FRI0364 PREVALENCE OF THE METABOLIC SYNDROME IN PSORIATIC ARTHRITIS: SYSTEMATIC LITERATURE REVIEW AND RESULTS OF THE CARMA COHORT

Background:The cardiovascular burden in psroriatic arthritis (PsA) is well recognized1.Objectives:To analyze the prevalence of metabolic syndrome (MetS) in patients with PsA.Methods:We conducted a systematic literature review (SLR) and a sub-analysis of the CARMA cohort. In the SLR, we searched in Pubmed, Embase, the Cochrane Central Library, and the ClinicalTrial until March 2019 using Mesh terms and free text words. We included SLR, clinical trials and observational studies analyzing the prevalence or frequency of MetS in PsA. Two reviewers selected articles, assessed the quality of the studies and collected data independently. The CARMA cohort was designed to establish the cardiovascular (CV) morbidity and associated risk factors for CV disease. It includes data from patients with chronic inflammatory rheumatic diseases (including PsA) of 67 Spanish hospitals. A sub-analysis of the prevalence of metS in PsA was performed using the National Cholesterol Education Program Adult Treatment Panel III criteria updated in 2005, which requires the presence of ≥3 of the following: high waist circumference, low HDL cholesterol level, high triglyceride level, high blood pressure and high fasting glucose values.Results:A total of 18 articles of moderate to high quality, were selected in the SLR. The included patients presented a balanced distribution by sex, with an average age ranging from 42 to 59 years. The frequency of MetS varied from 23.5% to 62.9% depending on the definition of MetS. The most widely used classification method was the National Cholesterol Education Program, followed by the method recommended by the International Diabetes Federation in 2009. A total of 724 patients with PsA were included in the CARMA study, of whom 327 (45.4%) were women and 157 (21.8%) smokers. The mean age at baseline was 51 ± 12 years and the mean duration of PsA disease 9 (4-16) years. Hypertension was the most frequently altered parameter (66.8%), followed by fasting glucose (42.6%) and hypertriglyceridemia (30.6%). Table 1 shows the frequency of patients according to the number of MetS components. A total of 222 (30.6%) PsA patients presented metabolic syndrome.Table 1.Prevalence of metabolic syndrome.Number of componentsN 0-5Patients (n)CARMA studyPercentage of patients, SLR(%)010113,95120828,73219326,66315120,864598,155121,66Total724100Conclusion:The frequency of the individual components of the MetS is variable according to the method of classification, which makes it difficult to compare between studies. In the CARMA study, the prevalence of MetS was around 30%, which supports the control of individual factors to prevent CV disease.References:[1]Liew JW, et al. Best Pract Res Clin Rheumatol. 2018;32(3):369-389.Disclosure of Interests:ANA URRUTICOECHEA-ARANA: None declared, Santos Castañeda: None declared, Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi, Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Diego Benavent: None declared, Maria Auxiliadora Martin-Martinez: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

Download Full-text

1468. Culture Conversion and Mortality in Patients With Mycobacterium abscessus (MAB) Lung Disease: A Systematic Literature Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1649 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S736-S736

Author(s):

Kevin L Winthrop ◽

Kevin C Mange ◽

Zhanna Jumadilova ◽

Kristan B Cline ◽

Patrick A Flume

Keyword(s):

