AB1116 DOPPLER EVALUATION OF ENTHESITIS SEEMS TO BE A RELEVANT OUTCOME IN THE ASSESSMENT OF ACTIVITY IN SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS

Background:

The assessment of activity in spondyloarthritis (SpA) and psoriatic arthritis (PsA) involves several domains, including enthesitis. Clinical enthesitis evaluation has shown low sensitivity, specificity and reliability. Ultrasound (US) examination of enthesitis can be an accurate and objective way to evaluate this domain, supporting its inclusion in the assessment of the global state of the disease

Objectives:

The main objective of this study is to analyze de prevalence of Doppler enthesitis in active SpA and PsA patients and to evaluate its association with the disease activity at patient level prior to start a biological therapy

Methods:

A prospective multicenter cross-sectional study in patients with SpA and PsA with active disease (defined as patients who were going to start or switch biological therapy according to physician criteria and in agreement with clinical guidelines) was undertaken. Basal assessment included clinical features, physical examination and laboratory tests. Patients underwent bilateral US examination of peripheral entheses according to the MAdrid Sonographic Enthesitis Index (MASEI). MASEI and Outcome Measures in Rheumatology (OMERACT) enthesitis Power Doppler (PD) definitions were checked. Each enthesis was scanned in two planes: longitudinal and transverse, and 5 second videos were recorded for reliability. An inter-reader analysis by three readers was performed at each included center. For statistical analysis Mann-WhitneyU and Kruskal-Wallis tests were used. Intraclass correlation coefficient (ICC) and kappa test were used for reliability

Results:

64 consecutive patients were included, of whom 19(29.7%) were ankylosing spondylitis (AS), 7(10.9%), non-radiographic axial spondyloarthritis (nr-axSpA) and 38(59.4%) PsA patients. Mean age was 52.4±12.5 years and 36(56.3%) were males. Mean DAS28 (3.6±1.3) for peripheral involvement, mean BASDAI (5.6±2.2) for axial involvement, and CRP values (10±10.9) reflect moderate-high disease activity at baseline. Demographic, clinical and MASEI baseline characteristics are shown in Table 1. Mean global MASEI score was 29.4 (±11.4) and 55 patients (86%) scored ≥18 (proposed cut-off point to diagnose SpA). At the patient level, abnormal US findings consistent with at least one enthesis showing PD signal were observed in 52(81.3%) of patients using MASEI PD and 48(75%) using OMERACT PD definition without significant variation among the different SpA subtypes (p=0.8 and p=0.6, respectively). The inter-reader reliability among the two cohorts from each center performed by three readers was high (ICC cohort 1:0.92; cohort 2:0.85) and inter three readers kappa was good (0.92 and 0.86 for Doppler MASEI and Doppler OMERACT respectively).

Table 1.

Baseline characteristics of SpA and PsA patients

Totaln= 64ASn=19 (29.7%)PsAn=38 (59.4%)nr-axSpAn=7 (10.9%)pAge52.4±12.550.3±14.554.6±11.646.3±9.90.2Sex (Male)36 (56.3%)10 (52.6%)23 (60.5%)3 (42.9%)0.6CRP (mg/L)10±10.913.7±11.49±10.96.8±9.10.3VSG (mm/h)17.3±1512.6±7.520.6±1811.9±40.4DAS28 n= 403.6±1.33.1±1.13.9±1.33.2±1.40.2BASDAI n=235.6±2.25.3±2.55.4±0.86.9±0.90.2MASES n=261.1±1.51.1±1.6-1.1±1.30.9MASEI29.4±11.429.1±930±12.826.7±10.40.9MASEI score ≥1855 (85.9%)18 (94.7%)32(84.2%)5(71.4%)0.3Mean number of enthesis with PD OMERACT1.6±1.41.7±1.31.5±1.51.6±1.70.6Mean number enthesis with PD MASEI2.1±1.71.9±1.42.2±1.81.7±1.70.8PD OMERACT ≥148 (75%)15(78.9%)28(73.7%)5(71.4%)0.9PD MASEI ≥152 (81.3%)15(78.9%)32(84.2%)5(71.4%)0.7

Conclusion:

PD enthesitis is found in the vast majority of patients with active SpA and PsA, independent of SpA subtype. MASEI PD might have some advantages versus OMERACT PD definition to detect active enthesitis. These findings support the usefulness of PD US in the assessment of activity in SpA and PsA at patient level.

Disclosure of Interests:

Juan Molina Collada: None declared, Cristina Macía-Villa: None declared, Chamaida Plasencia: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi)

AB0741 IS THE THERAPEUTIC TARGET ACHIEVEMENT INCREASING OVER TIME IN PATIENTS WITH PSORIATIC ARTHRITIS STARTING BIOLOGICAL THERAPY? DATA FROM 15 YEARS

Background:

Treatment in Psoriatic Arthritis (PsA) has undergone a major revolution in recent years, with the development of new targets and molecules. Despite these advances, data from clinical practice demonstrating a change in management success are scarce.

Objectives:

To evaluate if the proportion of patients (pts) with PsA maintaining an acceptable medium-term control of the disease activity after starting a first biologic agent is increasing over time.

Methods:

Prospective cohort including 101 patients (pts) with PsA starting a 1st biologic (TNF inhibitor, anti-IL 17 inhibitor) in a tertiary hospital between 2002-2018. Demographic, clinical and laboratory data were collected at the beginning of treatment. Disease activity indexes (ASDAS for axPsA and DAPSA for pPsA) were collected before starting biologic, six and twelve months later (baseline, 6m and 12m visit, respectively). Low disease activity (LDA) was defined as ASDAS < 2.1 (axPsA) and DAPSA ≤14 (pPsA). Three groups were established according to biologic initiation date: period 1 (p1) (between 2002-2007), (p2) 2008-2013 and (p3) 2014-2018. Each period had a minimum follow-up of 1 year for every patient. For each interval, the percentage of pts achieving persistent (at both follow-up visits) LDA was determined, as a marker of acceptable medium-term control of the disease. All collected variables were compared between groups by ANOVA and Chi-Squared test.

