Bristol Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Roche., Consultant of: AbbVie, Bristol Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Roche., Grant/research support from: AbbVie, Merck, and Roche, Jacob Aelion Grant/research support from: AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Galapagos/Gilead, Genentech, GlaxoSmithKline, Lilly, Mallinckrodt, Nektar Therapeutics, Nichi-Iko, Novartis, Pfizer, Regeneron, Roche, Sanofi, Selecta Biosciences, and UCB., Wenjing Lu Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Byron Padilla Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Alan Kivitz Shareholder of: AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB., Speakers bureau: AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB., Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB.

Long-term efficacy and safety of risankizumab for the treatment of moderate-to-severe plaque psoriasis: interim analysis of the LIMMitless open-label extension trial beyond 3 years of follow-up

Background

Psoriasis is a chronic inflammatory skin disease requiring prolonged treatment. New biologic therapies require long‐term evaluation to assess the durability of their efficacy and safety profiles over time.

Objectives

To evaluate the long‐term efficacy and safety of risankizumab (RZB) for the treatment of psoriasis.

Methods

LIMMitless is an ongoing, phase III, open‐label extension study evaluating the long‐term efficacy and safety of RZB in adults with moderate‐to‐severe plaque psoriasis following multiple phase II/III studies. This analysis assessed efficacy through 172 weeks of continuous RZB treatment by examining the proportion of patients achieving ≥ 90% or 100% improvement in Psoriasis Area and Severity Index (PASI 90 and PASI 100), static Physician’s Global Assessment of clear or almost clear (sPGA 0/1) and Dermatology Life Quality Index of no effect on quality of life (DLQI 0/1). Safety was assessed by recording adverse events (AEs) through the data cutoff date. The study is registered at ClinicalTrials.gov (identifier: NCT03047395).

Results

Of 955 patients randomized to RZB 150 mg in the base studies, 897 patients continued into LIMMitless; 799 patients were still receiving treatment in LIMMitless at the time of data cutoff for this analysis. After 172 weeks of continuous RZB treatment, 85·5% of patients achieved PASI 90, 54·4% achieved PASI 100, 85·2% achieved sPGA 0/1, and 78·4% achieved DLQI 0/1 using modified nonresponder imputation. Rates of AEs leading to discontinuation and AEs of safety interest were low with long‐term treatment and comparable with those identified in the base studies.

Conclusions

Overall, long‐term continuous RZB was well tolerated and showed high and durable efficacy over 172 weeks.

What is already known about this topic?

Risankizumab is a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin‐23 by binding to its p19 subunit.

In multiple phase II/III clinical trials in adults with moderate‐to‐severe psoriasis, risankizumab has displayed superior efficacy vs. placebo or other psoriasis treatments for up to 52 weeks.

What does this study add?

LIMMitless is an ongoing phase III open‐label extension study designed to evaluate the long‐term safety and efficacy of risankizumab treatment for up to 5 years of continuous use.

The results from this interim analysis demonstrate that risankizumab offers sustained efficacy after more than 3 years of continuous use, with no new safety signals identified.

Linked Comment: S. Gerdes and J. Albrecht. Br J Dermatol 2021; 185: 1086–1087.

AB0559 EFFICACY AND SAFETY OF RISANKIZUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AFTER INADEQUATE RESPONSE OR INTOLERANCE TO DMARDs: 24-WEEK RESULTS FROM THE PHASE 3, RANDOMIZED, DOUBLE-BLIND KEEPsAKE 1 TRIAL

Background:

Risankizumab (RZB) is a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit. RZB is being investigated as a treatment for adults with psoriatic arthritis (PsA).

Objectives:

To compare the efficacy and safety of RZB vs placebo (PBO) for the treatment of active PsA in patients who have had inadequate response or intolerance to ≥ 1 conventional synthetic disease modifying antirheumatic drug (csDMARD-IR).

Methods:

In KEEPsAKE 1 (NCT03675308), eligible adults (csDMARD-IR with ≥ 5 swollen joints [SJC] and ≥ 5 tender joints [TJC]) were randomized (1:1) to receive blinded subcutaneous RZB 150 mg or PBO at weeks 0, 4, and 16. The primary endpoint was the proportion of patients achieving 20% improvement in American College of Rheumatology score (ACR20) at week 24. Ranked secondary and other secondary endpoints are shown in the Table 1. Safety was assessed throughout the study. Results reported here are from the 24-week double-blind period; the open-label period with all patients receiving RZB is ongoing.

