tbuckley/cabot-search huggingface dataset:
SAT0165 Real-world utilization of concomitant medications in patients initiating etanercept: a retrospective cohort study of canadian claims-level data
Authors: M Khraishi, Y Zhang, J Ivanovic, B Millson, M-J Brabant, E Singh, J Woolcott, H Jones
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Methotrexate (MTX) and prednisone (pred) are immune suppressants frequently used to treat immune-mediated inflammatory diseases (IMIDs). Etanercept is a soluble TNF receptor (humanized protein) indicated for the treatment of IMIDs, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis (PsO), and ankylosing spondylitis (AS). Limited information exists on how MTX or pred use changes in patients who initiate etanercept in real-world settings. <h3>Objectives</h3> To evaluate whether initiation of etanercept impacts use of co-therapy with MTX or pred in Canadian patients with IMIDs. <h3>Methods</h3> A retrospective cohort study was conducted using claims-level data from QuintilesIMS Private Drug Plan database, Ontario Public Drug Plan database, and Quebec Public Drug Plan database. Bio-naïve patients initiating etanercept between 07/2013 and 06/2015, were identified and their claims made for MTX or pred were analyzed. Patients9 utilization of MTX or pred was calculated as average weekly dose in mg, and then compared in the 6-months pre versus 12-months post initiation of etanercept using a paired t-test. Differences in the presence of concomitant medications pre and post-etanercept were also examined using a paired t-test. <h3>Results</h3> The study captured 3,745 etanercept patients (61% female, 77% aged between 18 and 65, 84% rheumatic diseases, and 15% PsO) across Canada in the selection period. Of selected patients, 33% used MTX (n=1,244) and 14% (n=523) used pred pre and post initiation of etanercept. In concomitant MTX patients, the average weekly dose dispensed was 25.2mg in the 6 months prior to initiation of etanercept, and 25.0mg in the 12 months following the first claim of etanercept (<i>p</i>=0.7493). In concomitant prednisone patients, the average weekly dose dispensed reduced from 123mg pre-etanercept to 108mg post-etanercept initiation (<i>p</i>=0.2316). 19% of patients stopped MTX (n=287) use post-etanercept initiation, compared to 36% who stopped pred use (n=289). <h3>Conclusions</h3> In this real-world setting, approximately 1/5 of patients stopped or reduced co-therapy of MTX; and 1/3 of patients stopped or reduced co-therapy of pred following initiation of etanercept; however, those patients who remained on co-therapy showed non-significant changes in their average consumption. Further research is needed to understand the impact on overall patient outcomes and safety. <h3>Disclosure of Interest</h3> M. Khraishi Consultant for: Pfizer Canada and Amgen Canada, Y. Zhang: None declared, J. Ivanovic: None declared, B. Millson: None declared, M.-J. Brabant: None declared, E. Singh: None declared, J. Woolcott: None declared, H. Jones: None declared
AB0819 Is increasing the trend of primary total hip arthroplasties for the patients with osteoarthritis, but decreasing the rate of women in super-aging area of japan in last twelve years?
Authors: Y Takakubo, K Sasaki, H Oki, Y Naganuma, A Narita, J Ito, H Kawaji, M Ishii, M Takagi
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Elderly people over 65 year-old have increased year by year in many countries<sup>1</sup>. Because their rate was from 19.5% at 2004 to 26.8% at 2015 in Japan and 30.8% at 2015 in our super-aging area, the numbers of total joint arthroplasties have increased too<sup>2</sup>. In fact, the numbers of total hip arthroplasty predicted increasing from six hundred fifty-six thousand cases at 2010 to one million three hundred seventy-six thousand cases at 2020 in USA<sup>3</sup>. The rate of total joint arthroplasty, including primary total hip arthroplasty, may reflect trends in management and health outcomes of elderly people with osteoarthritis (OA) in our super-aging area of Japan<sup>1,4</sup>. <h3>Objectives</h3> The aim of this study was to analyze the trend of primary total hip arthroplasties for the patients