longitudinal_report

All Longitundinal Bleeds

Longitudinal days are based on a bleed date, relative to a new medication start, within the following parameters:

  • Bleed date between 0 to -180 days (-6 months) BEFORE a med start
  • Farthest longitudinal follow-up date of 540 days (18 months) AFTER a med start

Longitudinal bleed data exists for the following antibodies:

antibody

Freq

number_of_bleeds

EJ

3

11

JO1

42

119

MDA5

15

45

OJ

2

5

PL12

11

25

PL7

6

16

Total

79

221

Longitudinal Bleeds, Filtered

When filtering to require follow-up bleed dates that are:

  • \(\pm\) 3 months away from ANY OF:
    • 6 months after med start
    • 12 month after med start
    • 18 month after med start

here are the same results as above:

antibody

Freq

number_of_bleeds

EJ

2

8

JO1

30

75

MDA5

12

32

OJ

1

2

PL12

8

19

PL7

5

12

Total

58

148

Background Medication Data

Medication Details

Below are the numbers, by antibody, for patients on a background med (TRUE) or not (FALSE):

      
       FALSE TRUE
  EJ       0    2
  JO1     13   17
  MDA5     4    6
  OJ       1    0
  PL12     3    5
  PL7      3    2

Looking at the individual medications of this cohort, you get:

Looking at medication breakdowns, we see:

T cell Medications

In total, 44 unique patients received T cell effector medications, with good longitudinal data.

   antibody              drugdesc long_date_index number
1        EJ          AZATHIOPRINE               0      1
2        EJ          AZATHIOPRINE             180      1
3        EJ          AZATHIOPRINE             540      1
4        EJ          METHOTREXATE               0      2
5        EJ          METHOTREXATE             180      2
6        EJ          METHOTREXATE             540      2
7        EJ            PREDNISONE               0      3
8        EJ            PREDNISONE             180      1
9        EJ            PREDNISONE             360      2
10       EJ            PREDNISONE             540      1
11      JO1          AZATHIOPRINE               0     10
12      JO1          AZATHIOPRINE             180      7
13      JO1          AZATHIOPRINE             360      4
14      JO1          AZATHIOPRINE             540      1
15      JO1          METHOTREXATE               0      8
16      JO1          METHOTREXATE             180      7
17      JO1          METHOTREXATE             360      3
18      JO1          METHOTREXATE             540      1
19      JO1 MYCOPHENOLATE MOFETIL               0      6
20      JO1 MYCOPHENOLATE MOFETIL             180      4
21      JO1 MYCOPHENOLATE MOFETIL             360      2
22      JO1            PREDNISONE               0      2
23      JO1            PREDNISONE             180      1
24      JO1            PREDNISONE             360      1
25     MDA5          AZATHIOPRINE               0      4
26     MDA5          AZATHIOPRINE             180      3
27     MDA5          AZATHIOPRINE             540      3
28     MDA5          METHOTREXATE               0      1
29     MDA5          METHOTREXATE             540      1
30     MDA5    METHYLPREDNISOLONE               0      1
31     MDA5    METHYLPREDNISOLONE             360      1
32     MDA5 MYCOPHENOLATE MOFETIL               0      5
33     MDA5 MYCOPHENOLATE MOFETIL             180      4
34     MDA5 MYCOPHENOLATE MOFETIL             360      3
35     PL12          AZATHIOPRINE               0      2
36     PL12          AZATHIOPRINE             180      2
37     PL12          AZATHIOPRINE             360      1
38     PL12 MYCOPHENOLATE MOFETIL               0      2
39     PL12 MYCOPHENOLATE MOFETIL             180      1
40     PL12 MYCOPHENOLATE MOFETIL             360      1
41     PL12            PREDNISONE               0      2
42     PL12            PREDNISONE             360      2
43      PL7 MYCOPHENOLATE MOFETIL               0      1
44      PL7 MYCOPHENOLATE MOFETIL             540      1

B Cell Medications / Other

In total, 26 unique patients received B cell effector medications, with good longitudinal data.

