tbuckley/cabot-search huggingface dataset:
AB0394 SERUM CALPROTECTIN AS A PREDICTIVE MARKER OF THERAPEUTIC RESPONSE TO ADALIMUMAB IN RHEUMATOID ARTHRITIS
Authors: Guillaume Servant, Christophe Passot, Eric Piver, Oscar Knight, Valerie Devauchelle-Pensec, Stéphanie Rist, Aleth Perdriger, Elisabeth Gervais, Emmanuelle Dernis, Benoit Le Goff, Laurence Picon, Philippe Goupille, Denis Mulleman
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Adalimumab significantly reduces the activity of rheumatoid arthritis (RA), but reliable biomarkers of inflammation are still lacking to predict and evaluate the therapeutic response. Serum calprotectin is a mainstay of endogenous activation of the inflammatory response that can be useful as a marker of response to treatment in RA. <h3>Objectives</h3> To compare the evolution over time of serum calprotectin and C-Reactive Protein (CRP) after initiation of adalimumab. <h3>Methods</h3> Serum levels of calprotectin, CRP and adalimumab concentration were measured at visits V1 (week 0), V2 (week 4), V3 (week 8), V4 (week 12) and V5 (week 26). Changes in each variable were analyzed at each visit and each variable was compared to each other using a correlation test. Receiving operating characteristic curves were used to estimate the predictive value of response at V5 for calprotectin and CRP at each visit. <h3>Results</h3> Data from 66 patients were analyzed. Serum calprotectin level decreased from V1 to V5 (3.76 µg/mL [0 – 17.47] to 2.74 µg/mL [0 – 18.83]; p &lt; 0.05). A positive correlation was observed between serum calprotectin and DAS28<sub>ESR</sub> (Spearman 0.244; p &lt; 0.01), and between CRP and DAS28<sub>ESR</sub> (Spearman 0.512; p &lt; 0.01) for all visits combined. In contrast to CRP, serum calprotectin and serum calprotectin variation from V1 at each visit, were not predictive of DAS28<sub>ESR</sub> at V5. <h3>Conclusion</h3> Serum calprotectin decreases after initiation of adalimumab in RA but was weakly correlated with disease activity at week 26. Serum calprotectin cannot be considered as superior to CRP as predictive marker of therapeutic response in RA after initiation of adalimumab. <h3>Disclosure of Interests</h3> Guillaume Servant: None declared, Christophe Passot: None declared, Eric Piver: None declared, Oscar Knight: None declared, Valerie Devauchelle-Pensec Grant/research support from: Roche-Chugai, Speakers bureau: MSD, BMS, UCB, Roche, Stéphanie Rist: None declared, Aleth Perdriger: None declared, Elisabeth Gervais Speakers bureau: Abbvie, BMS, MSD, Pfzer, Roche, UCB, Novartis, Emmanuelle Dernis: None declared, Benoit Le Goff Speakers bureau: Abbvie, BMS, Janssen, MSD, Pfzer, Sanofi-Genzyme, UCB, Novartis, Laurence Picon: None declared, Philippe Goupille Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Speakers bureau: Abbvie, Biogaran, BMS, Hospira, Janssen, MSD, Pfizer, Sanofi-Genzyme, UCB, Denis Mulleman Speakers bureau: Pfizer, Novartis, Grifols
FRI0159 REAL-WORLD EVIDENCE OF EFFECTIVENESS OF SWITCHING FROM TOFACITINIB 5MG BID TO TOFACITINIB 11MG QD IN A COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS: A SINGLE-CENTER, OBSERVATIONAL STUDY IN TAIWAN
Authors: Liang-Hung Lin, Der-Yuan Chen
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic autoimmune disorder, precipitating chronic inflammation of the joints, also affecting organs throughout the body. For chronic conditions, such as RA, a once-daily (QD) dosing option has the potential to optimize patient adherence, and may enhance patient convenience and ease of use. Real-world data on effectiveness of switching from tofacitinib 5mg BID to 11mg QD is scarce. <h3>Objectives</h3> This study aimed at evaluating the effectiveness and safety of RA patients switching from tofacitinib 5mg BID to tofacitinib 11mg