Months Of Remission Research Articles

Prioritizing Hormone Therapy Over Vigabatrin as the First Treatment for Infantile Spasms: A Quality Improvement Initiative.

Infantile spasms (IS) are early childhood seizures with potentially devastating consequences. Standard therapies (adrenocorticotropic hormone [ACTH], high-dose prednisolone, and vigabatrin) are strongly recommended as the first treatment for IS. Although this recommendation comes without preference for one standard therapy over another, early remission rates are higher with hormone therapy (ACTH and high-dose prednisolone) when compared with vigabatrin. Using quality improvement (QI) methodology that included hormone therapy as the first treatment, we sought to increase the percentage of children with new-onset nontuberous sclerosis complex (TSC)-associated IS achieving 3-month electroclinical remission from a mean of 53.8% to ≥70%. This was an observational consecutive sample cohort study at a single academic tertiary care hospital that compared a prospective intervention cohort (May 2019-January 2022, N = 57) with a retrospective baseline cohort (November 2015-April 2019, N = 67). Our initiative addressed key drivers such as the routine use of vigabatrin over hormone therapy as first treatment and the common initiation of a second treatment after 14 days for initial nonresponders. We included consecutive children without TSC presenting with new-onset IS diagnosed and treated between ages 2 and 24 months. We displayed our primary outcome and process measures as control charts in which the centerline is the quarterly (previous 3 months) mean based on statistical process control methodology. QI interventions that included the standardization of hormone therapy as the first treatment resulted in higher rates of 3-month remission, rising from 53.8% (baseline cohort) to 75.9% (intervention cohort). Process measure results included an increased rate of children receiving hormone therapy as first treatment (mean, 44.6%-100%) and a decreased number of days to both clinical follow-up after first treatment (mean, of 16.3-12.6 days) and starting a second treatment within 14 days for initial nonresponders (mean, 36.3-17.2 days). For children with IS, improved rates of 3-month electroclinical remission can be achieved with QI methodology. Implementation of similar QI initiatives at other centers may likewise improve local remission rates.

A Machine Learning Approach to Predict Remission in Patients With Psoriatic Arthritis on Treatment With Secukinumab.

BackgroundPsoriatic Arthritis (PsA) is a multifactorial disease, and predicting remission is challenging. Machine learning (ML) is a promising tool for building multi-parametric models to predict clinical outcomes. We aimed at developing a ML algorithm to predict the probability of remission in PsA patients on treatment with Secukinumab (SEC).MethodsPsA patients undergoing SEC treatment between September 2017 and September 2020 were retrospectively analyzed. At baseline and 12-month follow-up, we retrieved demographic and clinical characteristics, including Body Mass Index (BMI), disease phenotypes, Disease Activity in PsA (DAPSA), Leeds Enthesitis Index (LEI) and presence/absence of comorbidities, including fibromyalgia and metabolic syndrome. Two random feature elimination wrappers, based on an eXtreme Gradient Boosting (XGBoost) and Logistic Regression (LR), were trained and validated with 10-fold cross-validation for predicting 12-month DAPSA remission with an attribute core set with the least number of predictors. The performance of each algorithm was assessed in terms of accuracy, precision, recall and area under receiver operating characteristic curve (AUROC).ResultsOne-hundred-nineteen patients were selected. At 12 months, 20 out of 119 patients (25.21%) achieved DAPSA remission. Accuracy and AUROC of XGBoost was of 0.97 ± 0.06 and 0.97 ± 0.07, overtaking LR (accuracy 0.73 ± 0.09, AUROC 0.78 ± 0.14). Baseline DAPSA, fibromyalgia and axial disease were the most important attributes for the algorithm and were negatively associated with 12-month DAPSA remission.ConclusionsA ML approach may identify SEC good responders. Patients with a high disease burden and axial disease with comorbid fibromyalgia seem challenging to treat.

