TOPLINE:

When provided detailed information on options, most men with low-risk prostate cancer chose active surveillance over treatment, and there was no difference in outcomes, new research from Italy shows.

METHODOLOGY:

• Active surveillance for patients with low-risk prostate cancer has been recommended for years, but its adoption often varies within and between countries.
• The current study, based in Italy, aimed to promote the adoption of active surveillance in two regions in Northern Italy and to understand patient acceptance and outcomes in comparison with active treatment.
• Men newly diagnosed with low-risk prostate cancer between June 2015 and December 2021 were eligible. All were informed of treatment options and were offered active surveillance.
• Multilevel models identified factors associated with choosing active surveillance over active treatment, which consisted of either radical prostatectomy or radiation therapy.

TAKEAWAY:

• Overall, 83% (706 of 852) men chose active surveillance over immediate treatment. There was an upward trend over time, from 78% in 2015-2017 to 90% in 2020-2021.
• Patients who chose active surveillance over any radical treatment were more likely to be aged 75 years or older (odds ratio, 4.27), to have a Charlson Comorbidity Index ≥ 2 (OR, 1.98), to have undergone independent revision of the first biopsy (OR, 2.35), and to have undergone multidisciplinary assessment (OR, 2.65).
• Worse prostate cancer prognostic factors, such as stage T2a (OR, 0.54) and Gleason Score 3+4 (OR, 0.20), were associated with lower odds of choosing active surveillance than any radical treatment.
• In an adjusted intention-to-treat analysis, among patients who initially chose active surveillance, overall survival was not worse in comparison with those who chose any radical treatment (hazard ratio, 0.86; 95% confidence interval, 0.41-1.79) or in comparison with those who chose radical prostatectomy (HR, 0.90; 95% CI, 0.37-2.20).

IN PRACTICE:

“The main remarkable finding of [the trial] is represented by the widespread adoption of active surveillance in our [Regional Oncology Network] since the beginning of the study, and the increasing trend over time, reaching approximately 90% of eligible patients in 2020 to 2021,” the authors wrote.

SOURCE:

The study, with first author Giovannino Ciccone, MD, PhD, AOU City of Health and Science of Turin, Italy, was published online in JAMA Network Open.

LIMITATIONS:

Key limitations include the relatively short follow-up (median, 57 months), variability between centers in terms of enrolling patients and discussing their choices, and the high rate of patients who abandoned active surveillance by year 2 of follow-up. Overall, about 281 patients (~40%) abandoned active surveillance by year 2, most commonly because of biochemical progression.

DISCLOSURES:

The START project was funded by the Fondazione Compagnia di San Paolo and partially by Rete Oncologica del Piemonte e Valle d’Aosta, Turin, Italy. Dr. Ciccone has disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE:

When provided detailed information on options, most men with low-risk prostate cancer chose active surveillance over treatment, and there was no difference in outcomes, new research from Italy shows.

METHODOLOGY:

• Active surveillance for patients with low-risk prostate cancer has been recommended for years, but its adoption often varies within and between countries.
• The current study, based in Italy, aimed to promote the adoption of active surveillance in two regions in Northern Italy and to understand patient acceptance and outcomes in comparison with active treatment.
• Men newly diagnosed with low-risk prostate cancer between June 2015 and December 2021 were eligible. All were informed of treatment options and were offered active surveillance.
• Multilevel models identified factors associated with choosing active surveillance over active treatment, which consisted of either radical prostatectomy or radiation therapy.

TAKEAWAY:

• Overall, 83% (706 of 852) men chose active surveillance over immediate treatment. There was an upward trend over time, from 78% in 2015-2017 to 90% in 2020-2021.
• Patients who chose active surveillance over any radical treatment were more likely to be aged 75 years or older (odds ratio, 4.27), to have a Charlson Comorbidity Index ≥ 2 (OR, 1.98), to have undergone independent revision of the first biopsy (OR, 2.35), and to have undergone multidisciplinary assessment (OR, 2.65).
• Worse prostate cancer prognostic factors, such as stage T2a (OR, 0.54) and Gleason Score 3+4 (OR, 0.20), were associated with lower odds of choosing active surveillance than any radical treatment.
• In an adjusted intention-to-treat analysis, among patients who initially chose active surveillance, overall survival was not worse in comparison with those who chose any radical treatment (hazard ratio, 0.86; 95% confidence interval, 0.41-1.79) or in comparison with those who chose radical prostatectomy (HR, 0.90; 95% CI, 0.37-2.20).

IN PRACTICE:

“The main remarkable finding of [the trial] is represented by the widespread adoption of active surveillance in our [Regional Oncology Network] since the beginning of the study, and the increasing trend over time, reaching approximately 90% of eligible patients in 2020 to 2021,” the authors wrote.

SOURCE:

The study, with first author Giovannino Ciccone, MD, PhD, AOU City of Health and Science of Turin, Italy, was published online in JAMA Network Open.

LIMITATIONS:

Key limitations include the relatively short follow-up (median, 57 months), variability between centers in terms of enrolling patients and discussing their choices, and the high rate of patients who abandoned active surveillance by year 2 of follow-up. Overall, about 281 patients (~40%) abandoned active surveillance by year 2, most commonly because of biochemical progression.

DISCLOSURES:

The START project was funded by the Fondazione Compagnia di San Paolo and partially by Rete Oncologica del Piemonte e Valle d’Aosta, Turin, Italy. Dr. Ciccone has disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE:

When provided detailed information on options, most men with low-risk prostate cancer chose active surveillance over treatment, and there was no difference in outcomes, new research from Italy shows.