QD in a real-world setting. <h3>Methods</h3> A retrospective chart review of patients with RA was performed at the rheumatology department of an integrated secondary teaching hospital in Taiwan. The following cohorts were defined: RA patients who switched from tofacitinib 5mg BID to tofacitnib 11mg QD between 1 July 2018 and October 2018, and the follow-up period was at least 3 months. The clinical demographics and laboratory variables were obtained from clinic records. <h3>Results</h3> As of December 2018, 71 patients were included (85% of women), with a mean (SD) age of 57.4 (12.7) years, 70.1% were biologic-experienced; 78.9% rheumatoid factor positive and 80.3% anti- citrullinated peptide antibody (ACPA) positive. At baseline (before patients initiated tofacitnib 5mg BID treatment), the mean DAS28-ESR was 5.0 (8.4% patients with low disease activity, and 2.8% in clinical remission), the mean CDAI was 23.0 (11.2% patients with low disease activity, and 0% in clinical remission). After an average duration of 20 months treatment on tofacitinib 5mg BID treatment, the mean DAS28-ESR was 3.3 (29.6% patients with low disease activity, and 2.8% in clinical remission), the mean CDAI was 7.5 (84.5% patients with low disease activity, and 2.8% in clinical remission). While switching to tofacitnib 11mg QD for 3 months, no significant difference was observed in terms of the ratio of DAS28-ESR LDA or CDAI LDA, but numerically more patients achieved DAS28-ESR LDA or CDAI LDA (32 and 64, respectively). During the 3-month follow-up period, no new adverse events were present. <h3>Conclusion</h3> Our study showed that RA patients switching from tofacitnib 5mg BID to tofacitnib 11mg QD sustained the effectiveness with no adverse clinical impact. <h3>References</h3> [1] Lamba M, Wang R, Fletcher T, et al. J Clin Pharmacol. 2016 Nov;56(11):1362-1371 [2] Kuo CF, Luo SF, See LC, et al. Rheumatol Int. 2013 Feb;33(2):355-60. <h3>Disclosure of Interests</h3> None declared
Doctor under stress from treating bomb victims will not face sanction for attacking wife
Authors: Clare Dyer
Journal: BMJ (2019)

A military doctor who roughly seized his GP wife and pushed her across the floor during an argument, leading her to call the police, will face no sanction from a medical practitioners tribunal despite a finding of serious misconduct and impaired fitness to practise.

David Roscoe, 41, who had been treating children injured in the May 2017 Manchester suicide bombing, had acted out of character while under exceptional stress, the tribunal found.

He was arrested by the police at his home, and the next day he pleaded guilty in a magistrates’ court to assault by beating. He received a conditional discharge for 18 months. Three days later he referred himself to the General Medical Council.

At his tribunal hearing in Manchester, counsel for the GMC …
Abstract 19901: Defining and Predicting the Burden and Risk of Cardiac Disease in Pregnancy in Kenya: A Retrospective Review of All Cases From 2011-2015
Authors: Rebecca H Lumsden, Felix A Barasa, Lawrence P Park, Christian B Ochieng, Joy M Alera, Astrid Christoffersen-Deb, Gerald S Bloomfield
Journal: Circulation (2017)

Introduction: Cardiac disease in pregnancy is associated with significant maternal and neonatal morbidity. Predicting the risk of adverse outcomes in pregnant women with cardiac disease in low-and-...
NHS to roll out specialist stroke centres across England
Authors: Gareth Iacobucci
Journal: BMJ (2019)

Specialist centralised stroke units are to be rolled out across England in a move that the NHS says will save thousands of lives.

Establishing specialist stroke units like those that already exist in London and Manchester will give patients faster access to diagnosis and treatment, NHS England said.

