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Werth V, Wissmar J, Strömbeck A, Tummala R, Kleoudis C, Albulescu M. POS0367 IMPROVEMENT OF INDIVIDUAL MUCOCUTANEOUS MANIFESTATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS TREATED WITH ANIFROLUMAB. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with cutaneous lupus erythematosus (CLE) experience disfiguring and painful lesions that can lead to psychological distress and significant impacts on quality of life.1 Treatment of patients with systemic lupus erythematosus (SLE) with anifrolumab, a type I interferon receptor antagonist, was associated with CLE Disease Area and Severity Index–Activity (CLASI-A) improvements compared with placebo through Week 52 in the phase 3 TULIP-1 and TULIP-2 SLE trials.2,3 CLASI assesses overall skin improvement and may be driven by erythema over the other components.4ObjectivesTo better understand the effect of anifrolumab on mucocutaneous SLE manifestations by analyzing the individual domains of CLASI-A using pooled data from the TULIP trials.MethodsTULIP-1 (NCT02446912) and TULIP-2 (NCT02446899) were randomized, double-blind, placebo-controlled, 52-week trials that evaluated efficacy and safety of intravenous anifrolumab administered every 4 weeks in patients with moderate to severe SLE despite standard therapy.2,3 In a post hoc analysis, individual CLASI-A domains (erythema, scale/hypertrophy, alopecia, and mucosal) were assessed at Week 24 (time point chosen to ensure adequate duration for improvement in slow-remitting manifestations [eg, scale, alopecia]) in 2 patient subgroups: 1) the “chronic” mucocutaneous subgroup (resembling chronic/discoid CLE), defined as patients with a baseline erythema score ≥4 and scale score ≥2, and alopecia score ≥1 or baseline mucosal lesions or ulceration score of 1; and 2) the “extended” mucocutaneous subgroup (resembling all CLE subtypes), defined as patients who met the “chronic” criteria or those who had a baseline erythema score ≥8.ResultsAcross the pooled TULIP trials, 360 patients received anifrolumab 300 mg and 366 patients received placebo. In patients with assessments at Week 24 in the “chronic” (anifrolumab n=58, placebo n=50) and “extended” (anifrolumab n=104, placebo n=96) subgroups, anifrolumab led to a greater mean percent reduction from baseline compared with placebo in erythema (chronic: −63.6% vs −39.9%; extended: −63.7% vs −41.2%) and scale/hypertrophy (chronic: −72.2% vs −42.6%; extended: −45.3% vs −7.3%). Anifrolumab-treated patients in both subgroups had no worsening in alopecia (chronic: 93.3% [56/60] vs 96.0% [48/50]; extended: 95.3% [102/107] vs 95.8% [92/96]) or mucous membrane (chronic: 95.0% [57/60] vs 96.0% [48/50]; extended: 96.3% [103/107] vs 94.8% [91/96]) from baseline vs placebo (Table 1).Table 1.Skin Responses at Week 24 Compared With BaselineCriteria, n (%)Chronic subgroupExtended subgroupAnifrolumab 300 mg (n=60)Placebo (n=50)Anifrolumab 300 mg (n=107)Placebo (n=96)Erythema score reduction≥25%53 (88.3)32 (64.0)93 (86.9)68 (70.8)≥50%42 (70.0)22 (44.0)71 (66.4)47 (49.0)≥60%34 (56.7)18 (36.0)61 (57.0)32 (33.3)Scale/hypertrophy score reduction≥10%49 (81.7)34 (68.0)55 (51.4)38 (39.6)≥25%47 (78.3)30 (60.0)53 (49.5)34 (35.4)≥50%46 (76.7)28 (56.0)51 (47.7)31 (32.3)No new/worsened lesions in any individual body area44 (73.3)26 (52.0)81 (75.7)56 (58.3)Alopecia≥1-point decreasea25 (41.7)19 (38.0)35 (32.7)27 (28.1)No worsening56 (93.3)48 (96.0)102 (95.3)92 (95.8)Mucosal lesion/ulceration1-point decreaseb25 (41.7)13 (26.0)39 (36.4)23 (24.0)No worsening57 (95.0)48 (96.0)103 (96.3)91 (94.8)aIf baseline score ≥1.bIf baseline score =1.ConclusionIn the phase 3 TULIP trials, SLE patients with mucocutaneous manifestations treated with anifrolumab experienced numerical improvements in erythema and scale/hypertrophy and no worsening in alopecia or mucous membrane CLASI-A domains compared with placebo, regardless of whether skin disease was classified by chronic or extended definitions. These encouraging data support further evaluation of anifrolumab in patients with CLE.References[1]Klein R. J Am Acad Dermatol. 