METHODOLOGY:

• Active surveillance for patients with low-risk prostate cancer has been recommended for years, but its adoption often varies within and between countries.
• The current study, based in Italy, aimed to promote the adoption of active surveillance in two regions in Northern Italy and to understand patient acceptance and outcomes in comparison with active treatment.
• Men newly diagnosed with low-risk prostate cancer between June 2015 and December 2021 were eligible. All were informed of treatment options and were offered active surveillance.
• Multilevel models identified factors associated with choosing active surveillance over active treatment, which consisted of either radical prostatectomy or radiation therapy.

TAKEAWAY:

• Overall, 83% (706 of 852) men chose active surveillance over immediate treatment. There was an upward trend over time, from 78% in 2015-2017 to 90% in 2020-2021.
• Patients who chose active surveillance over any radical treatment were more likely to be aged 75 years or older (odds ratio, 4.27), to have a Charlson Comorbidity Index ≥ 2 (OR, 1.98), to have undergone independent revision of the first biopsy (OR, 2.35), and to have undergone multidisciplinary assessment (OR, 2.65).
• Worse prostate cancer prognostic factors, such as stage T2a (OR, 0.54) and Gleason Score 3+4 (OR, 0.20), were associated with lower odds of choosing active surveillance than any radical treatment.
• In an adjusted intention-to-treat analysis, among patients who initially chose active surveillance, overall survival was not worse in comparison with those who chose any radical treatment (hazard ratio, 0.86; 95% confidence interval, 0.41-1.79) or in comparison with those who chose radical prostatectomy (HR, 0.90; 95% CI, 0.37-2.20).

IN PRACTICE:

“The main remarkable finding of [the trial] is represented by the widespread adoption of active surveillance in our [Regional Oncology Network] since the beginning of the study, and the increasing trend over time, reaching approximately 90% of eligible patients in 2020 to 2021,” the authors wrote.

SOURCE:

The study, with first author Giovannino Ciccone, MD, PhD, AOU City of Health and Science of Turin, Italy, was published online in JAMA Network Open.

LIMITATIONS:

Key limitations include the relatively short follow-up (median, 57 months), variability between centers in terms of enrolling patients and discussing their choices, and the high rate of patients who abandoned active surveillance by year 2 of follow-up. Overall, about 281 patients (~40%) abandoned active surveillance by year 2, most commonly because of biochemical progression.

DISCLOSURES:

The START project was funded by the Fondazione Compagnia di San Paolo and partially by Rete Oncologica del Piemonte e Valle d’Aosta, Turin, Italy. Dr. Ciccone has disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

DALLAS – Researchers identified behavioral, psychological, and environmental predictors of continued weight loss maintenance vs. weight regain in a large cohort of members of WeightWatchers who had successful long-term weight loss.

On average, the participants had lost 25.5 kg (56 lb) and kept it off for 3.5 years, when they entered the 1-year study.

At study entry and 1 year later, the participants replied to several questionnaires that asked about predictors of weight loss maintenance.

Compared with people who gained weight over the 1-year study, those who maintained their weight within 2.3 kg (5 lb) reported more consistent monitoring of their diet and weight and greater acceptance of uncomfortable food cravings.

They also had reduced disinhibition (tendency to overeat) when faced with food cues, as well as less pain and a more positive body image “at any weight, shape, or size,” Suzanne Phelan, MD, PhD, reported.

Dr. Phelan, from the department of kinesiology and public health, California Polytechnic State University, San Luis Obispo, presented the study in an Obesity symposium at the annual meeting of the Obesity Society, and it was simultaneously published in the journal. The study was selected as one of five top papers submitted to the journal to coincide with the meeting.

Future interventions to prevent weight regain should target overeating in response to internal and external food cues and declines in self-monitoring and body image, Dr. Phelan said.

The study aimed to identify behaviors that might predict who might “beat the odds” and sustain long-term weight loss, she said in an interview.

The findings suggest that the people who maintained their weight loss had developed skills to help them cope with cravings and not respond by eating, she said. Continued self-monitoring and body acceptance and appreciation (all body sizes are beautiful) were key elements of successful weight-loss maintenance.
 

No antiobesity drugs or surgery; don’t forget behavioral stuff

Importantly, although 43% of the study participants regained more than five pounds during this 1-year study, they still remained at 18% below their starting weight, “indicating that they were largely successful at weight loss,” Dr. Phelan said.

Michael D. Jensen, MD, editor-in-chief of Obesity, echoed this.

The researchers “did find some weak predictors of success,” said Dr. Jensen, from Mayo Clinic, Rochester, Minn. “But perhaps as important,” he said, “was that at the end of the trial, even those who had regained some slight weight still had 18% weight loss – which is not trivial – after, on average, 4.5 years with a standard commercial weight management program.

“At every talk I go to here,” the message is, “Let’s stampede towards use of the drugs and skip diet and exercise and behavioral stuff,” he observed. “I would argue,” he said, “that when it works, it works really well, and it’s free. So this idea that we shouldn’t even try it, because we know it’s going to fail, is wrong.

“If you have the right group, they have a decent chance of having a sufficiently good response that you don’t have to give the medications and you don’t have to send them for bariatric surgery.

“Once you learn from these programs what to do, you’re not paying $1,000 a month for a drug and you haven’t had bariatric surgery,” Dr. Jensen noted. “Their 3 years of follow-up of WeightWatchers cost less than 1 month worth of one of these [antiobesity medications].”

