POS0934 BIOLOGICAL THERAPY IN UVEITIS ASOCIATED TO AXIAL SPONDYLOARTHRITIS. SINGLE CENTER UNIVERSITY STUDY

Background:

Uveitis is the most frequent extraarticular manifestation of axial Spondyloarthritis (axSpA). Effects of Biological Therapy (BT) on uveitis associated to axSpA are contradictory (1-3).

Objectives:

To assess in uveitis associated to axSpA a) frequency and features of uveitis, and b) efficacy and relation of BT in a single-center university study.

Methods:

Observational study from a cohort of 301 consecutive unselected patients with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Episodes of uveitis were analyzed before and after BT initiation. Likewise, uveitis incidence rate (episodes/100 patients/year) at baseline and after first BT was calculated.

Results:

Uveitis was observed in 44 (25 men/19 women) out of 301 (14.6%) patients. Mean age was 45.6 ± 10.3 years. Demographic and clinical features in patients who developed uveitis and those that did not are summarized in Table 1. After 18.6 ± 10.4 years of follow-up, 44 (14.6%) patients suffered from at least one episode of uveitis. Uveitis was anterior and acute in all cases and unilateral in 37 (84.1%) patients. Mean anterior chamber cells was 1.7 ± 1.2 cells.

Per episode of uveitis, 20 patients received BT with: secukinumab (SECU) (n=7, 35%), adalimumab (n=6, 30%), golimumab (n=3, 15%), infliximab (n=2, 10%), certolizumab (n=1, 5%), and etarnecept (ETN) (n=1, 5%). Before the initiation of BT, patients treated with SECU developed 29.7 episodes/100 patients/year while those treated with monoclonal anti-TNFα 16.3 episodes/100 patients/year and patients with ETN 5.8 episodes/100 patients/year. After 5.9 ± 3.7 years of follow-up, patients treated with SECU developed 16.1 episodes/100 patients/year while those treated with monoclonal anti-TNFα 7.6 episodes/100 patients/year and patients with ETN 0 episodes/100 patients/year (Figure 1). No serious adverse effects were observed.

Conclusion:

Uveitis was observed in 14.6% of axSpA. Most of them were HLA-B27 positive. Acute, anterior and unilateral was the most frequent pattern of uveitis in axSpA. There was a similar decrease in incidence rate between patients treated with SECU and those treated with monoclonal anti-TNFα.

References:

[1]Deodhar AA, et al. ACR Open Rheumatol. 2020; 2:294-299.

[2]Roche D, et al [abstract]. Arthritis Rheumatol 2019; 71 (suppl 10).

[3]Lindström U, et al Annals of the Rheumatic Diseases 2020;79:9-10.

Table 1.

Main general features and differences between patients with and without uveitis.

Overalln= 301Uveitisn= 44Non uveitisn= 257pAge, years (mean±SD)44.9 ± 11.845.6 ± 10.344.8 ± 12.10.47Gender, n (m/w) (%)179/122 (59.5/40.5)25/19 (56.8/43.2)154/103 (59.9/40.1)0.71HLAB27 positive,n (%)190 (63.1)37 (84.1)153 (60.0)0.00Follow-up of axSpA, year (mean±SD)13.5 ± 11.218.6 ± 10.512.6 ± 11.10.33Family history, n (%)84 (27.9)15 (34.1)69 (27.2)0.35r-axSpA, n (%)217 (72.1)36 (81.8)181 (70.4)0.12nr-axSpA, n (%)84 (27.9)8 (18.2)76 (29.6)0.12Enthesitis, n (%)108 (35.9)14 (31.8)94 (36.6)0.54Peripheral arthritis, n (%)96 (31.9)12 (27.3)84 (32.7)0.47Psoriasis, n (%)35 (11.6)6 (13.6)29 (11.3)0.65Inflammatory bowel disease, n (%)22 (7.3)2 (4.5)20 (7.8)0.45Hip involvement, n (%)20 (6.6)3 (6.8)17 (6.6)0.96Dactylitis, n (%)17 (5.7)3 (6.8)14 (5.4)0.72Cardiovascular event, n (%)7 (2.3)1 (2.3)6 (2.3)0.98Figure 1.

Uveitis incidence rate before and after biological therapy.

Disclosure of Interests:

Alba Herrero-Morant: None declared, Iñigo González-Mazón: None declared, Vanesa Calvo-Río Speakers bureau: Abbott, Lilly, Celgene, Grünenthal, UCB Pharma, Grant/research support from: MSD and Roche, Javier Rueda-Gotor: None declared, Miguel Á. González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Sanofi, Lilly and MSD, Grant/research support from: AbbVie, MSD and Roche

OP0152 COMPARISON OF DIAGNOSTIC CRITERIA IN BEHÇET DISEASE AND SENSITIVITY IN DIAGNOSING SEVERE MANIFESTATIONS

Background:

Behçet disease (BD) is characterized by painful recurrent oral aphthosis genital ulcers and skin lesions. Nevertheless, the major causes of morbidity result from ocular, vascular and neurological involvement. Diagnosis of BD is usually performed according to the International Study Group (ISG) (Lancet 1990; 335:1078-80). Recently, criteria proposed by the International Team for the Revision of the International Criteria for BD (ITR-ICBD) have demonstrated a higher sensitivity (J Eur Acad Dermatology Venereol 2014;28:338-47).

Objectives:

To assess a) the concordance and differences between ISG and ICDB criteria b) sensitivity in diagnosing severe manifestations (ocular, vascular and neurological).

Methods:

The study included 120 patients diagnosed with definitive or possible BD by expert rheumatologists. They were diagnosed at a well-defined population in Northern Spain between January 1980 and December 2019. The ISG and ICBD diagnostic criteria for BD were applied to all patients and compared among them.

Results:

120 patients (62 men/ 58 women) were studied. Mean age at diagnosis was 37.6±13.8 years. 59 (49.2%) patients fulfilled ISG criteria and 96 (80%) ICBD criteria. Concordance between both criteria was moderate (Kappa 0.41). ICBD criteria diagnosed more patients with neurological (χ2=49.1, p<0.01), vascular (χ2= 56.7, p<0.01) and ocular manifestations (χ2=84.4 p<0.01) (Figure).

Figure 1.

Number of patients with vascular, neurological or ocular manifestations diagnosed with BD by different criteria. Abbreviations: ITRC-ICBD: International Team for the Revision of the International Criteria for BD; ISG: International Study Group for Behçet Disease.

Conclusion:

ICBD criteria are more likely to diagnose BD and classify more patients with severe manifestations of the disease.

References:

[1]Atienza-Mateo B, et al. Rheumatology (Oxford) 2018;57(5):856-864. doi: 10.1093/rheumatology/kex480.

[2]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94. doi: 10.1016/j.ajo.2018.12.019

[3]Calvo-Río V, et al. Clin Exp Rheumatol. 2014;32(4 Suppl 84):S54-7. PMID: 25005576

[4]Santos-Gómez M, et al. Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. PMID:27054359

[5]Atienza-Mateo B, et al. Arthritis Rheumatol. 2019; 71(12):2081-2089. doi: 10.1002/art.41026.

[6]Martín-Varillas JL, et al. Ophthalmology. 2018;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020

Table 1.

Main clinical features according to different diagnostic criteria. Patients characteristics, data are in n (%)

Expert rheumatologists (N=120)ISG criteria(N=59)ICBD criteria(N=96)Age, mean years / (SD)38 (13.8)35.6 (13)37 (13)Gender, men/women, N (%)62/58 (52.1/47.9)29/30 (49.1/50.8)48/48 (50/50)Oral aphthosis, N (%)113 (94.2)59 (100)94 (97.9)Genital aphthosis, N (%)71 (78.5)46 (78)71 (74)Skin manifestations N (%)76 (63.3)52 (88.1)64 (71.6)Ocular lesions, N (%)54 (45)31 (52.5)50 (52.1)Joint manifestations, N (%)78 (65)38 (64.4)62 (64.6)Neurological manifestations, N (%)23 (19.2)9 (15.2)20 (21.1)Vascular manifestations, N (%)14 (11.6)7 (11.9)14 (14.6)Gastrointestinal features, N (%)8 (6.6)3 (5.1)5 (5.3)

Disclosure of Interests:

Carmen Álvarez-Reguera: None declared, Alba Herrero-Morant: None declared, Lara Sanchez-Bilbao: None declared, David Martínez-López: None declared, José Luis Martín-Varillas: None declared, Guillermo Suárez Amorín: None declared, Cristina Mata-Arnaiz: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi and MSD., Grant/research support from: Abbvie, MSD, Janssen and Roche., Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Bristol-Myers, Janssen, Lilly and MSD., Grant/research support from: Abbvie, MSD and Roche.

POS0900 SECUKINUMAB 150 MG PROVIDES SUSTAINED IMPROVEMENT IN SIGNS AND SYMPTOMS OF NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 2-YEAR RESULTS FROM THE PREVENT STUDY

Background:

Axial spondyloarthritis (axSpA) is an inflammatory disease characterised by chronic back pain, and it comprises radiographic axSpA and non-radiographic axSpA (nr-axSpA).1 Secukinumab (SEC) 150 mg, with (LD) or without loading (NL), dose significantly improved the signs and symptoms of patients with nr-axSpA in the PREVENT (NCT02696031) study through Week 52.2

Objectives:

To report the long-term clinical efficacy and safety of secukinumab from the PREVENT study through 2 years.

Methods:

A detailed study design, key primary and secondary endpoints have been reported previously.2 In total, 555 patients fulfilling ASAS criteria for axSpA plus abnormal C-reactive protein (CRP) and/or MRI, without evidence of radiographic changes in sacroiliac (SI) joints according to modified New York Criteria for AS were randomised (1:1:1) to receive SEC 150 mg with LD, NL, or placebo (PBO) at baseline. LD patients received SEC 150 mg at Weeks 1, 2, 3, and 4, and then every 4 weeks (q4wk) starting at Week 4. NL patients received SEC 150 mg at baseline and PBO at weeks 1, 2, and 3, and then 150 mg q4wk. 90% patients were anti-tumour necrosis factor (anti-TNF) naïve, 57% had elevated CRP and 73% had evidence of SI joint inflammation on MRI. All images were assessed centrally before inclusion. All patients continued to receive open-label SEC 150 mg treatment after Week 52. Efficacy assessments through Week 104 included ASAS40 in anti-TNF-naïve patients, ASAS40, BASDAI change from baseline, BASDAI50, ASAS partial remission, and ASDAS-CRP inactive disease in the overall population. The safety analyses included all patients who received ≥1 dose of study treatment for the entire treatment period up to Week 104. Data are presented as observed.

Results:

Overall, 438 patients completed 104 weeks of study: 78.9% (146/185; LD), 77.7% (143/184; NL) and 80.1% (149/186; PBO). Efficacy results at Week 52 were sustained through Week 104 and are reported in the Table 1. The safety profile was consistent with the previous reports with no deaths reported during the entire treatment period up to Week 104.2

Conclusion:

Secukinumab 150 mg demonstrated sustained improvement in the signs and symptoms of patients with nr-axSpA through 2 years. Secukinumab was well tolerated with no new or unexpected safety signals.

References:

[1]Strand V, et al. J Clin Rheumatol. 2017; 23(7):383–91.

[2]Deodhar A, et al. Arthritis Rheumatol. 2020. Online ahead of print.

Figure 1.

ASAS40 response was maintained through Week 104 in the overall population

Table 1.

Summary of clinical efficacy (Observed data)

EndpointsWeekSEC 150 mg LD(N=185)SEC 150 mg NL(N=184)PBO-SEC 150 mg(N=186)*ASAS40 in anti-TNF-naïve patients, n/M (%)52a90/137 (65.7)95/145 (65.5)85/151 (56.3)10478/123 (63.4)83/123 (67.5)83/134 (61.9)BASDAI change from baseline, mean±SD52a−3.7±2.8−3.7±2.6−3.3±2.4104−4.1±2.6−3.9±2.6−3.7±2.5BASDAI50, n/M (%)52a90/153 (58.8)92/163 (56.4)90/161 (55.9)10488/137 (64.2)84/136 (61.8)87/142 (61.3)ASAS partial remission,n/M (%)52a46/152 (30.3)56/163 (34.4)46/161 (28.6)10451/137 (37.2)50/135 (37.0)50/142 (35.2)ASDAS CRP inactive disease, n/M (%)52a49/152 (32.2)58/163 (35.6)48/160 (30.0)10450/132 (37.9)53/133 (39.8)53/142 (37.3)

*For anti-TNF-naïve patients, N=164, LD; 166, NL; 171, PBO-SEC.

a total number of evaluable patients including open-label SEC and standard of care (SOC; 2 patients in LD, 1 patient in NL continued on SOC). After Week 52, only patients who continued to receive open-label SEC are presented.

ASAS, Assessment of SpondyloArthritis International Society; ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; M, number of patients with evaluation; N, total randomised patients; n, number of patients who are responders; SD, standard deviation

Disclosure of Interests:

Denis Poddubnyy Speakers bureau: AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Biocad, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Samsung Bioepis, UCB, Grant/research support from: AbbVie, MSD, Novartis, Pfizer, Atul Deodhar Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, GSK, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB, Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Celgene, Chugai, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, BMS, Celgene, Chugai, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie and Novartis, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma and MSD and Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma and MSD, Grant/research support from: AbbVie, MSD, and Roche, Eva Dokoupilova Grant/research support from: AbbVie, Affibody AB, Eli Lilly, Galapagos, Gilead, GSK, Hexal AG, MSD, Novartis, Pfizer, R-Pharm, Sanofi-Aventis, and UCB, Stephen Hall Speakers bureau: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Consultant of: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Grant/research support from: AbbVie, UCB, Janssen, and Merck, Alan Kivitz Shareholder of: Pfizer, Sanofi, Novartis, Amgen, GlaxoSmithKline, Gilead Sciences, Inc., Speakers bureau: Celgene, GlaxoSmithKline, Eli Lilly, Merck, Novartis, Pfizer, Sanofi, Genzyme, Flexion, AbbVie, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc., Marleen G.H. van de Sande Speakers bureau: Novartis, MSD, Consultant of: Abbvie, Novartis, Eli Lily, Grant/research support from: Novartis, Eli Lilly, Janssen, UCB, Anna Stefanska Shareholder of: Novartis, Employee of: Novartis, Patricia Pertel Shareholder of: Novartis, Employee of: Novartis, Hanno Richards Shareholder of: Novartis, Employee of: Novartis, Juergen Braun Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis and UCB pharma, Eli Lilly, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis and UCB, Eli Lilly, Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis and UCB, Eli Lilly

OP0065 TOCILIZUMAB IN VISUAL INVOLVEMENT OF GIANT CELL ARTERITIS. MULTICENTER STUDY OF 312 PATIENTS OF CLINICAL PRACTICE

Background:

Visual involvement is one of the most feared complication of Giant Cell Arteritis (GCA).Tocilizumab (TCZ) has shown efficacy and safety in large-vessel vasculitis (LVV) including GCA (1-4).

Objectives:

To assess the efficacy of TCZ to: a) prevent the appearance of new ocular involvement, and b) to improve visual symptoms if present.

Methods:

Observational, multicenter study of 312 patients with GCA treated with TCZ. Patients were diagnosed with GCA accordingly to a) ACR criteria, and/or b) biopsy of temporal artery, and/or c) presence of LVV by imaging.

Patients were divided into two subgroups: a) with, and b) without visual involvement at any time. Visual manifestations were classified as: a) Transient visual loss (TVL) (amaurosis fugax), b) Permanent visual loss (PVL) (longer than 24 hours) (partial or complete; unilateral or bilateral), c) diplopia, and d) blurred vision. Accordingly to visual duration up to TCZ onset, we considered: a) 1-10 days, b) 11-30 days, and c) more than 30 days.

Results:

We studied 312 (218 women/94 men; mean age73.4±9.6 years). Visual manifestations at any time (before and/or after TCZ) were observed in 78 (25%). In 47 of them visual manifestations were present at TCZ onset, and in the remaining 31 patients had had a complete recovery. Main clinical features of GCA with and without visual involvement are shown in TABLE. Patients with visual involvement were older, with other ischemic complications, and requiring more corticosteroids dose.

Table 1.

Main features of 312 patients at TCZ onset.

OverallN= 312GCA with visual involvement(n= 78)GCA without visual involvement(n=234)pGeneral featuresAge (mean±SD)73.4±9.676.6±8.072.4±9.80.001*Female/Male(% of female), n218/94 (70)47/31 (60)171/63(73)0.046*Time from GCA diagnosis to TCZ onset (months), median [IQR]8 [3-24]5 [1-14]10 [3-24]0.040*Positive TAB, n (%)137/229 (60)33/60 (55)104/169 (61)0.444Ischemic manifestationsVisual involvement, n (%)47 (15)47 (60)00.000*Headache, n (%)166 (53)59 (76)107 (46)0.000*Jaw claudication60 (19)26 (33)34 (14)0.001*Systemic manifestationsFever, n (%)27 (9)8 (10)19 (8)0.743Constitutional syndrome, n (%)115 (37)30 (38)85 (36)0.878PmR, n (%)188 (60)46 (59)142 (61)0.830Acute phase reactantsESR, mm/1st hour, median [IQR]27 [10-50]34.5 [15.2-58]26.0 [10.0-48.0]0.193CRP (mg/dL), median [IQR]1.4 [0.4-3.3]1.5 [0.3-5.5]1.3 [0.4-2.9]0.134Prednisone dose, mg/day, mean±SD22.3±16.627.1±18.620.8±15.60.008*TCZmono/TCZcombo, n (%)211/10157/21154/800.295Follow-up (months), mean±SD28.4±21.825.8±22.429.3±21.60.119

After TCZ onset, none patient developed new visual involvement. At TCZ onset 47 patients had the following visual manifestations; PVL (n= 28; unilateral/bilateral; 22/6), TVL (n=15; unilateral/bilateral; 9/6), diplopia (n=2) and blurred vision (n=2).

None of the patients with TVL presented new episodes after TCZ onset, while 8 out of 28 patients with PVL experienced partial improvement (FIGURE). The 2 patients with diplopia and 1 of 2 patients with blurred vision improved.

Figure 1.

Efficacy of TCZ in 47 patients with GCA and visual involvement at TCZ onset.

Conclusion:

TCZ seems to prevent the appearance of new ocular manifestations. When they are present, TCZ may improve totally TVL and partially PVL.

References:

[1]Stone JH, et al. N Engl J Med. 2017; 377: 317-28.

[2]Calderón-Goercke M, et al. Semin Arthritis Rheum 2019;49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003.

[3]Prieto Peña D et al. Clin Exp Rheumatol 2020 Nov 27. PMID: 33253103.

[4]Loricera J, et al. Clin Exp Rheumatol 2016; 34:S44-53. PMID: 27050507.

Disclosure of Interests:

Lara Sanchez-Bilbao: None declared, Javier Loricera: None declared, Vicente Aldasoro: None declared, Rafael Melero: None declared, Santos Castañeda: None declared, Olga Maiz: None declared, Clara Moriano: None declared, Ignacio Villa-Blanco: None declared, Eztizen Labrador-Sánchez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, Eva Galíndez-Agirregoikoa: None declared, Eva Perez-Pampín: None declared, Andrea García-Valle: None declared, Cristina Campos Fernández: None declared, Juan Ramón De Dios: None declared, Carlota Laura Iñíguez: None declared, José Luis Andréu Sánchez: None declared, Julio Sánchez: None declared, Monica Calderón-Goercke: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Consultant of: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Consultant of: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche

COVID-19 presenting with nystagmus

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15 days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

[COVID-19 presenting with nystagmus]

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15 days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

"Anterior interosseous nerve syndrome (Kiloh Nevin Syndrome) revealing Gantzer muscle and simultaneous myasthenia gravis"

There hasn't been a previous case report of the anterior interosseous nerve injury secondary to the presence of the muscle of Gantzer in a patient with myasthenia gravis in literature before. The anterior interosseous nerve compressive syndrome, also known as Kiloh-Nevin syndrome, is a rare disorder comprising less than 1% of all upper limb neuropathies. Establishing the etiology of anterior interosseous nerve compressive syndrome is challenging because of the lack of specific clinical findings or testing. Herein is the case of a 46 years-old male presented with left eye ptosis, ophthalmoparesis, diplopia, and right-hand weakness. On physical examination, the Pinch Grip test was positive. Electromyography studies showed neurogenic atrophy in the muscles innervated by the anterior interosseous nerve, as well as a pathological decrement of the muscle action potential of more than 10% on repetitive nerve stimulation. Concluding that the presence of the Gantzer muscle caused anterior interosseous nerve compressive syndrome was mainly a diagnosis of exclusion, after careful consideration of other possible etiologies including carpal tunnel syndrome, cervical radiculopathy, and Parsonage-Turner Syndrome. Even though anterior interosseous nerve compressive syndrome is very rare, clinical suspicion ought to arise in the presence of weak radial flexor digitorum profundus and flexor pollicis longus muscles. This case highlights the importance of a thorough medical history, a meticulous physical examination, and particularly the significance of electromyography studies in diagnosing different neuropathological entities. When appropriate, these steps offer information crucial to the differential diagnosis and eventual surgical management, assisting physicians in making informed and accurate treatment decisions.