Elaboration and pilot study of 3D vaccines for oncotherapy

The purpose of the study was to study the possibility of using intracorporeal constructs in vivo with healthy or autologous dead tumor cells on porous extracellular matrix of titanium nickelide (PEMTN).We aimed to determine the advantage of the effect of this method on the change in the immunological status of cancer patients in comparison with patients receiving traditional treatment.The study used CBA and AKR JY mice and studied 10 patients with solid stage IV tumors of various localization (pancreas, intestines, lungs, ovary, head and neck) and 3 oncohematological patients (lymphoblastic lymphosarcoma, chronic myeloid leukemia (CML)).PEMTN was seeded with a suspension with bone marrow cells from CBA mice and cultured for 8 weeks in a long-term Dexter culture. It was shown that after 6 weeks of incubation of bone marrow cells on PEMNT in vitro, the proportion of bone marrow cells produced from the pores of the matrix into the liquid medium varied within 58–82%, which corresponded to the figures of the 1st week of incubation.After implantation of PEMTN with fetal liver cells in AKR/JY mice with spontaneous lympholeukemia, the implant successfully engrafted and after 30 days, no noticeable fluctuations in the leukocyte count were observed. After 3–4 weeks implantation, a 3-fold increase in the level of erythrocytes with fetal hemoglobin, which is not normally found in adult AKR/JY mice, was observed. There was also an increase (by 274%, p < 0.05) in the number of blood reticulocytes and a 26% decrease in the activity of the tumor process.In cancer patients with solid tumors, the level of SH-groups erythrocytes of blood increased 1.5–2.3 times 2 months after the implantation of hybrid oncotherapy implants carrying autologous apoptized tumor cells, treated in vitro. This implants, already 3–4 weeks after implantation in oncopatients, restored the blood system parameters.The most active (2–3 times) increased individual indicators of cellular immunity, in particular the number of NK cells, active (CD25+) and apoptotic lymphocytes (CD95+ marker). From the 3rd month of the study, the level of humoral immunity increased (immunoglobulins, circulating immune complexes). Clinically, the activation of immunity was accompanied by the stabilization of the process or a decrease in the volume and fragmentation of the primary nodes of solid tumors.In oncohematological patients, an increase in the CD95 marker in the peripheral cells of blood was observed.Therefore, in a patient with CML, the implantation, which followed therapy with low doses of cytostatics (myelosan, hydroxyurea) and the immune effect of the implantation, led to a 6-month hematological remission with normal values of the total number of leukocytes and leukocyte blood count. It has been shown that healthy cells in this matrix retain their viability and it allows them to multiply both in the in vitro system and in the in vivo system. The possibility of clinical use of PEMNT carrying autologous dead tumor cells treated in vitro with the aim of improving antitumor immunity, accelerating the recovery of blood counts in cancer patients and achieving partial remission has been shown.

Children included in randomised controlled trials of biologics in inflammatory bowel diseases do not represent the real-world patient mix.

SummaryBackgroundPatients enrolled in randomised controlled trials (RCTs) may differ from the target population due to restricted eligibility criteria.AimTo compare treatment response to biologics in routine practice for children with inflammatory bowel diseases (IBD) who would and would not have been eligible for enrolment in the regulatory RCT of the same drug.MethodsWe enrolled children with IBD who initiated adalimumab, infliximab, vedolizumab or ustekinumab. The eligibility criteria as defined in the RCT of the corresponding biologic were applied to each patient. The primary outcome was 12‐month steroid‐free remission (SFR) without switching biologics or undergoing surgery.ResultsWe screened 289 children (198 [68%] with Crohn's disease [CD], 91 [32%] with ulcerative colitis [UC]) with 326 initiations of biologics. Only 62 of 164 (38%) children with moderate–to‐severe disease would have been eligible for inclusion in the original RCTs. The SFR rate was higher in the eligible children (51%) than in the ineligible children (31%; OR 2.3 [95%CI 1.2–4.5]; p = 0.01). The main exclusion criterion was prohibited previous therapies (47%). Ineligible CD patients were older, more often had a family history of IBD and had higher levels of CRP than eligible children; in UC there were no differences between the groups.ConclusionMost children with IBD who initiate biologics would not have been eligible to be included in the corresponding regulatory RCTs. The outcomes of ineligible patients were worse than for eligible patients. Results from RCTs should be interpreted with caution when applied to clinical practice.

Associations of Serum Serotonin Levels with 12-week and 12-month Remission in Patients with Depressive Disorders.