The predictive findings were like ‘”icing on the cake,” he said. Anybody can find five people who’ve done well with therapy, but this study was in more than 2,800 people who did well with a commercial program that is not expensive.
 

Study design and findings

Between 2019 and 2020, WeightWatchers invited adult members who had maintained weight loss of at least 9.1 kg (20 lb) for at least 1 year to participate in this study.

Of 7,025 participants who entered the study, 4,004 individuals (57%) who did not complete the 1-year questionnaires and others with implausible weight were excluded, leaving a final sample of 2,843 participants.

Most participants were women (92%), non-Hispanic White (95%), married (92%), and college educated. They had a mean age of 56 years.

On average, the participants had a body mass index (BMI) of 35.9 kg/m² (grade 2 obesity) at the start of the WeightWatchers program and a BMI of 26.7 when they entered the current study.

At the 1-year follow-up, 57% of the participants had maintained the same weight (within 2.3 kg) as when they enrolled in the study, and 43% had gained ≥ 2.3 kg.

On average, the weight-loss maintainers had gained 0.4 kg (0.88 lb). The weight gainers had gained 7.2 kg (15.9 lb) but were still 19.1 kg (42.1 lb) below the weight they had when they started the WeightWatchers program.

At baseline, compared with the weight gainers, the weight-loss maintainers were on average older (58 vs. 52 years), had a lower initial BMI (26 vs. 28), and had longer duration of weight loss maintenance (4 vs. 3 years).

At 1 year, those who had maintained their weight loss had greater self-monitoring, psychological coping, physical activity strategies, dietary choice strategies, and eating and physical activity habits, and they had less eating initiation in the absence of hunger.

They also had less disinhibition, more willingness to ignore cravings and accept food urges, more future orientation, more mindfulness, more positive body image and body satisfaction, better general health and mental health, and less bodily pain.

This research was supported by a grant to Dr. Phelan from WeightWatchers (WW) International, and three study authors are employees and shareholders of the company. Dr. Jensen discloses consulting for Biohaven Pharmaceuticals and for Seattle Gummy Co.

A version of this article first appeared on Medscape.com.

DALLAS – Researchers identified behavioral, psychological, and environmental predictors of continued weight loss maintenance vs. weight regain in a large cohort of members of WeightWatchers who had successful long-term weight loss.

On average, the participants had lost 25.5 kg (56 lb) and kept it off for 3.5 years, when they entered the 1-year study.

At study entry and 1 year later, the participants replied to several questionnaires that asked about predictors of weight loss maintenance.

Compared with people who gained weight over the 1-year study, those who maintained their weight within 2.3 kg (5 lb) reported more consistent monitoring of their diet and weight and greater acceptance of uncomfortable food cravings.

They also had reduced disinhibition (tendency to overeat) when faced with food cues, as well as less pain and a more positive body image “at any weight, shape, or size,” Suzanne Phelan, MD, PhD, reported.

Dr. Phelan, from the department of kinesiology and public health, California Polytechnic State University, San Luis Obispo, presented the study in an Obesity symposium at the annual meeting of the Obesity Society, and it was simultaneously published in the journal. The study was selected as one of five top papers submitted to the journal to coincide with the meeting.

Future interventions to prevent weight regain should target overeating in response to internal and external food cues and declines in self-monitoring and body image, Dr. Phelan said.

The study aimed to identify behaviors that might predict who might “beat the odds” and sustain long-term weight loss, she said in an interview.

The findings suggest that the people who maintained their weight loss had developed skills to help them cope with cravings and not respond by eating, she said. Continued self-monitoring and body acceptance and appreciation (all body sizes are beautiful) were key elements of successful weight-loss maintenance.
 

No antiobesity drugs or surgery; don’t forget behavioral stuff

Importantly, although 43% of the study participants regained more than five pounds during this 1-year study, they still remained at 18% below their starting weight, “indicating that they were largely successful at weight loss,” Dr. Phelan said.

Michael D. Jensen, MD, editor-in-chief of Obesity, echoed this.

The researchers “did find some weak predictors of success,” said Dr. Jensen, from Mayo Clinic, Rochester, Minn. “But perhaps as important,” he said, “was that at the end of the trial, even those who had regained some slight weight still had 18% weight loss – which is not trivial – after, on average, 4.5 years with a standard commercial weight management program.

“At every talk I go to here,” the message is, “Let’s stampede towards use of the drugs and skip diet and exercise and behavioral stuff,” he observed. “I would argue,” he said, “that when it works, it works really well, and it’s free. So this idea that we shouldn’t even try it, because we know it’s going to fail, is wrong.

“If you have the right group, they have a decent chance of having a sufficiently good response that you don’t have to give the medications and you don’t have to send them for bariatric surgery.

“Once you learn from these programs what to do, you’re not paying $1,000 a month for a drug and you haven’t had bariatric surgery,” Dr. Jensen noted. “Their 3 years of follow-up of WeightWatchers cost less than 1 month worth of one of these [antiobesity medications].”

The predictive findings were like ‘”icing on the cake,” he said. Anybody can find five people who’ve done well with therapy, but this study was in more than 2,800 people who did well with a commercial program that is not expensive.
 

Study design and findings

Between 2019 and 2020, WeightWatchers invited adult members who had maintained weight loss of at least 9.1 kg (20 lb) for at least 1 year to participate in this study.

