Background: Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) have clinically been evolving as separate disorders, though there is still debate on the nosological valence of both conditions, their interaction in terms of co-morbidity or disorder spectrum and their distinct pathophysiology.Objective: The objective of this review is to summarize evidence regarding clinical features, neuropsychological performance and neuroimaging findings from cross-diagnostic studies comparing BD and BPD, to further caracterize their complex interplay.Methods: Using PubMed, PsycINFO and TripDataBase, we conducted a systematic literature search based on PRISMA guidelines of studies published from January 1980 to September 2019 which directly compared BD and BPD.Results: A total of 28 studies comparing BD and BPD were included: 19 compared clinical features, 6 neuropsychological performance and three neuroimaging abnormalities. Depressive symptoms have an earlier onset in BPD than BD. BD patients present more mixed or manic symptoms, with BD-I differing from BPD in manic phases. BPD patients show more negative attitudes toward others and self, more conflictive interpersonal relationships, and more maladaptive regulation strategies in affective instability with separate pathways. Impulsivity seems more a trait in BPD rather than a state as in BD. Otherwise, BD and BPD overlap in depressive and anxious symptoms, dysphoria, various abnormal temperamental traits, suicidal ideation, and childhood trauma. Both disorders differ and share deficits in neuropsychological and neuroimaging findings.Conclusion: Clinical data provide evidence of overlapping features in both disorders, with most of those shared symptoms being more persistent and intense in BPD. Thus, categorical classifications should be compared to dimensional approaches in transdiagnostic studies investigating BPD features in BD regarding their respective explanatory power for individual trajectories.Systematic Review Registration: The search strategy was pre-registered in PROSPERO: CRD42018100268.

Background and importance Patient adherence is a key determinant of treatment success in rheumatological immunomediated diseases. Available data about adherence to biological treatments and factors associated with non-adherence are limited in Spain. Moreover, no studies have compared adherence between subcutaneous and oral drugs. Aim and objectives To evaluate non-adherence to prescribed subcutaneous biologicals and oral drugs in patients with rheumatological immunomediated diseases and to assess possible predictor factors associated with treatment non-adherence. Material and methods A retrospective observational study was conducted in all patients receiving oral and subcutaneous treatment for rheumatological immune mediated diseases from 2017 to 2019 in the outpatient pharmaceutical care area of a tertiary university hospital. Non-adherence was evaluated by reviewing all scheduled drug dispensing visits in the computerised application. We considered non-adherent every time that a patient missed at least one drug administration. Data collected were demographic, total patients and patient treatments, total dispensing visits and route of administration for the drug dispensed in every visit. We classified patients as adherent and non-adherent considering the number of dispensing visits. In the non-adherent group, we recorded the number of dispensing visits, reasons for non-adherence, number of missed administrations per patient, and drug and predictor factors for non-adherence. Results 783 patients were included, aged 52.4 (13.7) years, 427 (54.5%) were women, 164 (20.9%) were smokers and 697 (89%) were Caucasian. 79 (10.1%) of 783 patients received more than one treatment. There were 869 patient treatments: 294 adalimumab (33.8%), 236 etanercept (27.2%), 78 golimumab (8.9%), 47 apremilast (5.4%), 39 certolizumab (4.5%), 34 secukinumab (3.9%) and 30 tocilizumab (3.5%). There were 9197 dispensing visits. Route of administration was 6406 subcutaneous (93.2%) and 374 oral (6.8%). Non-adherence analysis 2417 (26.3%) dispensing visits, reasons for non-adherence/dispensing visits: 92 unjustified (97.5%), 33 infection (1.4%), 18 surgery (0.7%), 3 pregnancy (0.1%), 6 other (0.3%). Number of missed administrations/ patient treatments: 675 patients missed at least one administration (77.7%), mean 2.5 (±12.9) missed administrations. Number of missed administrations/drug: 9.9 baricitinib (±20.8), 15.8 tofacitinib (±31.2) and 25.4 apremilast (±53.2). Predictor factors for non-adherence: ethnicity (p=0.015), treatment with golimumab (p=0.006) and tocilizumab (p=0.036) and age (p=0.072). Conclusion and relevance Non-adherence to the prescribed drug occurred in 77.7% of patients with rheumatological immune mediated diseases. Demographic factors such as ethnicity as well as golimumab and tocilizumab treatment, despite their different frequency of administration, were predictors for non-adherence. Route of administration did not influence nonadherence.

BackgroundThere is a lack of evidence about the loss of efficacy of anti-TNF agents in JIA and its possible relation to the immunogenicity generated. In the last years there has been interest in the role of serum calprotectin in children diseases, including JIA.ObjectivesTo assess the immunogenicity and bioavailability of anti-TNF drugs, their relationship with disease activity and the clinical utility of serum calprotectin in monitoring JIA patients.MethodsThis is a 12-month prospective, multicenter, non-interventional, observational study. Patients from 2 to 18 years diagnosed with non-systemic JIA according to ILAR criteria and receiving treatment with IFX, ADA or ETN were included. The patients were evaluated using the CHAQ and the juvenile arthritis disease activity score (JADAS 71) and determination of anti-TNF drug, anti-drug antibody and calprotectina serum levels were performed.Results222 patients were included. At month 12, 181 (81.5%) continued receiving treatment, and 205 (94.5%) had positive serum levels of anti-TNF drug (96.2% of ETN, 93.5% of ADA and 66.7% of IFX) at baseline and at 12 months serum levels were positive in 161 (95.3%) patients (97.5% ETN, 93.2% ADA and 100% IFX). In total, 16 (7.3%) patients presented anti-drug A (1 of 106 anti-ETN, 13 of 109 anti-ADA, 2 of 3 anti-IFX) at baseline and 4 patients (2.4%) (0 of 81 anti-ETN, 4 of 88 anti-ADA, 0 of 1 anti-IFX) at 12 months. Regarding the relationship between anti-TNF levels or anti-drug Abs, disease activity, and functional disability overall, statistically significant differences were not observed between the groups. Patients with high levels of serum calprotectin at the baseline visit (16 of 216) showed higher JADAS-71 score [1.23 (2.06 SD) vs. 2.06 (3.44 SD)] and CHAQ [0.11 SD (0.28 SD)] vs 0.17 (0.40 SD)] compared with normal calprotectin group, although no statistically significant differences were observed (p = 0.066 and p = 0.288) between the groups with a normal and high level of serum calprotectin and the number of patients was small.ConclusionThe low prevalence of anti-drug Abs observed was in consonance with the high proportion of patients with a positive serum level of anti-TNF drug. These data suggest an appropriate management of the long-term treatment of Spanish JIA patients, who showed a maintained inactive disease/low disease activity state and a very low functional disability state as a consequence of a low immunogenicity and good bioavailability of anti-TNF drugs.Baseline patients’ characteristics.Table 2 JADAS -71 score according to immunogenicity and bioavailability of anti-TNF drugs Serum anti-TNF (Negative) Serum anti-TNF (Positive) Anti-drug antibodies (Negative) Anti-drug antibodies (Positive) Total Baseline N2219720019221 Mean (SD)1.52 (2.66)1.35 (2.29)1.30 (2.28)1.99 (2.66)1.38 (2.34)p value0.7430.216 Month 12 N2017818216199 Mean (SD)2.19 (2.61)0.94 (1.90)0.98 (1.97)2.06 (2.22)1.08 (2.01)p value0.0090.039Disclosure of InterestsInmaculada Calvo Grant/research support from: received research grants from Pfi...

No abstract

No abstract