Association between SARS-CoV-2 Symptoms, Ct Values, and Serological Response in Vaccinated and Unvaccinated Healthcare Personnel

BACKGROUND

SARS-CoV-2 vaccines are effective at reducing symptomatic and asymptomatic COVID-19. Limited studies have compared symptoms, threshold cycle (Ct) values from reverse transcription (RT)-PCR testing, and serological testing results between previously vaccinated vs unvaccinated populations with SARS-CoV-2 infection.

METHODS

Healthcare personnel (HCP) with a positive SARS-CoV-2 RT-PCR test within the previous 14 to 28 days completed surveys including questions about demographics, medical conditions, social factors, and symptoms of COVID-19. Ct values were observed, and serological testing was performed for anti-nucleocapsid (anti-N) and anti-Spike (anti-S) antibodies at enrollment and 40 to 90 days later. Serological results were compared to HCP with no known SARS-CoV-2 infection and negative anti-N testing.

RESULTS

There were 104 unvaccinated/not fully vaccinated and 77 vaccinated HCP with 2 doses of an mRNA vaccine at time of infection. No differences in type or duration of symptoms were reported (P = 0.45). The median (interquartile range [IQR]) Ct was 21.4 (17.6-24.6) and 21.5 (18.1-24.6) for the unvaccinated and vaccinated HCP, respectively. Higher anti-N IgG was observed in unvaccinated HCP (5.08 S/CO, 3.08-6.92) than vaccinated (3.61 signal to cutoff ratio [S/CO], 2.16-5.05). Anti-S IgG was highest among vaccinated HCP with infection (34 285 aribitrary units [AU]/mL, 17 672-61 775), followed by vaccinated HCP with no prior infection (1452 AU/mL, 791-2943), then unvaccinated HCP with infection (829 AU/mL, 290-1555). Anti-S IgG decreased 1.56% (0.9%-1.79%) per day in unvaccinated and 0.38% (0.03%-0.94%) in vaccinated HCP.

CONCLUSIONS

Vaccinated HCP infected with SARS-CoV-2 reported comparable symptoms and had similar Ct values relative to unvaccinated. However, vaccinated HCP had increased and prolonged anti-S and decreased anti-N response relative to unvaccinated.

Uncharacterized and lineage-specific accessory genes within the Proteus mirabilis pan-genome landscape

Proteus mirabilis is a Gram-negative bacterium recognized for its unique swarming motility and urease activity. A previous proteomic report on four strains hypothesized that, unlike other Gram-negative bacteria, P. mirabilis may not exhibit significant intraspecies variation in gene content. However, there has not been a comprehensive analysis of large numbers of P. mirabilis genomes from various sources to support or refute this hypothesis. We performed comparative genomic analysis on 2,060 Proteus genomes. We sequenced the genomes of 893 isolates recovered from clinical specimens from three large US academic medical centers, combined with 1,006 genomes from NCBI Assembly and 161 genomes assembled from Illumina reads in the public domain. We used average nucleotide identity (ANI) to delineate species and subspecies, core genome phylogenetic analysis to identify clusters of highly related P. mirabilis genomes, and pan-genome annotation to identify genes of interest not present in the model P. mirabilis strain HI4320. Within our cohort, Proteus is composed of 10 named species and 5 uncharacterized genomospecies. P. mirabilis can be subdivided into three subspecies; subspecies 1 represented 96.7% (1,822/1,883) of all genomes. The P. mirabilis pan-genome includes 15,399 genes outside of HI4320, and 34.3% (5,282/15,399) of these genes have no putative assigned function. Subspecies 1 is composed of several highly related clonal groups. Prophages and gene clusters encoding putatively extracellular-facing proteins are associated with clonal groups. Uncharacterized genes not present in the model strain P. mirabilis HI4320 but with homology to known virulence-associated operons can be identified within the pan-genome. IMPORTANCE Gram-negative bacteria use a variety of extracellular facing factors to interact with eukaryotic hosts. Due to intraspecies genetic variability, these factors may not be present in the model strain for a given organism, potentially providing incomplete understanding of host-microbial interactions. In contrast to previous reports on P. mirabilis, but similar to other Gram-negative bacteria, P. mirabilis has a mosaic genome with a linkage between phylogenetic position and accessory genome content. P. mirabilis encodes a variety of genes that may impact host-microbe dynamics beyond what is represented in the model strain HI4320. The diverse, whole-genome characterized strain bank from this work can be used in conjunction with reverse genetic and infection models to better understand the impact of accessory genome content on bacterial physiology and pathogenesis of infection.

