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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.
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Introduction: Hospitalized patients with COVID-19 are at increased risk of venous and arterial thrombosis, ARDS, and death. The optimal dosage of thromboprophylaxis in patients is unknown. Objective: To evaluate the efficacy and safety of tinzaparin in prophylactic, intermediate and therapeutic doses in non-critical patients admitted for COVID-19 pneumonia.Design, Setting, and Participants: The PROTHROMCOVID multicenter randomized clinical trial enrolled noncritical hospitalized adult patients with COVID-19 pneumonia from February 1, 2021, to September 30, 2021, at 18 centers in Spain. Methods: Patients were randomized to prophylactic tinzaparin 4500IU or intermediate dose 100IU/kg or therapeutic tinzaparin 175IU/kg during hospitalization, followed by 7 days of prophylactic tinzaparin at discharge. The patients were stratified at the time of randomization according to age, sex and the presence or absence of hypertension.The primary efficacy outcome was a composite endpoint of symptomatic systemic thrombotic events, need for invasive or non invasive mechanical ventilation or not, including high-flow nasal cannula oxygen, or death within 30 days. The main safety outcome was major bleeding at 30 days. Data were collected and adjudicated locally by non-blinded investigators through imaging, laboratory, and health record data. Results: Of 311 patients randomized, 300 were included in the analysis (mean [SD]age, 56.7 [14.6] years;men, 182 [60.7%];women, 118 [39.3%]). 106 patients (35.33%) were assigned to the prophylaxis group, 91 patients (30.33%) were allocated to the intermediate dose group and 103 patients (34.33%) were randomized to the anticoagulant dose group. The composite endpoint thrombotic event, need for invasive (IMV) or noninvasive mechanical ventilation (NIV) or HFT via nasal cannula or death at 30 days from randomization occurred in 58 patients (19.3%) of the whole population, 19 patients (17.09%) in prophylactic group, 20 (21.98%) in intermediate group and 19 (18.45%) in therapeutic group (P=0.72). No major bleeding were reported in the trial and non-major bleeding occurred in 5 patients (4.71%) in prophilactic, in 3 patients (3.2%) in intermediate arm and in 3 patients (2.9%) in therapeutic, without significant differences in each group (P=0.31). Conclusions: In non-critically ill patients with COVID 19, intermediate or full-dose of tinzaparin do not appear to offer benefit over standard prophylactic doses IU in the likelihood of thrombotic event, non-invasive ventilation or high-flow oxygen, or death. Funding Acknowledgement: Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Leo Pharma
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New York City’s health department developed a program to support vaccine outreach and counseling through an innovative collaboration with a diverse mix of health plans to identify unvaccinated patients and provide reimbursement for clinicians.
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Introduction: High levels of adoption and usage for the COVID Tracing Apps (CTA) among the population is a stipulated prerequisite for success of the implementation of these apps, aiming to mitigate the pandemic and track spreading of the virus more efficient and effectively. In the current study, the main objective was to investigate individuals' preferences in the intention to download a COVID-19 tracing app in a pilot-study in both the Netherlands and Turkey. Methods: We conducted a discrete choice experimental study through an online survey in two countries (the Netherlands [N = 62] and Turkey [N = 83]), with four different attributes: (1) data protection (data protection vs. no information), (2) manufacturer (government vs. company), (3) reward (no reward vs. voucher as a reward) and (4) gaming (no gaming elements vs. gaming elements). Participants were recruited among a student population. Results: The results showed that data protection is one of the most important factors that significantly increases the probability to adopt a CTA. In general, the manufacturer, reward or gaming affected the probability to download the CTA less. Discussions: Health authorities worldwide have generally released high quality CTA, although scientific studies assessing the most important factors that describe and predict the intention to download is limited. Sensitive personal data is collected through these apps, and may potentially threaten privacy, equality and fairness, which are important attributes to take into account when developing or launching a CTA, following the results of this study. Copyright © 2022 Folkvord, Peschke, Gümüş Ağca, van Houten, Stazi, Roca-Umbert, Güneş Peschke, Seyfafjehi, Gallego, Gaeta, Fico, Karinsalo and Lupianez Villanueva.
