AB1250 TOFACITINIB IS A SAFE AND EFFECTIVE TREATMENT OPTION FOR JUVENILE IDIOPATHIC ARTHRITIS

Background

The management of juvenile idiopathic arthritis(JIA) is often constrained by the limited number of oral drugs available. Whether JAK inhibitors would add a much needed therapeutic armamentarium in this regard needs to be explored.

Objectives

To assess the safety and efficacy of tofacitinib in juvenile idiopathic arthritis (JIA) patient who were prescribed during the period January 2021 to December 2021.

Methods

It’s a retrospective study of JIA patients who were prescribed tofacitinib during the period Jan 21 to Dec 21 with minimum of 3 months’ follow-up after prescribing tofacitinib. The demographics,details of medications,investigations parameters and any adverse events were noted.

Results

There were a total of 35 patients who were given tofacitinib during this period. Male is to female ratio is 25:10, mean age of 12.91(4.81) yrs., the mean disease duration was 58.6 months. Enthesitis related arthritis(ERA) was the commonest seen in 12, followed by oligo articular in 10, polyarticular in 7 and systemic onset in 6. In the ERA group 10 were HLA B27 +VE, of the oligo articular 6 were ANA +VE, in the polyarticular one was RF +ve. Out of the 35,14 were already on biologicals (tocilizumab and anti TNFs). Tofacitinib was stopped in 8 patients during this period, 5 as they achieved remission, 2 with no response and one because of itching and abdominal pain. There were no documented infections. There was significant reduction in the inflammatory markers (ESR, CRP), leucocyte count and platelet count.

Before tofaAfter tofap valueMethotrexate in mg (week) mean(stdev)9.64(1.94)8.88(3.34)0.66Steroid in mg mean (stdev)3(2.35)2.8(1.8)0.91Leucocyte count mean(stdev)11242(1858)7884(1471)0.005Platelet count in lakhsMean(stdev)4.51(0.48)3.37(0.82)0.017ESR mm/1hr57.75(17.25)30.83(11.48)0.009CRP mg/L25.36(10.9)12.36(7.97)0.05

Conclusion

Tofacitinib seems to be a promising drug in the management of JIA with good safety profile and efficacy.

References

[1] Brunner HI, Schanberg LE, Kimura Y et al. New medications are needed for children with juvenile idiopathic arthritis. Arthritis Rheumatol. 2020; 72: 1945-1951.

Disclosure of Interests

None declared

AB0268 LOW DOSE TACROLIMUS IS AN EFFECTIVE ADD ON THERAPY FOR PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS – A SINGLE CENTRE EXPERIENCE

Background:

Rheumatoid arthritis (RA) a chronic inflammatory arthritis requiring tight control of disease activity. While traditional DMARDS have been used effectively, there always remains a need for add on drugs in good number of patients. Tacrolimus since its first approval in 2004 had been used widely as monotherapy and in combination with conventional and biological DMARDS. The primary concern was safety followed by the efficacy for patients with active disease.

Objectives:

The main objective was to ascertain the safety and tolerability of patients who were treated with tacrolimus as an add on therapy over and above the standard care in RA.

Methods:

A retrospective analysis of patients who were prescribed Tacrolimus from January 2019 to August 2020 was done. Details of patients along with the change in Blood pressure(BP), Serum creatinine, Blood sugar and Clinical disease activity index(CDAI) before and after tacrolimus were analyzed.

Results:

A total of 245 patients with active Rheumatoid arthritis received the drug. The mean age was 48.58(1.49) years and the disease duration was 5.9(0.56) years. Of 245 patients, 24 patients were lost to follow up,103 patients stopped the drug for various reasons and 118 patients are still continuing the drug. The mean tacrolimus dose was 1.24 + 0.46 mg in the patients who are continuing. The commonest reason for stopping the drug was adverse events (57%) followed by lack of efficacy(29%), low disease activity (8%)and others(7%). There was no significant change in the mean blood pressure, Blood sugars and Creatinine levels in both the stopped and continuing group. However the CDAI and the steroid dosages reduced significantly in the patients who are still on tacrolimus.The lost to follow up group had high disease activity at baseline and also were on higher doses of steroids.

PARAMETERSRA – CONTINUING(118)RA STOPPED(103)LOST TO FOLLOWUP(24)BEFORE TACAFTER TACp valueBEFORE TACAFTER TACP valueBEFORE TACSBP mm of hg100.44(9.54)101.06(9.80)0.67103(9.77)104(9.92)0.44127.35(10.05)DBP mm of hg66.30(6.26)67.22(6.37)0.3068.44(6.4)70.43(6.65)0.0782.83(5.05)SUGAR mg76.43(13.73)76.67(11.24)0.9571.86(10.79)76.74(14.1)0.0889.12(9.7)S.CR mg0.55(0.06)0.56(0.09)0.800.66(0.16)0.57(0.06)0.210.74(0.06)STEROID USE mg2.82(0.41)1.65(0.54)<0.0012.12(0.43)2.43(0.54)0.362.86(1.42)CDAI12.28(1.84)7.42(1.49)<0.00112.23(2.03)10.49(2.69)0.0716.62(3.88)

Conclusion:

Low dose Tacrolimus is an effective add on therapy for patients with high disease activity and did not lead to change in serum creatinine, blood pressure or change in blood sugars in the study subjects.

References:

[1]Yocum D et al. Safety of tacrolimus in patients with rheumatoid arthritis: long-term experience. Rheumatology 2004; 43:992–999.

[2]Shouma Dutta,Yasmeen Ahmad. The efficacy and safety of tacrolimus in rheumatoid arthritis.Therapeutic Advances in Musculoskeletal Disease Ther Adv Musculoskel Dis. 2011; 3(6) 283–291.

Disclosure of Interests:

None declared

Design of P-Doped Mesoporous Carbon Nitrides as High-Performance Anode Materials for Li-Ion Battery

Herein, we demonstrate a simple and unique strategy for the preparation of P-doped into the substructure of mesoporous carbon nitride materials (P-MCN-1) with ordered porous structures as a high-energy and high-power Li-ion battery (LIB) anode. The P-MCN-1 as an anode in LIB delivers a high reversible discharge capacity of 963 mAh g^-1 even after 1000 cycles at a current density of 1 A g^-1, which is much higher than that of other counterparts comprising s-triazine (C₃H₃N₃, g-C₃N₄), pristine MCN-1, and B-containing MCN-1 (B-MCN-1) subunits or carbon allotropes like CNT and graphene (rGO) materials. The P-MCN-1 electrode also exhibits exceptional rate capability even at high current densities of 5, 10, and 20 A g^-1 delivering 685, 539, and 274 mAh g^-1, respectively, after 2500 cycles. The high electrical conductivity and Li-ion diffusivity (D), estimated from electrochemical impedance spectra (EIS), very well support the extraordinary electrochemical performance of the P-MCN-1. Higher formation energy, lower bandgap value, and high Li-ion adsorption ability predicted by first principle calculations of P-MCN-1 are in good agreement with experimentally observed high lithium storage, stable cycle life, high power capability, and minimal irreversible capacity (IRC) loss. To the best of our knowledge, it is an entirely new material with the combination of ordered mesostructures with P codoping in carbon nitride substructure which offers superior performance for LIB, and hence we believe that this work will create new momentum for the design and development of clean energy storage devices.