SPANISH NATIONAL REGISTRY OF BELIMUMAB IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

BackgroundBelimumab (BLM) is a monoclonal antibody that inhibits B-lymphocyte stimulating factor (BlyS) approved as a specific treatment for systemic lupus erythematosus (SLE) in 2011. We present the experience with BLM in a Spanish cohort with more than 460 patients.ObjectivesTo describe demographic characteristics, efficacy and safety of BLM in patients with SLE in Spanish population since its approval.MethodsDescriptive, retrospective, multicenter study in patients diagnosed with SLE according to EULAR/ACR 2019, SLICC and/or ACR 1997 diagnostic criteria. Data regarding SLE patients treated with BLM were collected from medical records (2011-2022). Demographic features, efficacy, laboratory variables, SLEDAI, renal involvement, steroid dose, administration routes and safety were assessed. To see whether a trend in BLM prescription had changed or not over time, two periods of time were analyzed: 2011-2016 (period1) and 2017-2022 (period2).ResultsBaseline characteristics of patients are summarized in Table 1.A total of 462 patients (36 hospitals) were included, 50.9% were on intravenous (IV), 34% on subcutaneous (SC) and 15.1% switched from IV to SC route. The median number of pre-BLM csDMARD use was 2.0 (2.0-3.0), being hydroxychloroquine (HCQ) the most frequently used (94.5%). Fifty-two patients were treated with IV cyclophosphamide with a median of 6 bolus received. At the time of BLM start, 443 patients were on prednisone with a median dose of 6.2 mg (5.0-10.0). Significant decreases in prednisone dose, SLEDAI and anti-DNA antibodies were observed from baseline until the last visit, whereas complement C3 and C4 values raised (Figure 1). A total of 118 patients (27.4%) had renal involvement with a median proteinuria of 1.0 g/day (0.5-2.4). Renal biopsy was done in 102 out of 118 patients, being class IV (33%), class III (21%) and class V (16%) the most frequently reported. After BLM, 73.3% of these patients improved (median proteinuria of 0.2 g/day (0.1-0.7).In period1, 100 patients started BLM compared to 362 in period2. The median time from SLE diagnosis to BLM begin was 7.1 (4.0-13.7) and 6.2 (2.1 -14.4) years in period1 and period2, respectively (p=0.454). We found a trend to use more csDMARD before BLM treatment in period1: 2.5 (2-3) vs. 2 (2-3) (p=0.088).A total of 143 (30.5%) patients discontinued treatment mostly due to inefficacy (55.9%) and infections (11.9%). In fact, 116 patients developed infections, mostly mild;2 patients died, 16 had COVID-19 and 4 patients developed tumors requiring discontinuation of the drug.ConclusionIn our cohort of SLE patients in a real-world setting, BLM has been effective, safe and seems to be a good choice to treat renal involvement.References[1]Navarra SV, Guzmán RM, Gallacher AE, et al. Lancet. 2011;377(9767):721-31.[2]Stohl W, Hiepe;rt al. Arthritis Rheum. 2012;64(7):2328-37.[3]Furie R, Rovin BH, Houssiau F, et al. N Engl J Med. 2020;383(12):1117-1128.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Guidelines for effective telephone communication of bad news in the health field in times of covid-19

Introduction: The crisis generated by the SARS-CoV-2 virus has had a great impact in health, economic and social sectors. In the health field, the exceptional circumstances in which many deaths have occurred have forced professionals to communicate bad news remotely by telephone. Objective: This article aims to synthesize in an organized way the main guidelines that contribute to effective communication, allowing professionals to reduce their stress levels and achieve greater efficiency when communicating a death by telephone in an emergency situation such as the current pandemic. Methodology: A review was carried out based on the scientific evidence collected in the existing bibliography on the subject. The databases consulted were PubMed, Scopus and the search engine Google Scholar. Results: To communicate bad news, the professional must have both good communication skills and adequate management of basic technical guidelines for action. Conclusion: The use of a series of guidelines with a certain degree of structure can increase the effectiveness of bad news communications through the telephone in emergency situations, maximizing the benefits for both the receiver and the sender.

COMPARATIVE DESCRIPTION of CYTOKINES and MATRIX METALLOPROTEINASES in A GROUP of PATIENTS with RHEUMATOID ARTHRITIS and OSTEOARTHROSIS under A STRICT FOLLOW-UP COMPARED with COVID-19 PATIENTS

Background: COVID-19, rheumatoid arthritis (RA) and osteoarthrosis (OA) are diseases characterized by the secretion of cytokines related to the stimulation of the infammatory response. Objectives: To identify the differences in the cytokine and matrix metalloprotein-ases (MMP) profile within one acute infectious disease and two chronic infam-matory rheumatic diseases. Methods: Analytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months), OA patients without strict clinical follow-up, evaluated once or twice a year, and Severe (mortality) COVID-19 patients were included. Eleven proteins (cytokines, MMPs and its tissue inhibitors) were quantifed through Luminex multiplex assay in serum samples. Univar-iate and bivariate analyzes were performed. Approval of Ethics Committee and informed consent were obtained. Results: A total of 108 patients with RA and OA were compared with 20 severe COVID-19 patients. There were no signifcant differences through the method of Kruskall-Wallis, between RA and OA patients. IL1-B and MMP-2 were signif-cantly lower in COVID-19 patients. Levels of IL-10, IL-1RA, IL-6, MMP-1, MMP-9, and TIMP-1 were signifcantly higher in COVID-19 patients. There were no differences in TNF-A, TIMP-2 and INF-G. (Table 1) Conclusion: Compared with RA and OA patients, severe COVID-19 patients have a great impact on the cytokines and MMPs addressed in this study, proving that COVID-19 patients suffer from a cytokine storm [1] when severely infected.

