Predictor Of Clinical Relapse Research Articles

Modificación de la dosis de mesalazina en función de los niveles de calprotectina fecal en pacientes con colitis ulcerosa en remisión clínica

BackgroundFaecal calprotectin (FC) shows an excellent correlation with endoscopic and histological activity of ulcerative colitis (UC) and it is the best predictor of clinical relapse. Our aim was to evaluate the usefulness of modifying the dose of mesalazine based on FC levels, in clinical practice. MethodsRetrospective, single-centre study in UC patients in clinical remission while treated with mesalazine which dosage was decreased (DOWN) or increased (UP) according to FC levels. The main endpoint was the long-term maintenance of clinical remission. ResultsA total of 56 patients were included (39 DOWN, 17 UP). In the DOWN group, the median baseline dose of mesalazine was 3.6g/day and the median baseline FC was 36μg/g. After a median follow-up of 22 months, 28% required rescue therapy. The cumulative relapse-free survival after tapering was 91% and 82% at 12 and 24 months, respectively. In the UP group, the median baseline dose of mesalazine was 2.4g/day, with a median baseline FC of 524μg/g. After a median follow-up of 12 months, 29% required rescue therapy. The cumulative relapse-free survival after dose increase was 86% and 72% at 12 and 24 months, respectively. ConclusionsMesalazine dose modification based on FC monitoring seems to be a safe strategy in patients with UC in clinical remission, with a probability of clinical relapse around 20% at two years.

Histologic Inflammation can Predict Future Clinical Relapse in Ulcerative Colitis Patients in Endoscopic Remission.

In ulcerative colitis (UC), endoscopic improvement, defined as a Mayo Endoscopic Score (MES) of 0 or 1, is a target of treatment. The aim of our study was to evaluate the risk of clinical relapse between patients with an MES of 0 or 1 and determine if histologic activity using the Robarts Histopathologic Index (RHI) was predictive of clinical relapse. UC patients with an MES score of 0 or 1, no prior colectomy, and at least 1 year of outpatient follow-up after colonoscopy were included. Demographic, clinical characteristics, and clinical relapse were retrospectively collected. Biopsy specimens were read by a gastrointestinal pathologist. Primary outcome was defined as a composite of relapse requiring change in medical therapy, new steroid use, UC-related hospitalization, and/or colectomy. Four hundred and forty-five UC patients were identified. Ninety-five percent of patients with MES 0 were in histologic remission by the RHI whereas only 35% of patients with MES 1 were in histologic remission. Twenty-six percent of patients experienced a clinical relapse; patients with MES 1 or RHI > 3 were significantly more likely to relapse (P < .01) compared to patients with MES 0 or RHI ≤ 3. When patients were stratified into 4 groups (MES 0, RHI ≤ 3; MES 0, RHI > 3; MES 1, RHI ≤ 3; MES 1, RHI > 3) and adjusted for age and sex, RHI > 3 was predictive of relapse (P = .008). UC patients with endoscopic improvement have a high rate of clinical relapse over time. Histologic activity is a predictor of clinical relapse.

Histological Disease Activity as Predictor of Clinical Relapse, Hospitalization, and Surgery in Inflammatory Bowel Disease: Systematic Review and Meta-Analysis.

The clinical impact of histological remission on short- and long-term clinical outcomes in patients with inflammatory bowel disease (IBD) is not well established. We assessed risk of clinical relapse, hospitalization, and need for surgery in patients achieving histological remission in comparison with active histological disease. A systematic review was conducted using MEDLINE, Scopus, Cochrane CENTRAL, EMBASE, and conference abstracts from inception to November 2022. Our main outcome was the rate of clinical relapse in patients with IBD who reached histological remission vs patients with active histological disease. Secondary outcomes were clinical complications of IBD such as hospitalization and need for surgery. The endpoints were investigated at 2 time points, 6 to 12 months (short term) and >12 months (long term). Short-term outcome analysis showed that the risk of clinical relapse was significantly higher in ulcerative colitis patients with active histological disease in comparison with patients at histological remission (risk ratio [RR], 2.41; 95% confidence interval [CI], 1.69-3.44; P < .01). The risk of hospitalization in ulcerative colitis patients was not significant among the 2 groups (RR, 4.22; 95% CI, 0.91-19.62; P = .07). Long-term outcome analysis demonstrated that the risk of clinical relapse (RR, 2.07; 95% CI, 1.55-2.76; P < .01), need for surgery (RR, 3.14; 95% CI, 1.53-6.45; P < .01), and hospitalization (RR, 2.52; 95% CI, 1.59-4.00; P < .01) was significantly higher in patients with active histological disease. Histological remission in IBD represents an important therapeutic goal that is not yet routinely pursued in clinical practice. In our study, patients who achieved histological remission have more favorable outcomes than those with active histological disease in ulcerative colitis.