Literature Review ◽

Lung Disease ◽

Systematic Literature Review ◽

Panel Member ◽

Cochrane Library ◽

Attributable Mortality ◽

Research Support ◽

Persistent Symptoms ◽

Conversion Rates ◽

Culture Conversion

Abstract Background Prognosis for patients with MAB lung disease is poor. We sought to examine the potential association between culture conversion and outcomes (progression, mortality) in patients with MAB lung disease. Methods English-language MAB lung disease studies with ≥ 10 patients and reporting mortality and/or microbiological outcomes were identified from Embase, PubMed, relevant congress abstracts, and the Cochrane Library (data cutoff, September 24, 2019) using the National Institute for Health and Clinical Excellence guidance for systematic literature reviews. Two independent reviewers screened 1,551 indexed records; relevant extracted data are expressed as population-weighted means. Results Mean all-cause mortality across 17 studies (N=1,291) was 12.1% (range, 3%–33%); mortality attributable to MAB lung disease was 7.6% (range, 0%–27%; N=526, 9 studies). Culture conversion across 44 studies (N=2,237) was 46.7% (range, 0%–98.6%), with higher rates reported for M. massiliense subspecies (76.9%; N=507,15 studies) than M. abscessus subspecies (35.8%; N=834,18 studies). No direct comparisons were made between mortality and culture conversion; in the 13 studies (N=1,202) that reported both outcomes there was a moderate correlation between increased rate of culture conversion and decreased MAB-attributable mortality (R2=0.60). The most common definition of progression (21 studies) was radiographic worsening supported by persistent symptoms and/or positive cultures. Across 8 studies (N=415) 57.8% patients had improvement while 35.2% progressed with treatment. A broad variance in treatment regimen and duration (range, 32 days to > 3 years) was observed. Limitations include a small number of studies, and inconsistency in methods and outcomes definitions. Conclusion In this systematic literature review, available data suggest that culture conversion was achieved in less than half of patients and was lower in patients with M. abscessus compared with M. massiliense. One third of patients had disease progression despite treatment. Some data suggest lower MAB-attributed mortality outcomes in studies with higher culture conversion rates, more evidence is needed to demonstrate a survival benefit associated with culture conversion. Disclosures Kevin L Winthrop, MD, MPH, Insmed Incorporated (Consultant, Grant/Research Support) Kevin C Mange, MD, MSCE, Insmed Incorporated (Employee) Zhanna Jumadilova, MD, Insmed Incorporated (Employee) Kristan B Cline, PhD, Insmed Incorporated (Employee) Patrick A Flume, MD, Insmed Incorporated (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member)

Download Full-text

Presence and risk factors of metabolic syndrome determinants in indian obese children and adolescents: according to national cholesterol education program (ncep) (atpiii) criteria

International Journal of Recent Scientific Research ◽

10.24327/ijrsr.2017.0803.0093 ◽

2017 ◽

Vol 08 (03) ◽

pp. 16180-16186

Author(s):

Kulshretha Himani ◽

◽

Gupta Vani ◽

Gupta Vandana ◽

Mishra Supriya ◽

...

Keyword(s):

Risk Factors ◽

Metabolic Syndrome ◽

Children And Adolescents ◽

Education Program ◽

National Cholesterol Education Program ◽

Obese Children

Download Full-text

AB0820 COMPARATIVE EFFICACY OF GUSELKUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS FROM SYSTEMATIC LITERATURE REVIEW AND NETWORK META-ANALYSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6013 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1713-1714

Author(s):