Announcing the plans at the NHS Confederation conference in Manchester on 20 June, Stephen Powis, NHS national medical director, cited a recently published study1 which found that 170 extra lives are saved a year in London and Manchester thanks to hyper acute stroke units.

Powis said: “In London and Manchester …
FRI0188 EARLY RENAL IMPROVEMENTS FOLLOWING RITUXIMAB IN LUPUS NEPHRITIS
Authors: Sophie Collinson, Ben Parker, Eoghan Mccarthy, Ian N. Bruce
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rituximab (RTX) is the monoclonal antibody of choice in patients with lupus nephritis (LN) who either fail to respond to, or cannot receive standard of care (SOC) therapy. Despite its continued use in clinical practice, published clinical trials regarding its use in LN management have failed to show any clear benefit. <h3>Objectives</h3> We aimed to analyse renal outcomes of LN patients in a large national register. <h3>Methods</h3> Patients with active LN on recruitment into the BILAG-Biologics Register (BILAG-BR) were included. Active LN was defined as a BILAG A or B score in the renal domain. Patients are eligible for RTX if they have failed either MMF or cyclophosphamide. We defined renal response at 6 and 12 months as a change in BILAG score from A to B/C/D or B to C/D. Non-renal disease activity was also described. <h3>Results</h3> Overall 259/897 patients in BILAG-BR had active LN at baseline. Of these, 230 received RTX and 29 received SOC. 109/159 (68.6%) RTX patients and 15/19 (78.9%) of SOC patients had a renal BILAG response at 6 months (p=0.792) (Table 1). In those with sufficient response data at 12 months, 31/98 (31.6%) and 7/15 (46.7%) (p=0.084) demonstrated continued renal response in the RTX and SOC groups respectively. Both groups made improvements or remained stable in all other renal domains (UPCR, eGFR, creatinine) at 6 and 12 months. Oral steroid doses decreased in both treatment groups. Of note, baseline steroid doses in the SOC group were higher than RTX patients (30mg (20-40) vs. 12.5mg (10-25), p&lt;0.001). Non-renal disease activity measures improved in both cohorts. <h3>Conclusion</h3> In a large UK-wide, real-world, observational LN cohort we have shown that RTX does improve renal outcomes at 6 and 12 months in refractory SLE patients. RTX is a valid treatment option for many patients with renal disease in SLE. <h3>Disclosure of Interests</h3> Sophie Collinson: None declared, Ben Parker Grant/research support from: GSK, Consultant for: AZ, UCB, GSK, Eoghan McCarthy: None declared, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GlaxoSmithKline, Consultant for: AstraZeneca, Eli Lilly, GlaxoSmithKline, ILTOO Pharma, MedImmune, Merck Serono, Speakers bureau: GlaxoSmithKline, UCB Pharma
AB1107 COMPLEMENTARY AND ALTERNATIVE MEDICINE USAGE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER
Authors: Seda Colak, Emre Tekgoz, Fatma İlknur Cinar, Sedat Yilmaz, Muhammet Çınar
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Familial Mediterranean Fever (FMF) is the most common hereditary, chronic autoinflammatory disease. Colchicine is the mainstay of the treatment, which reduces frequency of attacks and amyloidosis risk. Complementary and alternative medicine (CAM) therapies can be a non-mainstream treatment choice in chronic diseases. Frequency of use of CAM therapies among patients with FMF is not established yet. <h3>Objectives</h3> In the current study we aimed to identify the prevalence of the patients using CAM therapies and the factors associated with CAM usage among the patients with FMF. <h3>Methods</h3> One hundred and sixty-five patients were included in the study. Data regarding demographic, social and clinical characteristics were obtained from the patients. The patients were asked whether they were using any type of CAM and if they had suffered harm and/or benefit. The treatment adherence of the patients was assessed using by Morisky Green Levine Scale (MGLS). The Beliefs About Medicines Questionnaire (BMQ-T) was used to assess patient's beliefs about medicines. <h3>Results</h3> Fifty-six (33.9%) patients declared to use at least one CAM. The mean age of the patients was 34.1 ±12.7 years and the mean disease duration was 16.8±10.8 years. The mean dose of colchicine was 1.4±0.4 mg/day. Patients with concomitant disease and positive history of FMF in relatives had higher rates of using of CAM (p=0.011 and p=0.014 respectively). There was no statistically significance between age, sex, marital, socioeconomic