Results:

964 patients (RZB, N = 483; PBO, N = 481) were evaluated at week 24. Demographics and baseline characteristics were generally balanced between treatment groups (mean duration of PsA: 7.12 years; mean SJC: 12.2; mean TJC: 20.6; mean body surface area involved with psoriasis [BSA] in patients with BSA ≥ 3%: 16.7%). A significantly greater proportion of RZB- vs PBO-treated patients (57.3% and 33.5%, respectively) achieved the primary endpoint of ACR20 at week 24 (P < .001; Table 1). Significant differences were also observed for RZB vs PBO for the first 8 ranked secondary endpoints (P < .001 for all; Table 1). Serious adverse events were reported for 2.5% and 3.7% of RZB- and PBO-treated patients, respectively; serious infections were reported for 1.0% and 1.2%. There was 1 death in the RZB group.

Conclusion:

RZB resulted in significantly greater improvements in signs and symptoms of PsA compared with PBO and was well tolerated in patients who were csDMARD-IR.

Disclosure of Interests:

Lars Erik Kristensen Speakers bureau: LK has received honoraria or fees for serving as a speaker or consultant from AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB., Consultant of: LK has received honoraria or fees for serving as a speaker or consultant from AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB., MAURO KEISERMAN Speakers bureau: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Consultant of: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Grant/research support from: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Kim Papp Speakers bureau: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Consultant of: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Grant/research support from: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Leslie McCasland Speakers bureau: LM has received fees for serving on an advisory board from Lilly., Douglas White Speakers bureau: DW has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant from AbbVie, Merck, Novartis, and Roche., Consultant of: DW has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant from AbbVie, Merck, Novartis, and Roche., Lisa Barcomb Shareholder of: LB is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: LB is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Wenjing Lu Shareholder of: WL is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: WL is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Zailong Wang Shareholder of: ZE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: ZE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ahmed M. Soliman Shareholder of: AMS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AMS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ann Eldred Shareholder of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Frank Behrens Speakers bureau: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi., Consultant of: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi., Grant/research support from: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi.

OP0228 EFFICACY AND SAFETY OF RISANKIZUMAB FOR ACTIVE PSORIATIC ARTHRITIS, INCLUDING PATIENTS WITH INADEQUATE RESPONSE OR INTOLERANCE TO BIOLOGIC THERAPIES: 24-WEEK RESULTS FROM THE PHASE 3, RANDOMIZED, DOUBLE-BLIND, KEEPSAKE 2 TRIAL

Background:

Risankizumab (RZB) is a humanized immunoglobin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding its p19 subunit. RZB is being investigated as a treatment for adults with psoriatic arthritis (PsA).

Objectives:

To compare the efficacy and safety of RZB vs placebo (PBO) for the treatment of active PsA in patients who have had inadequate response or intolerance to 1 or 2 biologic therapies (Bio-IR) or to ≥ 1 conventional synthetic disease modifying antirheumatic drug (csDMARD-IR).

Methods:

KEEPsAKE 2 (NCT03671148) enrolled adults with active PsA (≥ 5 swollen joints [SJC] and ≥ 5 tender joints [TJC]) who were Bio-IR or csDMARD-IR. Patients were randomized to receive blinded subcutaneous RZB 150 mg or PBO at weeks 0, 4, and 16. The primary endpoint was the proportion of patients achieving ≥ 20% improvement in American College of Rheumatology score (ACR20) at week 24. Ranked secondary endpoints and other secondary endpoints are shown in the Table. Safety was assessed throughout the study. Results reported here are from the 24-week double-blind period; the open-label period with all patients receiving RZB is ongoing.

Results:

A total of 443 patients (RZB, N = 224; PBO, N = 219) were included in the analysis. Demographics and baseline disease characteristics were similar across treatment arms (mean SJC: 13.3; mean TJC: 22.6; mean duration of PsA: 8.2 years; mean body surface area involved with psoriasis [BSA] in patients with BSA ≥ 3%: 12.1%); 206 patients (46.5%) were Bio-IR. Significantly greater proportions of RZB-treated patients vs PBO-treated patients achieved the primary endpoint (51.3% vs 26.5%, respectively; P < .001) and all ranked secondary endpoints (P < .001 for all except for Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue; P < .009]; Table). Other secondary outcomes also showed improvement for RZB- vs PBO-treated patients (Table). Serious adverse events were reported for 4.0% and 5.5% of RZB- and PBO-treated patients, respectively; serious infections were reported for 0.9% and 2.3%.