   antibody               drugdesc long_date_index number
1        EJ HUMAN IMMUNOGLOBULIN G               0      2
2        EJ HUMAN IMMUNOGLOBULIN G             180      2
3        EJ HUMAN IMMUNOGLOBULIN G             540      1
7       JO1 HUMAN IMMUNOGLOBULIN G               0      7
8       JO1 HUMAN IMMUNOGLOBULIN G             180      4
9       JO1 HUMAN IMMUNOGLOBULIN G             360      4
17      JO1              RITUXIMAB               0      3
18      JO1              RITUXIMAB             180      1
19      JO1              RITUXIMAB             360      1
20      JO1              RITUXIMAB             540      1
25     MDA5 HUMAN IMMUNOGLOBULIN G               0      3
26     MDA5 HUMAN IMMUNOGLOBULIN G             180      2
27     MDA5 HUMAN IMMUNOGLOBULIN G             360      1
28     MDA5              RITUXIMAB               0      2
29     MDA5              RITUXIMAB             360      2
35       OJ HUMAN IMMUNOGLOBULIN G               0      1
36       OJ HUMAN IMMUNOGLOBULIN G             360      1
40     PL12              RITUXIMAB               0      1
41     PL12              RITUXIMAB             180      1
42     PL12              RITUXIMAB             540      1
45      PL7 HUMAN IMMUNOGLOBULIN G               0      1
46      PL7 HUMAN IMMUNOGLOBULIN G             180      1
47      PL7              RITUXIMAB               0      4
48      PL7              RITUXIMAB             180      3
49      PL7              RITUXIMAB             360      1
50      PL7              RITUXIMAB             540      2

Other Medications

   antibody                   drugdesc long_date_index number
1       JO1                 ETANERCEPT               0      1
2       JO1                 ETANERCEPT             180      1
3       JO1                 ETANERCEPT             360      1
4       JO1 HYDROXYCHLOROQUINE SULFATE               0      1
5       JO1 HYDROXYCHLOROQUINE SULFATE             360      1
6       JO1                 INFLIXIMAB               0      2
7       JO1                 INFLIXIMAB             180      1
8       JO1                 INFLIXIMAB             360      1
9       JO1                      OTHER               0      1
10      JO1                      OTHER             180      1
11      JO1              SULFASALAZINE               0      1
12      JO1              SULFASALAZINE             180      1
13      JO1        TOFACITINIB CITRATE               0      1
14      JO1        TOFACITINIB CITRATE             180      1
15     MDA5                 TACROLIMUS               0      2
16     MDA5                 TACROLIMUS             180      1
17     MDA5                 TACROLIMUS             360      1
18     MDA5        TOFACITINIB CITRATE               0      1
19     MDA5        TOFACITINIB CITRATE             540      1
20     PL12 HYDROXYCHLOROQUINE SULFATE               0      2
21     PL12 HYDROXYCHLOROQUINE SULFATE             180      1
22     PL12 HYDROXYCHLOROQUINE SULFATE             360      2
23     PL12                TOCILIZUMAB               0      1
24     PL12                TOCILIZUMAB             180      1

Limited to B and T Cell Meds

Here are the results of the above transformations if you ONLY include “of-interest” T cell and B cell effector medications.

For example, this list EXCLUDES bleeds for all medications seen in Section 3.2.

Combined B and T Cell Meds

antibody

Freq

number_of_bleeds

EJ

2

8

JO1

26

64

MDA5

10

26

OJ

1

2

PL12

6

14

PL7

5

12

Total

50

126

T Cell Meds Only

antibody

Freq

number_of_bleeds

EJ

2

7

JO1

22

51

MDA5

8

20

PL12

5

11

PL7

1

2

Total

38

91

B Cell Meds Only

antibody

Freq

number_of_bleeds

EJ

1

3

JO1

7

17

MDA5

4

8

OJ

1

2

PL12

1

3

PL7

4

10

Total

18

43

Medications by Antibody and Time

T Cell Medications

   antibody     drugdesc long_date_index number
1        EJ AZATHIOPRINE               0      1
2        EJ AZATHIOPRINE             180      1
3        EJ AZATHIOPRINE             540      1
4        EJ METHOTREXATE               0      2
5        EJ METHOTREXATE             180      2
6        EJ METHOTREXATE             540      2
7        EJ   PREDNISONE               0      3
8        EJ   PREDNISONE             180      1
9        EJ   PREDNISONE             360      2
10       EJ   PREDNISONE             540      1

