OP0158-HPR TELEMEDICINE CONSULTATIONS IN POLYMYALGIA RHEUMATICA PATIENTS. A TWO YEARS’ EXPERIENCE REPORT

Background:Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease of people over 50 years in Scandinavian countries and people of northern European descent, characterized by proximal pain, stiffness, raised inflammatory markers and prompt response to steroids(1). Relapse free during tapering off prednisone, are common in approximately 50% of patients. Studies reported that up to 70% of PMR patients are successfully tapered of prednisone due to remission, within 1-2 years from treatment initiation (1). Telemedicine has found a wider application in a number of chronic diseases resulting in a decreased number of hospital visits; however, no telemedicine studies on PMR patients have been performed before (2).Objectives:To evaluate the use of telemedicine consultation in newly diagnosed PMR patients.Methods:Telemedicine consultations managed by rheumatic nurses for newly diagnosed PMR patients was established in 2017 at our department. Patients diagnosed with PMR by a rheumatologist received written information concerning the nature of the disease, a “follow-up” schedule and a prednisone treatment/tapering plan. Telephone consultations (TC) including relevant blood analysis was planned after 4, 16, 52 and 78 weeks from the time of diagnosis. TC was managed by 4 nurses specialized in rheumatic diseases, who received appropriate education of PMR prior to the establishment. A predefined questionnaire was used for every telephone consultation.All PMR patients were initially treated with 15 mg of prednisone daily, with slowly tapering to 5 mg daily at week 16 and reduced to zero at week 48. In the case of relapse symptoms, patients were instructed to contact the treating nurses. In that case, relevant biomarkers were taken and a rheumatologist evaluated the need for a physical consultation and potential treatment adjustment.Only patients with minimum disease duration of 3 months were included in the study.Results:In a period of two years, 76 patients were evaluated. The mean age was 73 years and the mean follow up period was 10, 67 ± standard deviation (SD) 5,2 months. At the time of diagnosis, all patients fulfilled the 2012 Classifications criteria for PMR (3). The Mean number of TC was 4.27(± SD 2, 3).In 45 cases (60%) no additional physical consultation was necessary. In patients examined physically due to relapse suspicion, the most common findings were PMR relapses (66%), followed by non-inflammatory muscle and joint pain (18,5%), arthritis (14%), while one patient was diagnosed with giant cell arteritis.Successfully prednisone tapering was achieved in 23 cases (30%) while 27 patients (35,5%) at the time of data evaluation were treated with only 2,5 mg of prednisone daily. The mean current daily prednisolone dosage was 3.95 mg (± SD 3.25) while disease-modifying-anti-rheumatic-drugs had been initiated in 6 patients.Conclusion:Telemedicine consultations in PMR diminish the need for physical consultations in this patient cohort. More than half of all patients were either out of- or received only a very low dose of prednisone at the time of evaluation of data.References:[1]Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet. 2013 Jan 5;381(9860):63-72. doi: 10.1016/S0140-6736(12)60680-1.[2]Matteo Piga et al. Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda. Semin Arthritis Rheum. 2017 Aug;47(1):121-128. doi: 10.1016/j.semarthrit.2017.03.014. Epub 2017 Mar 22.[3]Dasgupta B, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012; 64: 943-54.Disclosure of Interests:None declared

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P205 The contemporary presentation and management of giant cell arteritis with large vessel vasculitis

Rheumatology ◽

10.1093/rheumatology/keab247.200 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Owen Cronin ◽

Neil D McKay ◽

Hannah Preston ◽

Helen Harris ◽

Barbara Hauser

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Polymyalgia Rheumatica ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Ct Angiogram ◽

