AB0844 SERUM sCD40L LEVEL CAN PREDICT SHORT-TERM CLINICAL OUTCOMES IN PATIENTS WITH PSORIATIC ARTHRITIS ON TREATMENT WITH APREMILAST

Background:

The pathogenesis of Psoriatic Arthritis (PsA) involves several pathways simultaneously, including the CD40/CD40L interaction. In vitro evidence suggests that the cleavage of soluble CD40L (sCD40L) may happen as a Phosphodiesterase 4- (PDE4) dependent reaction [1-3].

Objectives:

Here we investigate whether apremilast, a PDE4 inhibitor, could modify circulating level of soluble CD40L (sCD40L) in PsA patients, and the possible associations of these changes with clinical response.

Methods:

Consecutive patients with PsA starting apremilast in routine clinical practice between October 2018 and September 2019 in a single center were longitudinally observed. Sera were collected at baseline and at the 6-month follow up visit. Demographics and clinical characterstics at different observation times were recorded. Samples were ran in a Bio-Plex ProTM plate for sCD40L level. To investigate the association of sCD40L level with DAPSA minor response and DAPSA Low Disease Activity (LDA) and/or Remission (ie DAPSA ≤14) at 6 months of treatment, multivariate logistic regression models with backward selection (p <0.05) were built.

Results:

We studied n.27 patients (16/27 women, 59.6%) with PsA with mean age (± SD) of 58.4 ± 10.4 years. A significant reduction of the mean values of DAPSA, LEI and PASI was evidenced at 6 months. Mean serum level of sCD40L decreased from 5364.02 ± 2025.70 to 4412.14 ± 2629.81 pg/ml after 6 months of apremilast treatment (p=0.01, Figure 1). Baseline sCD40L was an independent predictor of DAPSA minor response (OR 1.0006, 95% CI 1.0001-1.0012; AUC 0.76 (95% CI 0.55-0.97)). Moreover baseline DAPSA (OR 0.80, 95% CI 0.65-0.98) and baseline sCD40L (OR 1.001, 95%CI 1.0001-1.0028; AUC 0.85 95% CI 0.69-0.98, Figure 2) were independently associated with DAPSA LDA/Remission.

Conclusion:

Apremilast may decrease sCD40L level in PsA patients. Higher baseline serum sCD40L level may predict short-term clinical response to apremilast.

References:

[1]Davidson DC, Jackson JW, Maggirwar SB. Targeting platelet-derived soluble CD40 ligand: a new treatment strategy for HIV-associated neuroinflammation? J Neuroinflammation 2013;10:144.

[2]Vanichakarn P, Blair P, Wu C, Freedman JE, Chakrabarti S. Neutrophil CD40 enhances platelet-mediated inflammation. Thromb Res 2008;122(3):346-58.

[3]Totani L, Amore C, Di Santo A, et al. Roflumilast inhibits leukocyte-platelet interactions and prevents the prothrombotic functions of polymorphonuclear leukocytes and monocytes. J Thromb Haemost 2016;14(1):191-204.

Disclosure of Interests:

Vincenzo Venerito: None declared, Dorotea Natuzzi: None declared, Rita Bizzoca: None declared, Nunzia Lacarpia: None declared, Marco Fornaro: None declared, maria giannotta: None declared, giulia righetti: None declared, Giuseppe Lopalco: None declared, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD

Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study

BACKGROUND AND AIMS

The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients.

METHODS

The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors.

RESULTS

A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01).

CONCLUSIONS

In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.

Intrathecal methotrexate affects cognitive function in children with medulloblastoma

BACKGROUND

Cognitive impairment occurs after malignant brain tumor treatment in children, following brain radiotherapy and systemic and intrathecal chemotherapy.

OBJECTIVES

1) To compare two groups of children who underwent surgery for cerebellar medulloblastoma with their cousins and siblings, assessing intelligence, executive function, attention, visual perception, and short-term memory. Both groups were treated with the same combined radiotherapy-chemotherapy, but differed in that only one group received intrathecal methotrexate (MTX+). 2) To relate these measures to MRI findings (leukomalacia).

RESULTS

The two groups performed worse than their control subjects in all tests. The MTX+ group younger than 10 years performed significantly worse in all tests, particularly executive ones. The group older than 10 years performed significantly worse only in short-term memory. Younger patients without MTX performed significantly worse than controls only in some neuropsychological measures; there were no differences between older patients and control subjects. Only in the MTX+ group was there a direct correlation between extent of leukomalacia and performance in some tests.

CONCLUSIONS

The administration of intrathecal methotrexate to children with medulloblastoma worsens the cognitive deficits induced by chemotherapy and radiotherapy. The use of intrathecal methotrexate in the treatment of medulloblastoma and other malignancies should be reassessed.