with OA in our institutes in the last twelve years. <h3>Methods</h3> We surveyed the number and rate of orthopaedic surgeries and primary total hip arthroplasties in our two institutes from 2004 to 2015. <h3>Results</h3> We had 19,862 cases of orthopaedic surgeries, including 3,782 primary total hip arthroplasties in the last twelve years. They have increased year by year (r=0.92, p&lt;0.05, Fig. 1). Mean age was 64.5 old-year (62.4–66.8) in last twelve years, had become older year by year (r=0.78, p&lt;0.05), 62.4 old-year at 2004 vs 66.8 old-year at 2015. Mean rate of female was 87% (85–91) in last twelve years, had gradually decreased year by year (r= -0.68, p&lt;0.05), 91% at 2004 vs 85% at 2015. <h3>Conclusions</h3> The rate of total joint arthroplasties including primary total hip arthroplasty increased year by year, and related to total numbers of orthopaedic surgeries in our super-aging area of Japan. Mean age at receiving primary total hip arthroplasty was older annually but mean rate of women had gradually decreased year by year. Although majority of OA hip consist of female which have secondary dysplastic acetabulum in our country<sup>2</sup>, it might increase gradually the patients of man with OA hip in super-aging time in Japan. <h3>References</h3> National Institute of Population and Social Security Research. Japanese Mortality Database, 2014. http://www.ipss.go.jp/. Jingushi S, et al. J Orthop Sci. 15:626–31, 2010. Kurtz SM, et al. J Bone Joint Surg Am. 96: 624–30, 2014. Yamagata prefecture, Health and longevity Promotion Section. Rate of elderly people in Yamagata prefecture, 2014. http://www.pref.yamagata.jp/ou/kikakushinko/020052/tokei/jinkel.html. <h3>Disclosure of Interest</h3> None declared
Circulating tumor DNA analysis using targeted sequencing of 508 clinically actionable genes in patients with high grade serous ovarian cancer.
Authors: Anniina Färkkilä, Liina Salminen, Kaisa Huhtinen, Sakari Hietanen, Seija Elisa Grenman, Rainer Lehtonen, Johanna Hynninen, Olli Carpen, Sampsa Hautaniemi
Journal: Journal of Clinical Oncology (2017)

5582 Background: The prediction of tumor chemoresponse and treatment toxicity is crucial for optimal patient care in high grade serous ovarian cancer (HGSC). We employed a targeted sequencing panel of 508 clinically annotated cancer genes to screen for actionable genetic variants in tumor tissue and ctDNA of patients with advanced HGSC. Methods: Tumor tissue, and serial plasma samples at diagnosis and during primary therapy were obtained from five patients with FIGO Stage IIIc HGSC. All patients were surgically debulked and received standard carboplatin and paclitaxel chemotherapy. DNA isolated from tumor tissue and plasma was analyzed for genetic alterations by targeted deep-sequencing of 508 previously annotated cancer genes. Somatic variants were systematically reported for alterations related to drug sensitivity and treatment toxicity, and analyzed with respect to clinical parameters and primary therapy outcomes. Results: In tumor tissues, and the corresponding pre-treatment ctDNA, oncogenic mutations were detected at a median of 13.0 and 1.6 allelic frequencies, respectively. The mutation frequency was higher, and also more unique mutations were detected in ctDNA of patients presenting with high tumor spread. Interestingly, a de-novo ctDNA MAPK1 mutation was detected in a sample taken during chemotherapy with partial response, while, no new mutations emerged in a patient with complete response. Analysis of the pretreatment plasma ctDNA revealed profiles of low and high drug sensitivities consistent with the clinical course of the patients. In two patients, increased risk profiles for treatment toxicities were identified via e.g. GSTP1. Consistently, these two patients were forced to discontinue standard therapy. Conclusions: Panel-based targeted sequencing of ctDNA identified potentially actionable mutations, and reflected tumor heterogeneity of HGSC. Further, the ctDNA gene panel annotations showed concordance with the chemoresponse- and treatment toxicity profiles, suggesting that ctDNA gene panel maybe a feasible approach to individualize treatment of HGSC patients.
