Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study

BACKGROUND

Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed.

OBJECTIVE

The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up.

METHODS

This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app.

RESULTS

Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025.

CONCLUSIONS

This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/55829.

Agreement between local and central anti-synthetase antibodies detection: results from the Classification Criteria of Anti-Synthetase Syndrome project biobank

OBJECTIVES

The CLASS (Classification Criteria of Anti-Synthetase Syndrome) project is a large international multicentre study that aims to create the first data-driven anti-synthetase syndrome (ASSD) classification criteria. Identifying anti-aminoacyl tRNA synthetase antibodies (anti-ARS) is crucial for diagnosis, and several commercial immunoassays are now available for this purpose. However, using these assays risks yielding false-positive or false-negative results, potentially leading to misdiagnosis. The established reference standard for detecting anti-ARS is immunoprecipitation (IP), typically employed in research rather than routine autoantibody testing. We gathered samples from participating centers and results from local anti-ARS testing. As an "ad-interim" study within the CLASS project, we aimed to assess how local immunoassays perform in real-world settings compared to our central definition of anti-ARS positivity.

METHODS

We collected 787 serum samples from participating centres for the CLASS project and their local anti-ARS test results. These samples underwent initial central testing using RNA-IP. Following this, the specificity of ARS was reconfirmed centrally through ELISA, line-blot assay (LIA), and, in cases of conflicting results, protein-IP. The sensitivity, specificity, positive likelihood ratio and positive and negative predictive values were evaluated. We also calculated the inter-rater agreement between central and local results using a weighted κ co-efficient.

RESULTS

Our analysis demonstrates that local, real-world detection of anti-Jo1 is reliable with high sensitivity and specificity with a very good level of agreement with our central definition of anti-Jo1 antibody positivity. However, the agreement between local immunoassay and central determination of anti-non-Jo1 antibodies varied, especially among results obtained using local LIA, ELISA and "other" methods.

CONCLUSIONS

Our study evaluates the performance of real-world identification of anti-synthetase antibodies in a large cohort of multi-national patients with ASSD and controls. Our analysis reinforces the reliability of real-world anti-Jo1 detection methods. In contrast, challenges persist for anti-non-Jo1 identification, particularly anti-PL7 and rarer antibodies such as anti-OJ/KS. Clinicians should exercise caution when interpreting anti-synthetase antibodies, especially when commercial immunoassays test positive for non-anti-Jo1 antibodies.

Quality of life of patients with rheumatic diseases

OBJECTIVE

Health-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population.

METHODS

Observational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0-1 scale) and a visual analog scale (VAS, 0-100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed.

RESULTS

1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18-95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially "pain/discomfort", followed by "daily activities" and "mobility". This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the "peripheral and axial mechanical pathology" and the "soft tissue pathology" group.

CONCLUSIONS

Patients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.

Severe COVID-19 in patients with immune-mediated rheumatic diseases: A stratified analysis from the SORCOM multicentre registry

OBJECTIVES

The aim of this study is to evaluate risk factors for severe coronavirus disease 2019 (COVID-19) in patients with immune-mediated rheumatic diseases, stratified by systemic autoimmune conditions and chronic inflammatory arthritis.

METHODS

An observational, cross-sectional multicentre study was performed. Patients from 10 rheumatology departments in Madrid who presented with severe acute respiratory syndrome coronavirus-2 infection between February 2020 and May 2021 were included. The main outcome was COVID-19 severity (hospital admission or mortality). Risk factors for severity were estimated, adjusting for covariates (socio-demographic, clinical, and treatments), using logistic regression analyses.

RESULTS

In total, 523 patients with COVID-19 were included, among whom 192 (35.6%) patients required hospital admission and 38 (7.3%) died. Male gender, older age, and comorbidities such as diabetes mellitus, hypertension, and obesity were associated with severe COVID-19. Corticosteroid doses >10 mg/day, rituximab, sulfasalazine, and mycophenolate use, were independently associated with worse outcomes. COVID-19 severity decreased over the different pandemic waves. Mortality was higher in the systemic autoimmune conditions (univariate analysis, P < .001), although there were no differences in the overall severity in the multivariate analysis.

CONCLUSIONS

This study confirms and provides new insights regarding the harmful effects of corticosteroids, rituximab, and other therapies (mycophenolate and sulfasalazine) in COVID-19. Methotrexate and anti-tumour necrosis factor therapy were not associated with worse outcomes.

Garetosmab in fibrodysplasia ossificans progressiva: a randomized, double-blind, placebo-controlled phase 2 trial

Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by heterotopic ossification (HO) in connective tissues and painful flare-ups. In the phase 2 LUMINA-1 trial, adult patients with FOP were randomized to garetosmab, an activin A-blocking antibody (n = 20) or placebo (n = 24) in period 1 (28 weeks), followed by an open-label period 2 (28 weeks; n = 43). The primary end points were safety and for period 1, the activity and size of HO lesions. All patients experienced at least one treatment-emergent adverse event during period 1, notably epistaxis, madarosis and skin abscesses. Five deaths (5 of 44; 11.4%) occurred in the open-label period and, while considered unlikely to be related, causality cannot be ruled out. The primary efficacy end point in period 1 (total lesion activity by PET-CT) was not met (P = 0.0741). As the development of new HO lesions was suppressed in period 1, the primary efficacy end point in period 2 was prospectively changed to the number of new HO lesions versus period 1. No placebo patients crossing over to garetosmab developed new HO lesions (0% in period 2 versus 40.9% in period 1; P = 0.0027). Further investigation of garetosmab in FOP is ongoing. ClinicalTrials.gov identifier NCT03188666 .