   antibody              drugdesc long_date_index number
1       JO1          AZATHIOPRINE               0     10
2       JO1          AZATHIOPRINE             180      7
3       JO1          AZATHIOPRINE             360      4
4       JO1          AZATHIOPRINE             540      1
5       JO1          METHOTREXATE               0      8
6       JO1          METHOTREXATE             180      7
7       JO1          METHOTREXATE             360      3
8       JO1          METHOTREXATE             540      1
9       JO1 MYCOPHENOLATE MOFETIL               0      6
10      JO1 MYCOPHENOLATE MOFETIL             180      4
11      JO1 MYCOPHENOLATE MOFETIL             360      2
12      JO1            PREDNISONE               0      2
13      JO1            PREDNISONE             180      1
14      JO1            PREDNISONE             360      1

  antibody              drugdesc long_date_index number
1      PL7 MYCOPHENOLATE MOFETIL               0      1
2      PL7 MYCOPHENOLATE MOFETIL             540      1

  antibody              drugdesc long_date_index number
1     PL12          AZATHIOPRINE               0      2
2     PL12          AZATHIOPRINE             180      2
3     PL12          AZATHIOPRINE             360      1
4     PL12 MYCOPHENOLATE MOFETIL               0      2
5     PL12 MYCOPHENOLATE MOFETIL             180      1
6     PL12 MYCOPHENOLATE MOFETIL             360      1
7     PL12            PREDNISONE               0      2
8     PL12            PREDNISONE             360      2

   antibody              drugdesc long_date_index number
1      MDA5          AZATHIOPRINE               0      4
2      MDA5          AZATHIOPRINE             180      3
3      MDA5          AZATHIOPRINE             540      3
4      MDA5          METHOTREXATE               0      1
5      MDA5          METHOTREXATE             540      1
6      MDA5    METHYLPREDNISOLONE               0      1
7      MDA5    METHYLPREDNISOLONE             360      1
8      MDA5 MYCOPHENOLATE MOFETIL               0      5
9      MDA5 MYCOPHENOLATE MOFETIL             180      4
10     MDA5 MYCOPHENOLATE MOFETIL             360      3

B Cell Medications

  antibody               drugdesc long_date_index number
1       EJ HUMAN IMMUNOGLOBULIN G               0      2
2       EJ HUMAN IMMUNOGLOBULIN G             180      2
3       EJ HUMAN IMMUNOGLOBULIN G             540      1

  antibody               drugdesc long_date_index number
1       OJ HUMAN IMMUNOGLOBULIN G               0      1
2       OJ HUMAN IMMUNOGLOBULIN G             360      1

  antibody               drugdesc long_date_index number
1      JO1 HUMAN IMMUNOGLOBULIN G               0      7
2      JO1 HUMAN IMMUNOGLOBULIN G             180      4
3      JO1 HUMAN IMMUNOGLOBULIN G             360      4
4      JO1              RITUXIMAB               0      3
5      JO1              RITUXIMAB             180      1
6      JO1              RITUXIMAB             360      1
7      JO1              RITUXIMAB             540      1

  antibody               drugdesc long_date_index number
1      PL7 HUMAN IMMUNOGLOBULIN G               0      1
2      PL7 HUMAN IMMUNOGLOBULIN G             180      1
3      PL7              RITUXIMAB               0      4
4      PL7              RITUXIMAB             180      3
5      PL7              RITUXIMAB             360      1
6      PL7              RITUXIMAB             540      2

  antibody  drugdesc long_date_index number
1     PL12 RITUXIMAB               0      1
2     PL12 RITUXIMAB             180      1
3     PL12 RITUXIMAB             540      1

  antibody               drugdesc long_date_index number
1     MDA5 HUMAN IMMUNOGLOBULIN G               0      3
2     MDA5 HUMAN IMMUNOGLOBULIN G             180      2
3     MDA5 HUMAN IMMUNOGLOBULIN G             360      1
4     MDA5              RITUXIMAB               0      2
5     MDA5              RITUXIMAB             360      2