Pet Ct ◽

The Mean ◽

Vessel Involvement

Abstract Background/Aims Giant cell arteritis with large vessel vasculitis (LV-GCA) represents a distinct, less researched sub-category of giant cell arteritis (GCA). In comparison to cranial GCA, the patient’s diagnostic pathway is less well described and it is thought that LV-GCA is underdiagnosed, including in patients with polymyalgia rheumatica and cranial-GCA. Advances in imaging (e.g. PET-CT) and treatment (tocilizumab), have provided additional options in the diagnosis and management of LV-GCA. The aim was to describe the contemporary clinical journey for patients diagnosed with LV-GCA. Methods The electronic patient health record system in NHS Lothian (TrakCare) was used to collect relevant data. Patients with imaging-confirmed large vessel vasculitis, diagnosed with GCA after 1 January 2017 were included. Follow-up was until August 2020. Results Eighteen patients with LV-GCA were included. The mean age was 65 years and 66.7% were female. Two patients had known cranial-GCA but 89% of patients were diagnosed exclusively with large vessel involvement. The most common symptoms were malaise (55%), weight loss (55%), polymyalgia rheumatica (55%) and limb claudication (44%). Pyrexia of unknown origin was a feature in only 17% of patients. Two patients were asymptomatic and were investigated on the basis of raised inflammatory markers. Mean CRP at baseline was 99mg/L and ESR 85mm/hour. The mean time from symptom-onset to diagnosis was 6.8 months (range 1 to 15 months). Sixteen patients (89%) were reviewed by at least one other secondary care specialist. One third of patients were referred from General Medicine followed by Vascular Surgery (16%) and General Practice (16%). 7/18 patients were inpatients at the time of referral. 56% of patients required two modalities of imaging to confirm large vessel involvement. The most commonly used imaging techniques (in descending order) were CT-Chest/Abdomen/Pelvis, CT-angiogram, PET-CT and Vascular Ultrasound. 50% of patients underwent follow-up imaging, most commonly MR- or CT-angiography. Mean follow-up was for 1.6 years. The mean prednisolone dose at 3 months (n = 18) was 24mg daily and 8mg at 12 months (n = 12). 28% of patients relapsed during the follow-up period at 4, 5, 8, 9 and 24 months post-diagnosis. 7/18 patients were commenced on methotrexate for steroid-side effects or for relapse. 8/18 received subcutaneous tocilizumab in combination with methotrexate in two cases. Three patients were started on azathioprine but only one continued. Conclusion In modern-day clinical practice, patients with LV-GCA experience a longer time to diagnosis than those with cranial symptoms. Patients with LV-GCA can experience an array of constitutional symptoms. Frequently, more than one imaging modality is required to confirm LV-GCA and the majority of patients will have seen other hospital specialists or have been admitted to hospital before diagnosis. Methotrexate and tocilizumab are the most frequently-used and effective steroid-adjunct in this single-centre cohort. Disclosure O. Cronin: None. N.D. McKay: Consultancies; Gilead. Other; Has received support for conference attendance from Pfizer and Gilead, Has received educational support from UCB, Gilead, Celgene, Biogen, Sanofi, Abbvie, Novartis, Pfizer. H. Preston: None. H. Harris: None. B. Hauser: None.

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Incidence of Tuberculosis in Inflammatory Rheumatic Diseases: Results from a Lithuanian Retrospective Cohort Study

Medicina ◽

10.3390/medicina56080392 ◽

2020 ◽

Vol 56 (8) ◽

pp. 392

Author(s):

Dalia Miltinienė ◽

Giedrė Deresevičienė ◽

Birutė Nakčerienė ◽

Valerija Edita Davidavičienė ◽

Edvardas Danila ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Incidence Rate ◽

