POS0762 LONG-TERM RENAL OUTCOMES OF PATIENTS WITH NON-PROLIFERATIVE LUPUS NEPHRITIS

Background

Although proliferative (class III or IV) lupus nephritis (LN) is the most common finding in the classification of LN, pure membranous (class V) or mesangial (class I or II) LN can occur as a form of LN. Even though non-proliferative LN (class I, II, or V) is a less severe form with good outcomes, data on long-term renal prognosis are limited.

Objectives

This study investigated the long-term outcomes and prognostic factors in non-proliferative LN.

Methods

We retrospectively reviewed the medical records of patients with systemic lupus erythematosus who were diagnosed with LN class I, II, V or II+IV by kidney biopsy between 1997 and 2021 at a tertiary referral center. Clinical and laboratory data were compared between patients with and without poor renal outcomes. Poor renal outcome was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 or death due to renal cause. Univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the factors associated with poor renal outcomes.

Results

We included 71 patients with non-proliferative LN (4: class I; 17: class II; 48: class V, 17; 2: class II+V). Median follow-up duration was 103 months (interquartile range 27–185) and the overall rate of poor renal outcomes at last follow-up was 29% (21/71), including end-stage renal disease (n=2) and renal death (n=1).

Univariate analysis indicated that older age (HR 1.05; 95% CI: 1.00–1.09), low eGFR (HR 0.97; 95% CI: 0.95–0.99) and failure to reach complete remission at 6 months (HR 0.332; 95% CI: 0.12–0.92) were significantly associated with poor renal outcomes. Multivariate analysis revealed that low eGFR at 6 months (HR 0.97; 95% CI: 0.95–0.99) was significantly associated with poor renal outcomes.

Figure 1.

Renal outcomes at last follow up

eGFR, estimated glomerular filtration rate (ml/min/1.73m2)

Table 1.

Univariate and multivariate Cox proportional hazard regression analyses of the factor associated with poor renal outcomes

ParameterUnivariate analysisMultivariate analysisHR95% CIp valueHR95% CIp valueClinical features Age1.0461.003-1.0910.0361.0020.960-1.0470.921 Sex1.6540.375-7.2980.506 SLEDAI1.0360.965-1.1120.327 Extra renal SLEDAI1.0380.971-1.110.272Renal profiles eGFR at LN diagnosis0.9930.976-1.0110.456 Proteinuria at LN diagnosis1.0001.000-1.0000.444 > 1g/24 hours0.6690.243-1.8410.437  > 3g/24 hours0.6240.229-1.6990.356 eGFR at 6M0.9670.948-0.9860.0010.9680.948-0.9880.002 eGFR at 12M0.9640.947-0.9810.000 Complete remission at 6M0.3320.119-0.9240.0350.5530.179-1.7070.303 Complete remission at 12M0.6670.232-1.9140.451 Transformation1.2460.423-0.7010.692Laboratory data Anti-dsDNA1.0010.999-1.0030.196 C31.0201.000-1.0410.051 C41.0270.969-1.0890.367 Albumin1.1800.661-2.1090.576ClassificationaClass I0.8020.102-6.3030.834Class II1.2980.412-4.0880.656Class V0.8870.308-2.5570.824Class II+V0.0480.000-16850.837Medicationsb ACEi/ARB1.6520.603-4.5280.329 Hydroxychloroquine1.3260.414-4.2420.635 Corticosteroid1.1860.154-9.1080.870 CNI2.4390.464-12.8240.292 MMF3.7880.959-14.9650.057  　 AZA0.5890.133-2.6110.486

a LN classifications were based on the International Society of Pathology/Renal Pathology Society (ISN/RPS) classification.

b Medications maintained at least one year since Lupus Nephritis diagnosis.

HR, hazard ratio; 95% CI, 95% confidence interval; SLEDAI, systemic lupus erythematosus disease activity index; eGFR, estimated glomerular filtration rate; LN, lupus nephritis; anti-dsDNA, anti-double strand DNA; C3/C4; complement 3/4; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CNI, carcineurin inhibitor; MMF, mycophenolate mofetil; AZA, azathioprine.