Myositis autoantibodies detected by line blot immunoassay: clinical associations and correlation with antibody signal intensity

The aim of this study is to assess the relationship between myositis specific (MSA) and myositis associated (MAA) antibodies and diagnosis (including idiopathic inflammatory myopathies [IIM] and other systemic autoimmune diseases [SAID]), and to explore the impact of antibody signal intensity in diagnostic accuracy. We retrospectively reviewed all the serum samples obtained from patients tested for MSA/MAA by line immunoassay (LIA) between 01/01/2018 and 31/12/2020 in Ramón y Cajal University Hospital (Spain). Clinical true positive (CTP) MSAs and MAAs were defined as those patients with IIM or SAID with phenotypes expected of that MSA/MAA. Patients who did not have a phenotype compatible with that antibody were classified as clinical false positive (CFP). One hundred and thirty positive samples were analysed. Forty-six patients (33.38%) were classified as IIM, forty-two (32.3%) as SAID and forty-two (32.3%) as non-IIM/SAID. Among these 130 patients, 164 MSA/MAA were detected. Eighty-five (51.8%) positive MSA/MAA were classified as CTP, and seventy-nine (48.2%) as CFP. Strongly positive antibodies were more frequently CTP (35/47, 74.5%) than weak positives (54/68, 36.8%), (p ˂ 0.001). Antibodies classified as CTP had a higher signal intensity than CFP (36.77 AU vs 20.00 AU, CI95% 7.79-22.09, p ˂ 0.001). The probability of a CFP was associated to negative ANA, low ANA titer, and multiple positive MSA/MAA (p ˂ 0.001). In this study, we confirmed that CFP results using LIA are frequent, and are associated with low signal intensity MSA/MAA, negative ANA, lower titer ANA, and with multiple positive samples.

Retention rate of secukinumab in psoriatic arthritis: Real-world data results from a Spanish multicenter cohort

Secukinumab is a novel anti-IL17 biologic treatment approved for the treatment of psoriatic arthritis (PsA). The purpose of the present study is to identify factors that can condition the retention rate of this drug in a real-world scenario. Methods: A multicentric retrospective study was conducted based on the registries of consecutive patients diagnosed with PsA who started secukinumab from January 2016 to December 2018. For purposes of Cox-regression analysis, the time spanning from the first administration of secukinumab until its interruption or the end of the follow-up was considered the independent variable. Variables of known relevance and those who demonstrated direct association with the drug retention rate were included in the model. Results: One hundred seventy-six registries were analyzed (average age at diagnosis 44.7 ± 12.1 years old, 114 females). The median retention rate of secukinumab was 636 days (95% confidence interval [CI] 542.4-729.5). Presence of peripheral arthritis (hazard ratio 0.424 [95% CI 0.213-0.847, P = .015]) and a time of evolution >6 years (hazard ratio 0.468 [95% CI 0.225-0.975, P = .043]) were the 2 variables that showed a significant influence on the drug retention rate. According to our results, patients who exhibit peripheral arthritis and those with a higher evolution time will have more probabilities of a larger secukinumab retention rate.

POS0847 MYOSITIS AUTOANTIBODIES DETECTED BY LINE BLOT IMMUNOASSAY: CLINICAL ASSOCIATIONS AND CORRELATION WITH ANTIBODY TITERS

Background

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases (AID) characterized by muscle inflammation and weakness, often accompanied with other organ involvement, such as skin rash or interstitial lung disease (ILD). Myositis specific (MSA) and myositis associated antibodies (MAA) can be detected in approximately 60% of patients with IIM. Besides, antibody titers have been suggested to be related with diagnostic accuracy, although it has not been widely studied. MSA are considered to be exclusive of patients with IIM, whilst MAA can occur in IIM and other systemic autoimmune diseases, nevertheless, most of the studies are focused exclusively on IIM patients.

Objectives

The aim of this study is to assess the relationship between MSA/MAA and diagnosis (including IIM and other AID), and to explore the impact of antibody titers in diagnostic accuracy.

Methods

We retrospectively reviewed all the serum samples obtained from patients tested for MSA/MAA between 01/01/2018 and 31/12/2020 in the Immunology department of Ramón y Cajal University Hospital (Spain). These antibodies were tested by line blot immunoassay (LIA) (EUROLINE Autoimmune Inflammatory Myopathies 16 Ag, Euroimmun, Lübeck, Germany). Positivity was stablished according to absorbance titer and adjusted by positive control of each test (arbitrary units, AU). True positive (TP) MSA and MAA were defined as those patients with IIM or AID with phenotypes expected of that MSA/MAA, according to the available information. The patients that did not have a phenotype compatible with that antibody were regarded as false positive (FP). Statistical analysis was carried out using IBM SPSS statistics version 22.

Results

We analyzed 130 positive samples which corresponded to 130 patients, 85 were women and mean age was 55.08 years. 44 patients (33.8%) were classified as IIM, 43 (33.1%) as AID, and 43 (33.1%) as non-IIM/AID. Among these 130 patients, 164 MSA/MAA were detected. 83 (50.6%) positive MSA/MAA were regarded as TP, and 81 (49.4%) as FP (positive predictive value [PPV] 50.6%). Antibodies regarded as TP had a higher antibody titer compared to FP (49,19 AU vs 26,96 AU, p<0.001). This difference was statistically significant for MSA and MAA when analysed separately (Figure 1). FP antibodies were associated with negative ANA and low titer ANA (p<0.001). Multiple positive antibodies (antibodies included in samples that were positive for > 1 MSA/MAA) were more frequently FP in comparison with isolated positive MSA/MAA (p<0.001).

Figure 1.

Autoantibody titers comparison between false positives and true positives. MSA=myositis specific antibody, MAA=myositis associated antibody, FP=false positive, TP=true positive

Conclusion

In this study we confirm that FP results using LIA are relatively frequent, and are associated with lower titer MSA/MAA, negative ANA, lower titer ANA, and with multiple positive MSA/MAA within one sample.

References

[1]Betteridge Z, Tansley S, Shaddick G, et al (2019) Frequency, mutual exclusivity and clinical associations of myositis autoantibodies in a combined European cohort of idiopathic inflammatory myopathy patients. J Autoimmun 101:48–55. https://doi.org/10.1016/j.jaut.2019.04.001

[2]Cavazzana I, Fredi M, Ceribelli A, et al (2016) Testing for myositis specific autoantibodies: Comparison between line blot and immunoprecipitation assays in 57 myositis sera. J Immunol Methods 433:1–5. https://doi.org/10.1016/j.jim.2016.02.017

[3]Tansley SL, Li D, Betteridge ZE, McHugh NJ (2020) The reliability of immunoassays to detect autoantibodies in patients with myositis is dependent on autoantibody specificity. Rheumatol (United Kingdom) 59:2109–2114. https://doi.org/10.1093/rheumatology/keaa021

[4]Mahler M, Betteridge Z, Bentow C, et al (2019) Comparison of Three Immunoassays for the Detection of Myositis Specific Antibodies. Front Immunol 10:848. https://doi.org/10.3389/fimmu.2019.00848

Disclosure of Interests

None declared

Clinical spectrum time course in non-Asian patients positive for anti-MDA5 antibodies

OBJECTIVES

To define the clinical spectrum time-course and prognosis of non-Asian patients positive for anti-MDA5 antibodies.