Of 7,025 participants who entered the study, 4,004 individuals (57%) who did not complete the 1-year questionnaires and others with implausible weight were excluded, leaving a final sample of 2,843 participants.

Most participants were women (92%), non-Hispanic White (95%), married (92%), and college educated. They had a mean age of 56 years.

On average, the participants had a body mass index (BMI) of 35.9 kg/m² (grade 2 obesity) at the start of the WeightWatchers program and a BMI of 26.7 when they entered the current study.

At the 1-year follow-up, 57% of the participants had maintained the same weight (within 2.3 kg) as when they enrolled in the study, and 43% had gained ≥ 2.3 kg.

On average, the weight-loss maintainers had gained 0.4 kg (0.88 lb). The weight gainers had gained 7.2 kg (15.9 lb) but were still 19.1 kg (42.1 lb) below the weight they had when they started the WeightWatchers program.

At baseline, compared with the weight gainers, the weight-loss maintainers were on average older (58 vs. 52 years), had a lower initial BMI (26 vs. 28), and had longer duration of weight loss maintenance (4 vs. 3 years).

At 1 year, those who had maintained their weight loss had greater self-monitoring, psychological coping, physical activity strategies, dietary choice strategies, and eating and physical activity habits, and they had less eating initiation in the absence of hunger.

They also had less disinhibition, more willingness to ignore cravings and accept food urges, more future orientation, more mindfulness, more positive body image and body satisfaction, better general health and mental health, and less bodily pain.

This research was supported by a grant to Dr. Phelan from WeightWatchers (WW) International, and three study authors are employees and shareholders of the company. Dr. Jensen discloses consulting for Biohaven Pharmaceuticals and for Seattle Gummy Co.

A version of this article first appeared on Medscape.com.

DALLAS – Researchers identified behavioral, psychological, and environmental predictors of continued weight loss maintenance vs. weight regain in a large cohort of members of WeightWatchers who had successful long-term weight loss.

On average, the participants had lost 25.5 kg (56 lb) and kept it off for 3.5 years, when they entered the 1-year study.

At study entry and 1 year later, the participants replied to several questionnaires that asked about predictors of weight loss maintenance.

Compared with people who gained weight over the 1-year study, those who maintained their weight within 2.3 kg (5 lb) reported more consistent monitoring of their diet and weight and greater acceptance of uncomfortable food cravings.

They also had reduced disinhibition (tendency to overeat) when faced with food cues, as well as less pain and a more positive body image “at any weight, shape, or size,” Suzanne Phelan, MD, PhD, reported.

Dr. Phelan, from the department of kinesiology and public health, California Polytechnic State University, San Luis Obispo, presented the study in an Obesity symposium at the annual meeting of the Obesity Society, and it was simultaneously published in the journal. The study was selected as one of five top papers submitted to the journal to coincide with the meeting.

Future interventions to prevent weight regain should target overeating in response to internal and external food cues and declines in self-monitoring and body image, Dr. Phelan said.

The study aimed to identify behaviors that might predict who might “beat the odds” and sustain long-term weight loss, she said in an interview.

The findings suggest that the people who maintained their weight loss had developed skills to help them cope with cravings and not respond by eating, she said. Continued self-monitoring and body acceptance and appreciation (all body sizes are beautiful) were key elements of successful weight-loss maintenance.
 

No antiobesity drugs or surgery; don’t forget behavioral stuff

Importantly, although 43% of the study participants regained more than five pounds during this 1-year study, they still remained at 18% below their starting weight, “indicating that they were largely successful at weight loss,” Dr. Phelan said.

Michael D. Jensen, MD, editor-in-chief of Obesity, echoed this.

The researchers “did find some weak predictors of success,” said Dr. Jensen, from Mayo Clinic, Rochester, Minn. “But perhaps as important,” he said, “was that at the end of the trial, even those who had regained some slight weight still had 18% weight loss – which is not trivial – after, on average, 4.5 years with a standard commercial weight management program.

“At every talk I go to here,” the message is, “Let’s stampede towards use of the drugs and skip diet and exercise and behavioral stuff,” he observed. “I would argue,” he said, “that when it works, it works really well, and it’s free. So this idea that we shouldn’t even try it, because we know it’s going to fail, is wrong.

“If you have the right group, they have a decent chance of having a sufficiently good response that you don’t have to give the medications and you don’t have to send them for bariatric surgery.

“Once you learn from these programs what to do, you’re not paying $1,000 a month for a drug and you haven’t had bariatric surgery,” Dr. Jensen noted. “Their 3 years of follow-up of WeightWatchers cost less than 1 month worth of one of these [antiobesity medications].”

The predictive findings were like ‘”icing on the cake,” he said. Anybody can find five people who’ve done well with therapy, but this study was in more than 2,800 people who did well with a commercial program that is not expensive.
 

Study design and findings

Between 2019 and 2020, WeightWatchers invited adult members who had maintained weight loss of at least 9.1 kg (20 lb) for at least 1 year to participate in this study.

Of 7,025 participants who entered the study, 4,004 individuals (57%) who did not complete the 1-year questionnaires and others with implausible weight were excluded, leaving a final sample of 2,843 participants.

Most participants were women (92%), non-Hispanic White (95%), married (92%), and college educated. They had a mean age of 56 years.

On average, the participants had a body mass index (BMI) of 35.9 kg/m² (grade 2 obesity) at the start of the WeightWatchers program and a BMI of 26.7 when they entered the current study.