Conclusion

Poor renal outcomes occurred in approximately 30% of patients with non-proliferative LN (class I, II or V) after long-term follow-up.

Our findings suggest that more active management may be needed for non-proliferative LN, particularly in patients with low eGFR at 6 months.

Disclosure of Interests

None declared

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Realizing topologically ordered states on a quantum processor

[Figure: see text].

Removing leakage-induced correlated errors in superconducting quantum error correction

Quantum computing can become scalable through error correction, but logical error rates only decrease with system size when physical errors are sufficiently uncorrelated. During computation, unused high energy levels of the qubits can become excited, creating leakage states that are long-lived and mobile. Particularly for superconducting transmon qubits, this leakage opens a path to errors that are correlated in space and time. Here, we report a reset protocol that returns a qubit to the ground state from all relevant higher level states. We test its performance with the bit-flip stabilizer code, a simplified version of the surface code for quantum error correction. We investigate the accumulation and dynamics of leakage during error correction. Using this protocol, we find lower rates of logical errors and an improved scaling and stability of error suppression with increasing qubit number. This demonstration provides a key step on the path towards scalable quantum computing.

Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes

Background

Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting.

Methods

We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct between January 2008 and December 2015. Marital status before hct was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after hct.

Results

We identified 10,226 allogeneic and 5714 autologous hct cases with, respectively, a median follow-up of 37 months (range: 1-102 months) and 40 months (range: 1-106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2-4 acute graft-versus-host disease (gvhd), p < 0.001, and chronic gvhd, p = 0.04. The risk of grades 2-4 acute gvhd was increased in separated compared with married patients [hazard ratio (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 0.82; 95% ci: 0.67 to 0.99).

Conclusions

Overall survival after hct is not influenced by marital status, but associations were evident between marital status and grades 2-4 acute and chronic gvhd. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization.

AB0212 FLARE RISK AFTER DISCONTINUING LONG-TERM METHOTREXATE TREATMENT IN PATIENTS HAVING RHEUMATOID ARTHRITIS WITH LOW DISEASE ACTIVITY

Background:

Several recent studies have reported that MTX could be discontinued in patients with low disease activity who are taking biologic DMARDs or tofacitinib. However, there are limited studies on whether MTX could be discontinued in patients with low disease activity who have taken MTX for a long term.

Objectives:

We investigated the disease flare rate in patients with rheumatoid arthritis (RA) who achieved low disease activity following long-term methotrexate (MTX) treatment and the factors related to flare.

Methods:

This retrospective longitudinal cohort study included patients with RA and low disease activity who were exposed to MTX for >10 years. Disease flare was defined as an increase in DAS28 of >1.2 within 6 months of discontinuation of MTX. Logistic regression analysis was performed to identify the factors associated with flare.

Results:

In total, 97 patients with RA were included in the study. The mean baseline DAS28 was 1.96 ± 0.56. The median cumulative MTX dose was 11.7g; the median duration of exposure to MTX was 19 years. Following MTX discontinuation, flare occurred in 43 (44.3%) patients; the mean time to flare was 98 ± 37.7 days. According to univariable logistic regression analysis, C-reactive protein, erythrocyte sedimentation rate (ESR) at discontinuation, the average ESR in the 6 months before discontinuation of MTX, a weekly dose of MTX before discontinuation, and use of other conventional synthetic DMARDs were associated with a higher risk of disease flare. In multivariable analysis, a weekly dose of MTX before discontinuation (OR, 1.014; 95% CI, 1.014–1.342; p = 0.031) was significantly associated with flare risk.

Conclusion:

Among patients with RA who achieved low disease activity with long-term treatment with MTX, more than half of the patients remained flare free after MTX discontinuation. A higher MTX dose before discontinuation was associated with a high flare risk.