Rheumatic Diseases ◽

Retrospective Cohort ◽

Significant Risk ◽

Inflammatory Rheumatic Diseases ◽

The Mean ◽

Rheumatic Patients

Background and objective: With an increase in survival rates among rheumatic patients, comorbidities and infections, in particular, have gained more importance, especially after the introduction of biologicals to the treatment algorithms. Tuberculosis (TB) infection has always been given a special attention in patients with rheumatic diseases (RD). Although Lithuanian population has one of the highest TB incidence rates among European countries, the incidence of TB in the rheumatic patients’ population is still unknown. The aim of this study was to assess the incidence rate of TB in an inflammatory RD retrospective cohort and to compare that rate with a rate in a general population. Material and Methods: Patients with the first-time diagnosis of inflammatory RD during the period between 1 January 2012 and 31 December 2017 were identified from the Lithuanian Compulsory Health Insurance Information System database SVEIDRA. All cases were cross-checked with Health Information center at the Institute of Hygiene, for the vital status of these patients and date of death if the fact of death was documented, and with Tuberculosis Register operated by Vilnius University Hospital Santaros Klinikos, for the confirmation of TB cases. Sex and age standardized incidence ratios (SIR) were calculated by dividing the observed numbers of TB among rheumatic patients by the expected number of cases, calculated using national rates from Lithuanian Department of Statistics Official Statistics website. Results: Overall, 8779 patients with newly diagnosed RD were identified during the 2013–2017 period, these included 458 patients who used biological disease modifying drugs (bDMARDs). The mean duration of the follow-up period was 2.71 years. The cohort consisted mainly of women (70%) and a half of the cohort were rheumatoid arthritis (RA) patients (53%). Mean age of patients at the time of RD diagnosis was 56 years (range = 18–97 years). There were 9 TB cases identified during 23,800 person years of follow-up: 2 cases among them were treated with bDMARDs. The mean calculated annual TB incidence in RD cohort was 37.81 per 100,000 person years, which is consistent with the incidence rate predicted by national estimates, with a resultant SIR of 0.90 (0.41–1.70). The unadjusted hazard ratio for bDMARD use versus no bDMARD use was 4.54 (0.94; 21.87) in a total cohort and very similar in rheumatoid arthritis cohort; in both cohorts, it was not a statistically significant risk. Conclusions: Here, we present the first nationwide cohort study to assess the incidence of TB in a broad spectrum of inflammatory RD. Although limited by short follow-up period, this study shows that TB incidence in RD cohort does not exceed TB incidence in the general Lithuanian population.

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The efficacy of low dose short-term prednisone therapy for remission induction in newly diagnosed rheumatoid arthritis patients

Advances in Rheumatology ◽

10.1186/s42358-021-00205-4 ◽

2021 ◽

Vol 61 (1) ◽

Author(s):

John M. Stacy ◽

Jacob R. Greenmyer ◽

James R. Beal ◽

Abe E. Sahmoun ◽

Erdal Diri

Keyword(s):

Rheumatoid Arthritis ◽

Disease Severity ◽

Low Dose ◽

Response Criteria ◽

Newly Diagnosed ◽

Short Term ◽

Eular Response ◽

The Mean ◽

Dose Prednisone

Abstract Background The ACR/EULAR recommendations endorse the use of glucocorticoids (GCs) for rheumatoid arthritis (RA) patients’ flares and as a bridge to a DMARD. However, the recommendation of low dose short-term monotherapy with (GCs) remains open to the discretion of the clinician. The aim of this study was to assess whether a short-term use of low dose prednisone monotherapy was effective in inducing remission in newly diagnosed RA patients. Methods A retrospective analysis of patients newly diagnosed with RA at a Community Health Center in North Dakota was performed based on the ACR/EULAR RA classification criteria. Demographic and clinical data were abstracted from patients’ medical charts. Patients treated with (< 10 mg/day) of prednisone up to 6 months were included. Response to prednisone was analyzed according to pre- and post-treatment DAS28-ESR score and EULAR response criteria. Results Data on 201 patients were analyzed. The mean prednisone dose was 8 mg/day (range: 5–10; SD = 1.2) and the mean treatment duration was 42.2 days (12–177; 16.9). Disease severity significantly improved from baseline to follow-up for: tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P < 0.001), swollen joint count (6.2 ± 5.0 vs. 1.4 ± 3.0; P < 0.001), and visual analog pain score (4.8 ± 2.6 vs. 2.1 ± 2.5; P < 0.001). DAS28-ESR disease severity significantly improved from baseline to follow-up: (5.1 ± 1.2 vs. 2.7 ± 1.3; P < 0.001). Per EULAR response criteria, 69.7% of patients showed good response to treatment and 20.4% showed moderate response. 54.2% of patients reached remission. Conclusion Short-term use of low dose prednisone monotherapy induced disease remission and improved clinical severity of RA in the majority of newly diagnosed patients.