Other Medications

   antibody                   drugdesc long_date_index number
1       JO1                 ETANERCEPT               0      1
2       JO1                 ETANERCEPT             180      1
3       JO1                 ETANERCEPT             360      1
4       JO1 HYDROXYCHLOROQUINE SULFATE               0      1
5       JO1 HYDROXYCHLOROQUINE SULFATE             360      1
6       JO1                 INFLIXIMAB               0      2
7       JO1                 INFLIXIMAB             180      1
8       JO1                 INFLIXIMAB             360      1
9       JO1                      OTHER               0      1
10      JO1                      OTHER             180      1
11      JO1              SULFASALAZINE               0      1
12      JO1              SULFASALAZINE             180      1
13      JO1        TOFACITINIB CITRATE               0      1
14      JO1        TOFACITINIB CITRATE             180      1

  antibody                   drugdesc long_date_index number
1     PL12 HYDROXYCHLOROQUINE SULFATE               0      2
2     PL12 HYDROXYCHLOROQUINE SULFATE             180      1
3     PL12 HYDROXYCHLOROQUINE SULFATE             360      2
4     PL12                TOCILIZUMAB               0      1
5     PL12                TOCILIZUMAB             180      1

  antibody            drugdesc long_date_index number
1     MDA5          TACROLIMUS               0      2
2     MDA5          TACROLIMUS             180      1
3     MDA5          TACROLIMUS             360      1
4     MDA5 TOFACITINIB CITRATE               0      1
5     MDA5 TOFACITINIB CITRATE             540      1

Candidates for Proteomics

drugdesc

0

180

360

540

Total

AZATHIOPRINE

17 (42.5%)

13 (32.5%)

5 (12.5%)

5 (12.5%)

40 (100.0%)

HUMAN IMMUNOGLOBULIN G

14 (46.7%)

9 (30.0%)

6 (20.0%)

1 (3.3%)

30 (100.0%)

METHYLPREDNISOLONE

1 (50.0%)

0 (0.0%)

1 (50.0%)

0 (0.0%)

2 (100.0%)

MYCOPHENOLATE MOFETIL

14 (46.7%)

9 (30.0%)

6 (20.0%)

1 (3.3%)

30 (100.0%)

PREDNISONE

7 (46.7%)

2 (13.3%)

5 (33.3%)

1 (6.7%)

15 (100.0%)

RITUXIMAB

10 (43.5%)

5 (21.7%)

4 (17.4%)

4 (17.4%)

23 (100.0%)

Total

63 (45.0%)

38 (27.1%)

27 (19.3%)

12 (8.6%)

140 (100.0%)

Given the above, it seems reasonable to remove entries for:

  • methprednisolone
  • prednisone

drugdesc

0

180

360

540

Total

AZATHIOPRINE

17 (42.5%)

13 (32.5%)

5 (12.5%)

5 (12.5%)

40 (100.0%)

HUMAN IMMUNOGLOBULIN G

14 (46.7%)

9 (30.0%)

6 (20.0%)

1 (3.3%)

30 (100.0%)

MYCOPHENOLATE MOFETIL

14 (46.7%)

9 (30.0%)

6 (20.0%)

1 (3.3%)

30 (100.0%)

RITUXIMAB

10 (43.5%)

5 (21.7%)

4 (17.4%)

4 (17.4%)

23 (100.0%)

Total

55 (44.7%)

36 (29.3%)

21 (17.1%)

11 (8.9%)

123 (100.0%)

Now when looking at the antibody breakdown, also by longitudinal dates:

$AZATHIOPRINE
 antibody          0        180       360       540       Total
       EJ  1 (33.3%)  1 (33.3%) 0  (0.0%) 1 (33.3%)  3 (100.0%)
      JO1 10 (45.5%)  7 (31.8%) 4 (18.2%) 1  (4.5%) 22 (100.0%)
     MDA5  4 (40.0%)  3 (30.0%) 0  (0.0%) 3 (30.0%) 10 (100.0%)
       OJ  0     (-)  0     (-) 0     (-) 0     (-)  0 (100.0%)
     PL12  2 (40.0%)  2 (40.0%) 1 (20.0%) 0  (0.0%)  5 (100.0%)
      PL7  0     (-)  0     (-) 0     (-) 0     (-)  0 (100.0%)
    Total 17 (42.5%) 13 (32.5%) 5 (12.5%) 5 (12.5%) 40 (100.0%)