Conclusion:

RZB resulted in significantly greater improvements in signs and symptoms of PsA compared with PBO and was well tolerated in patients who were Bio-IR or csDMARD-IR.

Disclosure of Interests:

Andrew Ostor Speakers bureau: AÖ has received speaker or consulting fees and/or research grants from AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB., Consultant of: AÖ has received speaker or consulting fees and/or research grants from AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB., Grant/research support from: AÖ has received speaker or consulting fees and/or research grants from AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB., Filip van den Bosch Speakers bureau: FVdB has received speaker and/or consulting fees from Abbvie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Consultant of: FVdB has received speaker and/or consulting fees from Abbvie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Kim Papp Speakers bureau: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Consultant of: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Grant/research support from: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., CECILIA ASNAL Speakers bureau: CA has received honoraria or fees for serving on advisory boards or as a speaker, as well as research support from AbbVie, Genentech, Janssen, Lilly, Pfizer, and Roche., Grant/research support from: CA has received honoraria or fees for serving on advisory boards or as a speaker, as well as research support from AbbVie, Genentech, Janssen, Lilly, Pfizer, and Roche., Ricardo Blanco Speakers bureau: RB has received grants or research support from AbbVie, Merck, and Roche; and has received consultation fees or honoraria for serving as a speaker for AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Roche., Consultant of: RB has received grants or research support from AbbVie, Merck, and Roche; and has received consultation fees or honoraria for serving as a speaker for AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Roche., Grant/research support from: RB has received grants or research support from AbbVie, Merck, and Roche; and has received consultation fees or honoraria for serving as a speaker for AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Roche., Jacob Aelion Grant/research support from: JA has received grants or research support from AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Galapagos/Gilead, Genentech, GlaxoSmithKline, Lilly, Mallinckrodt, Nektar Therapeutics, Nichi-Iko, Novartis, Pfizer, Regeneron, Roche, Sanofi, Selecta Biosciences, and UCB., Gabriela Alperovich Shareholder of: GA is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: GA is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ying Zhang Shareholder of: YZ is a former AbbVie employee, and may hold AbbVie stock or stock options., Employee of: YZ is a former AbbVie employee, and may hold AbbVie stock or stock options., Zailong Wang Shareholder of: ZW is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: ZW is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ahmed M. Soliman Shareholder of: AS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ann Eldred Shareholder of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Alan Kivitz Shareholder of: AK is a shareholder of or has received honoraria or fees as a consultant, speaker, or expert witness for AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB., Speakers bureau: AK is a shareholder of or has received honoraria or fees as a consultant, speaker, or expert witness for AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB., Consultant of: AK is a shareholder of or has received honoraria or fees as a consultant, speaker, or expert witness for AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB.

Patient-reported outcomes with risankizumab versus fumaric acid esters in systemic therapy-naïve patients with moderate to severe plaque psoriasis: a phase 3 clinical trial

BACKGROUND

In a phase 3 clinical study, patients from Germany with moderate to severe psoriasis who were naïve to systemic treatment and received risankizumab had greater and more rapid disease improvements compared with those who received fumaric acid esters (FAEs).

OBJECTIVE

To evaluate patient-reported outcomes (PROs) in patients treated with risankizumab compared with FAEs.

METHODS

Adult patients were randomized 1:1 to receive either risankizumab 150 mg subcutaneous injections at weeks 0, 4 and 16 or FAEs (Fumaderm^® ) provided according to the prescribing label. PRO secondary endpoints assessed were Psoriasis Symptom Scale (PSS), Dermatology Life Quality Index (DLQI), 36-Item Short Form Health Survey, version 2 (SF-36v2), Patient Benefit Index (PBI), Hospital Anxiety and Depression Scale (HADS), Patient Global Assessment (PtGA) and European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L). PROs were assessed at weeks 0, 16 and 24.