AB1213-HPR A national rheumatoid arthritis registry supported by a public policy as a strategy for disease control and risk management in colombia
Authors: O Valencia, P Sánchez, L Acuña, L Soler, CE Toro
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic disease that implies high direct and indirect costs for the health system (1,2). According to the needs of the health care system, the clinical interests and the national regulatory framework, it was developed a national registry information of RA patients (3). <h3>Objectives</h3> To show how a registry of information that would meet the RA situation was developed and to present the results obtained from the analysis of the Registry on this first year. <h3>Methods</h3> A national RA Registry was created after a comprehensive literature review to identify the relevant variables to determine monitoring indicators used by health insurers and health services providers in the attention of patients with RA. Variables were selected and defined by an agreement with clinical experts, thematic and methodological experts and were evaluated by the Ministry of Health in order to review and approve the structure to gather the information. <h3>Results</h3> A structure of 89 variables contained was defined. All entities must report annually to the Registry all the patients with a diagnosis of RA, their clinical and demographic characteristics, and the process of care and costs (3). On its first year the Registry provided a baseline of the disease situation of 68.357 patients with RA. Prevalence, incidence, state of disease and drugs including synthetic and biologic DMARDs were analyzed (Table 1). Most important results were: mean age 57 years; relation women: men 5.2:1; age at onset of disease: 36 years, mean evolution time of disease: 7 years; population with DAS 28 measured 45.6%; mean DAS-28 2.8; percentage of the patient with DMARD therapy 78.9% and bDMARD 16.5%. <h3>Conclusions</h3> A national Registry supported by an official policy, with data from the real world provided for healthcare insurers gives an opportunity to obtain a global vision and to identify failures and strengths in the attention process of RA, and to develop indicators to obtain better outcomes. In the future, through continuous efforts towards improving the quality of care provided, these will allow to monitoring and decreasing the burden of RA in the country and may serve as a model to other countries. <h3>References</h3> Muñetόn GA, Quintana G. La epidemiología de la artritis reumatoide. Rev Colomb Reumatol. 2015 Sep [cited 2016 Jul 25];22(3):145–7. Available from: http://www.elsevier.es/es-revista-revista-colombiana-reumatologia-374-articulo-la-epidemiologia-artritis-reumatoide-S0121812315000845. Quintana G., Restrepo JP, Cáceres H, Rueda JD. Economic evaluation of the treatment of rheumatoid arthritis with anti-TNF biological therapy in Colombia. Acta Médica Colomb. 2011;36(1):24–9. Available from: http://www.scielo.org.co/pdf/amc/v36n1/v36n1a05.pdf. MSPS. Resolucion No. 1393. 2015. p. 14. <h3>Disclosure of Interest</h3> None declared
Human Plasma Metabolomics Study across All Stages of Age-Related Macular Degeneration Identifies Potential Lipid Biomarkers
Authors: Inês Laíns, Rachel S. Kelly, John B. Miller, Rufino Silva, Demetrios G. Vavvas, Ivana K. Kim, Joaquim N. Murta, Jessica Lasky-Su, Joan W. Miller, Deeba Husain
Journal: Ophthalmology (2017)
AB0295 The recall survey: data from a multicenter educational event on patients with ra
Authors: A Delle Sedie, E Filippucci, O Epis, P Macchioni, S Tropea, C Bonali, M Canzoni, A Iagnocco
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Ultrasound (US) is able to show subclinical synovitis in patients (pts) with rheumatoid arthritis (RA) who are in clinical remission (CR); this has been proposed as a predictive factor for both clinical flares and progression of the structural damage in CR pts. <h3>Objectives</h3> To investigate the US characteristics of RA pts presenting either CR or low disease activity (LDA). <h3>Methods</h3> In 2015 an educational event focused on the added value of US in RA pts was held in 22 rheumatology centers in Italy. After a brief presentation on the evidence of US added value for the clinician given by expert sonographers (rheumatologists with a special interest in US that were performing US as their usual activity for many years), in every center, the local rheumatologists provided RA pts to be examined by US. All the US machines were identical both for type (Logiq E R7, General Electrics, with a 4.2–13 MHz linear probe) and settings (both for grey-scale and power Doppler (PD)). Pts signed an informed consent and a brief history of them was collected by the local rheumatologists (previous and current therapy, DAS28, HAQ score). The US examination was performed bilaterally on wrists, MCP and MTP joints, looking for synovitis (effusion, synovial proliferation and PD signal) and bone erosions. The positive findings were scored according to a 0–3 score for synovitis components and presence/absence for erosions; the number and size of the largest erosion was also registered. <h3>Results</h3> Demographic