A new injection method for identifying the subpopliteal recess of the knee

The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The joint fluid distribution reflects anatomical communications between synovial spaces. To observe the continuity between the knee joint cavity and the surrounding bursa, we devised a dissection method with a new injection agent, an eosin-containing congealed liquid that spreads uniformly over the entire space. The purpose of this study was to perform a detailed examination of the subpopliteal recess (SPR) where a bursa connects to the knee joint capsule. We also reported the advantages of this new injection agent compared with conventional materials (latex and epoxy resin). Twenty-two formalin-fixed cadavers (34 knees), two N-vinyl-pyrrolidone (NVP)-fixed cadavers (4 knees), and two cadavers (3 knees) fixed by Thiel's method were used. After filling the knee joint space and SPR with eosin congealed liquid, the specimens were dissected to investigate the morphology of the SPR. In addition, three different types of injection agents were assessed. The SPR extended distally along the popliteus tendon. The SPR length was 22.64 ± 11.38 mm from the upper end of the lateral tibial condyle to the lower end of the depression. The existence of a fabellofibular ligament made the SPR significantly longer, but abrasion of the femoral articular cartilage did not affect the SPR. Furthermore, the relationship between the popliteus muscle and the SPR was classified into three types (types 1-3). Types 2 and 3 in which the SPR extended to the proximal tibiofibular joint may cause instability of the knee joint. The eosin congealed liquid was highly useful in many aspects, such as fluidity and injection workability. The new dissection method with eosin congealed liquid provides insights into the anatomy of the posterior lateral knee, which are useful for radiological diagnoses and clinical treatments.

Double Inferior Vena Cava with Major Predominance of the Left Inferior Vena Cava: A Cadaver Case Report

We encountered a case of a double inferior vena cava with major predominance of the left inferior vena cava during an anatomical dissection course for medical students in 2015. The right inferior vena cava (normal inferior vena cava) was 2.0 mm wide, and the left inferior vena cava was 23.2 mm wide. The fine right inferior vena cava began at the right common iliac vein, ascended along the right side of the abdominal aorta, and then joined the left inferior vena cava at the level of the lower margin of the first lumbar vertebra. The dominant left inferior vena cava started from the left common iliac vein and ascended along the left side of the abdominal aorta. Most patients with a double inferior vena cava are asymptomatic, and these variants are incidentally detected by computed tomography or magnetic resonance imaging. Their presence may have significant implications for surgery, particularly abdominal surgery in patients with paraaortic lymphadenopathy and in those undergoing laparoscopic radical nephrectomy or inferior vena cava filter placement. We herein discuss the embryology of a double inferior vena cava based on detailed anatomical data of the variations of a double inferior vena cava, including those that require clinical attention.

The Key Structure of the Facial Soft Tissue: The Superficial Musculoaponeurotic System

The superficial musculoaponeurotic system (SMAS) was advocated by Mitz and Peyronie in 1976. The concept of this superficial fascia was established by surgical findings of facelift surgery and is familiar to plastic surgeons and anatomists. However, detailed characteristics of this fascia are still not widely known among head and neck surgeons. Moreover, the SMAS is generally located at the parotid and cheek regions and divides facial fat into superficial and deep layers. The SMAS connects to the superficial temporal fascia cranially and to the platysma caudally. The frontal muscle and the peripheral part of the orbicularis oculi are also in the same plane. The exact expanse of the SMAS in the face is controversial. Some authors claimed that the SMAS exists in the upper lip, whereas others denied the continuity of the SMAS to the superficial temporal fascia in a histological study. There are various other opinions regarding SMAS aside from those mentioned above. The concept of the SMAS is very important for facial soft tissue surgeries because the SMAS is a good surgical landmark to avoid facial nerve injuries. Therefore, this article summarized SMAS from an anatomical point of view.

Gross anatomical study of the subcutaneous structures that create the three-dimensional shape of the buttocks

The purpose of this study was to clarify the subcutaneous structures involved in the morphology of the gluteal region for clinical application. Thirty-seven formalin-fixed cadavers and one soft-fixed cadaver were used in this study. Gluteal tissue was removed from five formalin-fixed cadavers. A horizontal section and sections parallel to the long axis of the body were made from the excised tissue, and the subcutaneous fat was removed to observe the fibrous structure within the subcutaneous fat. Two formalin-fixed cadavers and one soft-fixed cadaver were used to perform conventional gross anatomical dissection and histological examination. On 30 formalin-fixed cadavers, the thickness of the subcutaneous fat was measured in various areas of the buttocks. The thickness of subcutaneous fat was thicker in the center of the buttocks and thinner on the lateral buttocks. Superficial fascia (SF) was found only in the upper buttock, being indistinct in the lower buttock. In the sacral and coccygeal areas, the dermis was tightly adhered to the bone as a single mass. Fibers arose from around the iliac crest to the SF. On the medial side of the gluteal fold, a strong fiber arose from the sciatic tubercle and inserted into the gluteus maximus and dermis. By identifying the characteristic subcutaneous structures of the gluteal region, we were able to identify the anatomical structures that shape the three-dimensional morphology of the buttocks. These findings may be useful in surgical treatments such as improving the buttock shape.

Genetic effects of demographic bottleneck and recovery in Kinkazan Island and mainland populations of Japanese macaques (Macaca fuscata)

Populations of Japanese macaques were significantly reduced in most areas from the 1900s to the 1960s and then recovered mainly in the northeastern part of Honshu. A drastic reduction in population size reduces genetic variability through a bottleneck effect. Demographic expansion after the reduction that accumulates new mutations can reduce the bottleneck effects or drive the recovery of genetic variability. We examined the genetic status of a small island population (Kinkazan Island) and a larger mainland population (southern Tohoku) of Japanese macaques that experienced recent demographic bottlenecks and recovery using eight microsatellite loci. The two populations were significantly genetically different from each other. The Kinkazan population exhibited lower genetic variability, remarkable evidence of bottleneck (i.e., significant heterozygosity excess and lower frequency of rare alleles), and a considerably smaller effective population size based on genetic data than based on the current census size. These results indicate that the genetic status has not completely recovered from the demographic bottleneck despite a full recovery in census size on Kinkazan Island. New mutations might rarely have accumulated because of the small carrying capacity of the island. Therefore, the genetic variability of the population would have been restrained by the severe bottleneck size, small carrying capacity, and long-term isolation. On the other hand, the bottleneck effect seems to be limited in the southern Tohoku population considering higher genetic variability, non-significant heterozygosity excess in many mutation conditions, and the highest frequency of rare alleles.

