Publications by authors named "Daniel Lovell"
Objective: Prognostic factors associated with medication discontinuation in children with juvenile dermatomyositis (JDM) remain largely elusive. We aim to identify the predictors of medication-free remission (MFR) in children with JDM.
Methods: In this retrospective study, patients diagnosed with JDM according to Peter & Bohan criteria and followed for ≥18 months at a tertiary care center from 2006 through 2022 were included.
Article Synopsis
- Over 300,000 children in the U.S. have pediatric rheumatic diseases (PRDs), with juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (cSLE), and juvenile dermatomyositis (JDM) being the most prevalent.
- The first biologic therapy for JIA, Etanercept, was approved in 1999, followed by other similar treatments that have significantly improved disease outcomes, though options for cSLE and JDM remain limited.
- The review explores the challenges in treating various PRDs, highlights advancements in treatment, and discusses current regulatory conditions affecting bDMARD and tsDMARD approvals.
Article Synopsis
- * Current treatment decisions often rely on general clinical trial data or insurance policies, rather than considering the individual characteristics of the patient and the unique effects of treatments.
- * A proposed solution is to use digital health technology to create a tool that incorporates real-world patient data, enabling personalized treatment decisions through shared discussions between families and rheumatologists.
Objective: To demonstrate the time to place temporary bilateral stents with indocyanine green (ICG) injection, time to intra-operative identification of bilateral ureters - with and without the use of ICG, and number of times for ICG activation in endometriosis excision surgery.
Design: Retrospective cross-sectional study SETTING: Single Tertiary Academic Hospital PARTICIPANTS: 50 serial patients with functioning pelvic ureters, who underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES) for all stages of endometriosis excision between September 2023 and May 2024.
Interventions: Placement of temporary bilateral ureteral stents with indocyanine green injection before the start of vNOTES, noting the time needed to identify intra-peritoneal ureters with and without ICG activation, and average number of times ICG was activated for endometriosis excision.
Identification of disease and therapeutic biomarkers remains a significant challenge in the early diagnosis and effective treatment of juvenile idiopathic arthritis (JIA). In this study, plasma metabolomic profiling was conducted to identify disease-related metabolic biomarkers associated with JIA. Plasma samples from treatment-naïve JIA patients and non-JIA reference patients underwent global metabolomic profiling across discovery (60 JIA, 60 non-JIA) and replication (49 JIA, 38 non-JIA) cohorts.
View Article and Find Full Text PDFObjective: To validate the ankle-specific Pediatric Arthritis Ultrasound Scoring System (PAUSS-ankle) in children with juvenile idiopathic arthritis (JIA).
Methods: Patients with a diagnosis of JIA prospectively underwent a standard clinical assessment and musculoskeletal ultrasound (MSUS) of one or both ankles. B-mode and Power-Doppler mode MSUS images were acquired and scored according to the PAUSS-ankle protocol.
Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES (RSP-vNOTES) Hysterectomy: A Case Series.
J Minim Invasive Gynecol
December 2024
Objective: To demonstrate the feasibility and short-term outcomes of Robot-Assisted Single Port vaginal NOTES (RSP-vNOTES) for total hysterectomy, with or without endometriosis resection for all stages.
Design: Retrospective case series.
Setting: Single academic tertiary care hospital in Houston, Texas, USA.
Using a collaborative learning health system approach to improve disease activity outcomes in children with juvenile idiopathic arthritis in the Pediatric Rheumatology Care and Outcomes Improvement Network.
Front Pediatr
August 2024
Article Synopsis
- The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) aims to enhance the health outcomes of children with juvenile idiopathic arthritis (JIA) through a shared patient registry and a focus on disease activity measures.
- With participation from 23 hospitals and over 7,200 patients, PR-COIN tracks various quality measures to assess and improve treatment effectiveness.
- Significant improvements have been noted, including an increase in patients achieving inactive or low disease activity from 76% to 81%, along with a decrease in the average disease activity score, indicating better overall patient outcomes.
