Predictive Value of Serum Infliximab Levels at Induction Phase in Rheumatoid Arthritis Patients

Background:The Infliximab, has proven effective in treating rheumatoid arthritis (RA). A good clinical response is usually associated with high serum drug levels. Development of antibodies toward Infliximab (ATI) can increase drug clearance, leading to treatment failure.Aims:To analyze whether serum Infliximab trough levels (ITL) at the induction phase are associated with Infliximab clearance and clinical outcomes at week(W) 54 and to investigate the association with immunogenicity development.Methods:Observational retrospective study in which ITL from 66 RA patients were measured by capture ELISA at W0, W2, W6, W14 and 22. Patients were classified as ITLpos if Infliximab was detectable at W54 and ITLneg otherwise. ATI were assayed by bridging ELISA and by two drug-tolerant assays. ITL cut-off values were established by ROC curves. The association between ITL at early-stage and clearance of Infliximab at W54 was analyzed by univariable and multivariable logistic regression.Results:ITLneg patients (n=25) always had significantly lower Infliximab levels than ITLpos (n=41). An ITL value of 4.4 μg/mL at W6 best predicted W54 Infliximab absence. In the multivariable analysis, only ITL below the cut-off at W6 (OR: 86.6; 95%CI: 6.58-1139.99) and non-use of methotrexate (OR: 6.9; 95%CI: 1.04-45.84) remained significantly associated with W54 Infliximab absence. ATI were more frequent in patients with ITL below the cut-off at W6.Conclusions:In RA, ITL at induction phase are inversely associated with Infliximab clearance and clinical outcomes at W54. ATI was the main reason for low early ITL. A predictive value of ITL at W6 was found as a useful prognostic measure of treatment efficacy.

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The incidence of peritoneal carcinomatosis and impact on outcomes in relapsed early T4 colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.73 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 73-73

Author(s):

Rosemary Habib ◽

Val Gebski ◽

Kenneth Micklethwaite ◽

Duncan McLeod ◽

James Toh ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Peritoneal Carcinomatosis ◽

Clinical Outcomes ◽

Proportional Hazards ◽

Early Stage ◽

Multivariable Analysis ◽

Stage Ii ◽

Tertiary Centre ◽

T4 Stage

73 Background: There is limited data regarding the association between peritoneal carcinomatosis (PC) and clinical outcomes in colorectal cancer (CRC). We examined the incidence of PC and explored the relationship to survival (RFS & OS) in CRC. Methods: The demographic and clinical details of patients with stage II/III CRC referred to a tertiary centre in Western Sydney between 2009-2016 were obtained. Associations between clinical outcomes and baseline prognostic factors were investigated using proportional hazards regression models. The effect of prognostic factors on outcome were examined by tumour stage. Results: 495 patients were identified, 281 (57%) with stage II and 214 (43%) with stage III. Median follow-up was 38 months. 330 (67%) had T3 and 165 (33%) had T4 disease. Median age at diagnosis was 72 years (19 -94). 104 (21%) patients relapsed, 24 (23%) had PC and of those, 6 had PC as their only site of metastasis. 10% (n = 5) with T3 developed PC compared with 35% (n = 19) with T4 disease (P = 0.02). Compared with non-PC, PC was associated with poorer median OS (28 Vs 46 m; p = 0.03). Median RFS for T3 was 16 months, T4, 14 months (NS). Median OS for T3 was 34 months Vs T4 28 months (P = 0.45). Of those with PC relapse, the diagnosis of PC was highest in the first two years post-operatively (88%). 9 patients (38%) with PC died due to bowel obstruction Vs 4 (5%) patients with non-PC relapse (P < 0.01). Poorer OS was associated with PC (HR 1.74; p = 0.03), right sided primary (HR 1.602; P = 0.05), T4 stage (HR 1.69; P = 0.03), LVI (HR 1.95; p < 0.01), N stage (HR 1.51; P < 0.01), and number of metastases at baseline (HR 1.25; p = 0.04). On multivariable analysis right sided primary and T4 stage remained significant. Conclusions: Patients with PC relapse have an 18 month shorter median OS than those with non-PC relapse. Further, PC recurrence is more common in patients with T4 compared with T3 CRC and was the only site of metastatic disease in 7% of relapsed patients with T4 CRC. Consideration for peritonectomy and/or HIPEC should be given for patients with PC metastases. For patients with resected early stage T4 CRC, consideration should be given for surveillance laparoscopy.