METHODS

We conducted a multicentre, international, retrospective cohort study.

RESULTS

149 anti-MDA5 positive patients (median onset age 53 years, median disease duration 18 months), mainly females (100, 67%), were included. Dermatomyositis (64, 43%) and amyopathic dermatomyositis (47, 31%), were the main diagnosis; 15 patients (10%) were classified as interstitial pneumonia with autoimmune features (IPAF) and 7 (5%) as rheumatoid arthritis. The main clinical findings observed were myositis (84, 56%), interstitial lung disease (ILD) (108, 78%), skin lesions (111, 74%), and arthritis (76, 51%). The onset of these manifestations was not concomitant in 74 cases (50%). Of note, 32 (21.5%) patients were admitted to the intensive care unit for rapidly progressive-ILD, which occurred in median 2 months from lung involvement detection, in the majority of cases (28, 19%) despite previous immunosuppressive treatment. One-third of patients (47, 32% each) was ANA and anti-ENA antibodies negative and a similar percentage was anti-Ro52 kDa antibodies positive. Non-specific interstitial pneumonia (65, 60%), organising pneumonia (23, 21%), and usual interstitial pneumonia-like pattern (14, 13%) were the main ILD patterns observed. Twenty-six patients died (17%), 19 (13%) had a rapidly progressive-ILD.

CONCLUSIONS

The clinical spectrum of the anti-MDA5 antibodies-related disease is heterogeneous. Rapidly-progressive ILD deeply impacts the prognosis also in non-Asian patients, occurring early during the disease course. Anti-MDA5 antibody positivity should be considered even when baseline autoimmune screening is negative, anti-Ro52 kDa antibodies are positive, and radiology findings show a NSIP pattern.

Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases

BACKGROUND

This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death.

METHODS

An observational longitudinal study was conducted during the first year of the SARS-CoV-2 pandemic (March 2020-March 2021). All pediatric patients attended at the rheumatology outpatient clinics of six tertiary referral hospitals in Madrid, Spain, with a diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic and clinical characteristics and treatment regimens. We ran a multivariable logistic regression model to assess associated factors for outcomes.

RESULTS

The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients (38.96%) were asymptomatic, 41 (53.25%) had a mild-moderate COVID-19 and 6 patients (7.79%) required hospital admission. The median length of hospital admission was 5 (2-20) days, one patient required intensive care and there were no deaths. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was previous use of glucocorticoids (OR 3.51; p = 0.00). No statistically significant risk factors for symptomatic COVID-19 were found in the final model.

CONCLUSION

No differences in COVID-19 outcomes according to childhood-onset rheumatic disease types were found. Results suggest that associated comorbidities and treatment with glucocorticoids increase the risk of hospital admission.

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

OBJECTIVES

To determine factors associated with COVID-19-related death in people with rheumatic diseases.

METHODS

Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.

RESULTS

Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.

CONCLUSION

Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Remission Induced by TNF Inhibitors Plus Methotrexate is Associated With Changes in Peripheral Naïve B Cells in Patients With Rheumatoid Arthritis

Biological therapies, such as TNF inhibitors (TNFi), are increasing remission (REM) rates in rheumatoid arthritis (RA) patients, although these are still limited. The aim of our study was to analyze changes in the profile of peripheral blood mononuclear cells (PBMC) in patients with RA treated with TNFi in relation to the clinical response. This is a prospective and observational study including 78 RA patients starting the first TNFi. PBMC were analyzed by flow cytometry both at baseline and at 6 months. Disease activity at the same time points was assessed by DAS28, establishing DAS28 ≤ 2.6 as the criteria for REM. Logistic regression models were employed to analyze the association between the changes in PBMC and REM. After 6 months of TNFi treatment, 37% patients achieved REM by DAS28. Patients who achieved REM showed a reduction in the percentage of naive B cells, but only when patients had received concomitant methotrexate (MTX) (OR: 0.59; 95% CI: 0.39–0.91). However, no association was found for patients who did not receive concomitant MTX (OR: 0.85; 95% CI: 0.63–1.16). In conclusion, PBMC, mainly the B-cell subsets, are modified in RA patients with TNFi who achieve clinical REM. A significant decrease in naive B-cell percentage is associated with achieving REM after 6 months of TNFi treatment in patients who received concomitant therapy with MTX.

POS0623 CYTOKINE PRODUCTION BY BLOOD LYMPHOCYTES DEFINES A PROFILE ASSOCIATED WITH NON-REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TNF INHIBITORS

Background:

In clinical practice no more than 50% of the patients treated with TNF inhibitors (TNFi) achieve remission (REM). Previous investigations suggested that peripheral blood mononuclear cells (PBMC) may be markers associated with the TNFi treatment success1.

Objectives:

This study aims to analyse the intracellular cytokine production by PBMC and its association with REM achievement after 6 months (m) of TNFi treatment in patients with RA.

Methods:

This was a prospective study including 62 patients with RA starting the 1st TNFi. PBMC were isolated from patients at baseline and after 6m of treatment with TNFi and cryopreserved until studied. In vitro stimulation and intracellular cytokine production by PBMC was performed as follow: in the presence of 2µg/mL brefeldin and 2µmol/L monensin monocytes were stimulated with 20ng/mL LPS during 4h whereas lymphocytes were stimulated with 50ng/mL phorbol 12-myristate 13-acetate and 750ng/mL ionomycin for 4h at 37°C. To identify IL10-producing B cells, PBMC were pre-incubated with 3µg/mL of CpG oligonucleotide during 20h at 37°C prior to stimulation. Intracellular cytokine production (TNFα, IL6, GM-CSF, IL10) by the different cell subsets (monocytes, CD4+ and CD8+ T cells, naïve and memory B cells) was analysed by flow-cytometry. Clinical activity at baseline and after 6m was assessed by DAS28-ESR. REM was defined as DAS28≤2.6 at 6m. The association between cytokine production by each PBMC subset and REM was analysed through univariable and multivariable logistic regression models. Receiving operating curve (ROC) analysis was used to select the optimal ratio of cytokine production associated with REM status.