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Efficacy and Safety of Timolol-Dorzolamide Fixed-Combination Three Times a Day Versus Two Times a Day in Newly Diagnosed Open Angle Glaucoma

10.20944/preprints201804.0310.v1 ◽

2018 ◽

Author(s):

Mohammad Pakravan ◽

Afsaneh Naderi Beni ◽

Shahin Yazdani ◽

Hamed Esfandiari

Keyword(s):

Blood Pressure ◽

Primary Open Angle Glaucoma ◽

Fixed Combination ◽

Open Angle Glaucoma ◽

Case Series ◽

Open Angle ◽

Newly Diagnosed ◽

Efficacy And Safety ◽

The Mean

Purpose: To compare the therapeutic efficacy and safety of dorzolamide/timolol fixed-combination in newly diagnosed primary open angle glaucoma patients. Methods: In this prospective, interventional case series, newly diagnosed primary open angle glaucoma (POAG) patients that had not been treated for glaucoma were included. Patients were started on Cosopt twice a day (BID) for 1 month and then switched to three times a day (TDS) for additional 1 month. Patients underwent comprehensive ophthalmic examination, diurnal intraocular pressure (IOP), blood pressure (BP) and 24-hours heart rate (HR) measurements at baseline, month 1( BID), and month 2( TDS). IOP, systolic and diastolic pressures were measured at 8:00 AM,12:00 AM, 4:00 PM, 8:00 PM and 12:00 PM. Throughout the study, all adverse events were recorded and monitored by the investigators. Results: In 31 POAG patients that completed the study ,mean baseline IOP was 23.1±3.15 mmHg . IOP was decreased significantly 16.5 ± 2.21 at 1 month (P < 0.0001) and 13.9 ± 2.23 mmHg at 1 and 2 month follow up. (P < 0.0001) IOP was significantly lower in month 2 compared to month 1 (P = 0.0004). While Cosopt BID significantly reduced the mean 24-hour systolic BP and mean 24-hour HR from baseline (P < 0.0001), the mean 24-hour systolic BP and HR remained unchanged 2ith Cosopt TDS compared to BID (P = 0.62). Conclusions: Cosopt TDS has a superior IOP-lowering effect than Cosopt BID in POAG patients with comparable safety profile.                 

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The association of pain and stiffness with fatigue in incident polymyalgia rheumatica: baseline results from the polymyalgia rheumatica cohort study

Primary Health Care Research & Development ◽

10.1017/s1463423619000082 ◽

2019 ◽

Vol 20 ◽

Author(s):

J.A. Prior ◽

S. Muller ◽

T. Helliwell ◽

S.L. Hider ◽

K. Barraclough ◽

...

Keyword(s):

General Practice ◽

Cohort Study ◽

Polymyalgia Rheumatica ◽

Symptom Severity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Newly Diagnosed ◽

Fatigue Score ◽

Numerical Rating ◽

The Mean

AbstractWe aimed to examine the association between pain, stiffness and fatigue in newly diagnosed polymyalgia rheumatica (PMR) patients using baseline data from a prospective cohort study. Fatigue is a known, but often ignored symptom of PMR. Newly diagnosed PMR patients were recruited from general practice and mailed a baseline questionnaire. This included a numerical rating scale for pain and stiffness severity, manikins identifying locations of pain and stiffness and the FACIT-Fatigue questionnaire. A total of 652 PMR patients responded (88.5%). The mean age of responders was 72.6 years (SD 9.0) and the majority were female (62.0%). Manikin data demonstrated that bilateral shoulder and hip pain and stiffness were common. The mean fatigue score (FACIT) was 33.9 (SD 12.4). Adjusted regression analysis demonstrated that a higher number of pain sites (23–44 sites) and higher pain and stiffness severity were associated with greater levels of fatigue. In newly diagnosed PMR patients, fatigue was associated with PMR symptom severity.