Neutrophil-to-lymphocyte ratio may predict clinical relapse in ulcerative colitis patients with mucosal healing.

Endoscopic mucosal healing (MH) is an important treatment goal for patients with ulcerative colitis (UC). The neutrophil-to-lymphocyte ratio (NLR) reflects systemic inflammation and has been reported to be a useful predictive marker for UC. This study aimed to evaluate the clinical utility of the NLR for predicting clinical relapse in UC patients with MH. We retrospectively enrolled patients with UC who underwent colonoscopy at the Osaka City University Hospital between January 2010 and December 2010, whose Mayo Endoscopic Subscore was 0 or 1. The correlation between the incidence of relapse and demographic factors, including the NLR, was analyzed. We included 129 patients in the present study. The median NLR at the time of endoscopy was 1.98, and differences in the high NLR group and the low NLR group were compared. During a median follow-up period of 46.4 months, 58 patients (45.0%) experienced relapse. The cumulative relapse-free rate was significantly higher in the low NLR group than in the high NLR group (P = 0.03, log-rank test). Multivariate analysis identified high NLR as an independent prognostic factor for clinical relapse (hazard ratio, 1.74; 95% confidence interval, 1.02-2.98; P = 0.04). NLR is a novel and useful predictor of clinical relapse in UC patients with MH, and it can potentially be a strong indicator to determine the appropriate treatment strategy and decision-making in clinical practice.

Clinical Predictors for Relapse Among Patients with AML Who Responded to Venetoclax-Based Treatment - a Real-World Prospective Analysis from the Revive Study Group