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Effective Prediction of Rheumatoid Arthritis (Ra) Diagnosis Using Hybrid Harmony Search with Adaptive Neuro Fuzzy Inference System

10.21203/rs.3.rs-252272/v1 ◽

2021 ◽

Author(s):

S SHANMUGAM ◽

C Saravanabhavan ◽

T Arunkumar

Keyword(s):

Rheumatoid Arthritis ◽

Fuzzy Inference System ◽

Predictive Value ◽

Fuzzy Inference ◽

Search Algorithm ◽

Early Stage ◽

Harmony Search ◽

Decision Support Model ◽

Inference System ◽

Neuro Fuzzy

Abstract One of the severe auto immune diseases that affects the entire human body is Rheumatoid Arthritis (RA), the disease triggers one’s immune system to attack the inner linings of bones and causes severe inflammation of the synovium. The continuous erosion of bone lining leads to permanent loss of the joint, accounting this severity the early prognosis of the disease is a significant and inevitable process. But, the sign and symptoms of the disease are always uncertain. The symptom of RA disease is similar to other inflammatory diseases, so highly experienced experts can identify the disease in its early stage. To support the clinicians and technicians for early prognosis of the disease, a computer-aided decision support model based on Harmony Search –Adaptive Neuro Fuzzy Inference System is presented in this study. The Harmony search algorithm is employed to select the optimal features, and ANFIS is adopted to perform classification. To demonstrate the effectiveness of the model, metrics such as Accuracy, Sensitivity, Specificity, Precision, Recall, F-measure, Positive Predictive Value, Negative Predictive Value, Root Mean Square Error, and Mean Absolute Error are employed and evaluated in MATLAB simulation environment. The proposed HS-ANFIS outperformed other models developed in this research and existing works of literature.

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Circulating miRNA-125b Is a Potential Biomarker Predicting Response to Rituximab in Rheumatoid Arthritis

Mediators of Inflammation ◽

10.1155/2014/342524 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 53

Author(s):

Isabelle Duroux-Richard ◽

Yves-Marie Pers ◽

Sylvie Fabre ◽

Meryem Ammari ◽

Dominique Baeten ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Predictive Value ◽

Predictive Biomarker ◽

Serum Levels ◽

High Serum ◽

Response To Treatment ◽

Serum Samples ◽

Total Blood ◽

Novel Mirna ◽

Potential Biomarker

Although biologic therapies have changed the course of rheumatoid arthritis (RA), today’s major challenge remains to identify biomarkers to target treatments to selected patient groups. Circulating micro(mi)RNAs represent a novel class of molecular biomarkers whose expression is altered in RA. Our study aimed at quantifying miR-125b in blood and serum samples from RA patients, comparing healthy controls and patients with other forms of rheumatic diseases and arthritis, and evaluating its predictive value as biomarker for response to rituximab. Detectable levels of miR-125b were measured in total blood and serum samples and were significantly elevated in RA patients compared to osteoarthritic and healthy donors. The increase was however also found in patients with other forms of chronic inflammatory arthritis. Importantly, high serum levels of miR-125b at disease flare were associated with good clinical response to treatment with rituximab three months later (P=0.002). This predictive value was not limited to RA as it was also found in patients with B lymphomas. Our results identify circulating miR-125b as a novel miRNA over expressed in RA and suggest that serum level of miR-125b is potential predictive biomarker of response to rituximab treatment.