Disclosure of Interests:

None declared

FRI0118 RISK OF LIVER FIBROSIS ON TRANSIENT ELASTOGRAPHY IN PATIENTS WITH RHEUMATIC DISEASE UNDER LONG-TERM METHOTREXATE TREATMENT

Background:

Methotrexate (MTX) is a cornerstone drug for the treatment of rheumatic disease and low doses of MTX are both tolerable and safe, with monitored toxicity, assessed via the liver function test. However, there is still controversy regarding the risk of liver fibrosis with long-term use of MTX. Transient elastography is commonly used to assess and monitor fibrosis progression in patients with chronic liver disease.

Objectives:

The present study aims to investigate liver fibrosis using transient elastography and related factors in patients with rheumatic disease receiving long-term MTX.

Methods:

The present retrospective, longitudinal, cross-sectional study included patients with an autoimmune disease who are taking cumulative MTX dosed over 7 g, and who had liver fibrosis upon examination using transient elastography. Liver fibrosis was defined as liver stiffness, valued over 7.2 kPa. Logistic regression analysis was performed to identify factors associated with liver fibrosis, and receiver operating characteristics analysis was used to determine the predictive value of each factor.

Results:

We included 83 patients with autoimmune disease, with a median MTX cumulative dose of 11.6 (range 7.3-16.0) g. Sixty-eight patients (81.9%) had rheumatoid arthritis (RA), and 13 patients (15.7%) had Takayasu arteritis. The median MTX exposure duration was 18 (range 9-31) years. The median liver stiffness value was 4 (range 1.8-10.2) kPa. Five patients (6%) showed liver fibrosis (3 patients; RA, 2 patients; Takayasu arteritis). In the linear regression analysis, cumulative MTX dose showed a tendency towards a positive correlation with increasing liver stiffness value (r2 =0.039, p = 0.074). In the logistic regression analysis, cumulative MTX dose was associated with a higher risk of liver fibrosis (OR: 1.734, 95% CI: 1.060–2.837, p = 0.029). In addition, cumulative MTX dose had an area under the curve (AUC) of 0.813 (95% CI 0.695-0.930) and a sensitivity of 80% and specificity of 71.8% at a cut-off value of 12.7 g.

Conclusion:

Liver fibrosis was observed in 6% of patients with long-term MTX use and higher cumulative MTX doses increased the risk of liver fibrosis. Thus, transient elastography should be considered in patients exposed to high cumulative doses of MTX.

Disclosure of Interests:

None declared

THU0210 EARLY DISCONTINUATION OF TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS CO-TREATED WITH RIFAMPIN FOR LATENT TUBERCULOSIS: RESULTS FROM THE REAL-WORLD DATA

Background:

Rheumatoid arthritis (RA) patients need to undergo screening and receive treatment for latent tuberculosis infection (LTBI) before starting tofacitinib, which is primarily metabolized by cytochrome P450 (CYP) 3A4. Among chemoprophylactic agents, rifampin is known to be a potent CYP3A4 inducer; therefore, it is expected to decrease the efficacy of tofacitinib. However, tofacitinib and rifampin have been co-administered practically because of the short duration of chemoprophylaxis.

Objectives:

The aim of this study was to determine the efficacy of tofacitinib on co-administration with rifampin.

Methods:

Biologic-naïve RA patients treated with tofacitinib were selected, and electronic medical reports were reviewed retrospectively. All patients underwent screening for LTBI before starting tofacitinib, and patients with positive results were treated to prevent progression to active tuberculosis. To evaluate the efficacy of tofacitinib with or without rifampin, the discontinuation rates of tofacitinib were examined during the first 6 months. Kaplan–Meier analysis was used to construct cumulative discontinuation curves, and comparisons were performed using the log-rank test.

