AB0898 IMPACT OF BIOLOGICAL AGENTS, ORAL GLUCOCORTICOIDS, OR BOTH ON THE EFFICACY OF DAILY TERIPARATIDE TREATMENT FOR OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Daily teriparatide (dTP) strongly affects bone metabolism in patients with rheumatoid arthritis (RA), resulting in increased bone mineral density (BMD). We reported the 2-year results of dTP treatment for osteoporosis (OP) in patients with RA in EULAR2014 [1]. Drugs affecting bone metabolism, such as biological agents (BIOs) and glucocorticoids (GCs), are frequently administered to patients with RA in addition to dTP in daily clinical practice. Although dTP increases bone turnover, BIOs reduce osteoclast activity and GCs decrease bone turnover. We reported the effects of GCs or BIOs on the efficacy of dTP in EULAR2015 [2]. The present retrospective study investigated the effects of GCs or BIOs on the efficacy of dTP in patients with RA using a larger patient cohort.

Objectives:

To evaluate the effects of BIOs, GCs, or both on the efficacy of dTP treatment for OP in patients with RA.

Methods:

The study included 56 female patients who had completed 2 years of dTP treatment. We separated these patients into four groups according to their treatment regimen at dTP initiation: B(−)G(−),included patients who did not receive BIOs or GCs (n = 14); B(+)G(−), included patients treated only with BIOs (n = 8); B(−)G(+), included patients treated only with GCs (n = 24); and B(+)G(+),included patients treated with both BIOs and GCs (n = 10). We determined baseline (BL) characteristics, % changes in BMD in the lumbar spine (LS) and total hip (TH) from BL to 24 months, and % changes in serum bone turnover markers (BTMs), such as BAP, P1NP, NTX, and TRACP-5b, from BL to 6 months after dTP initiation. Dunnett’s test was used for comparisons between B(−)G(−) and other groups.

Results:

The mean ages of the B(−)G(−), B(+)G(−), B(−)G(+), and B(+)G(+) groups at BL were 70.0, 65.5, 69.6, and 71.5 years, whereas the mean duration of RA in these groups were 15.4, 20.8, 69.9, and 71.5 years, respectively. Furthermore, the mean baseline DAS28-CRP levels in these groups were 2.8, 2.2, 2.8, and 2.3. The mean LS-BMD (g/cm2) at BL were 0.795, 0.819, 0.826, and 0.853, whereas the mean TH-BMD at BL were 0.619, 0.570, 0.601, and 0.629, respectively. The mean % changes in LS-BMD at 24 months were 15.5%, 12.7%, 11.9%, and 8.1%, respectively (Fig 1A). There were no significant differences between B(−)G(−) and other groups. The mean % changes in TH-BMD at 24 months in the B(−)G(−), B(+)G(−), B(−)G(+), and B(+)G(+) groups were 6.4%, 5.3%, 4.4%, and 1.5%, respectively (Fig 1B) A significant difference was observed between the B(−)G(−) and B(+)G(+) groups (p = 0.03). The % changes in BTMs in the B(−)G(−), B(+)G(−), B(−)G(+), and B(+)G(+) groups were as follows: BAP, 90.5%, 44.0%, 29.5%, and 87.7%; P1NP, 374.1%, 338.2%, 225.9%, and 640.0%; NTX, 75.2%, 106.6%, 42.5%, and 80.5%; and TRACP-5b, 75.8%, 43.85, 20.4%, and 122.3%, respectively. No significant differences were observed in the changes in BTMs among the groups.

Conclusion:

This study suggested that concomitant use of BIOs and GCs inhibited the increase in BMD induced by dTP treatment in patients with RA, particularly TH-BMD. Although BTM analysis revealed no statistical significance, GCs tended to decrease the % change in BTMs.

References:

[1]Hirano et al. Ann Rheum Dis 2014: 73 (Suppl 2): 166

[2]Hirano et al. Ann Rheum Dis 2015: 74 (Suppl 2): 528

Disclosure of Interests:

Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Hironobu Kosugiyama: None declared, Kyosuke Hattori: None declared, Daisuke Kihira: None declared

AB0362 HERPES ZOSTER IN BARICITINIB-TREATED JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS USING REAL-WORLD CLINICAL DATA

Background:

Similar to biologic disease-modifying anti-rheumatic drugs, the association between Janus kinase (JAK) inhibitors and infection is particularly interesting. The incidence of herpes zoster (HZ) among patients treated with JAK inhibitors is twofold to threefold higher in several regions of Asia (e.g., Japan and Korea) as compared with that observed in North America and Western Europe [1].

Objectives:

To evaluate the characteristics of patients who developed HZ during baricitinib treatment using real-world, multicenter, clinical data for Japanese population.

Methods:

The study enrolled 97 patients with rheumatoid arthritis (RA) who were treated with baricitinib therapy (68 biologic-naïve patients and 29 biologic-experienced patients) were enrolled in the study (observation period: 2–27 months). The severity of HZ infection was determined based on the extent of the rash and the presence or absence of organ damage. We evaluated the characteristics and clinical courses of patients who developed HZ.

Results:

Eight patients with HZ. The incidence ratio (IR) was 8.2 per patient-year. Patient data are described in Table 1 and Table 2. The IR was a little higher than that reported in clinical trials [2], which could be attributed to the high average age (i.e., 67.3 years) of the patients in this study. It was reported that adverse events occurred more frequently in elderly patients aged ≥65 years compared with younger patients [3]. The period from baricitinib administration to the onset of HZ varied between 2 months and 16 months. It is suggested that HZ may develop at any time during baricitinib therapy. There were no distinctive patient characteristics, except for age, at the time of initial baricitinib administration between patients who developed HZ and those who did not.

