EFFECTIVENESS of ABATACEPT in PATIENTS with INTERSTITIAL LUNG DISEASE ASSOCIATED with RHEUMATOID ARTHRITIS

Background: Interstitial Lung Disease (ILD) is the most common lung involvement in rheumatoid arthritis (RA) and leads to increased morbidity and mortality. Some retrospective observational studies suggest that abatacept (ABT) could be effective and safety, although there are no clinical trials and prospectively collected data are scarce. Objectives: To evaluate prospective the effectiveness and safety of ABT in patients with ILD associated RA (ILD-RA). Methods: Design and Protocol: We performed a multicenter, prospective, observational study of patients with interstitial lung disease secondary to rheumatoid arthritis (ILD-RA) receiving ABT between 2015 and 2021. The patients were assessed using high-resolution computed tomography and lung function tests at the beginning of treatment (V0), at 12 months (V12), and at the end of follow-up in 2021 (fV). The study was approved by the Ethics Committee (Code 1719-N-15). Main variable: effectiveness of ABT according to evolution of ILD at the end of follow-up: (1) improvement (ie improvement of FVC ≥10% or DLCO ≥15% and no radiological progression), (2) no progression (stabilization or improvement in FVC ≤ 10% or DLCO <15% and no radiological progression), (3) progression (worsening of FVC >10% or DLCO >15% and radiological progression) or (4) death. Other variables: clinical and analytical characteristics, treatments and safety (infections, hospitalization and mortality). Statistical analysis: Cox regression analysis to identify factors associated with worsening of ILD-RA treated with ABT. Results: Thirty-eight ILD-RA patients started ABT treatment during prospective follow-up. A total of 22/38 (57.9%) were men and the mean (SD) age was 66.1 (9.1) years. The mean (SD) evolution of ILD was 43.9 (30.0) months and the median (IQR) time with ABT was 17.0 (12.1-34.8) months. The baseline clini-cal-epidemiological characteristics and pulmonary progression of the patients are shown in Table 1. At the end of follow-up (fV) 28/38 (73.6%) had improvement/stabilization and 7/38 (18.4%) progressed and 3/38 (7.8%) of them died (COVID-19 pneumonia, respiratory infection and ILD progression, respectively). There were no signifcant differences in FVC (75.3 [8.7] vs 77.7 [14.6];p=0.775) or in FEV1 (83.9 [10.7] vs 84.7 [13.2];p=0.416) nor in the DLCO (61.0 [17.4] vs 60.7 [15.2];p=0.789) at the end of follow-up. There was a greater numberwith improvement/stabilization among the patients who were in combination with Methotrexate compared to those who were in monotherapy (83.3% vs 39.1%;p=0.046). The baseline variables that were independently associated with progression-mortality of ILD-RA in fV were: baseline FVC (OR [95% CI], 0.895 [0.805-0.996];p=0.042) and duration of ILD-RA (OR [95% CI], 1.204 [1.148-2.112;p=0.046]). Two patients discontinued ABT during follow-up due to insufficient joint and pulmonary response. Conclusion: More than half of the patients with ILD-RA treated with ABT manage to stabilize or improve their lung disease after a median follow-up of 17 months. Patients who worsen or die have lower baseline FVC values and ILD-RA with a longer evolution time.