Results:

Among 81 patients who started tofacitinib, 21 (25.9%) were LTBI-positive and 18 (22.2%) were administered rifampin concomitantly with tofacitinib. The median follow-up time was 6 months in both patients who received rifampin (interquartile range [IQR] 2.21, 6.00) and those who did not receive rifampin (IQR 5.97, 6.00) (p = 0.083). There were no significant differences between patients who received rifampin and those who did not receive rifampin in all baseline characteristics, except the swollen joint count (3.00 [1.75, 5.25] vs. 5.00 [4.00, 7.00]; p = 0.025), at the time of starting tofacitinib. In patients who received rifampin at the time of starting tofacitinib, the mean duration of co-administration was 47.00 ± 23.54 days (median 56; IQR 28.75, 59.00). During follow-up, 14 of the 81 patients (17.3%) discontinued tofacitinib. As shown in the Figures 1 and 2, the discontinuation rate of tofacitinib within the first 6 months was significantly higher among patients who received rifampin for LTBI than among those who did not receive rifampin (lack of efficacy: 24.7% vs. 5.1%, p = 0.008; all causes: 38.9% vs. 11.2%, p = 0.002). Seven patients discontinued tofacitinib because of uncontrolled RA activity, and rifampin had been administered concomitantly in four of these seven patients. Of the four patients, three stopped taking tofacitinib in the middle of LTBI treatment, and the DAS28-ESR scores of these patients were higher at discontinuation than at baseline.

Conclusion:

Discontinuation rates were higher in RA patients who started tofacitinib during chemoprophylaxis involving rifampin than in those who did not receive rifampin. Physicians should be aware that the efficacy of tofacitinib could be decreased by the chemoprophylactic regimen for tuberculosis.

Disclosure of Interests:None declared

SAT0009 ROLE OF EC-18 IN AUTOIMMUNE ARTHRITIS AND INTERSTITIAL LUNG DISEASE IN CURDLAN-ADMINISTERED SKG MICE

Background:

Although the mortality of patients with rheumatoid arthritis (RA), for which interstitial lung disease (ILD) is one of the major contributors, has still not decreased, new target therapies for RA have shown good response in peripheral arthritis. EC-18 (acetylated diacylglycerol 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol) is a mono-acetyl-diglyceride that has been isolated from the antlers of sika deer and can be chemically synthesized from glycerol, palmitic acid, and linoleic acid. Research using LPS-induced acute lung injury murine model has reported that EC-18 stimulates a more rapid resolution of LPS-induced lung Inflammation. In addition, it has been reported that in a murine model of collagen-induced arthritis, EC-18 treatment ameliorated arthritis, with down-regulation of IL-6 level by regulating the activity of STAT3 in the synovium. Curdlan-administered SKG mice develop ILD spontaneously followed by peripheral arthritis, which resembles RA-ILD.

Objectives:

We evaluated the modulatory effect of the EC-18 on arthritis and ILD in autoimmune arthritis animal model.

Methods:

Male SKG mice were obtained from Dr. S. Sakaguchi. We injected curdlan (3 mg/mice) in 8-week-old SKG mice and identified the presence of ILD by histological analysis at 20 weeks post-injection. Arthritis score was measured every week for up to 20 weeks. EC-18 (250 mg/kg body weight/day, Enzychem Lifesciences Co., Daejeon, Korea) was administered every day orally. At 20 weeks post-injection, lung sections were stained with H&E and Masson’s trichrome. Using the Opal method, multiplexed immunofluorescent staining of lung tissue was performed. According to the scale by Ashcroft et al., fibrosis severity of lung sections was assessed by a system of eight grades. Analysis of serum cytokines by the luminex multiplex cytokine assay was performed at 20 weeks post-injection.

Results:

Oral administration of EC-18 decreased arthritis score significantly until 8 weeks post-injection and remained unchanged thereafter. At 20 weeks post-injection, histological analysis showed severe pulmonary destruction, including bronchial alveolar tissue damage and massive leukocyte infiltration, and fibrosis in the curdlan-administered mice, which was attenuated in EC-18 treated mice. In particular, 67% of curdlan-administered mice showed ILD-like phenotype, whereas the incidence rate in EC-18-treated mice was 17%. Furthermore, immunofluorescent-staining showed both IL-17A and neutrophil accumulation in lung in curdlan-administered mice; these were decreased in EC-18-treated mice. Interestingly, at 20weeks post-injection, EC-18 treatment down-regulated serum levels of IL-6 and TNF-α and up-regulated sIL-7Rα (anti-fibrotic molecule).