Table 2.

Response rates of non-medical Switch from Cellcept to Myfortic

Case- No.Age (years)Time (years) from RA onsetGenderFemale:FMale: M)BMIBari dose (mg/d)PSL(mg/d)MTX (mg/w)HZ historyNumber of prior biologics1741.5F25.64012No226133F19.2206No136111.1F23.64010Yes04730.5M23.3408Yes057421.9F20.9200No06781.2F19.8406No074823.2F24.1448No08795.0F22.422.54No0Table 1.

Fatigue in NPSLE and non-NPSLE patients (N = 222)

Case No.HZ incidence period after baricitinib administration (months)Priod of baricitinib withdrawal (weeks)Severity(Mild; MilModerate: Mod)1164Mod224Mod3131Mil431Mil586Mod634Mil ~ Mod733Mod820Discontinuation due to pateient’s choiceMod

None of the patients had severe symptoms, and none of them experienced organ damage. All patients were cured with anti-viral agents. It should be noted that patients who had a history of HZ had milder symptoms than those who had no history of HZ. We noted an interesting finding in one patient (case 2). The half-life of baricitinib in the blood was very short (about 6 hours), and it is reported that the drug is almost fully excreted from the body 24 hours after its administration [4]. However, this patient developed an incidence of HZ at 17 days after the withdrawal of baricitinib for surgery management. Cells may take longer time to regain their original immune status even after excretion of the drug, especially, during intense stress such as in cases of surgical invasion.

Conclusion:

The HZ risk in Japanese patients with RA treated with baricitinib in real-world practice was high, especially in elderly patients. It is notable that HZ events were nonserious and that patients could restart baricitinib treatment after healing with antiviral therapy, for the most part.

References:

[1]Taylor PC et al. N Engl J Med. 2017;376:652-62

[2]Harigai M et al. Mod Reumatol. 2019;20:1-8.

[3]Fleischmann R et al. RMD open. 2017;3:e000546.

[4]Shi JG et al. J Clin Pharmacol. 2014;54:1354-61

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

FRI0097 EFFECTS OF BIOLOGICAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUG TREATMENT ON PHYSICAL ACTIVITY, MUSCLE POWER, AGILITY AND INHIBITION OF FALL IN PATIENTS WITH RHEUMATOID ARTHRITIS -THE 2-YEAR RESULTS

Background:

Treatment with biological DMARDs (bDMARDs) rapidly improves signs and symptoms in patients with rheumatoid arthritis (RA). The efficacy of these bDMARDs was evaluated using composite measures or biomarkers used in daily clinical practice or clinical studies. Although a rapid improvement in composite measures or biomarkers is important in the treatment of RA, the primary goal of treatment is improvement of long-term health-related quality of life (HR-QOL) [1]. HR-QOL is evaluated based on physical functions (PF) such as muscle power and agility. We reported the 1-year results of our study presented at EULAR 2019 [2]. The present study was conducted to investigate the 2-year results of our study by including more patents than those included in the previous one.

Objectives:

This study was aimed at investigating the efficacy of bDMARDs with respect to PF and fall risk in RA patients.

Methods:

At our institute, in addition to routine rheumatology evaluation, periodic evaluation of physical function is performed by staff members in our rehabilitation center in RA patients in whom the first bDMARD treatment was initiated in Oct. 2015–Feb. 2018. In total, 41 cases were registered in this study. Evaluation of PF included evaluation of muscle power [grasping power (GP) and knee extension power (KEP)]; agility [time up and go test (TUG) and 10-m walking time (10 mW)]; and a questionnaire using modified HAQ, portable fall risk index [3], and the 25-question geriatric locomotive function scale (locomo25) [4] at baseline (BL), which implies the time at the initiation of bDMARD treatment, i.e., 1, 3, 6, 12, and 24 months. Disease activity of RA was evaluated at the same time points. Although 2 years had elapsed from BL in 37 patients, 13 patients dropped out from the evaluation of physical function owing to cessation of bDMARD treatment, rejection of evaluation for physical function, or major joint surgery performed in a patient. The results of 24 patients who completed the evaluation at 24 months were investigated in this study.

Results:

Baseline characteristics of the 24 patients were as follows: mean age 60.8 years, RA duration 12.3 years, mean SDAI 19.0, and mean CRP level 2.1 mg/dl. The bDMARDs used in the study were abatacept in 7 patients, adalimumab in 4 patients, tocilizumab in 4 patients, golimumab in 4 patients, etanercept in 3 patients, certolizumab in 1 patient, and an infliximab biosimilar in 1 patients. Data are presented as mean values at BL and at 1, 3, 6, 12, and 24 months (Fig.1). SDAI and CRP levels were significantly improved at and after 1 month. GP and KEP were significantly improved at and after 3 and 6 months. TUG and 10 mW results were significantly improved at and after 3 and 6 months. Modified HAQ results were significantly improved at and after 3 months. Locomo25 scores were significantly improved at and after 1 month. Portable fall risk index values were significantly improved at and after 12 months.