and descriptive data of the 433 pts examined are reported in Table I. Pts were divided on the basis of the DAS28 result. Statistically significant differences in age and disease duration were registered between the group in CR and the group with DAS28≥3.2 (p=0,019 and p=0,012, respectively), while no differences were found for HAQ or MTX use. Higher positivity of findings, regardless which was the score, was present in LDA group for effusion, synovial proliferation and PD signal. Significant differences were seen between CR and LDA group for effusion (general, MCP and MTP joints; p=0,011, p=0,026, p=0,017 and p=0,013, respectively), PD positivity (general, wrist, MCP and MTP joints; p=0,006, p=0,023 and p=0,05, respectively) and erosions (p=0,002), with higher positivity for pts in LDA. <h3>Conclusions</h3> The US assessment in this large cohort of RA pts showed frequent positive findings both in the CR and in the LDA group, confirming the results from previous studies. US is a useful imaging tool for the detection of subclinical joint abnormalities in RA. <h3>Disclosure of Interest</h3> None declared
Initial symptom severity of bipolar I disorder and the efficacy of olanzapine: a meta-analysis of individual participant data from five placebo-controlled studies
Authors: Myrto T Samara, Yair Goldberg, Stephen Z Levine, Toshi A Furukawa, John R Geddes, Andrea Cipriani, John M Davis, Stefan Leucht
Journal: The Lancet Psychiatry (2017)
THU0199 Tofacitinib improves left ventricular mass and cardiac output in patients with rheumatoid arthritis
Authors: K Kume, K Amano, S Yamada, T Kanazawa, K Hatta
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatologists need to develop primary prevention strategies for cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients. We reported tofacitinib (Tofa) improved arterial stiffness in RA patients. RA is associated with an increased <i>left</i> ventricular mass index (LVMI), a strong marker of cardiovascular mortality.There is no evidence that Tofa effects on left ventricular (LV) morphology and function. <h3>Objectives</h3> To study the effect of Tofa plus methotrexate (MTX) on LV morphology and function in MTX resistant active RA patients, in a cohort study design. <h3>Methods</h3> RA patients were eligible if they had active disease despite treatment with MTX. All patients have no steroids, and no previous history of CVD. Consecutive 28 patients with moderate to severe active RA patients (DAS28&gt;3.2) despite MTX were received Tofa plus MTX. LV morphology and function was assessed with cardio-MRI at baseline and 24 weeks follow-up. Cardiovascular risk factors and clinical data were collected at regular visits. <h3>Results</h3> 24 patients completed 24 weeks. Left ventricular mass index (LVMI) was attenuated significantly by Tofa (week 0-week24, −12.4±5.4 g/m<sup>2</sup>; p=0.0002). Cardiac output (CO) was attenuated significantly by Tofa (week 0-week24,-0.87±1.2l/min). DAS28 and CRP improved significantly by Tofa (week 0-week24; DAS28: -2.26±0.91; CRP: 14.1±8.7 mg/l) (<i>p</i>&lt;0.05). Surprisingly, the change of disease activity (DAS 28 and CRP) is no correlation with the change of LVMI or CO in this study. Observationally, 4 cases significantly improved right ventricular mass as well as left ventricular mass (20% improved right ventricular mass index from baseline). <h3>Conclusions</h3> Tofa improved LVMI and CO in active RA despite MTX. TCZ improves LVMI and CO independently of its effects on disease activity. Tofa might be improved right ventricular mass. JAK-STAT pathway might be an important role of LV hypertrophy. Tofa, JAK-STAT pathway blocking, may prevent cardiovascular morbidity and mortality in RA. <h3>References</h3> Tocilizumab monotherapy reduces arterial stiffness as effectively as etanercept or adalimumab monotherapy in rheumatoid arthritis: an open-label randomized controlled trial. Kume K, et al.J Rheumatol. 2011 Oct;38(10):2169–71. doi: 10.3899/jrheum.110340. Epub 2011 Aug 1.PMID: 21807781. Etanercept normalises left ventricular mass in patients with rheumatoid arthritis. Claire Immediato Daïen et al. Annals of the rheumatic diseases. 2013 Jun; 72(6); 881–7. doi: 10.1136/annrheumdis-2012–201489. <h3>Acknowledgements</h3> Thanks for Noriko Kuwaba to calculate data. <h3>Disclosure of Interest</h3> None declared
FRI0772-HPR Formal rheumatology training for general practitioners
Authors: S Khan, A Mohammad, KP O'Rourke, C Sheeehy