Results:

After 6m of TNFi treatment, 30 (48%) patients achieved REM. No significant differences between REM and non-REM groups were observed for patients’ characteristics at baseline except for DAS28, which was lower in the REM group (non-REM: 5.4±0.9; REM: 4.3±0.9; p<0.0001) (Table 1). Therefore, further analyses were adjusted by baseline DAS28. A lower ratio between calculated with the IL10 and TNFα production by B cells and by CD4+ T cells (IL10 B/TNF CD4) at 6m was found for non-REM patients (non-REM: 0.31 vs REM: 0.54; p=0.007). Based on a ROC analysis, we found that a (IL10 B/TNF CD4)<0.54 at 6 m was significantly associated with a higher probability of non-REM at 6 months (OR: 5.0; 95% CI: 1.1-21.7) (Figure 1).

Table 1.

Baseline predictors of reduction of disease activity at 12 months from start of abatacept. Linear regression.

Baseline patients’ characteristicsTotal patients (n=62)DAS28>2.6(n=32; 52%)DAS28≤2.6(n=30; 48%)p-valueAge (years)53±1253±1352±100.8Female55 (89)30 (94)25 (83)0.2Disease duration (years)8 (4-11)8 (4-12)7 (3-11)0.7RF positive49 (79)23 (72)26 (87)0.1ACPA positive54 (87)26 (81)28 (93)0.2Smoking habit (n=55)0.2Non-smokers26 (47)16 (55)10 (38) Smoker29 (53)13 (45)16 (51)Body mass index (kg/m2)25.9±5.625.8±5.726.0±5.60.9DAS284.9±1.05.4±0.94.3±0.9<0.0001Concomitant csDMARDs60 (97)32 (100)28 (93)0.3MTX [±OD]46 (74)26 (81)20 (67)0.3Only OD14 (23)6 (19)8 (26)0.3Prednisone36 (58)19 (59)17 (57)0.9

Conclusion:

Our results show that the proinflammatory IL10 B/TNF CD4 ratio is associated with non-REM status. It could be useful to analyse the success of TNFi treatment in patients with RA.

References:

[1]Rodríguez-Martín E, et al. Front Immunol. 2020; 11: 1913.

Acknowledgements:

ISCIII (PI16/00474; PI16/01092)

Disclosure of Interests:

Borja Hernández-Breijo: None declared, Eulalia Rodríguez-Martín: None declared, Carlota García-Hoz: None declared, Victoria Navarro-Compán Speakers bureau: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Cristina Sobrino: None declared, ANA MARTÍNEZ-FEITO: None declared, Israel Nieto-Gañán: None declared, Javier Bachiller-Corral Speakers bureau: Abbvie, MSD, BMS and Roche, Grant/research support from: Pfizer, Paloma Lapuente-Suanzes: None declared, Gemma Bonilla: None declared, Cristina Pijoán-Moratalla: None declared, Mónica Vázquez: None declared, Alejandro Balsa Speakers bureau: Abbvie, BMS, Nordic, Novartis, Pfizer, Sandoz, Sanofi, Roche and UCB, DORA PASCUAL-SALCEDO: None declared, Luisa María Villar: None declared, Chamaida Plasencia Speakers bureau: AbbVie, Lilly, Novartis, Pfizer, Sanofi, Biogen and UCB

POS1260 FACTORS ASSOCIATED WITH SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES IN MADRID: RESULTS FROM REUMA-COVID SORCOM REGISTRY

Background:

Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.

Objectives:

To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in Madrid

Methods:

The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.

Results:

As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.

Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.

Conclusion:

Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.

Disclosure of Interests:

None declared

POS1204 LOW POSITIVITY RATE IN ANTIBODY SARS-COV2 TESTS IN PATIENTS WITH RHEUMATIC DISEASES TREATED WITH RITUXIMAB. A CASE CONTROL STUDY OF A HIGH IMPACT SARS-COV2 INFECTION AREA

Background:

Diagnosis of previous SARS-COV2 infection may be challenging in immunocompromised patients.

Objectives:

To analyze positivity rate to SARS-COV2 antibody tests (SC2AT) in patients diagnosed of rheumatic diseases (RMD) treated with Rituximab.

Methods:

We conducted a case-control study of patients diagnosed of RMD followed in a referral hospital in Madrid, Spain. Positivity rate to IgG-SC2AT were analyzed in Rituximab-treated patients (RTX) compared with patients treated with TNF inhibitors (TNFi) and/or conventional DMARDs (cDMARDs) (N-RTX).

We included patients that received Rituximab in the previous year to a confirmed SARS-COV2 infection (defined as a positive polymerase chain reaction test (PCR) and/or compatible chest Xray), to a suspected SARS-COV2 infection (2 or more symptoms) or to SC2AT determination. Patients with RMD treated with other biological DMARDs (bDMARDs) rather than Rituximab or TNFi were excluded.

Results:

We included 152 patients with RMD who underwent a SC2AT. Main characteristics are reported in Table 1.

Among RTX and N-RTX, 4/48 (8.3%) and 35/104 (33.7%) showed a positive IgG-SC2AT, respectively. Four out of 104 (38.5%) N-RTX tested positive without previous symptoms. No asymptomatic infection was diagnosed among RTX.

Univariable analysis showed a lower rate of positivity to SC2AT in confirmed and suspected infection among RTX [Positive IgG-SC2AT in confirmed infection: RTX 4/10 (40%), N-RTX 16/20 (80%); p=0.045. Positive IgG-SC2AT in suspected infection: RTX 0/3 (0%), N-RTX 15/18 (83.3%); p=0.015].

A logistic binary regression identified previous symptoms [OR 61.2, 95CI(13.3-280.6) p=0.0001], male sex [OR 4.8, 95CI(1.3-17.8) p=0.02], non-rituximab treatment [OR 19.7, 95CI(3.6-106.3) p=0.001] as independent factors associated with a higher probability of positive IgG-SC2AT. Age, previous PCR status, corticosteroid and cDMARD use showed no statistical significance. This model accounted for 47.6% of positive cases.

Table 1.