and working status, difficulty of access to the treatment center, dose of colchicine, adverse events related to colchicine, attack frequency and disease severity of the patients and frequency of CAM using (p&gt;0.05). The most frequently chosen types of CAM modalities were massage therapy (12.1%), imagining (9.7%), relaxation techniques (9.1%), cupping (9.1%) and natural products (9.1%). It is found that 42 (75.0%) of patients reported that they have suffered benefit from CAM. The mean duration of the using of CAM was 7.9 ±6.4 years. According to the BMQ-T, there was higher rate of concern about colchicine among patients that were using CAM (p=0.035) (Table 1). There was no statistically significance between compliance with colchicine treatment and using of CAM (p=0.313). <h3>Conclusion</h3> Colchicine is the gold standard of treatment because of the known effect of colchicine treatment on the severity and frequency of FMF attacks and the risk of development of amyloidosis. Approximately one third of patients with FMF were using at least one of the CAM modalities in the current study. Concerns about colchicine treatment may have increased the tendency to use CAM therapies. On the other hand, patients should be informed that CAM therapies should not be an alternative to colchicine. <h3>Disclosure of Interests</h3> None declared
Real World Data on Decitabine Treatment in 296 Patients with Acute Myeloid Leukemia: Outcome and Impact of TP53 Mutations
Authors: Christoph Rollig, Jan Moritz Middeke, Sebastian Stasik, Armin Zebisch, Heinz Sill, Michael Kramer, Sebastian Scholl, Andreas Hochhaus, Edgar Jost, Tim H. Brümmendorf, Ralph Naumann, Björn Steffen, Hubert Serve, Heidi Altmann, Volker Kunzmann, Hermann Einsele, Stefani Barbara Parmentier, Markus Schaich, Andreas Burchert, Andreas Neubauer, Frank Heits, Wolfgang E. Berdel, Katja Sockel, Friedrich Stoelzel, Uwe Platzbecker, Gerhard Ehninger, Martin Bornhäuser, Johannes Schetelig, Christian Thiede
Journal: Blood (2017)
Comparison of Universal Versus Age-Restricted Screening of Colorectal Tumors for Lynch Syndrome Using Mismatch Repair Immunohistochemistry
Authors: Dan Li, Elizabeth Hoodfar, Sheng-Fang Jiang, Natalia Udaltsova, Nhung P. Pham, Yves Jodesty, Mary Anne Armstrong, Yun-Yi Hung, Robin J. Baker, Debbie Postlethwaite, Uri Ladabaum, Theodore R. Levin, Douglas A. Corley, JoAnn Bergoffen
Journal: Annals of Internal Medicine (2019)

Guidelines recommend screening all patients with newly diagnosed colorectal cancer (CRC) for Lynch syndrome (LS). However, the efficiency of universal LS screening in elderly populations has not been well studied.To compare the performance of age-restricted and universal LS screening using reflex mismatch repair (MMR) immunohistochemistry (IHC) of CRC tumors.Retrospective cohort study.A large, diverse, community-based health care system.3891 persons with newly diagnosed CRC who had LS screening between 2011 and 2016.Diagnostic yield of different LS screening strategies.Sixty-three LS cases (diagnostic yield, 1.62%) were identified by universal screening, with only 5 (7.9%) detected after age 70 years and 1 (1.6%) detected after age 80 years. When all patients with CRC who had universal screening were used as the denominator, 58 LS cases (diagnostic yield, 1.49% [95% CI, 1.13% to 1.92%]) were identified in patients with CRC diagnosed at or before age 70 years, 60 LS cases (diagnostic yield, 1.54% [CI, 1.18% to 1.98%]) were identified in those with CRC diagnosed at or before age 75 years, and 62 LS cases (diagnostic yield, 1.59% [CI, 1.22% to 2.04%]) were identified in those with CRC diagnosed at or before age 80 years. Using 75 years as the upper age limit for screening missed 3 of 63 (4.8%) LS cases but resulted in 1053 (27.1%) fewer cases requiring tumor MMR IHC. Using 80 years as the upper age limit missed 1 of 63 (1.6%) LS cases and resulted in 668 (17.2%) fewer cases requiring tumor MMR IHC.Persons who were eligible for but did not complete germline analysis were excluded from calculations of performance characteristics.The incremental diagnostic yield decreased substantially after age 70 to 75 years. Stopping reflex CRC screening for LS after age 80 years may be reasonable because of very low efficiency, particularly in resource-limited settings, but this merits further investigation. Studies evaluating the effect of diagnosing LS in elderly persons on their family members are needed.Kaiser Permanente Northern California Division of Research.