2011;64:849–58.[2]Furie RA. Lancet Rheumatol. 2019;1:e208–19.[3]Morand EF. N Engl J Med. 2020;382:211–21.[4]Albrecht J. J Invest Dermatol. 2005;125:889–94.AcknowledgementsWriting assistance by Naomi Atkin (Fishawack Health). This study was sponsored by AstraZeneca.Disclosure of InterestsVictoria Werth Consultant of: Celgene, Medimmune, Resolve, Genentech, Idera, Janssen, Lilly, Pfizer, Biogen, BMS, Gilead, Amgen, Medscape, Nektar, Incyte, EMD Sorona, CSL Behring, Principia, Crisalis, Viela Bio, Argenx, Kwoya Kirin, Regeneron, AstraZeneca, Abbvie, Octapharma, GSK, Cugene, UCB, Corcept, Beacon Bioscience, Rome Pharmaceuticals, Horizon, Merck, Kezar, Sanofi, Bayer, Akari, Grant/research support from: Celgene, Janssen, Pfizer, Biogen, Gilead, Corbus Pharmaceuticals, Genentech, AstraZeneca, Viela, Syntimmune, Amgen, Regeneron, Argenx, CSL Behring, Ventus, q32 Bio, BMS, Jenny Wissmar Shareholder of: AstraZeneca, Employee of: AstraZeneca, Anna Strömbeck Employee of: AstraZeneca, Raj Tummala Shareholder of: AstraZeneca, Employee of: AstraZeneca, Christi Kleoudis Shareholder of: AstraZeneca, Employee of: AstraZeneca, Marius Albulescu Shareholder of: AstraZeneca Ltd, Consultant of: UCB, Kymab Ltd, Employee of: AstraZeneca Ltd
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Strömbeck A, Nordström I, Andersson K, Andersson H, Johansen S, Maglio C, Rabe H, Adlerberth I, Wold AE, Hesselmar B, Rudin A, Lundell AC. Allergic disease in 8-year-old children is preceded by delayed B cell maturation. Clin Exp Allergy 2017; 47:918-928. [PMID: 28295779 DOI: 10.1111/cea.12922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/15/2017] [Accepted: 03/07/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND We previously reported that exposure to a farming environment is allergy-protective, while high proportions of neonatal immature/naïve CD5+ B cells and putative regulatory T cells (Tregs) are risk factors for development of allergic disease and sensitization up to 3 years of age. OBJECTIVE To examine if B and T cell maturation are associated with allergic disease and farming environment over the first 8 years in life. METHODS In the prospective FARMFLORA study, including both farming and non-farming families, 48 of 65 children took part in the 8-year follow-up study. Various B and T cell maturation variables were examined in blood samples obtained at several occasions from birth to 8 years of age and related to doctors' diagnosed allergic disease and sensitization, and to farming environment. RESULTS We found that the incidence of allergic disease was lower among farmers' compared to non-farmers' children during the 8-year follow-up period, and that farmers' children had higher proportions of memory B cells at 8 years of age. Moreover, a high proportion of neonatal CD5+ B cells was a risk factor for and may predict development of allergic disease at 8 years of age. A high proportion of Tregs was not protective against development of these conditions. CONCLUSION AND CLINICAL RELEVANCE High proportions of neonatal naïve B cells remained as a risk factor for allergic disease in school-aged children. Thus, the accelerated B cell maturation observed among farmers' children may be crucial for the allergy-protective effect of a farming environment.