Three sublayers in the SMAS: Observations of facial soft tissue using the stretched tissue dissection method focusing on the SMAS

The characteristics of the superficial musculoaponeurotic system (SMAS), including the morphology of each part and the connection between tissues, remain controversial. The purpose of this study is to clarify the anatomy of the SMAS using our new dissection method. In this study, six hemi-sides of heads from formalin-preserved cadavers were used. Three were used for creating a horizontal section and three were used for creating the section along the axial line perpendicular to the surface of the skin, resulting in a gradual change from the coronal section at the lateral to the sagittal section at the median. The resected head was cut into slices with widths of 7 mm. The stretched tissue dissection method was performed by fixing a tissue slice to a board and pulling the skin outward to stretch the soft tissue. Blunt dissection was then performed under a microscope. The SMAS comprises three layers: superficial, intermediate, and deep. The superficial layer is a thin membrane directly connecting to the septa in the subcutaneous fat. The deep layer is the connective tissue in contact with the sub-SMAS structure. The layer surrounded by the superficial and deep layer of the SMAS is the intermediate layer, containing connective tissue, adipose tissue, and facial muscles. The detailed findings of the SMAS obtained using this method resolve theoretical discrepancies and provide important insight for the field of facial surgery.

An anaphylactic reaction after simultaneous injection of hyaluronic acid fillers and human collagen

Anaphylaxis is rare following the injection of hyaluronic acid fillers or human collagen for esthetic improvement of the face. We report a case occurring in a 63-year-old woman treated simultaneously with both. Symptoms included full-body urticaria and gastrointestinal symptoms that declined within a few hours, facial redness and swelling lasting a few days, and a nodule in the right tear trough that recurred over several months. Treatment with corticosteroids and antihistamine ultimately supported a complete recovery. Although rare, practitioners using injectables should be trained to manage anaphylactic events if they occur.

POS1298 RELATIONSHIP BETWEEN DISEASE ACTIVITY BY JADAS-27, SDAI, AND DAS-28 AND SUBSEQUENT CHANGES IN PHYSICAL FUNCTION IN ADULT PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Juvenile Arthritis Disease Activity Score (JADAS) has been developed as a composite disease activity score specific to Juvenile idiopathic arthritis (JIA). Evaluation of disease activity with a composite measure associated with subsequent changes in structural damage of joints and physical function is necessary for the proper management of Rheumatoid Arthritis (RA) with treat-to-target strategy, and this concept should be considered for patients with JIA in transition and adulthood as well. However, the usefulness of JADAS-27 and other composite measures for RA in these patients has been scarecely investigated. Additionally, JADAS-27 is unfamiliar to non-pediatric rheumatologists.

Objectives

We aimed to investigate an optimal composite score for disease activity in adult JIA from the viewpoint of the subsequent changes in physical function.

Methods

Patients diagnosed with JIA with the following conditions were enrolled: 1) disease onset at age < 18 years; 2) registered in the IORRA database for the first time between 2000 and 2020; and 3) ≥18 years old at the time of IORRA registration. The baseline of each patient was their initial entry into the IORRA database. The Simplified Disease Activity Index (SDAI), Disease Activity Score using 28 joints (DAS28), and JADAS-27 were compared. The patients were stratified into four disease activity categories: remission/inactive disease, low disease activity, moderate disease activity, and high disease activity according to mean disease activity scores in each index during the first year from baseline, and mean changes in J-HAQ (mean ΔJ-HAQ) during 2 years from baseline in each disease activity group were estimated using the linear mixed effect model to account for correlations of repeated measures without filling in the missing data after adjusting for sex, age, and disease duration.

Results

We included 294 eligible individuals (median age at onset, 14.0 years; rheumatoid factor positive in 64.7%). The median age at baseline and disease duration was 33.8 (24.1–47.7) years and 21.0 (11.0–34.0) years, respectively. The J-HAQ was completed in all 294 patients, and 171 (58.1%) had a score of less than 0.5 at baseline, which is defined as functional remission. During the 2-year observation period, the median J-HAQ of all patients remained unchanged. There was a trend toward improvement in disease activity over time in all three composite scores. Some differeces were obsered across the three indeces: a higher proportion of patients with high disease activity and a lower proportion of patients in remission/inactive disease were observed with JADAS-27 versus SDAI and DAS28. A significant increasing trend of the estimated mean ΔJ-HAQ at 2 years after baseline was observed along with an increase in the mean disease activity during the first year measured using DAS28 (p = 0.01) and SDAI (p = 0.018), but not using JADAS-27 as shown in Table 1.

Table 1.

Association of the mean disease activity categories during the first year after baseline and mean changes in J-HAQ during the two years after baseline

(n = 294)SDAIDAS28JADAS-27Remission/inactive disease0.019 [−0.190, 0.228]0.053 [0.024, 0.130]0.081 [−0.072, 0.234]LDA0.091 [−0.150, 0.332]0.102 [−0.013, 0.217]0.054 [−0.102, 0.210]MDA or HDA0.155 [−0.286, 0.596]0.136 [0.030, 0.242]0.087 [0.022, 0.152]p-value for trend0.0190.0100.115

(Data are expressed as J-HAQ [95% confidence interval]. P-value less than 0.05 indicate a significant trend of the mean ΔJ-HAQ during the two years after baseline. LDA low disease activity; MDA moderate disease activity; HDA high disease activity)

Conclusion

Disease activity measured using SDAI and DAS28, but not using JADAS27, was significantly associated with subsequent changes in physical function in transitional and adult patients with JIA. This study support the use of SDAI and DAS28, but not JADAS27, in assessing disease activity in these patients to adjust treatments for preventing future deterioration of physical function.

Disclosure of Interests

Takako Miyamae: None declared, Eisuke Inoue Speakers bureau: EI has received lecture fees or consulting fees from Bristol Myers Squibb Co., Ltd., Pfizer Japan Inc., and Nippontect systems Co. Ltd., Eiichi Tanaka Speakers bureau: ET has received lecture fees or consulting fees from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Celltrion Healthcare Japan CO, LTD., Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyo, Inc., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kyowa Pharma Chemical CO., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical CO., Ltd., Nippon Kayaku Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd, and UCB Japan Co. Ltd., Tomohiro Kawabe: None declared, Katsunori Ikari: None declared, Masayoshi Harigai Speakers bureau: MH has received speaker’s fee from AbbVie Japan GK, Astra Zeneca K. K., Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Gilead Sciences Inc., Janssen Pharmaceutical K.K., Kissei Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., Nippon Shinyaku Co., Ltd., Novartis Japan, Pfizer Japan Inc., CIMIC Holdings Co., Ltd., Mitsubishi Tanabe Pharma Co., Teijin Pharma Ltd and UCB Japan., Consultant of: MH is a consultant for AbbVie, Boehringer Ingelheim, Bristol Myers Squibb Co., Kissei Pharmaceutical Co., Ltd., and Teijin Pharma., Grant/research support from: MH has received research grants from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc., Eisai Co., Ltd., Kaken Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., Sekisui Medical, Taisho Pharmaceutical Co., Ltd., and Teijin Pharma Ltd.

