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AB1318-HPR VAGUS NERVE STIMULATION IN PATIENTS WITH RHEUMATOID ARTHRITIS: 48 MONTH SAFETY AND EFFICACY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a disease with significant remaining unmet medical needs for better treatments. Vagus nerve stimulation (VNS) to activate the inflammatory reflex (cholinergic anti-inflammatory pathway) represents a novel experimental therapy for RA.1Previously, we reported that inflammatory reflex activation by VNS reduced pro-inflammatory cytokine production and improved disease activity in a 17-patient rheumatoid arthritis (RA) proof-of-concept study using a reprogrammed epilepsy stimulator2; clinical improvement was sustained for 24 months without untoward safety signals.3Here we report the 48 months results from this long-term observational study.Objectives:Determine the long-term safety and efficacy of VNS for the treatment of RAMethods:In the primary study, a VNS device was implanted into 17 RA patients, mostly with insufficient response to multiple conventional and biologic DMARDs, on stable background of methotrexate (≤25 mg weekly) therapy2. The device electrically stimulated the vagus nerve, 1-4 min/day, over a 12-week open label period. On completion, subjects were offered to enroll into a follow-up study, where the study physicians were given flexibility to alter VNS dosing parameters and/or to add a biologic disease-modifying antirheumatic drug (DMARD) to the treatment regimen to induce disease remission. Clinical disease activity measures and safety were accessed over 4 years.Results:All patients electively continued VNS treatment in the long-term follow-up study, 4 subjects withdrew prior to month 48. Reasons for discontinuation were withdrawal of consent (N=3) and adverse event due to device discomfort (N=1). At the start of the follow-up study, the mean DAS28-CRP, CDAI and HAQ-DI were significantly reduced compared to the pre-implant baseline (mean difference± SD: DAS28-CRP=-1.60± 1.13, p<0.001; CDAI=-21.19± 13.5, p<0.001; HAQ-DI=-0.44± 0.49, p<0.01), and this effect was retained through 48 months. Patients using VNS monotherapy and those using a combination of VNS with biologic DMARDs exhibited stable improvements in DAS28-CRP, CDAI and HAQ-DI at month 48 (Table 1). Improvements were observed for patients who both previously had an insufficient response to targeted biological therapies as well those who had an insufficient response to standard DMARDs. No association was seen between DAS28-CRP and stimulation frequency (Range= 1X-8X/day). There was no difference in the adverse events profile between the two groups.Table 1.Efficacy of VNS treatment.Treatment ReinitiatedN=9VNS MonotherapyN=8TotalN=17Mo. 24Mo. 36Mo.48Mo. 24Mo. 36Mo. 48Mo. 24Mo. 36Mo. 48Mean change from baseline (SD)DAS28-CRP-2.58 (1.0)***-2.40 (1.0)**-2.28 (1.3)**-2.61 (1.3)*-1.77 (1.8)-2.0(1.7)-2.59 (1.1)***-2.19(1.2)**-2.17(1.4)**CDAI-24.06 (8.3)***-18.02 (13.3) *-16.2 (19.6)-33.5 (11.1)***-27.8 (16.0)*-27.9 (12.7)*-28.20 (10.5)***-21.93 (14.5)*-20.83(17.5)*HAQ-DI-.60 (0.64)*-.63(0.45)*-.31(0.60)-.89 (0.69)*-.88 (0.92)-.88(0.61)-0.73(0.66)***-0.73(0.64)**-0.54(0.64)**P<0.05, **P<0.01, ***P<0.001 versus primary study baseline (month -3.5)Conclusion:VNS was safe, well-tolerated, and resulted in significant and clinically important improvements in disease activity measures that were maintained over 48 months. These results support development of VNS devices as a new therapeutic option for RA treatment.References:[1]van Maanen MA, et al.Nat Rev Rheum2009[2]Koopman FA, et al.PNAS2016[3]Koopman FA, et al.Arthritis Rheum2018Disclosure of Interests:Frieda Koopman: None declared, Anne Musters: None declared, Marieke Backer: None declared, Danielle Gerlag Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, Sanda Miljko: None declared, Simeon Grazio Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi, Stada, Berlin-Chemie, Sekib Sokolovic: None declared, Yaakov Levine Shareholder of: SetPoint Medical, Employee of: SetPoint Medical, Emmett Glass Employee of: SetPoint Medical, David Chernoff Shareholder of: SetPoint Medical, Adamas Pharmaceuticals, Olly Nutrition, NAIA Pharma, Aquinox Pharma, Consultant of: Adamas Pharmaceuticals, Olly Nutrition, NAIA Pharma, Aquinox Pharma, Crescendo Bioscience, Employee of: SetPoint Medical, Niek de Vries Grant/research support from: AbbVie, Janssen, Ergomed Clinical Research, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Roche, Consultant of: MSD, Pfizer, Paul P. Tak Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline
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Antimicrobial activity of a novel aminoglycoside, ACHN-490, against Acinetobacter baumannii and Pseudomonas aeruginosa from New York City. J Antimicrob Chemother 2010; 66:332-4. [DOI: 10.1093/jac/dkq459] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Activity of a novel aminoglycoside, ACHN-490, against clinical isolates of Escherichia coli and Klebsiella pneumoniae from New York City. J Antimicrob Chemother 2010; 65:2123-7. [DOI: 10.1093/jac/dkq278] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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SU-GG-T-211: MapCHECK Patient Specific QA Cannot Suffice for MLC QA. Med Phys 2008. [DOI: 10.1118/1.2961963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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CMR 2007: 6.02: Targeted ultrasound contrast imaging of tumor vasculature markers. CONTRAST MEDIA & MOLECULAR IMAGING 2007. [DOI: 10.1002/cmmi.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Static and 29Si CP MAS spectra (spinning rates of 2000 and 500 Hz) of six silyl silicate cages are analyzed by deconvolution and simulation. The principal values of the various 29Si chemical shift tensors provide information about the point symmetry of the Si sites. The intensities of the signals correspond sufficiently well with the stoichiometries.
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Thrombopoietin stimulates megakaryocytopoiesis, myelopoiesis, and expansion of CD34+ progenitor cells from single CD34+Thy-1+Lin- primitive progenitor cells. Blood 1996; 88:1619-31. [PMID: 8781417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Thrombopoietin (TPO) or MpI ligand is known to stimulate megakaryocyte (MK) proliferation and differentiation. To identify the earliest human hematopoietic cells on which TPO acts, we cultured single CD34+Thy-1+Lin- adult bone marrow cells in the presence of TPO alone, with TPO and interleukin-3 (IL-3), or with TPO and c-kit ligand (KL) in the presence of a murine stromal cell line (Sys1). Two distinct growth morphologies were observed: expansion of up to 200 blast cells with subsequent differentiation to large refractile CD41b+ MKs within 3 weeks or expansion to 200-10,000 blast cells, up to 25% of which expressed CD34. The latter blast cell expansions occurred over a 3- to 6-week period without obvious MK differentiation. Morphological staining, analysis of surface marker expression, and colony formation analysis revealed that these populations consisted predominantly of cells committed to the myelomonocytic lineage. The addition of IL-3 to TPO-containing cultures increased the extent of proliferation of single cells, whereas addition of KL increased the percentage of CD34+ cells among the expanding cell populations. Production of multiple colony-forming unit-MK from single CD34+Thy-1+Lin- cells in the presence of TPO was also demonstrated. In limiting dilution assays of CD34+Lin- cells, TPO was found to increase the size and frequency of cobblestone areas at 4 weeks in stromal cultures in the presence of leukemia inhibitory factor and IL-6. In stroma-free cultures, TPO activated a quiescent CD34+Lin-Rhodamine 123lo subset of primitive hematopoietic progenitor cells into cycle, without loss of CD34 expression. These data demonstrate that TPO acts directly on and supports division of cells more primitive than those committed to the MK lineage.
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Piroxicam spares buprenorphine after total joint replacement. Controlled study of pain treatment in 81 patients. ACTA ORTHOPAEDICA SCANDINAVICA 1992; 63:658-60. [PMID: 1471517 DOI: 10.1080/17453679209169730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a blinded, placebo-controlled study, the nonsteroidal antiinflammatory drug piroxicam, in combination with the partial morphine agonist/antagonist buprenorphine, was compared with buprenorphine alone for analgesic effect and side-effects in a 10-day period following total replacement of the hip or knee. 117 patients entered and 81 completed the study. The patients receiving piroxicam consumed less buprenorphine. There were no differences concerning side-effects between the two treatment groups, apart from a tendency towards less nausea after the third postoperative day in the group receiving piroxicam.
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Passive ankle mobility. Clinical measurement compared with radiography. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 1989; 71:696-8. [PMID: 2768325 DOI: 10.1302/0301-620x.71b4.2768325] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We compared goniometric assessment of passive ankle movement with radiographic measurements in 100 normal ankles. Significant differences were recorded in both dorsiflexion and plantarflexion; clinical measurements overestimated the range of movement. For scientific documentation of tibiotalar mobility, radiographic measurements should be used.
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