I. Mcinnes ◽

P. J. Mease ◽

K. Eaton ◽

A. Schubert ◽

S. Peterson ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Literature Review ◽

Adverse Events ◽

Systematic Literature Review ◽

Targeted Therapies ◽

Meta Analysis ◽

Tumor Necrosis Factor Inhibitor ◽

Forest Plot ◽

Research Support ◽

Phase 3

Background:The efficacy of the interleukin (IL)-23 subunit p19 inhibitor guselkumab (GUS) for psoriatic arthritis (PsA) has recently been demonstrated in two Phase 3 trials (DISCOVER-1 & -2) but has not been evaluated versus existing targeted therapies for PsA.Objectives:To compare GUS to targeted therapies for PsA through network meta-analysis (NMA).Methods:A systematic literature review was performed to identify PsA randomized controlled trials from 2000 to 2018. Bayesian NMAs were performed to compare treatments on American College of Rheumatology (ACR) 20/50/70 response, Psoriasis Area Severity Index (PASI) 75/90/100 response, Health Assessment Questionnaire Disability Index (HAQ-DI) score, resolution of enthesitis (RoE), resolution of dactylitis (RoD), adverse events (AEs) and serious adverse events (SAEs). Analyses used random effects models that adjusted for placebo response via meta-regression on baseline risk when feasible. Results are summarized by ranking treatments according to median absolute probabilities of response derived from NMAs.Results:Twenty-six Phase 3 studies were included in the quantitative synthesis. Studies were placebo-controlled up to 24 weeks and evaluated 13 targeted therapies for PsA. Absolute probabilities are reported for PASI 90 & ACR 20 responses according toFigure 1,and a forest plot of relative risks versus placebo for AEs is reported according toFigure 2. For ACR 20 response, GUS 100 mg every 4 weeks (Q4W) and every 8 weeks (Q8W) ranked 5th and 8th out of 20 interventions and were comparable to IL-17A inhibitor (IL-17Ai) and most tumor necrosis factor inhibitor (TNFi) agents. Similar findings were observed for ACR 50 and 70 responses. For PASI 90 response, GUS Q4W and Q8W ranked 1st and 2nd out of 15 interventions and were highly likely to provide a greater benefit than most other agents. Similar findings were observed for PASI 75 and 100 responses. For HAQ-DI score, GUS Q4W and Q8W ranked 6th and 10th out of 20 interventions and were comparable to IL-17Ai and most TNFi agents. For RoE, GUS Q4W and Q8W ranked 8th and 6th out of 13 interventions and were comparable to IL-17Ai and TNFi agents. For RoD, GUS Q4W and Q8W ranked 8th and 9th out of 13 interventions and were comparable to most IL-17Ai and TNFi agents. For AEs, GUS Q4W and Q8W ranked 3rd and 2nd out of 19 interventions and were comparable to IL-17Ai and TNFi agents. Likewise, for SAEs, GUS Q4W and Q8W ranked 4th and 5th out of 20 interventions and were comparable to IL-17Ai and TNFi agents. Analyses that controlled for previous exposure to biologics or assessed outcomes at alternative timepoints were broadly consistent with primary analysis results.Conclusion:NMA results indicate that GUS is comparable to most targeted PsA treatments for improvement in arthritis, soft tissue damage, physical function, and safety outcomes. For PASI outcomes, GUS is highly likely to provide a greater benefit than other targeted PsA treatments.Disclosure of Interests:Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Kiefer Eaton Shareholder of: Test Pharma, Consultant of: Janssen, Agata Schubert Employee of: Janssen-Cilag, Steve Peterson Employee of: Janssen Research & Development, LLC, Tim Disher Consultant of: Janssen, Wim Noel Employee of: Janssen Pharmaceuticals NV, Hassan Fareen Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Suzy Van Sanden Employee of: Janssen, Christopher T. Ritchlin Grant/research support from: UCB Pharma, AbbVie, Amgen, Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Wolf-Henning Boehncke Grant/research support from: Janssen Research & Development, LLC, Consultant of: Janssen

Download Full-text

Arachnoid web of the spine: a systematic literature review

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine181371 ◽

2019 ◽

Vol 31 (2) ◽

pp. 175-184 ◽

Cited By ~ 7

Author(s):