Using advanced analysis of multifocal visual-evoked potentials to evaluate the risk of clinical progression in patients with radiologically isolated syndrome

This study aimed to assess the role of multifocal visual-evoked potentials (mfVEPs) as a guiding factor for clinical conversion of radiologically isolated syndrome (RIS). We longitudinally followed a cohort of 15 patients diagnosed with RIS. All subjects underwent thorough ophthalmological, neurological and imaging examinations. The mfVEP signals were analysed to obtain features in the time domain (SNR_min: amplitude, Lat_max: monocular latency) and in the continuous wavelet transform (CWT) domain (b_max: instant in which the CWT function maximum appears, N_max: number of CWT function maximums). The best features were used as inputs to a RUSBoost boosting-based sampling algorithm to improve the mfVEP diagnostic performance. Five of the 15 patients developed an objective clinical symptom consistent with an inflammatory demyelinating central nervous system syndrome during follow-up (mean time: 13.40 months). The (SNR_min) variable decreased significantly in the group that converted (2.74 ± 0.92 vs. 4.07 ± 0.95, p = 0.01). Similarly, the (b_max) feature increased significantly in RIS patients who converted (169.44 ± 24.81 vs. 139.03 ± 11.95 (ms), p = 0.02). The area under the curve analysis produced SNR_min and b_max values of 0.92 and 0.88, respectively. These results provide a set of new mfVEP features that can be potentially useful for predicting prognosis in RIS patients.

SAT0264 LONG TERM FOLLOW-UP AND OPTIMIZATION OF INFLIXIMAB IN REFRACTORY UVEITIS DUE TO BEHÇET’S DISEASE. MULTICENTER STUDY OF 103 CAUCASIAN PATIENTS

Background:

Biologic therapy has improved prognosis of Behçet Disease (BD) uveitis (1-5). Although infliximab (IFX) is approved in Japan, most data in Caucasian patients comes from small series. No data on optimization has been published

Objectives:

In a large series of Caucasian patients with refractory uveitis of BD, we assess:a) long-term efficacy and safety;b) IFX optimization when ocular remission was achieved

Methods:

Multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressants.103 patients were treated with IFX as 1st biologic as follows: 3-5 mg/kg i.v. at 0, 2, 6 and every 4-8 weeks. The main outcomes were anterior chamber cells, vitritis, retinal vasculitis, macular thickness, visual acuity, and glucocorticoids sparing effect; analysed at baseline, 1st week, 1st and 6th months and 1st and 2nd years. After remission, IFX optimization was performed

Results:

In whole series (n=103), main outcomes showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Severe side-effects were observed in 9 patients.

Comparative study between optimized and non-optimized groups showed:a) no differences in clinical baseline characteristics;b) similar maintained improvement in most ocular outcomes;c) lower severe adverse events andd) lower IFX cost in optimized group (4826.52 vs 9854.13 euros/patient/year)(Table)

Conclusion:

IFX seems effective and safe in Caucasian patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective

References:

[1]Martín-Varillas JL. Ophthalmology 2018;125:1444-1451.

[2]Atienza-Mateo B: Arthritis Rheumatol. 2019;71:2081-2089

[3]Santos-Gómez M. Clin Exp Rheumatol. 2016;34 (6 Suppl 102): S34-S40

[4]Urruticoechea-Arana A. Rheumatol Int. 2019;39:47-58.

[5]Atienza-Mateo B. Rheumatology (Oxford). 2018 1;57:856-864

Table.OptimizedN=18Non OptimizedN=42PPatients/eyes affected, n/n18/3442/77Age, mean (SD), years39.5 (9.8)38.8 (10.5)0.82Men, %55.659.50.78Duration of uveitis before IFX, median [IQR] months38 [18-119]35 [10-48]0.11Ocular features at time of IFX onset-AC cells count, median [IQR]2 [1-4]2 [1-2]0.29-Vitritis, median [IQR]2 [1.5-3]2 [1-2]0.02-BCVA, mean (SD)0.32 (0.21)0.37 (0.26)0.51-OCT, mean (SD)303.5 (23.3)397.7 (155.7)0.12-Retinal vasculitis, n (%)9 (50)26 (66.7)0.23Uveitis pattern, n (%)-Bilateral/unilateral16/2 (88.9/11.1)35/7 (83.3/16.7)0.71-Anterior0 (0)6 (14.3)0.17-Posterior5 (27.8)8 (19.0)0.50-Panuveitis13 (72.2)28 (66.7)0.67Prednisone dose at IFX onset, mean (SD), mg/d40.3 (20.6)41.4 (15.5)0.81IFX therapyMonotherapy/combined treatment, n (%)15 (83.3)30 (71.4)0.33-AZA5 (27.8)4 (9.5)0.11-CsA9 (33.3)8 (19.0)0.32-MTX4 (22.2)15 (35.7)0.30Follow-up on IFX therapy, median [IQR], months48 [33-60]24 [6-60]0.007-Relapses, median (IQR)0 [0-1]0 [0-2]-Remission, %10075.60.46-Severe side effects, n (per 100 patients/year)0 (0)3 (0.78)0.02-Cost (mean), euros per year4826.529854.130.55–

Disclosure of Interests:

José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Belén Atienza-Mateo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Emma Beltrán: None declared, Alfredo Adan: None declared, Elena Aurrecoechea: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, J. Luis Hernández: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

OP0053 SECUKINUMAB IMPROVES CLINICAL AND IMAGING OUTCOMES IN PATIENTS WITH PSORIATIC ARTHRITIS AND AXIAL MANIFESTATIONS WITH INADEQUATE RESPONSE TO NSAIDS: WEEK 52 RESULTS FROM THE MAXIMISE TRIAL

Background:

Although axial disease may affect up to 70% of patients (pts) with Psoriatic Arthritis (PsA), evidence on the efficacy of biologics in the treatment of axial manifestations in such pts is limited,1particularly as validated classification criteria for this subtype of PsA are not yet available. MAXIMISE (NCT02721966) is the first randomised controlled trial evaluating the efficacy of a biologic in the management of the axial manifestations of PsA and showed that secukinumab (SEC) 300 and 150 mg provided rapid and significant improvement in ASAS20 responses in these pts through week (Wk) 12.2

Objectives:

To present 52 wks efficacy results and imaging data from the MAXIMISE trial.

Methods:

This phase 3b, double-blind, placebo (PBO)-controlled, multicentre 52-wk trial included 498 pts (aged ≥18 years) with a diagnosis of PsA and classified by CASPAR criteria, spinal pain VAS score ≥ 40/100 and BASDAI score ≥ 4 despite use of at least two NSAIDs. Pts were randomised to SEC 300 mg (N=167) or SEC 150 mg (N=165) or PBO (N=166) wkly for 4 wks and every 4 wks thereafter. At Wk 12, PBO pts were re-randomised to SEC 300/150 mg. The primary endpoint was ASAS20 response with SEC 300 mg at Wk 12. The key secondary endpoint was ASAS20 response with SEC 150 mg at Wk 12. Wk 52 data are presented as observed. Bone marrow oedema of the entire spine and sacroiliac joints were assessed centrally with Berlin MRI scores at Baseline, Wk 12 and Wk 52.

Results:

Primary and key secondary endpoints were met; ASAS20 responses were sustained and increased further through Wk 52. 75%/79.7% of the PBO pts re-randomised at Wk 12 to SEC 300/150 mg achieved ASAS20 response at Wk 52 (Figure 1). ASAS40 responses at Wk 52 were 69.1% [SEC 300 mg], 64.5% [SEC 150 mg], 62.5% [PBO-SEC 300 mg], and 54.1% [PBO-SEC 150 mg]. At baseline, 59.5% [SEC 300 mg], 53.5% [SEC 150 mg] and 64.2% [PBO] of the pts had positive MRIs for the sacroiliac joints and/or the spine with Berlin MRI score ≥1. The reductions of Berlin MRI score for entire spine and sacroiliac joints were statistically significant for pts treated with SEC 300/150 mg vs. placebo (Figure 2a and b). There were no new or unexpected safety findings.

Figure 1.

ASAS20 Response over 52 Wks*

Figure 2.

Total Berlin MRI score for the Entire Spine and Sacroiliac Joints at Wk 12

Conclusion:

Secukinumab improved all evaluated ASAS responses through Wk 52 in PsA pts with axial manifestations and inadequate responses to NSAIDs and led to significant reduction of inflammatory MRI lesions in the spine and the Sacroiliac Joints. The safety profile of secukinumab through Wk 52 was consistent with previous reports.3-4

References:

[1]McInnes IB, et al.Lancet.2015;386(9999):1137–46.

[2]Baraliakos X, et al.Arthritis Rheumatol. 2019;71 (suppl 10).

[3]Langley RG, et al.N Engl J Med.2014;371:326–38.

[4]Sieper J, et al.Ann Rheum Dis.2016;0:1–8.

Acknowledgments:

The study was sponsored by Novartis Pharma AG, Basel, Switzerland.

Disclosure of Interests:

Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Effie Pournara Shareholder of: Novartis, Employee of: Novartis, Sławomir Jeka Grant/research support from: AbbVie, Pfizer, Roche, Novartis, MSD, Sandoz, Eli Lilly, Egis, UCB, Celgene, Speakers bureau: AbbVie, Pfizer, Roche, Novartis, MSD, Sandoz, Eli Lilly, Egis, UCB, Celgene, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD, Salvatore D’Angelo Consultant of: AbbVie, Biogen, BMS, Celgene, Eli Lilly, MSD, Novartis, and UCB, Speakers bureau: AbbVie, BMS, Celgene, Eli Lilly, Novartis, Pfizer, and Sanofi, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Barbara Schulz Employee of: Novartis, Michael Rissler Shareholder of: Novartis, Employee of: Novartis, Kriti Nagar Employee of: Novartis, Chiara Perella Shareholder of: Novartis, Employee of: Novartis, Laura C Coates: None declared

AB0829 INFLAMMATORY BOWEL DISEASE IN PSORIATIC ARTHRITIS. STUDY OF 306 PATIENTS FROM A SINGLE UNIVERSITARY CENTER. PREVALENCE, CLINICAL FEATURES AND RELATIONSHIP TO BIOLOGIC THERAPY

Background:

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), Ulcerative colitis (UC), and undetermined colitis may be related to psoriasis and psoriatic arthritis (PsA). Biologic therapy (BT) is useful in PsA and IBD but paradoxically has been related to IBD.

Objectives:

In a wide series of PsA, our aim was to assessa) the epidemiological and clinical features of associated IBD andb) its relationship with BT.

Methods:

All unselected consecutive patients studied in a single reference University Hospital with: a) PsA (CASPAR criteria) andb) IBD: CD, UC and undetermined colitis diagnosed by endoscopic patterns, clinical criteria and laboratory tests. A comparative study between patients with and without IBD was performed

Results:

We studied 306 (165 women/141 men) patients with PsA; mean age at PsA diagnosis of 41.7±15.79 years; delay of diagnosis from the onset of symptoms of 2.6±2.01 years. IBD (CD=6; UC=1 and undetermined colitis=3) was observed in 10 of 306 (3.3%, 8 women/2 men). A significant more frequency of enthesitis, positive HLA-B27 and non-significant more severe PsA (axial, and hip involvement, and a higher BASDAI, BASFI, DAPSA, PASI) was observed in patients with associated-IBD (TABLE).

IBD was present before PsA in 5 patients and in the other 5, after 9.6±15.3 years of evolution of PsA. BT for PsA has been used in 1 (20%) (etanercept) of these 5 patients which developed IBD and in 67 of 296 (22.6%) without IBD (Adalimumab 45; Certolizumab 8; Infliximab 6; Golimumab 4; Etanercept 4).

Conclusion:

IBD in PsA was uncommon (3.3%), may be associated to a more severe PsA, and no relationship to BT was found.

TABLE 1.Patients with IBD(n=10)Patients without IBD(n=296)pDEMOGRAPHIC PARAMETERSSex, n (%)2 ♂/8 ♀ (20.0/80.0)139 ♂/157 ♀ (46.9/53.1)p = 0.11Age at PsA symptoms onset (years), mean± SD39.0±15.144.2±11.4p = 0.17Age at PsA diagnosis, mean±SD41.7±15.746.4±15.8p = 0.22PsA RELATED DATAPsA type Asymmetric Oligoarticular, n (%)4.0 (40.0)159 (53.7)p = 0.59 Symmetrical Polyarthritis, n (%)0.0 (0.0)46 (15.5)p = 0.37 Axial, n (%)3.0 (30.0)40 (13.5)p = 0.31 Mixed, n (%)3.0 (30.0)51 (17.2)p = 0.54 Enthesitis, n (%)7.0 (70.0)111 (37.5)p = 0.03* Dactylitis, n (%)0.0 (0.0)79 (26.7)p = 0.70 Hip involvement n (%)4.0 (40.0)55 (18.5)p = 0.57Scores BASDAI, median [ICR]3.1 [0.0-4.4]2.2 [0.0-4.5)p = 0.64 BASFI, median [ICR]6.0[0.0–6.9]0.0 [0.0-3.3]p = 0.69 DAPSA, median [ICR]10.7 [0.0–14.62]4.3 [0.0-13.0]p = 0.31 PASI, median [ICR]2.3 [0.0–6.7]0.6 [0.0-2.38]p = 0.70Laboratory tests:HLA-B27, n (%)6.0 (60.0)23 (7.8)p = 0.001*

Disclosure of Interests:

Lara Sanchez-Bilbao Grant/research support from: Pfizer, David Martinez-Lopez: None declared, Natalia Palmou-Fontana: None declared, Susana Armesto: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

SAT0075 ABATACEPT IN COMBINATION WITH METOTREXATE IN PATIENTS WITH RHEUMATOID ARTHRITIS ASSOCIATED TO INTERSTITIAL LUNG DISEASE: NATIONAL MULTICENTER STUDY OF 263 PATIENTS

Background:

Interstitial Lung Disease (ILD) is an extra-articular complication of rheumatoid arthritis (RA) that is associated with increased morbidity and mortality. Conventional disease-modifying drugs (DMARDs) such as methotrexate (MTX) have been implicated in the development and exacerbation of a pre-existing ILD.

Objectives:

The aim of our study was to check the influence of combined MTX treatment in patients with RA-ILD treated with abatacept (ABA).

Methods:

National multicentre retrospective registry of 263 patients with RA-ILD treated with ABA. RA was diagnosed according to the ACR classification criteria of 1987 or by the EULAR/ACR criteria of 2010. ILD was diagnosed by high resolution computed tomography (HRCT). In this study we have done a subanalysis of the 46 patients treated with ABA in combination with MTX (ABA+MTX) vs. 217 patients treated with ABA in monotherapy or in combination with other synthetic DMARDs. Efficacy was evaluated according to the following parameters: a) Dyspnoea (MMRC) considering variations ≥ 1; b) Lung function test (LFT) considering variations ≥ 10% in FVC and a variation of DLCO ≥ 10%; c) Imaging test (HRCT) d) DAS28 score e) prednisone dose. Variables were collected at the beginning of the study and at months 3, 6, 12 and then every 12 months until a maximum of 60 months.

Results:

263 patients with ILD associated with RA were included in the study with mean age 64.64±10 years. RF or CCPA were positive in 235 (89.4%) and 233 (88.6%) cases, respectively, with a mean follow-up of 22.7±19.7 months. Baseline characteristics of both groups are shown in table 1, while data obtained during evolution of this complication are presented in Figure 1.

Conclusion:

Despite the baseline differences of both groups, the good evolution in the ABA+MTX subgroup suggests that this therapeutic strategy can be a safe combination for patients with RA-ILD.

ABA with MTX (n=46)ABA w/t MTX (n=217)PSex (F/M)28/18122/950.625Age (years)65.11±10.216.2±9.80.202RF/CCPA + (%)91.3/91.389.8/90.10.810Smoking or past smoking (%)47.855.10.417Follow-up (months)22.73±18.0022.3±20.850.916DAS28 at baseline4.08±1.514.61±1.470.056DAS28 at last visit3.00±1.463.13±1.310.642Prednisone at baseline, median (IQR) (mg)5 (5-7.5)7.75 (5-15)0.008*Prednisone at the end of study, median (IQR) (mg)5 (1-5)5 (5-7.5)0.032*DLCO at baseline (%)66.85±19.0465.43±18.210.823DLCO at the end of study (%)66.05±20.9565.17±19.720.831FVC at baseline (%)90.06±17.7785.40±21.560.164FVC at the end of study (%)90.58±15,4584.21±21.490.038*

Disclosure of Interests:

Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, J. Loricera: None declared, Francisco Ortiz-Sanjuán: None declared, A. Juan-Mas: None declared, Carmen Carrasco-Cubero Speakers bureau: Janssen, MSD, AbbVie, Novartis, Bristol Myers Squibb, and Celgene, S, Rodriguéz-Muguruza: None declared, S. Rodrigez -Garcia: None declared, R. Castellanos-Moreira: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

, CLARA AGUILERA CROS: None declared, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Sergi Ordoñez: None declared, Susana Romero-Yuste: None declared, C. Ojeda-Garcia: None declared, Manuel Moreno: None declared, Gemma Bonilla: None declared, I. Hernández-Rodriguez: None declared, Mireia Lopez Corbeto: None declared, José Luis Andréu Sánchez: None declared, Trinidad Pérez Sandoval: None declared, Alejandra López Robles: None declared, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, Natalia Mena-Vázquez: None declared, C. Peralta-Ginés: None declared, ANA URRUTICOECHEA-ARANA: None declared, Luis Marcelino Arboleya Rodríguez: None declared, J. Narváez: None declared, DESEADA PALMA SANCHEZ: None declared, Olga Maiz-Alonso: None declared, J. Fernández-Leroy: None declared, I. Cabezas-Rodriguez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, A. Ruibal-Escribano: None declared, JR De Dios-Jiménez Aberásturi: None declared, Paloma Vela-Casasempere: None declared, C. González-Montagut Gómez: None declared, J M Blanco: None declared, Noelia Alvarez-Rivas: None declared, N. Del-Val: None declared, M. Rodíguez-Gómez: None declared, Eva Salgado-Pérez: None declared, Carlos Fernández-López: None declared, E.C. Cervantes Pérez: None declared, A. Devicente-DelMas: None declared, Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, Cristina Hidalgo: None declared, Sabela Fernández: None declared, Edilia García-Fernández: None declared, R. López-Sánchez: None declared, S. Castro: None declared, P. Morales-Garrido: None declared, Andrea García-Valle: None declared, Rosa Expósito: None declared, L. Exposito-Perez: None declared, Lorena Pérez Albaladejo: None declared, Ángel García-Aparicio: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

SAT0523 BIOLOGICAL THERAPY IN REFRACTORY ATYPICAL OPTIC NEURITIS. MULTICENTER STUDY

Background:

Optic Neuritis (ON) is an inflammation of the optic nerve. Its most common presentation is demyelinating typical ON. Atypical ON is rare, severe, non-demyelinating and can be isolated or associated to different diseases including autoimmune diseases. If it is not treated, it can lead to devastating visual results. Conventional treatment includes systemic corticosteroids and conventional immunosuppressants (CIS).

Objectives:

Our aim was to assess the efficacy of biological therapy in atypical ON refractory to conventional treatment.

Methods:

Open-label multicenter study including 19 patients diagnosed with atypical ON refractory to systemic corticosteroids and at least one CIS. The main outcomes assessed were Best Corrected Visual Acuity (BCVA) and optic nerve and ganglionar cells Optical Coherence Tomography (OCT). These outcome variables were recorded at baseline, 1 week, 2 weeks, 1 month, 3 months and 6 months and 1 year after biological therapy onset.

FIGURE

Results:

We studied 19 patients (12 women/7 men); mean age of 34.8 ± 13.9 years. The underlying diseases were idiopathic (n=7), Behçet´s disease (n=5), systemic lupus erythematosus (n=2), neuromyelitis optica (n=3), sarcoidosis (n=1) and relapsing polychondritis (n=1)(TABLE).Before biological therapy and besides systemic corticosteroids, patients had received different CIS. Biological therapy was adalimumab (n=6), rituximab (n=6), infliximab (n=5) and tocilizumab (n=4). After biological therapy, an improvement in ocular parameters was observed: BCVA [0.7±0.3 to 0.8±0.3; p= 0.03], optic nerve OCT [123.2±58.3 to 190.5±175.4; p= 0.11], and ganglionar cells OCT [369.6±137.4 to 270.7±23.2; p= 0.03] at one year(FIGURE). After a mean follow-up of 29.1 ±19.2 months, there were no severe adverse effects observed.