At the 1-year follow-up, 57% of the participants had maintained the same weight (within 2.3 kg) as when they enrolled in the study, and 43% had gained ≥ 2.3 kg.

On average, the weight-loss maintainers had gained 0.4 kg (0.88 lb). The weight gainers had gained 7.2 kg (15.9 lb) but were still 19.1 kg (42.1 lb) below the weight they had when they started the WeightWatchers program.

At baseline, compared with the weight gainers, the weight-loss maintainers were on average older (58 vs. 52 years), had a lower initial BMI (26 vs. 28), and had longer duration of weight loss maintenance (4 vs. 3 years).

At 1 year, those who had maintained their weight loss had greater self-monitoring, psychological coping, physical activity strategies, dietary choice strategies, and eating and physical activity habits, and they had less eating initiation in the absence of hunger.

They also had less disinhibition, more willingness to ignore cravings and accept food urges, more future orientation, more mindfulness, more positive body image and body satisfaction, better general health and mental health, and less bodily pain.

This research was supported by a grant to Dr. Phelan from WeightWatchers (WW) International, and three study authors are employees and shareholders of the company. Dr. Jensen discloses consulting for Biohaven Pharmaceuticals and for Seattle Gummy Co.

A version of this article first appeared on Medscape.com.

MILAN – A tool kit combining a wearable device with automated algorithms allows for the passive monitoring of disease parameters in people with multiple sclerosis (MS) and may even be able to predict the course of the disease, suggests a pilot study.

Twenty patients were enrolled, only half of whom correctly completed all of the assessments and wore the included smartwatch regularly. Importantly, the data reported back for analysis was in line with expectations, and the patient feedback was positive.

The tool kit “seems feasible and usable to remotely monitor multiple domains of health status in people with multiple sclerosis,” conclude Ludovico Pedullà, PhD, Italian Multiple Sclerosis Foundation, Genoa, and colleagues.

Further analysis of the dataset, including the artificial intelligence and machine-learning algorithms, may allow the prediction of “relevant changes throughout the course of multiple sclerosis” and anticipate the need for therapeutic interventions.

The findings were presented at the 9th Joint ECTRIMS-ACTRIMS meeting.
 

Leveraging big data to improve outcomes

The authors note that the primary aim of the pan-European ALAMEDA project is to leverage “big data” through artificial intelligence and machine learning to provide “clinically actionable information” on patients with brain disorders that “complements medical recommendations” and thus improves treatment.

For the current pilot study, the researchers developed an integrated platform to collect patient-centered data from wearables and mobile devices using digital patient-reported outcomes (ePROs), with the aim of testing the resulting tool kit’s feasibility and usability in people with MS.

Dr. Pedullà said that they wanted to have “passive monitoring” of patients over the course of their daily lives and therefore searched for the best devices and the most relevant patient reported outcomes as well as used “innovative algorithms” to analyze the data to try to predict the disease course.

To reduce dropouts and increase adherence to the tool kit, they described the project to patients with MS and asked for their feedback to determine whether what they had designed was feasible from the patient perspective, Dr. Pedullà said.

This led to some changes in the way data were collected, and the team developed a social network channel so patients would be able to ask for support and stay engaged in the study.
 

Feasible with high levels of confidence

Twenty people with relapsing-remitting MS were enrolled, of whom 14 were women. The mean age was 37.8 years, and the mean disease duration was 9.1 years. The mean Expanded Disability Status Scale was 2.2.

The participants were asked to use the tool kit for 1 year, with half reaching the 6-month milestone. Participants correctly completed 53% of the scheduled ePROs and regularly wore the smartwatch without reporting discomfort.

The team reports that the data from the tool kit “are in line with those reported in the literature.”

It showed that participants took an average of 8,415 steps per day and completed 9.8 minutes of vigorous activity and 14.5 minutes of moderate activity daily. Daily sedentary minutes were 705.1.

Patients had a mean Perceived Deficit Questionnaire score of 25.2, a Beck Anxiety Inventory score of 17.3, a score on the 12-Item Multiple Sclerosis Walking Scale of 37.2, and an arm function on the Multiple Sclerosis Questionnaire of 47.4.

The mean Modified Fatigue Impact Scale score was 18.5, and the Pittsburgh Sleep Quality Index score was 25.2. The System Usability Scale revealed “high levels of confidence” with the tool kit, the team says, as well as “very high” intention of using it in the future.

Dr. Pedullà said that the researchers now want to evaluate the feasibility of the tool kit further by analyzing the adherence and usability data and targeting it to the patients who are most likely to use it.

They also want to determine not only whether the use of wearables in this way can predict relapse in multiple sclerosis but also disease progression, particularly as the current definitions are evolving.
 

Reducing daily step count

Approached for comment, Riley M. Bove, MD, MSc, Assistant Professor, UCSF Weill Institute for Neurosciences, San Francisco, said that the study is “very interesting and in line with what has been previously published.”

She pointed to a recent study that she co-authored, in which remote monitoring via a continuous step counter revealed that a decreasing average daily step count was associated with the worsening of standard ambulatory measures.

“There are nice benefits of an integrated platform” such as what was used in the current study, Dr. Bove noted, adding that it is “even better if it can also send the data to clinicians.”

The ALAMEDA project has received funding from the European Union’s Horizon 2020 research and innovation program. No relevant financial relationships declared.

A version of this article first appeared on Medscape.com.

MILAN – A tool kit combining a wearable device with automated algorithms allows for the passive monitoring of disease parameters in people with multiple sclerosis (MS) and may even be able to predict the course of the disease, suggests a pilot study.

