Bhaskar Dasgupta

Imperial College London, Londinium, England, United Kingdom

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Publications (80)369.54 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the effectiveness of a fast track pathway (FTP) on sight loss in patients with suspected giant cell arteritis (GCA). A longitudinal observational cohort study was conducted in the secondary care rheumatology department. One hundred and thirty-five newly referred suspected GCA patients seen via the FTP (Jan. 2012-Dec. 2013) were compared to 81 patients seen through the conventional referral and review system (Jan. 2009-Dec. 2011). The FTP resulted in significant reduction in irreversible sight loss from 37.0% (as seen in the historical cohort 2009-2011) to 9.0 % (2012-2013, OR 0.17, p=0.001). Adjustment for clinical and demographic parameters including known risk factors for GCA associated blindness did not significantly change the primary result (OR 0.08, p=0.001). FTP resulted in a reduction of time from symptom onset to diagnosis, particularly by reduction of time from general practitioner's (GP) referral to the rheumatology review (79% of FTP patients were seen within one working day compared to 64.6 % in the conventional pathway, p=0.023). The FTP has seen a reduction in number of GP appointments. There was a significant reduction of permanent sight loss with a fast track GCA pathway. The effect may be due to multiple factors including better GP education and reduction in delayed diagnosis. These results need verification at other sites.
    Clinical and experimental rheumatology 05/2015; 33(2 Suppl 89-2 Suppl 89):103-6. · 2.97 Impact Factor
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    ABSTRACT: We conducted a large-scale genetic analysis on giant cell arteritis (GCA), a polygenic immune-mediated vasculitis. A case-control cohort, comprising 1,651 case subjects with GCA and 15,306 unrelated control subjects from six different countries of European ancestry, was genotyped by the Immunochip array. We also imputed HLA data with a previously validated imputation method to perform a more comprehensive analysis of this genomic region. The strongest association signals were observed in the HLA region, with rs477515 representing the highest peak (p = 4.05 × 10(-40), OR = 1.73). A multivariate model including class II amino acids of HLA-DRβ1 and HLA-DQα1 and one class I amino acid of HLA-B explained most of the HLA association with GCA, consistent with previously reported associations of classical HLA alleles like HLA-DRB1(∗)04. An omnibus test on polymorphic amino acid positions highlighted DRβ1 13 (p = 4.08 × 10(-43)) and HLA-DQα1 47 (p = 4.02 × 10(-46)), 56, and 76 (both p = 1.84 × 10(-45)) as relevant positions for disease susceptibility. Outside the HLA region, the most significant loci included PTPN22 (rs2476601, p = 1.73 × 10(-6), OR = 1.38), LRRC32 (rs10160518, p = 4.39 × 10(-6), OR = 1.20), and REL (rs115674477, p = 1.10 × 10(-5), OR = 1.63). Our study provides evidence of a strong contribution of HLA class I and II molecules to susceptibility to GCA. In the non-HLA region, we confirmed a key role for the functional PTPN22 rs2476601 variant and proposed other putative risk loci for GCA involved in Th1, Th17, and Treg cell function. Copyright © 2015 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.
    The American Journal of Human Genetics 03/2015; 96(4). DOI:10.1016/j.ajhg.2015.02.009 · 10.99 Impact Factor
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    ABSTRACT: Objective: Rheumatoid arthritis (RA) management involves improving clinical outcomes and quality of life (QoL). Golimumab (GLM) is used as add-on therapy for patients who have failed disease-modifying antirheumatic drugs (DMARDs). This GO-MORE subanalysis investigated relationships between patient and physician expectations and outcomes. Methods: GO-MORE was an open-label, multinational, prospective study in biologic-naïve patients with active RA despite DMARD treatment. Patients received 50 mg subcutaneous GLM monthly for 6 months. At baseline and month 3, patients rated treatment expectations for the following 3 months using 5-point scales (1=good, 5=poor). Outcomes were compared among expectation tertiles: most positive, intermediate, and least positive. At baseline and month 3, physicians predicted patient disease state 3 months later. Results: At baseline, 3280 efficacy-evaluable patients with moderate (21.3%) or high (78.7%) disease activity had mean disease duration 7.6 (SD=7.9) years, mean Health Assessment Questionnaire Disability Index (HAQ-DI) 1.44 (SD=0.67), and mean EuroQoL-5D (EQ-5D) 0.42 (SD=0.33). Patients reported high treatment expectations (mean 1.44); 95.9% expected GLM to be better than current treatment. Patients with fewer DMARD failures, higher disease activity, shorter disease duration, younger age, and female gender reported higher expectations (all Ps<0.05). After 6 months, patients with the most positive expectations had higher remission rates (P<0.0001) and greater HAQ-DI (P<0.0001) and EQ-5D (P<0.0001) improvements. At baseline, physicians expected 29.6% and 59.2% of patients to attain remission and low disease activity, respectively, after 3 months. Conclusions: Patients had high expectations for GLM treatment. Patients with more positive expectations had greater remission rates, improvements in function, and QoL. © 2014 American College of Rheumatology.