$`HUMAN IMMUNOGLOBULIN G`
 antibody          0       180       360       540       Total
       EJ  2 (40.0%) 2 (40.0%) 0  (0.0%) 1 (20.0%)  5 (100.0%)
      JO1  7 (46.7%) 4 (26.7%) 4 (26.7%) 0  (0.0%) 15 (100.0%)
     MDA5  3 (50.0%) 2 (33.3%) 1 (16.7%) 0  (0.0%)  6 (100.0%)
       OJ  1 (50.0%) 0  (0.0%) 1 (50.0%) 0  (0.0%)  2 (100.0%)
     PL12  0     (-) 0     (-) 0     (-) 0     (-)  0 (100.0%)
      PL7  1 (50.0%) 1 (50.0%) 0  (0.0%) 0  (0.0%)  2 (100.0%)
    Total 14 (46.7%) 9 (30.0%) 6 (20.0%) 1  (3.3%) 30 (100.0%)

$`MYCOPHENOLATE MOFETIL`
 antibody          0       180       360       540       Total
       EJ  0     (-) 0     (-) 0     (-) 0     (-)  0 (100.0%)
      JO1  6 (50.0%) 4 (33.3%) 2 (16.7%) 0  (0.0%) 12 (100.0%)
     MDA5  5 (41.7%) 4 (33.3%) 3 (25.0%) 0  (0.0%) 12 (100.0%)
       OJ  0     (-) 0     (-) 0     (-) 0     (-)  0 (100.0%)
     PL12  2 (50.0%) 1 (25.0%) 1 (25.0%) 0  (0.0%)  4 (100.0%)
      PL7  1 (50.0%) 0  (0.0%) 0  (0.0%) 1 (50.0%)  2 (100.0%)
    Total 14 (46.7%) 9 (30.0%) 6 (20.0%) 1  (3.3%) 30 (100.0%)

$RITUXIMAB
 antibody          0       180       360       540       Total
       EJ  0     (-) 0     (-) 0     (-) 0     (-)  0 (100.0%)
      JO1  3 (50.0%) 1 (16.7%) 1 (16.7%) 1 (16.7%)  6 (100.0%)
     MDA5  2 (50.0%) 0  (0.0%) 2 (50.0%) 0  (0.0%)  4 (100.0%)
       OJ  0     (-) 0     (-) 0     (-) 0     (-)  0 (100.0%)
     PL12  1 (33.3%) 1 (33.3%) 0  (0.0%) 1 (33.3%)  3 (100.0%)
      PL7  4 (40.0%) 3 (30.0%) 1 (10.0%) 2 (20.0%) 10 (100.0%)
    Total 10 (43.5%) 5 (21.7%) 4 (17.4%) 4 (17.4%) 23 (100.0%)

Some of the bleed numbers, especially for antibodies other than JO1 or MDA5, are sparse (e.g., some antibodies only have one patient getting a medication each).

For Azathioprine

  • EJ patients: n = 1
  • PL12 patients: n = 2

If we remove these, we get:

antibody

0

180

360

540

Total

EJ

1 (33.3%)

1 (33.3%)

0 (0.0%)

1 (33.3%)

3 (100.0%)

JO1

10 (45.5%)

7 (31.8%)

4 (18.2%)

1 (4.5%)

22 (100.0%)

MDA5

4 (40.0%)

3 (30.0%)

0 (0.0%)

3 (30.0%)

10 (100.0%)

PL12

2 (40.0%)

2 (40.0%)

1 (20.0%)

0 (0.0%)

5 (100.0%)

Total

17 (42.5%)

13 (32.5%)

5 (12.5%)

5 (12.5%)

40 (100.0%)

For Mycophenolate Mofetil

Follow up numbers, while modest for MMF, often have multiple data points. The exception is EJ and PL7:

  • EJ patients: n = 0
  • PL7 patients: n = 1, with just a day 0 and day 540 f/u

If removing those, we get:

antibody

0

180

360

Total

JO1

6 (50.0%)

4 (33.3%)

2 (16.7%)

12 (100.0%)

MDA5

5 (41.7%)

4 (33.3%)

3 (25.0%)

12 (100.0%)

PL12

2 (50.0%)

1 (25.0%)

1 (25.0%)

4 (100.0%)

Total

13 (46.4%)

9 (32.1%)

6 (21.4%)

28 (100.0%)

B Cell Meds

For IVIG

Bleed numbers by specific antibodies are also low here.