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In the last decade, smartphone users grown from 2.8 billion worldwide in 2018 to 3.8 billion in 2021. This fact associates with greater ease of publishing and accessing fake news. This is a particularly concerning issue in a global crisis situation such as the COVID-19 pandemic. As stated by the WHO, this is a global health crisis and the spread of fake information could have a direct impact on people’s wellbeing. Due to this situation, all systems which compose the quadruple helix (i.e., science, economy, politics and media and culture-based public) are under great pressure. On the one hand, citizens demand fast and trusted information, and on the other hand, the scientific community is pushed to publish, resulting in scientific papers published very fast and, sometimes, without adequate peer review processes, as reflected by the unprecedented number of retreats. The PandeVITA ecosystem will contribute to offering a better understanding of how societal actors’ behave, understanding their reaction to and interaction with science and health developments in the context of pandemics, with the aim to encourage citizens to contribute to scientific research with different kinds of data. This paper describes a novel approach to citizen science interventions and user engagement based on motivational theory and behavioral science, aiming to provide a set of architectural components, technologies, tools and analytics to assess citizens’ activities, system performance and stakeholders-related key performance indicators (KPIs) in an observatory fashion, allowing to investigate the motivation of the target participants, user engagement and long-term retention. © Springer Nature Switzerland AG 2021.
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This work proposes a multimodal approach with which to predict the regional Gross Domestic Product (GDP) by combining historical GDP values with the embodied information in Twitter messages concerning the current economic condition. This proposal is of great interest, since it delivers forecasts at higher frequencies than both the official statistics (published only annually at the regional level in Spain) and the existing unofficial quarterly predictions (which rely on economic indicators that are available only after months of delay). The proposed method is based on a two-stage architecture. In the first stage, a multi-task autoencoder is initially used to obtain a GDP-related representation of tweets, which are then filtered to remove outliers and to obtain the GDP prediction from the consensus of opinions. In a second stage, this result is combined with the historical GDP values of the region using a multimodal network. The method is evaluated in four different regions of Spain using the tweets written by the most relevant economists, politicians, newspapers and institutions in each one. The results show that our approach successfully learns the evolution of the GDP using only historical information and tweets, thus making it possible to provide earlier forecasts about the regional GDP. This method also makes it possible to establish which the most or least influential opinions regarding this prediction are. As an additional exercise, we have assessed how well our method predicted the effect of the COVID-19 pandemic. © 2021 Elsevier B.V.
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Introduction: Due to SARS-CoV-2 pandemic there has been a delay in oncological diagnosis and treatments potentially increasing mortality. Aim: To evaluate the effects of the pandemic in patients treated in Clinica Alemana with recent diagnosis of breast cancer, comparing the reason of consultation, stage and treatment to a similar time frame in 2019. Materials and Method: This is a retrospective, descriptive and quantitative study. Analyzing patients registry from April 1st to July 31st, 2020 compared with same time frame of 2019. Retrospective analysis of our database searching for reason of consultation, stage and treatment. Data analysis using STATA, T student test and Fisher exact test, considering significant a p < 0.05. Results: N156, 70 (44.87%) consultations in the 2020-time frame versus 86 (55.13%) in 2019 (p = 0.1). Mean age 55 years versus 58 (p = 0.38). Palpable tumor 25 versus 29 (p = 0.86). There was a difference in patients consulting due to personal breast oncological background, 0 versus 6 (p = 0.033) or familiar breast oncological background 0 versus 6 (p = 0.033). Breast images control 39 versus 53 (p = 0.5). In Pandemic more Her 2 tumors were diagnosed 11 versus 2 (p = 0.006). No differences in stages were observed. Upfront surgical treatment in 49 versus 71 patients (p = 0.85) and neoadjuvant hormonal treatment 7 versus 1 (p = 0.058). Conclusions: In the pandemic time frame there were less consultations due to breast cancer. The majority of the patients came because of a palpable tumor or breast image control without a significant difference compared with a similar time frame in previous year. There were less surgeries and more neoadjuvant hormonal treatments. © 2021, Sociedad de Cirujanos de Chile. All rights reserved.
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The world is experiencing a coronavirus pandemic called SARS-COV-2 which causes coronavirus disease 2019 (COVID 19). This has led to a collapse in health systems, making the management of other diseases a challenge. Similarly, the presence of this disease generates many doubts for oncological groups regarding the provision of standard treatments, which should be carried out as soon as possible, in order to ensure better oncological outcomes. We propose the creation of an index (COVID 19 Cancer Index) taking into account clinical and epidemiological variables and the availability of hospital resources, which are useful for decision making and determining the best treatment for a patient with confirmed or strongly suspected gynecological neoplasia.