    Arthritis Care and Research 12/2014; 66(12). DOI:10.1002/acr.22371 · 4.04 Impact Factor
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    ABSTRACT: A Diagnostic Protocol for Giant Cell Arteritis (GCA) Using Ultrasound Assessment Jennifer Piper1, Ana Sofia Serafim1, Cristina Ponte1, Surjeet Singh2, Bhaskar Dasgupta3, Wolfgang A. Schmidt4, Eugene McNally5, Andreas P. Diamantopoulos6, Andrew Hutchings7 and Raashid Luqmani8, 1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, 2University of Oxford, Sciences, Oxford, England, 3Department of Rheumatology, Southend University Hospital, Essex, United Kingdom, 4Rheumatology, Immanuel Krankenhaus, Berlin, Germany, 5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom, 6Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway, 7Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom, 8Oxford NIHR Musculoskeletal Biomedical Research Unit, Oxford, United Kingdom Background/Purpose Ultrasound (US) has not yet superseded temporal artery biopsy as a diagnostic test. This may reflect poor consistency of the scanning technique, due to the lack of a standardised scanning protocol. We have developed a standardised protocol which was implemented in a prospective study of 857 participants: 439 healthy controls and 418 patients with suspected GCA (Temporal Artery Biopsy versus Ultrasound, TABUL). We assessed each patient for evidence of typical ultrasound features of GCA: the presence of a halo surrounding the vessel wall, stenosis or occlusion of the vessel. Methods A detailed scanning protocol was developed for all cases and controls. We recorded the presence or absence of ultrasound features of GCA in each segment of each temporal artery (common, parietal, frontal proximal and frontal distal) and both axillary arteries. Sonographers were asked to acquire video and static images for each patient to ensure accuracy of findings. The sonographer measured and documented: halo diameter (based on a normal range of up to 0.3 mm for the temporal artery and up to 1.0 mm in the axillary artery) and length; pulse Doppler measurements prior to and within a stenosis (confirmed if the highest maximum systolic velocity was over twice the lowest maximum systolic velocity) and arterial occlusion. Each study site sonographer was required to be proficient in the protocol by scanning at least 10 healthy controls, passing an online test showing normal and abnormal scans (pass mark >75%) and scanning a patient with ultrasound evidence of active GCA. Results The US scanning protocol was started by 33 sites, with only 22 sites completing the training in 6.7 months [range 0.2 – 16.4 months]. A total of 439 controls were scanned across 31 sites (1 sonographer covered 3 sites). The online test was passed by 39 sonographers (multiple sonographers at some sites) with an average of 2 attempts [range 1-4]); 22 sonographers successfully scanned an active GCA patient, validated by the expert panel. The longest delay in completing the training was due to difficulty in recruiting a patient with active GCA (hot case), which was necessary for each site prior to it joining the main study. Common issues encountered were a lack of time away from clinical duties and locating a new suspected GCA case for the hot case assessment. We have created a bank of 857 sets of consistently recorded US images of temporal and axillary arteries from 418 patients with suspected GCA and 439 healthy controls. Expert review of the first 263 suspected patients has confirmed positive US findings of GCA in 100 patients and no US evidence in 163 cases. Conclusion Quality and accuracy are imperative for the clinical use of ultrasound data in the diagnosis of GCA. We have developed an effective training program and scanning protocol which ensures consistency and proficiency. The methodology can be adapted and extended to allow for additional artery assessment, including carotid, vertebral and subclavian arteries, extending the value of a structured approach. We recommend the TABUL study scanning protocol as the standard approach for diagnosis of GCA using ultrasound.