Evaluation of Variability in Interpretation of Disk Diffusion Testing for Cefiderocol Using Different Brands of Mueller-Hinton Agar

BACKGROUND

Cefiderocol is a new antibiotic used to treat infections with antibiotic resistant Gram-negative bacilli. The impact of differences between Mueller-Hinton agar (MHA) brands on susceptibility testing is underexplored. Compounding the implementation of cefiderocol susceptibility testing is a lack of harmonization between different regulatory body breakpoint criteria.

METHODS

We performed Kirby-Bauer disk diffusion using BD, Hardy, and Remel MHA, in addition to broth microdilution for Acinetobacter baumannii (n = 25), Enterobacterales (n = 25), Stenotrophomonas maltophilia (n = 24), and Pseudomonas aeruginosa (n = 23). We analyzed disk diffusion diameters and minimum inhibitory concentrations using interpretive criteria from the Clinical and Laboratory Standards Institute (CLSI), US Food and Drug Administration (FDA), and the European Committee on Antimicrobial Susceptibility Testing (EUCAST).

RESULTS

Breakpoint criteria impacted interpretation of susceptibly testing results, for example with the broth microdilution we found 8% (2/25) of A. baumannii isolates change interpretation between CLSI and EUCAST and 32% (8/25) change between CLSI and FDA, 12% (3/25) of Enterobacterales change between CLSI and EUCAST, 13% (3/23) of P. aeruginosa interpretations change between CLSI and FDA, and 4% (1/25) S. maltophilia change between CLSI and FDA. There was a significant difference between the zone disk diffusion diameters for P. aeruginosa and S. maltophilia between Hardy and BD; which changed interpretation (using CLSI criteria) for 8.7% (2/23) for P. aeruginosa but 0% (0/24) for S. maltophilia.

CONCLUSIONS

Breakpoint criteria impact cefiderocol susceptibility testing interpretation for broth microdilution and disk diffusion. Choice of MHA brand can also affect result interpretation.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

AB1436 INFECTIONS IN PATIENTS WITH RHEUMATIC DISEASES IN TREATMENT WITH BIOLOGIC THERAPY

Background

Patients with rheumatic diseases (RD) have a higher risk of developing infections due to disease and immunosupressor treatment factors1. Biologic disease -modifying antirheumatic drugs (bDMARD) have been associated with the development of opportunistic infections, nevertheless their impact on severe infections has not been consistent2.

Objectives

To describe the sociodemographic and clinical characteristics of patients with RD on bDMARD treatment with and without infections, using data from the Mexican Adverse Events Registry (BIOBADAMEX), as well as to identify factors associated with the presence of infections.

Methods

BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs. In this analysis we included all patients registered in Biobadamex from 2016 to 2021. We compared sociodemographic, clinical and treatment characteristics between patients who developed infections with to those who did not. We used descriptive statistics, Chi square and Kruskal Wallis tests to analyze differences between the groups.

Results

A total of 780 patients registered in Biobadamex were included in this study, among them 42 (5%) patients presented infections and 738 (95%) did not. At baseline, patients had a median (IQR) age of 50 (40-58) years and median disease duration of 7 (3-15) years. The most common diagnosis was rheumatoid arthritis with 512 (66%) patients, followed by ankylosing spondylitis in 115 (15%), psoriatic arthritis in 44 (6%), systemic lupus erythematosus in 30 (4%) and idiopathic juvenile arthritis in 27 (3%) patients. Comorbidities were present in 351 (45%) of the patients. Conventional DMARD (cDMARD) were used by 626 (80%) patients, and 290 (37%) used steroids. The most frequently used bDMARDs were adalimumab in 166 (21%) patients, certolizumab in 129 (16%), tocilizumab in 103 (13%) and abatacept 94 (12%).

Table 1 shows baseline characteristics in the groups with and without infections. Patients with infections presented more severe adverse events 3 (7%) compared to those who did not 11 (2%), p=0.007, with a complete recovery without sequels. Most common infection site was skin (21%) followed by superior airways (12%). Most common infectious agents were gram negative bacteria. Only 2 patients presented bacteremia.

Table 1.