Conclusion:

Although there was a rapid improvement in the signs and symptoms of RA after the initiation of bDMARD treatment, improvement in PF was slightly delayed. Significant improvement of muscle power and agility was achieved after 3–6 months onward. Inhibition of fall risk was achieved at and after 12 months after the initiation of bDMARD treatment. These results suggest that physiotherapy plays a vital role in RA patients who undergo treatment with bDMARDs to gain more rapid improvement of PF.

References:

[1]Smolen JS et al. Ann Rheum Dis, 2016.

[2]Hirano Y et al. Ann Rheum Dis, suppl. 2, 2019.

[3]Toba K et al. Jpn J Geriat, 2005.

[4]Seichi A at al. J Orthop Sci, 2012.

Disclosure of Interests:

Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Ayako Morisaka: None declared, Hironobu Kosugiyama: None declared, Shiori Inuzuka: None declared, Takeshi Kamiya: None declared, Hiroyuki Mori: None declared, Naohito Morishima: None declared, Tomoji Ishikawa: None declared

SAT0472 GOAL-DIRECTED TREATMENT OF OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS USING DENOSUMAB FOR FIVE YEARS

Background:

Osteoporosis (OP) is frequent complication identified in patients with rheumatoid arthritis (RA). Effective treatment must be provided to treat OP in RA (RAOP). Denosumab (DMB) is one of the promising drugs that are currently being used for the treatment of RAOP. We reported the results of 12-month DMB treatment for RAOP as part of Japanese multicenter registry study (TBCR-BONE) in EULAR2016 [1]. Recently, a treatment goal of OP was reported by the American Society for Bone and Mineral Research and the National Osteoporosis Foundation (ASBMR-NOF) working group [2]. This report advocated that the goal of treatment is a T-score of >-2.5 at the femoral neck, total hip (TH) or lumbar spine (LS) on DXA if the primary reason for starting treatment was a T-score of ≤-2.5 at the abovementioned skeletal sites. The working group noted that it was reasonable to expect that initial treatment should offer at least a 50% chance of achieving the treatment goal within 3 to 5 years of initiating therapy. We have reported the achievement rates of treatment goal in RAOP with 3-year DMB treatment on RAOP in EULAR2019 [3].

Objectives:

The aim of this retrospective study was to evaluate whether 5-year DMB treatment can achieve treatment goal of OP using data from TBCR-BONE.

Methods:

The study included 46 female patients who had completed 5-year DMB treatment. The LS-BMD analysis included 22 patients with a baseline (BL) LS-BMD T-score of ≤ -2.5. The TH-BMD analysis included 29 patients with a BL TH-BMD T-score of ≤ -2.5. Similar to clinical setting in Japan, 60mg of DMB was administered once every 6 months with a vitamin D3 supplement. BL characteristics, change in T-score over time, and achievement of the treatment goal (T-score>-2.5) were evaluated.

Results:

BL characteristics of the 46 female patients included: mean age of 69.1 years and RA duration of 16 years. Prednisolone was administered to 37% of the patients. In the LS-BMD analysis, T-scores improved significantly; the mean value at BL was −3.4, which increased to −3.0 at 1 year, −2.6 at 3 years, and ultimately to −2.5 at 5 years. The fraction of patients who achieved the treatment goal was as follows: 36.4% at 1 year, 40.9% at 2 years, 45.5% at 3 years, 50.0% at 4 years, and 54.5% at 5 years (Fig. 1A). The patients who achieved this treatment goal were those who had a significantly lower risk of fracture at BL as determined by FRAX (17.9% vs. 32.2%, p = 0.044), who had significantly higher BL serum TRACP-5b level (572.8 vs. 401.0: p = 0.03), and who had significantly better BL LS-BMD T-scores (−3.0 vs. −3.9, p < 0.01) than the nonachievers. In the TH-BMD analysis, T-scores improved significantly; the mean value at BL was −3.0, and it increased to −3.0 at 1 year, −2.7 at 3 years, and reached −2.7 at 5 years. The fraction of patients who achieved the treatment goal was as follows: 20.7% at 1 year, 31.0% at 2 years, 34.5% at 3 years, 31.0% at 4 years, and 37.9% at 5 years (Fig. 1B). The patients who achieved this treatment goal were those who had significantly better BL TH-BMD T-scores (−2.7 vs. −3.2: p < 0.01) than the nonachievers. Cut-off values at BL for achievement of the treatment goal determined using ROC analysis were −3.1 for the LS-BMD (sensitivity 83.3%, specificity 90.0%) and −2.85 for the TH-BMD (sensitivity 100.0%, specificity 81.0%).

Conclusion:

The results of this study suggested that achievement of the treatment goal was comparatively easy for those with LS-BMD loss; however, it was comparatively difficult for those with TH-BMD loss. Early initiation or longer duration of DMB therapy may be necessary to improve achievement rates. Likewise, other agents, such as romosozumab, may be considered for those with significant TH-BMD loss.

References:

[1]Hiranoet al.Ann Rheum Dis 2016; 75 (Suppl 2): 94

[2]Cummingset al.J Bone Miner Res 2017; 32: 3-10

[3]Hiranoet al.Ann Rheum Dis 2019; 78 (Suppl 2): A940

Disclosure of Interests:

Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Yasuhide Kanayama: None declared, Hironobu Kosugiyama: None declared, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda

THU0182 THE EFFECTIVENESS OF BIOLOGICAL AGENTS CONCOMITANT WITH TACROLIMUS IN RHEUMATOID ARTHRITIS

Background:

In Japan, oral tacrolimus (TAC) was approved for the treatment of RA in 2005 and the improvement of symptoms thorough the use concomitant with disease modifying antirheumatic drugs (DMARDs), including MTX has been reported1 2. On the other hand, the efficacy and tolerance of biological agents therapy concomitant with TAC are unknown.