Background: Venetoclax (VEN)-based low intensity combinations are approved for the treatment of patients with acute myeloid leukemia (AML) ineligible for intensive chemotherapy. Despite the encouraging composite complete remission rates demonstrated in the VIALE-A trial, disease relapse remains a frequent event with dismal outcome. The aim of the current analysis is to characterize patterns and clinical predictors of relapse in a real-world setting. Methods: The REVIVE study is a prospective, real-life, observational study that assesses patterns of patient selection, efficacy and toxicity. 189 newly diagnosed AML patients from 12 medical centers in Israel were enrolled at initiation of VEN-based low-intensity therapy, between August 12, 2019, and April 15, 2022 (data cut). Demographic, clinical and patient-related baseline characteristics, as well as treatment patterns, safety and efficacy outcomes were collected. For the current analysis, remission was defined as either achieving complete remission (CR), CR with incomplete count recovery (CRi) or morphological leukemia-free state (MLFS). Relapse-free survival (RFS) was calculated from the date of first response to the date of progression of disease or death from any cause, whichever occurs first or lost follow-up in the population of responding patients (CR, CRi, MLFS). A cox proportional hazards model was used to compare relapse-free survival between subgroups of baseline characteristics. Results: Of the 189 patients recruited to the study, 110 (58.2%) achieved a response (CR- 55.5%, CRi- 39.1%, MLFS- 5.5%). The median age of these patients was 75 years, 58.2% were males and 69.1% had ECOG performance status of 0-1. The median time to remission was 35 (0-193) days. As of data cut, with a median follow-up of 278 (31-878) days, 50 patients (45% of responding patients) who achieved response have relapsed. Median RFS was 425 (275-588) days. 1-year after achieving remission 53.3% (42.3%-64.2%) of the patients remained in remission. The estimated OS of the patients who responded was 509 (302-680) days. In univariate analysis, there was a statistically significant association of age (p=0.005) and baseline neutrophil counts (p=0.001) with RFS. The expected hazard of relapse in patients <75 of age was 0.4 times the hazard in patients ≥75 (median RFS of 588 vs. 275 days, respectively). The expected hazard of relapse in patients with baseline neutrophils ≥1,000 cells/µl was 2.7 times the expected hazard in patients <1,000 cells/µl. Patients with a normal BMI (<25) had a hazard of relapse that was higher than those with an overweight BMI (≥25) (p=0.06). There was no statistical association of gender, ECOG performance status, type of AML, cytogenetic risk group, and prior HMA exposure with RFS. On a multivariate analysis, only age and baseline neutrophil counts remained significant in the cox proportional hazards model. A comparison of responding patients with prior myeloproliferative neoplasms (MPNs) (n=14), patients who were excluded from registrational clinical studies, to patients with therapy-related AML/ prior MDS (n=40) demonstrated a significant association with RFS. The median RFS was 154 days (range 76-not reached) in the MPN group compared to not reached in the other group (range 298-not reached, KM estimation for 1 year of 25% vs. 63.8%, respectively p=0.0119). Conclusions: In a real-world, prospective analysis, newly diagnosed AML patients who responded to treatment demonstrated a median relapse free survival of more than 1 year (425 days). Clinical factors significantly associated with shorter RFS were age≥75 and baseline neutrophil counts (≥1,000 cells/µl). AML patients with prior MPN have a shorter RFS compared to other secondary AML patients. Analysis of patterns of post-relapse salvage approaches and survival is planned for future analysis. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Anti-neutrophil cytoplasmic antibody patterns can predict clinical relapse in ANCA-associated vasculitis: overall population and subgroups.

In anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), relapses are cause of concern as they are unpredictable and predictors of poor prognosis. We aimed to assess the characteristic and predictors of clinical relapse in AAV. This retrospective study included 132 cases of AAV newly diagnosed from January 2016 through November 2021 in the Affiliated Hospital of Qingdao University. We reviewed clinical data of patients and analysed the risk factors for clinical relapse of overall population and subgroups by univariate and multivariate regression models and the K-M survival curve was plotted. The rate of relapse was highest in the positive conversion group than the others significantly (p<0.001). In overall population, ANCA patterns (p<0.001; persistent positive pattern: HR=3.352, 95%CI 1.463~7.678, p=0.004; positive conversion pattern: HR=4.760, 95%CI 2.094~10.820, p<0.001) and infections (HR =4.684, 95%CI 1.980~11.079, p<0.001) were significantly associated with clinical relapse. In myeloperoxidase (MPO)-AAV patients, ANCA patterns (p=0.001; persistent positive pattern: HR=4.495, 95%CI 1.508~13.396, p=0.007; positive conversion pattern: HR=7.404, 95%CI 2.652~20.671, p<0.001) and infections (HR=3.594, 95%CI 1.511~8.547, p=0.004) were significantly associated with clinical relapse. In renal involvement patients, ANCA patterns (p=0.004; persistent positive pattern: HR=3.618, 95%CI 1.364~9.592, p=0.01; positive conversion pattern: HR=4.492, 95%CI 1.778~11.352, p<0.001) and infections (HR=7.791, 95%CI 2.511~24.174, p<0.001) were significantly associated with clinical relapse, but were not in patients without renal involvement. Persistently positive and re-positive ANCA and infections predict clinical relapse in AAV, especially in patients with MPO-AAV and renal involvement. Regular ANCA monitoring should be carried out in high-risk populations.