Twenty patients were enrolled, only half of whom correctly completed all of the assessments and wore the included smartwatch regularly. Importantly, the data reported back for analysis was in line with expectations, and the patient feedback was positive.

The tool kit “seems feasible and usable to remotely monitor multiple domains of health status in people with multiple sclerosis,” conclude Ludovico Pedullà, PhD, Italian Multiple Sclerosis Foundation, Genoa, and colleagues.

Further analysis of the dataset, including the artificial intelligence and machine-learning algorithms, may allow the prediction of “relevant changes throughout the course of multiple sclerosis” and anticipate the need for therapeutic interventions.

The findings were presented at the 9th Joint ECTRIMS-ACTRIMS meeting.
 

Leveraging big data to improve outcomes

The authors note that the primary aim of the pan-European ALAMEDA project is to leverage “big data” through artificial intelligence and machine learning to provide “clinically actionable information” on patients with brain disorders that “complements medical recommendations” and thus improves treatment.

For the current pilot study, the researchers developed an integrated platform to collect patient-centered data from wearables and mobile devices using digital patient-reported outcomes (ePROs), with the aim of testing the resulting tool kit’s feasibility and usability in people with MS.

Dr. Pedullà said that they wanted to have “passive monitoring” of patients over the course of their daily lives and therefore searched for the best devices and the most relevant patient reported outcomes as well as used “innovative algorithms” to analyze the data to try to predict the disease course.

To reduce dropouts and increase adherence to the tool kit, they described the project to patients with MS and asked for their feedback to determine whether what they had designed was feasible from the patient perspective, Dr. Pedullà said.

This led to some changes in the way data were collected, and the team developed a social network channel so patients would be able to ask for support and stay engaged in the study.
 

Feasible with high levels of confidence

Twenty people with relapsing-remitting MS were enrolled, of whom 14 were women. The mean age was 37.8 years, and the mean disease duration was 9.1 years. The mean Expanded Disability Status Scale was 2.2.

The participants were asked to use the tool kit for 1 year, with half reaching the 6-month milestone. Participants correctly completed 53% of the scheduled ePROs and regularly wore the smartwatch without reporting discomfort.

The team reports that the data from the tool kit “are in line with those reported in the literature.”

It showed that participants took an average of 8,415 steps per day and completed 9.8 minutes of vigorous activity and 14.5 minutes of moderate activity daily. Daily sedentary minutes were 705.1.

Patients had a mean Perceived Deficit Questionnaire score of 25.2, a Beck Anxiety Inventory score of 17.3, a score on the 12-Item Multiple Sclerosis Walking Scale of 37.2, and an arm function on the Multiple Sclerosis Questionnaire of 47.4.

The mean Modified Fatigue Impact Scale score was 18.5, and the Pittsburgh Sleep Quality Index score was 25.2. The System Usability Scale revealed “high levels of confidence” with the tool kit, the team says, as well as “very high” intention of using it in the future.

Dr. Pedullà said that the researchers now want to evaluate the feasibility of the tool kit further by analyzing the adherence and usability data and targeting it to the patients who are most likely to use it.

They also want to determine not only whether the use of wearables in this way can predict relapse in multiple sclerosis but also disease progression, particularly as the current definitions are evolving.
 

Reducing daily step count

Approached for comment, Riley M. Bove, MD, MSc, Assistant Professor, UCSF Weill Institute for Neurosciences, San Francisco, said that the study is “very interesting and in line with what has been previously published.”

She pointed to a recent study that she co-authored, in which remote monitoring via a continuous step counter revealed that a decreasing average daily step count was associated with the worsening of standard ambulatory measures.

“There are nice benefits of an integrated platform” such as what was used in the current study, Dr. Bove noted, adding that it is “even better if it can also send the data to clinicians.”

The ALAMEDA project has received funding from the European Union’s Horizon 2020 research and innovation program. No relevant financial relationships declared.

A version of this article first appeared on Medscape.com.

MILAN – A tool kit combining a wearable device with automated algorithms allows for the passive monitoring of disease parameters in people with multiple sclerosis (MS) and may even be able to predict the course of the disease, suggests a pilot study.

Twenty patients were enrolled, only half of whom correctly completed all of the assessments and wore the included smartwatch regularly. Importantly, the data reported back for analysis was in line with expectations, and the patient feedback was positive.

The tool kit “seems feasible and usable to remotely monitor multiple domains of health status in people with multiple sclerosis,” conclude Ludovico Pedullà, PhD, Italian Multiple Sclerosis Foundation, Genoa, and colleagues.

Further analysis of the dataset, including the artificial intelligence and machine-learning algorithms, may allow the prediction of “relevant changes throughout the course of multiple sclerosis” and anticipate the need for therapeutic interventions.

The findings were presented at the 9th Joint ECTRIMS-ACTRIMS meeting.
 

Leveraging big data to improve outcomes

The authors note that the primary aim of the pan-European ALAMEDA project is to leverage “big data” through artificial intelligence and machine learning to provide “clinically actionable information” on patients with brain disorders that “complements medical recommendations” and thus improves treatment.

For the current pilot study, the researchers developed an integrated platform to collect patient-centered data from wearables and mobile devices using digital patient-reported outcomes (ePROs), with the aim of testing the resulting tool kit’s feasibility and usability in people with MS.