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Formal post graduate training in rheumatology is limited for primary care physicians or general practitioners. General practitioners (GPs) have extraordinary wide knowledge base, and deal with all age groups, from minor ailments to serious illnesses, thus it9s not possible to expect them to have a strong hold of specialised conditions like inflammatory arthritis (IA) (2). General practitioners can be trained to manage these conditions in order to break the disconnect between the flow of knowledge and the burden of care in rheumatic conditions. <h3>Objectives</h3> The Rheumatology department in Midlands Regional Hospital and University Hospital Waterford facilitates GPs teaching in rheumatology outpatients clinics. Every year six GP trainees are trained by consultant rheumatologist. Each trainee receives one on one education in managing rheumatologic conditions including joints and soft tissue injections. This survey was done to evaluate whether GP trainees benefited from it in diagnosing and treating rheumatologic diseases when compared to non rheumatology trainees. <h3>Methods</h3> This is a cross sectional study of a convenience cohort. GP trainees who received rheumatology training as part of their hospital rotation were included as "cases", and compared to those who didn9t have any formal rheumatology exposure during their training g as "control". The cases attended supervised rheumatology outpatients for one year, and. A questionnaire was emailed as well as distributed to the GP trainees, it included questions on trainees9 ability and comfort level in diagnosing, assessing and managing inflammatory and non inflammatory conditions, along with joint and soft tissue injections. <h3>Results</h3> There were 60 participants in the study, 30 cases and controls each. Majority (94%) didn9t have formal rheumatology teaching in the medical school, but had rheumatology experience post graduation, 30 being GP trainee in rheumatology and 7 as senior house officers attached to rheumatology team. The GP trainees had an average of 7 months exposure to rheumatology. The GP trainees who attended the rheumatology clinics were confident in: examining joints, differentiating musculoskeletal/ mechanical from inflammatory conditions, educating patients and commencing them on DMARDs, interpreting serological tests (RF, CCP, ANA etc), managing osteoarthritis, tennis elbow, and soft tissue and intra-articular Knee and shoulder injections, as compared to the trainees who didn9t have any formal rheumatology training (P&lt;0.001). <h3>Conclusions</h3> Rheumatology teaching for the GP trainees is certainly beneficial, and helps them in managing rheumatologic conditions in primary care settings. <h3>Acknowledgements</h3> Dr Declan Brennan, General Practicioners Coordinator, Midlands, Tullamore. <h3>Disclosure of Interest</h3> None declared
THU0451 A method for counting calcium pyrophosphate crystals in the synovial fluid
Authors: P Montagna, R Brizzolara, S Soldano, M Cutolo, MA Cimmino
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Identification of calcium pyrophosphate dihydrate (CPP) crystals in the synovial fluid (SF) from inflamed joints provides a definitive diagnosis of CPP deposition disease (CPPD) (1). CPP crystals may also be found in non-inflamed joints, allowing diagnosis also during asymptomatic periods (2). SF analysis and CPP crystals count could be used to evaluate disease activity during follow-up. It is more difficult than the count of monosodium urate (MSU) crystals, already tested in a previous work (3), for CPP crystals show different shapes, are often very minute and non-birefringent. <h3>Objectives</h3> To study an objective method for counting CPP crystals in the SF. <h3>Methods</h3> The SFs aspirated from the knees of 15 consecutive patients (8 men) affected by CPPD diagnosed according to the EULAR definition were analysed. Cytological evaluation included SF leukocyte and differential count. For crystal detection, a small drop of fresh SF was placed on a glass slide and examined by compensated polarized microscopy (400x). To facilitate crystal count, the slide was divided into 4 equal parts drawing a cross with a pencil. The count was performed by continuous viewing and for each field both the number of birefringent and non-birefringent crystals was noted. Two observers evaluated separately 6 SFs and repeated the count after 24 hours. SFs were divided into 4 groups: SFs with &lt;50, from 50 to 400, from 401 to 1200, and &gt;1200 crystals. <h3>Results</h3> Mean time needed for the count was 60 minutes. Inter-reader agreement was 0.68 (0.47–0.88) for CPP crystals, 0.68 (0.50–0.85) for the birefringent ones and 0.60 (0.38–0.81) for the non-birefringent. Intra-reader agreement was 0.48 (0.17–0.78) for the first examiner and 0.30 (0.14–0.74) for the second. In 7 patient the SF was aspirated from an inflamed knee. Crystal number did not correlate with the presence of knee inflammation (r=0.41; p=0.19), the SF volume (r=0.14; p=0.61), the number of leukocytes (r=0.36; p=0.19), the % of PMN (r=0.25; p=0.37), and the presence of intracellular crystals (r=0.31, p=0.27). Actively inflamed joints had a higher SF volume [11 ml (10–20 ml) vs. 2 ml (1–10 ml), p=0.03] and a higher percentage of PMN [72% (0–94%) vs. 12% (0–68%), p=0.028]. SF with intracellular crystals showed also a higher percentage of PMN (57.1%±34.3% vs. 3%±6% p=0.006). <h3>Conclusions</h3> Our preliminary results indicate that CPP crystal count is less reliable and more time-consuming that that of MSU crystals. Non-birefringent crystals show lower inter-reader agreement than birefringent ones. <h3>References</h3> Pascual E. J Rheumatol 1996; 35:306–8. Martinez A. Arthritis Rheum 1995; 38:S 246. Montagna P. Reumatismo 2015; 67(1):29–32. <h3>Disclosure of Interest</h3> None declared