RESULTS

Sixty patients each were randomized to receive risankizumab or FAEs. A significant PSS improvement was observed with risankizumab vs. FAEs at weeks 16 and 24 for total and psoriasis-associated redness, itching and burning scores (P < 0.001). DLQI scores were significantly lower (reflecting better health-related quality of life) with risankizumab vs. FAEs, with least squares (LS) mean differences of -7.4 and -7.6 at weeks 16 and 24, respectively (both P < 0.001). Patients randomized to risankizumab also had larger improvements in SF-36 Physical and Mental Component Summary scores, HADS anxiety and depression scores, PtGA, and EQ-5D-5L index and visual analogue scale scores (all P ≤ 0.002) at weeks 16 and 24 compared with FAEs. PBI was significantly higher, indicating greater benefit, with risankizumab vs. FAEs, with an LS mean difference of 1.1 and 1.3 at weeks 16 and 24, respectively (both P < 0.001).

CONCLUSIONS

Risankizumab provides significant benefits over FAEs in improving PROs across several dimensions in patients with moderate to severe psoriasis.

Effects of probiotic and Bidens pilosa on the performance and gut health of chicken during induced Eimeria tenella infection

AIM

In this study, we have examined the individual and combined protective mechanism of probiotic and Bidens pilosa on the performance and gut health of chickens during Eimeria tenella infection over a 29-day experimental trial.

METHODS AND RESULTS

A total of one hundred and fifty 1-day-old chickens were equally distributed into five treatment groups with three biological replicates: two groups were allocated as control groups (control group untreated unchallenged, CG and control positive untreated challenged, CPG) and three groups were fed diets with probiotic (PG), B. pilosa (BPG) and probiotic + B. pilosa (PG + BPG) and challenged with E. tenella. Birds of all groups were assessed for pre and post-infection body weights, oocysts shedding, caecal lesion scores and mRNA expression levels of apoptosis related proteins (Bcl-2, Bax and caspase-3), antioxidant enzymes (CAT and SOD 1), pro-inflammatory cytokines (IL-6 and IL-8) and tight junction proteins (CLDN 1 and ZO 1). Our results revealed that during infection (day 21-29), E. tenella challenged chickens significantly decreased the body weight compared with uninfected control chickens; however, there was no significant effect on body weight of chickens fed with probiotic, B. pilosa and probiotic + B. pilosa was observed. Eimeria tenella challenged untreated birds increased (P < 0·05) oocysts shedding, destructive ratio of caeca and mortality as compared to treated challenged birds. CPG group up-regulated the mRNA expression levels of anti-apoptosis protein Bcl-2 while down-regulated the pro-apoptosis protein Bax relative to PG, BPG and PG + BPG groups. Moreover chickens fed probiotic, B. pilosa and probiotic + B. pilosa diets enhanced the activities of antioxidant enzymes, pro-inflammatory cytokines and tight junction proteins with the comparison of control positive untreated challenged chickens.

CONCLUSION

These findings elaborated that feed supplementation of probiotic and B. pilosa (individually or in combination) appeared to be effective in inhibiting the occurrence of disease and decreasing the severity of Eimeria infection in chickens.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study explained the underlying anti-coccidial mechanism in which probiotic and B. pilosa (individually and/or in combination) improve the performance of chicken and protect against gut inflammatory responses caused by E. tenella.

Pharmacokinetics and tissue residue of enrofloxacin in healthy, Eimeria-infected broiler chickens and those pre-treated with amprolium and toltrazuril

The pharmacokinetics of enrofloxacin was compared in healthy chickens, Eimeria infected chickens and in Eimeria infected chickens pre-treated with amprolium or toltrazuril following a single IV and oral administration at dose 10 mg/kg. The blood samples were taken after administration at different time intervals (5 min to 24 hours) to determine the pharmacokinetic parameters of enrofloxacin. The different concentrations of enrofloxacin were determined by using HPLC assay method. Serum concentrations versus time were analysed by a non-compartmental method. The results explored a significant decrease in serum concentrations of enrofloxacin at different time intervals and a significant change in pharmacokinetic profiles in Eimeria infected chickens compared with those values in healthy chickens whereas, amprolium improves these values. Toltrazuril leads to a significant decrease in enrofloxacin concentrations compared with infected non-treated chickens. Multiple-dose study revealed a longer withdrawal period of enrofloxacin in infected non-treated and infected chickens pre-treated with amprolium compared with the healthy group.

