Efficacy of Tele-CO-OP in Children With Organic Acidemia: A Pilot Randomized Controlled Trial.

The objective of this study was to examine the efficacy of a 5-week, tele-CO-OP intervention in children with organic acidemia. Thirty-four children were randomly divided into intervention and control groups. While 17 received the home program, 17 received the CO-OP Approach with telehealth twice a week along with the home program. Children were assessed through the Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory, Child and Adolescent Scale of Participation, Kid-KINDL Questionnaire, and Assistance to Participate Scale. Between-group analyses show significant benefits (p < .05) for the CO-OP group compared with the control group on the Performance and Satisfaction scales of the Canadian Occupational Performance Measure, and on the total scores of the Pediatric Evaluation of Disability Inventory, Child and Adolescent Scale of Participation, KINDL, and the Assistance to Participate Scale. The findings are preliminary results of benefits as this is the first trial, and the CO-OP approach applied through telerehabilitation had positive effects on children with organic acidemia.

Abatacept as a Long-Term Targeted Therapy for LRBA Deficiency.

BACKGROUND: LPS-responsive beige-like anchor (LRBA) deficiency presents with susceptibility to infections, autoimmunity, and lymphoproliferation. The long-term efficacy of cytotoxic T-lymphocyte-associated antigen 4-immunoglobulin (abatacept) as targeted therapy for its immune dysregulatory features remains to be established. OBJECTIVE: To determine the clinical and immunologic features of LRBA deficiency and long-term efficacy of abatacept treatment in controlling the different disease manifestations. METHODS: Twenty-two LRBA-deficient patients were recruited from different immunology centers and followed prospectively. Eighteen patients on abatacept were evaluated every 3 months for long-term clinical and immunologic responses. LRBA expression, lymphocyte subpopulations, and circulating T follicular helper cells were determined by flow cytometry. RESULTS: The mean age of the patients was 13.4 ± 7.9 years, and the follow-up period was 3.4 ± 2.3 years. Recurrent infections (n = 19 [86.4%]), immune dysregulation (n = 18 [81.8%]), and lymphoproliferation (n = 16 [72.7%]) were common clinical features. The long-term benefits of abatacept in 16 patients were demonstrated by complete control of lymphoproliferation and chronic diarrhea followed by immune dysregulation, most notably autoimmune cytopenias. Weekly or every other week administration of abatacept gave better disease control compared with every 4 weeks. There were no serious side effects related to the abatacept therapy. Circulating T follicular helper cell frequencies were found to be a reliable biomarker of disease activity, which decreased on abatacept therapy in most subjects. However, high circulating T follicular helper cell frequencies persisted in 2 patients who had a more severe disease phenotype that was relatively resistant to abatacept therapy. CONCLUSIONS: Long-term abatacept therapy is effective in most patients with LRBA deficiency.