Conclusion:

Biological therapy may be effective in patients with refractory atypical ON.

TABLECaseGender/ AgeUnderlying diseaseLateralityIV steroids dose (g)Maximum prednisone oral dose (g)Conventional immunosuppressantsBiological therapyAdverse effects1F/29IdiopathicUnilateral460AZATCZNo2F/26IdiopathicBilateral5.530AZATCZNo3F/13IdiopathicBilateral-10MTXADANo4F/25IdiopathicBilateral460MTXIFX, TCZNo5F/24IdiopathicBilateral0.560MTX, AZAADANo6M/14IdiopathicBilateral-10MTXADANo7F/30Vasculitis ANCA+Unilateral360AZA, MMF, LFM, CFMRTXYes8M/21BehçetBilateral-60MTX, AZAADANausea Vomits9M/25BehçetUnilateral0.560MTX, CyAADANo10M/39BehçetUnilateral380MTX, MMFIFXNo11M/40BehçetUnilateral-80MMFIFXNo12M/37BehçetUnilateral-60CyAIFXNo13F/68NMOUnilateral2.530CFM, AZARTXNo14F/41NMOUnilateral360CFMRTXInfection15F/43NMOBilateral560AZARTXInfusion reaction16F/56SLEUnilateral-60HCQ, MMF, CFMRTXNo17F/47SLEUnilateral560HCQ, MMFRTXNo18F/43Relapsing polychondritisBilateral360MTX, CFMIFX, TCZNo19M/41SarcoidosisBilateral340AZAADANo

Disclosure of Interests:

Alba Herrero Morant: None declared, Carmen Álvarez Reguera: None declared, Vanesa Calvo del Rio Grant/research support from: MSD and Roche, Speakers bureau: Abbott, Lilly, Celgene, Grünenthal, UCB Pharma, Olga Maíz Alonso: None declared, Ana Blanco Speakers bureau: Abbvie, J. Narváez: None declared, Santos Castañeda: None declared, Esther Vicente Speakers bureau: BMS, Roche., Susana Romero-Yuste: None declared, Rosalía Demetrio-Pablo: None declared, ANA URRUTICOECHEA-ARANA: None declared, J. L. García Serrano: None declared, J. L. Callejas Rubio: None declared, Norberto Ortego: None declared, Julio Sánchez: None declared, Paula Estrada: None declared, Iñigo Rua-Figueroa: None declared, David Martínez-López: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

FRI0215 RESPONSE TO TOCILIZUMAB IN LARGE VESSEL VASCULITIS ACCORDING TO THE EXTENT OF BASELINE 18F-FDG VASCULAR UPTAKE

Background:

18F-FDG PET/CT is useful to establish the presence and extent of large vessel vasculitis (LVV)(1-2).Early therapy is needed to prevent severe complications.Tocilizumab (TCZ) has shown efficacy in LVV(3-5).However, it is unknown if the extent of FDG vascular uptake may influence on clinical response to TCZ

Objectives:

To assess the correlation of the extent of baseline FDG vascular uptake in PET/CT scan with clinical response to TCZ in patients with LVV.

Methods:

Single center study of patients with LVV treated with TCZ who were divided into 2 groups depending on the extent of vascular uptake in baseline PET/CT scan:a) 1-2 affected areasb) ≥affected 3 areas. Vascular uptake was qualitatively assessed by two experienced nuclear medicine physicians in five areas (supraaortic trunks, thoracic aorta, abdominal aorta, iliac and femorotibial arteries). We assessed clinical improvement (no improvement/partial/complete), normalization of CRP (≤0.5mg/dL) and/or ESR (≤ 20 mm/1sth) and reduction of prednisone dose (mg/day).

Results:

30 patients (24 w/6 m); mean age 65.3±10.6 yrs. In baseline PET/CT, vascular uptake was observed in 1 or 2 areas (n=13) and in ≥3 areas (n=17). There was a trend to higher ESR/CRP and shorter evolution of clinical symptoms before TCZ onset in patients with ≥3 affected areas (TABLE 1). Clinical/serological evolution and reduction of prednisone dose is shown in TABLE 2. No statistical differences were found. However, patients with ≥ 3 affected areas tended to experience a slower clinical response.

TABLE 1.1-2 vascular affected areas (n=13)≥3 vascular affected areas (n=17)PDemographic dataAge,mean ± SD66.0 ± 10.864.8 ± 10.70.77Sex (women),n (%)11 (84.6)13 (76.5)0.67Evolution time before TCZ (months),median [IQR]26.0 [3.5-34.0]5.0 [1.5-10.0]0.02Laboratory markersESR (mm/1st h),mean ± SD30.0 ± 27.334.8 ± 27.60.64CRP (mg/dL),mean ± SD1.3 ± 1.21.8 ± 1.70.28Previous treatmentPrednisone dose (mg/day),mean ± SD9.4 ± 6.27.9 ± 6.90.53TCZ therapyIntravenous, n(%)10 (76.9)11 (64.7)0.47Combined with MTX, n(%)6 (46.2)8 (47.1)0.96TABLE 2.1-2 vascular affected areas (n=13)≥ 3 vascular affected areas (n=17)PComplete clinical improvement,n/N (%)6 m11/13 (84.6)12/17 (70.6)0.4312 m12/13 (92.3)13/17 (76.5)0.3618 m10/11 (90.9)11/12 (91.7)0.9924 m8/8 (100)9/10 (90.0)0.99Normalization of ESR and/or CRP,n/N (%)6 m13/13 (100)16/17 (94.1)0.9912 m13/13 (100)16/17 (94.1)0.9918 m11/11 (100)11/12 (91.7)0.9924 m8/8 (100)10/10 (100)0.99Dose of Prednisone (mg/day),median [IQR]6 m5.0 [1.3-5.0]5.0 [0.0-5.0]0.9812 m2.5 [0.0-3.8]0.0 [0.0-5.0]0.9718 m0.0 [0.0-2.5]0.0 [0.0-1.9]0.7224 m0.0 [0.0- 2.2]0.0 [0.0-2.5]0.77

Conclusion:

TCZ therapy was effective in patients with LVV regardless the extent of FDG vascular uptake in baseline PET/CT scan. However, a trend to a slower clinical response was observed in patients with ≥3 affected areas.

References:

[1]Martínez-Rodríguez et al. (18)F-FDG PET/CT in the follow-up of large-vessel vasculitis: A study of 37 consecutive patients. Semin Arthritis Rheum.2018 Feb;47(4):530-537. doi: 10.1016/j.semarthrit.2017.08.009.

[2]Loricera et al. Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review. Clin Exp Rheumatol. 2015 Mar-Apr; 33(2 Suppl 89): S-19-31

[3]Calderón-Goercke M et al. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum. 2019 Aug; 49(1):126-135. doi: 10.1016/j.semarthrit.2019.01.003

[4]González-Gay MA et al. Current and emerging diagnosis tools and therapeutics for giant cell arteritis. Expert Rev Clin Immunol. 2018 Jul;14(7):593-605. doi: 10.1080/1744666X.2018.1485491.

[5]Loricera et al. Tocilizumab in patients with Takayasu arteritis: a retrospective study and literature review. Clin Exp Rheumatol. 2016 May-Jun;34(3 Suppl 97): S44-53.

Disclosure of Interests:

D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Isabel Martínez-Rodríguez: None declared, Jose Ignacio Banzo: None declared, Patricia Vicente-Gómez: None declared, Javier García-Fernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD

THU0297 SERIOUS INFECTIONS IN 134 PATIENTS WITH GIANT CELL ARTERITIS WITH TOCILIZUMAB IN CLINICAL PRACTICE. FREQUENCY, TYPE AND CLINICAL ASSOCIATIONS

Background:

Infections are the most common adverse event of Tocilizumab (TCZ) in Giant Cell Arteritis (GCA). In GiACTA study(1),serious infections were observed in 7% (9.6/100 patient-years) of patients who received TCZ weekly. Randomized clinical trials (RCTs) are conducted under highly standardized design excluding some real-world patients. Therefore, adverse events may be underestimated in RCTs. In our series of real-life, serious infections occurred in 11.9% (10.6/100 patient-years)(2).

Objectives:

In a wide series of GCA of clinical practice treated with TCZ, we assess the frequency, type and predisposing factors of serious infections.

Methods:

Multicenter study of 134 patients diagnosed with GCA, all of them refractory to conventional therapy, treated with TCZ. Serious infection was considered when a life-threatening infection, fatal, or requiring hospitalization occurred, intravenous antibiotics were required, or the infectious process led to persistent or significant disability.

Results:

16 of 134 (11.9%, 10.6/100 patient-years) patients developed serious infections during follow-up. The most frequent infections were pneumonia (n=4), urinary tract infection (n=4), and facial herpes zoster (n=2). At TCZ onset, serious infections were more frequent in older patients (74.3±9.6 vs 72.9±8.7 years), with a longer GCA evolution (20 [4.3-45.6] vs 13 [5-29.3] months), with visual manifestations (43.75% vs 17.8%) and a higher dose of prednisone at TCZ onset (30.4±15.5 vs 21.1±16.1 mg/day) (TABLE). Presence of comorbidities were similar in both groups. 13 of the 16 patients who had infections received a dose of prednisone greater than 15 mg/day (16.3/100 patient-years) compared to 3 patients under treatment with less than 15 mg/day of prednisone (4.2/100 patient-years).

Conclusion:

The age, GCA duration, ocular involvement and the dose of glucocorticoids, at TCZ onset, seem to be predisposing factors related to an increased risk of developing serious infections in GCA patients.

References:

[1]Stone JH, et al. N Engl J Med. 2017; 377:317-28.

[2]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135.

TABLESERIOUS INFECTIONS(n=16)WITHOUT SERIOUS INFECTIONS(n=118)pBASAL FEATURES AT TCZ ONSETGENERAL FEATURES Age, years, mean± SD74.3±9.672.9±8.70.552 Sex, female/male n(%)13/388/300.760 Time from GCA diagnosis to TCZ onset (months), median [IQR]20[4.3-45.6]13[5-29.3]0.604COMORBIDITIES Hypertension, n(%)9(56)86(73)0.551 Diabetes, n(%)3(19)39(33)0.677 Chronic kidney disease, n(%)3(19)27(23)0.512CLINICAL FEATURES OF GCA PMR, n(%)9(56.25)64(54.2)0.879 Aortitis, n(%)5(31.25)53(45)0.301 Visual manifestations, n(%)7(43.75)21(17.8)0.017CORTICOSTEROIDS AT TCZ ONSET Prednisone dose mg/d, mean (SD)30.4±15.521.1±16.10.031

Disclosure of Interests:

Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, 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), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, Carmen González-Vela: None declared, Javier García-Fernández: None declared, Patricia Vicente-Gómez: None declared, Ángel García-Manzanares: None declared, Norberto Ortego: None declared, Francisco Ortiz-Sanjuán: None declared, Montserrat Corteguera: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

THU0311 CERTOLIZUMAB THERAPY IN REFRACTORY UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES (IMID). MULTICENTER STUDY OF 39 PATIENTS

Background:

Infliximab and adalimumab therapy has significantly improved the prognosis of patients with non-infectious refractory uveitis. However, there is not enough evidence for the use of other anti-TNF drugs such as Certolizumab Pegol (CZP).

Objectives:

To evaluate the efficacy and safety of CZP in uveitis secondary to Immune-Mediated Inflammatory Diseases (IMID).

Methods:

Multicenter study of 39 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants. Efficacy of CZP was evaluated with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, macular thickness and presence of retinal vasculitis. Efficacy of CZP was compared between baseline, 1st week, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with the STATISTICA software (Statsoft Inc. Tulsa, Oklahoma, USA).

Results:

39 patients/56 affected eyes (18 men/21 women) with a mean age of 40.5±11.9 years were studied. IMIDs included were: spondyloarthritis (n=17), psoriatic arthritis (6), Crohn (3), JIA (2), Behçet (2), reactive arthritis (2), rheumatoid arthritis (1), relapsing polychondritis (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (3). Uveitis pattern was as follows: anterior (n=30), posterior (4), panuveitis (3) and intermediate (2).

Previous CZP, patients received: oral prednisone (n=18) methylprednisolone bolus (1), methotrexate (22), azathioprine (10), cyclosporine (4), leflunomide (2), mycophenolate mofetil (2) and cyclophosphamide (1). 77% of patients had received previous biological therapy, with a mean of 1.6±1.2 biological drugs per patient. Gestational desire was the reason for prescribing CZP in 8 patients. CZP was administered in monotherapy in 16 patients and in the remaining 23 patients combined with conventional immunosuppressants.

After a median follow-up of 24 [6-36] months, most of the ocular variables analysed showed a rapid and significantly sustained improvement (Table). CZP was discontinued in 11 patients for the following reasons: remission (n=1), insufficient response of ocular symptoms (n=1) and limited response of extraocular manifestations (n=9). No serious adverse effects were reported.

Conclusion:

CZP seems to be effective and safe in patients with refractory uveitis due to IMID.

TableBaseline1stweek1stMonth6thMonth1styear2ndyearBCVA (mean±SD)0.77±0.290.77±0.30*0.82±0.29*0.85±0.26*0.86±0.27*0.88±0.23*Tyndall (median [IQR])0 [0-2]0 [0-2]0 [0-1]*0 [0-0]*0 [0-0]*0 [0-0]*OCT (mean±SD)355±61.5-284.1±40.4*-224.8±121.1*-Retinal Vasculitis (eyes affected, %)2 (3.6)0 (0)0 (0)0 (0)0 (0)0 (0)

*p<0.05

Disclosure of Interests:

José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Iñigo González-Mazón: None declared, Ignacio Torre-Salaberri: None declared, Álvaro García Martos: None declared, Amalia Sanchez-Andrade: None declared, Ángel García-Aparicio: None declared, JR De Dios-Jiménez Aberásturi: None declared, ANA URRUTICOECHEA-ARANA: None declared, Olga Maíz: None declared, Raul Veroz Gonzalez: None declared, Andrea García-Valle: None declared, Sergio Rodríguez Montero: None declared, Roberto Miguélez: None declared, Vega Jovani: None declared, Marisa Hernández-Garfella: None declared, Arantxa Conesa: None declared, Olga Martínez González: None declared, Paula Rubio Muñoz: None declared, Belén Atienza-Mateo: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

SAT0014 ENDOTHELIAL PROGENITOR CELLS: ROLE IN ENDOTHELIAL DAMAGE OF INTERSTITIAL LUNG DISEASE ASSOCIATED TO RHEUMATOID ARTHRITIS

Background:

Interstitial lung disease (ILD) is one of the most significant comorbidities of rheumatoid arthritis (RA), increasing the mortality in these patients [1,2]. Although the pathogenesis of ILD associated to RA (RA-ILD+) remains poorly defined [1], it is known that vascular tissue plays a crucial role in lung physiology [3]. In this context, a population of cells termed endothelial progenitor cells (EPC) are involved in vasculogenesis and endothelial tissue repair [4]. Previous reports suggest the implication of EPC in different conditions such as RA and idiopathic pulmonary fibrosis (IPF), the most common and destructive ILD [5,6]. Nevertheless, little is known about their specific role in RA-ILD+.

Objectives:

The purpose of this study was to shed light on the potential role of EPC in endothelial damage in RA-ILD+.

Methods:

Peripheral venous blood was collected from a total of 68 individuals (18 with RA-ILD+, 17 with RA-ILD-, 19 with IPF and 14 healthy controls). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of EPC was analyzed by the expression of surface antigens by flow cytometry. The combination of antibodies against the stem cell marker CD34, the immature progenitor marker CD133, the endothelial marker VEGF receptor 2 (CD309) and the common leukocyte antigen CD45 was used. EPC were considered as CD34+, CD45Low, CD309+and CD133+. All statistical analyses were performed using Prism software 5 (GraphPad).

Results:

EPC frequency was significantly increased in patients with RA-ILD+, RA-ILD-and IPF compared to controls (p=0.001, p=0.002, p< 0.0001, respectively). Nevertheless, patients with RA, both RA-ILD+and RA-ILD-, showed a lower frequency of EPC than those with IPF (p= 0.048, p= 0.006, respectively).

Conclusion:

Our results provide evidence for a potential role of EPC as a reparative compensatory mechanism related to endothelial damage in RA-ILD+, RA-ILD-and IPF patients. Interestingly, EPC frequency may help to establish a differential diagnostic between patients with IPF and those who have an underlying autoimmune disease (RA-ILD+).

References:

[1] J Clin Med 2019; 8: 2038;

[2] Arthritis Rheumatol 2015; 67: 28-38;

[3] Nat Protoc 2015; 10: 1697-1708;

[4] Science 1997; 275: 964-966;

[5] Rheumatology (Oxford) 2012; 51: 1775-1784;

[6] Angiogenesis 2013; 16: 147-157.

Acknowledgments:

Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: PI18/00042 (ISCIII-ERDF); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests:

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Sonia Fernández-Rozas: None declared, Leticia Lera-Gómez: None declared, Pilar Alonso Lecue: None declared, Javier Rodriguez Carrio: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, David Merino: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD, Alfonso Corrales Speakers bureau: Abbvie, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

SAT0568 PERSISTENT VASCULAR 18F-FDG UPTAKE DESPITE CLINICAL-ANALYTICAL REMISSION IN PATIENTS WITH LARGE VESSEL VASCULITIS UNDER TOCILIZUMAB THERAPY. SINGLE UNIVERSITARY CENTER EXPERIENCE OF 30 PATIENTS

Background:

Tocilizumab (TCZ) has shown efficacy in large vessel vasculitis (LVV)(1-3). Disease activity assessed by laboratory markers (ESR,CRP) may be of less value with TCZ.18F-FDG PET/CT may be useful to monitor LVV disease activity(4-5).

Objectives:

To assessa) evolution of disease activity in LVV treated with TCZ by PET/CT andb) its correlation with clinical/serological markers.

Methods:

Single centre study of 30 patients with refractory LVV treated with TCZ who had a baseline and follow-up PET/CT scan. Vascular uptake was assessed quantitatively and qualitatively. Quantitative analysis was assessed as a target to background ratio (TBR)=SUVmax thoracic aorta/SUVmax aortic vascular pool. For qualitative analysis, FDG uptake at vessel wall was visually grading compared to the liver. We defined a total vascular score which included 5 vascular areas (supra aortic trunks, thoracic, abdominal, iliac and femorotibial arteries) ranging from 0 to 15. Clinical improvement (no improvement/partial/complete), analytical (CRP mg/dL; ESR mm/1sthour) and reduction of prednisone dose (mg/day) were also assessed.

Results:

30 patients (24 w/6 m); mean age 65.3 ± 10.6 yrs. TCZ was started after 6.5 [2.0-20.0] months from LVV diagnosis. Most patients received TCZ as intravenous infusions (70%) and almost half of them (46.7%) received combined therapy with MTX. Clinical/analytical evolution and quantitative/qualitative uptake assessment is shown inTABLE. After a mean follow-up of 37.0±18.5 months, 92.3% of patients experienced complete clinical/analytical improvement. Complete quantitative normalization of vascular uptake (TBR< 1.34) was achieved in 30.8%. Qualitatively, 23.1% of patients showed normalization (total vascular score =0) at the end of the study period.

Conclusion:

Most patients with LVV under TCZ experienced rapid and effective clinical and analytical response. Decrease of vascular uptake was also observed both quantitatively and qualitatively assessed. However, complete normalization of vascular uptake despite clinical remision was only observed in less than one-third of patients.

TABLE.Basal(n=30)6 months(n=9)12-18 months(n=21)>18 months(n=13)Clinical improvementComplete,n (%)7 (77.8)16 (76.2)12 (92.3)Laboratory markersESR (mm/1sth),median [IQR]24.0 [9.8-53.0]2.0 [2.0-3.0] *2.0 [2.0-4.0] *2.0[2.0-3.5] *CRP (mg/dL),median [IQR]1.5 [0.5-2.4]0.1 [0.1-0.2] *0.1 [0.1-0.1] *0.1 [0.1-0.1] *ESR/CRP normalization, n(%)9 (100)21 (100)13 (100)FDG vascular uptakeTBR,mean ± SD1.69 ± 0.521.56±0.41 *1.46±0.16 *1.40 ± 0.18 *Total vascular score,mean ± SD5.0 ± 2.63.7 ± 2.23.3 ± 1.7*2.7 ± 2.4*Quantitative normalization, n(%)4 (44.4)5 (23.8)4 (30.8)Qualitative normalization, n(%)1 (11.1)1 (4.8)3 (23.1)

*test Wilcoxon: p < 0.05. Quantitative normalization when TBR <1.34. Qualitative normalization when total vascular score =0.