    ACR 2014, Boston, MA; 11/2014
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    ABSTRACT: Early Halo Sign Features on Ultrasound Examination of Treated Patients with Giant Cell Arteritis Ana Sofia Serafim1, Surjeet Singh1, Jennifer Piper1, Andrew Hutchings2, Mike Bradburn3, Cristina Ponte4, Bhaskar Dasgupta5, Wolfgang A. Schmidt6, Andreas P. Diamantopoulos7, Eugene McNally8 and Raashid Luqmani9, 1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, 2Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom, 3Clinical Trials Research Unit (CTRU), Sheffield University, Sheffield, United Kingdom, 4Rheumatology and Metabolic Bone Diseases Department, Rheumatology Research Unit - IMM, Lisbon Academic Medical Centre, Lisbon, Portugal, 5Department of Rheumatology, Southend University Hospital, Essex, United Kingdom, 6Rheumatology, Immanuel Krankenhaus, Berlin, Germany, 7Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway, 8Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom, 9Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom Background/Purpose The TABUL study (Temporal Artery Biopsy Vs Ultrasound in diagnosis of Giant Cell Arteritis) is assessing the relative performance of ultrasound and temporal artery biopsy for diagnosing GCA. All patients with newly suspected GCA underwent a single ultrasound scan of both temporal and axillary arteries within 7 days of commencing glucocorticoid therapy. We aimed to examine the ultrasound response to treatment as a potential biomarker in GCA, by measuring differences in the size of the halo around the arteries with different steroid duration within a 7 day period; furthermore we correlated the halo size with ischaemic symptoms of GCA. Methods All 415 cases with suspected GCA had an ultrasound examination of the temporal and axillary arteries and a biopsy of the temporal artery within 7 days of inclusion. The 301 patients with clinically defined definite or probable GCA at baseline were included in this analysis. Using the IBM SPSS Statistics package v20, we performed a cross-sectional analysis with linear and logistic regression models to determine the relationship of the halo size with days of steroid treatment and with ischaemic symptoms of GCA (jaw and tongue claudication, amaurosis fugax and reduced, lost or double vision). Results We included 214 women and 87 men (mean age 72.6 and 71.2 years old respectively) from 20 different recruitment centres. Fifty percent were scanned on the second day of steroid treatment or before. Forty three per cent (131 patients) had one or more temporal segments with a halo, 48.5% (146 patients) had bilateral temporal artery halos and 12.6% (38 patients) had axillary involvement. The linear regression model showed a consistently smaller halo size over the 7 days of steroid treatment (p<0.005) for the temporal arteries. The likelihood of finding a halo diminished with time, which was confirmed in a logistic regression until day 4 of steroid treatment (p<0.005), whereas this trend was not possible to predict after that time. At least one ischaemic symptom was present in 42% of the patients: jaw claudication in 48.2% (146 patients), reduced or lost vision in 36.6% (111 patients), double vision in 8.6% (26 patients), tongue claudication in 6.6% (20 patients) and amaurosis fugax in 4% (12 patients). The presence of jaw claudication was more frequent in patients with a halo (p<0.05). The symptomatic side of temporal arteries correlated significantly with the ipsilateral ultrasound findings (p<0.05 for right and left side findings on physical examination). Conclusion In newly diagnosed GCA, ultrasound halo size decreases with steroid treatment and correlates with the presence of ischaemic symptoms, supporting its early use as a diagnostic and potentially prognostic marker. We are exploring the potential value of change in halo size in individual patients over time to determine its value in monitoring response to treatment.
    ACR 2014, Boston, MA; 11/2014
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    ABSTRACT: This study sets out to investigate the relationship between health status [EuroQol five-dimensions questionnaire (EQ-5D)] in primary SS and three of the European League Against Rheumatism (EULAR) SS outcome measures-the disease activity index (ESSDAI), the patient reported index (ESSPRI) and the sicca score. In particular, the goal was to establish whether there is a relationship between the EULAR outcome measures and quality of life.
    Rheumatology (Oxford, England) 09/2014; 54(4). DOI:10.1093/rheumatology/keu361 · 4.44 Impact Factor
  • Rheumatology 07/2014; 53(suppl 2):i15-i15. DOI:10.1093/rheumatology/keu210.008 · 4.44 Impact Factor
  • J. Hollywood, A. Hutchings, B. Dasgupta
    Rheumatology 07/2014; 53(suppl 2):i14-i14. DOI:10.1093/rheumatology/keu210.007 · 4.44 Impact Factor
  • Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):553-553. DOI:10.1136/annrheumdis-2014-eular.2316 · 9.27 Impact Factor
  • Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):697-697. DOI:10.1136/annrheumdis-2014-eular.3986 · 9.27 Impact Factor
  • Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):552-552. DOI:10.1136/annrheumdis-2014-eular.2271 · 9.27 Impact Factor
  • Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):233-234. DOI:10.1136/annrheumdis-2014-eular.2258 · 9.27 Impact Factor
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    ABSTRACT: Objective: This study investigates the relationship between health status (EQ-5D) in primary Sjögren’s syndrome and three of the EULAR Sjögren’s syndrome outcome measures – the disease activity index (ESSDAI), the patient reported index (ESSPRI) and the sicca score. Methods: Health status was evaluated using a standardised measure developed by the EuroQol Group - the EQ5D. This permits calculation of two measures of health status: time trade-off values (TTO) and the EQ5D visual analogue scale (VAS) scores. We used Spearman rank correlation analysis to investigate the strength of association between health status and three EULAR measures of physician and patient reported disease activity in 639 patients from the United Kingdom primary Sjögren’s syndrome registry (UKPSSR) cohort. Results: This study demonstrates that the EULAR Sjögren’s syndrome disease specific outcome measures are significantly correlated with health outcome values (p<0.001). Higher scores on the ESSDAI, EULAR sicca score and ESSPRI are associated with poorer health states – i.e. lower TTO values and lower VAS scores. While all three are significantly correlated with TTO values and EQ5D-VAS scores, the effect is strongest for the ESSPRI index. Conclusion: This study provides further evidence supporting the use of ESSDAI, EULAR sicca score and ESSPRI measures in the clinic. We also discuss the need for disease-specific measures of health status and their comparison to standardised health outcome measures.