AB0332 EVALUATION OF THE RABBIT RISK SCORE IN JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS NEWLY TREATED WITH BIOLOGIC DMARDS: DATA FROM THE IORRA COHORT

Background

Serious infection is one of the most critical adverse events in patients with rheumatoid arthritis (RA) using biologic disease-modifying antirheumatic drugs (bDMARDs). During the first year, infections occur more frequently. Therefore, estimating the risk of developing a serious infection is important for the safe use of bDMARDs. The Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) risk score predicted the incidence rate of serious infection during 1 year in patients with RA taking DMARDs. Moreover, it has been validated using data from various observational cohort studies and nationwide registries with favorable results, with a reported area under the receiver operating characteristic curve (AUROC) of 0.68–0.871–5. However, the RABBIT risk score has not been validated in RA patients starting a first bDMARD.

Objectives

To investigate the discriminatory ability of the RABBIT risk score for predicting the development of serious infection during 1 year after starting first bDMARDs in Japanese patients with RA using data from the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort.

Methods

The IORRA cohort is a large observational cohort at the Institute of Rheumatology, Tokyo Women’s Medical University. Japanese patients with RA visiting our institute were registered and clinical parameters were assessed biannually. This study enrolled patients with RA who were registered in the IORRA cohort and treated with a first bDMARD. Patients who were missing data needed to calculate the RABBIT risk score were excluded. The RABBIT risk score was calculated using the patient’s age, comorbidities, Japanese-Health Assessment Questionnaire score, history of previous infections, and types of DMARDs used. Serious infections were defined as those requiring hospitalization or treatment with intravenous antibiotics. The occurrence of serious infection during 1 year after starting the first bDMARDs was identified using data from the biannual IORRA cohort and confirmed using medical records. The discriminatory ability of the RABBIT risk score was analyzed by the AUROC.

Results

A total of 1,081 patients with RA and a median age of 55.3 years, in which females were the majority (88.2%), were included. Serious infection occurred in eight patients during 1 year before starting their first bDMARDs. The number of patients starting a TNF inhibitor, IL-6 inhibitor, and abatacept were 830 (76.8%), 170 (15.7%), and 81 (7.5%), respectively. A total of 23 patients (1.7%) had serious infections during 1 year after starting the first bDMARD; the most frequent infection was pneumonia (n=16, 69.6%). The median RABBIT score was 2.3 (IQR 1.6–5.4) in patients with serious infections during the follow-up period, and 1.6 (IQR 1.2–2.5) in patients without serious infections. The discriminatory ability of the RABBIT risk score was slightly poor, with an AUROC of 0.67 (95% CI, 0.52– 0.79).

Conclusion

The RABBIT risk score is highly practical; however, our present study suggested that some adjustments may be required to predict the risk of serious infection in Japanese patients with RA starting a first bDMARD.

Figure 1.

ROC curve of serious infection and RABBIT score with an AUROC of 0.67 (95% CI, 0.52– 0.79).

Disclosure of Interests

Tomoaki Higuchi: None declared, Eiichi Tanaka Speakers bureau: Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Paid instructor for: Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: Bristol-Meyers and Pfizer, Consultant of: Nippontect systems, Mai Abe: None declared, Kumiko Saka: None declared, Eri Sugano: None declared, Naohiro Sugitani: None declared, Yoko Shimizu: None declared, Moeko Ochiai: None declared, Rei Yamaguchi: None declared, Katsunori Ikari Speakers bureau: Asahi Kasei Pharma Corp., Astellas Pharma Inc., AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp. Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Ltd and UCB Japan Co. Ltd., Yamanaka Hisashi: None declared, Masayoshi Harigai Speakers bureau: AbbVie Japan, Ayumi, Boehringer Ingelheim Japan, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly Japan, GlaxoSmithKline, Kissei, Pfizer Japan Inc, Takeda, Teijin, Consultant of: AbbVie Japan, Boehringer Ingelheim Japan, Bristol-Myers Squibb, Kissei, Teijin, Grant/research support from: AbbVie Japan, Asahi Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Kissei, Mitsubishi Tanabe, Nippon Kayaku, Sekiui Medical, Shionogi, Taisho, Takeda, Teijin.

Increase in the incidence of acute inflammatory reactions to injectable fillers during COVID-19 era

Background

Acute inflammatory reactions (AIRs) are a rare complication following esthetic treatment with hyaluronic acid (HA) and/or human collagen fillers. However, a substantial increase in the frequency of AIRs was observed in the first author's clinic since May 2020.

Aims

To report AIR cases, we experienced and discuss potential underlying mechanisms.

Methods

This was a retrospective review of patients representing AIR symptoms following filler injection with HA or human collagen in our clinic.

Results

Although only one case of an AIR with an incidence rate of 0.01% was recorded following filler treatment between September 2008 and April 2020 in our clinic, we observed 14 AIR cases without anaphylaxis, with an incidence rate of 1.18% between May 2020 and June 2021, in line with the spreading of the new coronavirus pandemic. All cases were females aged 40–57 years, and the time of onset was within hours after filler injection. Three patients had been treated with HA fillers only, 2 with HA plus human collagen, and 9 with human collagen only. Most patients had been treated with these products in the past. Nine patients were treated with oral prednisolone. In all cases, symptoms resolved entirely within a week without sequelae.

Conclusions

The marked increase in AIRs coincided with the COVID‐19 pandemic. Possible explanations include immune system alterations caused by extensive changes in domestic and personal hygiene, prolonged and elevated stress levels, and subclinical COVID‐19 infection. Further studies may be warranted.

OP0187 INCIDENCE OF MALIGNANCY IN JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE JAPANESE IORRA PATIENT REGISTRY

Background:

The risk of some types of malignancy is increased in patients (pts) with rheumatoid arthritis (RA), compared with the general population. We have previously reported the incidence of malignancy in Japanese pts with RA.1-4

Objectives:

This analysis further evaluated the incidence of malignancy in Japanese pts with RA using recent data from the large prospective observational study, IORRA.

Methods:

This analysis included all pts with RA aged ≥18 years who were enrolled in IORRA from April 2013 to October 2018, with follow-up through October 2019, and participated in ≥2 surveys. Index was defined as the date of the first entry in the IORRA database, with baseline defined as the 6-month period prior to the index date. Malignancies were identified in pt reports of biannual IORRA surveys and confirmed using medical records. Age- and sex-standardised incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated.

Results:

In total, 8020 pts were included. At baseline, the majority (85.0%) of pts were female; mean disease duration was 12.8 years, 5.8% and 4.8% of pts had a past history of malignancy or comorbid malignancy at baseline, respectively, and the majority (75.9%) of pts were receiving methotrexate (Table). The SIR (95% CI) was 0.90 (0.80, 1.01). SIRs (95% CI) of site-specific malignancies were: breast cancer, 0.91 (0.69, 1.18); lung cancer, 0.67 (0.44, 0.97); colon cancer, 0.93 (0.62, 1.32); stomach cancer, 0.82 (0.56, 1.14); and lymphoma, 3.74 (2.73, 4.96).

Table 1.