Main characteristics. AS, axial spondylitis; bDMARDs, biological disease-modifying anti-rheumatic drugs; cDMARDs, conventional DMARDs; COPD, Chronic obstructive pulmonary disease; CVD, Cardiovascular disease; IMM, immune-mediated myositis; JIA, Juvenile Idiopathic arthritis; PsoA, Psoriatic Arthritis; RA, Rheumatoid Arthrtis; SLE, Systemic Lupus Erythematosus; SSc, Systemic Sclerosis; SSj, Sjogren Syndrome.

Rituximab (RTX)Non-Rituximab (N-RTX)p valuePatients, n (%)48 (31.6)104 (68.4)Age, years, median (IQR)65 (54-72)60 (47-71.8)p= 0.190Female, n (%)38 (79.2)74 (71.2)p=0.297Diagnosis, n (%)p=0.2- RA20 (41.7)42 (40.4)- SSj4 (8.3)6 (5.8)- RA SSj3 (6.3)0 (0)- SLE4 (8.3)8 (7.7)- Vasculitis7 (14.6)13 (12.5)- IMM1 (2.1)4 (3.8)- JIA2 (4.2)3 (2.9)- SSc7 (14.6)15 (14.4)- AS0 (0)4 (3.8)- PSoA0 (0)5 (4.8)- Othersa0 (0)4 (3.8)Comorbidities, n (%)- Hypertension18 (37.5)34 (32.7)p=0.561- Diabetes5 (10.4)10 (9.6)p=0.878- Dyslipidemia18 (37.5)30 (28.8)p=0.286- COPD/asthma6 (12.5)4 (3.8)p=0.049*- CVD11 (35.4)25 (24)p=0.831Interstitial lung disease, n (%)17 (35.4)8 (7.7)p<0.0001*Corticosteroids use, n (%)26 (54.2)33 (31.7)p=0.008*cDMARDs use, n (%)27 (56.3)73 (70.2)p=0.092bDMARDs, n (%)-- None0 (0)83 (79.8)- TNF inhibitors0 (0)21 (20.2)- Rituximab48 (100)0 (0)Previous positive PCR, n (%)- Time from positive PCR to SC2AT, days, mean ±SD8 (16.7)47.4 (38.7)20 (19.2)65.1 (49)p=0.191p=0.368Previous symptoms, n (%)- Time from symptom onset to SC2AT, days, mean ±SD13 (27.1)130.3 ±91.136 (34.6)93.5 ±72.6p=0.356p=0.15COVID, n (%)p=0.183- Non suspected35 (72.9)66 (63.5)- Suspected3 (6.3)18 (17.3)- Confirmed10 (20.8)b20 (19.2)

aIncluding gout, polymyalgia rheumatica.

bTwo patients had negative PCR but compatible symptoms and chest X-Ray.

Conclusion:

RTX had a lower rate of positivity to IgG-SC2AT compared to N-RTX. Previous symptoms, male sex and non-RTX treatment were independently associated with higher probability of positive IgG-SC2AT.

Disclosure of Interests:

None declared.

Garetosmab Reduces Flare-ups in Patients With Fibrodysplasia Ossificans Progressiva

Background: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare, autosomal dominant disorder driven by mutations in ACVR1 that render it responsive to Activin A. FOP is characterized by progressive heterotopic ossification (HO) and distressing inflammatory events called “flare-ups.” Flare-ups can precede new HO; however, limited prospective data exists on this phenomenon. Garetosmab (GAR), an investigational human monoclonal antibody against Activin A, blocks formation of new HO in FOP. Methods: This is a post-hoc analysis of LUMINA-1 (NCT03188666) a phase 2, randomized, double-blind, placebo-controlled study, which evaluated the safety and efficacy of GAR (10 mg/kg/week IV) versus placebo (PBO) in adult patients with FOP over 28 weeks. Patient-reported flare-ups were collected via a patient diary and severity level was reported as mild, moderate or severe. Clinician-reported flare-ups were collected as adverse events in the trial. HO lesions were imaged by 18F-NaF positron emission tomography (PET) and whole-body low-dose X-ray computed tomography (CT). Results: There was a two-fold higher proportion of patients who reported one or more flare-ups on PBO 17/24 (71%) compared with GAR 7/20 (35%). Clinicians reported a four-fold higher proportion of patients experiencing one or more flare-ups on PBO 10/24 (42%) compared with GAR 2/20 (10%). Overall rates of flare-up events were two-fold higher on PBO vs. GAR (1.4 vs. 0.65 events/patient/28 weeks) for patient-reported events and eight-fold higher on PBO vs. GAR by clinician report (0.83 vs. 0.10 events/patient/28 weeks). Most flare-ups occurred on the extremities and back; pain was the most commonly reported symptom. Patient-reported flare-ups on PBO were more frequently reported as severe (29.4%) compared with GAR (7.7%). Among subjects with at least 12 weeks of follow-up from start of patient-reported flare-up, development of new HO near the site was 5/27 (18.5%) on PBO and (0%) on GAR. Of all new HO lesions, 41% on PBO and 0% on GAR occurred with spatial and temporal relation to flare-up. Conclusions: Approximately two-thirds of patients on PBO reported flare-ups over 28 weeks. GAR was associated with reductions in frequency and severity of flare-ups. Fewer than 20% of patient-reported flare-ups were associated with new HO, indicating frequent discordance of these phenomena, and compatible with previous reports. GAR’s ability to reduce patient- and clinician-reported flare-ups, as well as new HO lesions may provide an important therapeutic option.

Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases

OBJECTIVE

To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in the Ramón y Cajal Hospital, and to determine the increased risk of severe coronavirus disease 2019 (COVID-19) in patients with no IRD.

METHODS

This is a retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID-19.

RESULTS

Forty-one (1.8%) out of 2315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission OR for patients with IRD was 1.91 against the general population, and it was considerably higher in patients with Sjögren syndrome, vasculitis, and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab [RTX], 4 anti-tumor necrosis factor [anti-TNF], and 1 abatacept), and 1 with Janus kinase inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with RTX (OR 12.9) but not in patients treated with anti-TNF (OR 0.9).

CONCLUSION

Patients with IRD, especially autoimmune diseases and patients treated with RTX, may be at higher risk of severe pneumonia due to SARS-CoV-2 compared to the general population. More studies are needed to analyze this association further in order to help manage these patients during the pandemic.

