| 1. |
- Izadi, Z., et al.
(författare)
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Association Between Tumor Necrosis Factor Inhibitors and the Risk of Hospitalization or Death Among Patients With Immune-Mediated Inflammatory Disease and COVID-19
- 2021
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Ingår i: Jama Network Open. - : American Medical Association (AMA). - 2574-3805. ; 4:10
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Although tumor necrosis factor (TNF) inhibitors are widely prescribed globally because of their ability to ameliorate shared immune pathways across immune-mediated inflammatory diseases (IMIDs), the impact of COVID-19 among individuals with IMIDs who are receiving TNF inhibitors remains insufficiently understood. OBJECTIVE To examine the association between the receipt of TNF inhibitor monotherapy and the risk of COVID-19-associated hospitalization or death compared with other commonly prescribed immunomodulatory treatment regimens among adult patients with IMIDs. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a pooled analysis of data from 3 international COVID-19 registries comprising individuals with rheumatic diseases, inflammatory bowel disease, and psoriasis from March 12, 2020, to February 1, 2021. Clinicians directly reported COVID-19 outcomes as well as demographic and clinical characteristics of individuals with IMIDs and confirmed or suspected COVID-19 using online data entry portals. Adults (age >= 18 years) with a diagnosis of inflammatory arthritis, inflammatory bowel disease, or psoriasis were included. EXPOSURES Treatment exposure categories included TNF inhibitor monotherapy (reference treatment), TNF inhibitors in combination with methotrexate therapy, TNF inhibitors in combination with azathioprine/6-mercaptopurine therapy, methotrexate monotherapy, azathioprine/6-mercaptopurine monotherapy, and Janus kinase (Jak) inhibitor monotherapy. MAIN OUTCOMES AND MEASURES The main outcome was COVID-19-associated hospitalization or death. Registry-level analyses and a pooled analysis of data across the 3 registries were conducted using multilevel multivariable logistic regression models, adjusting for demographic and clinical characteristics and accounting for country, calendar month, and registry-level correlations. RESULTS A total of 6077 patients from 74 countries were included in the analyses; of those, 3215 individuals (52.9%) were from Europe, 3563 individuals (58.6%) were female, and the mean (SD) age was 48.8 (16.5) years. The most common IMID diagnoses were rheumatoid arthritis (2146 patients [35.3%]) and Crohn disease (1537 patients [25.3%]). A total of 1297 patients (21.3%) were hospitalized, and 189 patients (3.1%) died. In the pooled analysis, compared with patients who received TNF inhibitor monotherapy, higher odds of hospitalization or death were observed among those who received a TNF inhibitor in combination with azathioprine/6-mercaptopurine therapy (odds ratio [OR], 1.74; 95% CI, 1.17-2.58; P = .006), azathioprine/6-mercaptopurine monotherapy (OR, 1.84; 95% CI, 1.30-2.61; P = .001), methotrexate monotherapy (OR, 2.00; 95% CI, 1.57-2.56; P < .001), and Jak inhibitor monotherapy (OR, 1.82; 95% CI, 1.21-2.73; P = .004) but not among those who received a TNF inhibitor in combination with methotrexate therapy (OR, 1.18; 95% CI, 0.85-1.63; P = .33). Similar findings were obtained in analyses that accounted for potential reporting bias and sensitivity analyses that excluded patients with a COVID-19 diagnosis based on symptoms alone. CONCLUSIONS AND RELEVANCE In this cohort study, TNF inhibitor monotherapy was associated with a lower risk of adverse COVID-19 outcomes compared with other commonly prescribed immunomodulatory treatment regimens among individuals with IMIDs.
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| 3. |
- Turner, D. L., et al.
(författare)
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Examining Coherency Scales, Substructure, and Propagation of Whistler Mode Chorus Elements With Magnetospheric Multiscale (MMS)
- 2017
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Ingår i: Journal of Geophysical Research - Space Physics. - : American Geophysical Union (AGU). - 2169-9380 .- 2169-9402. ; 122:11, s. 11201-11226
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Tidskriftsartikel (refereegranskat)abstract
- Whistler mode chorus waves are a naturally occurring electromagnetic emission observed in Earth's magnetosphere. Here, for the first time, data from NASA's Magnetospheric Multiscale (MMS) mission were used to analyze chorus waves in detail, including the calculation of chorus wave normal vectors, k. A case study was examined from a period of substorm activity around the time of a conjunction between the MMS constellation and NASA's Van Allen Probes mission on 07 April 2016. Chorus wave activity was simultaneously observed by all six spacecraft over a broad range of L shells (5.5 < L < 8.5), magnetic local time (06: 00 < MLT < 09: 00), and magnetic latitude (-32 degrees < MLAT < -15 degrees), implying a large chorus active region. Eight chorus elements and their substructure were analyzed in detail with MMS. These chorus elements were all lower band and rising tone emissions, right-handed and nearly circularly polarized, and propagating away from the magnetic equator when they were observed at MMS (MLAT similar to-31 degrees). Most of the elements had "hook"-like signatures on their wave power spectra, characterized by enhanced wave power at flat or falling frequency following the peak, and all the elements exhibited complex and well-organized substructure observed consistently at all four MMS spacecraft at separations up to 70 km (60 km perpendicular and 38 km parallel to the background magnetic field). The waveforms in field-aligned coordinates also demonstrated that these waves were all phase coherent, allowing for the direct calculation of k. Error estimates on calculated k revealed that the plane wave approximation was valid for six of the eight elements and most of the subelements. The wave normal vectors were within 20-30 degrees from the direction antiparallel to the background field for all elements and changed from subelement to subelement through at least two of the eight elements. The azimuthal angle of k in the perpendicular plane was oriented earthward and was oblique to that of the Poynting vector, which has implications for the validity of cold plasma theory.
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