References:

[1]Calderón-Goercke M et al. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum. 2019 Aug; 49(1):126-135. doi: 10.1016/j.semarthrit.2019.01.003.

[2]Loricera et al. Tocilizumab in patients with Takayasu arteritis: a retrospective study and literature review. Clin Exp Rheumatol. 2016 May-Jun;34(3 Suppl 97): S44-53.

[3]González-Gay MA et al. Current and emerging diagnosis tools and therapeutics for giant cell arteritis. Expert Rev Clin Immunol. 2018 Jul;14(7):593-605. doi: 10.1080/1744666X.2018.1485491.

[4]Martínez-Rodríguez et al. (18)F-FDG PET/CT in the follow-up of large-vessel vasculitis: A study of 37 consecutive patients. Semin Arthritis Rheum.2018 Feb;47(4):530-537. doi: 10.1016/j.semarthrit.2017.08.009.

[5]Loricera et al. Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review. Clin Exp Rheumatol. 2015 Mar-Apr; 33(2 Suppl 89): S-19-31.

Disclosure of Interests:

D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Isabel Martínez-Rodríguez: None declared, Jose Ignacio Banzo: None declared, Javier García-Fernández: None declared, Patricia Vicente-Gómez: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD

THU0217 UPADACITINIB MONOTHERAPY IN METHOTREXATE-NAÏVE PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS AT 72 WEEKS FROM SELECT-EARLY

Background:

Upadacitinib (UPA), an oral JAK inhibitor, demonstrated significant improvements in signs, symptoms, and structural inhibition as monotherapy vs methotrexate (MTX) in a randomized, controlled trial (RCT) of MTX-naive RA patients (pts) through 48 weeks (wks).1

Objectives:

To present the safety and effectiveness of UPA through 72 wks in an ongoing long-term extension (LTE) of the SELECT-EARLY RCT.

Methods:

SELECT-EARLY included 2 study periods: (1) a 48-wk double-blind, active comparator-controlled, with pts randomized to UPA monotherapy 15 or 30 mg once daily or MTX (titrated to 20 mg/wk by Wk8); (2) an LTE, up to 4 years. Pts received open-label treatment once the last pt reached Wk48. Rescue therapy was added (MTX, for UPA groups; UPA, for MTX group) to pts not achieving CDAI remission (≤2.8) at Wk26. Non-responder imputation (NRI) was used for missing data as well as for pts receiving rescue therapy. Treatment-emergent adverse events (TEAEs) are summarized per 100 pt yrs (PY) through the cut-off date of 21 Feb 2019, when all pts had reached Wk72. Data are censored at the time of MTX or UPA addition among rescued patients.

Results:

Of 945 pts randomized and treated, 781 (83%) completed Period 1. Of these, 775 entered the LTE, including 57 rescued pts (MTX, 33; UPA 15 mg, 17; UPA 30 mg, 7). A total of 52 (7%) pts discontinued during the LTE through the cut-off date (primary reasons: AEs [n=16, 2.1%]; consent withdrawal [n=12, 1.5%]; lost to follow-up [n=10, 1.3%]). Cumulative exposures to monotherapy with MTX, UPA 15 mg, and UPA 30 mg were 350.6, 389.5, and 383.9 PYs, respectively. Both UPA 15 mg and 30 mg as monotherapy was associated with continued statistically significant improvements in disease activity measures vs MTX monotherapy through 72 wks (Table). The safety profiles of the UPA 15 and 30 mg groups were comparable for total TEAEs and numerically higher than MTX. Serious TEAEs and TEAEs leading to discontinuation of study drug were comparable across all groups (Figure). Most AEs of special interest were comparable across MTX and UPA groups, with the exception of higher rates of herpes zoster, opportunistic infections, and elevated creatine phosphokinase among the UPA groups. Two pts receiving MTX monotherapy experienced a venous thromboembolic event, with one event reported on UPA 30 mg and none on UPA 15 mg. There were 12 deaths (including 3 non-treatment-emergent) due to varied causes.

Table.

Proportion of Patients at Week 72 (NRI)

Parameter (%)MTXMonotherapyUPA 15 mg QDMonotherapyUPA 30 mg QDMonotherapyACR20/50/7050/39/2671***/62***/47***72***/67***/54***DAS28(CRP) ≤3.2/<2.638/2863***/52***69***/61***CDAI ≤10/≤2.842/1960***/35***69***/44***Boolean Remission1329***33***

***,P<0.001 for differences between MTX and UPA 15 and UPA 30 mg groups.

MTX, methotrexate; UPA, upadacitinib; QD, once daily; ACR, American College of Rheumatology; DAS28(CRP), 28-joint disease activity index based on C-reactive protein; CDAI, clinical disease activity index.

Figure.

Treatment-emergent Adverse Events Through ≥72 Weeks (E/100 PYs, 95% CI).

Conclusion:

Long-term UPA monotherapy was associated with continued improvements in RA signs and symptoms vs MTX monotherapy through 72 wks, and only a small proportion of pts required MTX addition at Wk26. Through 72 wks of treatment, the safety profile of UPA monotherapy remained consistent with data reported through 48 wks.1

References:

[1]van Vollenhoven R,et al.Ann Rheum Dis2019;78(S):376.

Disclosure of Interests: :

Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, Tsutomu Takeuchi Grant/research support from: Eisai Co., Ltd, Astellas Pharma Inc., AbbVie GK, Asahi Kasei Pharma Corporation, Nippon Kayaku Co., Ltd, Takeda Pharmaceutical Company Ltd, UCB Pharma, Shionogi & Co., Ltd., Mitsubishi-Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co. Ltd., Consultant of: Chugai Pharmaceutical Co Ltd, Astellas Pharma Inc., Eli Lilly Japan KK, Speakers bureau: AbbVie GK, Eisai Co., Ltd, Mitsubishi-Tanabe Pharma Corporation, Chugai Pharmaceutical Co Ltd, Bristol-Myers Squibb Company, AYUMI Pharmaceutical Corp., Eisai Co., Ltd, Daiichi Sankyo Co., Ltd., Gilead Sciences, Inc., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi K.K., Dainippon Sumitomo Co., Ltd., Maureen Rischmueller Consultant of: Abbvie, Bristol-Meyer-Squibb, Celgene, Glaxo Smith Kline, Hospira, Janssen Cilag, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche, Mark Howard Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Alan Friedman Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB

SAT0512 OCULAR INVOLVEMENT AND TREATMENT IN SARCOIDOSIS. STUDY OF 41 PATIENTS OF A SERIES OF 383 PATIENTS FROM A SINGLE UNIVERSITY HOSPITAL

Background:

The eye is a common and potential severe complication of sarcoidosis. Topical and systemic corticosteroids are the first-line treatment. Conventional and biological immunosuppressants (IS) are frequently needed(1-5).

Objectives:

To assess the frequency, clinical and treatment of ocular involvement of sarcoidosis.

Methods:

Study of a large cohort (n=383) of systemic sarcoidosis from a single university hospital. All consecutive patients diagnosed with sarcoidosis from January 1,1999 to January 1,2019 according the ATS/ERS/WASOG criteria(Eur Respir J 1999;14:735–737) were included.

Results:

41 (22 women/19 men) of 383 (10.7%) patients had ocular involvement, mean age 44.8±16 years. Uveitis (n=34; 82.9%) was the most common ocular manifestation, especially anterior uveitis (n=18; 52.9%). Ocular surface and eye orbit may also be affected(Table). In addition to topical and systemic corticosteroids, conventional (n=23; 56.1%) and biologic (n=14; 34.1%) IS drugs were required. Adalimumab and Infliximab were the most used biologic treatments(Table).Cystoid macular edema (CME) and Retinal Vasculitis was observed in both cases in 3 (7.3%) patients, 2 of them (66.7%) required biological treatment. Papilitis appeared in 7 (17.1%) cases, biological treatment was needed in 3 (42.9%) patients. The most frequent sequels were cataract (n=9, 21.9%), intraocular hypertension (n=5; 12.2%) and pupil alterations (n=4; 9.7%). The average of the best corrected visual acuity was 0.6±0.3 at diagnosis and 0.7±0.3 after one year follow up.

Conclusion:

Ocular involvement of sarcoidosis is a relative frequent and potential severe complication, especially if panuveitis is presented.

References:

[1]Riancho-Zarrabeitia L, et al. Semin Arthritis Rheum. 2015; 45:361-8.

[2]Calvo-Río V, et al. Clin Exp Rheumatol. 2014; 32:864-8.

[3]Riancho-Zarrabeitia L, et al. Clin Exp Rheumatol. 2014; 32:275-84.

[4]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94.

[5]Calvo-Río V, et al. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7.

Table.

Ocular manifestations of sarcoidosis and treatment with corticosteroids, conventional and biological IS.

CONVENTIONAL ISBIOLOGICAL ISOCULAR INVOLVEMENTCasesTCSOCSMD of OCSIVMPCISMTXAZACFMMMFBTADAIFXTCZGLMETNSURFACE n(%)3(7.3)2(66.7)2(66.7)2(66.7)2(66.7)2(66.7)2(66.7)1(33.3)0(0)2(66.7)2(66.7)2(66.7)0(0)0(0)0(0)-CG/N, n(%)1(33.3)1(100)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)-PUK, n(%)2(66.7)1(50)2(100)602(100)2(100)2(100)2(100)1(50)0(0)2(100)2(100)2(100)0(0)0(0)0(0)UVEITIS n(%)34(82.9)25(73.5)28(82.3)10(29.4)19(55.6)18(52.9)7(20.6)1(2.9)1(2.9)12(35.3)11(32.3)4(11.8)3(8.8)2(5.9)1(2.9)-Anterior uveítis, n(%)18(52.9)11(61.1)13(72.2)301(5.5)5(27.8)5(27.8)1(5.5)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)-Posterior uveítis, n(%)4(11.7)2(50)3(75)601(25)3(75)2(50)2(50)0(0)0(0)2(50)1(25)0(0)0(0)1(25)0(0)-Panuveítis, n(%)12(35.3)12(100)12(100)608(66.7)11(91.7)11(91.7)4(33.3)1(8.3)1(8.3)10(83.3)10(83.3)4(33.3)3(25)1(8.3)1(8.3)EYE ORBIT n(%)4(9.7)2(50)3(75)2(50)2(50)2(50)2(50)0(0)0(0)2(50)1(25)1(25)1(25)0(0)0(0)-Proptosis, n(%)2(50)1(50)1(50)301(50)1(50)1(50)1(50)0(0)0(0)1(50)1(50)0(0)1(50)0(0)0(0)-Strabismus, n(%)2(50)1(50)2(100)601(50)1(50)1(50)1(50)0(0)0(0)1(33.3)0(0)1(33.3)0(0)0(0)0(0)TOTAL, n(%)41(100)29(70.7)33(80.5)50±15.514(34.1)23(56.1)22(53.7)11(26.9)2(4.9)1(2.4)14(34.1)14(34.1)7(17.5)3(7.3)2(4.9)1(2.4)

TCS:topical corticosteroids;OCS:oral corticosteroids;MD:maximum dose;IVMP:intravenous methylprednisolone;CIS: conventional immunossupresors;BT:biologic therapy;CG/N:conjunctival granuloma/nodule;PUK:peripheral ulcerative keratitis

Disclosure of Interests:

Monica Calderón-Goercke: None declared, Jorge Javier Gaitán-Valdizán: None declared, Raúl Fernández-Ramón: None declared, Lara Sánchez-Bilbao: None declared, Rosalía Demetrio-Pablo: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

FRI0477 SYSTEMIC TREATMENT IN SARCOIDOSIS. STUDY OF 377 PATIENTS FROM A SINGLE UNIVERSITY HOSPITAL

Background:

Sarcoidosis is a multisystemic disease characterized by the formation of non-necrotizing granulomas. The most frequently affected organs are lungs, skin and eyes. Systemic corticosteroids are the most used drugs in the treatment of this disease. Conventional and biological immunosuppressants (IS) may also be used(1-3).

Objectives:

To evaluate the systemic treatment of sarcoidosis according to clinical domains.

Methods:

Study of all consecutive patients diagnosed with sarcoidosis between 1/1/1999 and 1/1/2019 in a tertiary university hospital. The diagnosis was established following the ATS/ERS/WASOG criteria(Eur Respir J. 1999;14(4):735-737):compatible clinical and radiological presentation, evidence of non-caseifying granulomas and exclusion of other granulomatous diseases.

Results:

We studied 377 patients (188 men/189 women), mean age at diagnosis of 46.0±14.8 years. After a mean follow-up of 13.0±9.3 years, 161 (42.7%) patients did not require treatment. The remaining 216 (57.3%) received oral glucocorticoids (206, 54.6%) with a maximum mean dose of 43.2±19.0 mg/day, conventional IS (60, 16.2%), biological therapy (28, 7.4%) and/or endovenous methylprednisolone (15, 4.0%). Biological therapy was indicated by pulmonary (9, 32.1%), ocular (9, 32.1%), neurological (3, 10.7%), muskuloeskeletal (3, 10.7%), cutaneous (2, 7.1%), nephrological involvement (1, 3.6%); and Heerfordt’s syndrome (1, 3.6%). Adalimumab and Infliximab were the biologics used more frequently (Table).

TABLE

Systemic treatment of sarcoidosis according to clinical domains.

Conclusion:

Compared to other studies, the high percentage of patients who required systemic treatment is remarkable. It also highlights the frequency of the use of biological drugs in more severe organ involvement (ocular and neurological), which is consistent with the trend in recent years.

References:

[1]Riancho-Zarrabeitia L, et al. Semin Arthritis Rheum. 2015; 45:361-8.

[2]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94.

[3]Calvo-Río V, et al.. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7.

Disclosure of Interests:

Monica Calderón-Goercke: None declared, Raúl Fernández-Ramón: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Lara Sanchez-Bilbao Grant/research support from: Pfizer, David Martínez-López: None declared, Iñigo González-Mazón: None declared, Jorge Javier Gaitán-Valdizán: None declared, Rosalía Demetrio-Pablo: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

OP0106 SECUKINUMAB 150 MG SIGNIFICANTLY IMPROVED SIGNS AND SYMPTOMS OF NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 52-WEEK RESULTS FROM THE PHASE III PREVENT STUDY

Background:

Axial spondyloarthritis (axSpA) spectrum covers radiographic axSpA and non-radiographic axSpA (nr-axSpA). PREVENT (NCT02696031) is the first phase III, placebo (PBO) controlled study evaluating secukinumab (SEC) 150 mg with (LD) or without loading (NL) dose, in patients (pts) with nr-axSpA.1The study had 2 independent analysis plans as per EU (Wk 16) and US (Wk 52) regulatory requirements.

Objectives:

To report efficacy through Wk 52 and safety up to two years for the PREVENT study.

Methods:

555 pts fulfilling ASAS criteria for axSpA plus abnormal CRP and/or MRI, without evidence of radiographic changes in sacroiliac (SI) joints according to modified New York Criteria for AS were enrolled. All images were assessed centrally before inclusion. Pts were randomised (1:1:1) to SEC 150 mg with LD, NL, or PBO at baseline (BL). LD pts received SEC 150 mg at Wks 1, 2, 3, and 4, and then every 4 wks (q4wk) starting at Wk 4. NL pts received SEC 150 mg at BL and PBO at Wks 1, 2, and 3, and then 150 mg q4wk. Switch to open-label (OL) SEC 150 mg or standard of care (SoC) was permitted after Wk 20. Primary endpoint was ASAS40 at Wk 16 (LD) and at Wk 52 (NL) in anti-TNF-naïve pts. Secondary endpoints (overall population) included ASAS40, BASDAI50, SI joint bone marrow edema (BME) score by MRI at Wks 16 and 52 and ASDAS-CRP inactive disease (ID) at Wk 52. Endpoints were analysed according to statistical hierarchy. Analysis used non responder imputation through Wk 52. Safety analyses included all pts who received ≥1 dose of study treatment.

Results:

Overall, 481 pts completed 52 wks with no major differences in retention across groups: 84.3% (156/185; LD), 89.7% (165/184; NL) and 86.0% (160/186; PBO). BL characteristics were similar across groups; 90% pts were anti-TNF-naïve, 56-58% pts had elevated CRP, 71-75% pts had evidence of SI joint inflammation by MRI. Proportion of pts who switched to OL or SoC between Wks 20 and 48 was 52.1% (LD), 49.2% (NL), and 67.4% (PBO). Primary endpoints at Wk 16 and Wk 52 were met (Table). SEC 150 mg LD or NL significantly improved secondary endpoints at Wk 16 and 52 vs PBO (Table). SEC significantly reduced SI joint MRI BME score vs PBO at Wk 16 (-1.68 and -1.03 vs -0.39;P= 0.0197 and 0.026, LD and NL respectively). No unexpected safety signals were reported.

Conclusion:

SEC 150 mg provided significant and sustained improvement in signs and symptoms of pts with nr-axSpA through Wk 52. MRI BME scores were reduced accordingly. There was no major difference between LD and NL. Safety of SEC was consistent with previous reports.2

References:

[1]Deodhar A, et al.Arthritis Rheumatol. 2019;71(suppl 10).

[2]Deodhar A, et al. Arth Res Ther. 2019;21:111.

TableEndpoints, % respondersWkSEC150 mg LD(N = 185)SEC150 mg NL(N = 184)PBO(N = 186)PrimaryASAS40 in anti-TNF-naïve pts1641.5‡42.2‡29.25235.4‡39.8‡19.9SecondaryASAS401640.0‡40.8‡28.05233.5‡38.0‡19.4BASDAI501637.3‡37.5‡21.05230.8‡35.3‡19.9ASDAS-CRP ID1620.5†21.7†8.15215.723.9‡10.2

†P< 0.001;‡P< 0.05 vs PBO (Pvalues are adjusted for multiplicity of testing at Wks 16 and 52. UnadjustedPvalue for ASDAS-CRP ID at Wk 16). Missing values were imputed as non-response.

N, number of randomised pts

Disclosure of Interests:

Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD, Eva Dokoupilova Grant/research support from: Eli Lilly, AbbVie, Novartis, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB, Alan Kivitz Shareholder of: AbbVie, Amgen, Gilead, GSK, Pfizer Inc, Sanofi, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Genzyme, Gilead, Janssen, Novartis, Pfizer Inc, Regeneron, Sanofi, SUN Pharma Advanced Research, UCB, Paid instructor for: Celgene, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, Horizon, Merck, Novartis, Pfizer Inc, Regeneron, Sanofi, Stephen Hall Grant/research support from: Abbvie, UCB, Janssen, Merck, Hideto Kameda Grant/research support from: Abbvie, Asahi-Kasei, Chugai, Eisai, Mitsubishi-Tanabe and Novartis, Consultant of: Abbvie, Boehringer, Celgene, Eli Lilly, Janssen, Novartis, Sanofi, UCB, Speakers bureau: Abbvie, Asahi-Kasei, BMS, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Novartis and Pfizer, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Marleen van de Sande Grant/research support from: Novartis, Eli Lilly, Boehringer Ingelheim, Janssen, Consultant of: Abbvie, Novartis, Eli Lilly, Speakers bureau: Novartis, MSD, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Anna Wiksten Shareholder of: Novartis, Employee of: Novartis, Brian Porter Shareholder of: Novartis, Employee of: Novartis, Hanno Richards Shareholder of: Novartis, Employee of: Novartis, Sibylle Haemmerle Shareholder of: Novartis, Employee of: Novartis, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB

AB0458 SYSTEMIC TREATMENT IN BEHÇET’S DISEASE ACCORDING TO CLINICAL PHENOTYPES. STUDY OF 111 PATIENTS

Background:

Behçet’s disease (BD) is a multisystemic vasculitis. Different clinical phenotypes can be distinguished. Systemic corticosteroids are the most used drugs in BD. Conventional and biological immunosuppressants (IS) may also be used.

Objectives:

To evaluate the systemic treatment of BD according to clinical domains.

Methods:

Study of all consecutive 111 patients diagnosed with definitive or possible BD by expert rheumatologists in a well-defined population of Northern Spain, between 1980 and 2019. Most of them met the International Criteria for BD (ICBD) (1).

