Objectives Hydroxychloroquine (HCQ) is a key therapy in systemic lupus erythematosus (SLE). Medication non-adherence is reported in up to 80% of lupus patients and results in increased morbidity, mortality, and health care utilization. HCQ levels are a sensitive and reliable method to assess medication adherence. Our study evaluated the role of HCQ level measurement in routine clinical care and its association with disease activity in a predominantly Hispanic population. Methods SLE patients from the Columbia University Lupus cohort treated with HCQ for ≥ 6 months and reporting medication adherence were included. HCQ levels were measured by whole blood high performance liquid chromatography. Non-adherence was defined as an HCQ level <500 ng/ml. The association between HCQ levels and disease activity measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was evaluated. Results One hundred and eight patients were enrolled; the median age was 38 years, 91% were female, and 63% were Hispanic. The median SLEDAI-2K was 4.3 (0–20). Forty-one percent of patients had an HCQ level <500 ng/ml consistent with non-adherence, of which 19% had undetectable levels. A higher SLEDAI-2K score was associated with low HCQ levels ( p = 0.003). This association remained significant after adjusting for depression ( p = 0.0007). Conclusion HCQ levels < 500 ng/ml were associated with higher disease activity and accounted for 32% of the SLEDAI-2K variability. HCQ blood measurement is a simple and reliable method to evaluate medication adherence in SLE. Reasons for non-adherence (levels < 500 ng/ml) should be further explored and addressed.

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ObjectivesLupus nephritis (LN) requires renal replacement therapy in 10%–30% of patients. About 30% of these patients receive a kidney transplant. Belatacept is a second-generation, selective, T-cell co-stimulator blocker (inhibits cytotoxic, T-lymphocyte antigen 4, CTLA-4) used as an alternative to calcineurin inhibitors (CNI) for maintenance regimens after kidney transplantation. The pathogenic relevance of CTLA-4 inhibition and the favourable cardiovascular profile of belatacept make it an attractive therapeutic option in systemic lupus erythematosus (SLE). Intravenous administration of belatacept ensures therapeutic adherence.MethodsThis retrospective, single-centre study evaluates the outcomes of LN kidney transplant recipients treated with belatacept for reasons not related to SLE at the Columbia University Lupus and Renal Transplant Cohort.ResultsBelatacept was started in six patients on CNI regimens at 15.5±17.1 months following transplantation for LN. In five patients, creatinine levels stabilised 6 months after belatacept, one returned to haemodialysis due to CNI toxicity and pyelonephritis and one relisted for a kidney transplant following acute cellular rejection and cortical necrosis. Five patients are followed for extrarenal lupus; no extrarenal manifestations were documented in the other two patients. Data on SLE disease activity pre-belatacept and post-belatacept were available and scored in three patients using the SLE Disease Activity Index Glucocorticosteroid Index (SLEDAI-2KG), which accounts for clinical and laboratory manifestations, as well as steroid dose. Mean SLEDAI-2KG decreased from 13 to 7.6.ConclusionBelatacept in LN kidney transplant recipients may decrease extrarenal manifestations, attenuate CNI toxicity and stabilise allograft function, providing a better alternative to CNI regimens. Furthermore, these data suggest that belatacept, although initiated for reasons not related to SLE, might have a beneficial effect in SLE.

BACKGROUND Trans-radial approach for percutaneous coronary intervention (PCI) has been shown to be superior to trans-femoral approach in reducing the risks of adverse events; However, it is unknown whether bivalirudin would offer any added benefit.METHODS Electronic databases were searched for randomized trials comparing bivalirudin with unfractionated heparin in patients

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BACKGROUND Psilocybin is a psychedelic substance which has demonstrated promise in the treatment of depression, anxiety, and substance use disorders. Significant media coverage has been dedicated to psychedelic medicine, but it is unclear whether the public associates psilocybin with its potential therapeutic benefits. The COVID-19 pandemic led to an increase in depression, anxiety, and substance abuse in the general population. OBJECTIVE This study attempts to link increases in interest in these disorders with increases in interest in psilocybin using Google Trends. METHODS Weekly, interest-over-time Google Trends data for four years, from the week of March 11th, 2018 to the week of March 6th, 2022, was downloaded for “psilocybin”, as well as search terms to be used as controls: “cannabis,” “cocaine,” “psychedelic therapy,” “antidepressant,” “depression,” “anxiety,” and “addiction.” Important psilocybin-related news drivers and the declaration of the pandemic were marked visually on a line graph of psilocybin trends data. Two t-tests of slopes were performed for all queries versus a trendline with a slope of zero, one using two years of data prior to the declaration of the pandemic and one using two years of data after the declaration of the pandemic. T-test of slope was performed internally for each query as well, with two years prior to the pandemic data being compared to two years after the pandemic data to determine if the slope of the trendlines changed significantly after the declaration of pandemic. RESULTS Psilocybin-, psychedelic therapy- and antidepressant-related search interest had been increasing before the declaration of pandemic and significantly increased after the declaration. Addiction-related search interest was decreasing before the declaration of pandemic and increasing after the declaration, which represented a significant change. Cannabis-related searches were level prior to the pandemic and decreasing after the pandemic, but this change was not significant. Cocaine-related searches were decreasing prior to the pandemic and level after the declaration, and this was a significant change. Depression-related search interest was decreasing before the pandemic and level after the pandemic, but this change was not significant. Anxiety-related search interest was level prior to the pandemic, and increasing after the pandemic, but this difference was not significant. CONCLUSIONS This study suggests that interest in psilocybin is increasing when measured by Google Trends data, that the interest in psilocybin and psychedelic therapy increased after declaration of pandemic, and that this increase in interest correlates with an increase in interest in antidepressants after the pandemic declaration, perhaps suggesting that there is an association with psilocybin as a therapeutic similar to antidepressants. The lack of correlation with increases in interest in cannabis or cocaine further support this.

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