Healthcare utilization and cost burden among women with endometriosis by opioid prescription status in the first year after diagnosis: a retrospective claims database analysis

Aims: Opioids do not represent standard therapy for endometriosis; however, women with endometriosis are frequently prescribed an opioid to manage related abdominal or pelvic pain. The aim of this study was to evaluate the impact of opioid use on endometriosis-related economic and healthcare burden in the United States.Materials and methods: We performed a retrospective, propensity-matched cohort analysis of the Truven MarketScan Commercial database from 1 January 2011 to 31 December 2016. Eligible women had at least 1 inpatient or 2 outpatient codes for endometriosis and 12 months of continuous enrollment before and after the index date (i.e. first recorded endometriosis diagnosis). The primary analysis examined healthcare costs and utilization for 12 months after the index date in women who filled at least 1 opioid prescription versus those who did not. The secondary analysis examined healthcare costs and utilization by the pattern of opioid use.Results: The primary analysis matched 43,516 women across 2 groups and the secondary analysis matched 13,230 women across 5 groups. In the primary analysis, total 12-month healthcare costs were significantly higher in the opioid group compared to the non-opioid group ($29,236.00 vs. $18,466.00, respectively; p < .001); the same pattern was observed for all healthcare utilization parameters. In the secondary analysis, higher morphine equivalent daily dose and proportion of days covered were associated with the highest healthcare costs and utilization compared to the non-opioid group.Limitations: Retrospective design and inability to confirm whether filled opioid prescriptions were actually taken.Conclusions: Filling an opioid prescription within 1 year after an endometriosis diagnosis was associated with significant excess healthcare burden. Patients prescribed an opioid may experience inadequate symptom management and benefit from the use of disease-specific, non-opioid therapies.

Study of Using Solar Thermal Power for the Margarine Melting Heat Process

The heating process of melting margarine requires a vast amount of thermal energy due to its high melting point and the size of the reservoir it is contained in. Existing methods to heat margarine have a high hourly cost of production and use fossil fuels which have been shown to have a negative impact on the environment. Thus, we perform an analytical feasibility study of using solar thermal power as an alternative energy source for the margarine melting process. In this study, the efficiency and cost effectiveness of a parabolic trough collector (PTC) solar field are compared with that of a steam boiler. Different working fluids (water vapor and Therminol-VP1 heat transfer oil (HTO)) through the solar field are also investigated. The results reveal the total hourly cost ($/h) by the conventional configuration is much greater than the solar applications regardless of the type of working fluid. Moreover, the conventional configuration causes a negative impact to the environment by increasing the amount of CO₂, CO, and NO₂ by 117.4 kg/day, 184 kg/day, and 74.7 kg/day, respectively. Optimized period of melt and tank volume parameters at temperature differences not exceeding 25 °C are found to be 8-10 h and 100 m³, respectively. The solar PTC operated with water and steam as the working fluid is recommended as a vital alternative for the margarine melting heating process.

Hypoglycemic and antioxidative effects of fenugreek and termis seeds powder in streptozotocin-diabetic rats

BACKGROUND AND OBJECTIVES

Diabetes mellitus is a heterogeneous disease characterized by altered cellular metabolism. So, many traditional herbs are being used by diabetic patients to control this disease. In the present study, an attempt has been made to investigate the anti-diabetic and antioxidative effects of water suspension of Fenugreek (F), and Termis (T) seeds powder and their mixture (M) who were studied in Streptozotocin (STZ)-induced diabetic rats.

MATERIALS AND METHODS

Experimental diabetes was induced by injection a single dose of STZ (50 mg/kg, i.p.). Adult male albino rats were divided into five groups; normal control, diabetic control, diabetic-F supplement (1 g/kg b.wt.), diabetic-T supplement (1 g/kg b.wt.) and diabetic-M supplement 1 g/kg b.wt. of each seed powder concurrently for 30 days. Serum glucose, insulin, lipid profile, activities of serum marker enzymes of liver function as well as liver and muscle glycogen content were measured. The oxidative stress was assessed by blood reduced glutathione (GSH) content and enzyme activities of glutathione-S-transferase (GST) and catalase (CAT) in plasma.