Results:

We studied 111 patients (62 women/49 men), mean age at diagnosis 36.8±13.2 years. After a mean follow-up of 81.4±85 months, all patients required systemic treatment (TABLE 1-2).Biological therapy (n=28) was indicated by ocular manifestations (n=13; 46.4%) persistent, severe and refractory oral ulcers (n=10, 35.7%), neurological (n=2; 7.1%), musculoskeletal (n=2; 7.1%) or cutaneous involvement (1; 3.6%). Adalimumab and Infliximab were the biological therapy more frequently used.

TABLE.CLÍNICALPHENOTYPESCases N (%)COLCHCOSDosis total ISAZAMTXCYAMMFTLDAPRDAPOral ulcers110 (99.1)85 (77.9)81 (73.6)51 (46.4)30 (27.3)25 (22.7)14 (12.7)2 (1.8)6 (5.5)6 (5.5)3 (2.7)Genital ulcers69 (62.2)56 (81.2)51 (74)32 (46.4)17 (24.6)16 (23.2)10 (14.5)1 (1.5)5 (7.2)2 (3.4)3 (4.3)Cutaneous lesions76 (68.5)58 (76.3)61 (80.3)52 (68.4)32 (42.1)22 (29)9 (11.8)05 (6.6)6 (7.9)3 (4)Ocular manifestations39 (35.1)27 (69.2)36 (92.3)19 (48.7)17 (43.6)12 (30.8)11 (28.2)2 (5.1)4 (10.3)2 (5.1)2 (5.1)Neurological involvement20 (18)12 (60)15 (75)15 (75)3 (15)4 (20)3 (15)1 (5)001 (5)Vascular manifestations11 (10)8 (72.7)9 (81.8)5 (45.5)3 (27.3)3 (27.3)1 (9.1)0000Gastrointestinal involvement4 (3.6)2 (50)1 (25)1 (25)1 (25)000000TOTAL11185 (76.6)85 (76.6)51 (46)30 (27)25 (22.5)14 (12.6)2 (1.8)6 (5.4)6 (5.4)3 (2.7)

Conclusion:

Most patients with BD required oral corticosteroids and colchicine. Almost half required conventional IS. Up to a third required biologic therapy, especially by ocular involvement. Most patients had clinical improvement.

References:

[1]Criteria for diagnosis of Behcet’s disease, International Study Group for Behçet’s Disease,The Lancet, Volume 335, Issue 8697, 1078 – 1080

TABLE 2.CLINICALPHENOTYPESBTADAIFXETNTCZNo improvementPartial improvementComplete responseOral ulcers28 (35.5)22 (20)12 (11)3 (2.7)2 (1.8)22 (20)22 (20)66 (60)Genital ulcers17 (24.7)13 (18.8)8 (11.6)2 (2.9)1 (1.4)16 (23.2)12 (17.4)41 (59.4)Cutaneous lesions21 (27.6)18 (23.7)8 (10.5)3 (4)2 (2.6)8 (10.5)19 (25)49 (64.5)Ocular manifestations19 (50)16 (42.1)9 (23.7)1 (2.6)2 (5.3)08(21)30 (79)Neurological involvement7 (35)2 (10)4 (20)1 (5)03 (15)5 (25)12 (60)Vascular manifestations4 (36.4)3 (27.3)2 (18.2)1 (9.1)1 (9.1)2 (18.2)4(36.4)5 (45.5)Gastrointestinal involvement000001 (25)1 (25)2 (50)TOTAL28 (25.2)22 (19.8)12 (10.8)3 (2.7)2 (1.8)22 (19.8)22 (19.8)67 (60.4)

Abbreviations: COLCH: Colchicine; OCS: Oral Corticosteroids; IS: Immunosuppressants; AZA: Azathioprine; MTX: Methotrexate; CYA: Cyclosporine A; MMF: Mycophenolate Mofetil; TLD: Talidomide; APR: Apremilast; DAP: Dapsone; BT: Biologic Therapy; ADA: Adalimumab; IFX: Infliximab; ETN: Etanercept; TCZ: Tocilizumab

Disclosure of Interests:

Carmen Alvarez Reguera: None declared, David Martínez-López: None declared, Lara Sanchez Bilbao: None declared, Alba Herrero Morant: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Guillermo Suárez Amorín: None declared, Patricia Setien Preciados: None declared, M. Cristina Mata Arnaiz: None declared, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

SAT0508 DIAGNOSIS OF BEHÇET’S DISEASE: COMPARISON OF TWO SETS OF CLASSIFICATION CRITERIA. APPLICATION IN 111 PATIENTS OF A WELL-DEFINED POPULATION

Background:

Behçet’s disease (BD) is a systemic, chronic, relapsing vasculitis with no pathognomonic diagnostic test. The most widely used classification criteria are those of the International Study Group (ISG) for BD (1). These criteria were repeatedly found to have low sensitivity. Therefore, the International Criteria for Behçet’s Disease (ICBD) were published in 2014 (2).

Objectives:

To compare the ISG with ICBD diagnostic criteria for BD.

Methods:

The study included all consecutive 111 patients diagnosed with definitive or possible BD by expert rheumatologists. They were diagnosed at a well-defined population in Northern Spain between 1980 and 2019. The ISG and ICBD diagnostic criteria for BD were applied to and compared among all patients.

Results:

We studied 111 patients (62 Women/49 Men), mean age 36.8±13.2 years. BD was diagnosed in 65 (58.5%) by ISGBD criteria and in 86 (77.5%) by ICBD criteria. No significant differences were observed between both criteria (p < 0.001). The overall concordance was fair (Kappa 0.3; p<0.001). Sensitivity was 58.6% for ICBD criteria and 80.2% for ISG.(TABLE-1)

Conclusion:

ICBD criteria exhibit higher sensitivity than ISG criteria. Thus, the application of these new criteria can achieve a more correct and earlier diagnosis of BD.

References:

[1]Criteria for diagnosis of Behcet’s disease, International Study Group for Behçet’s Disease,The Lancet, Volume 335, Issue 8697, 1078 – 1080

[2]The International Criteria for Behçet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria, J Eur Acad Dermatol Venereol. 2014; 28:338-47

TABLE 1Expert diagnosis (N=111)ISG criteria -(N=65)ICBD criteria (N=86)Age, mean (SD)36.7 (13.2)36 (12.8)36.7 (13)Gender, men/women, N (%)49/62 (44.1/55.8)29/36 (44.6/55.4)38/48 (44.2/55.8)Oral aphthosis110 (99)65 (100)85 (100) -Recurrent (3 times/year)91 (87.2)61 (93.8)74 (86)Genital aphthosis59 (53.1)42 (64.6)56 (65.1)Skin manifestations76 (68.4)56 (86.15)71 (70.9) -Pseudofolliculitis/ Erythema nodosum51 (67.1)/ 27 (35.5)38 (58.5)/ 21 (32.3)42 (68.8)/ 22 (36.1)Ocular lesions39 (35.1)32 (49.2)39 (45.3) -Anterior/ Posterior/ Panuveitis17 (43.6);12 (30.8)/ 016 (50)/ 8(25)/ 7 (21.9)17 (45.6); 0; 12 (30.8) -Retinal vasculitis4 (10.3)1 (3.1)4 (10.6)Joint manifestations76 (68.5)43 (66.1)58 (67.4) -Arthralgias / Arthritis69 (92.8)/ 45 (60)39 (90.7)/ 24 (55.8)52 (89.6)/ 33 (56.9)Neurological manifestations20 (18)11 (16.9)16 (18.6) -Peripheral / Central11 (55)/ 14 (70)7 (63.6)/ 7 (63.6)12 (75)/ 10 (62.5)Vascular manifestations9 (8.6)7 (10.8)10 (11.6) -Arterial/ Vein thrombosis/ Phlebitis0/ 5 (55)/ 1 (11.1)0/ 4 (57.1)/ 1 (14.3)1 (12.5)/ 5 (62.5)/0Gastrointestinal features4 (4.5)4 (6.1)4 (4.6)Pathergy test positive (available data; %)6 (28; 21.4)4 (19; 21)4 (25, 16)HLA B51 positive (available data; %)38 (86; 44.2)19 (47; 40.4)28 (63; 44.4)

Disclosure of Interests:

Carmen Alvarez Reguera: None declared, Alba Herrero Morant: None declared, Lara Sanchez Bilbao: None declared, David Martínez-López: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Guillermo Suárez Amorín: None declared, Patricia Setien Preciados: None declared, M. Cristina Mata Arnaiz: None declared, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

SAT0270 TOCILIZUMAB IN REFRACTORY TAKAYASU ARTERITIS. OPEN-LABEL NATIONAL MULTICENTER STUDY OF 53 PATIENTS OF CLINICAL PRACTICE

Background:

Tocilizumab (TCZ) was recently approved for Takayasu Arteritis (TAK) in Japan based on the results of the TAKT trial(1).However, data in clinical practice in Europe and America are scarce(2).

Objectives:

To assess efficacy and safety of TCZ in TAK of clinical practice in Spain.

Methods:

Observational, open-label multicentre study of 53 TAK patients treated with TCZ due to refractoriness or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants and glucocorticoid-sparing effect.

Results:

53 patients (46w/7m); mean age, 40.6±14.6 years at TCZ onset. TCZ was started after a median of 12 [3.0-48.0] months from TAK diagnosis. In addition to systemic corticosteroids and before TCZ they received conventional immunosuppressant drugs (n=42) and biologic therapy (n=14). TCZ was prescribed as standard I.V. (n=42; 79.2%) or subcutaneous (n=11; 20.8%). The initial dose was 8 mg/kg/IV/4 weeks or 162 mg/SC/week, respectively. TCZ was used in monotherapy or combined with immunosuppressants (n=32; 60.4%): methotrexate (n=27), azathioprine (n=2), cyclosporine (n=3). Main clinical features at TCZ onset were: malaise (n=30),limb claudication (n=22), headache (n=18), fever (n=14), abdominal pain (n=10), and chest pain (n=9). Most of the patients experienced a rapid and maintained clinical, analytical improvement(TABLE).After a median follow-up of 18.0 [7.0-45.0] months, TCZ was discontinued in 20 patients due to: sustained remission (n=6), relapse (n=6), adverse event (n=5), gestation (n=3). Most relevant adverse side effects were serious infections: pneumonia (n=2), herpes zoster (n=1), abdominal sepsis (n=1).

Table.Basal(N=53)Month 1(N=53)Month 3(N=46)Month 6(N=44)Month 12(N=34)Clinical improvement, n/N(%)Complete17/53 (32.1)19/46 (41.3)23/44 (52.3)26/34 (76.5)Partial30/53 (54.6)26/46 (56.5)18/44 (40.9)8/34 (23.5)No improvement6/53 (11.3)1/46 (2.2)3/44 (6.8)0/34 (0.0)Analytical markers,ESR (mm/1sth),median [IQR]35.0 [16.0-52.0]7.5 [3.0-14.0] *3.5 [2.0-8.0]*5.0[2.0-6.0]*5.0 [2.0-8.5]*CRP (mg/dL),median [IQR]1.7 [0.6 -3.5]0.21 [0.05-0.6]*0.14 [0.05-0.5]*0.14 [0.04-0.4]*0.10 [0.03-0.30]*Hb (g/dL),mean±SD12.3±1.512.8±1.2*12.9±1.3*12.9±1.4*12.9±1.4*Prednisone dose (mg/day),median [IQR]30.0 [15.0-50.0]20.0 [10.0-37.5]*10.0 [5.0-20.0]*5.0 [5.0-12.5]*5.0 [0.0-7.5]*

*Wilcoxon test p < 0.001.

Conclusion:

TCZ appears to be effective and safe in patients with refractory TAK in clinical practice.

References:

[1]Nakaoka Y et al. Ann Rheum Dis. 2018;77:348-354

[2]Loricera J et al. Clin Exp Rheumatol. 2016; 34: S44-53.

Disclosure of Interests:

D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Pilar Bernabéu: None declared, Paloma Vela-Casasempere: None declared, J. Narváez: None declared, Carlos Fernández-López: None declared, Mercedes Freire González: None declared, Beatriz González-Alvarez: None declared, Roser Solans-Laqué: None declared, Jose Luis Callejas-Rubio: None declared, Norberto Ortego: None declared, Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Esteban Rubio Romero: None declared, SALVADOR GARCÍA MORILLO: None declared, Mauricio Minguez: None declared, Cristina Fernández-Carballido Consultant of: Yes, I have received fees for scientific advice (Abbvie, Celgene, Janssen, Lilly and Novartis), Speakers bureau: Yes, I have received fees as a speaker (Abbvie, Celgene, Janssen, Lilly, MSD, Novartis), 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), Sheila Melchor: None declared, Eva Salgado-Pérez: None declared, Beatriz Bravo: None declared, Susana Romero-Yuste: None declared, J Salvatierra: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, C. Romero-Gómez: None declared, Patricia Moya: None declared, Noelia Alvarez-Rivas: None declared, Javier Mendizabal: None declared, Francisco Miguel Ortiz Sanjuan: None declared, I. Pérez de Pedro: None declared, Javier Loricera: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD

AB1215 EPIDEMIOLOGY AND CLINICAL PHENOTYPE OF BEHÇET’S DISEASE IN A WELL-DEFINED POPULATION OF NORTHERN SPAIN

Background:

Considerable epidemiological variations in prevalence of Behçet’s disease (BD) have been reported. These disparities may either reflect geographical differences, methodological artifacts, changes over time or random fluctuations. In Spain, published BD’s epidemiological studies are scarce.

Objectives:

To study epidemiological and clinical domains of BD in a well-defined population of Northern Spain, as well as, to compare results with other regions.

Methods:

We included all consecutive 111 patients, diagnosed of definitive or possible BD by expert rheumatologists between 1980 and 2019. Two Classification criteria were applied: a) International Study Group (ISG) for BD(Lancet. 1990; 335:1078-80), and b) International Criteria for BD (ICBD)(J Eur Acad Dermatol Venereol. 2014; 28:338-47). In addition, a literature review of Medline publications was carried out.

Results:

In our study, prevalence was higher than in most European populations regardless of the diagnostic criteria applied. Incidence was low (expert opinion: 0.021, ICBD: 0.016, ISG: 0.012). Mean age at onset (36.8±13.2) and gender distribution (55.9% females) were similar to other countries. Pathergy test was performed in 9% of patients giving low results (25.2%). Clinical domains’ frequency was in line with other regions except vascular and gastrointestinal involvement, which were lower. (TABLE)

Conclusion:

BD’s prevalence in Northern Spain is higher than in most European populations. These differences likely reflect a combination of true geographic variation, methodological artifacts as well as the easy access to Public Health System and its efficiency. In contrast, clinical phenotypes are similar to other regions.

TABLEDiagnostic criteria and study periodn cases / population sizeMean age at onset and sex (%females)Prevalence (over 100000) / incidenceOral / genital ulcers (%)Skin lessions/ pathergy test (%)Ocular involvement (%)Joint involvement (%)Neurobehcet/ Vascular/ Gastrointestinal involvement (%)Herrero, A et al. Southern Europe (Cantabria, Spain)Expert opinion, ISG, ICBD / 1980-2019111 (expert opinion) / 86 (ICBD) / 65 (ISG) / 58107836.8±13.2/ 55.919.1 (expert opinion), 14.8 (ICBD), 11.2 (ISG) / 0.021 (expert opinion), 0.016 (ICBD), 0.012 (ISG)99 / 53.168.4 / 25. 235.168.518 / 10 / 4.5Calamia, K. T. et al. North America (Minnesota, USA)ISG / 1960-200513 / NR31 / 305.2 / 0.38100 / 6285 / NR624623 / 23 / NRAltenburg, A. et al. Northern Europe (Berlin, Germany)ISG and ABD classification tree / 1961-2005590 / 339134426 / 584.9 / 1 (estimated)98.5 / 63.762.5 / 33.758.15310.9 / 22.7 / 11.6Mohammad, A. et al. Northern Europe (Skane County, Sweden)ISG / 1997-201040 / 80931730.5 / 334.9 / 0.2100 / 8088 / NR53400 / 20 / NRMahr, A. et al. Southern Europe (Seine-Saint-Denis County, France)ISG / 200379 / 109441227.6 / 437.1 / NR100 / 8090 / 20515910 / NR / 10Salvarani, C. et al. Southern Europe (Reggio Emilia, Italy)ISG, 1988-200518 / 48696133 / 503.7 / 0.24100 / 78100 / NR565011 / 6 / NRAzizlerli, G. et al. Middle East (Istambul, Turkey)ISG / prevalence study101 / 23986NR / 48.542 / NR100 / 70.2Not globally reported / 69.327.7Not globally reportedNR / Not globally reported / NRDavatchi, F. et al. Middle East (Iran nationwide)Expert opinion / 1975-20187641 / NR25.6 / 44.280 / NR97.5 / 64.462.2 / 50.455.638.13.9 / 8.9 / 6.8Krause, I. et al. Middle East (Galilee, Israel)ISG / 15 years (not specific years have been reported)112 / 73700030.6 / 4715.2 / NRNR / 6841 / 44.4587011.6 / Not globally reported / NRNishiyama, M. et al. Asia (Japan nationwide)1987 JCBD / 19913316 / NR35.7 / 50.6NR / NR98.2 / 73.287.1 / 43.869.156.911 / 8.9 / 15.5

Disclosure of Interests:

Alba Herrero Morant: None declared, Guillermo Suárez Amorín: None declared, Lara Sanchez Bilbao: None declared, Carmen Álvarez Reguera: None declared, David Martínez-López: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Patricia Setien Preciados: None declared, M. Cristina Mata Arnaiz: None declared, Rosalía Demetrio-Pablo: None declared, Miguel Ángel Gordo Vega: None declared, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

FRI0487 APREMILAST IN MONOTHERAPY OR COMBINED IN NON-ULCER MANIFESTATIONS OF BEHÇET’S DISEASE. NATIONAL MULTICENTER STUDY OF 34 REFRACTORY CASES OF CLINICAL PRACTICE

Background:

Apremilast (APR) has demonstrated efficacy in orogenital ulcers of Behçet´s disease (BD). Response of other clinical manifestations remains unknown.

Objectives:

To assess the efficacy and safety of APR in monotherapy or combined with disease-modifying anti-rheumatic drugs (DMARDs) in non-aphthous ulcers of BD.

Methods:

National multicenter open-label study on 34 BD patients treated with APR at maintained standard dose of 30 mg twice daily.

Results:

From a cohort of 51 patients with APR by refractory orogenital ulcers of BD, we selected 34 (24 women/10 men, mean age 43.8±14.3 years), cases with another clinical manifestation/s.

Excluding CTs, colchicine or NSAIDs, APR was given in monotherapy (n=21) or combined with conventional and/or biologic DMARDs in 13 cases (5 methotrexate, 3 azathioprine, 3 hydroxychloroquine, 1 sulfasalazine, 1 dapsone, 2 tocilizumab, 1 IFX). Other active manifestations present at APR onset were: arthralgia/arthritis (16, true arthritis in 5), folliculitis/pseudofolliculitis (14), erythema nodosum (3), furunculosis (2), paradoxical psoriasis by TNFi (2), intestinal ileitis (2), deep venous thrombosis (2), leg ulcers (1), erythematosus and scaly skin lesions (1), fever (1), unilateral anterior uveitis (1) and neurobehçet (1).

After a median follow-up of 6 [3-12] months, folliculitis and ileitis improved, neurobehçet remained stable and musculoskeletal manifestations evolved in a variable way.(TABLE)

TABLE.

Conclusion:

In addition of orogenital ulcers, APR in monotherapy or combined, seems to be useful in skin manifestations of BD

Disclosure of Interests:

Alba Herrero Morant: None declared, Belen Atienza Mateo: None declared, J. Loricera: None declared, Vanesa Calvo del Rio Grant/research support from: MSD and Roche, Speakers bureau: Abbott, Lilly, Celgene, Grünenthal, UCB Pharma, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Gerard Espinosa: None declared, Jenaro Graña: None declared, Clara Moriano: None declared, Trinidad Pérez Sandoval: None declared, Manuel Martín Martínez: None declared, Elvira Diez: None declared, María Dolores García-Armario: None declared, Esperanza Martínez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Patricia Moya Alvarado: None declared, Francisca Sivera: None declared, Jaime Calvo Grant/research support from: Lilly, UCB, Consultant of: Abbvie, Jansen, Celgene, Isabel de la Morena: None declared, Francisco Ortiz Sanjuán: None declared, José Andrés Román Ivorra: None declared, Ana Pérez Gómez: None declared, Alejandro Olive: None declared, Carolina Díez: None declared, Juan José Alegre: None declared, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, Ángels Martínez-Ferrer: None declared, Javier Narvaez: None declared, Ignasi Figueras: None declared, Ana Isabel Turrión: None declared, Susana Romero-Yuste: None declared, Pilar Trénor: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

AB1206 OCULAR SARCOIDOSIS AND CLUSTERS OF CLINICAL ASSOCIATIONS. STUDY OF A SERIES OF 383 PATIENTS WITH SYSTEMIC SARCOIDOSIS FROM A SINGLE UNIVERSITY HOSPITAL

Background:

Sarcoidosis is an inflammatory disease which can affect multiple organs. The most frequent affected organs are lungs, skin and eyes (1-5). Ocular involvement is a severe complication.