Patients baseline characteristics

Infectionn=42Without infectionn=738pFemale, n(%)33 (79)595 (80)0.74Age, median(IQR)50.9 (43-59)49.8 (40-58)0.58Disease duration (years), median (RIC)7.5 (2-16)7.0 (3-15)0.9Diagnostic, n(%): Rheumatoid arthritis25 (59)487 (66)0.42 Idiopathic Juvenile Arthritis0 (0)27 (4) Ankylosing Spondylitis6 (14)109 (15) Others11 (26)115 (15)Comorbidities, n(%):22 (52)329 (44.6)0.32Previous bDMARD, n(%):15 (36)271 (37)0.89Use of steroids, n(%):16 (38)274 (37)0.9cDMARD, n(%)33 (79)593 (80)0.77Severe Adverse Events, n(%)3 (7)11 (2)0.007  Outcome, n(%)Recovered without sequels3 (100)6 (55)p=0.34*Not recovered03 (27)Unknown02 (18)Infection site, n(%)Skin9 (21)Superior airways5 (12)Urinary tract4 (10)Agent, n(%)Gram- bacteria9 (21)Gram+ bacteria0 (0)Virus4 (14)

*Chi2

Conclusion

The frequency of infections in patients using bDMARD in Biobadamex is low compared to the frequency reported in similar studies in other countries3. The presence of infections was associated with more severe adverse events in general, which recovered completely without sequels.

References

[1]Wallis D. Curr Opin Rheumatol. 2014;26(4):404-9.

[2]Singh JA et al. Lancet. 2015;386(9990):258-65.

[3]Pérez-Sola MJ, et al. Med Clin (Barc). 2011;137(12):533-40.

Disclosure of Interests

VIJAYA RIVERA TERAN: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos: None declared, Miguel A Saavedra: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Angel Castillo Ortiz: None declared, Omar Eloy Muñoz-Monroy: None declared, Sergio Duran Barragan: None declared, Azucena Ramos: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Alfonso Torres: None declared, Samara Mendieta: None declared, Daniel Xavier Xibille Friedmann: None declared, Francisco Guerrero: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Deshire Alpizar-Rodriguez Consultant of: Scientific advisor for GSK, unrelated to this study., Employee of: Scientific advisor for GSK, unrelated to this study.

POS1447 SOCIODEMOGRAPHIC, CLINICAL AND TREATMENT DIFFERENCES OF RHEUMATIC DISEASES IN THREE MEXICAN REGIONS

Background

Rheumatic diseases prevalence and characteristics in Mexico may vary depending on the country´s region1. To acknowledge these differences is needed to develop focused strategies for early diagnosis and treatment2.

Objectives

Identify the sociodemographic, clinical and treatment characteristics of the rheumatic diseases in the different regions in Mexico using data from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods

In this analysis we included all patients registered from 2016 to 2021. We described the prevalence in the northern region of Mexico (NR), central (CR) and southern region (SR). We compared sociodemographic, clinical and treatment characteristics between these three regions. We used descriptive statistics, Chi square and Kruskal Wallis tests to analyze differences between the groups.

Results

A total of 780 patients were included in this study, 248 patients (32%) were from the NR, 471 (60%) were from the CR and 61 (8%) from the SR. At baseline, patients had a median (IQR) age of 50 (40-58) years and median disease duration of 7 (3-15) years. NR patients had longer disease duration (9.7 years, p <0.001) and SR patients had higher BMI (29, p 0.001). Overall, 351 (45%) had comorbidities. In CR and SR more than the half of the patient had comorbidities, while in NR only 29% (p 0.001).

The most common diagnosis was rheumatoid arthritis with 512 (66%) patients, followed by ankylosing spondylitis in 115 (15%), psoriatic arthritis in 44 (6%), systemic lupus erythematosus in 30 (4%) and idiopathic juvenile arthritis in 27 (3%), this proportions were maintained when analyzed by regions. We found SR had higher DAS 28 and higher BASDAI (Table 1).

Table 1.

Baseline characteristics by region.