Cardiovascular mortality and cardiovascular event rates in patients with inflammatory rheumatic diseases in the CARdiovascular in rheuMAtology (CARMA) prospective study—results at 5 years of follow-up

Objectives

To determine cardiovascular (CV) mortality and incidence of the first CV event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) after 5 years of follow-up.

Methods

This is an analysis of the CARdiovascular in rheMAatology (CARMA) study after 5 years of follow-up. It includes patients with RA (n = 775), AS (n = 738) and PsA (n = 721), and individuals without CIRD (n = 677) attending outpatient rheumatology clinics from 67 public hospitals in Spain. Descriptive analyses were performed for the CV mortality at 5 years. The Systematic COronary Risk Evaluation (SCORE) function at 5 years was calculated to determine the expected risk of CV mortality. Poisson models were used to estimate the incidence rates of the first CVE. Hazard ratios of the risk factors involved in the development of the first CVE were evaluated using the Weibull proportional hazard model.

Results

Overall, 2382 subjects completed the follow-up visit at 5 years. Fifteen patients died due to CVE. CV deaths observed in the CIRD cohort were lower than that predicted by SCORE risk charts. The highest incidence rate of CVE [7.39 cases per 1000 person-years (95% CI 4.63, 11.18)] was found in PsA patients. However, after adjusting for age, sex and CV risk factors, AS was the inflammatory disease more commonly associated with CVE at 5 years [hazard ratio 4.60 (P =0.02)], compared with those without CIRD.

Conclusions

Cardiovascular mortality in patients with CIRD at 5 years of follow-up is lower than estimated. Patients with AS have a higher risk of developing a first CVE after 5 years of follow-up.

AB0279 IMPACT OF DISEASE-MODIFYING DRUGS IN SECOND BIOLOGICAL TREATMENT SURVIVAL IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Several studies have proposed that the immunosenescence of elderly patients with Rheumatoid Arthritis (RA) in treatment with biological therapies could eliminate the need for concomitant immunosuppression with disease-modifying drugs (DMARDs), due to a probable lower production of anti-drug antibodies; however, the evidence is limited.

Objectives:

To compare the characteristics of patients with RA who started a second biological agent, according to age groups. To analyse second biological agent survival and its relationship with DMARDs.

Methods:

Retrospective, observational and longitudinal study. Patients with RA who started a second biologic between 2000 and 2019, who discontinued a first-line TNF inhibitor, were included. Demographic, clinical and analytical data were obtained. The sample was divided in 2 groups: <70 and ≥70 years old. A comparative analysis was performed. Kaplan-Meier curves and Log-rank were used to conduct the survival analysis.

Results:

156 patients were included. 83.3% were women, with a mean age at the beginning of second biological treatment of 54.64±13.54 years. 22 patients (14.1%) were ≥70 years. Comparative analysis is detailed in table 1: patients ≥70 years presented a longer time from diagnosis to the start of biological treatment, and a higher prevalence of hypertension and diabetes mellitus. The main cause of withdrawal in this group was adverse events (46.67%) while in younger patients was treatment failure (25.27% primary failure, 29.66% secondary failure). The most frequent biological agent in ≥70 years was Rituximab (27.26%) while in <70 years was Etanercept (26.12%). 126 patients (80.8%) had a DMARD associated. In both groups, Methotrexate was the most frequent (table 2). The second biological agent survival analysis showed that patients who received a DMARD presented a higher survival [77 months (55.50-98.55) vs. 51.53 months (41.67-61.40); p=0.023]. After conducting a survival analysis in patients whose withdrawal cause was treatment failure, DMARDs use was associated with an increased biological agent survival in patients <70 years [103.48 months (82.28-124.68) vs. 81.95 months (66.05-97.86); p=0.037]; but statistical differences were not found in patients ≥70 years [117.33 months (82.15-152.52) vs. 65.07 months (40.72-89.42); p=0.291].

Table 1.Variable<70 years = 134 (mean ± SD or %)≥70 years = 22 (mean ± SD or %)pAge at diagnosis (years)40.5 ± 12.358.8 ± 8.9<0.001Age at the beginning of the treatment (years)51.28 ± 11.4475.14 ± 3.5<0.001Time since diagnosis (years)10.65 ± 8.2016.27 ± 9.090.003Women113 (84.33%)17 (77.27%)0.373Smokers29 (21.64%)2 (9.09%)0.320Rheumatoid factor positive109 (81.34%)17 (77.27%)0.770Anti-CCP positive114 (90.48%)14 (82.35%)0.390Erosions92 (70.23%)16 (76.19%)0.576Arterial hypertension28 (21.37%)14 (66.67%)<0.001Diabetes mellitus3 (2.24%)4 (18.18%)<0.001Retirement91 (67.91%)15 (68.18%)0.980Infections10 (7.46%)3 (13.64%)0.397Second biological agent withdrawal causePrimary failure23 (25.27%)3 (20%)0.242Secondary failure27 (29.66%)3 (20%)Adverse events25 (27.47%)7 (46.67%)Remission2 (2.20%)0 (0%)Exitus3 (3.30%)0 (0%)Neoplasia3 (3.30%)0 (0%)Table 2.Disease-modifying drug<70 years old≥70 years oldpMethotrexate72 (53.73%)9 (40.91%)0.667Leflunomide22 (16.42%)5 (22.73%)Sulfasalazine2 (1.49%)1 (4.55%)Hydroxychloroquine6 (4.48%)0 (0%)At least two of the above7 (5.22%)1 (4.55%)

Conclusion:

DMARD concomitant treatment has been related to a higher second biological treatment survival. This beneficial effect was not observed in RA patients ≥70 years of age whose second biological agent withdrawal cause was failure. In this age group, withdrawal related to adverse events was more frequent.

References:

[1]Kalden JR, Schulze-Koops H. Immunogenicity and loss of response to TNF inhibitors: implications for rheumatoid arthritis treatment. Nature reviews Rheumatology. 2017;13(12):707-718.

Disclosure of Interests:

None declared

FRI0301 DO PATIENTS AND PHYSICIANS AGREE ON THE DEFINITION OF REMISSION AND LOW DISEASE ACTIVITY IN AXIAL SPONDYLOARTHRITIS?