Conclusion:

Taken together, EC-18 exerts an anti-arthritic effect in early phase, but a long-term effect was not indicated. We emphasize the effect on ILD prevention of EC-18 via up-regulation of sIL-7Rα and inhibition of neutrophil accumulation, suggesting a therapeutic agent potentially for RA-ILD.

Disclosure of Interests:

None declared

OP0023 PREDICTION OF REMISSION FOR EACH BIOLOGICS BASED ON PATIENT’S CLINICAL INFORMATION BEFORE STARTING BIOLOGICS USING EXPLAINABLE ARTIFICIAL INTELLIGENCE: DATA FROM THE KOREAN COLLEGE OF RHEUMATOLOGY BIOLOGICS REGISTRY

Background:

Many studies have identified predictive factors of response to biologics in patients wirh rheumatoid arthritis (RA). However, there is still a lack in using them in daily clinical practice. Therefore, it is necessary to develop a method that can assist the physician in selecting effective biologics.

Objectives:

The purpose of this study is to establish machine learning model that predicts remission in patients treated with biologics using data of RA patients from the Korean College of Rheumatology Biologics (KOBIO) registry, and to identify the important features that have the most influence on the response to biologics using explainable artificial intelligence (AI).

Methods:

A total of 1,527 patients who started with biologics such as etanercept, adalimumab, golimumab, infliximab, abatacept, and tocilizumab from December 2012 to June 2019 were enrolled. Remission was predicted using 46 variables corresponding to baseline profiles at the starting of each biologics. We used five machine learning methods such as lasso, ridge, SVM, random forest, and XGBoost. For explainability of those models, we used Shapley plot to interpret the feature importance for each biologics.

Results:

In all machine learning methods, the accuracy and the area under the receiver operating characteristic (AUROC) were 57.2%~74.5%, 0.547~0.747, respectively (Table 1). The accuracy and AUROC of each biologics were similar between machine learning methods. Figure 2 showed interpretation of feature importance with the Shapley plot for remission. The most important feature was age in adalimumab (younger were closer to remission), daily corticosteroid dose in etanercept, golimumab, and all TNF inhibitors (using fewer doses daily were closer to remission), baseline erythrocyte sedimentation rate in infliximab (lower ESR were closer to remission), disease duration in abatacept (longer disease durations showed difficulty determining remission), baseline c-reactive protein in tocilizumab (higher CRP were closer to remission).

Table.

Predicting remission for all biologics in various machine learning method.

MeasureLassoRidgeSVMRandom ForestXGBoostNo info rateSampleAbataceptAccuracy74.1%74.1%70.6%71.8%68.8%70.6%216AUROC0.7250.7420.7070.6770.6470.500AdalimumabAccuracy73.6%72.0%70.4%72.0%70.4%68.8%315AUROC0.7100.7290.7000.6750.6630.500EtanerceptAccuracy72.0%72.0%70.0%71.5%70.0%68.0%250AUROC0.7410.7470.7260.7190.7040.500GolimumabAccuracy71.3%68.5%66.7%68.5%68.5%68.5%138AUROC0.7460.7270.7010.6900.6550.500InfliximabAccuracy72.8%73.5%67.6%73.5%69.1%72.5%172AUROC0.6630.6830.6160.5970.5270.500TNF inhibitorsAccuracy73.9%74.5%73.9%74.2%73.6%70.3%875AUROC0.7390.7410.7260.7470.7240.500TocilizumabAccuracy62.4%63.6%62.4%59.5%57.2%59.5%436AUROC0.6330.6400.6330.6150.5470.500Figure 2.