Results:

Out of the 101 pts initiating biological therapy, 46 % were males and 57 % had peripheral PsA. At the biologic treatment start, mean ± SD age was 48.5 ± 12 years and disease duration was 9.9 ± 10 years. Biological therapies initiated included etanercept in 38 % of pts, infliximab in 24 %, adalimumab in 25 %, golimumab in 7 %, secukinumab in 3 % and certolizumab in 3 %.

Stratified by time intervals, 36 (35.6%) pts started in p1, 36 (35.6%) in p2 and 29 (28.8%) in p3. Baseline characteristics of pts by periods are shown in Table 1. For patients in p3, compared to the previous intervals, a significant lower CRP (p=0.03) and ESR (p=0.004) were found at baseline, whereas there were no significant differences on baseline disease activity indices. Fifty-one (50%) pts achieved persistent-LDA after one year of starting biologic. Figure 1 reports the total number of patients that were in LDA in all the visits in the 1styear, stratified per period of time and predominant manifestation. A lower percentage of patients in LDA (33% in p1 vs, 67% in p2 vs 52% in p3, p = 0.02) was found in the first interval, in comparison to the most recent periods. The difference in response between p2 and p3 is mainly due to the group of patients with pPsA, whereas the improvement in the group of patients with axPsA remains constant in both periods.

Table 1.

Baseline patient’s characteristics by periods of time

Figure 1.

Patients achieving persistent-LDA during the 1styear of biological therapy, stratified by period of time and by disease.* Statistically significant difference with respect to p1.

Conclusion:

The percentage of pts with PsA achieving LDA status after one year of initiating a biological therapy has substantially increased over time. A lower threshold of inflammation at biological therapy start and a broader spectrum of therapies might explain this better management on PsA.

Disclosure of Interests:

Diego Benavent: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Irene Monjo: None declared, Marta Novella-Navarro: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Chamaida Plasencia: None declared

FRI0294 MUSCULOSKELETAL MANIFESTATIONS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE TREATED WITH VEDOLIZUMAB

Background:

Musculoskeletal manifestations (MEM) are frequent extraintestinal symptoms in patients suffering from inflammatory bowel disease (IBD), affecting up to 40% of them. Tumor necrosis factor inhibitors (TNFi) are effective in both IBD and IBD-related spondylarthritis (SpA). Additionally, vedolizumab (VDZ), an α4β7 integrin inhibitor with selective action on intestinal tissue, has been recently proposed as 1st line treatment on TNFi refractory IBD. The effectiveness of VDZ in MEM has not been properly evaluated but even exacerbation of previously diagnosed SpA has been described.

Objectives:

The main objective is to analyse the occurrence of articular exacerbations in patients with IBD-related SpA treated with VDZ. The secondary objective is to analyse the new-onset MEM in IBD patients treated with VDZ.

Methods:

Descriptive study of a retrospective cohort of every adult with IBD (Crohn’s disease -CD- and ulcerative colitis -UC-) patients starting treatment with VDZ in a tertiary hospital. All data were collected as a collaboration between the Rheumatology and Gastroenterology Departments, through revision of the clinical history and databases from both departments. In patients previously diagnosed of SpA exacerbation was assessed, defined as a clinical worsening causing a treatment modification. The patients with new-onset MEM were classified as: i) nonspecific arthralgia (NsA), not suggestive of SpA; and ii) SpA according to ASAS criteria. A statistical analysis was performed using frequency charts

Results:

A total of 61 patients were included, 55.7% women and with an mean (SD) age of 50 (17) years. The proportion of UC and CD was similar (49% and 51%, respectively). Among the patients studied, 12 (19.7%) had a diagnosis of IBD-related SpA and 3 (25%) of them suffered articular exacerbation of SpA within 3,5 and 6 months of treatment. On the other hand, 9 (14.7%) patients showed new-onset MEM, 3 (33%) of them showed symptoms and clinical and/or radiological findings compatible with axial SpA. In 2 of the cases a treatment with a cDMARD was used and the other one required a combination therapy between iTNF and VDZ. The remaining 6 (67%) patients were classified as NsA and inflammatory arthritis was discarded. Table 1 shows the demographic and clinical characteristics of patients included in the analysis.

Table 1.

Demographic, clinical characteristics and symptoms onset in patients included in the study.

Total (n=61)Diagnosed SpA (n=12New-Onset MEM (n=9)Stable (n=9)Exacerbation (n=3New-onset SpA (n=3)NsA (n=6)Age (years), mean ± SD50 ± 1755 ± 1950 ± 7.538 ± 1350 ± 14Gener (female), n (%)34 (55.7%)6 (66.7%)3 (100%)1 (33.3%)3 (50%)BMI (Kg/m2), mean ± SD24.7 ± 4.327.5 ± 5.528.3 ± 3.930.2 ± 0.524.3 ± 4.6Smoking habit (smokers), n (%)11 (18%)1 (11.1%)0 (0%)2 (66.7%)0 (0%)CD diagnosis, n (%)31 (50.8%)2 (22.2%)1 (33.3%)3 (100%)2 (33.3%)UC diagnosis, n (%)30 (49.2%)7 (77.8%)2 (66.7%)0 (0%)4 (66.7%)IBD follow-up, (years) mean ± SD11 ± 9.610.6 ± 102 (1-29) *12 ± 6.89.8 ± 4.6bDMARD naïve, n (%)7 (11.5%)2 (22.2%)0 (0%)0 (0%)0 (0%)

*shown as median (range).