RESULTS

The increase in serum glucose, total lipid, triglycerides, total cholesterol, AST, ALT, ALP and decreased insulin, plasma, GSH, GST, CAT, as well as liver and muscle glycogen content were the salient features recorded in diabetic control rats. The F, T and M supplements significantly reverted the levels of the studied metabolites and enzymes activities to near normal control values. Co-administration of F and T seeds powder was considered as an effective agent in modulating the alterations in total lipid, AST, ALT, GSH and muscle glycogen.

CONCLUSIONS

Our data suggest that F, T and M seeds powder supplementation may be beneficial for preventing diabetic complications in this animal model.

2-(1,3-Benzothiazol-2-yl)guanidin-2-ium acetate

In the title compound, C₈H₉N₄S⁻·C₂H₃O₂⁻, the cation is essentially planar (r.m.s deviation = 0.037 Å) with the guanidine unit bent out of the plane of the fused-ring system by 4.6 (3)°. In the asymmetric unit, the cations and anions are linked into R₂²(8) motifs. In the crystal, further N—H⋯O and N—H⋯N hydrogen bonds link the components into a two-dimensional network.

Protective and curative effects of the 15 KD isolated protein from the Peganum harmala L. seeds against carbon tetrachloride induced oxidative stress in brain, tests and erythrocytes of rats

BACKGROUND AND OBJECTIVES

The present study aimed to evaluate the protective and curative effects of the 15 KD protein isolated from the seeds of Peganum harmala L. against carbon tetrachloride (CCl4) induced oxidative stress in rats.

MATERIALS AND METHODS

In the protective study, animals were pretreated intraperitoneally with 15 KD isolated protein at doses of 4 and 8 mg/kg body weight as well as vitamin C (250 mg/kg body weight p.o) for 7 days and then challenged with CCl4 orally (1 ml/kg body weight) in olive oil (50%) for 2 days. In the curative study, rats were administered CCl4 orally for 2 days, then treated intraperitoneally with 15 KD protein (4 and 8 mg/kg body weight) and orally with vitamin C.

RESULTS

Administration of CCl4 induced induction in malondialdehyde (MDA) and decrease in reduced glutathione (GSH) levels as well as glutathione-S-transferase (GST) activity in brain, testes and erythrocytes. The activity of acetylcholinesterase (AchE) in brain was also inhibited by CCl4 administration.

CONCLUSIONS

Treatment of rats either pre or post CCl4 intoxication successfully alleviated the oxidative stress in the brain, testes and erythrocytes of the experimental animals. Data also showed that the isolated protein possessed strong antioxidant activity comparable to that of vitamin C.

Synthesis of a new antischistosomally active and toxicologically tolerant C-12 monothione surrogate of the universal antihelmintic praziquantel

A new C-12 monothione mimic (III) of the universal antihelmintic Praziquantel (I) namely, 2-cyclohexylthiocarbonyl( 1,2.3,6,7,11b)-hexahydro-4H-pyrazino[2-1a] isoquinoline-4-one was chemically synthesized and structurally elucidated (Elemental analysis. El-Mass, 13C-NMR and IR spectroscopy). Antischistosomal potency in the order of -76% comparable to that for our newly reported C-12 and C-4 dithion mimic II (-70%) and Praziquantel. Praziquantel (100%, mice infected with S. mansoni cercariae), was realized. Toxicological evaluation (mice liver and kidney functions) and biochemical parameters (cholesterol, triglycerides, albumin, total serum proteins and amino acid profile of liver protein homogenate) were also assayed. Comparable to the parent drug, general insignificant toxicological diferences could be attributed for III. Interestingly, III exhibited intermediate biological figures between I and II. An order of II<III<I with respect to the antischistosomal potency and II>III>I, for the other tested biochemical parameters was observed. A consideration of obtained results could indicate that, structurally, an intact glycine amide segment of the pyrazine moiety, as it is the case in both I and III, and not in II (glycine thioamide) seemed now more crucial for exhibiting an optimum antihelmintic potency as well as a more tolerant toxicity characteristics. Additionally, the obtained comparable amino acid profile of mice liver protein homogenate after the treatment by III, could suggest similar biochemical, lethal mechanistic and metabolic routes for II, III and I. The new lipophilic candidatee III seems to merit more profound chemical, biological, and pharmaceutical investigations.