Objectives:

To assess the association of ocular sarcoidosis with other clinical domains.

Methods:

Study of a large cohort of systemic sarcoidosis from a single tertiary university hospital. All consecutive patients were diagnosed with systemic sarcoidosis from January 1, 1999 to January 1, 2019 according the ATS/ERS/WASOG criteria (6).

Results:

41 (22 women/19 men) of 383 (10.7%) patients had ocular involvement, mean age 44.8±16 years. Lung was the most common affected organ associated with ocular sarcoidosis (n=36; 87.8%) followed by skin (n=14; 34.1%), joints (n=12; 29.3%) and neurological affection (n=8; 19.5%).

Ocular sarcoidosis presents a higher percentage of renal and neurological affection compared to organs affected in general sarcoidosis of our larger cohort (12% vs 6% and 19.5 vs 7%; respectively) (FIGURE).

Conclusion:

The proportion of clinical domains affected in ocular sarcoidosis is mostly similar to global sarcoidosis, except the neurological (which almost is threefold) and renal (which doubles) affection. Hence, the importance of being aware of neurological and renal complications when ocular affection is present.

References:

[1]Riancho-Zarrabeitia L, et al. Semin Arthritis Rheum. 2015; 45:361-8.

[2]Calvo-Río V, et al. Clin Exp Rheumatol. 2014; 32:864-8.

[3]Riancho-Zarrabeitia L, et al. Clin Exp Rheumatol. 2014; 32:275-84.

[4]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94.

[5]Calvo-Río V, et al. Clin Exp Rheumatol. 2014;32 (4 Suppl 84): S54-7.

[6]Costabel U, Hunninghake GW. Eur Respir J 1999; 14: 735-737

FIGURE.

Comparison between distribution of organs affected in ocular sarcoidosis (left) and distribution of organs affected in general sarcoidosis (right)

Disclosure of Interests:

Carmen Alvarez Reguera: None declared, Jorge Javier Gaitán-Valdizán: None declared, Raúl Fernández-Ramón: None declared, Rosalía Demetrio-Pablo: None declared, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

AB0721 OCULAR INVOLVEMENT IN INFLAMMATORY BOWEL DISEASE. STUDY OF 1442 PATIENTS FROM A SINGLE UNIVERSITARY CENTER

Background:

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), and Ulcerative colitis (UC) are related to Spondyloarthritis (SpA). Ocular manifestations (OM) are well-stablished in SpA but not in IBD. It has been classically reported that whereas uveitis with SpA is predominantly anterior, unilateral, sudden, and limited; in IBD it is bilateral, posterior, insidious, and chronic(Lyons & Rosenbaum JT. Arch Ophthalmol 1997; 115:61-4).

Objectives:

In a large unselected series of IBD, we study the OM and assess;a) epidemiological, clinical features,b) the relationship with extraintestinal manifestations.

Methods:

Study of all consecutive patients from a single University Hospital during the last 40 years with: a) IBD (CD and UC), andb) OM: uveitis and scleral pathology diagnosed by clinical features and slit-lamp.

Results:

OM were present in 42 (2.9%) (25 women/17 men) (84 eyes) of 1442 IBD patients; OM included the uveitis group (UG) (n=23; 1.6%) and the scleral pathology group (SG) (n=19, 1.32%) (TABLE).

The most common pattern in SG was episcleritis (n=16; 84.21%) and scleritis (n=3). In UG, uveitis was typically anterior (n=18; 78.3%), unilateral (n=19; 82.6%), sudden (n=19; 82.6%), and limited (n=12; 52.2%).

The comparative study between SG vs UG showed in UG a significant predominance of women and UC. Also, a non-significative higher frequency in Pyoderma gangrenosum, erythema nodosum and joint involvement was observed in UG.

After a mean follow-up of 15.2±9.97 years, extraintestinal manifestations were observed in 100% of patients, being articular forms (n=16; 38.10%) the most common type. In addition, joint/axial flare is more related to the presence of uveitis (p=0.038).

Conclusion:

Both uveitis and episcleritis are equally frequent OM in IBD. Although uveitis is more infrequent in IBD than in SpA, it is also anterior, unilateral, sudden and limited in contrast with published data from selected series.

References:

[1]Lyons & Rosenbaum JT. Arch Ophthalmol 1997; 115:61-4

TABLE.Uveitis(n= 23)Epi/scleritis(n=19)pDEMOGRAPHIC PARAMETERSSex, n (%)6 ♂ / 17 ♀11 ♂ / 8 ♀p= 0.04*Age at diagnosis (years) mean ± SD49.13±14.6447.63±12.48p= 0.415INTESTINAL AFFECTIONCD, n (%)12 (52.17)16 (84.21)p= 0.02*UC, n (%)11 (47,83)3 (15,74)p= 0.16EXTRAINTESTINAL AFFECTIONCutaneous manifestations•Erythema nodosum, n (%)6 (26.09)2 (10.53)p= 0.30•Pyoderma gangrenosum, n (%)1 (4.35)0 (0)p= 0.92•Psoriasis, n (%)1 (4.35)4 (21.01)p= 0.23Joint involvement10 (43.50)6 (31.60)p= 0.36•Psoriathic arthritis, n (%)1 (4.35)3 (15.80)p= 0.47•Enteropathic Spondyloarthritis, n (%)6 (26.09)3 (15.80)p= 0.66•Ankylosing Spondylitis, n (%)3 (13.04)0 (0)p= 0.28Digestive manifestations•NASH, n(%)4 (17.39)6 (31.58)p= 0.28

*p value < 0.05. SD:standard deviation;CD:Crohn’s disease; UC:ulcerative colitis; NASH:non-alcoholic steatohepatitis.

Disclosure of Interests:

Lara Sanchez-Bilbao Grant/research support from: Pfizer, David Martinez-Lopez: None declared, Iñigo González-Mazón: None declared, María José García-García: None declared, Montserrat Rivero-Tirado: None declared, Beatriz Castro: None declared, Javier Crespo: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0768 TREATMENT WITH TOFACITINIB IN REFRACTORY PSORIATIC ARTHRITIS. MULTICENTER STUDY OF 87 PATIENTS IN CLINICAL PRACTICE

Background:

Tofacitinib (TOFA) is the first JAKi approved for psoriatic arthritis (PsA) in Europe (July 2018). TOFA has shown efficacy in refractory patients to anti-TNF in Randomized Clinical Trials (RCT) (Gladman D. NEJM 2017; 377: 1525-36).

Objectives:

To assess efficacy and safety of TOFA in clinical practice (CP). To compare the profile of CP with RCT

Methods:

Study of 87 patients of CP with PsA treated with TOFA; Results are expressed as percentage, mean±SD or median [IRQ].

Results:

87 patients (28♀/59♂), mean age of 52.8±11.4 years (Table 1). Pattern of joint involvement was: peripheral (n=60), axial (1) and mixed (26). Presented also enthesitis (49.4%), nail involvement (30.2%) and dactylitis (31%).

Prior TOFA, most patients (80%) received oral prednisone, synthetic immunosuppressants (mean 2.3±0.9) and biological therapy (BT) (3.6±1.9): etanercept (n=58), adalimumab (54), infliximab (31), golimumab (37), certolizumab (30), secukinumab (54), ustekinumab (39) and ixekizumab (2). Apremilast was used in 17.

After a mean follow-up of 12.3±9.3 years from PsA diagnosis, TOFA was started (5 mg/12 h). In 48 (55.2%) TOFA was used in combined therapy: methotrexate (30) and leflunomide (15). In the remaining 39, monotherapy was prescribed.

Patients of CP compared with RCT have a longer duration of PsA, worst functional disability (HAQ) and received a higher proportion of corticosteroids and BT (anti-TNF and non-anti-TNF) (Table 1).

Patients improved in activity indexes (PASI, DAS28, DAPSA) and laboratory test (table 2). Minor side effects were reported in 21 patients (gastrointestinal symptoms), and TOFA was discontinued in 29 due to inefficiency mainly.

Conclusion:

Patients of CP had a longer evolution and received a greater number of biologics than those of RCT. TOFA as in RCT seems effective, rapid and relatively safe for refractory PsA.

Table 1.

Baseline features

CLINICAL TRIALGladmanN=131CLINICAL PRACTICEN=87Age, years (mean±SD)49.5±12.352.8±11.4Sex, n (%)67M/64F (51/49)59M/28F (68/32.2)Duration PsA, years (mean±SD)9.6±7.612,3±9.3HAQ-DI1.3±0.71.4±0.7 (n=26)Swollen joint count, mean±SD12.1±10.65.7±5.8Painful joint count, mean±SD20.5±13.08.0±6.6Elevated CRP, n (%)85 (65)55 (63.2)PASI score, median [IQR]7.6 [0.6-32.2]9.0 [4.2-15]Oral glucocorticoid, n (%)37(28)44(50.5)Concomitant synthetic DMARDs, n (%)- Methotrexate98 (75)30 (34.4)- Leflunomide12 (9)15 (17.2)- Sulfasalazine21 (16)6 (6.9)- Others2 (2)N. of previous TNF inhibitors, mean±SD1.7±1.02.4±1.4Previous use of other biological no anti-TNF, n (%)11 (8)68 (78.2)Table 2.

Table 2. Improvement at 1st, 6thand 12thmonth

Baselinen=871st monthn=776th monthn=5212th monthn=20Nail involvement, n (%)17 (19.5)Improvement, n (%)5 (35.7)6 (60)5 (83.3)Enthesitis, n (%)28 (32.2)Improvement, n (%)8 (47.1)10 (58.8)3 (50)Dactylitis, n (%)16 (18.4)Improvement, n (%)9 (69.2)6 (85.7)0 (0)CRP mg/dl, median [IQR]1.9 [0.3-5]0.5 [0.1-2.2]0.5 [0.3-1.2]0.4 [0.4-3.7]p (vs baseline)0.0040.0050.66DAS28, median [IQR]4.8 [4.1-5.403.7 [2.8-4.6]2.8 [2.2-3.8]2.9 [2.2-3.7]p (vs baseline)<0.001<0.001<0.001DAPSA, median [IQR]28 [18.41-34.05]15.5 [10.1-25.7]9 [6.07-15]4.3 [2.4-8]p (vs baseline)<0.001<0.001<0.001PASI, median [IQR]5 [1-14]1.4 [0-7]0 [0-4]0.05 [0-2.7]p (vs baseline)0.1920.1050.300

Disclosure of Interests:

E. Galindez: None declared, D. Prieto-Peña: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Olga Rusinovich: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, LARA MENDEZ DIAZ: None declared, Agusti Sellas-Fernández Speakers bureau: Abbott, Lilly, Celgene, Pfizer, Schering-Plough, Janssen, Novartis, and Nordic Pharma, À Martínez-Ferrer: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Clara Ventín-Rodríguez: None declared, Julio Ramirez: None declared, Manuel Moreno: None declared, Maria jose Moreno: None declared, María del Carmen Castro Villegas: None declared, Antia Crespo Golmar: None declared, Natalia Palmou-Fontana: None declared, FRANCISCO ORTIZ SANJUAN: None declared, Ximena Elizabeth Larco Rojas: None declared, Antonio Juan Mas: None declared, Christian Y Soleto: None declared, Iñigo Gorostiza: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

THU0320 RENAL TRANSPLANTATION DUE TO RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS (RPGN) AND SYSTEMIC AUTOIMMUNE DISORDERS. STUDY OF 42 PATIENTS FROM A SINGLE CENTER

Background:

Rapidly Progressive Glomerulonephritis (RPGN) is characterized by a rapid and severe decline in kidney function that may lead to a kidney transplantation. RPGN is classified in three groups:a) Type I or associated to anti-glomerular basement membrane antibodies (RPGN-GBMa),b) Type II or associated to immunocomplexes (RGPN-immunocomplexes), andc) Type III or pauci-immune (RPGN-pauci-immune). RPGN can be primary, without extra-renal involvement (RPGN-renal-limited), or secondary to systemic autoimmune disorders (RPGN-SAD), infectious diseases or drugs. Kidney transplantation in RPGN-SAD may be associated to a worse outcome.

Objectives:

To assessa) clinical features of the three types of RPGN,b) comparison of post-transplant survival and graft survival between these three types.

Methods:

We studied three groups of patients according to renal biopsy:a) RPGN-GBMa (n = 11),b) RPGN-immunocomplexes (n = 2) and c) RPGN-pauci-immune (n=29). All these patients were transplanted in a single reference University Hospital. The main outcome variables werea) graft survival up to 15 years and patient survival up to 30 years andb) evolution of renal function (serum creatinine and proteinuria) in the first 5 years of follow-up.

Results:

We included a total of 42 patients with renal transplant due to RPGN, mean age at diagnosis 44.87±17.01 years (48.53±17.45 at the time of the transplant). No significant differences at baseline were observed between the three RPGN groups regarding sex, age and cardiovascular risk factors. Renal biopsy had been performed in the 42 patients with RPGN: type I or RPGN-GBMa (n=11, 26.2%), type II or RPGN-immunocomplexes (n=2, 4.8%) and type III or RPGN-pauci-immune (n=29, 69.0%).

It was also reported the presence or absence of systemic autoimmune disorders (31% RPGN-SAD and 69% RPGN-renal-limited). According to the presentation and the clinical characteristics of the patients, another classification has been established:a) type I (18.2% (n = 2) Goodpasture-syndrome),b) type II (100% renal-limited),c) type III (13.8% (n = 4) granulomatosis with polyangiitis) and 20.70% (n = 6) microscopic polyangiitis. The evolution of serum creatinine and the proteinuria after the transplant is shown in TABLE 1and 1.1. Neither differences were found in terms of graft and patient survival between the 3 groups (Figures 1 and 2).

TABLE 1.1 Month6 Months1 YearSerum Creatinine mg/dLRPGN-type IRPGN-type IIRPGN-type IIIRPGN-type IRPGN-type IIRPGN-type IIIRPGN-type IRPGN-type IIRPGN-type IIIN112261022210222Mean±SD1.78±0.83.85±.4.031.64±0.671.59±0.731.45±0.771.99±1.311.55±0.621.50±0.701.77±1.10Proteinuria mg/24 hRPGN-type IRPGN-type IIRPGN-type IIIRPGN-type IRPGN-type IIRPGN-type IIIRPGN-type IRPGN-type IIRPGN-type IIIN92231011910ND19Mean±SD470.00±566.85400.00±565.68408.22±449.00611.87±832.20*797.00±556.29*362.98±323.38*656.10±1206.68ND282.54±272.35

*p<0.05

Figure 1.

Graft survival.

Conclusion:

Our study has shown similar graft and patient survival as well as renal outcome in renal transplant due to the three types of RPGN. Renal transplantation could be the best option for patients with end stage renal disease due to RPGN regardless of systemic manifestations.

TABLE 1.13 Years5 YearsSerum Creatinine mg/dLRPGN-type IRPGN-type IIRPGN-type IIIRPGN-type IRPGN-type IIRPGN-type IIIN112208218Mean±SD1.64±0.741.70±0.691.85±1.341.55±0.861.60±0.841.72±0.82Proteinuria mg/24 hRPGN-type IRPGN-type IIRPGN-type IIIRPGN-type IRPGN-type IIRPGN-type IIIN112178216Mean±SD510.79±832.90272.57±291.20340.65±344.17238.23±311.19443.88±300.87579.26±1114.5

*p<0.05

Figure 2.

Patient survival.

Disclosure of Interests:

Lara Sanchez-Bilbao Grant/research support from: Pfizer, Marina de Cos-Gómez: None declared, Juan Carlos Ruiz-San Millán: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0012 ROLE OF IRF5 GENE ON THE PATHOGENESIS OF IMMUNOGLOBULIN-A VASCULITIS

Background:

Interferon signaling pathway plays a relevant role in autoimmunity. Genetic variants in theinterferon regulatory factor (IRF) 5gene, that encodes the major regulator of the type I interferon induction [1], have been related to the development of several inflammatory diseases [2].

Objectives:

To determine the influence ofIRF5on Immunoglobulin-A vasculitis (IgAV), an inflammatory vascular disease.

Methods:

ThreeIRF5polymorphisms (rs2004640, rs2070197 and rs10954213) representative of 3 different haplotype blocks were genotyped in 372 Caucasian patients with IgAV and 876 sex and ethnically matched healthy controls.

Results:

No statistically significant differences between patients with IgAV and controls were observed when eachIRF5polymorphism was analyzed independently. Similarly, no statistically significant differences between patients with IgAV and controls were found whenIRF5polymorphisms were evaluated combined conforming haplotypes. Additionally, there were no statistically significant differences in genotype, allele and haplotype frequencies ofIRF5when patients with IgAV were stratified according to the age at disease onset or to the presence/absence of gastrointestinal or renal manifestations.

Conclusion:

Our results do not support an influence ofIRF5on the pathogenesis of IgAV.

References:

[1]Nat Immunol 2011; 12: 231-8;

[2]Arthritis Res Ther 2014; 16: R146.

Acknowledgments:

This study was supported by European Union FEDER funds and “Fondo de Investigaciones Sanitarias” (grant PI18/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). RL-M is a recipient of a Miguel Servet type I programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) (grant CP16/00033). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) (ISCIII, co-funded by the European Regional Development Fund (ERDF)). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). LL-G is supported by funds of PI18/00042 (ISCIII, co-funded by ERDF).

Disclosure of Interests:

Sara Remuzgo Martinez: None declared, Fernanda Genre: None declared, Verónica Pulito-Cueto: None declared, D. Prieto-Peña: None declared, Belén Atienza-Mateo: None declared, Belén Sevilla: None declared, Javier Llorca: None declared, Norberto Ortego: None declared, Leticia Lera-Gómez: None declared, Maite Leonardo: None declared, Ana Peñalba: None declared, María Jesús Cabero: None declared, Luis Martín-Penagos: None declared, Jose Alberto Miranda-Filloy: None declared, Antonio Navas Parejo: None declared, Javier Sanchez Perez: None declared, Maximiliano Aragües: None declared, Esteban Rubio: None declared, MANUEL LEON LUQUE: None declared, Juan María Blanco-Madrigal: None declared, E. Galindez: None declared, Javier Martin Ibanez: None declared, Santos Castañeda: None declared, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Raquel López-Mejías: None declared

AB0011 INFLUENCE OF IL17A GENE ON THE PATHOGENESIS OF IMMUNOGLOBULIN-A VASCULITIS

Background:

Cytokines signaling pathway genes represent a key component of the genetic network implicated in the pathogenesis of Immunoglobulin-A vasculitis (IgAV) [1], an inflammatory vascular pathology.Interleukin (IL)17Ais a genetic risklocusfor autoimmune diseases, such as giant cell arteritis [2] and spondyloarthritis [3].

Objectives:

To determine the potential influence ofIL17Aon IgAV.

Methods:

FiveIL17Atag polymorphisms (rs4711998, rs8193036, rs3819024, rs2275913 and rs7747909) were genotyped in 360 Caucasian patients with IgAV and 1,003 sex and ethnically matched healthy controls.

Results:

No statistically significant differences between patients with IgAV and healthy controls were observed when eachIL17Agenetic variant was analyzed independently. Similarly, no statistically significant differences between patients with IgAV and healthy controls were found when the fiveIL17Apolymorphisms were evaluated combined conforming haplotypes. In addition, there were no statistically significant differences in genotype, allele and haplotype frequencies ofIL17Awhen patients with IgAV were stratified according to the age at disease onset or to the presence/absence of gastrointestinal or renal manifestations.

Conclusion:

Our results do not support an influence ofIL17Aon the pathogenesis of IgAV.

References:

[1]Autoimmun Rev 2018; 17: 301-15

[2]Ann Rheum Dis 2014; 73: 1742-5

[3]Mediators Inflamm 2018; 2018: 1395823.

Acknowledgments:

This study was supported by European Union FEDER funds and “Fondo de Investigaciones Sanitarias” (grant PI18/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). RL-M is a recipient of a Miguel Servet type I programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) (grant CP16/00033). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) (ISCIII, co-funded by the European Regional Development Fund (ERDF)). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). LL-G is supported by funds of PI18/00042 (ISCIII, co-funded by ERDF).