Conclusion:

Switching TNFi treatment to VDZ in patients with IBD-related SpA was found to be associated with articular exacerbation of SpA in 1 out of 4 patients within the first 5 months. New-onset MEM is also observed in up to 15% of patients with IBD treated with VDZ. A multidisciplinary assessment of these patients is necessary in order to achieve a proper management of their diseases.

Disclosure of Interests:

Pablo Rodríguez-Merlos: None declared, MARIA ANGELES RUIZ- RAMIREZ: None declared, Chamaida Plasencia: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Cristina Suarez-Ferrer: None declared, Eduardo Martin-Arranz: None declared, Maria Dolores Martín Arranz: None declared, Diana Peiteado: None declared, Gemma Bonilla: None declared, María Sánchez Azofra: None declared, Joaquín Poza Cordón: None declared, Karen Nathalie Franco Gomez: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz

AB0313 CLINICAL PREDICTORS OF MULTIPLE FAILURES TO BIOLOGICAL THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Biological therapies have improved the clinical course and quality of life of Rheumatoid Arthritis (RA) patients. Despite the availability and effectiveness of these treatments, some patients present multiple failures to biologic disease-modifying anti-rheumatic drugs (bDMARDs), constituting a challenge to clinicians.

Objectives:

To determine the frequency of multiple failure to bDMARDs in RA patients and to identify baseline/early features as possible predictors of multiple failure.

Methods:

This case-control study involved subjects with RA1,2treated with bDMARDs from the RA-Registry at La Paz Hospital between 2000 and 2019. Patients who presented insufficient response to >3 different bDMARDs or >2 bDMARDs with different mechanism of action were considered Multi-refractory (MR-patients). Patients who achieved low disease activity or remission (by DAS-28) with the first bDMARD and maintained it in a follow-up period of at least 5 years were considered non-refractory(NR-patients).For all patients, demographic, clinical characteristics and laboratory parameters were assessed in the database at baseline visit, just prior to start bDMARD for first time and at 6-months visit.

Descriptive analysis was performed, and using the “refractory status” as the dependent variable, multiple bivariate logistic regression models were performed to identify which variables should be considered in the multivariate analyses. P<0.05 was considered statistically significant. Odds Ratio (OR) and Confidence Intervals (CI) were calculated. IBM SPSS 21.0

Results:

In total, 402 RA patients who had ever received bDMARD treatment were identified. According to pre-established inclusion criteria, 112 patients were included: 41MR-patients(10%) and 71NR-patients(18%). No differences in gender, age or age at RA diagnosis were found between both groups. Global time on bDMARD treatment was longer inMR-patients(11.7 vs 9.7 years, p=0.01) and survival on first bDMARD was 4.1±3.4 years, which was decreasing with the successive treatments. InMR-patients, shorter disease duration between RA diagnosis and starting bDMARD (6.9 vs 10.0; p=0.04) and higher number of previous cDMARDs were observed. Also presence of erosions and extra-articular manifestations were more frequent inMR-patients (58.5% vs 25.4%, p=0.03 and 29.3% vs 12.7%, p<0.001).

Results of variables included in bivariate and multivariate analyses are shown in Table 1. Finally, factors associated with multi-bDMARDs refractoriness in the multivariate analysis were presence of erosions, earlier age at bDMARD start, higher baseline DAS-28 and especially ΔDAS< 1.2 in the first 6 months of treatment (OR 11.12; 95% CI 3.34-26.82).

Table 1.VARIABLEBivariateOR (95%CI)MultivariateOR (95%CI)Age at diagnosis0.99 (0.96-1.0)-Sex (Female)1.67 (0.58-4.73)5.94 (0.92-38.20)Age at bDMARD treatment0.97 (0.93-1.00)0.95 (0.90-0.99)Time between diagnosis and bDMARD0.94 (0.89-1.00)-Body mass index1.01 (0.94-1.09)-Erosions (ref yes)4.07 (1.79-9.26)3.26 (1.18-9.00)Extraarticular manifestations (ref yes)2.81 (1.0-7.52)2.14 (0.59-7.78)Metothrexate (ref yes)1.83 (0.66-5.10)-Previous cDMARDs3.54 (2.05-6.1)-CRP baseline1.02 (0.99-1.05)-DAS28 baseline1.77 (1.2-2.6)2.29 (1.39-3.76)ΔDAS-28 (ref <1.2)0.22 (0.09-0.52)11.12 (3.34-26.82)HAQ baseline1.13 (1.03-1.23)1.09 (0.92-1.29)

Conclusion:

In our cohort,10%of patients with RA were observed to have multi-refractoriness to bDMARDs. This study also identified baseline and early clinical characteristics of patients as predictors of multi-refractoriness, especially absence of clinical response during the first 6 months on a first bDMARD.

References:

[1]Arnett FC. Arthritis Rheum 1988;31:315-24.2Aletaha D. Arthritis Rheum. 2010;62:2569-81

Disclosure of Interests:

Marta Novella-Navarro: None declared, Chamaida Plasencia: None declared, Carolina Tornero: None declared, Karen Nathalie Franco Gomez: None declared, Irene Monjo: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Diana Peiteado: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz

AB0701 ANTERIOR UVEITIS AND HLA B27, ARE THERE ANY CLINICAL OR THERAPEUTIC DIFFERENCES IN PATIENTS WITH POSITIVE HLA B27 VERSUS THOSE WITH HLA B27 NEGATIVE?

Background:

Anterior uveitis is the most frequent form of presentation of uveitis. An important part of patients do not associate extraocular manifestations, so more information about the clinical profile is needed to optimize therapeutic decisions.

Objectives:

To describe the clinical profile of patients with anterior uveitis related and not related to the antigen HLA-B27. Compare both groups to establish differences.