  • OJ patients: n = 1

So if excluding OJ, we get:

antibody

0

180

360

540

Total

EJ

2 (40.0%)

2 (40.0%)

0 (0.0%)

1 (20.0%)

5 (100.0%)

JO1

7 (46.7%)

4 (26.7%)

4 (26.7%)

0 (0.0%)

15 (100.0%)

MDA5

3 (50.0%)

2 (33.3%)

1 (16.7%)

0 (0.0%)

6 (100.0%)

PL7

1 (50.0%)

1 (50.0%)

0 (0.0%)

0 (0.0%)

2 (100.0%)

Total

13 (46.4%)

9 (32.1%)

5 (17.9%)

1 (3.6%)

28 (100.0%)

For Rituximab

These is some complexity to the rituximab data.

  • PL12 patients: n = 1

I propose keeping all samples, since the PL12 patient above has n = 3 total bleeds.

antibody

0

180

360

540

Total

JO1

3 (13.0%)

1 (4.3%)

1 (4.3%)

1 (4.3%)

6 (26.1%)

MDA5

2 (8.7%)

0 (0.0%)

2 (8.7%)

0 (0.0%)

4 (17.4%)

PL12

1 (4.3%)

1 (4.3%)

0 (0.0%)

1 (4.3%)

3 (13.0%)

PL7

4 (17.4%)

3 (13.0%)

1 (4.3%)

2 (8.7%)

10 (43.5%)

Total

10 (43.5%)

5 (21.7%)

4 (17.4%)

4 (17.4%)

23 (100.0%)

Hand-Vetted Exclusions

After looking up the ILD statuses in EPIC of the patients above, a small group showed inconsistencies with their titer-based antibody diagnoses (what we are using here) and what their clinical diagnosis in the chart holds.

Thus, we propose excluding the following patients:

antibody

MYCOPHENOLATE MOFETIL

RITUXIMAB

Total

MDA5

2

0

2

PL12

2

3

5

Total

4

3

7

antibody

0

180

540

Total

MDA5

1

1

0

2

PL12

2

2

1

5

Total

3

3

1

7

Overall Proposed Proteomics Dataset

N = 37 unique patients
N = 90 total bleeds

n = 2 / 37 EJ patients
n = 20 / 37 JO1 patients
n = 8 / 37 MDA5 patients
n = 3 / 37 PL12 patients
n = 4 / 37 PL7 patients

antibody

Freq

number_of_bleeds

EJ

2 (5.4%)

6 (6.7%)

JO1

20 (54.1%)

46 (51.1%)

MDA5

8 (21.6%)

21 (23.3%)

PL12

3 (8.1%)

7 (7.8%)

PL7

4 (10.8%)

10 (11.1%)

Total

37 (100.0%)

90 (100.0%)

antibody

AZATHIOPRINE

HUMAN IMMUNOGLOBULIN G

MYCOPHENOLATE MOFETIL

RITUXIMAB

Total

EJ

3 (2.7%)

5 (4.5%)

0 (0.0%)

0 (0.0%)

8 (7.1%)

JO1

22 (19.6%)

15 (13.4%)

12 (10.7%)

6 (5.4%)

55 (49.1%)

MDA5

10 (8.9%)

6 (5.4%)

10 (8.9%)

4 (3.6%)

30 (26.8%)

PL12

5 (4.5%)

0 (0.0%)

2 (1.8%)

0 (0.0%)

7 (6.2%)

PL7

0 (0.0%)

2 (1.8%)

0 (0.0%)

10 (8.9%)

12 (10.7%)

Total

40 (35.7%)

28 (25.0%)

24 (21.4%)

20 (17.9%)

112 (100.0%)

Filter Out by Samples on hand at NIH

We already have n = 19 / 90 bleeds on hand.
Of that:
    - n = 1 / 19 are from SOMA testing
    - n = 18 / 19 are from other non-SOMA testing at the NIH

Thus, we need to request n = 71 / 90 samples

antibody

Freq

number_of_bleeds

EJ

2

6

JO1

20

34

MDA5

8

18

PL12

3

5

PL7

4

8

Total

37

71