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Disease-Management of Low- and Intermediate-1 Risk Myelodysplastic Syndromes: Report on 800 Newly Diagnosed MDS Patients From the European LeukemiaNet MDS Registry

Blood ◽

10.1182/blood.v116.21.2917.2917 ◽

2010 ◽

Vol 116 (21) ◽

pp. 2917-2917 ◽

Cited By ~ 4

Author(s):

Louise de Swart ◽

Alex Smith ◽

Pierre Fenaux ◽

Argyris Symeonidis ◽

Eva Hellström-Lindberg ◽

...

Keyword(s):

Overall Survival ◽

Disease Management ◽

Serum Ferritin ◽

Research Funding ◽

Iron Chelation ◽

Progression Free Survival ◽

Newly Diagnosed ◽

Free Survival ◽

The Mean

Abstract Abstract 2917 Background: The European LeukemiaNet MDS (EUMDS) registry is designed to collect information about the demographics and disease-management of newly diagnosed low-risk and intermediate-1 risk MDS patients. From April 2008 until July 2010, 828 patients have been registered in eleven participating countries through a web-based reporting system. Objectives: This report describes the disease-management of the first 800 registered patients, including transfusion-related issues like secondary iron overload and its treatment. Results: 159 of 800 patients (20%) started MDS specific treatment within three months before registration; this percentage increased to 50% at 18 months of follow-up. Most patients received erythroid-stimulating agents (ESA), like erythropoietin (Table 1). In patients with a clinical indication for ESA, the percentage of transfusion-independency was similar to the transfusion-independent group without indication for ESA at 18 months of follow-up (Table 1). Overall, 27% of the patients received blood transfusions at registration. This percentage remained stable during follow-up, probably due to the therapeutic effect of ESA (Table 1). The number of units transfused, per 6 months, in these patients increased from 5 to 13 units at 18 months of follow-up, with a mean pre-transfusion Hb level of 7.6 g/dL. The serum ferritin levels of the transfusion-dependent patients at registration were available in 159 patients. The serum ferritin level at registration was ≥2000 μg/L in 4% of the patients who received a mean number of 10 units (SD 7). This increased to 28% of the patients who received a mean number of 20 units (SD 11) at 18 months of follow-up. The percentage of patients on iron chelation therapy increased from 1% to 9% during follow-up (Table 1). In these patients the mean serum ferritin levels remained stable: 1913 μg/L (SD 1183) at registration and 1626 μg/L (SD 1232) at 18 months of follow-up. In contrast, transfusion-dependent patients not treated with iron chelation or ESA had increasing ferritin levels, with a mean ferritin of 630 μg/L (SD 597) at registration and 1586 μg/L (SD 1017) at 18 months of follow-up. 37 patients (5%) progressed to high-risk MDS or acute myeloblastic leukemia at a median of 155 days from registration. 62 patients (8%) have died within a median of 269 days from registration, 32 deaths were MDS related. The overall survival was 93% at 18 months of follow-up, with a progression-free survival of 90%. Differences in overall survival between transfusion-independent and transfusion-dependent patients were significant: 97% versus 85%, respectively (p<0.0001; Table 2). In the multivariate analysis transfusion-dependency, ferritin levels and IPSS score predicted survival (Table 2). The IPSS score had a significant prognostic impact on overall survival and progression-free survival in contrast to the WHO classification (Data not shown). Conclusions: Despite a high transfusion load the mean serum ferritin levels remained stable during treatment with iron chelation. Transfusion-dependent patients had a worse overall survival and progression-free survival with higher ferritin levels and higher IPSS score as compared to transfusion-independent patients. This report demonstrates the importance of detailed disease-management in low- and intermediate-1 risk MDS patients. Disclosures: Fenaux: Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Janssen Cilag: Honoraria, Research Funding; ROCHE: Honoraria, Research Funding; AMGEN: Honoraria, Research Funding; GSK: Honoraria, Research Funding; Merck: Honoraria, Research Funding; Cephalon: Honoraria, Research Funding. Bowen:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AMGEN: Honoraria; Celgene: Honoraria, Research Funding; Chugai: Honoraria, Research Funding.