Methods:

Retrospective cohort study. Consecutive patients diagnosed with non-infectious anterior uveitis, assessed in the multidisciplinary uveitis unit of the Infanta Leonor University Hospital (Madrid) from its establishment in October 2017 to December 2019, were included. To compare categorical variables Chi square was used and the test of Fisher; and Student’s T or Mann-Whitney U test for continuous variables. Finally, a multivariate analysis was performed to established differences between the two groups. A value of p <0.05 was considered statistically significant.

Results:

62 patients with anterior uveitis, 26 (42%) with HLA B27 positive and 36 (58%) with HLA B27 negative were included. There were no differences between the two groups regarding sex. Differences were found in the mean age at diagnosis, 35 + -9.6 in the HLA B27 positive group vs 47 + -14.9 in the HLA B27 negative group (p 0.01). The time since uveítis diagnosis was longer in the HLA B27 positive group: 7.08 years (3.45-11.79) versus 2.41 years (1.66-3) in the HLA B27 negative group (p 0.000). Regarding the etiology, the majority of patients in the HLA B27 negative group had a diagnosis of idiopathic anterior uveitis (72.2%), and 53.8% of the patients in the HLA B27 positive group were diagnosed with spondyloarthritis (p 0.000). There were no significant differences in the number of patients that require systemic treatment. There were no differences regarding oral corticosteroids intake, with very few patients needing it (2 patients in the HLA B27 positive group and 5 patients in the HLA B27 negative group (p 0.699). The percentage of patients who needed to start an immunosuppressive treatment were similar between the two groups, 6 patients (23.1%) in the HLA B27 positive group and 11 patients (30.6%) in the HLA B27 negative group (p 0.717) No significant differences could be detected between groups in the multivariate analysis in terms of laterality, clinical course, treatment with immunosuppressants or development of complications.

Conclusion:

In our cohort patients with HLA B27 positive debut at an earlier age. There were no differences between both groups in laterality, course of uveitis, systemic treatment or ocular complications.

Disclosure of Interests:

None declared

SAT0084 SERUM ADIPOKINES PROFILE IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TNF-INHIBITORS

Background:

In recent years, the relationship between obesity and autoimmune diseases has taken interest, since adipose tissue has been identified as an endocrine organ that secretes cytokines (adipokines), among which leptin stands out as a soluble pro-inflammatory mediator associated with the body mass index (BMI).

Objectives:

The main objectives of this study are: i) to analyse the influence of BMI on clinical response in Rheumatoid Arthritis (RA) patients who initiate TNF-inhibitor (TNFi) therapy; ii) to analyse the differences in the serum profile of adipokines (leptin and adiponectin) according to BMI and their association with response to treatment.

Methods:

Observational study of a prospective cohort of 73 RA patients who initiated biological treatment with TNFi from the Complex Therapy Unit (CTU) of our Hospital. Patients were classified according to their BMI in normal-weight (BMI<25) and overweight/obesity (O/O) (IMC≥25). Demographic, clinical and laboratory variables were collected at baseline and at 6 months. Our outcome measures were DAS28-VSG remission (DAS28<2.6) at 6 months after TNFi initiation. Serum leptin and adiponectin levels were measured by Enzyme-Linked Immuno Sorbent Assay (ELISA) at baseline and 6 months. A descriptive sample analysis comparing the characteristics of both patient subgroups was performed using Chi-square, T-test for independent samples and U-Mann Whitney. Likewise, a bivariate analysis was carried out by means of binary logistic regression to assess the probable association of the parameters studied with remission.

Results:

Of the 73 patients studied, 51% were classified in O/O group. The O/O patients presented higher levels of baseline CRP (16.69±6.16 vs 8.74±3.81, p=0.01). No statistically significant differences were observed in the remaining variables (sex, age at the beginning of the TNFi, disease duration, baseline DAS-28), as well as therapeutic variables (use of previous DMARDs and doses of methotrexate and/or steroids). Patients with overweight/obesity presented higher DAS28-ESR values at 6 months of treatment (3.59±1.14 vs 2.93±1.27, p=0.02) and achieved remission less frequently (18.9% vs 48.6%, p=0.007). Serum leptin levels were significantly higher in O/O patients, both baseline (29.39±21.50 vs 13.49±8.78, p<0.001) and 6 months (33.06±22.03 vs 14.77±9.50, p<0.001) after TNFi initiation. In addition, O/O patients were less likely to reach remission at 6 months than normal-weight patients. [OR= 4.04 IC95% (1.40-11.64); p=0.009]. Lower frequency of remission was associated to greater leptin levels at 6 months [OR=0.94 CI95% (0.90-098); p=0.012]. No differences in serum adiponectin were found between both subgroups of patients.

Conclusion:

In this RA patient cohort, overweight/obesity is associated with i) a reduced response to TNFi therapy and ii) a lower short-term remission rate. Within the adipokine profile, leptin seems to play a relevant role in the maintenance of pro-inflammatory activity with a negative influence on the response to TNFi therapy in O/O patients.

References:

[1] Versini M. et al. Autoimmun Rev. 2014; 13, 981-1000

[2] Toussirot E et al. Life Sci. 2015;140: 29-36.

Disclosure of Interests:

Marta Novella-Navarro: None declared, Borja Hernández-Breijo: None declared, Fernanda Genre: None declared, Leticia Lera-Gómez: None declared, Verónica Pulito-Cueto: None declared, Laura Nuño: None declared, Alejandro Villalba: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Chamaida Plasencia: None declared

SAT0366 CLINICAL RESPONSE TO BIOLOGIC DMARDS IN AXIAL SPONDYLOARTHRITIS AND AXIAL PSORIATIC ARTHRITIS. DIFFERENT DISEASES, SAME OUTCOMES?