Shapley plots and SHAP values for the feature importance from clinical information in patients with RA.

Conclusion:

We developed machine learning models for predicting remission as a response to each biologics in active RA patients based on their clinical profiles, and found important clinical features using explainable AI. This approach may support clinical decisions to improve treatment outcomes in patients with RA.

Disclosure of Interests:

None declared

AB1018 TREATMENT RESPONSE OF HYDRONEPHROSIS ASSOCIATED WITH IDIOPATHIC RETROPERITONEAL FIBROSIS, FOCUSING ON RATIO OF IgG4/IgG3 SERUM CONCENTRATION

Background:

Hydronephrosis, a common complication of idiopathic retroperitoneal fibrosis (iRPF), may lead to poor renal outcomes unless it is resolved. Pathological confirmation can help to identify the aetiology of the disease and determine the treatment strategy. But, in most cases, it is difficult to obtain sufficient tissue due to the location of fibrosis. In a recent study, parts of iRPF are correlated with IgG4-related disease characterised by elevated serum IgG4 levels (>135 mg/dL). Normal serum IgG3 level (21–176 mg/dL) has been known to be higher than normal serum IgG4 level (4–86 mg/dL). The reverse IgG4/IgG3 ratio has been suggested to be an IgG4-related disease component that distinguishes it from primary sclerosing cholangitis [1]. However, the ratio of IgG3 and IgG4 may be reversed in iRPF patients with hydronephrosis.

Objectives:

We aimed to investigate the ratio of IgG subclasses as a predictive factor associated with treatment response of hydronephrosis in patients with iRPF.

Methods:

We retrospectively recruited 19 iRPF patients with hydronephrosis who evaluated serum IgG subclasses in a tertiary hospital between 2004 and 2019. Hydronephrosis was evaluated on the basis of imaging findings. Medications and clinical and laboratory findings, including IgG subclasses, were reviewed following the diagnosis of hydronephrosis. Hydronephrosis improvement on subsequent images was evaluated to assess treatment response. Categorised data were compared using chi-square or Fisher’s exact test. Continuous variables were compared using Mann–Whitney U test.

Results:

At baseline, median serum IgG3 and IgG4 levels were 64 (IQR 37–82) mg/dL and 71 (IQR 40–171) mg/dL. Five patients had serum IgG4 levels > 135 mg/dL and 11 patients had the reverse serum level of IgG4/IgG3. On subsequent images (median follow-up at 3.2 [IQR 1.7–4.0] months), 11 patients showed hydronephrosis improvement. The proportions of positive ratio of serum IgG4/IgG3 (81.8% vs. 25%, p = 0.024), periaortic involvement (81.8% vs. 25%, p = 0.024) and high-dose glucocorticoid treatment (45.5% vs. 0%, p = 0.045) were significantly higher in patients with improvement than in those without improvement (Table 1). Interestingly, even in cases with normal serum IgG4 levels, patients with improvement showed a higher serum IgG4/IgG3 ratio than in those without improvement (median 1.5 vs. 0.7, p = 0.038).

Table 1.

Clinical characteristics and treatment according to the shortterm outcome of hydronephrosis

Improvement(n = 11)No improvement(n = 8)p-valueTime to subsequent imaging (months)a2.2 (1.3–4.2)3.2 (2.0–3.8)0.778Males (n, %)8 (72.7%)7 (87.5%)0.603Periaortic involvement (n, %)9 (81.8%)2 (25%)0.024Impaired renal function (n, %)b5 (45.5%)2 (25%)0.633Serum IgG4 (mg/dL)a114 (59–172)43 (35–109)0.152Elevated serum IgG4 (n, %)4 (36.4%)1 (12.5%)0.338Serum IgG4/IgG3 ratioa2.1 (1.2–4.9)0.8 (0.4–1.0)0.041Positive ratio of serum IgG4/IgG3 (n, %)9 (81.8%)2 (25%)0.024Medical treatment (n, %)7 (63.6%)1 (12.5%)0.059High-dose glucocorticoid treatment (n, %)5 (45.5%)0 (0%)0.045Surgical intervention (n, %)8 (72.7%)4 (50%)0.377

aValues are median and interquartile range (25th–75thpercentile)

bDefined as serum creatinine level > 1.24 mg/dL

Conclusion:

The reverse ratio of serum IgG4/IgG3 was associated with hydronephrosis treatment response, thus suggesting favourable responses to high-dose corticosteroid.