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Long-Term Outcomes of Imatinib Real-Life Treatment for Chronic Myeloid Leukemia- a 20-Year Review

Blood ◽

10.1182/blood-2020-140835 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 52-53

Author(s):

Elzbieta Szczepanek ◽

Ositadima Chukwu ◽

Magdalena Kaminska ◽

Hubert Wysoglad ◽

Agnieszka Cenda ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Median Time ◽

Myeloid Leukemia ◽

Initial Therapy ◽

Imatinib Therapy ◽

Newly Diagnosed ◽

Long Term Outcomes ◽

The Mean

Introduction Imatinib, approved as first-line treatment for patients with newly diagnosed chronic myeloid leukemia (CML) by FDA approximately 20 years ago, revolutionized the treatment of this disease. The life expectancy of newly diagnosed patients with CML has been approaching that of the global population. Second generation TKI (2GTKI) administered as a frontline therapy can induce deeper and faster molecular responses in a higher percentage of patients, however, the overall survival is comparable to that achieved with imatinib. To investigate the outcomes of long-lasting therapy with imatinib administered as initial therapy, we analyzed patients with CML who received imatinib as initial therapy at our institution starting from 2001. Methods We retrospectively analyzed long term outcomes of 267 patients treated with imatinib 400 mg at the Department of Hematology, Jagiellonian University Medical College, Cracow, Poland from 2001. Data from medical records were collected and statistical analysis was performed using R software (R version 4.0.2). Results The median age was 53.5 (16 to 88 years), 129 of patients (pts) (48.31%) were female. At the time of this analysis, 99 pts (37.08 %) remained on imatinib with the median dose at last follow-up (FU) 400 mg. The mean initial dose of imatinib was 410.4 mg/d. Imatinib dose was increased in 53 pts (19.85%), up to 800mg and up to 600 mg in 3 pts (1.13%), and in 49 pts (18.35%) respectively. The mean maximal dose was 465.2 mg. At baseline 124 pts (46.44%) had comorbidities: 79 pts (29.59%) vascular/cardiac, 11 pts (4.12%) renal, and 101 pts (37.33%) other comorbidities. 15 patients (5.63%) had prior malignancies, newly diagnosed malignancies occurred among 11 (4.12%) pts on imatinib. The median follow-up time was 11.37 years (range from 2 months to 19.5 years). 168 pts (62.92%) discontinued imatinib permanently, the median time to imatinib discontinuation was 2.02 years. Among them, 123 pts (71.93 %) switched imatinib to 2GTKI- 79 pts (29.59%) to dasatinib, 68 pts (25.47%) to nilotinib, and 14 pts (5.24%) to bosutinib. During the following treatment 87 pts (32,58%) received one 2GTKI, 33 pts (12.36%) two, and 3 pts (1.12%) more than two 2GTKIs. The main reasons for imatinib therapy discontinuation were intolerance (87 pts, 32.58%) and disease progression (90 pts, 33.71%). The median time to the imatinib discontinuation due to its intolerance was 2 years. Adverse events (AEs) during imatinib therapy were as follows: cardiac/vascular AEs in 22 pts (8.24%), renal in 42 pts (15.73%), hematologic in 43 pts (16.10%), and other in 189 pts (70.79%). Overall, 28 patients died (10.5%), 7 pts (2.2%) transformed to blast phase, 9 pts (3.37%) underwent allo-HSCT. Estimated OS for patients that remained on imatinib for the whole observation period for 15 and 18 years was: 80.2%, and 64.1% respectively (Figure 1). Median follow-up time for patients who continued imatinib was 7.91 years. Intention to treat (ITT) analysis available for 99 pts (37.08%) revealed ITT responses at three months, one, five, ten and fifteen years: 50.52%, 77.4%, 86.25%, 90.28%, 100% for CCyR, 32.99%, 58.07%, 80%, 86.11%, 100% for MMR, 11.34%, 20.44%, 63.75%, 63.89%, 90% for MR4, 2.06%, 12.91%, 35%, 38.89%, 70% for MR4.5, 2.06%, 7.53%, 26.25%, 33.33%, 50% for CMR (undetectable transcripts with ≥100,000 copies ABL) (Table 1). The overall best response rates (at any time) for these 99 pts was 4.04% for MCyr, 5.05% for CCyR, 11.11% for MMR, 14.14% for MR4, 9.09% for MR4.5, 49.49% for CMR. Conclusion The analysis of long-term therapy with imatinib showed that the efficacy of imatinib persisted over time and that long-term administration of imatinib was associated with low rate of late toxic effects. Disclosures Sacha: Novartis: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Speakers Bureau; Adamed: Consultancy, Honoraria; Incyte: Consultancy, Honoraria, Speakers Bureau; Bristol-Myers Squibb Company: Consultancy, Honoraria, Speakers Bureau.