Background:

Patients with psoriatic arthritis may present predominant axial involvement. Currently, it is unclear whether these patients should be considered as axial spondyloarthritis (axSpA) with psoriasis or psoriatic arthritis with axial involvement –also known as axial PsA (axPsA). Data comparing medium-term treatment response to biological drugs in axSpA and axPsA would add relevant information to answer this question.

Objectives:

To compare the clinical response and predictor factors after one year of biological therapy in patients with axSpA and axPsA.

Methods:

One-year follow-up data from all patients (pts) with axSpA or axPsA (defined by the treating rheumatologist) included in a prospective cohort of pts receiving biological therapy from la Paz University Hospital between 2002 and 2019 were analysed. Demographic information, laboratory tests, concomitant treatments and disease status were collected at baseline. Clinical disease activity was measured by PhGA and ASDAS criteria at baseline, 6 and 12 months. According to ASDAS, disease activity was defined as: inactive disease (ID) (ASDAS <1.3), low disease activity (LDA) (ASDAS 1.3-2.1), high disease activity (HDA) (ASDAS 2.1-3.5) and very high disease activity (VHDA) (ASDAS >3.5). Clinical important improvement and major improvement were defined by ASDAS (delta-ASDAS ≥ 1.1 and ≥ 2.0, respectively). According to PhGA, disease activity was assorted by consensus of 3 expert rheumatologists in: ID with PhGA<5, LDA with PhGA 5-30, HDA with PhGA >30-60 and VHDA with PhGA >60. Clinical improvement by PhGA was defined as an improvement of 30 % compared to baseline. In the statistical analysis, the frequency of pts achieving each clinical activity status and clinical improvement at 6m and 12m were compared using Fisher test, separately for axSpA and axPsA. Baseline predictor factors for achieving clinical response and clinical improvement were identified using univariable and multivariable binary regression.

Results:

Out of 352 included pts, 287 (81.5%) had axSpA and 65 (18.5%) axPsA. Sixty percent were males, 158 (45%) smokers, with mean (SD) baseline disease activity of ASDAS (bASDAS): 3.3 (0.9) and PhGA: 39.1 (21.5). Biological therapies initiated included TNF inhibitors in 93.8 % and secukinumab in 6.2%. In comparison to axPsA, pts with axSpA were more HLA B27 positive (p<0.001) and had better PhGA at baseline (p=0.02). They also had more uveitis (p=0.03) and were more radiographically affected (p<0.001).

Response rates at 6m and 12m in both diseases according to ASDAS are shown in Figure 1, and to PhGA in Figure 2. Both diseases presented a similar clinical response, and no statistically significant differences were observed for any disease activity interval between them for ASDAS or PhGA. There were no differences between both diseases on clinical improvement, regardless the type of measurement.

Figure 1.

Response rates (in percentage) by ASDAS at 6m and 12m in axSpA and PsA

In the group of axSpA, the univariate analysis observed that LDA (by ASDAS) at 12m was associated with bASDAS (OR=0.67, p=0.02), male gender (OR=2.8, p=0.001) and HLA B27 positive (OR=2.3, p=0.01). In the multivariate analysis, these variables remained significantly associated with LDA (bASDAS: OR= 0.67; p<0.05; male gender: OR=2.7, p<0.01; and HLA B27 positivity OR=2.6, p<0.01). In the group of axPsA, the univariate analysis showed a tendency that male pts achieved LDA more frequently at 6m (OR=3.0, p=0.05) and at 12m (OR=2.75, p=0.09). In the multivariable analyses, none of the factors was significantly associated neither with clinical improvement nor with LDA in pts with axPsA.

Conclusion:

In clinical practice, pts with axSpA and axPsA present a similar clinical response to biological therapy within the first year of treatment. Male pts seem to have better medium-term outcomes in both diseases, and HLA B27 pts respond better in axSpA.

Disclosure of Interests:

Diego Benavent: None declared, Chamaida Plasencia: None declared, Karen Nathalie Franco Gomez: None declared, Laura Nuño: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

SAT0566 ULTRASOUND DOPPLER MASEI SHOWS SENSITIVITY TO CHANGE AFTER BIOLOGICAL THERAPY IN SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS PATIENTS

Background:

The assessment of activity in spondyloarthritis (SpA) and psoriatic arthritis (PsA) involves several domains, including enthesitis. Clinical enthesitis has shown low sensitivity, specificity and reliability. The MAdrid Sonographic Enthesitis Index (MASEI) is a feasible and reliable ultrasound score, but its responsiveness to treatment has not yet been evaluated.

Objectives:

The main objective of this study was to investigate the sensitivity to change of MASEI in active SpA and PsA patients.

Methods:

Longitudinal study in patients with SpA and PsA with active disease (defined as patients who were going to start or switch biologic disease modifying antirheumatic drugs (bDMARD) therapy according to physician criteria and in agreement with clinical guidelines). MASEI evaluation was performed at baseline, 3- and 6-months visits. MASEI and Outcome Measures in Rheumatology (OMERACT) enthesitis Power Doppler (PD) definitions were checked. Each enthesis was scanned in both the longitudinal and transverse planes, and 5 second videos were recorded for reliability. An inter-reader analysis by three readers was performed. For statistical analysis t-Student test was used to determine changes between visits and kappa test was used for reliability.

Results:

A total of 72 US evaluations of 25 patients were included, of whom 13(52%) were ankylosing spondylitis (AS) patients, 9(36%) PsA, and 3(12%) non radiographic axial spondyloarthritis (nr-axSpA). Mean age was 51.2±14.1 years and 13(52%) were females. Mean DAS28 (3.5±1.2) for peripheral involvement, mean BASDAI (5.8±2) for axial involvement, and CRP values (13.1±13.6) reflect moderate-high disease activity at baseline. US parameters at baseline and at the 3- and 6-month follow-up visits are shown in Table 1. Global MASEI score was responsive at the 3- and 6-month follow-up visit (-4.9 and -5.7, respectively) (p<0.05) and both MASEI and OMERACT PDUS definitions of active enthesitis improved significantly at 3- (-0.6 and -1.1) and 6-month follow-up visits (-0.7 and -1.1) (p<0.05). Reliability of PD MASEI definition among the three readers was excellent (kappa = 0.918).

