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84 p0003 However the incidence of central nervous system CNS progression was not associated with PDL1 positivity with a twoyear cumulative CNS progression rate of 263 and 284 in PDL1positive and PDL1negative patients respectively log rank p0944 Furthermore positive PDL1 expression did not affect CNS progression or overall survival in patients with synchronous brain metastasis long rank p0513 and 0592 respectively Initial brain metastases are common in NSCLC patients with positive PDL1 expression Further studies are necessary to understand the relationship between early brain metastasis and cancer immunity Initial brain metastases are common in NSCLC patients with positive PDL1 expression Further studies are necessary to understand the relationship between early brain metastasis and cancer immunity Optimal strategies for managing lupus medications after endstage renal disease ESRD have not been addressed This study identifies the current United Stateswide prescribing patterns of hydroxychloroquine HCQ and oral corticosteroids CS among SLE patients with incident ESRD enrolled in the US Renal Disease Systems USRDS registry We identified incident ESRD patients 18 years with SLE as a primary cause of ESRD between January 2006 and June 2013 Patients who were started on dialysis at ESRD onset and enrolled in Medicare Part D within 93 days as required by Medicare were included Among the 2654 newonset ESRD patients with Part D the median IQR duration of followup was 761 374 1375 days At baseline 1076 41 were not on HCQ or CS 220 8 were prescribed HCQ alone 509 19 were prescribed both HCQ and CS and 849 32 were prescribed CS alone Of the 1983 patients who either never received or discontinued HCQ after ESRD onset 667 34 continued CS to the end of the followup period Subasumstat datasheet The median IQR CS dose was lower for patients on HCQ 14 9 21 mg compared to patients who were never prescribed HCQ 15 9 27 mg or patients who discontinued HCQ after ESRD 17 10 27 mg p0001 About one third of patients with lupus nephritis and new onset ESRD received CS monotherapy at high doses As CSrelated complications contribute to hospitalizations and deaths in SLE ESRD changing these prescribing practices may improve morbidity and mortality outcomes About one third of patients with lupus nephritis and new onset ESRD received CS monotherapy at high doses As CSrelated complications contribute to hospitalizations and deaths in SLE ESRD changing these prescribing practices may improve morbidity and mortality outcomesThe aim of this study was to evaluate the impact of renal impairment on the pharmacokinetics PKs safety and tolerability of daridorexant a dual orexin receptor antagonist intended for the treatment of insomnia A singlecenter openlabel study evaluated the PKs of daridorexant in patients with severe renal function impairment SRFI determined by creatinine clearance using the CockcroftGault equation N 8 not on dialysis and in matched control subjects based on sex age and body weight N 7 A single oral dose of daridorexant 25 mg was orally administered in the morning Blood samples were collected up to 72 h postdose for PK assessments of daridorexant In patients with SRFI maximum plasma concentrations Cmax geometric mean ratio GMR and 90 confidence interval CI 094 060146 time to reach Cmax Tmax median difference 90 CI of 025 h 075 to 025 and halflife GMR 90 CI of 099 066148 were virtually unchanged Exposure area under the plasma concentrationtime profile to daridorexant was slightly higher in patients with SRFI than in control subjects with the GMR 90 CI being 116 063212 No safety issue of concern was detected as all adverse events were transient and of mild or moderate intensity and no treatmentrelated effects on vital signs clinical laboratory or electrocardiogram variables were observed following daridorexant administration in patients with SRFI and control subjects Based on these observations PK alterations of daridorexant due to renal function impairment are not considered of clinical relevance and no dose adjustment is necessary in these patients To describe highdose biologic use when treating juvenile idiopathic arthritis JIA Patients with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry and treated with a biologic after enrollment were eligible We described frequency of highdose biologic use and characteristics of patients on highdose biologics We utilized regression modeling to compare 6month outcomes using disease activity measures between those who increased their biologic from standard to high dose high dose to those who initiated and remained on standard dosing no change and to those who switched biologic agents biologic switch We also compared serious adverse events SAEs between groups 5352 patients with JIA were treated with biologics following enrollment 1080 20 had ever received a highdose biologic There were no significant differences in outcomes between the high dose group and the biologic switch group both improved disease activity measures including clinical juvenile arthritis disease activity score10 353 and 395 respectively p068 Although the SAE rates in the highdose group and the biologic switch group were numerically higher than the no change group the event rates were similar and neither rate was significantly higher than the no change group unadjusted incident rate ratio 25 0785 and 18 0746 respectively Dosing escalation appears to be a reasonable choice to improve disease control however large prospective randomized studies evaluating specific biologic agents are needed Dosing escalation appears to be a reasonable choice to improve disease control however large prospective randomized studies evaluating specific biologic agents are needed Computed tomography CTguided lung biopsy is a frequently performed procedure in the diagnostic workup for suspicious lung nodules that can be complicated by pneumothorax This retrospective study assessed the efficacy of biopsy tract occlusion with a gelatin sponge slurry for preventing postbiopsy pneumothorax Retrospective analysis was conducted on consecutive adult patients who underwent CTguided lung biopsy over a 10year period Age gender existing chronic obstructive pulmonary disease COPD evidence of emphysema on CT location of the lesion and the presence of pneumothorax on postprocedure CT and 4h chest radiograph were recorded Two hundred and ninetysix patients were included 126 patients in the nongelfoam group and 170 in the gelfoam group When gelfoam was used risk of developing an immediate pneumothorax was lower P0032 Patients with emphysema were 24 times more likely to develop a delayed pneumothorax without gelfoam P0034 There was a significantly higher risk of both immediate and delayed pneumothorax in nonperipheral lesions without gelfoam P0