Therapeutic drug monitoring of LAI antipsychotics as a predictor of clinical relapse: a one-year follow-up

IntroductionClinical relapses in schizophrenia remain a frequent event. Long-acting injectable (LAI) antipsychotics enhance adherence, but low blood levels can sometimes be observed despite an adequate posology. Nonetheless, the evaluation of this parameter is uncommon in clinical practice.ObjectivesTo explore the potential advantages of therapeutic drug monitoring (TDM) of LAIs as a predictor of relapse in clinically stable outpatients with schizophrenia.Methods44 individuals who had reached the pharmacokinetic steady state of LAI treatment (paliperidone, olanzapine, aripiprazole) underwent an anamnestic and psychopathological assessment. LAI blood levels were measured using liquid chromatography-mass spectrometry and classified as “in range” or “under range” according to the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) guideline values. Individuals who relapsed during the one-year follow-up were compared to non-relapsers (Fisher’s exact test, χ2 or Mann-Whitney U). An exploratory binary logistic regression tested the role of other possible relevant predictors of relapse.ResultsNo differences were observed in baseline use of mood stabilisers (p=0.211), antidepressants (p=0.530), or prescribed LAI (p=0.563). Other comparisons are presented in the table: among these variables, in-range LAI levels were the only significant predictor of relapse (F=5.95, p=0.015; OR 0.04, 95%CI 0.02-0.56).Relapse (n=6)No relapse (n=38)pAge (years)41.33±10.7843.95±12.980.667Male4 (66.7%)21 (55.3%)0.600Illness duration (years)21.83±2.6419.13±11.820.289Previous acute episodes3.50±1.053.29±1.470.652PANSS-total49.33±14.8342.74±14.140.231In-range LAI2 (33.3%)32 (84.2%)0.006ConclusionsTDM of LAIs may optimise the clinical management of schizophrenia by highlighting a suboptimal dosage and a consequent higher relapse risk. Large-scale, drug-specific assessments are needed to confirm these findings.DisclosureNo significant relationships.

Mucosal interleukin-8 expression as a predictor of subsequent relapse in ulcerative colitis patients with Mayo endoscopic subscore 0.

Complete endoscopic mucosal healing is defined as a Mayo endoscopic subscore of 0. Some patients diagnosed with a Mayo endoscopic subscore 0 may present with subsequent clinical relapse. Here, we aimed to demonstrate mucosal cytokine profile as a predictor of clinical relapse in ulcerative colitis patients with a Mayo endoscopic subscore of 0 as a marker of mucosal healing. We conducted prospective observational pilot study to examine the relationship between mucosal cytokine expression and subsequent relapse of UC patients diagnosed with a Mayo endoscopic subscore of 0. We enrolled 55 patients, and expression of cytokines tumor necrosis factor-α, interferon γ, interleukin-1β, interleukin-2, interleukin-4, interleukin-5, interleukin-6, interleukin-7, interleukin-8, interleukin-9, interleukin-10, interleukin-12, interleukin-13, interleukin-15, interleukin-17A, interleukin-17F, interleukin-18, interleukin-21, interleukin-22, interleukin-23, interleukin-27, and interleukin-33 was measured by quantitative real-time PCR using rectal mucosa biopsy materials. Cytokine expression levels were compared between patients who relapsed between March 1, 2016, and March 30, 2020, of the study period and those who remained in remission. Ten cytokines, including interleukin-2, interleukin-4, interleukin-8, interleukin-10, interleukin-12, interleukin-15, interleukin-17A, interleukin-21, interleukin-23, and interleukin-33, were significantly elevated in patients with subsequent relapse compared with those who remained in remission. Interleukin-8 expression was the most useful predictor. In the rectal mucosa of ulcerative colitis patients with Mayo endoscopic subscore 0, levels of several cytokines were elevated in cases of subsequent relapse. Among these, interleukin-8 expression was the most useful for predicting relapse.

Clinical Predictors of Relapse in a Cohort of Steroid-Treated Patients With Well-Controlled Myasthenia Gravis.