Table 1.

MASEI evaluation at baseline, 3- and 6-month follow-up visits

ParameterBaselinen=253 monthsn=25Pa6 monthsn=22PaMASEI score28±9.323.2±7.60.00224.7±8.10.01PD US MASEI score1.8 ±1.31.1±1.10.0461±0.90.004PD US OMERACT score1.6±1.20.9±0.90.0240.8±0.90.006

at-Student test for comparison to baseline

Conclusion:

MASEI score significantly improves at 3 and 6 months of follow up in patients under bDMARD treatment and both MASEI and OMERACT Doppler definitions of active enthesitis reflects treatment response. These findings support the usefulness of PD US in the assessment of bDMARD treatment response in SpA and PsA.

Disclosure of Interests:

Juan Molina Collada: None declared, Cristina Macía-Villa: None declared, Chamaida Plasencia: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi)

AB0476 GIANT CELL ARTERITIS: A DISEASE WITH DIFFERENT SUBSETS

Background:

Giant cell arteritis (GCA) is the most common form of autoimmune vasculitis in the elderly. Some evidence indicates that GCA is a heterogeneous disease in terms of symptoms, immune pathology and response to treatment1.

Objectives:

To analyze whether the identification by image of cranial vessels (VC) or large vessels (VG) involvement allows to characterize different clinical subsets of the disease.

Methods:

Descriptive observational study of the last 87 consecutive patients with a new diagnosis of GCA in our hospital. All patients had a CV and LV CDUS exam that included axillary, subclavian, vertebral and carotid arteries or a Positron Emission Tomography (PET-CT). The OMERACT (Outcome Measures in Rheumatology) definitions of halo sign were used for ultrasound diagnosis and IMT limits were established as ≥ 0.34 mm for superficial temporal arteries and ≥ 1 mm for axillary, subclavian and carotid arteries; a clear halo sign was used in the vertebral arteries. The radiologist’s report and the liver/vascular wall index were used for the definition of positive PET-CT. The medical records of these patients were reviewed and their demographic, clinical and laboratory data were compared between the different patterns of GCA. The statistical significance limit was set at P < 0.05. Statistical analyses were performed by using SPSS version 25.

Results:

Out of 198 patients with suspected GCA who underwent a CDUS or PET-CT between November 2016 and November 2019, 87 were diagnosed of GCA. Three different patterns were detected: 44 patients (50.6%) had an exclusive cranial pattern, 31 (35.6%) had a mixed pattern with involvement of both CV and LV and 12 (13.8%) had an exclusive large vessel pattern. The differences between these 3 subsets are shown in table 1. Patients with a LV pattern had more fever and polymyalgia rheumatica than patients with CV involvement and fewer ischemic visual disturbances than those with mixed pattern, reaching statistical significance. In addition, they tended to have fewer other ischemic symptoms (headache, jaw claudication) and more general symptoms than patterns with CV involvement. Regarding laboratory values, the erythrocyte sedimentation rate was significantly higher in the exclusive CV involvement group and lower in those with only LV involvement.

Table 1.

Characteristics of the patients with the different patterns

Cranial pattern (n = 44; 50.6%)Mixed pattern(n = 31; 35.6%)Large vessel pattern(n = 12; 13.8%)p-valueAge, years (mean, SD)78 ± 776 ± 774 ± 110.291Male sex12 (27.3%)14 (45.2%)5 (41.6%)0.252ESR, mm/h (mean, SD)78.7 ± 33.763.9 ± 33.052.1 ± 33.50.031*CRP, mg/L (mean, SD)55.8 ± 46.668.3 ± 63.685.9 ± 89.30.801Headache36 (81.8%)25 (80.6%)8 (66.6%)0.704Jaw claudication12 (27.3%)5 (16.1%)1 (8.3%)0.249Ischemic visual disturbances9 (20.4%)11 (35.5%)0 (0%)0.041#PMR18 (40.9%)13 (41.9%)8 (66.6%)0,018*0,029#General symptoms17 (38.6%)13 (41.9%)8 (66.6%)0.132Fever5 (11.4%)3 (9.7%)6 (50%)0.005*#

SD: standard deviation. ESR: erythrocyte sedimentation rate. CRP: C reactive protein. PMR: polymyalgia rheumatica.

*Statistically significant difference between cranial pattern and large vessel pattern.

#Statistically significant difference between mixed pattern and large vessel pattern.

Conclusion:

Imaging in GCA allow us to establish different patterns of involvement (cranial, mixed, large vessel) that correspond to different clinical subsets. The patients with LV subset debut with a lower ESR and have more fever and polymyalgia rheumatica and less ischemic symptoms.

References:

[1]van der Geest KSM, Sandovici M, van Sleen Y, et al. Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?. Arthritis Rheumatol. 2018;70(9):1366–1376. doi:10.1002/art.40520

Disclosure of Interests: :

Elisa Fernández: None declared, Irene Monjo: None declared, Gemma Bonilla: None declared, Diana Peiteado: None declared, Chamaida Plasencia: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi)

FRI0582 GM-CSF PRODUCED BY CD4+ T CELLS AS A MARKER OF CLINICAL REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TNF INHIBITORS

Background:

According to the EULAR recommendations, the therapeutic target in patients with RA should be remission (REM). However, no more than 50% of the patients treated with TNF inhibitors (TNFi) attains this outcome. Previous investigations suggested the peripheral blood mononuclear cells (PBMC) as markers associated with the TNFi treatment success1,2. Granulocyte-monocyte colony-stimulating factor (GM-CSF) plays a relevant role in the pathogenesis of rheumatoid arthritis (RA) because it promotes the macrophage differentiation, survival and activation3.