Patient demographics and baseline disease characteristics

Patients with RA (N=8020)Age (years), mean (SD)59.3 (13.8)Female, n (%)6816 (85.0)Duration of RA (years), mean (SD)12.8 (10.3)Never smoked, n (%)5086 (66.2)DAS28, mean (SD)2.8 (1.1)J-HAQ, mean (SD)0.60 (0.72)Malignancy status, n (%)Past history of malignancy467 (5.8)Comorbid malignancy at baseline386 (4.8)Medication use, n (%)MTX6088 (75.9)Tacrolimus787 (9.8)Corticosteroids2641 (32.9)bDMARD use1508 (18.8)TNFi1163 (14.5)Tocilizumab311 (3.9)Abatacept106 (1.3)JAK inhibitors4 (0.05)

bDMARD, biological disease-modifying antirheumatic drug; DAS28, Disease Activity Score in 28 joints; JAK, Janus kinase; J-HAQ, Japanese Health Assessment Questionnaire; MTX, methotrexate; N, the number of patients included in the analysis, the number of patients assessed for each characteristic may be fewer than N; n, the number of patients with each characteristic; SD, standard deviation; TNFi, tumour necrosis factor inhibitor

Conclusion:

Overall risk of malignancy was similar to that in the general Japanese population, although a significantly higher risk of lymphoma was identified.

References:

[1]Sugimoto et al. Rheumatol Int 2017; 37: 1871-1878.

[2]Shimizu et al. Clin Rheumatol 2017; 36: 1237-1245.

[3]Askling et al. Ann Rheum Dis 2016; 75: 1789-1796.

[4]Yamada et al. Rheumatol Int 2011; 31: 1487-1492.

Acknowledgements:

Study sponsored by Pfizer Inc. Medical writing support was provided by Anthony G McCluskey, CMC Connect, and funded by Pfizer Inc.

Disclosure of Interests:

masayoshi harigai Speakers bureau: AbbVie Japan, Ayumi, Boehringer Ingelheim Japan, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly Japan, GlaxoSmithKline, Kissei, Pfizer Japan Inc, Takeda, Teijin, Consultant of: AbbVie Japan, Boehringer Ingelheim Japan, Bristol-Myers Squibb, Kissei, Teijin, Grant/research support from: AbbVie Japan, Asahi Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Kissei, Mitsubishi Tanabe, Nippon Kayaku, Sekiui Medical, Shionogi, Taisho, Takeda, Teijin, Naohiro Sugitani: None declared, Ryoko Sakai Speakers bureau: Bristol-Myers Squibb, Eisuke Inoue Speakers bureau: Pfizer Japan Inc, Bristol-Myers Squibb, Michika MOCHIZUKI Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Shigeyuki Toyoizumi Employee of: Pfizer R&D Japan, Noritoshi Yoshii Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Naonobu Sugiyama Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Eiichi Tanaka Speakers bureau: AbbVie Japan, Asahi Kasei, Astellas, Ayumi, Chugai, Eisai, Eli Lilly Japan, GlaxoSmithKline, Kyowa, Janssen, Mochida, Pfizer Japan Inc, Takeda, Teijin, Hisashi Yamanaka Speakers bureau: Astellas, Bristol-Myers-Squibb, Pfizer Inc, Mitsubishi Tanabe, Teijin, YLBio, Consultant of: Corrona, LLC

POS0603 ANALYSIS OF FACTORS ASSOCIATED WITH THE EFFECTIVENESS OF ABATACEPT IN THE ORIGAMI STUDY

Background:

The ORIGAMI study is a multicenter, observational study to evaluate the effectiveness, safety, and patient-reported outcomes of abatacept (ABA) in Japanese patients with csDMARD-resistant, Simplified Disease Activity Index (SDAI)-moderate, biologic-naïve rheumatoid arthritis (RA). ABA has shown better effectiveness/efficacy in RA patients with anti-cyclic citrullinated peptide antibody (ACPA) positive (1) and high ACPA titer (2) compared to ACPA negative and low ACPA titer, respectively. However, more accurate predictors of effectiveness in clinical practice are needed than ACPA status.

Objectives:

This post-hoc analysis is aimed to determine the association between ACPA and ABA effectiveness (disease activity and physical function) or retention rate and to investigate other factors associated with the effectiveness of ABA in patients enrolled in the ORIGAMI study.

Methods:

Of the 279 patients in the effectiveness analysis set of the ORIGAMI study, 270 patients with baseline ACPA measurement were analyzed. The patients were divided into the ACPA-positive group (ACPA +ve, ≥4.5 U/mL at baseline) and the ACPA-negative group (ACPA –ve, <4.5 U/mL). Patients’ characteristics, changes in disease activity and physical function (Japanese Health Assessment Questionnaire; J-HAQ) through 52 weeks, and retention rates of ABA at week 52 were evaluated. Baseline characteristics and use of concomitant drugs were analyzed as independent variables by multiple regression analysis using a standard linear model adjusted by SDAI at week 0 to identify factors associated with SDAI change at week 52. In addition, the interaction effects among ACPA status, RF status, and the factor that was significantly associated with SDAI change in multiple regression analysis on changes in SDAI were explored.

Results:

The numbers of ACPA +ve and –ve patients were 226 and 44, respectively. ACPA values (mean ± SD, U/mL) were 280.3 ± 376.8 and 0.9 ± 0.7, and rheumatoid factor (RF) values were 174.8 ± 302.6 and 20.9 ± 61.7 in the ACPA +ve and –ve groups, respectively. Mean (95% confidence interval) changes in SDAI at week 52 were −11.3 (−12.4 to −10.3) and −8.0 (−10.5 to −5.5), and those in J-HAQ were −0.27 (−0.34 to −0.20) and −0.16 (−0.34 to 0.01) in the ACPA +ve and –ve groups, respectively. In the Kaplan–Meier analysis, the retention rates of ABA at week 52 in the ACPA +ve and –ve groups were 72.1% and 58.7%, (discontinuation for any reason), and 91.6% and 75.7% (discontinuation because of lack of effectiveness), respectively. In a multiple regression analysis, the duration of disease (< 1 year) was associated with the change in SDAI at week 52. With respect to SDAI changes, the estimated difference of ACPA +ve and disease duration (< 1 year), ACPA +ve and disease duration (≥1 year), and ACPA –ve and disease duration (< 1 year), versus ACPA −ve and disease duration (≥ 1 year), were −4.26 (p = 0.022), −0.82 (p = 0.618), and −0.93 (p = 0.716), respectively (Fig. 1). The estimated difference of ACPA +ve and RF +ve, ACPA +ve and RF –ve, and ACPA –ve and RF +ve, versus ACPA –ve and RF –ve, were −2.48 (p = 0.060), −2.77 (p = 0.107), and −5.48 (p = 0.087), respectively.

Conclusion:

A higher retention rate as well as better effectiveness of ABA on disease activity and physical function in ACPA +ve group versus ACPA –ve group were shown in the simple subgroup analysis. ABA effectiveness on the SDAI change was significantly better in patients with disease duration <1 year and ACPA +ve compared to those with ACPA −ve and disease duration ≥ 1 year.

References:

[1]Harrold LR et al. J Rheumatol 2018;45(1):32–39.