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Affiliation(s)
- A Strömbeck
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Nordström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Andersson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Andersson
- Pediatric Clinic, Skaraborg Hospital, Lidköping, Sweden
| | - S Johansen
- Pediatric Clinic, Skaraborg Hospital, Lidköping, Sweden
| | - C Maglio
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Rabe
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - I Adlerberth
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - A E Wold
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - B Hesselmar
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Rudin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A-C Lundell
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Strömbeck A, Rabe H, Lundell AC, Andersson K, Johansen S, Adlerberth I, Wold AE, Hesselmar B, Rudin A. High proportions of FOXP3(+) CD25(high) T cells in neonates are positively associated with allergic sensitization later in childhood. Clin Exp Allergy 2015; 44:940-52. [PMID: 24528482 PMCID: PMC4215110 DOI: 10.1111/cea.12290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/16/2013] [Accepted: 01/27/2014] [Indexed: 01/06/2023]
Abstract
Background The role of FOXP3+ regulatory T cells in the prevention against sensitization
and allergy development is controversial. Objective We followed 65 newborn Swedish children from farming and non-farming families from birth to
3 years of age and investigated the relation between CD4+ T cell subsets in
blood samples and development of sensitization and allergic disease. Methods The proportions of FOXP3+CD25high,
CTLA-4+CD25+, CD45RO+,
HLA-DR+, CCR4+ or α4β7+ within
the CD4+ T cell population were examined by flow cytometry of blood samples at
several time-points. Mononuclear cells were isolated from blood and stimulated with birch allergen,
ovalbumin or the mitogen PHA, and the levels of IL-1β, IL-6, TNF, IFN-γ, IL-5 and
IL-13 were measured. A clinical evaluation regarding the presence of allergen-specific IgE and
allergy was performed at 18 and 36 months of age. Results Multivariate discriminant analysis revealed that children who were sensitized at 18 or
36 months of age had higher proportions of FOXP3+CD25high T
cells at birth and at 3 days of life than children who remained non-sensitized, whereas
allergy was unrelated to the neonatal proportions of these cells. The proportions of
CTLA-4+CD25+ T cells were unrelated to both sensitization and
allergy. The association between higher proportions of FOXP3+CD25high T
cells and sensitization persisted after exclusion of farmer's children. Finally, a farming
environment was associated with lower proportions of FOXP3+CD25high T
cells in early infancy and to a more prominent T cell memory conversion and cytokine production. Conclusion & Clinical Relevance Our results indicate that high proportions of FOXP3+CD25high T cells
in neonates are not protective against later sensitization or development of allergy.
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Affiliation(s)
- A Strömbeck
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Abul-Kasim K, Strömbeck A, Maly P, Overgaard A, Persson E, Sundgren PC. Interobserver and intraobserver agreement in the evaluation of CT perfusion in ischemic stroke. Funct Neurol 2009; 24:139-145. [PMID: 20018141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Knowledge of interrater reliability in the evaluation of perfusion computed tomography (CTP) studies is very limited even though the method is widely used in the workup of acute stroke. The aims of this study were to estimate the inter- and intraobserver agreement in the evaluation of CTP data and to evaluate the feasibility of the method. The CTP data of 20 consecutive patients (50% were females) aged 68+/-11 years with different categories of acute ischemic stroke were included in this retrospective analysis. Perfusion studies were evaluated independently by six radiologists on two different occasions. The overall inter- and intraobserver agreement was substantial, showing a capital KA, Cyrillic value of 0.65 (95% confidence interval 0.39-0.91). The time required for the post-processing and interpretation ranged from 37 to 460 seconds. Evaluation of manually post-processed CTP data according to the maximum slope model appears to be reliable. Experience and also a short training period increase the reliability of the method and reduce the time needed for delivery of the results to the treating clinician.
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Affiliation(s)
- Kasim Abul-Kasim
- Faculty of Medicine, University of Lund and Division of Neuroradiology, Department od Radiology, Malmo University Hospital, Malmo, Sweden.
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Abul-Kasim K, Maly P, Strömbeck A, Svensson J, Sundgren PC. Perfusion Weighted MR Imaging may Differentiate Primary CNS Lymphoma from other Homogeneously Enhancing Brain Tumors. Neuroradiol J 2008; 21:637-44. [PMID: 24257004 DOI: 10.1177/197140090802100505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 09/13/2008] [Indexed: 11/15/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL), glioblastoma multiforme (GBM) and metastases may be difficult to differentiate based on conventional imaging alone. The aim of this study was to investigate the value of perfusion weighted imaging (PWI) in differentiating homogeneously enhancing PCNSL from homogeneously enhancing GBM and metastases. Seven consecutive patients presenting with homogeneously enhancing intraaxial tumors on MRI were retrospectively analyzed. All seven patients (three immunocompetent patients with PCNSL, three with GBM, and one with cerebral metastases) were examined with identical MR-sequences including PWI. The relative regional Cerebral Blood Volume (rrCBV) and the rrCBV ratio (rrCBVratio) were calculated. In lymphomas rrCBVratio was 0.93 ± 0.42 (mean ± SD) compared with 7.93 ± 1.44 in GBM and metastases. All lymphomas had rrCBVratio < 1.43 while all GBM and metastases had rrCBVratio > 1.43 (Fischer exact test; p < 0.001). PWI may be a valuable method in differentiating homogenously enhancing PCNSL from GBM and metastases.
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Affiliation(s)
- K Abul-Kasim
- Department of Radiology, Section of Neuroradiology, University of Lund, Malmö University Hospital; Malmö, Sweden -
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