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Comparison of the prognostic value of SYNTAX score and clinical SYNTAX score on outcomes of Chinese patients underwent percutaneous coronary intervention

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02144-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiao-Qin Li ◽

Chun Yin ◽

Xiao-Li Li ◽

Wen-Li Wu ◽

Kun Cui

Keyword(s):

Percutaneous Coronary Intervention ◽

Clinical Outcomes ◽

Multivariable Analysis ◽

Scoring Systems ◽

Roc Curves ◽

Coronary Intervention ◽

Chinese Patients ◽

Syntax Score ◽

Vascular Events ◽

Percutaneous Coronary

Abstract Background Previous studies have validated the capability of SYNTAX score (SS) and clinical SYNTAX score (CSS) in the prediction of clinical outcomes in patients who have undergone PCI; however, studies on comparison of these two scoring systems in Chinese population have been sparse. Methods To study the ability of SS and CSS in prediction of clinical outcomes of Chinese patients underwent percutaneous coronary intervention (PCI). We retrospectively calculated SS and CSS for 547 Chinese patients from a single center who underwent PCI. Patients were stratified into tertiles according to their SS and CSS. We compared the 2-year clinical outcomes in these patients stratified separately by SS and CSS tertiles. Results The incidence of major adverse cardiac and cerebro-vascular events (MACCE) was the highest in patients with SSHIGH (13.5%), comparing to 6.8% in SSMED and 0% in SSLOW (p < 0.0001). The Cox multivariable analysis showed that the SS and CSS were both strong independent predictors for MACCE [1.100 (1.069–1.133), 1.017 (1.010–1.025), both p < 0.0001]. The receiver operating characteristic (ROC) curves showed the areas-under-the-curves for all-cause death by CSS was slightly larger comparing to SS but not significantly (AUC SS, 0.64; AUC CSS, 0.71; p = 0.23). Conclusion We concluded that both the SS and CSS were capable of risk stratification of clinical outcomes in all-comers population as well as in low and moderate risk Chinese patients undergoing PCI with CSS showing slightly better advantage.

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High Serum Cartilage Oligomeric Matrix Protein Determines the Subset of Patients with Early-Stage Rheumatoid Arthritis with High Serum C-Reactive Protein, Matrix Metalloproteinase-3, and MRI-Proven Bone Erosion

The Journal of Rheumatology ◽

10.3899/jrheum.080926 ◽

2009 ◽

Vol 36 (6) ◽

pp. 1126-1129 ◽

Cited By ~ 20

Author(s):

KEITA FUJIKAWA ◽

ATSUSHI KAWAKAMI ◽

MAMI TAMAI ◽

MASATAKA UETANI ◽

SHOICHIRO TAKAO ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cartilage Oligomeric Matrix Protein ◽

Matrix Protein ◽

Bone Erosion ◽

Early Stage ◽

High Serum ◽

C Reactive Protein ◽

Matrix Metalloproteinase 3 ◽

Reactive Protein ◽

Mri Features

Objective.To identify the significance of serum cartilage oligomeric matrix protein (COMP), a marker of cartilage turnover, in patients with early-stage rheumatoid arthritis (RA) in relation to other serologic variables and magnetic resonance imaging (MRI) features.Methods.Ninety-eight patients with early-stage RA, whose disease duration from onset was less than 2 years, were enrolled. The objective measures at baseline were Disease Activity Score (DAS28), serum C-reactive protein (CRP), serum matrix metalloproteinase-3 (MMP-3), serum antibodies against cyclic citrullinated peptide (anti-CCP), and MRI features of both wrist and finger joints. The MRI features included the number of sites scored positive for synovitis, bone edema, and bone erosion.Results.Serum COMP concentration was not different among groups identified with low, moderate, and high DAS28-CRP values. However, COMP values were statistically high in subjects positive for bone erosions on MRI compared with the subjects who were negative for bone erosions. A positive correlation of COMP with CRP and with MMP-3 values was also identified.Conclusion.Elevation of COMP may reflect joint damage that is dependent on the synovial inflammatory process in early-stage RA.

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Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

Journal Of Cardiovascular, Neurovascular & Stroke ◽

10.32896/cvns.v1n1.11-15 ◽

2019 ◽

Vol 1 (1) ◽

pp. 11-15 ◽

Cited By ~ 1

Author(s):

Sarah Yaziz ◽

Ahmad Sobri Muda ◽

Wan Asyraf Wan Zaidi ◽

Nik Azuan Nik Ismail

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Predictive Value ◽

Area Under The Curve ◽

Rank Correlation ◽

Treatment Decision ◽

Roc Curves ◽

Significant Negative Correlation ◽

Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods: A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

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