Aktueller Stand der Impfung gegen SARS-CoV-2

ZUSAMMENFASSUNG: Am 21.12.2020 hat die EMA mit der mRNA-Vakzine BNT162b2 der Firmen BioNTech/Pfizer (Comirnaty®, BioNTech, Mainz, Deutschland; Pfizer, New York City, NY, USA) den ersten Impfstoff gegen SARS-CoV‑2 in der Europäischen Union zugelassen, am 06.01.2021 folgte bereits der zweite (Moderna®, Moderna, Cambridge, MA, USA). Viele weitere Zulassungen werden in Kürze folgen. Mit der Verfügbarkeit der Impfung sind bei Patienten/-innen genau wie bei Ärzten/-innen viele Fragen aufgekommen, die in diesem Hot-Topic-Artikel so aktuell wie möglich adressiert werden sollen. ABSTRACT: On 21 December 2020 the European Medicines Agency (EMA) approved the mRNA vaccine BNT162b2 (Comirnaty®, BioNTech, Mainz, Germany; Pfizer, New York City, NY, USA) as the first vaccine against SARS-CoV‑2 in the European Union and the second vaccine (Moderna®, Moderna, Cambridge, MA, USA) followed on 6 January 2021. Many more approvals will follow within a short period of time. With the availability of the vaccination many questions have arisen for patients as well as for physicians, which are addressed as up to date as possible in this hot topic article

International Journal of Artificial Intelligence in Education (1998), 9, 159-177.

Increasingly, organizations are geographically distributed with activities coordinated and integrated through the use of information technology. Such organizations face constant change and the corresponding need for continual learning and renewal of their workers. In this paper we describe a prototype system called PHelpS (Peer Help System) that facilitates workers in carrying out such "life long learning". PHelpS supports workers as they perform their tasks, offers assistance in finding peer helpers when required, and mediates communication on taskrelated topics. When a worker runs into difficulty in carrying out a task, PHelpS provides a list of other workers who are ready, willing and able to help him or her. The worker then selects a particular helper with PHelpS supporting the subsequent help interaction. The PHelpS system acts as a facilitator to stimulate learning and collaboration, rather than as a directive agent imposing its perspectives on the workers. In this way PHelpS facilitates the creation of extensive informal peer help networks, where workers help one another with tasks and opens up new research avenues for further exploration of AI-based computer-supported collaborative learning

Pregnancy outcomes in DMARD-exposed patients with juvenile idiopathic arthritis-results from a JIA biologic registry

Objectives. To investigate the courses and outcomes of pregnancies involving JIA patients who were exposed to DMARDs. Methods. In the Juvenile arthritis MTX/Biologics long-term Observation study, pregnant patients or male patients with pregnant partners were identified. Standardized patient interviews were conducted, and the course and outcome of pregnancy were assessed. Prospectively collected physician- and patient-reported data were also considered in the analysis. Results. The study sample included 152 pregnancies in 98 women with JIA and 39 pregnancies involving 21 male patients as partners. The majority of patients had polyarticular-onset/-course JIA (61%). The average age of patients at first pregnancy was 24.1 (4.5) years, and their mean disease duration was 13.8 (5.9) years. Patients had been exposed to DMARDs for 9.5 (5.6) years, and 90% of these patients had received biologics before. Half of the pregnancies occurred during DMARD exposure, mostly with etanercept. Significant differences in pregnancy outcomes between DMARD-exposed and -unexposed pregnancies were not observed. Spontaneous abortion (13.1%) and congenital anomaly (3.6%) rates were not suggestive of increased risk compared with expected background rates. However, the rates of premature birth (12.3%) and caesarean section (37.7%) were slightly above those in the German birthing population. The disease activity of female patients remained relatively stable in pregnancy, with mean cJADAS-10 scores of 5.3, 7.1 and 5.6 in each trimester, respectively. Conclusion. Young adults with JIA often become pregnant or become fathers of children while still being treated with DMARDs. Data suggest no increased risk of major adverse pregnancy outcomes

Medication burden in young adults with juvenile idiopathic arthritis: data from a multicentre observational study

Objective To assess the medication and disease burden of young adults with juvenile idiopathic arthritis (JIA). Methods Young adults with JIA prospectively followed in the Juvenile Arthritis Methotrexate/Biologics long-term Observation reported on their health status and medication use. All medications taken (disease-modifying antirheumatic drugs (DMARDs)/prescription/over-the-counter drugs, but excluding most local therapies) classified according to the Anatomical Therapeutic Chemical Classification System were included in this analysis. Medication use at last follow-up was evaluated by sex, JIA category and time from symptom onset to the first biological DMARD (bDMARD) start. Results A total of 1306 young adults (68% female) with JIA and a mean disease duration of 13.6 +/- 6 years were included in the study. Patients reported using on average 2.4 +/- 2.1 medicines and 1.5 +/- 1.7 non-DMARD medicines, respectively, at the last follow-up. Almost a quarter of the patients reported polypharmacy. The higher the number of medications used was, the higher the disease activity, pain and fatigue, and the lower the quality of life of patients. Medication usage differed significantly between sexes and JIA categories, being highest in patients with rheumatoid factor-positive polyarthritis and systemic JIA. The number of medications used was significantly associated with the time from symptom onset to bDMARD start. Patients taking opioids or antidepressants had a particularly high disease burden and had received bDMARDs an average of 2 years later than patients not taking these medications. Conclusion Medication use in adults with JIA varies depending on sex, JIA category, and the time between symptom onset and initiation of treatment with bDMARD