[2]Sokolove J et al. Ann Rheum Dis 2016;75(4):709–714.

Disclosure of Interests:

Kenta Misaki Speakers bureau: Eisai Co., Ltd., AbbVie GK, Eli Lilly Japan K.K., Ono Pharmaceutical Co., Ltd., Grant/research support from: Ono Pharmaceutical Co., Ltd., Eiichi Tanaka Speakers bureau: AbbVie GK, Asahi Kasei Pharma Corporation, Astellas Pharma Inc, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kyowa Pharma Chemical Co., Ltd., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co., Ltd., Pfizer, Takeda Pharmaceutical Co., Ltd, and Teijin Pharma Ltd., Eisuke Inoue Speakers bureau: Pfizer Japan, Bristol-Myers Squibb K.K., Katsuki Tsuritani Employee of: Bristol-Myers Squibb K.K., Shigeru Matsumoto Employee of: Ono Pharmaceutical Co., Ltd., Hisashi Yamanaka Consultant of: Bristol-Myers Squibb K.K., masayoshi harigai Speakers bureau: AbbVie GK, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd., Consultant of: AbbVie GK, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., and Gilead Sciences Inc., Grant/research support from: AbbVie GK, and Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd. Daiichi-Sankyo, Inc., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation., Nippon Kayaku Co., Ltd., Taisho Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd.

POS0551 MEDICAL COSTS FOR PATIENTS STARTING TREATMENT FOR RHEUMATOID ARTHRITIS WHO HAVE COMORBID DIABETES MELLITUS IN JAPAN

Background:

Rheumatoid arthritis (RA) patients can experience various comorbidities1. The incidence of diabetes mellitus (DM) is reported higher in patients with RA2 and comorbid DM is likely to affect treatment outcomes3 and then healthcare resource uses, however, no previous study has not focused on it.

Objectives:

To evaluate medical costs and resource use in patients starting treatment for RA with and without DM using a large claims database in Japan.

Methods:

We used a large Japanese administrative claims database constructed by the Japan Medical Data Center (JMDC)4. Patients with the International Classification of Diseases 10th revision (ICD-10) codes for RA who started medication with disease-modifying antirheumatic drugs (DMARDs) after 6 months without them in the period from 1/1/2012 to 12/31/2017 and who were observable for 12 months as a follow-up period were enrolled. These patients were categorized as DM or non-DM group with ICD-10 codes for DM plus use of antidiabetic drugs in 6 months before starting DMARDs (baseline period). To adjust baseline characteristics between the 2 groups, they were matched by sex, age, Charlson Comorbidity Index (CCI) except for DM, months from the first RA codes to starting DMARDs, and medications. The primary endpoint was mean medical cost per patient in the 12-month follow-up period. Costs in JPY were converted into EUR (1 EUR = 125 JPY in 2020). Costs for drugs, treatments, and materials and their subcategories were evaluated both with and without DM-specific costs. The secondary endpoints were the proportions of patients using the subcategories of each resource.

Results:

Patients of 161 for the DM group and 2,974 for the non-DM group were eligible, and 109 patients were matched from each group. The medians of age and CCI were 59 years and 2.0 in both groups and no significant difference was observed in all baseline characteristics used for matching between the groups. Total mean costs were significantly higher in the DM group (DM, 5,331 EUR, non-DM 3,200 EUR; P< 0.05). After excluding DM-specific costs, drug costs were significantly higher in the DM group than in the non-DM group (DM 1,883 EUR, non-DM 896 EUR; P < 0.05), especially costs for biological DMARDs (DM 1,156 EUR, non-DM 292 EUR; P < 0.05), mainly because a higher proportion of patients used these drugs in the DM group (Table 1). Treatment costs (DM 2,380 EUR, non-DM 2,133 EUR) and material costs (DM 74 EUR, non-DM 149 EUR) were not different between the groups, but only costs for examinations were significantly higher in the DM group (DM 970 EUR, non-DM 779 EUR; P < 0.05).

Table 1.

Number and proportion of patients who used drugs

Type of drugDrug use, n (%)DM (N = 109)Non-DM (N = 109)P-valuecsDMARDsTotal109 (100.0)109 (100.0)1.000Methotrexate101 (92.7)102 (93.6)1.000Others46 (42.2)51 (46.8)0.583bDMARDsTotal16 (14.7)6 (5.5)0.041TNFi11 (10.1)4 (3.7)0.118IL6i6 (5.5)2 (1.8)0.219T-cell4 (3.7)0 (0.0)0.125tsDMARDs0 (0.0)0 (0.0)1.000CSs65 (59.6)62 (56.9)0.711AnalgesicsTotal103 (94.5)96 (88.1)0.167Acetaminophen24 (22.0)23 (21.1)1.000Acetaminophen /Opioids10 (9.2)6 (5.5)0.454NSAIDs102 (93.6)93 (85.3)0.093Opioids0 (0.0)4 (3.7)0.125Others25 (22.9)17 (15.6)0.185

bDMARDs=biological disease-modifying antirheumatic drugs; CSs=corticosteroids; csDMARDs=conventional synthetic disease-modifying antirheumatic drugs; DM=diabetes mellitus; IL6i=interleukin-6 inhibitor; NSAID=non-steroidal anti-inflammatory drug; T-cell=selective T-cell co-stimulation modulator; TNFi=tumor necrosis factor α inhibitor; tsDMARDs=targeted synthetic disease-modifying antirheumatic drugs; P-values were calculated using McNemar test

Conclusion:

Medical costs for RA were higher in the DM group than in the non-DM group because of more prevalent use of biological DMARDs in the DM group.

References:

[1]Gabriel SE et al., Arthritis Res Ther. 2009;11(3):229.

[2]Giacomelli R et al., Expert Rev Clin Immunol. 2016;12(8):849-55.

[3]Crepaldi G et al., PLoS One. 2016;11(1):e0146991.

[4]JMDC claims database, Tokyo, Japan.

Disclosure of Interests:

Eiichi Tanaka Speakers bureau: AbbVie GK, Asahi Kasei Pharma Corporation, Astellas Pharma Inc, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kyowa Pharma Chemical Co., Ltd., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co., Ltd., Pfizer, Takeda Pharmaceutical Co., Ltd, and Teijin Pharma Ltd., Eisuke Inoue Speakers bureau: Pfizer Japan, Bristol-Myers Squibb K.K., Ryoko Sakai Speakers bureau: Bristol Myers Squibb Co., Ltd., Grant/research support from: Tokyo Women’s Medical University (TWMU), particularly the Division of Multidisciplinary Management of Rheumatic Diseases, Department of Rheumatology, has received unrestricted research grants from Ayumi Pharmaceutical Co.; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd., Nippon Kayaku Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Mitsubishi Tanabe Pharma Co.; and Teijin Pharma Ltd., with which TWMU paid the salaries of RS., Iwasaki Katsuhiko: None declared, Ayako Shoji: None declared, masayoshi harigai Speakers bureau: AbbVie GK, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd., Consultant of: AbbVie GK, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., and Gilead Sciences Inc., Grant/research support from: AbbVie GK, and Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd. Daiichi-Sankyo, Inc., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation., Nippon Kayaku Co., Ltd., Taisho Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd.