Dr. Pedullà said that they wanted to have “passive monitoring” of patients over the course of their daily lives and therefore searched for the best devices and the most relevant patient reported outcomes as well as used “innovative algorithms” to analyze the data to try to predict the disease course.

To reduce dropouts and increase adherence to the tool kit, they described the project to patients with MS and asked for their feedback to determine whether what they had designed was feasible from the patient perspective, Dr. Pedullà said.

This led to some changes in the way data were collected, and the team developed a social network channel so patients would be able to ask for support and stay engaged in the study.
 

Feasible with high levels of confidence

Twenty people with relapsing-remitting MS were enrolled, of whom 14 were women. The mean age was 37.8 years, and the mean disease duration was 9.1 years. The mean Expanded Disability Status Scale was 2.2.

The participants were asked to use the tool kit for 1 year, with half reaching the 6-month milestone. Participants correctly completed 53% of the scheduled ePROs and regularly wore the smartwatch without reporting discomfort.

The team reports that the data from the tool kit “are in line with those reported in the literature.”

It showed that participants took an average of 8,415 steps per day and completed 9.8 minutes of vigorous activity and 14.5 minutes of moderate activity daily. Daily sedentary minutes were 705.1.

Patients had a mean Perceived Deficit Questionnaire score of 25.2, a Beck Anxiety Inventory score of 17.3, a score on the 12-Item Multiple Sclerosis Walking Scale of 37.2, and an arm function on the Multiple Sclerosis Questionnaire of 47.4.

The mean Modified Fatigue Impact Scale score was 18.5, and the Pittsburgh Sleep Quality Index score was 25.2. The System Usability Scale revealed “high levels of confidence” with the tool kit, the team says, as well as “very high” intention of using it in the future.

Dr. Pedullà said that the researchers now want to evaluate the feasibility of the tool kit further by analyzing the adherence and usability data and targeting it to the patients who are most likely to use it.

They also want to determine not only whether the use of wearables in this way can predict relapse in multiple sclerosis but also disease progression, particularly as the current definitions are evolving.
 

Reducing daily step count

Approached for comment, Riley M. Bove, MD, MSc, Assistant Professor, UCSF Weill Institute for Neurosciences, San Francisco, said that the study is “very interesting and in line with what has been previously published.”

She pointed to a recent study that she co-authored, in which remote monitoring via a continuous step counter revealed that a decreasing average daily step count was associated with the worsening of standard ambulatory measures.

“There are nice benefits of an integrated platform” such as what was used in the current study, Dr. Bove noted, adding that it is “even better if it can also send the data to clinicians.”

The ALAMEDA project has received funding from the European Union’s Horizon 2020 research and innovation program. No relevant financial relationships declared.

A version of this article first appeared on Medscape.com.

The US Department of Veterans Affairs (VA) and 13 health care systems have signed a pledge for interoperability—to securely share data on veteran health care, regardless of whether it is provided inside the VA or not.

“This pledge will improve veteran health care by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” said VA Under Secretary for Health Shereef Elnahal, MD, MBA. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care—including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”

The pledge will allow the health systems to access local, state, and federal health resources and will provide the VA access to health system clinical and administrative data for quality assessment and care coordination. The pledge signers are committed to developing and providing capabilities that: (1) Accurately identify veterans when they seek care from clinicians in [the signers’] communities; (2) Connect veterans with VA and community resources that promote health and health care—especially VA services that lower veterans’ out-of-pocket expenses; and (3) Responsively and reliably coordinate care for shared patients—including exchanging care information requested and provided.

In addition to helping reduce the financial burden for veterans, the VA says, the information sharing could help clinicians outside the VA system to provide more targeted care: “[I]t will also allow us to send helpful information to our partner health systems that they can then offer to veterans in their care,” Elnahal said, “to include information about new benefits we are offering under the PACT Act and other resources that assist with suicide prevention and identifying social risk factors."

The first pledge partners are Emory Healthcare, Inova, Jefferson Health, Sanford Health, University of California Davis Health, Intermountain Health, Mass General Brigham, Rush Health, Tufts Medicine, Marshfield Clinic, Kaiser Permanente Health Plan and Hospitals, University of Pittsburg Medical Center, and Atrium Health. Any health system or clinician that supports the pledge’s objectives is encouraged to participate, the VA says. Signers have begun work, and aim to provide proof-of-concept in early 2024.

The US Department of Veterans Affairs (VA) and 13 health care systems have signed a pledge for interoperability—to securely share data on veteran health care, regardless of whether it is provided inside the VA or not.

“This pledge will improve veteran health care by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” said VA Under Secretary for Health Shereef Elnahal, MD, MBA. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care—including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”

The pledge will allow the health systems to access local, state, and federal health resources and will provide the VA access to health system clinical and administrative data for quality assessment and care coordination. The pledge signers are committed to developing and providing capabilities that: (1) Accurately identify veterans when they seek care from clinicians in [the signers’] communities; (2) Connect veterans with VA and community resources that promote health and health care—especially VA services that lower veterans’ out-of-pocket expenses; and (3) Responsively and reliably coordinate care for shared patients—including exchanging care information requested and provided.

In addition to helping reduce the financial burden for veterans, the VA says, the information sharing could help clinicians outside the VA system to provide more targeted care: “[I]t will also allow us to send helpful information to our partner health systems that they can then offer to veterans in their care,” Elnahal said, “to include information about new benefits we are offering under the PACT Act and other resources that assist with suicide prevention and identifying social risk factors."