Northern regionn=248Central regionn=471Southern regionn=61pAge, median(IQR)49.7 (42-58)49.9 (38-58)51.6 (43-61)0.4Female, n(%)193 (78)383 (81)52 (85)0.33Body Mass Index, median (IQR)28 (25-32)26 (22-29)29 (26-32)0.001Disease duration (years), median (RIC)9.7 (5-16)5.9 (2-14)4.5 (1-10)0.001Diagnostic, n(%): Rheumatoid arthritis173 (70)300 (64)39 (64)0.001 Idiopathic Juvenile Arthritis3 (1)23 (5)1 (2) Ankylosing Spondylitis47 (19)59 (13)9 (15)Laboratory studies, n(%)Rheumatoid factor97 (39)274 (58)38 (62)0.001ACPA15 (6)68 (14)12 (19)0.001Disease activity scores, median (IQR) DAS284.8 (3-6)5.1 (4-6)5.2 (5-7)0.001 BASDAI2.8 (0-7)4.9 (2-7)8.0 (5-9)0.003Comorbidities, n(%)72 (29)247 (52)32 (52)0.001Previous bDMARD, n(%):136 (55)149 (32)1 (2)0.001Steroids, n(%):93 (38)155 (33)42 (69)0.001cDMARD, n(%)200 (81)373 (79)53 (87)0.4Cause of bDMARD discontinuation, n(%) aLack of efficacy85 (62)45 (33)2 (22)0.001Adverse Event4 (3)25 (18)3 (33)Pregnancy1 (1)3 (2)0(0)Loss of patient follow up10 (7)0 (0)2 (22)Remission23 (17)5 (4)0 (0)Others14 (10)59 (43)2(22)

a) 238 patients.

Glucocorticoids were used by 290 (37%) patients, SR had the highest use rate (69%, p <0.001) and 80% of the patients used conventional DMARDs (cDMARDs) with no differences between regions. Overall, the most used bDMARDs were adalimumab, certolizumab, tocilizumab and abatacept.

At the time of the analysis 238 (36%) had discontinued bDMARDs treatment, 132 (47%) due to lack of response, being this the most frequent cause reported overall, with the highest rate in NR (62%, p <0.001). All NR patients have social security compared to 83% in CR and 79% in SR.

Conclusion

There are regional differences between patients with rheumatic diseases registered in Biobadamex. It was remarkable that all patients form NR had social security, which may impact in the access to treatment. There were differences in the treatments between regions. The data from this analysis may be useful to policy makers, pharmaceutical companies and physicians. Differences in size samples between regions could have influenced in the results, further analyses will be performed in the future including more patients.

References

[1]Peláez-Ballestas I et al. J Rheumatol 2011;86;3-8.

[2]Chopra A et al. Best Pract Res Clin Rheumatol 2008;22:583-604.

Disclosure of Interests

VIJAYA RIVERA TERAN: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos: None declared, Miguel A Saavedra: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Angel Castillo Ortiz: None declared, Omar Eloy Muñoz-Monroy: None declared, Sergio Duran Barragan: None declared, Azucena Ramos: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Alfonso Torres: None declared, Samara Mendieta: None declared, Daniel Xavier Xibille Friedmann: None declared, Francisco Guerrero: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Deshire Alpizar-Rodriguez Consultant of: Scientific advisor for GSK, unrelated to this study., Employee of: Scientific advisor for GSK, unrelated to this study.

AB1461 IMPACT OF BASELINE DISEASE ACTIVITY ON DISCONTINUATION OF BIOLOGICAL DMARDS IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE MEXICAN ADVERSE EVENTS REGISTRY (BIOBADAMEX)

Background

Decrease treatment persistence in rheumatoid arthritis (RA) patients has been associated with several factors, including number of previous biological DMARDs (bDMARDs), female gender and higher disease activity or lower function at baseline [1].

Objectives

Determine if drug discontinuation of bDMARDs differs by disease activity level at baseline in patients with RA in the Mexican Adverse Events Registry (BIOBADAMEX).

Methods

BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs. In this analysis we included all patients with RA registered from 2016 to 2021 with at least two assessments. Survival on bDMARDs was estimated using Kaplan-Meier analysis. Predictors of discontinuation, including high disease activity defined as DAS28-ESR>5.1, were investigated by Cox regression analyses.