Objective: To report pharmacokinetics (PK), immunogenicity, clinical effect, and safety of intravenous (IV) golimumab in children with active polyarticular-course juvenile idiopathic arthritis (pcJIA) who participated in A Study to Evaluate the Pharmacokinetics, Efficacy and Safety of Intravenous Golimumab in Pediatric Participants With Active Polyarticular Course Juvenile Idiopathic Arthritis Despite Methotrexate Therapy (GO-VIVA)'s open-label, long-term extension (LTE) through week 252.
Methods: GO-VIVA participants who continued IV golimumab (80 mg/m every 8 weeks) after week 52 were included. PK and safety were assessed through week 244 (last dose) and week 252, respectively, and clinical response through week 116.
Objective: The goal was to develop and validate classification criteria for axial juvenile spondyloarthritis (SpA; AxJSpA).
Methods: This international initiative consisted of four phases: (1) item generation, (2) item reduction, (3) criteria development, and (4) validation of the AxJSpA criteria by an independent team of experts in an internationally representative validation cohort.
Results: These criteria are intended to be used on youth with a physician diagnosis of juvenile SpA and for whom axial disease is suspected.
Background: Juvenile idiopathic arthritis (JIA) comprises a heterogeneous group of conditions that can cause marked disability and diminished quality of life. Data on predictors of clinical response are insufficient to guide selection of the appropriate biologic agent for individual patients. This study aimed to investigate the propensity of S100A8/9 and S100A12 as predictive biomarkers of abatacept response in polyarticular-course juvenile idiopathic arthritis (pJIA).
View Article and Find Full Text PDFArticle Synopsis
- The study evaluates the safety, tolerability, and effectiveness of tofacitinib in children and adolescents with juvenile idiopathic arthritis (JIA) in a long-term extension (LTE) study.
- Out of 225 patients treated with tofacitinib, a high percentage experienced adverse events (AEs), although serious AEs were relatively low, with a focus on infection rates and disease activity.
- Results showed significant improvement in disease activity scores over time, with a notable increase in patients achieving inactive disease status after 48 months of treatment.
Laparoscopy has advanced over the last three decades with residency training programs focusing on trans-abdominal laparoscopic techniques whether conventional or robotic. Despite attempts over many years to adopt vaginal surgery as the preferred method of hysterectomy, traditional vaginal surgery has largely fallen out of favor. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has gained popularity with patients and promises to provide an attractive option, but the surgical skills of many gynecologists have limited its widespread adoption.
View Article and Find Full Text PDFStudy Objective: To show feasibility and short-term outcomes of robot-assisted vaginal NOTES (RvNOTES) for the treatment of stage IV endometriosis during total hysterectomy with/without complete cul-de-sac obliteration.
Design: Retrospective case series.
Setting: Single academic tertiary care hospital in Houston, Texas, USA.
Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery for Frozen Pelvis.
J Minim Invasive Gynecol
June 2024
Article Synopsis
- The study aimed to demonstrate the feasibility and techniques for performing a total hysterectomy, salpingectomy, endometriosis resection, and ovarian reconstruction in a patient with a challenging frozen pelvis due to a past ruptured tubo-ovarian abscess.
- The intervention approach focused on using a vaginal method to minimize complications from dense abdominal adhesions and facilitate safer access to crucial anatomy, supported by the use of indocyanine green for ureter visualization.
- The video showcases various surgical strategies, including rotational maneuvers and ovarian reconstruction, highlighting the effectiveness of robot-assisted vaginal endoscopic surgery in complex cases.
Objective: The aim of this study was to report the interim 5-year safety and effectiveness of abatacept in patients with JIA in the PRINTO/PRCSG registry.
Methods: The Abatacept JIA Registry (NCT01357668) is an ongoing observational study of children with JIA receiving abatacept; enrolment started in January 2013. Clinical sites enrolled patients with JIA starting or currently receiving abatacept.