Objectives:

The objective of this study was to investigate the efficacy and tolerance of biological agents concomitant with TAC in Japanese patients with RA using retention rate analysis.

Methods:

Total patients (n=2860) who underwent 5 biological agents (etanercept: ETN, adalimumab: ADA, golimumab:GLM, tocilizumab: TCZ, abatacept: ABT) treatment between 2003 and 2017 at Nagoya University Hospital and 12 other institutes (Tsurumai Biologics Communication Study Group) were enrolled3. In each biologics analysis, patients were divided into three groups: (1) concomitant only MTX (MTX group) (2) concomitant only TAC (TAC group) (3) others (others group). In TAC or MTX group, these drugs were only ones which concomitant with biologics. Kaplan-Meier analysis was used to estimate retention rate in each biologics group. To estimate the tolerance of concomitant biologics with TAC, cumulative hazard function in adverse events rate was performed in each biologics group. In both analyses, hazard ratios (HR) were assessed by Cox proportional hazards modeling adjusted for age, sex, disease duration and previously used biologics.

Results:

In total 2860 patients, 142 patients (5.0%) administered each biologics concomitant with TAC (ETN: n=47, ADA: n=10 GLM: n=14, TCZ: n=27, ABT: n=49). Baseline characteristics of 142 patients were shown in table 1. Average dosages of TAC at starting were ETN: 2.2±0.7mg ADA: 2.4±1.0mg GLM: 1.9±1.0mg TCZ: 1.7±0.9mg ABT: 1.9±0.9mg. With comparison of retention rate between 3 groups in each biologics under analysis of cox proportional hazard modeling, in ETN and ABT analysis, the retention rate of TAC group was higher than others group (table 2, figure 1). Comparison of incidence of adverse event between 3 group using cumulative hazard function and cox proportional hazard modeling in ETN and ABT analysis. In ETN analysis, incident rate of other group was higher than TAC group. In ABT analysis, there was no significant difference between 3 gruops (figure 2).

Table 1.Baseline characteristic (n=142)age (years)63 ± 3gendermale33 (23%)female109 (77%)disease duration (years)12.0 ± 7.8stage1,234 (24%)3,4108 (76%)class1,299 (70%)3,443 (30%)naïve vs switchnaïve71 (50%)switch71 (50%)corticosteroid use, no (%)+98 (75%)-32 (25%)corticosteroid dose (mg)5.6 ± 3.2DAS28-ESR4.71 ± 1.55Table 2.HR (95%CI)/p-valuen (MTX/TAC/others)ETNADAGLMTCZABT(774/ 47/ 486)(339/ 10/ 135)(156/ 14/ 61)(272/ 27/ 207)(213/ 49/ 178)TAC vs others0.27 (0.16-0.45)<0.0010.9 (0.37-2.20)ns0.46 (0.13-1.63)ns0.55 (0.24-1.31)ns0.51 (0.26-0.97)<0.05TAC vs MTX0.65 (0.38-1.08)ns1.42 (0.61-3.31)ns0.83 (0.24-2.87)ns0.5 (0.21-1.17)ns0.74 (0.39-1.42)nsMTX vs others0.42 (0.35-0.50)<0.0010.9 (0.50-0.88)<0.0010.56 (0.33-0.96)<0.051.01 (0.78-1.57)ns0.68 (0.46-0.99)<0.05

Bold italic: p<0.05CI: confidence interval ns: not significant

Conclusion:

We suspected that, in ETN and ABT treatment, combination therapy with TAC are subsequent options for treatment to RA patients, especially in whom MTX cannot be administration.

References:

[1]Kino T, et al. Antibiot. 1987 Sep 40(9): 1256-65

[2]Kondo H, et al. J Rheumatol. 2004 Feb;31(2):243-51

[3]Kojima T, et al. Mod Rheumatol. 2011 Sep 3.

Disclosure of Interests:

KENYA TERABE: None declared, Nobunori Takahashi Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan, Shuji Asai Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan, Atsushi Kaneko Speakers bureau: Abbvie, Asahi-Kasei, Astellas, Bristol-Myers Squibb, Chugai, Eisai, Eli Lily, Mitsubishi-Tanabe, Pfizer, and UCB Japan, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Yasuhide Kanayama: None declared, Yuichiro Yabe Speakers bureau: Asahi Kasei, Janssen, and Mitsubishi Tanabe, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama

SAT0156 EFFECTIVE OF BARICITINIB ON RADIOGRAPHIC PROGRESSION OF STRUCTURAL JOINT DAMAGE AT 48 WEEKS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD MULTICENTER CLINICAL DATA

Background:

Baricitinib (bari) is an oral Janus kinase 1 (JAK1)/JAK2 selective inhibitor that has demonstrated good efficacy in patients with rheumatoid arthritis (RA) and adequate response to conventional synthetic (cs) DMARDs in some clinical trials [1,2]. We report the efficacy and safety of bari within 24 weeks in real-world clinical data at EULAR2019.

Objectives:

To evaluate the radiographic progression of structural joint damage at 48 weeks in Japanese patients with RA in real-world multicenter clinical data.