FRI0252 CLINICAL AND SEROLOGICAL LUPUS ACTIVITY BEFORE AND AFTER DEVELOPING END STAGE RENAL DISEASE
Authors: Maria Salgado Guerrero, Alejandra Londono Jimenez, Chrisanna Dobrowolsky, Shudan Wang, Anna R. Broder
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> SLE disease activity tends to diminish after the development of end stage renal disease (ESRD)<sup>1, 2</sup>. Nonetheless, some patients continue to show signs of active disease and experience flares after ESRD<sup>3</sup>. To date, little is known about the evolution of SLE-related symptoms pre and post ESRD. Whether specific symptoms abate after ESRD or a shift towards different manifestations occurs deserves further study. Prompt identification of subtler SLE manifestations is further complicated by a trend towards poor rheumatology follow once ESRD develops. SLE manifestations post-ESRD may be underdiagnosed and undertreated contributing to increased morbidity and mortality. <h3>Objectives:</h3> To study the different clinical manifestations and serological markers of SLE disease activity before and after ESRD development. <h3>Methods:</h3> We performed a retrospective chart review of SLE patients with ESRD at a tertiary care center between the years of 2010 and 2017. SLE was defined by ACR and/or SLICC criteria. SLE ESRD patients were included if they had at least one visit with rheumatology, nephrology, or primary care pre- and post-ESRD. SLE-related symptoms and serologic markers of disease activity were identified from chart review before and after ESRD onset. <h3>Results:</h3> Fifty-eight patients were included. Twenty-five patients had a least one clinical non-renal criteria documented pre-ESRD. Of them, 14 achieved complete clinical remission post-ESRD. Post-ESRD, cytopenias persisted in 49 of the 55 patients who were cytopenic pre-ESRD. Arthritis persisted in 3 of the 13 patients who had arthritis pre-ESRD. Of the 37 patients with hypocomplementemia pre-ESRD, 29 remained hypocomplementemic post-ESRD. Twenty-nine had elevated dsDNA pre-ESRD, of them, dsDNA remained elevated in 16 patients post-ESRD. Six patients developed at least one new clinical criteria post-ESRD. Three patients developed low complement, 5 developed elevated dsDNA, 3 developed new onset of serositis and 4 new osent of arthritis post-ESRD. <h3>Conclusion:</h3> Lupus activity may diminish after ESRD onset. However, many patients experience persistent disease activity. New arthritis, serositis, low complements and elevated dsDNA may develop after ESRD. Limited evaluation and documentation of disease activity by non-rheumatology providers may have resulted in under-reporting of SLE signs and symptoms on this study. SLE ESRD patients should be carefully evaluated for subtle signs of active SLE. <h3>References:</h3> [1] Mattos P, Santiago MB. Clin Rheumatol. 2012; 31:897–905. [2] Stone JH. Lupus. 1998; 7:654–659. [3] Krane NK, Burjak K, Archie M, O'Donovan R. Am J Kidney Dis. 1999; 33:872–879. <h3>Disclosure of Interests:</h3> None declared
A Phase 1/1b Dose-Escalation Trial Evaluating Cpi-818, an Oral Interleukin-2-Inducible T-Cell Kinase Inhibitor, in Subjects with Relapsed/Refractory T-Cell Lymphoma