The first pledge partners are Emory Healthcare, Inova, Jefferson Health, Sanford Health, University of California Davis Health, Intermountain Health, Mass General Brigham, Rush Health, Tufts Medicine, Marshfield Clinic, Kaiser Permanente Health Plan and Hospitals, University of Pittsburg Medical Center, and Atrium Health. Any health system or clinician that supports the pledge’s objectives is encouraged to participate, the VA says. Signers have begun work, and aim to provide proof-of-concept in early 2024.

The US Department of Veterans Affairs (VA) and 13 health care systems have signed a pledge for interoperability—to securely share data on veteran health care, regardless of whether it is provided inside the VA or not.

“This pledge will improve veteran health care by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” said VA Under Secretary for Health Shereef Elnahal, MD, MBA. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care—including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”

The pledge will allow the health systems to access local, state, and federal health resources and will provide the VA access to health system clinical and administrative data for quality assessment and care coordination. The pledge signers are committed to developing and providing capabilities that: (1) Accurately identify veterans when they seek care from clinicians in [the signers’] communities; (2) Connect veterans with VA and community resources that promote health and health care—especially VA services that lower veterans’ out-of-pocket expenses; and (3) Responsively and reliably coordinate care for shared patients—including exchanging care information requested and provided.

In addition to helping reduce the financial burden for veterans, the VA says, the information sharing could help clinicians outside the VA system to provide more targeted care: “[I]t will also allow us to send helpful information to our partner health systems that they can then offer to veterans in their care,” Elnahal said, “to include information about new benefits we are offering under the PACT Act and other resources that assist with suicide prevention and identifying social risk factors."

The first pledge partners are Emory Healthcare, Inova, Jefferson Health, Sanford Health, University of California Davis Health, Intermountain Health, Mass General Brigham, Rush Health, Tufts Medicine, Marshfield Clinic, Kaiser Permanente Health Plan and Hospitals, University of Pittsburg Medical Center, and Atrium Health. Any health system or clinician that supports the pledge’s objectives is encouraged to participate, the VA says. Signers have begun work, and aim to provide proof-of-concept in early 2024.

Key clinical point: Ultrasound assessment of individuals with painful ankles revealed that abnormalities of the flexor retinacula (FR) were more common in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA).

Major finding: The FR were thicker in patients with PsA vs patients with RA and control individuals (0.96 vs 0.64 and 0.56, respectively; both P < .001), with abnormalities, such as retinaculitis (39.0% vs 2.7%), hypoechogenicity (46.0% vs 6.8%), power Doppler positivity (43.0% vs 8.1%), and periostosis (43.0% vs 8.1%), being significantly more prevalent in patients with PsA vs RA (all P < .001).

Study details: Findings are from a cross-sectional observational study including patients with PsA (n = 23) and RA (n = 37) who reported painful ankles and control individuals (n = 20) without rheumatic disease or ankle pain.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Forien M et al. Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study. Joint Bone Spine. 2023 (Oct 4). doi: 10.1016/j.jbspin.2023.105649

Key clinical point: Ultrasound assessment of individuals with painful ankles revealed that abnormalities of the flexor retinacula (FR) were more common in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA).

Major finding: The FR were thicker in patients with PsA vs patients with RA and control individuals (0.96 vs 0.64 and 0.56, respectively; both P < .001), with abnormalities, such as retinaculitis (39.0% vs 2.7%), hypoechogenicity (46.0% vs 6.8%), power Doppler positivity (43.0% vs 8.1%), and periostosis (43.0% vs 8.1%), being significantly more prevalent in patients with PsA vs RA (all P < .001).

Study details: Findings are from a cross-sectional observational study including patients with PsA (n = 23) and RA (n = 37) who reported painful ankles and control individuals (n = 20) without rheumatic disease or ankle pain.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Forien M et al. Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study. Joint Bone Spine. 2023 (Oct 4). doi: 10.1016/j.jbspin.2023.105649

Key clinical point: Ultrasound assessment of individuals with painful ankles revealed that abnormalities of the flexor retinacula (FR) were more common in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA).

Major finding: The FR were thicker in patients with PsA vs patients with RA and control individuals (0.96 vs 0.64 and 0.56, respectively; both P < .001), with abnormalities, such as retinaculitis (39.0% vs 2.7%), hypoechogenicity (46.0% vs 6.8%), power Doppler positivity (43.0% vs 8.1%), and periostosis (43.0% vs 8.1%), being significantly more prevalent in patients with PsA vs RA (all P < .001).

Study details: Findings are from a cross-sectional observational study including patients with PsA (n = 23) and RA (n = 37) who reported painful ankles and control individuals (n = 20) without rheumatic disease or ankle pain.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Forien M et al. Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study. Joint Bone Spine. 2023 (Oct 4). doi: 10.1016/j.jbspin.2023.105649

Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.

Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.

Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.

Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.

Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720

Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.

Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.

Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.

Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.

Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720

Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.

Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.

Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.

Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.

Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720

Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.

Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.

Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.

Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.

Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275

Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.

Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.

Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.

Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.

Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275

Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.

Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.

Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.

Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.

Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275

Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.

Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).

Study details: Findings are from a cross-sectional study including 1134 patients with PsA.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z

Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.

Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).

Study details: Findings are from a cross-sectional study including 1134 patients with PsA.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z

Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.

Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).

Study details: Findings are from a cross-sectional study including 1134 patients with PsA.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z

Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.

Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).

Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).

Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.

Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8

Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.

Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).

Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).

Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.

Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8

Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.

Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).

Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).

Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.

Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8

Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).

Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.

Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.

Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.

Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3

Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).

Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.

Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.

Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.

Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3

Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).

Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.

Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.

Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.

Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3