Objectives:

To analyse the intracellular cytokine production by PBMC and its association with REM attainment after 6 months (m) of TNFi treatment in patients with RA.

Methods:

This was a prospective bi-center pilot study including 36 patients with RA. PBMC were isolated from patients at baseline and after 6m of treatment with TNFi and cryopreserved until studied. Intracellular cytokine production by PBMC was stimulated in the presence of 2µg/mL brefeldin as follow: monocytes were stimulated with 20ng/mL LPS during 4h; and simultaneously lymphocytes were stimulated with 50ng/mL phorbol 12-myristate 13-acetate (PMA) and 750ng/mL ionomycin during 4h at 37°C. To identify IL-10-producing B cells, PBMC were pre-incubated with 3µg/mL of CpG oligonucleotide during 20h at 37°C prior to stimulation in presence of 2µmol/L monensin. 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. REM was defined as DAS28≤2.6 at 6m. The association between REM and the change in cytokine production (Δ, 6m-0m) by each PBMC subset was analysed through univariable and multivariable logistic regression models.

Results:

Seventy-eight percent of the patients were female. After 6m of TNFi treatment, 47% patients attained REM. Univariable analyses was performed to investigate the association between REM and the baseline variables. Male sex (OR: 12.6; 95% CI: 1.35-117.57; p=0.03) and having lower baseline DAS28 (OR: 0.4; 95% CI: 0.19-0.85; p=0.02) were independently associated with attaining REM after 6m of TNFi. In the multivariable analysis, only being male (OR: 19.7; 95% CI: 1.4-273.9; p=0.03) remained independently associated with REM after 6m of treatment. Therefore, further analyses were adjusted by sex. Decreased production of GM-CSF by CD4+T cells percentage was found after 6m of TNFi treatment in REM patients (0m: 6.07%; 6m: 3.87%; p=0.007) while no-REM patients did not show differences with the baseline (0m: 3.70%; 6m: 3.75%; p=0.9). The decrease was significantly associated with attaining REM (OR: 0.56; 95% CI: 0.33-0.95; p: 0.03). No significant association was found between any other analysed intracellular cytokine produced by the different PBMC subsets and REM.

Conclusion:

GM-CSF intracellular production by CD4+T cells was significantly decreased by TNFi treatment only in patients who attained REM. Therefore, our results suggest that GM-CSF production by CD4+T cells may be a useful marker of REM to TNFi in RA.

References:

[1] Sobrino C, et al. Ann Rheum Dis. 2019; 78 (S2): A1665.

[2] Hernández-Breijo B, et al. Ann Rheum Dis. 2019; 78 (S2): A711.

[3] Avci AB, et al. Clin Exp Rheumatol. 2016; 34 (S98), 39-44.

Figure. 1:

Association between the change in intracellular cytokine production (Δ, 6m-0m) by each PBMC subset and REM. Adjusted logistic regression analyses were performed for each cytokine.

Acknowledgments:

ISCIII (PI16/00474; PI16/01092)

Disclosure of Interests:

Borja Hernández-Breijo: None declared, Chamaida Plasencia: None declared, Carlota García-Hoz: None declared, Cristina Sobrino: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, ANA MARTÍNEZ-FEITO: None declared, Israel Nieto-Gañán: None declared, Paloma Lapuente-Suanzes: None declared, Javier Bachiller-Corral: None declared, Gemma Bonilla: None declared, Cristina Pijoan Moratalla: None declared, Garbiñe Roy: None declared, Mónica Vázquez Díaz: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Luisa María Villar: None declared, DORA PASCUAL-SALCEDO Grant/research support from: Pfizer, Novartis & Progenika, Speakers bureau: Pfizer, Merck, Novartis, Takeda, Menarini & Grifols, Eulalia Rodríguez-Martín: None declared

False positives in the ultrasound diagnosis of giant cell arteritis: some diseases can also show the halo sign

Objectives

To describe the frequency and causes for the presence of a halo sign on the ultrasound of patients without a diagnosis of GCA.

Methods

In total, 305 patients with temporal artery colour Doppler ultrasound showing the presence of halo sign (intima-media thickness ≥0.34 mm for temporal arteries [TAs] and ≥1 mm for axillary arteries) were included, and their medical records were reviewed. The clinical diagnosis based on the evolution of the patient over at least one year was established as the definitive diagnosis.

Results

Fourteen of the 305 (4.6%) patients included showed presence of the halo sign without final diagnosis of GCA: 12 patients in the TAs (86%), and two patients with isolated AAs involvement (14%). Their diagnoses were PMR (n = 4, 29%); atherosclerosis (n = 3, 21%); and non-Hodgkin lymphoma type T, osteomyelitis of the skull base, primary amyloidosis associated with multiple myeloma, granulomatosis with polyangiitis, neurosyphilis, urinary sepsis and narrow-angle glaucoma (n = 1 each, 7%).

Conclusion

The percentage of halo signs on the ultrasound of patients without GCA is low, but it does exist. There are conditions that may also show the halo sign (true positive halo sign), and we must know these and always correlate the ultrasound findings with the patient’s clinic records.

Cost evolution of biological drugs in rheumatoid arthritis patients in a tertiary hospital: Influential factors on price

OBJECTIVE

To assess the evolution of cost per patient/year and the cost per patient/year/drug in patients with rheumatoid arthritis (RA) receiving biological treatments. To analyze and quantify the factors influencing this evolution, such as the optimization of the biological drugs, the use of biosimilars, and official discounts and discounts obtained after negotiated procedures. In addition, to assess specific clinical parameters of disease activity in these patients.