    Rheumatology 06/2014; · 4.44 Impact Factor
  • Rheumatology (Oxford, England) 05/2014; 53(suppl 2):i7-i8. DOI:10.1093/rheumatology/keu198 · 4.44 Impact Factor
  • Andreas P Diamantopoulos, Bhaskar Dasgupta
    Rheumatology (Oxford, England) 05/2014; 53(suppl 2):i8. DOI:10.1093/rheumatology/keu199 · 4.44 Impact Factor
  • Bhaskar Dasgupta
    Rheumatology (Oxford, England) 05/2014; 53(suppl 2):i7. DOI:10.1093/rheumatology/keu197 · 4.44 Impact Factor
  • Rheumatology (Oxford, England) 05/2014; 53(suppl 2):i9. DOI:10.1093/rheumatology/keu200 · 4.44 Impact Factor
  • Rheumatology (Oxford, England) 05/2014; 53(suppl 2):i5-i6. DOI:10.1093/rheumatology/keu191 · 4.44 Impact Factor
  • Sarah L Mackie, Bhaskar Dasgupta
    Nature Reviews Rheumatology 03/2014; DOI:10.1038/nrrheum.2014.38 · 10.25 Impact Factor
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    ABSTRACT: The aim of this 12-week Phase IIb study was to assess the efficacy and safety of olokizumab (OKZ), a humanised anti-IL6 monoclonal antibody, in patients with rheumatoid arthritis (RA) with moderate-to-severe disease activity who had previously failed tumour necrosis factor (TNF) inhibitor therapy. The dose-exposure-response relationship for OKZ was also investigated. Patients were randomised to one of nine treatment arms receiving placebo (PBO) or OKZ (60, 120 or 240 mg) every 4 weeks (Q4W) or every 2 weeks (Q2W), or 8 mg/kg tocilizumab (TCZ) Q4W. The primary endpoint was change from baseline in DAS28(C-reactive protein, CRP) at Week 12. Secondary efficacy endpoints were American College of Rheumatology 20 (ACR20), ACR50 and ACR70 response rates at Week 12. Exploratory analyses included comparisons of OKZ efficacy with TCZ. Across 221 randomised patients, OKZ treatment produced significantly greater reductions in DAS28(CRP) from baseline levels at Week 12, compared to PBO (p<0.001), at all the OKZ doses tested (60 mg OKZ p=0.0001, 120 and 240 mg OKZ p<0.0001). Additionally, ACR20 and ACR50 responses were numerically higher for OKZ than PBO (ACR20: PBO=17.1-29.9%, OKZ=32.5-60.7%; ACR50: PBO=1.3-4.9%, OKZ=11.5-33.2%). OKZ treatment, at several doses, demonstrated similar efficacy to TCZ across multiple endpoints. Most adverse events were mild or moderate and comparable between OKZ and TCZ treatment groups. Pharmacokinetic/pharmacodynamic modelling demonstrated a shallow dose/exposure response relationship in terms of percentage of patients with DAS28(CRP) <2.6. OKZ produced significantly greater reductions in DAS28(CRP) from baseline at Week 12 compared with PBO. Reported AEs were consistent with the safety profile expected of this class of drug, with no new safety signals identified. NCT01242488.
    Annals of the rheumatic diseases 03/2014; 73(9). DOI:10.1136/annrheumdis-2013-204760 · 9.27 Impact Factor

Publication Stats

1k Citations
369.54 Total Impact Points

Institutions

  • 2014
    • Imperial College London
      Londinium, England, United Kingdom
  • 2007–2014
    • Southend University Hospital NHS Foundation Trust
      Southend, England, United Kingdom
  • 2013
    • Newcastle University
      • Institute of Cellular Medicine
      Newcastle-on-Tyne, England, United Kingdom
  • 2008–2013
    • University of Essex
      Colchester, England, United Kingdom
  • 2012
    • Mayo Foundation for Medical Education and Research
      • Division of Rheumatology
      Scottsdale, AZ, United States