Authors: Mehrdad Mobasher, Richard A. Miller, James W. Janc, Long Kwei, Joseph J. Buggy, Gabriel Luciano, Anahita Mohammady, Won Seog Kim, Youn H. Kim, Michael S. Khodadoust, Steven M. Horwitz, Dejan Radeski
Journal: Blood (2019)
SAT0476 JUVENILE IDIOPATHIC ARTHRITIS IN SINGAPORE: A 10-YEAR CLINICAL EXPERIENCE
Authors: Poh Lin Pauline Chan Ng, Pei Ling Ooi, Elizabeth Ang, Lee Kean Lim, Sook Fun Hoh, Lena Das, Yun Xin Book, Thaschawee Arkachaisri
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Juvenile Idiopathic Arthritis (JIA) is the commonest inflammatory arthritis of childhood worldwide. <h3>Objectives</h3> To describe the incidence, clinical characteristics and experience with JIA in Singapore over a 10-year period. <h3>Methods</h3> A prospective study was conducted in KK Women's &amp; Children's Hospital and National University Hospital, Singapore from Jan 2009-Dec 2018. JIA was defined and classified according to ILAR criteria<sup>1</sup>. Demographics and clinical information were collected for every patient diagnosed with JIA. <h3>Results</h3> 379 children were diagnosed with JIA (60.2% male, 71.2% Chinese). Average estimated incidence was 5.8 per 100000/yr. Clinical characteristics and treatment used are summarized in Table 1. Table 1. *Median (IQR). Rest expressed in n (%). Disease modifying anti-rheumatic drugs (DMARD) were used in 67.8%, and younger age of diagnosis (p=0.002), longer lag time (p=0.004), males (p=0.018) and ERA (p=0.043) predicted their use. 38.3% required biologics, and males (p=0.047), longer lag time (p=0.037) and HLA-B27 positivity (p=0.030) were associated with their use. Uveitis incidence was 2.9%; 54.5% had oligoarthritis, 36.4% ERA, 9.1% polyarthritis (RF-). Younger age at JIA diagnosis was associated with uveitis (p=0.030). <h3>Conclusion</h3> ERA is the commonest subtype of JIA in our cohort, explaining the male predominance and higher HLA-B27 positivity as compared to the West<sup>2</sup>. Longer lag time was associated with DMARD and biologic use, likely due to more severe disease at presentation. HLA-B27 association with biologic use may predict ineffectiveness of DMARD. Uveitis incidence was low as compared to Western literature that cites a prevalence of 11-30%<sup>3,4</sup>. Young age at diagnosis is a risk factor for uveitis. Interestingly, ANA-positivity and female gender were not associated with uveitis cases. <h3>References</h3> [1] Petty RE, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004Feb;31(2):390-2. [2] Żuber Z, et al. Prevalence of HLA-B27 antigen in patients with juvenile idiopathic arthritis. Reumatologia. 2015;53(3):125-30. [3] Angeles-Han ST, et al. Characteristics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis. Pediatr Rheumatol Online J. 2015;13(1):19. [4] Clarke SL, et al. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J. 2016;14:27. <h3>Disclosure of Interests</h3> Poh Lin Pauline Chan Ng: None declared, Pei Ling Ooi: None declared, Elizabeth Ang: None declared, Lee Kean Lim: None declared, Sook Fun Hoh: None declared, Lena Das: None declared, Yun Xin Book: None declared, Thaschawee Arkachaisri Speakers bureau: Abbvie Pte, Ltd