Traumatic auricular hematoma: a case report

Traumatic recurrent auricular hematoma can be a challenging medical problem, with complications resulting in cauliflower ear. Proper management often depends on an understanding of the pathophysiology and pathogenesis of fibroneocartilage--an abnormal fibrous cartilage formation in response to injury. Traditional treatment by incision and drainage, and compression dressing technique may be inadequate in the setting of recurrent or chronic hematoma. Instead, excision of the fibroneocartilage is essential in promoting hematoma resolution and wound healing. Appropriate treatment of auricular hematoma can reduce needless cosmetic deformity and can avoid difficult secondary reconstruction. The authors present a case of recurrent auricular hematoma and review its pathophysiology and current therapy.

Synthetic and bioorganic investigations of 2-cyclohexylthiocarbonyl( 1,2,3,6,7,11B)hexahydro-4H-pyrazino [2-1a] isoquinoline-4-thione, a new dithione mimic of the universal anthelminthic Praziquantel

As a continuation for our previous approaches to establish structure-antischistosomal activity relationship (SAR) among some new rationally synthesized analogues of praziquantel, herein a new C-4 and C-12 dithione mimic of the drug namely, 2-cyclohexylthiocarbonyl (1, 2, 3, 6, 7, 11b) hexahydro-4H-pyrazino[2-la]isoquinoline-4-thione (II) was synthesized and antischistosomally investigated (mice infected with S. masoni cercariae). Further, some significant biochemical and toxicological parameters for both the control and the dithione II treated mice, particularly the total serum and liver proteins, liver enzymes, serum total lipids, cholesterol, triglycerides, albumin, globulins and creatinine, were assayed. The determined induced amino acid profile of liver protein hydrolysate could indicate a close similarity of the working biological mechanism for both I and II. Comparable to praziquantel, the dithione II was found, still promisingly antischistosomally active (approximately 70% of I, collective average activity, based on 500 mg II/kg mouse body weight). Equally, generally tolerant toxicity parameters for liver and kidney functions could be attributed. Due to the still absence of quasi-potent praziquantel candidates since its discovery (1975), the dithione II could be considered as an interesting anthelminthic candidate susceptible for further profound studies and structure modulations. In this context, some perspectives were also suggested.

Changing trends in angioedema

Angioedema can be a life-threatening event presenting to otolaryngologists, emergency medicine physicians, and other physicians. Recent reports suggest an increasing role of angiotensin-converting enzyme inhibitors (ACEIs) in the causation of angioedema. Sixty-four cases occurring between 1994 and 1998 were identified and examined retrospectively. Fifty-eight percent of patients presenting with angioedema were using ACEIs. Ninety-four percent of patients overall, and 92% of patients with ACEI-associated angioedema, were African-American. Tongue, lip, facial, and supraglottic edema were most common. Treatment included intubation in 13% and intensive care unit monitoring in 20%. Nearly all patients were treated with corticosteroids and antihistamines. There were no deaths. Angioedema associated with ACEI use appears to be much more common than previously reported. African-American patients may be at higher risk for angioedema with ACEI use. Successful management was achieved with observation, expectant airway management, corticosteroids, and discontinuation of ACEIs. Patients without airway obstruction or pharyngeal or laryngeal edema who improved with treatment and observation were successfully treated as outpatients.

A new flavonoid from Limonium axillare

A new flavonol glycoside identified as myricetin 3-O-beta-D-sorboside (1) has been isolated from the leaves of L. axillare. The new compound showed a moderate inhibition of Ehrlich ascites carcinoma cells.

Synthesis and study of the antischistosomal potency and induced biological parameters of a new 2-palmitoyl analogue of the universal antihelminthic praziquantel

2-Palmitoyl[1,2,3,6,7,11b]hexahydro-4H-pyrazino[2-la]isoquinoline-4-one [III] a highly lipophilic analogue of the universal antihelminthic PRAZIQUANTEL [I] was rationally multi-stepwise synthesized and antischistosomally and biochemically screened. The 2-palmitoyl conjugation was hypothesized to be an antischistosomal adjuvant (Tween 40 mimicry), to the reported crucial pyrazino-isoquinoline moiety. On a constant weight doses bases of I and III (500 mg/kg mouse body weight), the activity of III was found to be approximately 70% of I (mice infected with S. mansoni cercariae) and with satisfactory toxicological and biochemical profile (mice liver and kidney functions). Equivalent molar weight assay (M 1:1.4 for I and III, respectively), which could further plead in favour of the potency of III, was not yet tested. The analogue III, which favourable incorporates the human metabolically and physiologically compatible, palmitic acid segment, seems to be an antischistosomally promising candidate for more integrated studies.