ObjectiveTo investigate associations between baseline serum serotonin levels and short- and long-term treatment outcomes in outpatients with depressive disorders in a naturalistic one-year prospective study design.MethodsPatients were recruited at a University hospital in South Korea from March 2012 to April 2017. At baseline, blood samples were obtained from 1,094 patients who received initial antidepressant monotherapy (Step 1). After the Step 1 treatment, further treatment steps (at least Steps 2−4) could be administered every 3 weeks during the acute treatment phase (3, 6, 9, and 12 weeks; n = 1,086), and every 3 months during the continuation treatment phase (6, 9, and 12 months; n = 884). In cases showing an insufficient response or intolerable side effects, patients were asked to choose whether to remain at the current step or enter the next treatment step, with alternative strategies including switching, augmentation, combination, and a mixture of these approaches. Remission was defined as a Hamilton Depression Rating Scale score of ≤ 7.ResultsThe remission group had significantly higher baseline serum serotonin levels among patients who received Step 1 monotherapy in both acute and continuation treatment phases. These associations remained significant after adjustment for relevant covariates. No associations were found with any other treatment steps.ConclusionBaseline serum serotonin levels may be used as a biomarker for predicting short- and long-term treatment outcomes in antidepressant monotherapy-treated patients with depressive disorders in a real-world clinical setting.

Prospective associations of multimodal serum biomarkers with 12-week and 12-month remission in patients with depressive disorders receiving stepwise psychopharmacotherapy

Prognostic biomarkers for depression treatment outcomes have yet to be elucidated. This study sought to evaluate whether a multi-modal serum biomarker panel was prospectively associated with 12-week and 12-month remission in outpatients with depressive disorders receiving stepwise psychopharmacotherapy. At baseline, 14 serum biomarkers and socio-demographic/clinical characteristics were evaluated in 1094 patients. They received initial antidepressant monotherapy followed, as required by a protocol of successive alternative pharmacological strategies administered in 3-week steps during the acute (3–12 week) phase (N = 1086), and in 3-month steps during the continuation (6–12 month) phase (N = 884). Remission was defined as a Hamilton Depression Rating Scale score of ≤ 7. Remission was achieved in 490 (45.1%) over the 12-week, and in 625 (70.7%) over the 12-month, treatment periods. Combination scores of four serum biomarkers (high-sensitivity C-reactive protein, interleukin-1 beta, interleukin-6, and leptin) were prospectively associated with 12-week remission; and four (high-sensitivity C-reactive protein, tumor necrosis factor-alpha, interleukin-1 beta, and brain-derived neurotrophic factor) were prospectively associated with 12-month remission in a clear gradient manner (P-values < 0.001) and after adjustment for relevant covariates. These associations were evident after the Step 1 treatment monotherapy but weakened with increasing treatment steps, falling below statistical significance after 4 + treatment steps. Application of combined multiple serum biomarkers, particularly on inflammatory markers, could improve predictability of remission at acute and continuation treatment phases for depressive disorders. Patients with unfavourable biomarkers might require alternative treatment regimes for better outcomes.

Comparison of fully coated anti-reflux metal stenting and per-oral endoscopic myotomy in patients with achalasia: a propensity score-matched retrospective study

BackgroundAchalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of per-oral endoscopic myotomy (POEM) treatment is equivalent to that of surgical myotomy. So far, there is still few evidence to prove FCARMS implantation or POEM which is better for achalasia. The choice of treatment for achalasia is still controversial. The aim of this study is to find a more suitable therapy for achalasia by comparing the efficacy of FCARMS implantation and POEM.MethodsA propensity score (PS) matching (1:2) was used in this retrospective cohort study. Data collected from consecutive patients of Achalasia, receiving FCARMS implantation or POEM therapy at the department of gastroenterology, the Seventh Medical Center of the Chinese People’s Liberation Army General Hospital from May 2007 to May 2018. According to their previous treatment, they are divided into two groups, FCARMS group and POEM group. Clinical efficacy and complications were compared between the two groups.ResultsA total of 166 cases were collected, including 113 cases of FCARMS and 53 cases of POEM. By PS matching, 150 patients were enrolled (100 cases of FCARMS and 50 cases of POEM). By comparison, the FCARMS group has shorter operation time, shorter fasting time and lower hospitalization costs than the POEM group (p < 0.05). Common complications in the FCARMS group are nausea, vomiting, and stent shift. Repetitions of gastroscopy in the FCARMS group was more often, which were 3.8 ± 2.4 (vs 2.1 ± 1.8 of POEM) (p = 0.00 < 0.05) The 6-month remission rates of the FCARMS combination POEM group were 89% and 94%, respectively (p = 0.39), and the 2-year remission rates were 61% and 90%, respectively (p = 0.00).ConclusionsStent placement is a cost-effective and safe treatment option for achalasia. The short-term effect (less than 6 months) of FCARMS is similar to that of POEM, the long-term effect (more than 2 years), POEM is better than FCARMS. HRMIIis most suitable for POEM treatment. It indicate that Patients can choose treatment methods according to their own conditions.