Methods:

We included 53 Japanese patients with RA who showed an inadequate response to csDMARDs or biologic (b) DMARDs. Patients were scheduled to receive a once-daily dose of 4 or 2 mg/day bari as monotherapy or in combination with other csDMARDs. We divided the patients into two groups: those treated with 2 mg/day of bari (2mg-group; n = 27) and those treated with 4 mg/day of bari (4-mg group; n = 26) throughout the observation period. Patients were allowed to decrease their predonisolone and csDMARDs combined with bari treatment if their disease activity improved. First, we evaluated changes in CDAI and HAQ-DI after 48 weeks. Second, we evaluated the change in the van der Heijdge modified total sharp score (ΔmTSS), erosion score (ΔERN), and joint space narrowing score (ΔJSN). In addition, we assessed predictors for suppression of joint destruction at 48 weeks after bari treatment.

Results:

The baseline characteristics of the patients were as summarized in Table 1. There were no significant differences in any items. CDAI scores significantly improved 4 weeks after the treatment. This tendency continued until the final evaluation (Table 2). At 48 weeks, remission and low disease activity rates were 37.0% and 74.1% in the 2-mg group and 38.4% and 76.9% in the 4-mg group, respectively. Structural remission (mTSS ≤ 0.5) was noted in 21 patients (80.8%) and 21 patients (77.8%) in 4-mg group and 2-mg group, respectively (Figure). Mean scores (ΔmTSS, ΔERN, and ΔJSN) of all patients in the 2-mg group and 4-mg groups were (0.26, 0.15, and 0.11), (0.30, 0.17, and 0.13) and (0.23, 0.13, and 0.10), respectively (Figure). There were no significant differences in ΔmTSS scores between the two groups. A matrix metalloproteinase-3 score within the standard value at 12 weeks after the treatment was associated with a predictor for suppression of joint destruction at 48 weeks (logistic regression analysis; odds ratio = 11.6, 95% confidence interval: 1.5–112.4,P= 0.020).

Table 1.

Characteristics of patients at baricitinib initiation

2mg-group (n=27)4mg-group (n=26)p-valueAge (years)69.1 (12.0)65.6 (10.3)0.20Gender, female, n (%)19 (73.1)23 (85.2)0.28Disease duration (years),9.7 (10.4)5.7 (7.4)0.23Prior use of biologics, (0/1/2/3)(18/6/2/1)(18/2/5/1)------MTX (mg/week),4.5 (3.7)6.5 (4.29)0.08PSL (mg/day)1.0 (1.9)1.2 (1.8)0.49RF, U/ml254 (372)134 (222)0.21ACPA, U/m152 (176)133 (301)0.45MMP-3196 (220)215 (221)0.43Table 2.

Serial change of clinical assessment

2mg-groupBaseline4 week12 week24 week48 weekCDAI22.5 (9.2)7.4 (7.7)6.7 (6.9)6.9 (6.8)6.9 (6.8)HAQ-DI0.88 (0.51)0.45 (0.47)0.53 (0.58)0.56 (0.56)0.56 (0.56)MMP-3196 (221)98.9 (62.2)115 (164)106 (78)106 (78)4mg-groupBaseline4 week12 week24 week48 weekCDAI24.4 (9.7)9.4 (5.7)8.6 (6.3)6.7 (8.6)6.8 (8.6)HAQ-DI1.01 (0.51)0.58 (0.48)0.54 (0.60)0.45 (0.49)0.44 (0.45)MMP-3216 (222)99 (62)101 (123)89 (72)95 (81)

Conclusion:

The data showed that bari has a favorable effect on the radiographic progression of structural joint damage regardless of its dose in a real-world clinical setting. In consideration of the risk/benefit balance, we suggest that the dose of bari could be reduced in patients with favorable disease activity.

References:

[1]Tanaka Y et al. Mod Rheumatol. 2018;28:583-91

[2]Tanaka Y et al. Mod Rheumatol. 2018;28:20-9

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

THU0171 EFFICACY OF ABATACEPT FOR SUPPRESSING RADIOGRAPHIC PROGRESSION OF CERVICAL LESIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS COMPARISON WITH METHOTREXATE TREATMENT; TWO YEARS OF FOLLOW-UP ~A MULTICENTER REGISTRY STUDY ~

Background:

Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with biological agents are more clinically effective than the DMARDs that were in use previously, in particular, with their efficacy in suppressing joint destruction having been emphasized. We reported the efficacy of infliximab, anti-tumor necrosis factor antibodies for suppressing the radiographic progression of RA cervical lesions at ACR2009, EULAR2010, 11, 12, 13, 14,16 and 18. However there is still few studies of efficacy of against RA cervical lesions of Abatacept (ABT) that inhibits T cell activation by binding to CD80/86.

Objectives:

To evaluate the efficacy of ABT for suppressing the radiographic progression of RA cervical lesions comparison with MTX for 2 years.

Methods:

We used ABT or MTX for treating Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of each 60 and 75 patients received continuous ABT and MTX treatment for at least 2 years. For evaluation of cervical lesions, the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value were measured by plain lateral radiographs in the flexion position, at initiation and Year 1,2.