Results

Among 528 RA patients in the registry, 302 had at least two assessments. Of patients analyzed, 276 (91%) were women. At baseline, patients had a median (IQR) age of 52.7 (44-60) years old, median disease duration of 9.3 (4-16) months. A total of 142 (47%) had comorbidities, 34 (11%) had more than 2 morbidities. At baseline DAS28-ESR was 4.8 (4-6), 59 (20%) patients had low (DAS28-ESR<=3.2) and 130 (43%) had high disease activity. The most common bDMARDs received at baseline were abatacept 68 (23%), tocilizumab 59 (20%), adalimumab 50 (17%) and certolizumab 41 (14%). At the time of analysis, the median bDMARDs treatment duration was 17.2 (12-27) months. Overall, 130 (43%) patients had discontinued treatment, the most common causes of discontinuation were inefficacy in 64 patients, 15 for remission, 12 for adverse events and 26 for others. Figure 1 shows discontinuation rate curves in patients by disease activity. Cox proportional hazards demonstrated significant difference in bDMARD discontinuation between patients with baseline high disease activity (HR 1.3, 95% CI 1.1-1.7, p=0.03), but not differences were found regarding baseline age (HR 1.0, 95% CI 0.9-1.0, p=0.16), sex (HR 0.9, 95%CI 0.6-1.4), disease duration (HR 1.0, 95%CI 0.9-1.0, p=0.92), smoking (HR 1.2, 95% CI 0.7-2.1, p=0.44), number of comorbidities (HR 1.0, 95%CI 0.9-1.2, p=0.51) or other factors. The significant association of baseline high disease activity remained after adjusting by baseline age, sex, smoking, disease duration and number of comorbidities (HR 1.3, 95% CI 1.1-1.7, p=0.02).

Figure 1.

Discontinuation rate curves in RA patients with high disease activity (DAS28 >5.1) and DAS28<=5.1

Conclusion

In Mexican RA patients registered in BIOBADAMEX, we found that baseline high disease activity is associated with the discontinuation of bDMARDs. Further longitudinal analyses will be performed including more patients to assess retention rate of specific bDMARDs and identify predictive variables of discontinuation in Mexican population.

References

[1]Lauper K, Finckh A. Predictive factors of treatment persistence in rheumatoid arthritis. Joint Bone Spine. 2020 Dec;87(6):531-534.

Disclosure of Interests

VIJAYA RIVERA TERAN: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos: None declared, Miguel A Saavedra: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Angel Castillo Ortiz: None declared, Omar Eloy Muñoz-Monroy: None declared, Sergio Duran Barragan: None declared, Azucena Ramos: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Daniel Xavier Xibille Friedmann: None declared, Francisco Guerrero: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Deshire Alpizar-Rodriguez Consultant of: Scientific advisor for GSK, unrelated to this study., Employee of: Scientific advisor for GSK, unrelated to this study.

POS0642 THE IMPACT OF AGE ON DISCONTINUATION OF BIOLOGIC DMARDs IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is the most common autoimmune disease. Older patients treated with biologic DMARDs (bDMARDs) are at a significantly greater risk of adverse effects (AEs) [1]. However, the rate of drug discontinuation because of adverse effects caused by bDMARDs has not differed in elderly compared to younger patients in different registries.

Objectives:

Determine if drug discontinuation of bDMARDs differs by age in patients with rheumatoid arthritis in the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs since 2016. In this analysis we included all patients with diagnosis of RA with at least two assessments. Survival on bDMARDs was estimated using Kaplan-Meier analysis. Predictors of discontinuation, including age older than median age in the sample were investigated by Cox regression analyses.

Results:

Among 743 patients in the registry, 497 had RA diagnosis, from which, 214 had at least two assessments. At baseline, patients had a median (IQR) age of 53.4 (45-61) years old, median disease duration of 10.7 (6-17) months and median DAS28 of 4.7 (3-6). Conventional DMARDS were used by 185 (87%) patients and 94 (44%) patients used corticosteroids. Comorbidities were present in 194 (91%). The most common bDMARDs received at baseline were abatacept 59 (27%), tocilizumab 45(21%), adalimumab 31 (15%) and certolizumab 30 (14%). At the time of analysis, the median bDMARDs treatment duration was 21.0(13-34) months, 128 (59%) had discontinued treatment, 66 for inefficacy, 32 for adverse events and 30 for others. Fig 1 shows discontinuation rate curves in patients younger and older than median age. Cox proportional-hazards demonstrated no significant differences regarding age older than median age (HR 1.1, 95% CI 0.8-1.4, p=0.7), female sex (HR 1.2, 95% CI 0.7-1.9, p=0.44), use of corticosteroids (HR 1.2, 95% CI 0.9-1.6, p=0.20), comorbidities (HR 0.9, 95% 0.6-1.5, p=0.78), DAS28 (HR 0.9, 95% 0.9-1.1, p=0.93) or other factors.

Figure 1.