POS0554 MEDICAL COST AND RESOURCE USE IN PATIENTS STARTING TREATMENT FOR RHEUMATOID ARTHRITIS TREATED WITH AND WITHOUT CORTICOSTEROIDS IN JAPAN

Background:

The 2019 update of the European League Against Rheumatism (EULAR) treatment recommendations strongly recommends co-administration of corticosteroids (CSs) with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in patients with RA as bridging therapy to improve the success rate of the first-line treatment and to avoid disease flare-ups1; however, current treatment guidelines for RA in Japan do not clearly mention about their use. Poor disease management after the initial diagnosis can affect the overall use of health services and the economic burden on patients.

Objectives:

To describe medical costs and resource use in patients with early RA treated with and without oral or injectable corticosteroids (CSs) as part of their initial treatment with disease-modifying antirheumatic drugs (DMARDs) in Japan.

Methods:

We used a large Japanese administrative claims database constructed by the Japan Medical Data Center (JMDC)2. Patients with the International Classification of Diseases 10th revision (ICD-10) codes for RA were enrolled at the first DMARDs prescription after no DMARDs prescription period for 6-months (index date) in the period from 1/1/2012 to 12/31/2017. Patients who were observable for 12 months after the index date as a follow-up period were included. Patients treated with CSs within the follow-up period were compared with those without them (CS and non-CS group). The primary endpoint was mean medical cost per patient in the 12-month follow-up period. The secondary endpoints were costs for drugs, treatments, and materials and the proportions of patients using the subcategories of each resource. Drugs were divided into medications for RA or for comorbidities including adverse events (AEs). Costs in JPY were converted into EUR (1 EUR = 125 JPY in 2020).

Results:

Eligible patients of 1,670 and 1,487 were identified as the CS and non-CS group (median age: 51 years and 50 years). Total mean costs were significantly higher in the CS group (CS, 4,448 EUR, non-CS 3,208 EUR; P< 0.05). Drug, treatment, and material costs were significantly higher in the CS group than in the non-CS group (drug for RA and AEs, CS 2,367 EUR, non-CS 1,581 EUR, P < 0.05; drug for RA only, CS 2,265 EUR, non-CS 1,516 EUR, P < 0.05; treatment, CS 1,987 EUR, non-CS 1,562 EUR, P < 0.05; material, CS 94 EUR, non-CS 65 EUR; P < 0.05). The resource use in almost all drug subcategories were higher in the CS group (Table 1), as well as in all treatment and material subcategories.

Table 1.

Number and proportion of patients who used drugs

Type of drugDrug use, n (%)CS (N = 1,670)Non-CS (N = 1,487)P-valuecsDMARDsTotal1,635 (97.9)1,447 (97.3)0.328 Methotrexate1,481 (88.7)1,315 (88.4)0.870 Others790 (47.3)551 (37.1)< 0.001bDMARDsTotal342 (20.5)181 (12.2)< 0.001 TNFi252 (15.1)129 (8.7)< 0.001 IL6i93 (5.6)40 (2.7)< 0.001 T-cell40 (2.4)17 (1.1)0.012AnalgesicsTotal1,512 (90.5)1,274 (85.7)< 0.001 Acetaminophen379 (22.7)273 (18.4)0.003 Acetaminophen / Opioids84 (5.0)37 (2.5)< 0.001 NSAIDs1,459 (87.4)1,214 (81.6)< 0.001 Opioids16 (1.0)10 (0.7)0.491 Others198 (11.9)101 (6.8)< 0.001AntibioticsTotal1,086 (65.0)873 (58.7)< 0.001 Antibacterial drugs1,022 (61.2)800 (53.8)< 0.001 Antifungal drugs133 (8.0)86 (5.8)0.019 Antiviral drugs172 (10.3)129 (8.7)0.136 Antiparasitic drugs5 (0.3)8 (0.5)0.443Anti-osteoporotic drugs341 (20.4)95 (6.4)< 0.001

bDMARDs=biological disease-modifying antirheumatic drugs; CSs=corticosteroids; csDMARDs=conventional synthetic disease-modifying antirheumatic drugs; IL6i=interleukin-6 inhibitor; NSAID=non-steroidal anti-inflammatory drug; T-cell=selective T-cell co-stimulation modulator; TNFi=tumor necrosis factor α inhibitor; P-values were calculated using Chi-square test

Conclusion:

Patients with early RA treated with CSs in the first year after starting DMARDs tended to use more resources and have higher medical costs than patients not treated with CSs.

References:

[1]Smolen JS et al., Ann Rheum Dis. 2020;79(6):685-699.

[2]JMDC claims database, Tokyo, Japan.

Disclosure of Interests:

Eiichi Tanaka Speakers bureau: AbbVie GK, Asahi Kasei Pharma Corporation, Astellas Pharma Inc, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kyowa Pharma Chemical Co., Ltd., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co., Ltd., Pfizer, Takeda Pharmaceutical Co., Ltd, and Teijin Pharma Ltd., Eisuke Inoue Speakers bureau: Pfizer Japan, Bristol-Myers Squibb K.K., Ryoko Sakai Speakers bureau: Bristol Myers Squibb Co., Ltd., Grant/research support from: Tokyo Women’s Medical University (TWMU), particularly the Division of Multidisciplinary Management of Rheumatic Diseases, Department of Rheumatology, has received unrestricted research grants from Ayumi Pharmaceutical Co.; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd., Nippon Kayaku Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Mitsubishi Tanabe Pharma Co.; and Teijin Pharma Ltd., with which TWMU paid the salaries of RS., Iwasaki Katsuhiko: None declared, Ayako Shoji: None declared, masayoshi harigai Speakers bureau: AbbVie GK, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd., Consultant of: AbbVie GK, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., and Gilead Sciences Inc., Grant/research support from: AbbVie GK, and Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd. Daiichi-Sankyo, Inc., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation., Nippon Kayaku Co., Ltd., Taisho Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd.

THU0144 DESCRIPTIVE ANALYSIS OF PREGNANCY, DELIVERY, AND LACTATION IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM THE IORRA COHORT

Background:

Rheumatoid Arthritis (RA) is common in women with reproductive age. For this reason, RA treatment during pregnancy and lactation is very important. In recent years, the use of biologic disease-modifying antirheumatic drugs (bDMARDs) has become common in RA treatment (1), treatment during pregnancy and lactation has changed drastically (2,3).

Objectives:

To investigate the pregnancy, delivery and lactation status of RA patients and treatment during that period in daily practice.