Adaptive/innate immunity balance in a complex social world

Prognostic biomarkers for depression treatment outcomes have yet to be elucidated. This study sought to evaluate whether a multi-modal serum biomarker panel was prospectively associated with 12-week and 12-month remission in outpatients with depressive disorders receiving stepwise psychopharmacotherapy. At baseline, 14 serum biomarkers and socio-demographic/clinical characteristics were evaluated in 1094 patients. They received initial antidepressant monotherapy followed, as required by a protocol of successive alternative pharmacological strategies administered in 3-week steps during the acute (3–12 week) phase (N = 1086), and in 3-month steps during the continuation (6–12 month) phase (N = 884). Remission was defined as a Hamilton Depression Rating Scale score of ≤ 7. Remission was achieved in 490 (45.1%) over the 12-week, and in 625 (70.7%) over the 12-month, treatment periods. Combination scores of four serum biomarkers (high-sensitivity C-reactive protein, interleukin-1 beta, interleukin-6, and leptin) were prospectively associated with 12-week remission; and four (high-sensitivity C-reactive protein, tumor necrosis factor-alpha, interleukin-1 beta, and brain-derived neurotrophic factor) were prospectively associated with 12-month remission in a clear gradient manner (P-values < 0.001) and after adjustment for relevant covariates. These associations were evident after the Step 1 treatment monotherapy but weakened with increasing treatment steps, falling below statistical significance after 4 + treatment steps. Application of combined multiple serum biomarkers, particularly on inflammatory markers, could improve predictability of remission at acute and continuation treatment phases for depressive disorders. Patients with unfavourable biomarkers might require alternative treatment regimes for better outcomes.

Sex differences in the immune system: Implications for cocaine relapse

Prognostic biomarkers for depression treatment outcomes have yet to be elucidated. This study sought to evaluate whether a multi-modal serum biomarker panel was prospectively associated with 12-week and 12-month remission in outpatients with depressive disorders receiving stepwise psychopharmacotherapy. At baseline, 14 serum biomarkers and socio-demographic/clinical characteristics were evaluated in 1094 patients. They received initial antidepressant monotherapy followed, as required by a protocol of successive alternative pharmacological strategies administered in 3-week steps during the acute (3–12 week) phase (N = 1086), and in 3-month steps during the continuation (6–12 month) phase (N = 884). Remission was defined as a Hamilton Depression Rating Scale score of ≤ 7. Remission was achieved in 490 (45.1%) over the 12-week, and in 625 (70.7%) over the 12-month, treatment periods. Combination scores of four serum biomarkers (high-sensitivity C-reactive protein, interleukin-1 beta, interleukin-6, and leptin) were prospectively associated with 12-week remission; and four (high-sensitivity C-reactive protein, tumor necrosis factor-alpha, interleukin-1 beta, and brain-derived neurotrophic factor) were prospectively associated with 12-month remission in a clear gradient manner (P-values < 0.001) and after adjustment for relevant covariates. These associations were evident after the Step 1 treatment monotherapy but weakened with increasing treatment steps, falling below statistical significance after 4 + treatment steps. Application of combined multiple serum biomarkers, particularly on inflammatory markers, could improve predictability of remission at acute and continuation treatment phases for depressive disorders. Patients with unfavourable biomarkers might require alternative treatment regimes for better outcomes.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Childhood Abuse, Social Support, and Long-Term Pharmacological Treatment Outcomes in Patients With Depressive Disorders.