SARS-COV-2 INFECTION and IT VACCINATION in AUTOINMUNE DISEASE-ASSOCIATED INTERSTICIAL LUNG DISEASE

Background: Intersticial lung disease (ILD) is a common condition in patients with systemic autoinmune diseases (SAI) that is characterized by increased morbility and mortality. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has posed huge challenges worldwide and previous studies suggest that ILD patients experience a more severe clinical course. Objectives: To analyze COVID-19 infection effects in patients with ILD associated systemic autoinmune disease (ILD-SAI) and to describe their vaccination status. Methods: Design We performed a multicenter, retrospective, observational study from 6 teaching hospitals in Andalusia, Spain. Study protocol We included ILD-SAI patients: rheumatoid arthritis (RA), systemic sclerosis (SS) and infam-matory myopathies (IM), assisted in reumatology consultations in 2021. Variables COVID-19 infection was the main variable that we collected and it was confrmed by a positive result on a PCR test. Secondary variables: (1) COVID-19 severity defned as hospitalization or death;(2) vaccination status;(3) temporary relationship between infection and vaccination. Other variables included: clinical, epidemiological characteristics, treatments received, type of ILD (UIP/NSIP), pulmonary function testing and high-resolution computed tomography. Statistic analysis Tw o multivariable logistic regression analysis to indentify the 'COVID-19' and 'severe COVID-19' associated factors. Results: We included 176 ILD-SAI, of whom: 105 (59.7%) had RA, 49 (27.8%) had SS and 22 (12.54%) had IM. The main baseline characteristics for the over-sall simple and te 3 subgroups are shown in Table 1. We recorded 22/179 (12.5%) SARS-CoV-2 infections, 7/22 (31.8%) of them were severe and 3/7 (42.85%) died. As to the vaccination, 163/176 (92.6%) patients received the complete dosis. Among those correctly vaccinated 18/163 (11%) had the SARS-CoV-2 infection, 4/18 (22.2%) after the vaccinated date and 14/18 (77.7%) when they still dint't have the complete vaccination. From the 13 not vaccinated patients, 4/13 (30.7%) had COVID-19. As to frequency, COVID-19 severity and vaccination, there were no difference between subgroups of CTD-ILD patients. The risk factors associated with the COVID-19 infection were the last FVC (OR [CI 95%], 0.971 [0.944-0.998];p=0.048), the vaccination (OR [CI 95%], 0.185 [0.049-0.691];p=0.012) and the Rituximab treatment(OR [CI 95%], 3.172 [1.028-6.785];p=0.045). Moreover, the only variable associated independently with the severe COVID-19 was the protective effect of vaccination (OR [CI 95%], 0.020 [0.003-0.119];p<0.001). Conclusion: A total of 12.5% ILD-SAI patients were COVID-19 infected, most of them without the complete vaccine. Rituximab and a deterioration of FVC were risk factors for the COVID-19 wehreas the vaccination was a protective factor for the mild and severe infection.

STRATEGY AND RESULTS OF THE MASSIVE IMPLEMENTATION OF REIMBURSED CONTINUOUS GLUCOSE MONITORING IN PEOPLE WITH TYPE 1 DIABETES

Background and Aims: Widespread use of continuous glucose monitoring (CGM) in Type 1 Diabetes (T1D) under nationwide reimbursement, has shown an improvement in glucometrics, acute complications and patient satisfaction. Following the last phase of the reimbursement program for CGM in Catalonia (Spain), the feasibility and effectiveness of a decision tree algorithm addressed to its massive implementation was evaluated during COVID-19 pandemic. Methods: A straightforward decision tree algorithm was developed to systematically detect and categorize T1D patients from our Diabetes Unit. An administrative assistant, supported by healthcare-staff, contacted candidates and enrolled them into the program if willing to and according to: previous self-financing and digital skills. New users received information about the device, a contact number and 5 training webinars links. Patients unfamiliar with technology received a face-to-face education program. Results: Over a 3-month period, 1519 candidates were contacted by phone (52% women, mean age 43.82±15.29 years, mean HbA1c 7.71%±1.19, 19% of them were pump users). 320 (21%) self-financed CGM previously, 1045 patients (69%) initiated reimbursed CGM use, 331 (22%) declined the use of the device and we could not get in touch with 143 (9%) of patients. 292 patients (29%) joined the Diabetes educator-led webinars, while only 39 (3%) required face-to-face training. No major acute complication or relevant clinical issues were reported. Conclusions: Massive implementation of reimbursed CGMin T1D population in a short period of time is feasible, effective and safe using coordinated strategies between healthcare and nonhealthcare professionals including on-site, virtual visits and a web-site education package.

Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial.

The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1-441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0-742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.

Resilience, Digital Tools, and Knowledge Management Systems in the Pandemic Era: The IHU Strasbourg Experience

Disasters like the recent COVID-19 pandemic can benefit from the use of digital tools and Knowledge Management Systems (KMSs) to manage the emergency and improve the resilience of the system. Such KMSs must prove the quality of the system, service, situation, and knowledge which is gathered, transferred, and shared. However, KMSs must cope with the presence of knowledge barriers, which limit to manage data and information successfully. Our chapter wants to deepen such a topic through the analysis of the case study of a web application developed by the IHU Strasbourg, one research and clinical centre, to collect and share knowledge between the end-users (citizens) and healthcare institutions, decision-makers, and public entities during the COVID-19 pandemic. Our findings highlight the need to ensure that not only the KMS possesses the recommended quality standards, but that specific features are put in place to cope with the presence of knowledge barriers, and the need for speed in the information flows to enhance resilience. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.