Background:

Current recommendations for axial Spondyloarthritis (axSpA) include the treat-to-target concept and suggest that the ideal target should be remission or low disease activity (LDA). Also, the importance of a shared decision is highlighted. Unfortunately, the definition of remission is not consensual, and most of the definitions are difficult to evaluate in clinical practice

Objectives:

To propose an evaluation of remission by a single question to the patient, by comparing it to the different available definitions. To analyze the metric properties of the current definitions against patient’s perception

Methods:

One-center cross-sectional study in a tertiary care hospital including consecutive patients with a diagnosis of axSpA (and fulfilling the ASAS criteria) were included between February to November 2019. Patient’s perception of remission and LDA was evaluated by a single question. Physician’s perception of remission and LDA was assessed identically. The level of agreement between patients’ perception and the other available definitions was tested by the Prevalence and Bias adjusted Kappa (PABAK). The metric properties Sensitivity (S) and Specificity (Sp) of the available definitions (BASDAI cut-offs, ASDAS disease states, ASAS criteria for partial remission and patient acceptable symptom state), were tested against the patients perspective, as the gold standard.

Results:

A total of 105 axSpA patients were included. 63,8% were males and 67,6% had radiographic sacroiliitis (Table 1). 21% and 72% of them considered themselves in remission and LDA, respectively. Physician’s perception was 45.7% and 81% for remission and LDA, respectively. The prevalence of the different definitions are shown in Figure 1. The best agreement for patients’s perception of remission was found with a BASDAI <2 + normal CRP (Table 2). This definition was also the most sensitive (S=72,7%) and specific (Sp=83,1%) when taking the patient’s perception as a reference.

Table 1.

Characteristics of 105 patients with axSpA

All (N:105)Patients in self-defined REM (N:22)Patients in self-defined LDA (N:54)Patients No REM no LDA (N:29)Male, n (%)67 (63,8)18 (81,8)34 (63)15 (51,7)r-axSpA, n (%)71 (67,6)17 (77,3)33 (61,1)21 (72,4)Mean age, years (SD)49 (13)51(15)47 (13)50 (11)Mean AxSpA duration, years (SD)12,2 (13)17,1 (16,2)11,2 (11,7)10,3 (12,3)HLA- B27+, n (%)Data from 10472 (69,2)17/22 (77,3)33/54 (61,1)22/28 (78,6)Periferic arthritis, n (%)34 (32,4)7 (31,8)17 (31,5)10 (45,4)Uveitis, n (%)22 (21)6 (27,3)10 (18,5)6 (20,7)Biological treatment, n (%)43 (41)14 (63,6)19 (35,1)10 (34,5)CRP, mean (SD)3,61 (5,36)2,31 (2,17)2,84 (3,87)6,04 (8,14)ASDAS, mean (SD)1,78 (1,08)0,98 (0,71)1,63 (0,89)2,68 (1,03)BASDAI, mean (SD)3,35 (2,32)1,39 (1,30)3,13 (1,84)5,26 (2,33)BASFI, mean (SD)2,81 (2,45)1,24 (1,37)2,57 (2,00)4,43 (2,92)

Table 1.REM: Remission; LDA: Low Disease Activity; SD: Standard Desviation; CRP: C-Reactive Protein IBD: Inflammatory Bowel Disease.

Table 2.

Agreement between different definitions of remission

ASDAS <1,3BASDAI<2+Normal CRPPGA ≤1PhysicianREMPatientREMASAS PR0.53 (0.58)0.59 (0.68)0.76 (0.83)0.22 (0.26)0.39 (0.56)ASDAS <1,30.64 (0.68)0.50 (0.56)0.44 (0.45)0.28 (0.37)BASDAI <2+Normal CRP0.60 (0.69)0.25 (0.28)0.50 (0.62)PGA ≤10.20 (0.24)0.42 (0.62)Physician REM0.20 (0.24)

Agreement is presented as Cohen’s Kappa (PABAK: prevalence and bias adjusted kappa).

Patient and Physician remission (REM) are based on the single question; ASAS PR:

ASAS partial remission; PGA: Patient global assessment.

Conclusion:

In this real-life population, the evaluation of remission by the patient through a single question was shown to be feasible and to present an acceptable agreement with other definitions.

References:

[1]Gorlier C, et al. Ann Rheum Dis 2019;78(2):201-8.

Fig. 1.

REM/LDA: remission/ low disease activity self-defined patient or physician through a simple question. ASDAS <1,3: inactive disease; ASDAS <2,1: low activity; PGA: Patient global assessment; PASS: Patient acceptable symptom state.

Acknowledgments:

To Ansgar Seyfferth and Alfonso Muriel. To Carlos Sanchez-Piedra, Fernando Alonso and Mercedes Guerra from Sociedad Española de Reumatología, Research Unit.

Disclosure of Interests:

Marta Valero Grant/research support from: Novartis, Pfizer, Abvie, Speakers bureau: Novartis, Celgene, Javier Bachiller-Corral: None declared, Boris Anthony Blanco Cáceres: None declared, M. Ángeles Blázquez: None declared, Consuelo Díaz-Miguel: None declared, Maria Jesus Garcia Villanueva: None declared, Carmen Larena: None declared, Jose Luis Morell Hita: None declared, Carlos De la Puente Bujidos: None declared, Ana Rodriguez-García: None declared, Mónica Vázquez Díaz: None declared, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB

AB0740 SECOND-LINE BIOLOGIC DMARDs SURVIVAL IN PSORIATIC ARTHRITIS. DATA FROM A SPANISH THIRD-LEVEL HOSPITAL

Background:

Psoriatic arthritis (PsA) covers a wide spectrum of disease manifestations, including arthritis, enthesitis, dactylitis and axial spondylitis. This range of symptoms presents a challenge to the treating physician. Biologic disease-modifying antirheumatic drugs (bDMARDs) have proven effective through randomized clinical trials; and most international PsA guides include them as main option upon first-line treatment failure. However, studies regarding drug efficacy after bDMARD switching are scarce, lower response rates and drug survival on consecutive lines has been explored in previous research.

Objectives:

To assess bDMARDs survival after first-line failure in PsA patients treated in a third-level hospital and to determine baseline clinical and laboratory parameters associated with drug survival.

Methods:

We conducted a retrospective, single-centre study. 47 patients who received a second-line bDMARD were included, with diagnosis of PsA according to the criteria of an expert rheumatologist. All patients were studied according to a standard protocol. Data regarding bDMARD prescribed, baseline characteristics, axial or peripheral involvement and immunological profile (included both HLA-B27 and HLA-Cw6) were extracted. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at bDMARD start were included, as well. Kaplan-Meier, log-rank analyses and Cox regression models were applied.