ObjectivesThis study was performed to investigate the roles of childhood abuse and social support in predicting short- and long-term pharmacological treatment outcomes in outpatients with depressive disorders in a naturalistic 1-year prospective design.MethodsPatients were recruited at a university hospital in South Korea between March 2012 and April 2017. Subjects with stepwise pharmacotherapy (switching, augmentation, combination, and mixture of these approaches) included 1246 patients at 12-week points in the acute treatment response and 1,015 patients at 12-months in the long-term treatment response. Remission was defined as Hamilton Depression Rating Scale score ≤ 7. Exposure to three types of childhood abuse (physical, emotional, and sexual) before the age of 16 and perceived social support were assessed at baseline.ResultsIndividual associations of childhood abuse were associated with poorer treatment outcomes in the 12-month long-term phase, and no significant individual associations were found for social support level with any period outcome. In combination, any child abuse, emotional abuse, and physical abuse were significantly associated with long-term 12-month remission rate in the presence of higher level of social support after adjustment with significant interaction terms. However, no significant interactions were found with sexual abuse.ConclusionSynergistic interactive effects of child abuse and social support levels on treatment outcomes in depressive patients were found during long-term pharmacotherapy. Thus, depressed patients with a history of childhood abuse may require specialized clinical approaches, including social support, to enhance the long-term treatment outcomes.

P426 Association Between vedolizumab therapy outcome and Pre-treatment DUBLIN Score &amp; CRP-Albumin Ratio in Ulcerative Colitis

Abstract Background The DUBLIN score is a measure of ulcerative colitis (UC) inflammatory burden and is associated with clinical outcomes. A high CRP/albumin ratio (CAR) is associated with disease severity in IBD. The aim of our study was to evaluate if there was an association between vedolizumab therapy outcome and pre-treatment DUBLIN score and CAR in UC. Methods 35 patients with UC initiating vedolizumab with available pre-treatment DUBLIN score and CAR data were identified. Baseline characteristics, biochemistry and endoscopic findings were defined by retrospective review. A previously validated DUBLIN score threshold of ≥3 and CAR threshold &amp;gt;0.6 were utilised to categorise patients with high inflammatory burden. Clinical response at, 3-months and corticosteroid-free remission at, 6-months were recorded. The association between, 3-month clinical response and, 6-month remission rates &amp; pre-treatment DUBLIN score and CAR ratio were evaluated. P values &amp;lt;0.05 were considered significant. Results Baseline characteristics of the study cohort: age [median, range], 53 [19 -87] years;, 60% male; disease duration [median, range], 11 [2–41] years. A pre-treatment DUBLIN score ≥3 and CAR &amp;gt;0.6 were observed in, 65% and, 51% of patients respectively., 3-month clinical response and, 6-month corticosteroid-free remission rates were observed in, 79% and, 67% of the cohort respectively. There was no significant difference between rates of, 3-month clinical response and, 6-month corticosteroid-free remission comparing high and low pretreatment DUBLIN score and CAR groups, p=0.59 and p=0.16 respectively. Conclusion Vedolizumab was an effective therapy in patients with a significant inflammatory burden assessed by DUBLIN score and CAR. Pre-treatment DUBLIN score and CAR were not associated with therapy outcome.