Discontinuation rate curves in patients younger and older than median age (< 53.4 and >=53.4 years old)

Conclusion:

This analysis did not show a role of age on discontinuation of bDMARDs in Mexican RA patients. Further longitudinal analyses will be performed including more patients to assess retention rate of bDMARDs and identify predictive variables of discontinuation in Mexican population.

References:

[1]Akter R, et al. Can Geriatr J. 2020 May 1;23(2):184-189.

[2]Ikari Y, et al. Medicine (Baltimore). 2020 Dec 24;99(52):e23861.

Disclosure of Interests:

None declared

THU0329 SAFETY, TARGET ENGAGEMENT, AND INITIAL EFFICACY OF AVID200, A FIRST-IN-CLASS POTENT AND ISOFORM-SELECTIVE INHIBITOR OF TGF-BETA 1 AND 3, IN PATIENTS WITH DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC): A PHASE 1 DOSE ESCALATION STUDY

Background:

AVID200 is a novel, potent TGF-beta receptor ectodomain-based trap designed to selectively neutralize TGF-beta 1 and 3. These two isoforms have been implicated as central mediators of the pathogenesis of systemic sclerosis (SSc). AVID200 avoids inhibition of TGF-beta 2, the isoform that supports normal cardiac function and hematopoiesis.

Objectives:

This first-in-human study (AVID200-01;NCT03831438) is a Phase 1, open label, multicenter, cohort dose-escalation trial designed to evaluate safety, tolerability, pharmacokinetic (PK) profile, pharmacodynamic (PD) effects, target engagement, and preliminary efficacy in patients with diffuse cutaneous SSc (dcSSc).

Methods:

Eligible patients must have dcSSc of <5 years (y) duration and a modified Rodnan Skin Score (MRSS) ≥15. AVID200 at dose levels of 1, 3, 9, or 15 mg/kg IV is administered every 2 weeks (Q2W) for 6 weeks (3 doses). Patients tolerating dosing and who have not experienced disease worsening during the initial Treatment Period may receive up to 6 additional doses Q2W (Extension Period). The ability of AVID200 to selectively sequester its target is assessed in plasma by TGF-beta quantification per ELISA and a cell-based functional readout. Expression of biomarkers of TGF-beta inhibition and genes correlating with MRSS are assessed.

Results:

The first 2 dose cohorts have completed treatment: male/female 3 each, median age 61y (range 45-70), median MRSS at baseline 31 (range 23-39). Recruitment into cohort 3 is complete. AVID200 was well tolerated with no dose limiting toxicities or serious adverse events (SAEs). AEs, all considered possibly related, included single cases of Grade 1 dizziness and CPK elevation, and Grade 2 anemia. All patients demonstrated a decline in MRSS at 6 weeks by 3, 4, and 9 points in Cohort 1, and 2, 8, and 9 points in Cohort 2. Four of 6 patients demonstrated continued decrease in MRSS 12 weeks after the last dose, with all patients showing a decline in MRSS relative to baseline at this timepoint by 7, 6, and 7 points in Cohort 1 and 4, 8, and 13 points in Cohort 2. AVID200 in plasma engaged endogenous activated TGF-beta and potently neutralized signaling from exogenous TGF-beta 1 and 3, but not TGF-beta 2, across the treatment period. PD effects in skin biopsies, including expression of markers of SSc activity, TGF-beta activity, and myofibroblast-associated genes were assessed. Five of 6 patients showed decreased expression of PD biomarker genes, THBS1 and MS4A4A, comparing end of treatment biopsies to baseline, and all patients showed a decline in SERPINE1 expression, a marker gene for TGF-beta activity. Clustering of RNA-seq expression data showed close coregulation of COMP, THBS1, SERPINE1, LOXL, COL10A1, COL11A1, COL12A1, CTGF, and CDH11, suggesting that blocking TGF-beta inhibits this group of profibrotic genes. Single-cell sequencing data show that expression of these genes is upregulated by subsets of SSc fibroblasts.

Conclusion:

AVID200 at doses of 1 and 3 mg/kg was well-tolerated in this first study in dcSSc patients. Evidence of anti-fibrotic effects as indicated by rapid, persistent and clinically meaningful declines in MRSS was observed in all patients, as well as AVID200 target engagement and modulation. Recruitment into additional dose and extension cohorts is ongoing. Together, these clinical data support selective TGF-beta 1 and 3 inhibition by AVID200 as a promising therapeutic approach for dcSSc.