Results:

Of 47 patients receiving a second bDMARD, 55,3% (26) were female and mean (S.D.) age was 40,6 (12,52) years. Median (interquartile range) disease duration was 10,1 (3,7-14,8) years. Prescribed drugs were Adalimumab (ADL) (36,2%, 17), Etanercept (ETN) (27,6%, 13), Infliximab (IFX) (6,4%, 3), Golimumab (GOL) (10,6%, 5), Certolizumab (CTZ) (4,3%, 2), Secukinumab (SCK) (8,5%, 4) and Apremilast (APR) (6,4%, 3). 42,3% cases suffered from axial involvement, rest of the sample (57,6%) presented a pure peripherical form of PsA. HLA-B27 and -Cw6 were assessed in 80,9% (38) and 68,1% (32), respectively; of whom, HLA-B27 carriers were 10,5% and HLA-Cw6 positive, 46,9%. Mean CRP level was 10,25 mg/L and mean ESR was 23,17 mm. Patients showed mean and median global drug retention of 44,57 (29,8-59,3) and 23 months. At 12-month visit, drug survival was 70%, 47% at 24 months, and 33% at 4 years from onset. Mean drug persistence by bDMARD prescribed was: ADL, 62,1 months; ETN, 51,9 months; IFX, 39 months; GOL, 22,8 months; CTZ, 9,5 months; SCK, 13,5 months; and APR, 16,3 months. Through log-rank analyses, differences in drug retention were investigated by several variables. Female sex (30,35m, 16,5-44,2 m.) was identified as statistically significant different than male patients (62,5m, 35,6-89,4m, p=0,021). Although not significant, other differences were remarkable: non-axial involvement, HLA-Cw6 negativity, HLA-B27 positivity and CRP level over 5 mg/L. No differences were found between altered and normal ESR patients.

Conclusion:

Second-line bDMARD survival is lower in female PsA patients, according to our data and previous bibliography. Despite our reduced sample and possible bias, non-axial involvement, absence of HLA-Cw6, presence of HLA-B27 and higher levels of CRP at biologic onset might be predictors of better drug persistence. Further investigations are required on this field.

References:

[1]Glintborg B et al. Clinical Response, Drug Survival, and Predictors Thereof Among 548 Patients With Psoriatic Arthritis Who Switched Tumor Necrosis Factor α Inhibitor Therapy. Results from the Danish Nationwide DANBIO Registry. Arthritis Rheum 2013:65(5):1213-23.

[2]Stober C et al. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis. Rheumatology (Oxford) 2018:57(1):158-163.

Table 1. Kaplan–Meier survival analysis of persistence according to sex.

Table 2. Kaplan Meier survival analysis of persistence according to HLA-Cw6.

Disclosure of Interests:

None declared

OP0002 INCIDENCE OF FIRST CARDIOVASCULAR EVENT IN SPANISH PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: PROSPECTIVE DATA FROM THE CARMA PROJECT AFTER 5 YEARS OF FOLLOW-UP

Objectives:

To determine the incidence and risk factors implicated in the development of first cardiovascular (CV) event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) attending Spanish rheumatology clinics after 5 years of follow-up

Methods:

Analysis of data of patients included in an observational prospective study [CARdiovascular in rheuMAtology (CARMA) project] after 5 years of follow-up. The study includes a cohort of 2234 patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA), and another cohort of matched individuals (n=677) without CIRD from 67 hospitals in Spain. Cumulative incidence per 1000 patients of CVE was estimated in both cohorts at 5 years from the start. Weibull proportional hazard model was used to calculate the Hazard Ratio (HR) and 95% confidence intervals (CI) of the risk factors involved in the development of CV events. Losses to follow-up and their causes were also analyzed.

Results:

The total number patient who completed the follow-up visit at 5 years was 2.382 (81.9%). Fifteen patients died due to CVE and sixty due to non-CVE. The patients with CIRD showed higher cardiovascular cumulative incidence (40.5; 95% CI: 36.2-44.8) than controls (28.3; 95% CI: 21.8-34.8). The higher risk of developing a first CVE during the 5 years of follow-up was seen in patients with AS (HR: 4.60; 95% CI: 1.32-15.99; p=0.02), those with older age (HR:1.09; 95% CI: 1.05-1.13; p<0.001), higher systolic blood pressure (HR: 2.64; 95% CI: 1.32-5.25; p=0.006), and those with longer duration of the rheumatic disease (HR: 1.07; 95% CI: 1.03-1.12; p=0.002). In contrast, woman gender was a protective factor (HR: 0.45; 95% CI: 0.21-0.99; p=0.047).

Conclusion:

Patients with AS prospectively followed-up at rheumatology outpatient clinics showed higher risk of developing a first CVE than those without CIRD. Besides traditional CV disease risk factors, a longer time course of the disease is a risk factor for the development of CV disease in patients with CIRD.

Acknowledgments:

This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results and preparation of the manuscript has been done independently of Abbvie.

Disclosure of Interests:

Maria Auxiliadora Martin-Martinez: None declared, Santos Castañeda: None declared, Fernando Sánchez-Alonso: None declared, Carmen García Gomez: None declared, Carlos Gonzalez Juanatey: None declared, Maria Angeles Belmonte: None declared, Jesús Tornero: None declared, José Santos Rey: None declared, CARMEN OLGA SANCHEZ GONZALEZ: None declared, Estefanía Quesada-Masachs: None declared, MARIA DELPUERTO MORENO GIL: None declared, Tatiana Cobo-Ibáñez: None declared, Jose Antonio Pinto Tasende: None declared, Jesús Babío: None declared, Gemma Bonilla: None declared, Antonio Juan Mas: None declared, Javier Manero: None declared, Montserrat Romera: None declared, Javier Bachiller-Corral: None declared, Eugenio Chamizo Carmona: None declared, Javier Calvo: None declared, Raimon Sanmarti: None declared, Maria Celia Erausquin: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Carmen Barbadillo: None declared, Sergio Ros Exposito: None declared, Javier del Pino Grant/research support from: Roche, Bristol, Consultant of: Gedeon, MARIA JOSE GONZALEZ: None declared, José Manuel Pina Salvador: None declared, Javier Llorca: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD