ObjectiveTo assess the impact of various antiretroviral/antiviral regimens in pregnant women living with HIV or hepatitis B virus (HBV).DesignWe performed random effects meta-analysis for HIV-related outcomes and network meta-analysis for HBV outcomes, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess quality separately for each outcome.Data sourcesEmbase and Medline to February 2017.Eligibility criteriaFor maternal outcomes, we considered randomised controlled trials (RCTs) comparing tenofovir-based regimens with those with alternative nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). For child outcomes, we included RCTs and comparative observational studies of tenofovir-based regimens versus alternative NRTIs regimens or, for HBV, placebo.ResultsTen studies (seven RCTs) met the inclusion criteria for maternal and child outcomes, and an additional 33 studies (12 RCTs) met the inclusion criteria for HBV-specific outcomes. The most common comparison was tenofovir and emtricitabine versus zidovudine and lamivudine. There was no apparent difference between tenofovir-based regimens and alternatives in maternal outcomes, including serious laboratory adverse events (low certainty) and serious clinical adverse events (moderate certainty). There was no difference between NRTIs in vertical transmission of HIV: 1 more per 1000, 8 fewer to 10 more, low certainty; or vertical transmission of HBV: 7 fewer per 1000, 10 fewer to 38 more, moderate certainty. We found moderate certainty evidence that tenofovir/emtricitabine increases the risk of stillbirths and early neonatal mortality (51 more per 1000, 11 more to 150 more) and the risk of early premature delivery at <34 weeks (42 more per 1000, 2 more to 127 more).ConclusionsTenofovir/emtricitabine is likely to increase stillbirth/early neonatal death and early premature delivery compared with zidovudine/lamivudine, but certainty is low when they are not coprescribed with lopinavir/ritonavir. Other outcomes are likely similar between antiretrovirals.PROSPERO registration numberCRD42017054392.

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Objectives The COVID-19 pandemic created challenges for patients with rheumatoid arthritis (RA). We examined the potential impact of the pandemic on patient-reported outcomes (PROs), disease activity (DA), and medication profiles, comparing the periods pre-pandemic and during the pandemic. Methods Patients enrolled in the Ontario Best Practices Research Initiative were included if they had at least one visit with a physician or study interviewer within 12 months before and after the start of pandemic-related closures in Ontario (March 15th, 2020). Baseline characteristics, DA, PROs (i.e. Health Assessment Questionnaire Disability Index, Rheumatoid Arthritis Disease Activity Index (RADAI), European Quality of Life -5 Dimension Questionnaire), medication use and changes were included. Paired two-sample t-tests and McNamar’s tests were performed for continuous and categorical variables between time periods. Results The analytic sample consisted of 1508 patients, with a mean (SD) age of 62.7 (12.5 years), and 79% were female. Despite decreases in the number of in-person visits during the pandemic, there was no significant negative impact on DA or PRO scores. The DA scores in both periods remained low, with either no clinically significant differences or patients slightly improved. Scores for mental, social, and physical health were either stable or improved. There were statistically significant decreases in conventional synthetic DMARD use (p &lt; 0.0001) and increased JAK inhibitor usage (p = 0.0002). Biologic DMARD use remained stable throughout the pandemic. Conclusion In this cohort, DA and PROs of RA patients remained stable during the COVID-19 pandemic. The longer-term outcomes of the pandemic warrant investigation.

BackgroundInternational guidelines recommend switching to advanced therapy (AT) in patients with Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA), when conventional synthetic disease modifying antirheumatic drugs (csDMARD) fail. There are several factors playing a role in that decision, including patients’ comorbidities and choices as well as the availability of the treatments.ObjectivesHere we present the results of a comparison of PsA and RA patient profiles requiring advanced therapies, from our pilot biologics clinic. Better patient outcomes in one disease may help us to recognize what can be improved in the other.MethodsBiologics clinic is a new initiative at Ottawa Hospital aiming to improve the long-term outcomes. Patients who are about to start or switch advance therapy are evaluated at the biologics clinic. Extensive data regarding disease history, medication exposure and disease activity are collected in a standardized fashion; the comorbidity burden is documented. A protocoled ultrasound (US) is conducted at baseline and three-month intervals, until reaching remission. The data presented here represent a pilot exploratory comparative analysis.ResultsPsA (n=18) and RA(n=42) patients had similar demographic features, other than RA patients being older (table 1). The majority of the comorbidities were similar in both groups, although PsA patients had more frequent liver disease numerically (5 (27.8 %) vs 5 (11.9%), p= 0.149) and less alcohol use (19 (38.9%) vs 7 (45.2%), p= 0.649). PsA patients had more frequent moderate/severe depression using the PHQ (61.1% of PsA vs 26.2% of RA; p=0.01).For disease activity, PsA patients tend to have higher disease activity based on the TJC, HAQ and physician global; in addition to significantly longer morning stiffness then RA (Table 1). Conversely, the disease activity within the joints based on the US scores of RA patients were higher. Disease duration at the time of initiation of the first advanced therapy was significantly shorter in PsA (median (IQR) 1.0 (7.75) years) compared to RA (6 (12.5), p=0.005) and PsA patients were treated with less numbers of csDMARD.ConclusionAccording to our preliminary data, PsA patients access to advanced therapy earlier than the RA. This may be due to the heterogeneity of PsA, such as manifestations other than the joint inflammation (enthesitis and axial disease) determining treatment decisions. PsA patients also had more frequent liver disease, which also may have prevented initiation of csDMARD and led to expediated initiation of the advance therapy- as early as at diagnosis. Whether earlier access leads to better patient outcomes in PsA, will be investigated with long-term follow up. PsA patients having more tender joints despite less severe US scores may be due to the proximity of the enthesis to the joints and difficulties to differentiate entheseal pain from joint involvement by the physical exam. The use of US may improve the assessment of the domains in PsA leading to choosing the right treatments.Table 1.Comparison of PsA and RA patient profilesRA (N:42)N (%)PSA (N:18)N (%)pDemographicsSex: Female30 (71.4 %)12 (66.7 %)0.712Age; Mean±SD59.3±14.950.3±13.60.033Smoking (ever)27 (64.3 %)12 (66.7 %)0.859Disease FeaturesRF positive30 (73.2 %)2 (12.5 %)<0.001anti-CCP positive23 (57.5 %)2 (14.3 %)0.005CRP positive16 (38.1 %)6 (33.3 %)0.726ESR positive16 (38.1 %)7 (38.9 %)0.954Disease duration (years)*14.0 (19.8)5 (13.8)0.036Previous therapies*Previous number of csDMARDs3 (1)2 (2)0.005Previous number of advanced therapies0.5 (2)0.5 (2)0.945Time to first biologics initiation from diagnosis6 (12.5)1 (7.75)0.005Disease activity/Clinical*Duration of morning stiffness (hours)1 (1.4)2 (5.5)<0.001Swollen joint count (44)8 (5)5 (5.5)0.199Tender joint count (44)8.5 (13)14 (17)0.244Patient VAS5.5 (4)6 (3)0.648Physician VAS5 (3)6 (2)0.066HAQ1.125 (1.125)1.625 (1.094)0.087Disease activity/US*Ultrasound: GLOESS score36 (28)22 (28)0.025Ultrasound: Doppler score8 (18)3.5 (7.8)0.058* Median (IQR)REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.