ObjectiveDespite the high efficiency of glucocorticoids (GCs), ~18–34% patients with myasthenia gravis (MG) may experience relapses of the disease. Here, we aim to identify clinical factors related to relapses during steroid tapering or after withdrawal in MG patients who were well-managed on steroid monotherapy.MethodsWe conducted a retrospective study on 125 MG patients from the Xuanwu Hospital MG Trial Database. Patients were treated with corticosteroids and achieved minimal manifestation status (MMS) or better. Patients were divided into steroid reduction subset (N = 74) and steroid withdrawal subset (N = 51). Clinical characteristics and therapeutic data were compared between patients with disease relapse and those who maintained clinical remission at the last follow-ups. Cox proportional hazards regression models were used to identify risk factors of relapse in each subset.ResultsThirty-seven (29.6%) patients experienced relapses during the follow-up periods. Relapse during the steroid reduction was significantly associated with drug reducing duration (HR = 0.81, 95%CI 0.74–0.89, P < 0.001). Risk of relapse was augmented if the drug reducing duration was <11.5 months (HR 27.80, 95%CI 5.88–131.57, P < 0.001). Among patients who discontinued the steroids, those with onset symptoms of bulbar weakness (adjusted HR 3.59, 95%CI 1.19–10.81, P = 0.023) were more likely to experience relapse.ConclusionOur study demonstrated that patients could benefit from prolonged steroid-reducing duration to prevent disease relapse. Patients with bulbar weakness at disease onset should be proposed to take long-term steroids or other immunosuppressants.

Beyond complete endoscopic healing: Goblet appearance using an endocytoscope to predict future sustained clinical remission in ulcerative colitis

Complete endoscopic healing, defined as Mayo endoscopic score (MES) = 0, is an optimal target in the treatment of ulcerative colitis (UC). However, some patients with MES = 0 show clinical relapse within 12 months. Histologic goblet mucin depletion has emerged as a predictor of clinical relapse in patients with MES = 0. We observed goblet depletion in vivo using an endocytoscope, and analyzed the association between goblet appearance and future prognosis in UC patients. In this retrospective cohort study, all enrolled UC patients had MES = 0 and confirmed clinical remission between October 2016 and March 2020. We classified the patients into two groups according to the goblet appearance status: preserved-goblet and depleted-goblet groups. We followed the patients until March 2021 and evaluated the difference in cumulative clinical relapse rates between the two groups. We identified 125 patients with MES = 0 as the study subjects. Five patients were subsequently excluded. Thus, we analyzed the data for 120 patients, of whom 39 were classified as the preserved-goblet group and 81 as the depleted-goblet group. The patients were followed-up for a median of 549 days. During follow-up, the depleted-goblet group had a significantly higher cumulative clinical relapse rate than the preserved-goblet group (19% [15/81] vs. 5% [2/39], respectively; P = 0.02). Observing goblet appearance in vivo allowed us to better predict the future prognosis of UC patients with MES = 0. This approach may assist clinicians with onsite decision-making regarding treatment interventions without a biopsy.

ANCA-Associated Vasculitis Clinical Presentation and Clinical Predictors of Relapse in Saudi Arabia

BackgroundAnti-neutrophil cytoplasm antibodies-associated vasculitis (AAV) is a rare autoimmune condition with high-relapsing rate and incidence of complications, resulting in increased morbidity and mortality. Characters of patients with anti-neutrophil cytoplasm antibodies-associated vasculitis in Saudi Arabia require further exploration.ObjectiveTo evaluate the clinical profile, relapse rate and disease-related complications among patients with AAV at a tertiary hospital in Saudi Arabia. To estimate the role of BVAS score at the time of presentation in predicting relapse during the disease course.Design and SettingThis retrospective cohort study was performed through data collection from patients’ records who had AAV, who visited the rheumatology clinic. The collected data involved the demographics of patients and their investigations, medications, and outcomes of treatment. Statistical analysis was executed through SPSS version 26.ResultsFifty-two patients were eligible for inclusion, while 48 patients were analyzed because of missing data. Females represented 60.4%. Half of the patients were more than 50 years old, and 68.8% had comorbidities. As for diagnosis, 62.5% had granulomatosis with polyangiitis, 25% had eosinophilic granulomatosis with polyangiitis, and 12.5% had microscopic polyangiitis. The rate of relapse was 31.3%, while the remission rate was 68.8%. Additionally, 66.7% had lower respiratory involvement, and 43.8% had renal involvement. More than half of the patients had BVAS score below 14.5 points. The study did not explore a positive correlation between the disease relapse and high BVAS at the first presentation.ConclusionEarly prediction of relapse and such intervention is of paramount importance in order to avoid accrual of organ damage with treatments that prevent further relapses. BVAS score was not found to be a potential predictor in our study. Future studies are highly endorsed, with prospective design and large sample size to achieve statistical significance for the incidence of relapses and complications.