Disclosure of Interests:

Robert Lafyatis Grant/research support from: Forbius, Consultant of: Certa Therapeutics, Forbius, FBM Therapeutics, Robert Spiera Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Forbius, Sanofi, Inflarx, Consultant of: Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Forbius, Mistubishi Tanabe, Robyn Domsic Consultant of: Forbius, Anna Papazoglou: None declared, Colin Ligon Grant/research support from: Forbius, Christina Mae Zinger Morse: None declared, Jean-François Denis Employee of: Forbius, Margaret Davis Employee of: Forbius, Tina Gruosso Employee of: Forbius, Gilles Tremblay Employee of: Forbius, Maureen O’Connor McCourt Employee of: Forbius, Sandra Sinclair Employee of: Forbius, Jonathan Delara Employee of: Forbius, Krista Alvarado Employee of: Forbius, Debra Wood Consultant of: Forbius, Symphogen, Paul Nadler Consultant of: Forbius, Symphogen, Karyopharm, Elizabeth Volkmann Grant/research support from: Forbius, Corbus Pharmaceuticals, Consultant of: Boehringer Ingelheim, Forbius, Speakers bureau: Boehringer Ingelheim

FRI0546 GENDER DIFFERENCES OF RHEUMATIC DISEASES IN MEXICAN POPULATION: DATA FROM THE MEXICAN BIOLOGICS REGISTRY

Background:

Most autoimmune diseases are more prevalent in women. Symptom severity, disease progression, response to therapy and overall survival differ between males and females with rheumatic diseases.

Objectives:

To identify the characteristics of autoimmune diseases presentation and treatment between male and female population using information from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican ongoing cohort that collects the information of patients using biologic and biosimilar drugs since 2016. For this study we included all patients enrolled in the registry and compared baseline clinical and disease characteristics, treatment and presence of adverse events between genders. We used logistic regression to analyze univariable associations.

Results:

A total of 655 participants were analysed, of which 82% were female (Table 1). We found women were older with a median of 53 years compared to 46 years in men (OR 1.02, CI 1.0-1.1). Smoking was higher in men (16%) compared to women (5%), (OR 0.3, CI 0.2-0.6). Women had longer disease duration, 9 years compared to 7 years in men (OR 1, CI 1.0-1.1). Rheumatoid arthritis (RA) was more prevalent in women (OR 2.7, CI 1-6.9), while ankylosing spondylitis (AS) and psoriatic arthritis (PsA) were more prevalent in men (OR 0.2, CI 0.1-0.4, and OR 0.3, CI 0.1-0.9 respectively). Women had more comorbidities than men (OR 1.8, CI 1.1-2.8) and used steroids more frequently (OR 1.7, CI 1.1-2.7). Differences in disease activity were not found, however we noticed high activity scores among participants.

Table 1.

Baseline characteristics in the cohort by sex

Womenn=532 (82%)Menn=123 (18%)UnivariableaOR(95%CI)Age, median (IQR)53 (44-60)47 (34-55)1.02 (1.0-1.1)*Body Mass Index, median (IQR)27 (23-31)26 (23-30)1.0 (0.9-1.1)Smoking, n(%)28 (5)18 (16)0.3 (0.2- 0.6)*Disease duration, median (IQR)9 (4-16)7 (2-13)1.0 (1.0-1.1)*Diagnosis, n(%): RA414 (78)37 (30)2.4 (1.0-5.7)* AIJ12 (2)5 (4)0.5 (0.1-1.9) AS37 (7)56 (46)0.1 (0.1-0.4)* PsA19 (4)15 (12)0.3 (0.1-0.8)* SLE17 (3)3 (2)1.2 (0.3-5.2) Others33 (6)7 (6)1Disease Activity indexes, median (IQR) DAS28a4.9 (3.6-5.9)4.9 (3.0-5.9)1.1 (0.9-1.3) BASDAIb4.8 (2.9-8)5.3 (2.8-7.5)0.9 (0.8- 1.1) ASDASc3.2 (1.9-4.5)3.9 (2.5-4.7)0.8 (0.6-1.2) SLEDAId14.5 (5.0-19.5)25 (25.0-31.0)0.6 (0.4-1.1)High blood pressure, n(%)77 (15)14 (12)1.3 (0.7-2.4)Diabetes mellitus, n(%)46 (9)7 (6)1.5 (0.7-3.5)High cholesterol, n(%)41 (8)8 (7)1.2 (0.4-2.6)Other comorbidities, n(%):173 (33)26 (21)1.8 (1.1 -2.8)*Use of previous biologic, n(%):216 (40)44 (36)1.2 (0.8- 1.8)Use of steroids, n(%):215 (42)34 (29)1.7 (1.1 -2.7)*Use of DMARD, n(%):418 (79)89 (72)1.4 (0.9-2.2)Adverse eventsb, n(%):69 (13)14 (11)1.2 (0.7-2.1) Severeb, n(%):12 (17)3 (21)0.8 (0.2-3.1)