Currently, the criteria used to classify patients with SJIA are different from those used for AOSD. However, it has been recognized that the existing terms are too narrow, subdividing the Still's population unnecessarily between pediatric-onset and adult-onset disease and excluding an appreciable group of children in whom overt arthritis is delayed or absent. Government regulators and insurers rely upon the guidance of subject experts to provide disease definitions, and when these definitions are flawed, to provide new and better ones.
View Article and Find Full Text PDFObjective: We undertook this study to validate the Pediatric Arthritis Ultrasound Scoring System for the knee joint (PAUSS-knee) in children with juvenile idiopathic arthritis (JIA).
Methods: Children with JIA were enrolled to prospectively receive a musculoskeletal ultrasound (MSUS) examination of the knee and a physical examination to determine presence/absence of clinical arthritis. MSUS images were scored using the PAUSS-knee, a semiquantitative MSUS scoring system (0-3, normal to severe) for B-mode and power Doppler mode.
Objective: To describe the efficacy and safety data of children with polyarticular-course juvenile idiopathic arthritis (pcJIA) treated with abatacept (ABA) + methotrexate (MTX) or ABA monotherapy when prior MTX use was either ineffective or not tolerated.
Methods: Posthoc analysis of 2 phase III trials of subcutaneous (SC) and intravenous (IV) ABA over 2 years in patients with pcJIA (aged 2-17 years). Patients were stratified by treatment with ABA + MTX or ABA monotherapy and further by prior biologic use.
Article Synopsis
- An 8-year-old girl was referred to a pediatric ophthalmology clinic for blurred vision and was found to have bilateral pan-uveitis after recovering from COVID-19 two weeks earlier.
- Despite extensive testing for other causes, the investigation revealed no underlying issues, and she has not experienced any recurrence of symptoms after two years.
- This case suggests a possible link between COVID-19 and eye inflammation in children, emphasizing the need for awareness and further research into how the virus might affect the eyes through immune responses.
Objective: To describe the selection, development, and implementation of quality measures (QMs) for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network using quality improvement methods and leveraging QMs to drive improved outcomes across a JIA population since 2011.
Methods: An American College of Rheumatology-endorsed multistakeholder process previously selected initial process QMs. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome QMs.
Long-Term Maintenance of Clinical Responses by Individual Patients With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Abatacept.
Arthritis Care Res (Hoboken)
November 2023
Objective: To investigate the frequency and trajectories of individual patients with polyarticular-course juvenile idiopathic arthritis (JIA) achieving novel composite end points on abatacept.
Methods: Data from a clinical trial of subcutaneous abatacept (NCT01844518) and a post hoc analysis of intravenous abatacept (NCT00095173) in patients with polyarticular-course JIA were included. Three end points were defined and evaluated: combined occurrence of low disease activity (LDA) measured by the Juvenile Arthritis Disease Activity Score; 50% improvement in American College of Rheumatology criteria for JIA (ACR50); and patient-reported outcomes.
Objective: Stakeholders met to address persistent challenges facing the development of therapeutics for polyarticular juvenile idiopathic arthritis (pJIA), which result in fewer approved therapies for children with pJIA than adults with rheumatoid arthritis (RA) and long lag times from adult RA approval to pediatric labeling. Ensuring that new medications are authorized in a timely manner to meet the needs of JIA patients worldwide is critically important to multiple stakeholders.
Methods: The Food and Drug Administration in collaboration with the University of Maryland Center for Regulatory Science and Innovation held a public workshop entitled "Accelerating Drug Development for pJIA" on October 2, 2019, to address challenges surrounding access to new medications for children and adolescents with pJIA.
Objectives: To assess the heterogeneity in factors affecting physician's global assessment of disease activity (PhGA) and in PhGA scoring of multiple JIA patient's case scenarios.
Methods: An electronic web-based questionnaire of factors potentially considered in PhGA was sent worldwide to members of PRINTO and the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN). The respondents were asked to rate from 0 to 100 the relevance of 17 factors possibly affecting PhGA scoring and to derive a PhGA score of 17 detailed JIA patient cases.