References:

[1]Boonstra K, Culver EL, de Buy Wenniger LM, et al. Serum immunoglobulin G4 and immunoglobulin G1 for distinguishing immunoglobulin G4-associated cholangitis from primary sclerosing cholangitis. Hepatology 2014;59:1954-63.

Disclosure of Interests:

None declared

FRI0088 CHANGE IN SERUM BILIRUBIN SUGGESTS TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH MOLECULAR-TARGETED AGENTS

Background:

Bilirubin is an antioxidant with anti-inflammatory properties. In previous reports, serum bilirubin levels were correlated with disease activity of autoimmune diseases including rheumatoid arthritis (RA). Various molecular-targeted agents have been developed for RA, and targets, such as IL-6 and TNFα, are associated with liver function. However, the association between serum bilirubin and treatment response in RA patients treated with molecular-targeted agents is still unknown.

Objectives:

We aimed to evaluate the role of serum bilirubin in the prediction of the early treatment response in RA patients who initiated molecular-targeted agents.

Methods:

We retrospectively recruited biologic naïve RA patients (n=292) with moderate-to-high disease activity from a tertiary hospital between Jan 2013 and Dec 2019. Patients with viral hepatitis, drug-induced hepatitis, or alcoholic liver disease were excluded. Molecular-targeted agents included tocilizumab (TCZ, n=40), adalimumab (ADA, n=59), etanercept (ETN, n=66), golimumab (GOL, n=60), abatacept (ABA, n=31), and tofacitinib (TOF, n=36). Clinical and laboratory data were collected from electronic medical records. Patients were categorised into an increased bilirubin group (higher serum bilirubin at 3 months than at baseline) and decreased bilirubin group (equal or lower serum bilirubin at 3 months than at baseline). At 6 months of treatment, good response (defined as a DAS28 score ≤3.2) was evaluated. Multivariate logistic regression analysis and multiple linear regression analysis were used to evaluate the association between serum bilirubin and treatment response. The variables included in the multiple logistic and linear regression analyses were age, female sex, rheumatoid factor, prednisolone, DMARDs, baseline liver enzymes, baseline DAS28 score, and components.

Results:

The mean serum bilirubin level at baseline was 4.7±1.8 mg/L. After 6 months of treatment, 180 (61.6%) patients achieved good responses. The mean serum bilirubin levels at 3 and 6 months were 5.3±2.3 and 5.5±2.2 mg/L, respectively. At 6 months, a good response was more frequent in the increased bilirubin group than in the decreased bilirubin group (71.2% [99/139] vs. 52.9% [81/153], p=0.001). In multivariate logistic regression analysis, the ORs among good responders at 6 months were 1.221 (95% CI 1.014–1.471, p=0.036) for baseline serum bilirubin and 1.377 (95% CI 1.146–1.654, p=0.001) for the change in serum bilirubin at 3 months. According to target agents, the mean changes in serum bilirubin from baseline to 6 months were 1.9±2.5 for TCZ, 1.0±1.5 for ADA, 0.7±1.9 for ETN, 0.6±2.2 for GOL, 0.3±1.2 for ABA, and 0.4±2.2 for TOF (Figure 1). Among the target agents, TCZ showed a significant increase in the mean serum bilirubin level at 3 and 6 months from baseline. In multiple linear regression analysis performed on TCZ, the change in bilirubin at 3 months was associated with the DAS28 score at 6 months (β=−0.349, p=0.020).

Figure 1.