Univariable logistic regression analysis. *p<0.05.an=469,bn=99,cn=71,dn=19,

Table 1.

Analysis of association between change (Δ) in FMD and relevant parameters by univariate and multivariate linear regression analysis.

UnivariateRho (p)MultivariateBeta (p)Δ FMD (%)(r2=0.30)ChangeADMA (µmol/l)-0.63 (<0.001)-0.25 (0.01)MDA (nmol/ml)-0.58 (<0.001)-0.18 (0.02)SOD (U/ml)0.48 (<0.001)NSGSH (U/ml)0.02 (0.75)NSHOMA-0.21 (0.001)NSeGFR (ml/min/ 1.73 m2)-0.03 (0.62)NShsCRP (mg/l)-0.45 (<0.001)NSPTX3 (ng/ml)-0.49 (<0.001)-0.21 (0.01)SBP (mmHg)-0.26 (<0.001)NSDBP (mmHg)-0.11 (0.12)NSHemoglobin (g/dl)0.07 (0.32)NSTotal Cholesterol (mg/dl)-0.05 (0.49)NSTriglyceride (mg/dl)-0.11 (0.12)NSLDL (mg/dl)-0.12 (0.07)NSHDL (mg/dl)0.02 (0.82)NSHbA1c (%)-0.26 (<0.001)NSFigure 1.

Scatter-plot graphs between FMD and ADMA, MDA, CuZn-SOD, PTX-3.

Conclusion:

In our study we found sex differences regarding age and disease duration, being higher in women. As expected, the prevalence of RA was higher in women and AS and PsA in men. Overall, women used more steroids than men. An interesting finding was that patients had high disease activity. Future longitudinal analyses will allow us to analyse sex differences in disease progression and treatment response.

References:

[1] Ortona E et al. Ann Ist Super Sanita 2016;52(2):205-12

[2] Ngo ST et al. Front Neuroendocrinol 2014;3(3):347-69

Disclosure of Interests:

Vijaya Rivera Teran: None declared, Deshire Alpizar-Rodriguez: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos Consultant of: Bristol-Myers Squibb, Janssen, Pfizer Inc, Roche and UCB, Dafhne Miranda: None declared, David Vega-Morales: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, angel castillo: None declared, Sergio Duran Barragan: None declared, Omar Muñoz: None declared, Aleni Paz: None declared, Angélica Peña: None declared, Alfonso Torres: None declared, Daniel Xavier Xibille Friedmann Consultant of: Lilly, Abbvie, Speakers bureau: Lilly, Abbvie, Azucena Ramos: None declared, José Francisco Moctezuma: None declared, Francisco Aceves: None declared, Estefania Torres: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Erick Zamora: None declared, Francisco Guerrero: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Cesar Francisco Pacheco Tena: None declared

Experiencing nursing governance: developing a post merger nursing committee structure

In a mid-sized city in south-central Ontario, two hospitals with four physical sites underwent a merger to form one large corporation; this merger was in response to the recommendations of a provincial restructuring commission. Health care delivery within the large corporation was reorganized using a program management structure. An outcome of program management within this corporation was the dissolution of the traditional nursing departments. In recognition of the need for a professional voice, the corporation created a new governance structure, which included the Professional Advisory Committee. Twenty-five disciplines are represented within this committee; each of these disciplines created its own professional committee. Nursing, then, was responsible for developing the Nursing Practice Committee (NPC). The following article describes the process by which front line nursing staff developed the NPC. A nursing structure task force was struck to accomplish this purpose; the task force is described, including membership, mandate, activities, principles and goals. The environmental assessment that was conducted by the task force is described, along with the process by which the NPC structure was designed and implemented. Challenges and successes experienced are presented. Rosabeth Kanter's framework for staff empowerment is used to understand how nursing governance was transformed in the development of the NPC.