Methods:

The IORRA cohort is a large, single institute-based, observational cohort of RA patients established at Institute of Rheumatology, Tokyo Women’s Medical University, in 2000. We identified female RA patients aged 20-49 years who answered ‘pregnant’ or ‘delivered’ in the IORRA survey in 2010-2016 and whose pregnancies were confirmed in the medical records. We examined the Disease Activity Score with 28 joint count (DAS28)-CRP, medication use situation, the outcome of pregnancy, and lactation in those patients.

Results:

A total of 101 patients and 143 pregnancies were confirmed, of which 136 outcomes of pregnancy could be confirmed in the medical records. Among 136 confirmed pregnancy cases, there were 106 births and 30 miscarriages. Among 106 births, 4 cases (3.8%) were birth defects that could be confirmed in the medical records. The average age at pregnancy was 34.2±3.7 years and 36.1±3.3 years in delivered and miscarried cases, respectively. Miscarried cases were significantly older pregnancies (p=0.01). Of the 106 births, 65 birth weeks were confirmed, with an average of 37.9±1.8 weeks. The number of preterm delivery was 11 cases (16.9%). The average birth weight of 59 babies whose birth weight could be confirmed was 2699±517 g. There were 21 cases (35.6%) of low birth weight infants. The proportion of patients in DAS28-CRP remission was 73.1% before pregnancy, 61.6% during pregnancy, and 68.0% 1 year after delivery. Drugs used before pregnancy were glucocorticoid (48.8%), non-steroidal anti-inflammatory drugs (14.2%), conventional synthetic DMARDs (24.8%), and bDMARDs (48.0%). Etanercept accounted for 90% of bDMARDs. Among taking bDMARDs patients, 73.8% were discontinued after the pregnancy, and 26.2% were continued during pregnancy. Among those patients who continued bDMARDs, lactating patients were 12/26 (46.2%) cases after delivery, 10/30 (33.3%) cases in six months after delivery, and 7/36 (19.4%) cases in 1 year after delivery, respectively.

Conclusion:

The actual situation of pregnancy, delivery, and lactation in RA patients was revealed. Especially, bDMARDs were used at relatively high rates in RA patients who wish to have a child.

References:

[1]Lancet. 2017;10;389:2338-2348.

[2]Semin Arthritis Rheum. 2019;49:S32-S35.

[3]Rheumatology. 2016;55:1693-7.

Disclosure of Interests:

Moeko Ochiai: None declared, Eiichi Tanaka Consultant of: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Speakers bureau: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: EI has received speaker fee from Bristol-Meyers, Pfizer, Merck serono., Mai Abe: None declared, Eri Sugano: None declared, Naohiro Sugitani: None declared, Kumiko Saka: None declared, higuchi yoko: None declared, Rei Yamaguchi: None declared, Naoki Sugimoto: None declared, Ikari Katsunori Speakers bureau: KI has received speaker’s fee from Asahi Kasei Pharma Corp., Astellas Pharma Inc., AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eis, ai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp.Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Ltd and UCB Japan Co. Ltd., Ayako Nakajima Grant/research support from: AN has received research grants from Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Consultant of: AN has consultant fee from Nippon Kayaku Co. Ltd., Speakers bureau: AN has received speaker’s fee from AbbVie Japan GK, Actelion Pharmaceuticals Japan LTD., Asahi Kasei Pharma Co., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Hisamitsu Pharmaceutical Co. Inc., Kyorin Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., Otsuka Pharmaceutical Co. Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd., Atsuo Taniguchi: None declared, Hisashi Yamanaka Grant/research support from: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., Speakers bureau: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.

AB1199 COST-EFFECTIVENESS OF EARLY INITIATION OF ABATACEPT ON JAPANESE RHEUMATOID ARTHRITIS PATIENTS BASED ON THE AMPLE STUDY, USING IORRA REAL WORLD DATA

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory disorder leading to disability and reduced quality of life. Effective treatment with biologic disease-modifying antirheumatic drugs (bDMARD) poses a significant economic burden. The abatacept (ABT) versus adalimumab comparison in biologic-naive RA subjects with background methotrexate (AMPLE) trial1was a head-to-head randomized study.

Objectives:

To assess the cost-effectiveness (CE) of early initiation of ABT on Japanese RA patients with data from the IORRA database (ID).2

Methods:

A model based on the AMPLE study was used to estimate the CE of ABT 1stversus ABT 2ndlines in a cohort of 1000 patients based on responses on ACR20/50/70, HAQ-DI, CDAI and SDAI estimated from the real-clinical data of the ID. Unit costs for direct medical costs of adverse events (AEs), proportions of patients with concomitant medications or outpatient/inpatient visits; doses and duration of concomitant medications were taken from the JMDC claims database.3Uncertainty was assessed in sensitivity analyses (SA) where cost parameters were tested on their ±30% levels. Results were compared between subgroups using cut-offs of 65-years of age and 1.5 of HAQ, or 5-years of treatment duration. The study used a Japanese healthcare payers’ perspective over a 2-year time horizon.

Results:

Incremental costs were all in favor of ABT 2ndline with 137 MJPY (1.1 M€, 120 JPY=1 €), 6 MJPY (0.05 M€), 41 MJPY (0.3 M€), 8 MJPY (0.07 M€) and 2.2 MJPY (0.02 M€) for bDMARDs, concomitant medication, AEs, serious AE, and hospitalizations due to infections, respectively. In total, the incremental costs were expected to be 195 MJPY (1.6 M€) higher for ABT as 1stline treatment, but the cost per responding patient and per patient in remission favored ABT 1stline across most response outcomes (Table 1).

Table 1.

Total costs per responder and patient in remission per 2-year

Difference in cost per health gain(ABT first line - ABT second line)Cost per responding patient (kJPY)ACR20-2,927 (-24 k€)ACR50-6,406 (-53 k€)ACR70-10,822 (-90 k€)HAQ-DI-5,120 (-43 k€)Cost per patient in remission (kJPY)DAS28828 (7 k€)CDAI-7,019 (-58 k€)SDAI-5,584 (-47 k€)

ABT=abatacept; ACR20/50/70= 20/50/70% improvement of the American college of rheumatology criteria; HAQ-DI=health assessment questionnaire disability index; DAS28=disease activity score; CDAI=clinical disease activity index; SDAI=simplified disease activity index

SA showed that the cost for bDMARDs drives the difference in healthcare costs between the cohorts (-685 MJPY to 1,074 MJPY). For sub-groups of patients ≥65 years, <65 years, HAQ≥1.5, HAQ <1.5, treatment duration ≥5 years, <5 years the total 2-yearly costs per responder (SDAI remission) were 106 kJPY (0.9 k€), 321 kJPY (2.7 k€), 1,353 kJPY (11.3 k€), 106 kJPY (0.9 k€), 231 kJPY (1.9 k€) and 178 kJPY (1.5 k€) lower for ABT 1stline, respectively.

Conclusion:

Savings per responding patient are expected if ABT are prescribed as 1stline versus 2ndor 3rdline treatment, irrespective of age, disease duration and functional impairment level.