Disclosure of Interests:

Fernanda Genre: None declared, Sara Remuzgo Martinez: None declared, Verónica Pulito-Cueto: None declared, D. Prieto-Peña: None declared, Belén Atienza-Mateo: None declared, Belén Sevilla: None declared, Javier Llorca: None declared, Norberto Ortego: None declared, Leticia Lera-Gómez: None declared, Maite Leonardo: None declared, Ana Peñalba: None declared, María Jesús Cabero: None declared, Luis Martín-Penagos: None declared, Jose Alberto Miranda-Filloy: None declared, Antonio Navas Parejo: None declared, Diego de Argila: None declared, Maximiliano Aragües: None declared, Esteban Rubio-Romero: None declared, MANUEL LEON LUQUE: None declared, Juan María Blanco-Madrigal: None declared, E. Galindez: None declared, Javier Martin Ibanez: None declared, Santos Castañeda: None declared, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Raquel López-Mejías: None declared

THU0307 RESPONSE OF BEHÇET’S REFRACTORY ORAL AND/OR GENITAL ULCERS TO APREMILAST IN COMBINATION VS MONOTHERAPY. NATIONAL MULTICENTER STUDY OF 51 CASES OF CLINICAL PRACTICE

Background:

Apremilast (APR) has demonstrated efficacy in the treatment of oral and/or genital aphthous ulcers in Behçet´s disease (BD). Combination of APR to other disease-modifying anti-rheumatic drugs (DMARDs) has not been assessed.

Objectives:

To compare the efficacy and safety of APR in monotherapy or combined with DMARDs in refractory BD.

Methods:

National multicenter open-label study on 51 BD patients with oral and/or genital ulcers refractory to conventional treatment.

Results:

We included 51 patients (35 women/16 men), mean age 44.7±13.2 years. Before APR, all patients had received several systemic conventional drugs. The main clinical symptoms for starting APR were oral (n=19) and genital (2) aphthous ulcers or both (30).

Excluding corticosteroids, colchicine or NSAIDs, APR was given at standard dose of 30 mg twice daily in monotherapy (n=31), or combined with conventional DMARDs in 16 cases (6 azathioprine, 5 methotrexate, 4 hydroxychloroquine, 4 sulfasalazine, 1 dapsone) or with biologic DMARDs in 4 (2 tocilizumab, 1 adalimumab, 1 infliximab). There were not found statistically significant differences in demographic features, previous therapy, clinical manifestations or reported adverse effects.

After a median follow-up of 6 [3-12] months, most of the patients experienced improvement of the orogenital ulcers in both groups (89.8% in the first 2 weeks), without statistically significant differences.(TABLE)

Conclusion:

APR leads to a rapid and maintained improvement in most patients with refractory BD orogenital ulcers. APR seems as effective and safe in monotherapy as combined.

TABLE:Week 1-2Week 4Month 6Month 12Month 24Outcome of oral and/or genital ulcers n, (%)Cn=19Mn=30Cn=19Mn=26Cn=12Mn=17Cn=7Mn=6Cn=1Mn=1 Complete resolution8 (42.1)11 (36.7)12 (63.2)20 (77)7 (58.4)14 (82.4)3 (42.8)3 (50)1 (100)1 (100) Partial resolution9 (47.4)16 (53.4)7 (36.8)3 (11.5)5 (41.6)2 (11.7)4 (57.2)3 (50)00 No response2 (10.5)3 (9.9)03 (11.5)01 (5.9)0000p value0.90.10.10.80.7

Abbreviations: C= combined; M= monotherapy; n= available data.

Disclosure of Interests:

Alba Herrero Morant: None declared, Belen Atienza Mateo: None declared, J. Loricera: None declared, Vanesa Calvo del Rio Grant/research support from: MSD and Roche, Speakers bureau: Abbott, Lilly, Celgene, Grünenthal, UCB Pharma, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Jenaro Graña: None declared, Gerard Espinosa: None declared, Clara Moriano: None declared, Trinidad Pérez Sandoval: None declared, Manuel Martín Martínez: None declared, Elvira Diez: None declared, María Dolores García-Armario: None declared, Esperanza Martínez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Patricia Moya Alvarado: None declared, Francisca Sivera: None declared, Jaime Calvo Grant/research support from: Lilly, UCB, Consultant of: Abbvie, Jansen, Celgene, Isabel de la Morena: None declared, Francisco Ortiz Sanjuán: None declared, José Andrés Román Ivorra: None declared, Ana Pérez Gómez: None declared, Sergi Heredia: None declared, Alejandro Olive: None declared, Águeda Prior: None declared, Carolina Díez: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, Ángels Martínez-Ferrer: None declared, J. Narváez: None declared, Ignasi Figueras: None declared, Ana Isabel Turrión: None declared, Susana Romero-Yuste: None declared, Pilar Trénor: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

OP0033 OPTIMIZATION OF TOCILIZUMAB THERAPY IN GIANT CELL ARTERITIS. A MULTICENTER REAL-LIFE STUDY OF 134 PATIENTS

Background:

Tocilizumab (TCZ) is the only biological agent approved in Giant Cell Arteritis (GCA). There is general agreement on the initial and the standard maintenance dose of TCZ. However, information on duration and optimization of TCZ in GCA is scarce.

Objectives:

Our aim was to assess efficacy and safety of TCZ therapy optimization in an unselected wide series of GCA in clinical practice.

Methods:

Multicenter study, 134 patients with GCA who received TCZ due to inefficacy/adverse events of previous therapy. Once complete remission was reached and based on a shared decision between patient and physician TCZ was optimized in some cases. Optimization was done by decreasing the dose and/or prolonging the TCZ dosing interval progressively.

Results:

134 GCA patients treated with TCZ (101w/33m); mean age 73.0±8.8 years. TCZ was administered IV to 106 (79.1%) patients and SC to 28 (20.9%). TCZ was optimized in 43 (32.1%) patients. No demographic, clinical manifestations or laboratory data differences had been found at TCZ onset (TABLE). After a follow up of 12 [6-15.5] months, and a complete remission for 6 [3-12] months; the first TCZ optimization was performed. Median prednisone dose at first TCZ optimization was 2.5 [0-5] mg/day. TCZ IV was optimized from 8 to 4 mg/kg/4weeks in 12 of 106 (11.3%) and from 162 mg/SC/week to 162 mg/SC/2weeks in 9 of 28 (32.1%) cases. Five (11.6%) of the 43 optimized cases relapsed. In 4 cases, the relapses were treated increasing TCZ up to the pre-optimization dose, in 1 case the route of administration was change (4 mg/kg/4week to 162 mg/SC/week). In 8 of 43 optimized patients (18.6%), it was possible to withdraw TCZ after complete remission for 30 [16.25-45.75] months. Regarding adverse events and severe infections were similar in both groups. The mean TCZ treatment costs were lower in the optimized group.

Conclusion:

Once remission is reached in GCA patients under TCZ treatment, optimization of TCZ may be performed. Based on our experience it could be performed by reducing the dose with IV TCZ or by prolonging dosing interval with SC TCZ.

References:

[1]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135.

TABLE.OPTIMIZED-TCZ GROUP (n=43)NON-OPTIMIZED TCZ GROUP (n=91)pBASAL FEATURES AT TCZ ONSETGENERAL FEATURESAge, years, mean± SD68.9±8.771.4±8.50.125Sex, female/male n(%)32/1068/240.779Time from GCA diagnosis to TCZ onset (months), median [IQR]19.5[7.75-45]10.5[4 – 25]0.047SYSTEMIC MANIFESTATIONSFever, n(%)1(2.4)8(8.7)0.176Constitutional syndrome, n(%)11(26.2)19(20.7)0.476PMR, n(%)18(42.9)56(60.9)0.052ISCHEMIC MANIFESTATIONSVisual involvement, n(%)5(11.9)23(25)0.084Headache, n(%)26(61.9)42(45.7)0.081Jaw claudication, n(%)1(2.4)11(12)0.072CORTICOSTEROIDS AT TCZ ONSETPrednisone dose, mg/d mean (SD)15.1±11.125±17.40.001FOLLOW-UP ON TCZ THERAPY (MONTHS), MEDIAN [IQR]24[18-27]6 [3-18]0.000Relapses, n(%)5(11.6)5(5.5)0.207End follow-up remission, n(%)40(93)84(92)0.99Severe side efects, n(%)14(32.6)22(24.2)0.307Seriuos infections, n(%)6(14)10(11)0.878Cost, (mean) euros per yearIVSC7 538.47 329.011 726.411 726.4--

Disclosure of Interests:

Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, 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), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0443 RENAL TRANSPLANTATION IN LUPUS NEPHRITIS. LONG-TERM FOLLOW-UP. STUDY FROM A SINGLE REFERRAL CENTER

Background:

Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE). Approximately 10-20% of LN develop end stage renal disease (ESRD) and need replacement therapy. Renal transplantation may be a good option. However, concerns about LN recurrence after renal transplantation have been reported.

Objectives:

In a series of 23 patients with first renal transplantation due to LN our aim was to assessa) clinical features,b) renal transplantation as replacement therapy,c) SLE flares after transplantation

Methods:

Observational study of unselected all consecutive patients studied in a single reference University Hospital with: a) diagnosis of SLE by ACR/SLICC 2012 criteria.b) diagnosis of NL by performing biopsy (according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification),c) first renal transplant. Cumulative survival rates after transplantation were estimated by the Kaplan-Meier method.

Results:

We studied 23 (16 women/7 men) patients with first renal transplantation due to LN; mean age at SLE diagnosis of 26.37±12.70 years and mean age at kidney transplantation of 39.80±11.27 years. Mean follow-up of 12.18±9.02 years. Demographic baseline characteristics and clinical manifestations of these patients are shown in TABLE 1and 1.1.

TABLE 1.

Demographic baseline characteristics and clinical manifestations of patients with renal transplantation due to LN.

DEMOGRAPHIC PARAMETERSSex, n (%)7 ♂ / 16 ♀ (30.4%/69.06%)Age at SLE diagnosis (years), mean ± SD26.37±12.70Age at renal transplantation, mean ± SD39.80±11.27SLE RELATED DATASystemic symptoms12.0 (52.17) Fever, n (%)8.0 (34.78) Weight loss, n (%)3.0 (30.0) Asthenia, n (%)3.0 (30.0)Articular affection12.0 (52.17) Joint swelling, n (%)9.0 (39.13) Arthralgia, n (%)3.0 (13.04)Skin affection13.0 (56.52) Malar erythema, n (%)2.0 (8.6) Discoid lupus, n (%)0.0 (0.0) Photosensitivity, n (%)3.0 (13.04) Ulcers, n (%)5.0 (21.73) Alopecia, n (%)3.0 (13.04) Raynaud, n (%)1.0 (4.34)

The main clinical manifestations at diagnosis were articular (n= 12; 52.17%) and cutaneous (n=13; 56.52%). On the other hand, 16 patients (69.6%) presented impaired renal function at diagnosis. In the other 7 patients (30.4%), this manifestation appeared with a delay of diagnosis from the onset of symptoms of 13.17±7.73 years.

Renal biopsy had been performed in 21 patients with LN: type II LN (n=2; 9.1%), type III (n=8; 36.4%), type IV (n=9; 40.9%) and type V (n=2; 9.1%).

Patient and graft survival function after transplantation is represented in Figure 1and 2.

Figure 1.

Regarding lupus flares after transplantation, 3 patients (13.04 %) developed a lupus flare: 2 cases presented as extrarenal disease (one of them was a pneumonitis and the other one was a cutaneous and articular flare) and only 1 case with histological recurrence in the graft (Mean follow-up 15.00±9.84 years).

Conclusion:

Renal transplantation is a safe alternative therapy for ESRD in this population and can provide a long-term survival. However, it is very important to consider the occurrence of flares even in the long-term post-transplant.

Figures 1 and 2.

Figure 2.Table 2.

1.1.

SLE RELATED DATARenal involvement16.0 (69.56)Hematological involvement13.0 (56.52) Anemia, n (%)6.0 (26.10) Leukopenia, n (%)5.0 (21.73) Thrombocytopenia, n (%)2.0 (8.70)Pericarditis2.0 (8.70)Nervous system6.0 (26.10) Peripheral, n (%)1.0 (4.34) Central4.0 (17.40)

Disclosure of Interests:

Lara Sanchez-Bilbao Grant/research support from: Pfizer, Marina de Cos-Gómez: None declared, Juan Carlos Ruiz-San Millán: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

SAT0035 RESPONSE TO ABATACEPT OF DIFFERENT PATTERNS OF INTERSTITIAL LUNG DISEASE IN RHEUMATOID ARTHRITIS: NATIONAL MULTICENTER STUDY OF 263 PATIENTS

Background:

Interstitial Lung Disease (ILD) is a severe extraarticular manifestation of rheumatoid arthritis (RA). In this line, several radiological patterns of RA-ILD have been described: i) usual interstitial pneumonia (UIP), ii) nonspecific interstitial pneumonia (NSIP), iii) obliterating bronchiolitis, iv) organized pneumonia and mixed patterns. Abatacept (ABA) could be an effective and safe option for patients with RA-ILD, although the response in the different radiological patterns is not well defined.

Objectives:

Our aim was to assess the response to ABA in different radiological patterns of ILD.

Methods:

Observational retrospective multicenter study of RA-ILD treated with ABA. ILD was diagnosed by HRCT and classified by radiological patterns in 3 different subgroups of RA-ILD: a) UIP, b) NSIP and c) “other”. ABA was used sc. or iv. at standard dose. We assessed: a) Dyspnoea (MMRC scale; significant variation ≥1); b) Respiratory function tests (significant changes ≥10% in FVC and DLCO); c) HRCT imaging; d) DAS28 e)prednisone dose.

Variables were collected at months 0, 3, 6, 12 months and subsequently every 12 months until a maximum of 60 months.

Results:

We included 263 patients: 106 UIP, 84 NSIP and 73 others (150 women / 113 men), mean age 64.64±10 years. Total patients positive for RF or CCPA were 235 (89.4%) and 233 (88.6%), respectively. In 26 out of 263 patients, the development of ILD was closely related to the administration of sDMARDs (MTX n = 11 and LFN n = 1) or bDMARDs (ETN n = 5, ADA n = 4, CZP n = 2 and IFX n = 3). Patient characteristics are shown in table 1. Figure 1 shows the evolution of the cases with available data after a mean follow-up of 22.7±19.7 months. Mean DLCO and FVC remained stable in the 3 groups without statistically significant changes, and all the groups showed a statistically significant reduction in DAS28 and prednisone dose.

Conclusion:

ABA could be a good choice of treatment in patients with RA-ILD independently of the radiological pattern of ILD.

Disclosure of Interests:

Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, J. Loricera: None declared, Francisco Ortiz-Sanjuán: None declared, A. Juan-Mas: None declared, Carmen Carrasco-Cubero Speakers bureau: Janssen, MSD, AbbVie, Novartis, Bristol Myers Squibb, and Celgene, S, Rodriguéz-Muguruza: None declared, S. Rodrigez -Garcia: None declared, R. Castellanos-Moreira: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

, CLARA AGUILERA CROS: None declared, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Sergi Ordoñez: None declared, Susana Romero-Yuste: None declared, C. Ojeda-Garcia: None declared, Manuel Moreno: None declared, Gemma Bonilla: None declared, I. Hernández-Rodriguez: None declared, Mireia Lopez Corbeto: None declared, José Luis Andréu Sánchez: None declared, Trinidad Pérez Sandoval: None declared, Alejandra López Robles: None declared, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, Natalia Mena-Vázquez: None declared, C. Peralta-Ginés: None declared, ANA URRUTICOECHEA-ARANA: None declared, Luis Marcelino Arboleya Rodríguez: None declared, J. Narváez: None declared, DESEADA PALMA SANCHEZ: None declared, Olga Maiz-Alonso: None declared, J. Fernández-Leroy: None declared, I. Cabezas-Rodriguez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, A. Ruibal-Escribano: None declared, JR De Dios-Jiménez Aberásturi: None declared, Paloma Vela-Casasempere: None declared, C. González-Montagut Gómez: None declared, J M Blanco: None declared, Noelia Alvarez-Rivas: None declared, N. Del-Val: None declared, M. Rodíguez-Gómez: None declared, Eva Salgado-Pérez: None declared, Carlos Fernández-López: None declared, E.C. Cervantes Pérez: None declared, A. Devicente-DelMas: None declared, Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, Cristina Hidalgo: None declared, Sabela Fernández: None declared, R. López-Sánchez: None declared, Edilia García-Fernández: None declared, S. Castro: None declared, P. Morales-Garrido: None declared, Andrea García-Valle: None declared, Rosa Expósito: None declared, L. Exposito-Perez: None declared, Lorena Pérez Albaladejo: None declared, Ángel García-Aparicio: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0005 HLA CLASS II CONFERS RESISTANCE OR SUSCEPTIBILITY TO HIDRADENITIS SUPPURATIVA IN A CAUCASIAN SPANISH POPULATION (NORTHERN SPAIN)

Background:

Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease affecting terminal hair follicles in apocrine glands bearing skin. The pathogenesis of HS remains unknown, although increasing evidence suggests that the immune system plays an important role. To date, two previous studies, did not find any association betweenHLAand HS.

Objectives:

Our aim was to analyze the association of HLA class II with HS in a Caucasian population from Cantabria (northern Spain).

Methods:

In this study we analyzed theHLA-A, -B, -C, DRB1, -DQA1 and –DQB1allele distribution in 106 HS patients and 262 age- and sex-matched controls from a Caucasian population of Cantabria (northern Spain).

Results:

HLA-A*29 andB*50 were significantly more frequent in HS patients andA*30 andB*37 in controls, but these associations disappeared after correction. On the other hand,DRB1*07,DQA1*02 andDQB1*02 were significantly more frequent in controls (p0.026,p0.0012 andp0.0005 respectively), and theHLAalleleDQB1*03:01 was significantly more frequent in HS patients (p0.00007) all of them after Bonferroni correction. Furthermore, theDRB1*07;DQA1*02;DQB1*02 haplotype was significantly more frequent in controls (p0.0005).

Conclusion:

This is the first study showing an association of HLA-class II with HS. Our results suggest that HLA-II alleles (DRB1*07,DQA1*02,DQB1*02 andDQB1*03:01) and theDRB1*07~DQA1*02~DQB1*02 haplotype could influence on resistance or susceptibility to HS.

References:

[1]González-López MA. J Am Acad Dermatol. 2016; Aug;75(2):329-35.

[2]González-López MA. PLoS One. 2018 Jan 4;13(1).

[3]Vilanova I. J Eur Acad Dermatol Venereol. 2018 May;32(5):820-824.

[4]Durán-Vian C, et al. J Eur Acad Dermatol Venereol. 2019 Nov;33(11):2131-2136.

Disclosure of Interests:

Monica Calderón-Goercke: None declared, J. Gonzalo Ocejo-Vinyals: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Marcelo A. Fernández-Viña: None declared, Juan Cantos-Mansilla: None declared, Iosune Vilanova: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD, Marcos González-López: None declared

AB1055 CERTOLIZUMAB PEGOL: A SAFE AND EFFICIENT TREATMENT IN PATIENTS WITH UVEITIS DURING PREGNANCY

Background:

Anti-TNFα agents are useful in uveitis(1-5).Certolizumab pegol (CZP) differs from other anti-TNFα agents due to its limited placental transfer.

Objectives:

To assess efficacy and safety of CZP in women with uveitis during pregnancy.

Methods:

Multicenter study of women with uveitis under CZP during pregnancy and their neonates.

Results:

14 women (23 eyes); mean age 34.3±5.5 yrs (TABLE 1). Pattern of uveitis: 10 anterior, 2 posterior, 1 intermediate, 1 panuveitis. Uveitis was bilateral in 9 and chronic in 7. CZP was started before conception in 10 patients and after in 4. All patients obtained or maintained ocular remission throughout pregnancy (FIGURE). Prednisone was reduced from a mean dose of 21.7±19.7 mg/day to 4.1±3.8 mg/day at 6 months (p=0.03), leading to complete discontinuation in 4. 15 healthy infants were born. Only 1 woman presented a mild infection. No infections or malformations were found in neonates after a follow-up of 6 months. 6 infants were breastfed and all received scheduled vaccinations without complications (TABLE 2).

TABLE 1.AgeUnderlying diseaseImmunosuppressants before CZPCombined treatment134SpAMTX, AZA, ADAAZA237SpAMTX, AZA, IFX, ADA, GOLI339SpAAZA, ADAAZA446SpACyA, ETN, ADA, IFX, GOLI532SpASSZ, ADASSZ636SpAMTX, HCQ, ADA740SpAMTX, LFN, HCQ, IFX, ADA, GOLIHCQ831IdiopathicMTX, MMF, CyA, ADA933IdiopathicMTX, AZA, ADA, ETN1032RAMTXAZA1123Vogt-Koyanagi-HaradaAZA, ADAAZA1236Juvenil Idiopathic ArthritisADA1332Punctate inner choroidopathyADA1429BehcetCyA, IFX, ADA

Conclusion:

CZP seems to be effective and safe in female patients with uveitis during pregnancy and neonates.