Change in serum bilirubin during treatment with molecular-targeted agents in rheumatoid arthritis patients

Conclusion:

High baseline serum bilirubin and an increase in serum bilirubin during treatment are helpful to predict a good response to molecular-targeted agents, especially TCZ.

Disclosure of Interests:

None declared

FRI0248 PROGNOSTIC FACTORS FOR STEROID-FREE REMISSION IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: IMPORTANCE OF ANTHROPOMETRIC MEASUREMENTS

Background:

Several studies have been conducted on factors associated with mortality in idiopathic inflammatory myopathies (IIM), but few studies have assessed prognostic factors for steroid-free remission in IIM.

Objectives:

We investigated the various clinical factors, including body measurements, that affect IIM treatment outcomes.

Methods:

Patients who were newly diagnosed with IIM between 2000 and 2018 were included. Steroid-free remission was defined as at least three months of normalisation of muscle enzymes and no detectable clinical disease activity. The factors associated with steroid-free remission were evaluated by a Cox regression analysis.

Results:

Of the 106 IIM patients, 35 displayed steroid-free remission during follow-up periods. In the multivariable Cox regression analyses, immunosuppressants’ early use within one month after diagnosis [hazard ratio (HR) 6.21, 95% confidence interval (CI) 2.61–14.74, p < 0.001] and sex-specific height quartiles (second and third quartiles versus first quartile, HR 3.65, 95% CI 1.40–9.51, p = 0.008 and HR 2.88, 95% CI 1.13–7.32, p = 0.027, respectively) were positively associated with steroid-free remission. Polymyositis versus dermatomyositis (HR 0.21, 95% CI 0.09–0.53, p = 0.001), presence of dysphagia (HR 0.15, CI 0.05–0.50, p = 0.002) and highest versus lowest quartile of waist circumference (WC) (HR 0.24, 95% CI 0.07–0.85, p = 0.027) were negatively associated with steroid-free remission.

Conclusion:

The early initiation of immunosuppressant therapy, type of myositis and presence of dysphagia are strong predictors of steroid-free remission in IIM; moreover, height and WC measurements at baseline may provide additional important prognostic value.

Disclosure of Interests:

None declared

0387 Effect of Air Pollution on the Quality of Sleep - Korean Nationwide Cross-Sectional Study

Introduction

Poor sleep quality is associated with adverse health outcomes, such as cardiovascular disease, diabetes and obesity. Several studies have indicated the association between exposure to air pollution and sleep quality. However, the evidence is very limited in South Korea.

Methods

We conducted a cross-sectional study using data from a nationwide sample of 165,193 individuals aged 19 years or older from the 2018 Korea Community Health Survey. Perceived air pollution was measured in the baseline survey. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined by the global score of PSQI &gt; 5. The associations between perceived air pollution and sleep quality were examined using the regression models. Additionally, the average concentration of PM2.5 was measured in each region using a satellite-based prediction to see the association between perceived air pollution and long term exposure of fine dust.

Results

After adjusted for age, education, and income, the adjusted odds ratios (95% confidence interval) of poor sleep quality associated with perceived air pollution was 1.45. The average of daily concentrations of PM2.5 over 3 years was highest in Incheon area, followed by Seoul and Busan city. Among Gyeonggi Province, the most populous region in South Korea, the PM2.5 concentrations was the highest in Ansan. In each region in Korea, Incheon had the highest poor sleep quality rate of 48.0%, while Ansan in Gyeonggi Province had the highest rate of 61.5%. The results are in line with the distribution of PM2.5 concentrations by region.

Conclusion

Perceived air pollution and long term exposure of fine dust were associated with poor sleep quality in South Korea. Improvement of air quality may help to improve sleep quality. More studies are in need in the future to explore the biological mechanism for the relationship, and to also examine such relationship among different populations and in difference environments.

Support

For this study, we used raw data from the 2018 Korea Community Health Survey (KCHS), conducted by the Korea Centers for Disease Control and Prevention