Results:

In the patients receiving ABT (n=60) and MTX (n =75), the number of female were each 48(80%) and 52(69%) cases(p=0.160). The mean age was 67.7 ± 12.9 and 63.6 ± 11.0 years old (p=0.004); disease duration was 16.7 ± 14.2 and 8.0 ± 9.5 years (p<0.001) and the mean dose of MTX was 8.4 ± 3.6 and 8.2 ± 2.9 mg/w (p=0.804). Clinical findings related to RA were as follows; CRP 2.2± 2.1 and 1.7± 2.3 mg/dl(p=0.008); ESR 47.2 ± 23.4 and 31.9 ± 21.8mm/h(p<0.001); MMP3 253 ± 280 and 223 ± 350ng/ml(p=0.003); the number of RF-positive 57(95%) and 60(80%) cases(p=0.011); DAS28-ESR 5.13 ± 0.99 and 4.30 ± 1.38 (p<0.001); ADI 3.6 ± 2.1 and 2.6 ± 1.6mm(p=0.003); SAC 18.5 ± 2.8 and 20.8 ± 2.5mm(p<0.001) and Ranawat value 14.4 ± 1.9 and 16.0 ± 1.5mm (p<0.001). The respective changes in cervical lesion parameters after 1 year were as follows: ADI: 0.20 ± 0.40 and 0.27 ± 0.45 mm (p = 0.367); SAC: −0.12 ± 0.32 and −0.17 ± 0.38 mm (p = 0.359); and Ranawat value: −0.15 ± 0.36 and −0.13 ± 0.34 mm (p = 0.783). The respective changes in cervical lesion parameters after 2 years were as follows: ADI: 0.35 ± 0.58 and 0.55 ± 0.70 mm (p = 0.099); SAC: −0.25 ± 0.47 and −0.45 ± 0.62 mm (p = 0.047); and Ranawat value: −0.23 ± 0.47 and −0.33 ± 0.55 mm (p = 0.293) in the patients receiving ABT and MTX (Fig. 1). The numbers of patients who did not showed progression in ADI, SAC and Ranawat value were each 42(70%) and 43(57%) cases(p=0.130); 46(77%) and 46(61%) cases(p=0.057) and 47(78%) and 53(71%) cases(p=0.313) after 2 years. Also the number who was able to suppress progression in all three parameters were each 42 cases (70%) receiving ABT and 43 cases (57%) receiving MTX (p=0.130) after 2 years (Fig. 2).

Conclusion:

This study suggested that ABT treatment can be used to suppress the progression of RA cervical lesions more than MTX treatment.

Disclosure of Interests:

Yasuhide Kanayama: None declared, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Nobunori Takahashi Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan, Yukiyoshi Oishi: None declared, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama

FRI0137 Discontinuation of baricitinib after achieving low disease activity in patients with rheumatoid arthritis in clinical practice; a multicenter observational study

Background:

Baricitinib (bari) is an oral Janus kinase (JAK) 1/JAK2 selective inhibitor that has shown good efficacy in patients with RA and adequate response to conventional synthetic DMARDs in some clinical trials [1,2]. However, concerning the high cost and long-term safety related to the inhibition of particular molecules, we would like to discontinue bari after achieving long low disease activity (LDA).

Objectives:

To evaluate the clinical outcomes in patients with RA who discontinued bari after achieving LDA for 24 weeks in real-world multicenter clinical data.

Methods:

Japanese 67 patients with RA who show an inadequate response to csDMARDs or bDMARDs were scheduled to receive bari 4 or 2 mg/day once daily dose as a monotherapy or in combination with other csDMARDs. We included 51 patients who achieved and maintained LDA at least for 24 weeks after baricitinib therapy. They were allowed to decrease baricitinib after discontinuation of prednisolone. Bari was either discontinued or continued after study enrolment. The decision of discontinuation and continuation of baricitinib was determined based on patient-physician decision making with informed consent. We divided patients into two groups: a discontinuation group (D group; n = 23) and a continuation group (C group; n = 28). We evaluated the proportion of patients who remained LDA for 24 weeks in both groups. Clinical outcomes including Clinical Disease Activity Index (CDAI), and HAQ-DI were compared between both groups. The last observational carried forward method was used for patients who could not discontinue baricitinib due to flare before 24 weeks. In D group, patients were treated with re-initiation of bari or initiation of the other DMARDs in the event of flare. We investigated the serial changes of patients treated with re-initiation of bari in CDAI after flare.

Results:

The baseline characteristics of the patients are summarized in Table. The titer of RF was lower in D group than that in C group. There were no significant differences in any other items. Ten of 23 (43.4%) in D group remained bari-free without disease activity flare. Serial changes of CDAI were summarized in Figure. CDAI in D group significantly increased from 3.6 at baseline to 9.8 at last observation. LDA rates in C group were 92.9% at last observation. CDAI in C group did not change throughout the follow-up period. CDAI at last observation was higher in D group than that in C group. HAQ-DI in D group changed from 0.28 at baseline to 0.45 at last observation. There was no significant change in HAQ-DI between both groups (P = 0.28). In D group, rescue by re-administration of bari or other DMARDs induced improvement, reducing CDAI from 15.5 at disease flare to 6.8. Especially, all patients treated with re-initiation of bari resulted in re-introduction of LDA in this study.

Table.

Characteristics of patients at baricitinib initiation

D group (n=23)C group (n=28)p-valueAge (years)66.9 (8.6)67.9 (12.7)0.31Gender, female, n (%)6 (73.9)24 (85.7)0.49Disease duration (years)7.6 (10.3)8.3 (9.9)0.37Prior use of biologics, n (0/1/2/≥3)(21/2/0/0)(17/6/4/1)------MTX (mg/w)5.5 (3.8)4.9 (4.3)0.62PSL (mg/d)1.4 (1.9)0.9 (0.9)0.51RF, U/ml99 (141)187 (214)0.04ACPA, U/ml135 (173)194 (214)0.11CDAI24.4 (9.2)22.5 (9.7)0.36HAQ-DI0.83 (0.49)0.83 (0.52)0.98

Conclusion:

It was possible to discontinue bari without flare in about 43% of patients with RA. Overall the patients treated with re-initiation of bari could result in re-introduction of LDA without deterioration of HAQ-DI.