P452 Tofacitinib Effectiveness and Safety as Therapy for Ulcerative Colitis

Abstract Background Tofacitinib is an oral small molecule directed against the JAK/STAT pathway. It is the first JAK inhibitor approved for the treatment of ulcerative colitis (UC) and is licenced for use in moderate to severely active disease. This study aims to evaluate tofacitinib effectiveness and safety in real-world clinical practice for moderate-to-severely active UC. Methods Consecutive patients receiving Tofacitinib for UC in four Irish tertiary referral centres were identified. Baseline clinical data and information on therapy outcomes were collected by retrospective review of electronic patient records. Patients included in the study cohort were older than 18 years of age, had a confirmed diagnosis of UC, had received at least one induction dose of tofacitinib, and had available clinical follow-up. The primary study endpoint was 6-month corticosteroid-free remission rate. Secondary endpoints included 3-month clinical response, inflammatory biomarkers responses to tofacitinib therapy, rates of tofacitinib discontinuation, and side effects. Continuous variables are presented as median [range]. P values &amp;lt; 0.05 were considered significant in all analyses. Results Fifty-three UC patients were included; age 40.4 [33.3 – 53.9] years, 66% male, disease duration 5.7 [2.6–10.9] years; follow-up 8.7 [6.4–14.1] months. 43%, 40% and 17% of patients had extensive, left-sided disease and proctitis respectively. At baseline, clinical Mayo subscore was 7 [5–8], CRP 4.0 [1.0–16.7] mg/L and faecal calprotectin 914 [444.0–1000] mcg/g. The 3-month clinical response and 6-month corticosteroid-free remission rates were 69% and 43%, respectively. Following tofacitinib therapy, compared with baseline values, a significant reduction in 3-month clinical Mayo score, 3-month CRP, and post-induction faecal calprotectin was observed, p &amp;lt;0.03 for all comparisons. 36% of patients (n=19) discontinued tofacitinib during study follow-up (time to Tofacitinib discontinuation 1.9 [0.5–18.9] months). Side effects occurred in 26% percent of patients with the majority minor and self-limiting. No cardiovascular or venous thromboembolic events were observed and no hospitalisations occurred due to therapy-related side effects Conclusion These data are in concordance with prior studies of tofacitinib effectiveness and safety in real world practice. They demonstrate that, in a cohort of UC patients with significant prior therapy exposure, tofacitinib is an effective therapy with an acceptable safety profile.

A Phase II Study of Azacitidine, Venetoclax and Trametinib in Relapsed/Refractory AML Harboring a Ras Pathway-Activating Mutation

A Phase II Study of Azacitidine, Venetoclax and Trametinib in Relapsed/Refractory AML Harboring a Ras Pathway-Activating Mutation

Residual alcohol use disorder symptoms after treatment predict long-term drinking outcomes in seniors with DSM-5 alcohol use disorder.

Risk of relapse within the first months after alcohol use disorder (AUD) interventions is substantial among older adults. For this vulnerable group, little information exists on how this risk is associated with residual DSM-5 AUD symptoms after treatment. To investigate among older adults who received short-term treatment for DSM-5 AUD (1) the prediction of drinking behaviors and quality of life 12months after treatment initiation by 6-month DSM-5 AUD symptoms, AUD severity, and AUD remission, and (2) whether these DSM-5 AUD indicators provide prognostic information beyond that gained from 6-month alcohol use (AU) status. The international multicenter RCT "ELDERLY-Study" enrolled adults aged 60+ with DSM-5 AUD. We used data from the subsample of 323 German and Danish participants with complete DSM-5 AUD criterion information 6 months after treatment initiation (61% male; mean age = 65.5years). AU was assessed with Form 90, DSM-5 AUD with the M.I.N.I., and quality of life with the WHOQOL-BREF. Generalized linear models were applied to investigate the associations between 6-month AUD indicators and 12-month AU and quality of life. Independent of AU at 6 months, having 1 (vs. no) residual AUD symptom at 6 months predicted a 12-month "slip," defined as exceeding a blood alcohol concentration of 0.05% at least once during that time (OR: 3.7, 95% CI: 1.5 to 9.0), heavy episodic drinking, and hazardous use (p<0.05). AUD remission was associated with a lower risk of a "slip" at 12 months (p<0.05). Failed reduction/cessation was associated with poorer physical health (Coef.: -0.4, 95% CI -0.7 to -0.1). For older adults, residual AUD symptoms in the first months after short-term treatment predict problematic AU outcomes during the first 12months after treatment entry. Thus, residual symptoms should be addressed in this patient population during posttreatment screenings.

The first 20 weeks of pregnancy is a high-risk period for eating disorder relapse.

Eating disorders (ED) are associated with adverse pregnancy outcome and pregnancy is associated with both relapse and remission of ED. Knowledge is lacking on the risk of ED relapse during pregnancy and the postpartum period for women in stable remission. This study examined the occurrence of perinatal ED relapse as well as obstetric and postpartum outcome in women with at least a 6-month ED remission before pregnancy. A total of 122 women in stable remission before pregnancy were included in a prospective longitudinal study. Changes in ED symptoms based on the Eating Disorder Examination were systematically evaluated at each antenatal visit and in the postpartum period. A total of 30 (25%) women relapsed. Twenty women relapsed within the first 20 weeks of pregnancy and eight in the early weeks postpartum. Severe postpartum depression symptoms (33%) were frequent in women with ED relapse; hyperemesis gravidarum (30%) was frequently present independent of the woman's relapse status. To prevent relapse of ED and possible consequences, attention to relapse in women in stable remission is especially important in early pregnancy and in the postpartum period.