Predictors of clinical relapse in patients with new-onset inflammatory bowel disease: A retrospective single-center study

Background and Aims: Inflammatory bowel disease (IBD) usually follows a pattern of more or less frequent relapses of alterable duration, interspersed with periods of remission. Various clinical predictors have been broadly studied, but the research study populations reported are mostly from Western countries. Methods: From January 2013 to December 2018, 106 new-onset Crohn's disease (CD) patients and 76 new-onset ulcerative colitis (UC) patients were followed up for a median of 12 months or until relapse. The predictors of clinical relapse were analyzed according to demographic, clinical, histological, endoscopic, and imaging variables. Results: In multivariate analysis, predictors of relapse were age of onset <35 years (hazard ratio [HR] = 5.236; 95% confidence interval [CI] 1.252–22.222; P = 0.023) in CD patients and poor medication adherence (HR = 2.070; 95% CI 1.018–4.202; P = 0.044) in UC patients. Conclusion: Younger age of onset and poor medication adherence increases the risk of clinical relapse in CD and UC, respectively.

Virological and immunological predictors of long term outcomes of peginterferon alfa-2a therapy for HBeAg-negative chronic hepatitis B

Predictors of long-term outcomes of peginterferon (PegIFN) therapy for patients with chronic hepatitis B (CHB) remain to be explored. This study aimed to evaluate the predictive value of virological and immunological biomarkers and outcomes of PegIFN for CHB. 57 HBeAg-negative CHB patients receiving 48 weeks of PegIFN therapy were prospectively followed for a median period of 5.3 years after the end of treatment (EOT). Serum CXCL9 and IP-10 levels were measured. Flow cytometry analysis for T cell subsets was performed in 23 patients. Factors associated with long-term outcomes were analyzed. The cumulative incidences of virological relapse, clinical relapse and HBsAg loss at year 7 were 18.1%, 0%, 31.6%, respectively, in patients with sustained off-treatment virological response (SVR), and 100%, 67.4%, 6.7%, respectively, in patients without SVR. By multivariate analysis, baseline CXCL9 > 80pg/mL (hazard ratio (HR)=0.418, p=0.018) and on-treatment HBsAg declines were associated with a lower risk of virological relapse. Non-SVR was the only predictor of clinical relapse. CXCL9 >200pg/mL (HR=8.154, p=0.038) and HBsAg <750 IU/mL (HR=10.507, p=0.036) were baseline predictors of HBsAg loss, while HBsAg decline >1 log at EOT (HR=23.296, p=0.005) was the on-treatment predictor of HBsAg loss. In subgroup patients with available PBMC, populations of T cell subsets correlated with virological and clinical relapses in univariate analysis. Baseline serum CXCL9 and HBsAg levels could predict HBsAg loss after PegIFN therapy for HBeAg-negative CHB. Combining virological and immunological biomarkers could predict long-term outcomes of PegIFN therapy for HBeAg-negative CHB.

Brief Report: Predictors of Relapse for Patients With Dextromethorphan Dependence.

The recreational use of dextromethorphan (DXM) triggers dependence. The pattern and clinical predictors of relapse are unclear. Here, we retrospectively analyzed the clinical information of 28 patients with DXM dependence (20 males and 8 females). The mean age at admission was 25.89 years (standard deviation [SD] = 7.84), and the average duration of DXM abuse was 24.96 months (SD = 17.40). The relapse rates at 1 month, 3 months, 6 months, and 1 year were 7.14%, 25%, 71.43%, and 89.29%, respectively. Depression and anxiety status at baseline were positive predictors of relapse (r = -.539, P = .006, R2 = 0.290; r = -.449, P = .024, R2 = 0.202, respectively). Our results suggest that patients with DXM dependence are at high risk of relapse and that measuring affective disturbance is important for predicting the outcomes of their treatment. This study first identified a high relapse rate among patients with DXM dependence and found that the baseline depression and anxiety status was correlated with the time length of relapse. These findings not only warn us of the vulnerability of DXM-dependent relapse but also reveal the importance of measuring affective disturbance in relapse prevention. (Am J Addict 2020;00:00-00).