References:

[1]Tanaka Y et al. Mod Rheumatol. 2018;28:583-91

[2]Tanaka Y et al. Mod Rheumatol. 2018;28:20-9

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

Matrix-material dependence on the elongation of embedded gold nanoparticles induced by 4 MeV C60 and 200 MeV Xe ion irradiation

We report the elongation of embedded Au nanoparticles (NPs) in three different matrices, i.e. amorphous carbon (a-C), crystalline indium tin oxide (In_xSn_1-xO_z; ITO) and crystalline calcium fluoride (CaF₂), under irradiations of 4 MeV C₆₀ ⁺ cluster ions and 200 MeV Xe¹⁴⁺ ions. Under 4 MeV C₆₀ cluster irradiation, strong sputtering is induced in CaF₂ layer so that the whole the layer was completely lost at a fluence of 5 × 10¹³ ions cm^-2. Au NPs were partly observed in the SiO₂, probably due to the recoil implantation. Amorphous carbon (a-C) layer exhibits low sputtering loss even under 4 MeV C₆₀ irradiation. However, the elongation in a-C layer was low. While the ITO layer showed a certain decrease in thickness under 4 MeV C₆₀ irradiation, large elongation of Au NPs was observed under both 4 MeV C₆₀ and 200 MeV Xe irradiation. The ITO layer preserved the crystallinity even after large elongation was induced. This is the first report of the elongation of metal NPs in a crystalline matrix.

Mediastinal metastasis from ovarian serous carcinoma 29 years after initial treatment

Ovarian cancer is a critically lethal gynecologic malignancy. More than 80% of patients with ovarian cancer have relapses within 5 years after initial treatment. However, recurrence from ovarian cancer more than 20 years later is extremely rare. We report a case of a 67-year-old female with mediastinal metastasis from ovarian cancer 29 years after initial gynecologic surgery and chemotherapy.

The benefit of stool mycobacterial examination to diagnose pulmonary tuberculosis for adult and elderly patients

Background

In patients with suspected pulmonary tuberculosis, who have difficulty in expectorating sputum, alternative specimens by invasive procedures, gastric aspirate or sputum suction, are not always available in the feeble elderly. Several studies report the benefit of stool test for pediatric or HIV infected patients, but few in adult patients.

Objective

To evaluate the benefit of stool examination as non-invasive alternative test to detect Mycobacterium tuberculosis (MTB) infection.

Methods

Stool specimens were examined for mycobacteria in 187 cases of microbiologically-diagnosed pulmonary tuberculosis between September 2013 and August 2017. We retrospectively reviewed the medical records to determine the positive detection rate of MTB with stool specimens and investigated factors related to MTB detection.

Results

Among 187 patients included, positive rate of MTB in stool was 12.8% (24/187) by stool acid-fast bacilli smear, 68.1% (98/144) by TRC Rapid^®, and 40.6% (76/187) by culture. Multivariate logistic regression analysis revealed two contributing factors to MTB detection in stool; cavitation and male. The adjusted odds ratio with 95% confidence interval (CI) for cavitation was 2.9 (95%CI 1.48–5.69) and 2.1 (95%CI 1.08–3.93) for male.

Conclusion

We recommend stool examination for those who are unable to give sputum and have risks for invasive procedures.

Effects of Manufacturing Processing Conditions on Retronasal-Aroma Odorants from a Milk Coffee Drink

To develop a ready-to-drink (RTD) milk coffee that retains the original coffee flavor, the effects of manufacturing processing conditions on retronasal-aroma (RA) odorants were investigated by gas chromatography-olfactometry (CharmAnalysis™) using an RA simulator (RAS). Twenty-nine of 33 odorants detected in the RAS effluent (RAS odorants) were identified. The detected odorants were classified into 19 odor-description groups. The total odor intensity (charm value, CMV) of all coffee RAS odorants decreased approximately 68% following pH adjustment, whereas the total CMV increased 6% to 7% following ultra-high-temperature sterilization. The total CMV ratio (about 83%) of the milk coffee produced using a new blending-after-sterilization (BAS) process without pH adjustment of the coffee was greater than that (approximately 56%) prepared using a conventional blending-before-sterilization (BBS) process with pH adjustment. In BAS-processed milk coffees, the total CMV ratio (91%) with infusion (INF)-sterilized reconstituted milk (r-milk) was greater than that (83%) of plate (PLT)-sterilized r-milk. Principal component analysis of odor-description CMVs indicated that the effect of coffee pH adjustment on odor characteristics was greater than that of sterilization, that BAS and BBS samples differed, and that BAS milk coffee prepared using INF sterilization was more similar to homemade milk coffee (blending unsterilized coffee without pH adjustment with PLT-sterilized milk) than milk coffee prepared using PLT sterilization. In conclusion, the BAS process using INF sterilization is superior for manufacturing RTD milk coffee that retains odor characteristics similar to targeted homemade milk coffee. PRACTICAL APPLICATION: Ready-to-drink milk coffee beverages produced using conventional blending-before-sterilization methods do not retain their original coffee flavor following adjustment of the pH of the coffee during manufacturing. The use of newly developed blending-after-sterilization methods, by contrast, produces ready-to-drink milk coffee with an aroma more similar to that of homemade milk coffee, as demonstrated using an analytical system for characterizing food product aromas. The blending-after-sterilization process is now being used in Japan to produce ready-to-drink milk coffee beverages.