Time of Disease-Modifying Antirheumatic Drug Start in Juvenile Idiopathic Arthritis and the Likelihood of a Drug-Free Remission in Young Adulthood

Objective To study juvenile idiopathic arthritis (JIA) long-term outcomes in relation to the time of initiation of biologic disease-modifying antirheumatic drug (bDMARD). Methods Outcomes of JIA patients prospectively followed by the Biologika in der Kinderrheumatologie (BiKeR) and Juvenile Arthritis Methotrexate/Biologics Long-Term Observation (JuMBO) registers were analyzed with regard to drug-free remission and inactive disease, functional status and quality of life, and surgery. To analyze the influence of early bDMARD therapy on outcomes, patients were assigned to 3 groups based on the time from symptom onset to bDMARD start (G1: 2 to 5 years). Propensity score-adjusted outcome differences were analyzed by multinomial logistic regression analyses among the groups. Results A total of 701 JIA patients were observed for mean +/- SD 9.1 +/- 3.7 years. At the last follow-up (disease duration mean +/- SD 14.3 +/- 6.1 years), 11.7% of patients were in drug-free remission, and 40.0% had inactive disease. More than half of the patients reported no functional limitation, while 5% had undergone arthroplasty, and 3% had eye surgery. At the 10-year time point, patients in G1 (n = 108) were significantly more likely to be in drug-free remission than those patients who began treatment later (G2, n = 199; G3, n = 259), with 18.5%, 10.1%, and 4.9%, respectively. Patients in G1 had significantly lower disease activity (clinical Juvenile Arthritis Disease Activity Score in 10 joints = 4.9), a better overall well-being (18.2% patient global assessment score = 0), and higher functional status (59.2% Health Assessment Questionnaire score = 0), compared to patients in G3 (7.1, 8.4%, and 43.7%, respectively). G1 patients required arthroplasty significantly less frequently than G3 patients and had significantly lower disease activity over time than patients in both G2 and G3. Conclusion Early DMARD treatment is associated with better disease control and outcomes, which supports the concept of a window of opportunity for JIA

Outcome of adult patients with JIA treated with the biosimilar Benepali (R): results of the biologic register JuMBO

Background: To analyze therapy adherence, safety, and outcome in adult patients with juvenile idiopathic arthritis (JIA) treated with the etanercept biosimilar Benepali (R) (Biogen Inc, Cambridge, USA). Methods: Data from the prospective registry, JuMBO (Juvenile arthritis MTX/Biologics long-term Observation), were used for the analysis. JuMBO is a long-term observational cohort study. It follows adult patients with JIA who were formerly included in the national JIA biologic register (BiKeR Registry). Both registries provide individual trajectories of clinical data and outcomes from childhood to adulthood in JIA patients treated with disease-modifying anti-rheumatic drugs (DMARDs). Results: Eighty-three patients from the German JuMBO registry were treated with Benepali (R). Of these, 74% had switched from Enbrel (R) (Pfizer Inc., NYC, USA) the originator of etanercept to Benepali (R) for cost reasons. Therapy survival of patients treated with Benepali (R) in comparison to Enbrel (R) in patients matched by significant parameters was comparable. Adverse events (AE) were reported in 25.3% and serious adverse events (SAE) in 9.6% of patients. Physicians rated no SAE causative related to Benepali (R). The majority of SAEs were surgical/medical procedures and there was only one infection. All efficacy parameters (cJADAS-10, Physician Global Assessment, number of joints with active arthritis, patients' overall well-being, pain, and HAQ) demonstrated improvement over 24 months (p-values were not significant). 9.6% of patients permanently discontinued Benepali (R) because of an AE. Conclusions: Tolerability and effectiveness of the biosimilar Benepali (R) were satisfactory and therapy survival was comparable to the originator. Further data on therapy with biologics and biosimilars such as Benepali (R) must be collected by registries such as BiKeR and JuMBO in order to optimize therapy and patient outcomes and to reduce costs in the health system in the long term

Comparison of physician and artificial intelligence-based symptom checker diagnostic accuracy

Graf M, Knitza J, Leipe J, et al. Comparison of physician and artificial intelligence-based symptom checker diagnostic accuracy. Rheumatology International. 2022.Symptom checkers are increasingly used to assess new symptoms and navigate the health care system. The aim of this study was to compare the accuracy of an artificial intelligence (AI)-based symptom checker (Ada) and physicians regarding the presence/absence of an inflammatory rheumatic disease (IRD). In this survey study, German-speaking physicians with prior rheumatology working experience were asked to determine IRD presence/absence and suggest diagnoses for 20 different real-world patient vignettes, which included only basic health and symptom-related medical history. IRD detection rate and suggested diagnoses of participants and Ada were compared to the gold standard, the final rheumatologists' diagnosis, reported on the discharge summary report. A total of 132 vignettes were completed by 33 physicians (mean rheumatology working experience 8.8 (SD 7.1) years). Ada's diagnostic accuracy (IRD)was significantly higher compared to physicians (70 vs 54%, p=0.002) according to top diagnosis. Ada listed the correct diagnosis more often compared to physicians (54 vs 32%, p<0.001) as top diagnosis as well as among the top 3 diagnoses (59 vs 42%, p<0.001). Work experience was not related to suggesting the correct diagnosis or IRD status. Confined to basic health and symptom-related medical history, the diagnostic accuracy of physicians was lower compared to an AI-based symptom checker. These results highlight the potential of using symptom checkers early during the patient journey and importance of access to complete and sufficient patient information to establish a correct diagnosis. © 2022. The Author(s)