METHODS

Retrospective, observational study conducted in a Spanish tertiary hospital. Adult patients diagnosed with RA under treatment from 2009 to 2017 were included.

RESULTS

320, 270 and 389 patients were included in 2009, 2013 and 2017, respectively. The patient/year cost decreased from 10,789€ in 2009, 7491€ in 2013 to 7116€ in 2017. In 2017, due to the established competition, discounts of 14% and 29.5% were achieved on etanercept and its biosimilar; 11.5%, 17.8%, 17.9%, 17.3% on adalimumab, certolizumab, golimumab and tocilizumab IV respectively, and 24.6% and 43.1% on infliximab and its biosimilar. The percentage of patients optimized in 2017 was 35.2%. The annual saving in 2017 was 1,288,535€ (830,000€ due to dose optimization and/or administration regimens, 249,666€ corresponding to 7.5% of the official discount and 208,868€ after negotiated procedures).

CONCLUSION

The annual cost per patient in RA decreased considerably due to different factors, such as discounts on the purchase of drugs due to official discounts and negotiated procedures, together with the optimization of therapies, the latter being the factor that contributed most to this decrease.

Cost evolution of biological agents for the treatment of spondyloarthritis in a tertiary hospital: influential factors in price

Background Spending on biological agents has risen dramatically due to the high cost of the drugs and the increased prevalence of spondyloarthritis. Objective To evaluate the annual cost per patient and cost for each biological drug for treating patients with spondyloarthritis from 2009 to 2016, and to calculate factors that affect treatment cost, such as optimizing therapies by monitoring drug serum levels, the use of biosimilar-TNF inhibitors, and official discounts or negotiated rebates in biologicals acquired by the pharmacy department. Method Retrospective, observational study in a Spanish tertiary hospital. Main outcome Annual cost per patient and per drug. Factors that influenced the costs and socio-demographic parameters and disease activity. Results A total of 129, 215, and 224 patients were treated in 2009, 2013, and 2016, respectively. The annual cost per patient decreased: EUR11,604 in 2009, EUR8513 in 2013, and EUR7464 in 2016. The introduction of new drugs drives economic competition, leading to total savings per drug, with discounts reaching 5.8, 12.4, 16.7, 17.7, 13.7, and 24.8% for original infliximab, etanercept, adalimumab, ertolizumab, golimumab, and secukinumab, respectively, while rebates for biosimilar infliximab reached 31.90% in 2016. The number of patients with optimized therapies reached 47.5% in 2016, which led to cost savings of EUR798,614, in addition to savings from official discounts and rebates of EUR252,706 and savings from optimized therapies of EUR545,908 in 2016. Conclusion The cost of biological treatments declined after official discounts, negotiated rebates, and optimized therapies, leading to a significant decrease in the annual cost per patient. The greatest contribution to economic savings in biological therapy according to our study was biological therapy optimization.

Infusion reactions during infliximab treatment are not associated with IgE anti-infliximab antibodies

OBJECTIVES

Controversy exists on the role of IgE antidrug antibodies (IgE-ADA) in infusion reactions (IR) on infliximab treatment, partly due to the lack of a positive control used for assay validation. We sought to (1) develop a robust assay to measure IgE-ADA, including a positive control, (2) determine the association between IgE-ADA and IR and (3) determine the incidence of IgE-ADA in infliximab treated patients.

METHODS

A recombinant human IgE anti-infliximab monoclonal antibody was developed as standard and positive control. With this antibody, we set up a novel robust assay to measure IgE-ADA. IgE-ADA was determined in three retrospective cohorts (n=159) containing IR+ (n=37) and IR- (n=39), and longitudinal sera of 83 spondyloarthritis.

RESULTS

IgE-ADA was found in 0/39 IR-, whereas 4/37 (11%) IR+ showed low levels (0.1-0.3 IU/mL, below the 0.35 IU/mL threshold associated with elevated risk of allergic symptoms). All patients who were IgE-ADA positive also had (very) high IgG-ADA levels. The incidence of IgE-ADA in patients with infliximab-treated spondyloarthritis was estimated at less than approximately 1%.

CONCLUSIONS

IgE-ADA is rarely detected in infliximab-treated patients. Moreover, the absence of IgE-ADA in the majority of IR+ patients suggests that IgE-ADA is not associated with infusion reactions.

Comparing a tapering strategy to the standard dosing regimen of TNF inhibitors in rheumatoid arthritis patients with low disease activity

OBJECTIVES

The aim of this study is to compare clinical outcomes, incidence of flares and administered drug reduction between rheumatoid arthritis (RA) patients under TNF inhibitors (TNFi) tapering strategy and RA patients on standard regimen.

METHODS

Two groups of RA patients on TNFi with DAS28<3.2 were compared: the tapering group (TG: 67 pts from Spain) and the control group with standard therapy regimen (CG: 77 pts from the Netherlands). DAS28 was measured at different time points: visit 0 (prior starting TNFi), visit 1 (prior to start tapering in TG and with DAS28<3.2 in TG and CG), visit 2 (6 months after visit 1), visit 3 (1 year after visit 1), visit 4 (the last visit available after visit 1) and visit-flare (visit with the worst flare between visit 1 and visit 4).

RESULTS

Despite the reduction of administered drug at visit 4 in the TG (interval elongation of 32.8% in infliximab, 52.9% in adalimumab and 52.6% in etanercept), the DAS28 remained similar between groups at the end of the study (DAS28: 2.7±0.9 in TG vs. 2.5±1 in CG, p=0.1). No differences were seen in the number of patients with flares [26/67 (38.9%) in the TG vs. 30/77 (39%) in the CG, p=0.324] and only nineteen out of 136 patients (14%) had anti-drug antibodies at the end of the study.

CONCLUSIONS

The tapering strategy of TNFi in RA patients result in a reduction of the drug administered, while the disease control is not worse than patients on the standard regimen.