Cell adhesion molecules in normal laryngeal development

Larynges taken from normally developing rats ranging from embryos starting at embryonic day 10 to adults were harvested. Sections of the larynges were prepared with the use of immunohistochemical techniques with primary antibodies directed to the neural cell adhesion molecule; selected sections were exposed to antibodies directed against the embryonic polysialated form of the neural cell adhesion molecule and against L1. Cell adhesion molecules were present throughout embryonic development associated with the recurrent laryngeal nerve. Downregulation of expression was observed after postnatal day 14. We conclude that cell adhesion molecules may play a role in the normal neural development of the larynx in rats.

Autoantibodies in inner ear disease

The etiopathogenesis of many inner ear disorders still remains idiopathic. Immunological mechanisms are attracting attention in relation to a number of these diseases. Some cases are believed to be autoimmune in origin. The present study was conducted to determine whether patients with inner ear disorders produce antibodies that may be pathologic to the inner car or result from its damage. Sera from 100 patients with various inner ear disorders were tested for autoantibodies using the indirect immunofluorescence test. Inner ear tissue preparations from healthy guinea pigs were used as antigen substrates. Adequate tissue and serological controls were applied. Two groups of antibodies were detected; antibodies directed against the inner ear tissues (18%) and antibodies directed against different tissue/cellular elements (41%). A wide variety of inner ear antibodies were found, though no common type manifested itself. Meniere's disease was the most common clinical diagnosis in the antibody-positive group.

A subpopulation of Menière's patients produce antibodies that bind to endolymphatic sac antigens

The endolymphatic sac (ES) has been suggested to serve an important immunological role within the inner ear. Meanwhile, immunological mechanisms have been studied in connection with Meniere's disease. The aim of this study is to look for and recognize antibodies against the ES in the sera of patients with Meniere's disease, using the technique of indirect immunofluorescence. Sera from 50 patients with Meniere's disease, from an animal model of autoimmune inner ear disease, and from healthy controls were tested against ES tissue substrates obtained from guinea pigs. Immunoglobulin deposition in the ES was found in 20 patients (40%) compared with one control (10%). The difference was statistically significant when computing the odds ratios at 95% confidence level. Fluorescein labeling was demonstrated in the ES epithelium in 16% and in the surrounding perisaccular stroma in 24%. Identical immunoreactivity against the ES tissue was depicted in the sera of the experimental animal model. These findings support the possibility of humoral immunological involvement in the Meniere's disease process. Immunological derangement of the ES function could be the first step in a cascade of reactions leading to endolymphatic hydrops and presenting as Meniere's disease.

Decreasing the number of points in the standard curve for determining iron in flour: summary of collaborative study

Seven laboratories participated in a collaborative study conducted to (1) evaluate the effects of reducing the number of points for the standard curve in the AOAC Official Method for iron in flour 944.02A-944.02C(a) from 10 points to 5 points, and (2) compare the levels of iron found in foods by using the 10-point and 5-point standard curves. The 5 points (0.2, 0.6, 1.0, 1.4, and 1.8 micrograms Fe/mL) were selected by eliminating every other standard point from the 10-point curve after correction for the reagent blank. No differences in the performance parameters between method versions were found when blind duplicate analysis was used to estimate the performance parameters for each sample analyzed. Results from 2 laboratories were excluded from statistical calculations because of failure to follow the specific instructions to increase the dilution when sample absorbance readings exceeded the highest standard point reading. The 5-point standard curve has been adopted first action in method 944.02 by AOAC INTERNATIONAL.

Immune-mediated inner ear disease

Recent clinical studies, experimental research, and various testing techniques in otoimmunology have resulted in presentation of the synonymous terms autoimmune sensorineural hearing loss, autoimmune inner ear disease, immune-mediated sensorineural hearing loss, and immune-mediated inner ear disease or disorder. The development of this terminology and the clinical presentation of this disease as well as whether it is really a distinct clinical entity are discussed. Laboratory tests for immune-mediated inner ear disease are presented along with a discussion of progress being made in the growing field of otoimmunology.