A single-arm pilot study of guided self-help treatment based cognitive behavioral therapy for bulimia nervosa in Japanese clinical settings

Objective

Guided self-help treatments based on cognitive behavioral therapy (CBT-GSH) are regarded as a first-line effective treatment for bulimia nervosa (BN). With limited application for CBT-GSH in Japanese clinical settings, we conducted a single arm pilot study in order to confirm the acceptability and availability of CBT-GSH in Japan.

Results

25 women with BN received 16–20 sessions of face-to-face CBT-GSH. Primary outcomes were the completion rate of intervention and abstinence rates from objective bingeing and purging as assessed by the Eating Disorder Examination. Secondary outcomes were other self-report measurements of the frequency of bingeing and purging, and characteristic psychopathologies of eating disorders. Assessments were conducted before CBT as baseline as well as after CBT. 92% (23/25) of the participants completed the CBT sessions. After CBT-GSH, 40% (10/25) of the participants (intention-to-treat) achieved symptom abstinence. The mean binge and purge episodes during the previous 28 days improved from 21.88 to 10.96 (50% reduction) and from 22.44 to 10.88 (52% reduction), each (before CBT-GSH to after CBT-GSH), and the within-group effect sizes were medium (Cohen’s d = 0.67, 0.65, each). Our study provided a preliminary evidence about the feasibility of CBT-GSH in Japanese clinical settings for the future.

Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 10, 2013 (registration ID: UMIN000011120)

Effects of Processing Conditions During Manufacture on Retronasal-Aroma Compounds from a Milk Coffee Drink

To develop a ready-to-drink (RTD) milk coffee retaining the original coffee flavor, the effects of processing conditions during manufacture on retronasal-arma (RA) compounds from the milk coffee were investigated by gas chromatography-mass spectrometry using an RA simulator (RAS). Thirteen of 46 detected compounds in the RAS effluent (RAS compounds) decreased significantly following pH adjustment of coffee (from pH 5.1 to 6.8) and 5 compounds increased. RAS compounds from coffee tended to decrease through the pH adjustment and subsequent sterilization. Significantly higher amounts of 13 RAS compounds were released from the milk coffee produced using a blending-after-sterilization (BAS) process without the pH adjustment than from that using a blending-before-sterilization (BBS) process with the pH adjustment. In BAS-processed milk coffee, significantly lower amounts of 8 high-volatility compounds and 1H-pyrrole were released from coffee containing infusion-sterilized (INF) milk than from coffee containing plate-sterilized (PLT) milk, whereas 3 low-volatility compounds were released significantly more from coffee using PLT milk. Principal component analysis revealed that the effect of the manufacturing process (BAS, BBS, or homemade (blending unsterilized coffee without pH adjustment with sterilized milk)) on milk coffee volatiles was larger than that of the sterilization method (INF or PLT) for milk, and that the sterilization method could result in different RAS volatile characteristics in BAS and homemade processes. In conclusion, a BAS process was found to be superior to a BBS process for the manufacture of an RTD milk coffee that retains volatile characteristics similar to that of a homemade milk coffee.

PRACTICAL APPLICATION

Ready-to-drink (RTD) milk coffee manufactured using the conventional blending-before-sterilization process does not retain its original coffee flavor due to pH adjustment of the coffee during the process. The new blending-after-sterilization (BAS) process enabled the production of RTD milk coffee whose volatiles are closer to that of homemade milk coffee, as demonstrated by the results of RAS-GC-MS analysis. The BAS process has already been applied to the manufacture of RTD milk coffees in Japan.

First report of serotype 23B Streptococcus pneumoniae isolated from an adult patient with invasive infection in Japan

Serotype 23B Streptococcus pneumoniae was isolated from a 67-year-old Japanese patient with meningitis. This isolate was susceptible to penicillin G, while genotyped as gPISP with a mutation in a penicillin-binding motif in PBP2b. The 23B isolate was assigned to ST11996 that is related to CC439, a dominant group among serotype 23B.

The role of α4 integrin in Theiler's murine encephalomyelitis virus (TMEV)-induced demyelinating disease: an infectious animal model for multiple sclerosis (MS)

Natalizumab, which is an antibody against α4 integrin, has been used for the treatment of multiple sclerosis (MS). In the present study, we investigated both the role of α4 integrin and the therapeutic effect of HCA3551, a newly synthesized orally active small-molecule α4 integrin antagonist, in the development of TMEV-induced demyelinating disease (TMEV-IDD). The mRNA levels of α4 integrins were significantly up-regulated in the CNS of mice with TMEV-IDD as compared with naïve mice (*p<0.05). HCA3551 treatment in the effector phase significantly suppressed both the clinical and histological development of TMEV-IDD. The number of infiltrating mononuclear inflammatory cells in the CNS was significantly decreased in the mice treated with HCA3551 (**p<0.01). The labeling indices for CD68 antigen and the absolute cell numbers of TNF-α-producing CD4⁺ T cells and IFN-γ-producing CD8⁺ T cells were significantly decreased in the CNS of mice treated with HCA3551 (*p<0.05). HCA3551 treatment in the effector phase might inhibit the binding of α4 integrin to VCAM-1, thereby decreasing the number of MNCs in the CNS.