Peyton L. Nisson ◽

Ibrahim Hussain ◽

Roger Härtl ◽

Samuel Kim ◽

Ali A. Baaj

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Thoracic Spine ◽

Case Reports ◽

Neurological Function ◽

Sensory Loss ◽

Cochrane Library ◽

Radiographic Findings ◽

Ovid Medline ◽

The Mean

OBJECTIVEAn arachnoid web of the spine (AWS) is a rare and oftentimes challenging lesion to diagnose, given its subtle radiographic findings. However, when left untreated, this lesion can have devastating effects on a patient’s neurological function. To date, only limited case reports and series have been published on this topic. In this study, the authors sought to better describe this lesion, performing a systematic literature review and including 2 cases from their institution’s experience.METHODSA systematic literature search was performed in September 2018 that queried Ovid MEDLINE (1946–2018), PubMed (1946–2018), Wiley Cochrane Library: Central Register of Controlled Trials (1898–2018), and Thompson Reuters Web of Science: Citation Index (1900–2018), per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with an AWS in which any relevant surgery types were considered and applied. Studies on arachnoid cysts and nonhuman populations, and those that did not report patient treatments or outcomes were excluded from the focus review.RESULTSA total of 19 records and 2 patients treated by the senior authors were included in the systematic review, providing a total of 43 patients with AWS. The mean age was 52 years (range 28–77 years), and the majority of patients were male (72%, 31/43). A syrinx was present in 67% (29/43) of the cases. All AWSs were located in the thoracic spine, and all but 2 (95%) were located dorsally (1 ventrally and 1 circumferentially). Weakness was the most frequently reported symptom (67%, 29/43), followed by numbness and/or sensory loss (65%, 28/43). Symptoms predominated in the lower extremities (81%, 35/43). It was found that nearly half (47%, 20/43) of patients had been experiencing symptoms for 1 year or longer before surgical intervention was performed, and 35% (15/43) of reports stated that symptoms were progressive in nature. The most commonly used surgical technique was a laminectomy with intradural excision of the arachnoid web (86%, 36/42). Following surgery, 91% (39/43) of patients had reported improvement in their neurological symptoms. The mean follow-up was 9.2 months (range 0–51 months).CONCLUSIONSAWS of the spine can be a debilitating disease of the spine with no more than an indentation of the spinal cord found on advanced imaging studies. The authors found this lesion to be reported in twice as many males than females, to be associated with a syrinx more than two-thirds of the time, and to only have been reported in the thoracic spine; over 90% of patients experienced improvement in their neurological function following surgery.

Download Full-text

Polypharmacy in Middle-European Rheumatoid Arthritis-Patients: A Retrospective Longitudinal Cohort Analysis With Systematic Literature Review

Frontiers in Medicine ◽

10.3389/fmed.2020.573542 ◽

2020 ◽

Vol 7 ◽

Author(s):

Jacqueline Désirée Jack ◽

Rick McCutchan ◽

Sarah Maier ◽

Michael Schirmer

Keyword(s):

Rheumatoid Arthritis ◽

Literature Review ◽

Systematic Literature Review ◽

Anatomical Therapeutic Chemical ◽

Cohort Analysis ◽

World Health ◽

Management Guidelines ◽

The Mean ◽

Health Organization

Objective: To assess polypharmacy and related medication aspects in Middle-European rheumatoid arthritis (RA) patients, and to discuss the results in view of a systematic literature review.Methods: In this retrospective cohort study, charts were reviewed from RA-patients consecutively recruited between September 27, 2017 and April 29, 2019. Drugs were assigned to the Anatomical Therapeutic Chemical (ATC) groups as proposed by the World Health Organization (WHO). Results were compared to those of a systematic literature review.Results: One hundred seventy-five consecutive RA-patients were included. The mean number of drugs was 6.6 ± 3.5, with 2.4 ± 1.2 drugs taken specifically for RA—compared to 2.6 in the literature. 33.7% of patients experienced polypharmacy defined by ≥5 drugs, compared to 61.6% in the literature–with women affected more frequently than men. After 7 years of follow-up, the number of drugs increased in all ATC-groups by an average of 12.7 %, correlating with age (Corrcoeff = 0.46) and comorbidities (Corrcoeff = 0.599). In the literature, polypharmacy is not always defined precisely, and has not been considered in management guidelines so far.Conclusion: Polypharmacy is a frequent issue in RA-management. With an increasing number of comorbidities during the course of the disease, polypharmacy becomes even more relevant.

Download Full-text