T238. RATES AND PREDICTORS OF RELAPSE IN AN AUSTRALIAN FIRST EPISODE PSYCHOSIS COHORT

BackgroundClinical and functional recovery is usually achieved after treatment for a first episode of psychosis (FEP). Unfortunately, subsequent relapse remains common, occurring within a year for approximately 30% of individuals and within five years for 80%. What makes someone more likely to relapse remains poorly understood.MethodsThis study is a naturalistic cohort study of young people (15–25 years old) accessing an early intervention in psychosis service in Melbourne, Australia between 1st January 2011 and 31st December 2016. Demographic and clinical predictors of relapse were collected from patient records and analysed using Cox regression analysis.ResultsA total of 1220 young people presented with a FEP during the study period and 37.7% (N=460) experienced at least one relapse during their episode of care. Over half of all relapses resulted in an admission to hospital. Non-adherence to medication, substance use and psychosocial stressors precipitated relapses. Significant predictors of relapse in this sample were a diagnosis of a schizophrenia spectrum disorder or an affective psychotic disorder, amphetamine use, and substance use during treatment.DiscussionThese findings suggest that relapse occurs frequently for young people who have experienced FEP. This is one of the first studies to find that amphetamine use increases the risk of relapse. Clinical services, especially in Australasia, need to consider how best to manage this co-morbidity in young people with FEP.

Naturalistic follow-up in bipolar patients after successful electroconvulsive therapy

BackgroundElectroconvulsive therapy (ECT) is an effective treatment for acute depression, mania and mixed states. We evaluated the long-term outcome of patients with bipolar depression or mixed state, responsive to ECT. Methodsthis observational follow-up study was conducted in 70 patients with Bipolar Disorder: 36 patients met DSM-IV-TR criteria for a major depressive episode (MDE) and 34 for a mixed episode (MXE). During the follow-up after ECT, the relapse rates and the duration of response and remission periods were recorded. Resultsthe mean duration of the follow-up was 57 weeks. 93% of the patients maintained at least a partial therapeutic response for more than 90% of the follow-up period. 73% of patients fulfilled the criteria for a full remission, 33% showed a depressive relapse and 10% a mixed relapse. No manic relapses occurred but almost 1/3 of the sample presented hypomanic episodes. MDE patients presented higher rates of remission compared to MXE ones. Patients with anxiety disorders reported earlier relapses than those without this comorbidity. Relapsed-patients showed higher functional impairment at baseline evaluation, compared to non-relapsed ones. Limitationsnonrandom allocation, limited sample size, possible influence of psychopharmacological treatment. ConclusionsGiven several methodological limitations, this study cannot draw definite conclusions but could suggest that in treatment-resistant bipolar patients with severe depression or mixed state, ECT may represent a useful treatment option. Patients with mixed features, comorbid anxiety disorders and higher functional impairment present less favorable outcome. Future research on long-term efficacy of ECT and on clinical predictors of relapse is needed.

Gliadin-Induced Ex Vivo T-Cell Response in Dermatitis Herpetiformis: A Predictor of Clinical Relapse on Gluten Challenge?

Gliadin-Induced Ex Vivo T-Cell Response in Dermatitis Herpetiformis: A Predictor of Clinical Relapse on Gluten Challenge?