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Adherence to treatment and prevalence of side effects when medical abortion is delivered via telemedicine

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2021-201263 ◽

2021 ◽

pp. bmjsrh-2021-201263

Author(s):

John Joseph Reynolds-Wright ◽

Anne Johnstone ◽

Karen McCabe ◽

Emily Evans ◽

Sharon Cameron

Keyword(s):

Side Effects ◽

Medical Abortion ◽

Drug Regimen ◽

Telephone Consultation ◽

Pain Scores ◽

Telemedicine Consultation ◽

Gastrointestinal Side Effects ◽

Scottish Government ◽

At Home

BackgroundThe Scottish government introduced legislation during the COVID-19 outbreak to permit medical abortion at home with telemedicine. All women received an initial telephone consultation. For those choosing medical abortion, we provided self-administered medications to eligible women with pregnancies under 12 weeks’ gestation.AimsTo assess adherence to the recommended abortion drug regimen, with particular focus on the number of misoprostol doses used and the interval between mifepristone and misoprostol administration and the induction–expulsion interval. Additionally, to evaluate use of analgesia, antiemetics and antibiotics, and the side effects, pain and bleeding profile of medical abortion at home.MethodsWe conducted a prospective cohort study of 663 women choosing medical abortion at home via telemedicine at an NHS abortion service in Edinburgh, Scotland between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed at telephone follow-up 4 and 14 days following treatment. Outcome measures were self-reported and included use of mifepristone and misoprostol, induction–expulsion interval (time from misoprostol administration until expulsion of pregnancy), antiemetics, antibiotics, analgesia use, pain scores, rates of side effects, bleeding and preparedness for treatment.ResultsAmong the respondents, 652/663 women (98%) answered at least one questionnaire, and 594/663 (89.6%) used both abortion medications as directed (24–72 hours between medications). The mean (SD) induction–expulsion interval was 4.3 (4.3) hours. Antiemetics were used by 611/663 (92%), 383/599 (64%) completed the course of prophylactic antibiotics, and 616/663 (93%) used analgesia, with mean (SD) worst-pain scores of 6.7 (2.2) out of 10. Regarding side effects, 510/663 (77%) experienced either nausea, vomiting, diarrhoea or headache, 101/663 (15%) experienced headache and 510/663 (77%) experienced bleeding that was heavier than a period; 554/663, (84%) felt prepared for their treatment by teleconsultation.ConclusionPatients are able to correctly self-administer abortion medications following a telemedicine consultation. Further research is required to optimise pain management and gastrointestinal side effects during medical abortion.