Communication of bad news in the health field in times of COVID-19. Telephone communication

This article has examined the telepho ne communication of bad news in the health field during the public health emergency of international concern decreed by the WHO on March 11, 2020. Communicating bad news is not an easy or pleasant task, especially when it comes to a death. Its effects, bot h for the sender and the receiver, will depend on the way it is carried out. In relatio n to the recipient, adequate communication can facilitate the process of acceptance and adaptation to the new reality, the one in which your loved one is no longer. Rega rding the issuer, a correct transmission of information can lead to a reduction in stre ss levels, increasing the efficiency of communication, present and future, as well as reducing the probability of problems such as burnout. A good notification of unfavo rable news requires communication skills and the handling of basic technical guidelines for action, for which training is necessary. The pandemic situation caused by the SARS - CoV - 2 virus has made the communication of bad news, until now considered a minor competence, a central element of the care process. The exceptional circumstances of thi s health emergency have also meant having to carry out communications over the phone on many occasions, an action not recommended in normal situations due to the associa ted inconveniences and which has been a real challenge for professionals. The scarcity of specific material on remote communication in exceptional situations such as the current one, makes it necessary to study and research in depth on the area. This artic le has attempted to address these issues.

A study of sustained androgen signaling dependence in metastatic castrate resistant prostate cancer (mCRPC)

Background: Advanced androgen signaling inhibition, a prevailing therapy approach in advanced prostate cancer, incurs variable response. Therapy selection guided by predictors is an unmet need. Methods: We reviewed MDACC GU department and Hellenic Sister Institute records for Abiraterone Acetate (AA) treated mCRPC patients (pts) with extraordinary response (absence of radiographic/clinical progression for ≥3 years). We compared to reported findings for COU-AA-302 and real world experience to identify candidate predictors of outcome. We applied a previously proposed COU-AA-302 response prognostic model. Archived diagnostic and subsequent tumor specimens were retrieved for molecular characterization. Results: Forty four of 430 reviewed mCRPC pts had extraordinary response. Table depicts features. Median time to AA discontinuation was 5.8 yr (range 3-12.5+) and 20 pts are on treatment. Safety profile is acceptable with no overt increase in fractures or cardiovascular, metabolic morbidity. All pts experienced >50% PSA decline with nadir ≤0.1 in 80%, occurring within 5mo (median) (range <1-57). Median time to PSA progression 5.9 yr (95% CI 4.4-7.5), median rPFS 11.5 yr. Median OS 9.4 yr (95% CI 8.1-10.7). Pretreatment features differed significantly from other datasets for: Longer time from cancer diagnosis (median 8.5 yr), longer time to CRPC (median 3.1 yr), bone metastatic burden (63% ≤3 lesions), and PSA (median 5.5 yr). We applied the model to the cohort and it predicted only 7/44 (16%). Tissue analyses to be reported at meeting due to COVID19 research shutdown. [Formula presented] Conclusions: Extraordinary response to enhanced androgen signaling inhibition in mCRPC appears linked to androgen signaling ‘addiction’ and limited disease volume. Available prognostic models are not sensitive enough to guide selection. Routine biopsy derived predictors will help guide therapeutic strategies and improve curative fraction in advanced prostate cancer. Ref: https://doi.org/10.1016/j.clgc.2017.07.014. Clinical trial identification: MDACC: PA16-0736. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: S.K. Subudhi: Advisory/Consultancy: Valeant;Honoraria (self), Advisory/Consultancy: Dendreon;Honoraria (self), Advisory/Consultancy, and Ownership interest: Apricity Health;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Janssen;Honoraria (self), Advisory/Consultancy: Polaris;Advisory/Consultancy: Amgen;Advisory/Consultancy: Bayer;Advisory/Consultancy: Exelixis;Research grant/Funding (institution): Bristol-Myers-Squibb;Research grant/Funding (institution): AstraZeneca;Honoraria (self): Compugen;Honoraria (self): Parker Institute of Cancer Immunotherapy;Honoraria (self): Society for Immunotherapy od Cancer. C. Logothetis: Honoraria (institution), Advisory/Consultancy, Research grant/Funding (institution): Janssen;Research grant/Funding (institution): Bristol-Myers-Squibb;Advisory/Consultancy, Research grant/Funding (institution): Pfizer. E. Efstathiou: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Sanofi;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Janssen;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Astellas;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Tolmar;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Bayer;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Merck;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Honoraria (self), Advisory/Consultancy, Research g ant/Fun ing (institution), Travel/Accommodation/Expenses: Oric. All other authors have declared no conflicts of interest.