Rates and Predictors of Relapse in First-Episode Psychosis: An Australian Cohort Study

Abstract Background Clinical and functional recovery is usually achieved after treatment for a first episode of psychosis (FEP). Unfortunately, subsequent relapse remains common, occurring within a year for approximately 30% of individuals and up to 80% over 5 years. Factors that make relapse more likely in any given individual remain poorly understood. Methods This article presents a naturalistic cohort study of young people (15–24 years old) accessing an early intervention in psychosis service in Melbourne, Australia between January 1, 2011 and December 31, 2016. Demographic and clinical predictors of relapse were collected and analyzed using Cox regression analysis. Results A total of 1220 young people presented with an FEP during the study period; 37.7% (N = 460) experienced at least 1 relapse during their episode of care. Over half of all relapses resulted in an admission to hospital. Non-adherence to medication, substance use, and psychosocial stressors were commonly noted as clinical precipitants of relapse. Significant predictors of relapse (vs no relapse) were a diagnosis of schizophrenia spectrum disorder (adjusted hazard ratio [aHR] = 1.62) or affective psychotic disorder (aHR = 1.37), lifetime amphetamine use (aHR = 1.48), and any substance use during treatment (aHR = 1.63). Conclusion These findings suggest that relapse occurs frequently for young people who have experienced FEP. This is one of the first studies to report that amphetamine use (predominantly illicit methamphetamine) increases the risk of relapse. Clinical services, especially in Australasia, need to consider how best to manage this comorbidity in young people with FEP.

Predictors of relapse after cessation of nucleos(t)ide analog treatment in HBeAg-negative chronic hepatitis B patients: A meta-analysis

ObjectivesThe aim of this study was to identify the predictors of relapse after the withdrawal of nucleos(t)ide analog (NA) therapy in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB). MethodsThe PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched through January 2019. A random-effects model meta-analysis was performed, with hazard ratios (HR) and 95% confidence intervals (CI) used as summary statistics. ResultsSeventeen studies were included in the meta-analysis. Age (HR=1.022 per year), baseline hepatitis B surface antigen (HBsAg) (HR=1.509 per log IU/l), end of treatment (EOT) HBsAg level (HR=1.896 per log IU/l), EOT HBsAg level ≥1000 IU/ml (HR=1.749), and HBsAg decline from baseline to EOT (HR=0.748 per log IU/l) were associated with virological relapse. The predictors of clinical relapse were baseline HBsAg level (HR=1.312 per log IU/l), EOT HBsAg level (HR=1.458 per log IU/l), EOT HBsAg level ≥100IU/ml (HR=3.199) or ≥1000 IU/ml (HR=1.810), and duration of consolidation therapy (HR=0.991 per month). ConclusionsThis meta-analysis indicates that age, the duration of consolidation therapy, and levels of baseline and EOT HBsAg were factors predictive of relapse in HBeAg-negative CHB patients who discontinued NA treatment.

Effects of Delay Discounting and Other Predictors on Smoking Relapse.

Despite the substantial decrease in the prevalence of tobacco smoking and the availability of effective smoking cessation treatments, smoking relapse after formal treatments remains extremely high. Evidence regarding clinical predictors of relapse after quitting is essential to promote long-term abstinence among those who successfully quit. This study aimed to explore whether baseline delay discounting (DD) rates and other sociodemographic, psychological, and smoking-related variables predicted relapse to smoking at six-month follow-up. Participants were 188 adult smokers (mean age = 42.9, SD = 12.9; 64.4% females) who received one of three treatment conditions: 6-weeks of cognitive-behavioral treatment (CBT) alone; or combined with contingency management (CBT + CM); or combined with cue exposure treatment (CBT+CET). Smoking status was biochemically verified. Logistic regression was conducted to examine prospective predictors of smoking relapse at six months after an initial period of abstinence. Greater DD rates (OR: 0.18; 95% CI [0.03, 0.93]), being younger (OR: 0.96; 95% CI [0.94, 0.99]), high nicotine dependence (OR: 1.34; 95% CI [1.13, 1.60]), and a higher number of previous quit attempts (OR: 4.47; 95% CI [1.14, 17.44]) increased the likelihood of smoking relapse at six-month follow-up. Besides sociodemographic and smoking-related characteristics, greater DD predisposes successful quitters to relapse back to smoking. These results stress the relevance of incorporating specific treatment components for reducing impulsivity.