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The availability of health information to patients with newly diagnosed polymyalgia rheumatica: results from the Polymyalgia Rheumatica (PMR) Cohort study

Primary Health Care Research & Development ◽

10.1017/s1463423618000543 ◽

2018 ◽

Vol 20 ◽

Author(s):

Maatla Tshimologo ◽

Toby Helliwell ◽

Samantha Hider ◽

Christian Mallen ◽

Sara Muller

Keyword(s):

Primary Care ◽

Cohort Study ◽

Polymyalgia Rheumatica ◽

Internet Access ◽

Information Provision ◽

Baseline Survey ◽

Newly Diagnosed ◽

Baseline Phase ◽

Written Information ◽

Search For Information

AbstractAimThe aim of this study was to assess the provision of information to, and seeking of information by, patients newly diagnosed with polymyalgia rheumatica (PMR) in primary care.BackgroundPMR is an inflammatory rheumatological condition of older people that can be treated with long-term oral glucocorticoids. Management usually requires the patient to understand the potential complications of treatment and the disease, as well as involvement in reducing treatment dose. This may be complex for patients to understand.MethodData are taken from the baseline phase of the PMR Cohort study, which recruited newly diagnosed patients with PMR from UK primary care. Participants provided information on their PMR symptoms, general health and sociodemographics. They also completed items regarding information provision by their doctor at diagnosis, its usefulness and their own search for information.FindingsA total of 652 people responded to the baseline survey. In all, 399 (62.7%) had received written information from their doctor; 237 (98%) found it useful; 265 (42.9%) would have liked more information; and 311 (48.4%) sought out more information. Those who were not given information and did not seek it out tended to be older and have poorer internet access.Information provided at diagnosis to patients with PMR is useful, but more than a third did not receive any. This is concerning when PMR requires self-management and vigilance for red flags. Doctors should make use of the resources already available to them to support patients and should specifically ensure that these are available to more elderly patients and those without internet access.

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Clinical Profile of Diabetic Ketoacidosis among Children in Eastern Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v15i4.21985 ◽

2019 ◽

Vol 15 (4) ◽

pp. 226-229

Author(s):

Dipak Muktan ◽

Lisa Tamang Ghising ◽

Rupa Rajbhandari Singh

Keyword(s):

Diabetic Ketoacidosis ◽

Pediatric Intensive Care ◽

Study Data ◽

Newly Diagnosed ◽

Duration Of Symptoms ◽

Life Threatening ◽

Awareness Programs ◽

The Mean ◽

Precipitating Factor

Background: Diabetic ketoacidosis (DKA) is a life threatening complication which is the most common reason for hospital admission in children with Type 1 Diabetes. This study was carried out to determine the clinical characteristics of children admitted with Diabetic Ketoacidosis. Methods: Descriptive retrospective study was conducted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. A total of 25 children of less than 20 years old diagnosed with Diabetic ketoacidosis who were admitted to the pediatric ward and pediatric intensive care unit from January 2013 to December 2017 were included in the study. Data were collected via hospital records of patients. Results: The mean age at presentation was 10.5 ± 4.5 years. Sixteen (64%) children were newly diagnosed as diabetes while, nine (36%) children were known cases of diabetes. The most common precipitating factor for DKA was omission of insulin 6 (24%). Twelve (48%) children had presented with severe DKA. Polyuria 23 (92%) was the commonest symptom followed by polydipsia 22 (88%), weight loss 17 (68%), abdominal pain 13 (52%), vomiting 13 (52%) and unconsciousness 8 (32%). The mean duration of symptoms before presentation was 11.3 ± 5.7 days. Mean HbA1c at presentation was 10.4 ± 2.2. Conclusion: Majority of the patients was newly diagnosed as diabetes who presented with Diabetic ketoacidosis. Omission of insulin was the main precipitating factor. Polyuria was the most common presenting symptom. Proper follow up care of diabetes and community awareness programs should be emphasized to reduce the incidence of Diabetic ketoacidosis.

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