References:

[1]Llorenç V et al. Certolizumab Pegol, a New Anti-TNF-α in the Armamentarium against Ocular Inflammation. Ocul Immunol Inflamm. 2016;24(2):167-72. doi: 10.3109/09273948.2014.967779

[2]Urruticoechea-Arana A et al. Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review. Rheumatol Int. 2019 Jan;39(1):47-58. doi: 10.1007/s00296-018-4193-z

[3]Martín-Varillas JL et al. Successful Optimization of Adalimumab Therapy in Refractory Uveitis Due to Behçet’s Disease Ophthalmology. 2018 Sep;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020

[4]Santos-Gómez M et al. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behçet’s disease: results of a multicentre open-label study. Clin Exp Rheumatol. 2016. Sep-Oct;34(6 Suppl 102): S34-S40

[5]Calvo-Río V et al. Golimumab in refractory uveitis related to spondyloarthritis. Multicenter study of 15 patients.Semin Arthritis Rheum. 2016 Aug;46(1):95-101. doi: 10.1016/j.semarthrit.2016.03.002

Disclosure of Interests:

D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Alfredo Adan: None declared, Lillian Chamorro-López: None declared, Olga Maiz: None declared, JR De Dios-Jiménez Aberásturi: None declared, Raul Veroz Gonzalez: None declared, Soledad Blanco: None declared, José M Santos: None declared, Francisco Navarro: None declared, Adela Gallego: None declared, Senen González-Suárez: None declared, Arantxa Conesa: None declared, Andrea García-Valle: None declared, Miguel Cordero-Coma: None declared, Nieves Pardiñas-Barón: None declared, Rosalía Demetrio-Pablo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Victor Manuel Mora-Cuesta: None declared, Santos Castañeda: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD

THU0388 UVEITIS IN AXIAL SPONDYLOARTHRITIS: FREQUENCY AND RELATIONSHIP TO BIOLOGICAL THERAPY. SINGLE CENTER UNIVERSITY STUDY OF 255 PATIENTS

Background:

Uveitis is one of the most frequent extra articular manifestation of spondyloarthritis (SpA). Biological therapy, especially monoclonal TNF inhibitors, may be useful to prevent and to treat uveitis. However, other biologics had been related to paradoxical uveitis.

Objectives:

Our aim was to assess a) the epidemiological and clinical features of uveitis associated to SpA and b) its relationship with biological treatment used in SpA.

Methods:

An observational study of patients who developed uveitis form a cohort of 255 consecutive unselected patients with axial SpA (axSpA) classified according to the ASAS criteria. They were divided into: a) ankylosing spondylitis (AS) according to New York modified criteria (n= 193) b) non-radiographic axSpA (nr-axSpA) (n= 62). All these patients were followed in a single reference University Hospital.

Results:

We studied 255 patients with axSpA (151 men/104 women); mean age 37.8±10.6 years. In 36 (31 in AS; 5 in nr-axSpA) (14.2%) patients at least one episode of uveitis was observed after a follow-up 12.4±4.5 years. The mean age at onset of uveitis was 45.7±14.2 years. The diagnosis of uveitis preceded SpA diagnosis in 5 patients, but most of them occurred after a median of 6 [2-15] years of follow-up. Pattern of uveitis was anterior and acute in all cases, and unilateral in 83%. Median of anterior chamber cells was 1 [1-2] cells. Comparison of baseline characteristics and clinical features between patients who developed uveitis and those who did not is shown in table. Almost all patients who developed uveitis were HLAB27 positive. In these patients a lower frequency of enthesitis and inflammatory bowel disease was observed.

Table.UveitisN= 36Non uveitisN= 219pBaseline general featuresAge, years (mean±SD)45.7 ± 14.244.7 ± 12.10.49Sex, n (m/w) (%)21/15 (58.3/41.7)130/89 (59.4/40.6)0.91HLAB27, positive n (%)35 (97.2)130 (59.4)0.00Anti-TNF, n Adalimumab3530.06 Certolizumab140.79 Golimumab1110.87 Infliximab1290.13 Etanercept0120.31Disease CharacteristicsFollow-up of AxSpa, year (mean±SD)13.64 ± 7.612.16 ± 9.730.33AS, n (%)31 (86.1)162 (74.0)0.12nr-AxSp, n (%)5 (13.9)57 (26.0)0.12Peripheral arthritis, n (%)9 (25.0)67 (30.6)0.49Hip affection, n (%)3 (8.3)15 (6.8)0.97Enthesitis, n (%)9 (25.0)81 (37.0)0.16Dactylitis, n (%)2 (5.5)14 (6.4)0.85Psoriasis, n (%)4 (11.1)24 (11.0)0.79Inflammatory bowel disease, n (%)1 (2.8)15 (6.8)0.57Family history, n (%)12 (33.3)58 (26.5)0.39

6 patients with uveitis received anti-TNF therapy and suffered from 7 episodes of uveitis after 5.6±4 years of treatment, meanwhile only 1 out of the 3 patients who were treated with anti IL-17 did a single episode of uveitis after 4.2±1.9 of follow-up. Patients treated with secukinumab developed 2.72 episodes of uveitis/100 patients/year, meanwhile those who received monoclonal anti TNF presented 2.53 episodes/100 patients / year.

Conclusion:

The most frequent clinical pattern of uveitis was acute unilateral anterior. Almost all of them were HLA B27 positive. No differences were found in cumulative incidence between secukinumab and monoclonal anti-TNF.

Disclosure of Interests:

Iñigo González-Mazón: None declared, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Javier Rueda-Gotor: None declared, David Martinez-Lopez: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0242 SURVIVAL ANALYSIS IN THE DEVELOPMENT OF SERIOUS INFECTIONS AND SERIOUS RESPIRATORY INFECTIONS IN AR PATIENTS INCLUDED IN A VACCINATION PROGRAM

Background:

Rheumatoid arthritis is an autoimmune disorder in which patients have an increased risk of developement of serious infections. This risk may be augmented due to RA itself and to immunosuppressive drugs, specially biologic therapy. Vaccination programs may change this condition.

Objectives:

Our aim in this study was to evaluate the incidence of serious infections in a vaccinate RA patients cohort.

Methods:

Prospective study of 401 patients diagnosed with RA who were invited to participate in the vaccination program of the Preventive Medicine department of our hospital from October 2011 to October 2016. The follow up was made until June 2017 with a minimun follow-up period of 8 months and maximun of 5.5 years. Serious infections were defined as those that required hospitalization or at least one dose of intravenous antibiotic treatement at emergency room. Information was retrieved from dthe hospital records.

Only 7 patients refused vaccination (2%). Information was not obtained in 4 of the remaining 394 patients. Therefore, these 4 patients were not incuded in the assessment.

Survival análisis was assessed by Kaplan-Meier method.

Results:

We finally studied 390 patients (307♀/83♂) mean age±SD 61,28 ± 12,9 years that participate in the vaccination program and followed-up. The main features at the time of vaccination were: median disease duration (4years), positive rheumatoid factor (56,7%), subcutaneous nodules (4.9%), erosive arthritis (36.9%), pulmonary fibrosis (3.8%), secondary Sjögren syndrome (5.1%), other extraartocular manifestations (14.6%) and rheumatoid vasculitis (5.6%) Most patients had received imunosuppressive drugs before the vaccination program. The most frequently used were systemic corticosteroids (n=228), methotrexate (n=362) and biologic agents (40.3%).

During the follow-up, 42 patients (10.7%) had required hospital admissions due to infections, 17 of them were severe respiratory infections (4.35%). The remaining 25 admissions were in the setting of urinary tract infections (n=12), intraabdominal infections (7), skin and soft tissues (12) and articular (1). Also 12 of these patients had a zoster herpes.

Afeter a median follow-up of 1061,89 ± 417 days, the incidence of serious infection, with a CI (95%), was 4.00 (2.95-5.41) for 100 patients yearly. Concerning to admissions due to serious respiratory infections, with a CI (95%), was 1.55 (0.9-2.47) for 100 patients yearly.Images 1 and 2.

Image 1.

Survival analysis on serious infections

Image 1.

Survival analysis on serious respiratory infections

Conclusion:

In this stydy we can concluded that our RA vaccinated patients present a dicrease of the incidence of serious infeccions, similar to other published cohorts. The incidence of serious respiratory infections shows a dicrease even lower to other published cohorts. The vaccination program seems to be effective to prevent hospital admissions due to infections.

Disclosure of Interests:

Lucia Domínguez: None declared, Paz Rodriguez Cundin: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Nuria Vegas-Revenga Grant/research support from: AbbVie, Roche, Pfizer, Lilly, Gebro Pharma, MSD, Novartis, Bristol-Myers, Janssen, and Celgene, Virginia Portilla: None declared, Francisco Manuel Antolin-Juarez: None declared, Maria Henar Rebollo Rodriguez: None declared, Alfonso Corrales Speakers bureau: Abbvie, Natalia Palmou-Fontana: None declared, D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0777 EPIDEMIOLOGY, CLINICAL FEATURES AND BIOLOGICAL TREATMENT OF UVEITIS IN 320 PATIENTS WITH PSORIATIC ARTHRITIS. STUDY FROM A SINGLE UNIVERSITY CENTER

Background:

Uveitis is an extra articular manifestation of psoriatic arthritis (PsA). Biological therapy, especially monoclonal TNF inhibitors, are useful to prevent and to treat refractory non-infectious uveitis. However, other biologics had been related to paradoxical uveitis

Objectives:

Our aim was to assessa) the epidemiological and clinical features of uveitis associated to PsA andb) its relationship with biological treatment used in PsA.

Methods:

Observational study of unselected consecutive patients studied in a single reference University Hospital with: a) diagnosis of PsA by CASPAR criteria andb) diagnosis of uveitis by ophthalmologist exploration. Demographics features, clinical findings, complementary tests and treatment were recorded.

Results:

We studied 320 (182 women/138 men) patients with PsA; mean age at PsA diagnosis of 41.7±15.79 years and with a delay of diagnosis from the onset of symptoms of 2.6±2.01 years.

Ten patients (4 men/6 women) out of 320 patients (prevalence 3.13%) with a mean age of 42.2 ± 16.8 years were diagnosed of uveitis after a mean follow-up of 10±7.9 years. In all cases, the uveitis had an anterior pattern. Only 1 (10%) of them had a bilateral affection, acute onset in 10 patients (100%), and 4 of them (40%) had a recurrent pattern. The diagnosis of uveitis preceded the one of PsA in 5 (50%) patients in 1.6±0.87 years. In those with a previous diagnosis of PsA, it was done 13.3±10.4 years before the uveitis onset. Only 1 patient (10%) with recurrent unilateral uveitis presented vitritis. In 10 patients the mean number of anterior chamber cells was 2±0.4. Comparison of baseline characteristics and clinical features between patients who developed uveitis and those who did not is shown intable.

Only 2 patients (20%) with uveitis received biological therapy. The first one developed its first episode of uveitis after 29 months with etanercept. After the episode, a switch to adalimumab was done, without any other episode of uveitis after 22 months of treatment. The second one was a patient with multiple episodes of recurrent uveitis, who developed new flares with adalimumab, certolizumab and golimumab.

Conclusion:

Most of the uveitis had an anterior and unilateral pattern. The onset of uveitis in patients with PsA can either precede or go after the diagnosis of the PsA. HLA B27+ was more frequent in patients with uveitis. Biological therapy did not achieve good answer in patients with recurrent uveitis.

Table.Uveitis (n=10)Non uveitis (n= 310)pBaseline general featuresAge, years (mean±SD)42.2 ± 16.846.4 ± 11.90.38Sex, n (m/w) (%)4/6 (40/60)134/176 (43.2/56.8)0.90HLAB27, positive %6011.8<0.01Disease CharacteristicsAxial arthritis, %40.037.00.88Peripheral arthritis, %80.072.90.89Hip affection, %30.020.00.71Enthesitis, %60.040.50.55Dactylitis, %20.029.50.77ScoresBASDAI (mean ± SD)3.3 ± 2.082.4 ± 1.90.26BASFI (mean ± SD)2.7 ± 1.91.6 ± 10.31

Disclosure of Interests:

Iñigo González-Mazón: None declared, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Natalia Palmou-Fontana: None declared, David Martinez-Lopez: None declared, Susana Armesto: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

OP0212 ABATACEPT IN INTERSTITIAL LUNG DISEASE ASSOCIATED WITH RHEUMATOID ARTHRITIS. NATIONAL MULTICENTER STUDY OF 263 PATIENTS

Background:

Interstitial Lung Disease (ILD) is a severe complication of Rheumatoid Arthritis (RA). Several conventional disease-modifying anti-rheumatic drugs (cDMARDs) and biologic (b) DMARDs may induce or impaired ILD-RA. Abatacept (ABA) may be useful in ILD-RA (1).

Objectives:

To assess the efficacy and safety of ABA in a large series of ILD-RA for a long-term follow-up.

Methods:

Multicenter open-level study of ILD-RA treated with at least 1 dose of ABA. ILD was diagnosed by high-resolution computed tomography (HRTC). We study these outcomes: a) 1-point change Modied Medical Research Council (MMRC); b) forced vital capacity (FVC) and/or DLCO improvement or decline ≥10%; c) change in HRCT, d) change in DAS28. e) Prednisone dose. Values were collected at 0, 3, 6, 12 and then every 12 months.

Results:

We studied 263 patients (150 women/113 men) (mean age;64.6±10 years), with ILD-RA. At ABA-onset they were smokers or exsmoker (53.8%), positive APCC (88.6%), median [IQR] duration of ILD of 12 [3-41.25] months, mean DLCO (65.7±18.3) and FVC (85.9±21.8).

The ILD-pattern were usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%).

ABA was prescribed at standard subcutaneous (125 mg/w) in 196 (74.5%) or intravenously (10 mg/kg/4 w) in 67 (25.5%); in monotherapy (n=111) or combined with cDMARDs (n=152); especially leflunomide (n=55), MTX (n=46), or antimarials (n=21).

After a mean follow-up of 22.7±19.7 months most outcomes remain stable (Figure). Moreover, DAS28 improved from 4.5±1.5 to 3.1±1.3; prednisone dose reduced from a median 7.5 [5-10] to 5 mg [5-7.5] and retention rate was 76.4%. The main adverse effects were serious infections (n=28), neoplasia (n=3), serious infusion reaction (n=1) and myocardial infarction (n=1).

Conclusion:

ABA seems effective and relatively safe in ILD-RA.

References:

[1]Fernández-Díaz C et al. Semin Arthritis Rheum. 2018; 48:22-27

Disclosure of Interests:

Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, J. Loricera: None declared, Francisco Ortiz-Sanjuán: None declared, A. Juan-Mas: None declared, Carmen Carrasco-Cubero Speakers bureau: Janssen, MSD, AbbVie, Novartis, Bristol Myers Squibb, and Celgene, S, Rodriguéz-Muguruza: None declared, S. Rodrigez -Garcia: None declared, R. Castellanos-Moreira: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

CLARA AGUILERA CROS: None declared, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Sergi Ordoñez: None declared, Susana Romero-Yuste: None declared, C. Ojeda-Garcia: None declared, Manuel Moreno: None declared, Gemma Bonilla: None declared, I. Hernández-Rodriguez: None declared, Mireia Lopez Corbeto: None declared, José Luis Andréu Sánchez: None declared, Trinidad Pérez Sandoval: None declared, Alejandra López Robles: None declared, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, Natalia Mena-Vázquez: None declared, C. Peralta-Ginés: None declared, ANA URRUTICOECHEA-ARANA: None declared, Luis Marcelino Arboleya Rodríguez: None declared, J. Narváez: None declared, DESEADA PALMA SANCHEZ: None declared, Olga Maiz-Alonso: None declared, J. Fernández-Leroy: None declared, I. Cabezas-Rodriguez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, A. Ruibal-Escribano: None declared, JR De Dios-Jiménez Aberásturi: None declared, Paloma Vela-Casasempere: None declared, C. González-Montagut Gómez: None declared, J M Blanco: None declared, Noelia Alvarez-Rivas: None declared, N. Del-Val: None declared, M. Rodíguez-Gómez: None declared, Eva Salgado-Pérez: None declared, Carlos Fernández-López: None declared, E.C. Cervantes Pérez: None declared, A. Devicente-DelMas: None declared, Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, Cristina Hidalgo: None declared, Sabela Fernández: None declared, Edilia García-Fernández: None declared, R. López-Sánchez: None declared, S. Castro: None declared, P. Morales-Garrido: None declared, Andrea García-Valle: None declared, Rosa Expósito: None declared, L. Exposito-Perez: None declared, Lorena Pérez Albaladejo: None declared, Ángel García-Aparicio: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0004 TLR10 SINGLE NUCLEOTIDE POLYMORPHISMS ARE ASSOCIATED WITH HIDRADENITIS SUPPURATIVA IN A CAUCASIAN SPANISH POPULATION (NORTHERN SPAIN)

Background:

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory cutaneous disease affecting terminal hair follicles in apocrine-gland bearing skin. The pathogenesis of HS is still unknown, although increasing evidence suggests that the immune system plays an important role. In order to study the role of innate immunity we analyzed several Toll Like Receptors (TLRs) functional single nucleotide polymorphisms (SNPs). To date, only one previous study focused about the role of TLR4 SNPs in HS showing no association with this disease.

Objectives:

The main goal of this study was to analyze the role of several TLRs functional SNPs in HS patients and healthy controls, in a Caucasian population from Cantabria (northern Spain).

Methods:

Through a case-control study, we analyzed the allele and genotype distribution of the SNPs in 106 patients with HS and 278 age and sex matched healthy control subjects for the following SNPs (TLR1 rs5743611 and rs4833095, TLR2 rs5743704 and rs5743708, TLR6 rs5743810, and TLR10 rs11096955, rs11096957 and rs4129009, by Real-Time PCR using a TaqMan assay.

Results:

We did not find any significant difference in the allelic distribution of the different SNPs between HS patients and controls. Regarding genotypes, only TLR10 rs11096955 (dominant, codominant and overdominant), rs11096957 (dominant, codominant and overdominant) and rs4129009 (codominant and overdominant) showed significant differences between HS patients and controls. However, no association was found when we analyzed the different TLR10 haplotypes.

Conclusion:

To the best of our knowledge, this is the first study showing an association of TLR10 SNPs with HS.

References:

[1]González-López MA. J Am Acad Dermatol. 2016; Aug;75(2):329-35.

[2]González-López MA. PLoS One. 2018 Jan 4;13(1)

[3]Vilanova I. J Eur Acad Dermatol Venereol. 2018 May;32(5):820-824.

[4]Durán-Vian C, J Eur Acad Dermatol Venereol. 2019 Nov;33(11):2131-2136.

Disclosure of Interests:

Monica Calderón-Goercke: None declared, J. Gonzalo Ocejo-Vinyals: None declared, Juan Irure-Ventura: None declared, María Gutiérrez-Larrañaga: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Iosune Vilanova: None declared, Juan Cantos-Mansilla: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD, Marcos González-López: None declared

Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry)

Background

Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations.

Objectives

This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences.

Methods

This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out.

Results

A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038–2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30–1.66)).

Conclusion

SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

High prevalence of non-alcoholic fatty liver disease among hidradenitis suppurativa patients independent of classic metabolic risk factors

BACKGROUND

Some chronic inflammatory skin diseases, such as psoriasis, have been associated with an increased prevalence of non-alcoholic fatty liver disease (NAFLD). Nevertheless, this prevalence in hidradenitis suppurativa (HS) has not been assessed to date.

OBJECTIVES

To determine the prevalence of NAFLD in patients with HS and the risk factors associated with this disorder.

METHODS

This case-control study enrolled 70 HS patients and 150 age- and gender-matched controls who were evaluated by hepatic ultrasonography (US) and transient elastography (TE) after excluding other secondary causes of chronic liver disease. The diagnosis of NAFLD was established if US and/or TE were altered.

RESULTS

The prevalence of NAFLD was significantly increased in patients with HS compared to controls (72.9% vs. 24.7%: P < 0.001). In the multivariable regression model adjusted for age, sex and classic metabolic risk factors for NAFLD, HS was significantly and independently associated with the presence of NAFLD [OR 7.75 confidence interval (CI) 2.54-23.64; P < 0.001].

CONCLUSIONS

Our results show a high prevalence of NAFLD in HS patients independent of classic metabolic risk factors. Therefore, we suggest HS patients to be evaluated for NAFLD and managed accordingly.