Predictive values of tumor necrosis factor-\u03b1 for depression treatment outcomes: effect modification by hazardous alcohol consumption

Inflammation is potentially associated with poor antidepressant treatment outcomes. Pro-inflammatory cytokines are influenced by hazardous alcohol consumption. The aim of the present study was to investigate the effects of the serum tumor necrosis factor-α (sTNF-α) level on antidepressant treatment outcomes in terms of the 12-week and 12-month remission rates and 24-month relapse rate, and to investigate the potential modifying effects of alcohol consumption on these associations in patients with depressive disorders. At baseline, sTNF-α was measured and alcohol-related data from the Alcohol Use Disorders Identification Test (AUDIT) and consumption history were collected from 1094 patients. Patients received stepwise antidepressant treatment. Remission at 12 weeks and 12 months was defined as a Hamilton Depression Rating Scale (HAMD) score ≤ 7. Relapse (HAMD score ≥ 14) was identified until 24 months for those who had initially responded (HAMD score <14) at 12 weeks. Higher sTNF-α levels were found to have significant effects on the 12-week and 12-month non-remission and 24-month relapse rates. These effects were more prominent in those with low levels of alcohol consumption (AUDIT score ≤ 8 or no current alcohol consumption); the effects were not significant in those exhibiting hazardous alcohol consumption (AUDIT score > 8 or current drinking). Significant interactions were found for the 12-month non-remission and relapse rates, although the interaction was not statistically significant for 12-week remission. In conclusion, baseline sTNF-α levels may be a useful predictor for both short- and long-term antidepressant treatment outcomes, and the consideration of alcohol consumption status may increase predictability, in particular for long-term outcomes.

Outcomes of children and adolescents 1 year after being seen in a multidisciplinary psychogenic nonepileptic seizures clinic.

Psychogenic nonepileptic seizures (PNES) are paroxysmal events that may involve altered subjective experience and change in motor activity with a psychological cause. The aim of this work is to describe a population of pediatric patients with PNES and identify factors predictive of 12-month outcomes. We conducted a prospective observational study of children and adolescents referred to the multidisciplinary Nationwide Children's Hospital PNES clinic between November 2017 and July 2019. Information was collected from patients during clinic visits and semistructured follow-up phone calls. Descriptive statistics and Fisher exact test were used for analysis. Of the 139 consecutive patients referred to the PNES clinic, 104 were seen in clinic and 63 answered 12-month follow-up calls. Patients with comorbid epilepsy had increased rates of participation at 12-month follow-up (p = .04). Complete remission was achieved by 32% (20/63) of patients at 12 months. Combined PNES remission and improvement was 89% (56/63) at 12 months. Patients and families who were linked with counseling at 1 month were more likely to achieve remission at 12 months (p = .005). Less than half (44%, 28/63) of patients reached at 12 months had their events documented on video-electroencephalogram (EEG) at diagnosis; however, those who did were not more likely to be accepting of the diagnosis at 12 months (p = 1.0), be linked with counseling at 12 months (p = .59), or be event-free at 12 months (p = .79). Remission occurred in one third of patients by 12months; however, improvement in events was seen in 89%. Connection to counseling by 1 month was associated with increased remission rates at 12 months. Capturing events on video-EEG was not associated with increased acceptance or event freedom at 12 months. Diagnosis should be followed by strong encouragement to connect with counseling quickly to achieve a goal of increasing 12-month PNES remission rates.

MO323MEDICATION INDUCED RELAPSE OF FGSG

Abstract Background and Aims 31-year-old female with past medical history of Multiple Sclerosis diagnosed with Minimal Change Disease (MCD) in 2011. At diagnosis she had proteinuria that exceeded 7 g per day. She was treated with steroids and went into complete remission. In 2017 presented again with nephrotic syndrome and on repeat biopsy she was diagnosed with Focal Segmental Glomerulosclerosis (FSGS). She was restarted on steroids and had some improvement but despite 20 weeks of high dose steroids did not achieve remission. After every attempt of tapering, she would relapse. Method Other treatments tried without success were tacrolimus, cyclophosphamide and rituximab. Mild improvement with tacrolimus but stopped after a grand mal seizure. The lowest achievable steroid dose was 20mg daily. She was started on combination therapy tacrolimus and mycophenolate mofetil and was able to come off steroids and went into remission. Results After a few months of remission, she began to relapse. It was noted after extensive investigation that she had been placed on cabergolin for hyperprolactinemia by her endocrinologist at the time she began to relapse. Cabergolin was stopped and she went into remission again. We present the first case of FSGS relapse due to cabergolin. Conclusion Cabergoline is metabolized by hydrolysis and has limited cytochrome P450 (CYP) metabolism. Despite limited CYP metabolism, cabergoline does have an interaction with clarithromycin, a known inhibitor of CYP and p-glycoprotein. One rat study suggest that mycophenolate is a substrate for p-glycoprotein, so it is possible that there is some competitive inhibition. This would explain why the patient relapsed while on cabergoline and in remission after stopping it.

POS0019 PREDICTORS OF SUSTAINED 6 MONTHS REMISSION AND FLARE IN PATIENTS WITH POLYMYALGIA RHEUMATICA

Background:Polymyalgia rheumatica (PMR) is a typical inflammatory disease of the elderly. The mainstay of treatment is usage of oral glucocorticoids (GC) usually leading to a dramatic response. However, long-term treatment is often required. In some instances, remission cannot be achieved and disease flares can occur. To date, few papers investigated the predictive factors of response to GC therapy suggesting a role for weight, elevated plasma viscosity and C-reactive protein (CRP). Moreover, there are no data on predictor factors of disease flares after 6 months of sustained remission.Objectives:To evaluate the factors predictive of sustained 6 months remission and of flare in patients with PMR.Methods:We evaluated clinical data from 137 PMR patients treated with GC for more than 6 months between September 2002 and June 2020. Patients were evaluated at baseline, re-evaluated at 1 month and after 3 months and then at least every 3 months. We analyzed the differences between patients who achieved remission within 6 months of diagnosis, who maintained it for at least 6 months, and patients who did not. Remission was defined as 1) the absence of clinical symptoms, 2) &lt;7.5 mg / day of prednisone equivalents and 3) negativity of ESR and CRP. Patients treated with methylprednisolone were excluded from the analysis.Results:Among the 137 patients (baseline F68: M69, mean age ± SD 74.5±6.6 years, mean ESR ± SD 49.9±27.7 mm/h, mean CRP ± SD 6.1±11.4 mg/dl), 57 achieved remission at 6 months (41.6%), and after this period, another 47 went into remission for a total of 104 patients (75.9%). The months required to achieve remission averaged 6.4 ± 3. No differences were observed between patients who achieved remission and patients who did not regarding age, sex, CRP, starting dose of GC, anti-CCP and rheumatoid factor. The ESR at baseline was higher in patients who did not achieve remission (58.1±33.4 mm/h) than in patients who achieved it (46±24.8 mm/h, p=0.06). ESR at baseline correlated with the time needed to reach normalization of both ESR and CRP (p=0.01, Figure 1). Thirty-six of 104 patients (34.6%) had a disease flare after a mean of 6.1±2.7 months of remission. The mean GC intake at flare was 2.8±3 mg/day. Only 15/36 (41.6%) patients were able to withhold GCs after flare, compared with 48/68 (70.5%) patients who achieved remission and did not experience flare. There were no significant differences in any analyzed parameters between patients who experienced flares and those who did not, including ESR and CRP values at baseline (50.3±26.7 mm/h and 6.8±12.1 mg/dl, respectively). A higher percentage of patients who did not achieve remission experienced flare than patients who went into remission (p=0.009).Conclusion:Achieving complete remission at 6 months occurs in a consistent percentage of patients with PMR. Despite this, a significant percentage of patients may need prolonged steroid treatment and may experience flare, even after 12 months of follow-up. Remission at 6 months is likely to be a good predictor of remission at 12 months, as already reported in recent studies (1, 2). Elevated ESR at diagnosis appears to be a negative predictor for remission at 6 months. Patients who achieve complete remission are less likely to develop flare. True remission should coincide with the discontinuation of steroid treatment; in fact, the maintenance of steroid therapy, even at low doses, is predictive of the development of flare.