References:

[1]Sokolove J MS et al.,Anna rheum dis.2015;74(Suppl 2)

[2]IORRA cohort database, Tokyo Women’s Medical University, Tokyo, Japan

[3]JMDC claims database, Tokyo, Japan

Disclosure of Interests:

Eiichi Tanaka Consultant of: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Speakers bureau: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: EI has received speaker fee from Bristol-Meyers, Pfizer, Merck serono., Ayako Shoji Consultant of: To conduct this work, Jonas Nilsson Consultant of: To conduct this study, Christos Papagiannopoulos Consultant of: To conduct this study, Dhanda Devender Shareholder of: BMS, Employee of: BMS, Yoshio Anazawa Shareholder of: BMS, Employee of: BMS, Yuri Yoshizawa Shareholder of: BMS, Employee of: BMS, masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.

AB0257 ASSESSMENT OF PHYSICAL DYSFUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS WHO PLANNED PREGNANCY FROM THE IORRA COHORT

Background:

It has been reported that female rheumatoid arthritis (RA) patients have a longer time to pregnancy than healthy women (1), and that high Disease Activity Score with 28 joint count (DAS28) -CRP in preconception increases the frequency of infertility (2). Before the era of biologics, RA treatment tended to be inadequate from pregnancy planning to the end of lactation. And it was not uncommon for female RA patients to be unable to get pregnant or develop physical dysfunction as a result of insufficient control of the disease. There are some reports of disease activity during pregnancy and postpartum in RA patients, and the effects of RA disease activity on pregnancy and childbirth outcomes (3-5), but there are few reports focusing on the physical function during pregnancy planning of RA patients.

Objectives:

To investigate disease activity and physical function in female patients with RA who planned and didn’t plan pregnancy.

Methods:

The IORRA cohort is a large, single institute-based, observational cohort of RA patients established at the Institute of Rheumatology, Tokyo Women’s Medical University, in 2000. We identified female RA patients aged 20-49 years who answered ‘pregnant’ or ‘delivered’ in the IORRA survey in 2010-2015 and whose pregnancy and the pregnancy planning time was confirmed in the medical records, and defined them as the pregnancy planning (PP) group. Matched control was extracted at 1:3 ratio from patients without pregnancy plan based on entry time, age, RA disease duration, DAS28-CRP, Japanese version of Health Assessment Questionnaire (J-HAQ) score, and comorbidities. The primary endpoint was J-HAQ at 3years from the baseline, which was defined as the most recent IORRA survey before planning pregnancy. The mixed-effect model for repeated measures was used to analyze group difference.

Results:

There were 40 patients in the PP group (average 32.2 years, disease duration 5.7 years, DAS28-CRP 1.7, J-HAQ 0.26), and 120 patients in the control group (average 32.4 years, disease duration 5.9 years, DAS28-CRP 1.7, J-HAQ 0.21). The proportion of user and dosage of MTX and glucocorticoid (GC) and bDMARDs user at baseline were comparable between the groups (MTX: PP 87.5% [9.8 mg/week], control 85.0% [8.8 mg/week]; GC: PP 32.5% [3.6 mg/day], control 27.5% [4.4 mg/day]; bDMARDs: PP 40.0%, control 27.5%). DAS28-CRP at year 3 of the PP group elevated and was higher than the control group (PP 2.3, control 1.7, p<0.01), while J-HAQ was stable over the observation period and did not differ significantly at year 3 (PP 0.21, control 0.22, p=0.92). At year 3, the proportion of patients taking MTX was lower and taking GC was higher in the PP group than those in the control group (MTX: PP 36.7%, control 76.7%, p<0.01; GC: PP 70.0%, control 25.6%, p<0.01). The proportion of patients taking bDMARDs was not different in both groups (PP 36.7%, control 32.6%, p=0.68).

Conclusion:

Physical function in pregnancy planning patients with RA did not deteriorate as well as the control patients in clinical settings.

References:

[1]Arthritis Rheum. 2011;63:1517-1521.

[2]Ann Rheum Dis. 2015;10:1836-1841.

[3]J Rheumatol. 2015;42:1376-1382.

[4]J Rheumatol. 2019;46:245-250.

[5]Arthritis Care Res. 2017;69:1297-1303.

Disclosure of Interests:

Moeko Ochiai: None declared, Eiichi Tanaka Consultant of: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Speakers bureau: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: EI has received speaker fee from Bristol-Meyers, Pfizer, Merck serono., Mai Abe: None declared, Eri Sugano: None declared, Naohiro Sugitani: None declared, Kumiko Saka: None declared, higuchi yoko: None declared, Rei Yamaguchi: None declared, Naoki Sugimoto: None declared, Ikari Katsunori Speakers bureau: KI has received speaker’s fee from Asahi Kasei Pharma Corp., Astellas Pharma Inc., AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eis, ai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp.Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Ltd and UCB Japan Co. Ltd., Ayako Nakajima Grant/research support from: AN has received research grants from Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Consultant of: AN has consultant fee from Nippon Kayaku Co. Ltd., Speakers bureau: AN has received speaker’s fee from AbbVie Japan GK, Actelion Pharmaceuticals Japan LTD., Asahi Kasei Pharma Co., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Hisamitsu Pharmaceutical Co. Inc., Kyorin Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., Otsuka Pharmaceutical Co. Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd., Atsuo Taniguchi: None declared, Hisashi Yamanaka Grant/research support from: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., Speakers bureau: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.

OP0221 HAVE 5-YEAR SURVIVAL RATE AND MORTALITY CHANGED IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS IN THE PAST TWENTY YEARS?-RESULTS FROM THE IORRA COHORT

Background:

The mortality of patients with rheumatoid arthritis (RA) had been reported as being worse than that of the general population [1, 2], but is expected to have improved over time because the progress in treatment of RA during the past twenty years has been actively adopted to RA management [3, 4]. However, the change in the mortality still remains controversial in patients with early RA [5, 6].

Objectives:

To investigate whether the vital prognosis of patients with early RA has changed in the past twenty years.

Methods:

The IORRA cohort is a large observational cohort established in 2000 at the Institute of Rheumatology, Tokyo Women’s Medical University. Essentially, all Japanese patients diagnosed with RA at our institute were registered and clinical parameters were assessed biannually. As there is no National Death Registry in Japan, we obtained death report from residual families who responded to our mail query to patients who failed to conduct the subsequent IORRA survey, from physicians of affiliated hospitals and from police in case they found dead patient outside of a hospital. In this study, the patients with early RA (less than 2 years of disease duration) who participated in the survey for the first time from 2001 to 2012 were included and observed for five years from the date of the initial survey. We classified patients into group A (enrolled in 2001-2006) and B (enrolled in 2007-2012). Five-year survival rate and standardized mortality ratio (SMR) were calculated for each group. SMR was calculated using the life tables in Japanese general population reported by the Ministry of Health, Labour and Welfare, Japan. The effects of loss to follow-up cases were evaluated by multiple imputation method as a sensitivity analysis of SMR.

Results:

A total of 3,217 patients with early RA were analyzed. The number of patients was 1,609 (79.4% female) in the group A and 1,608 (81.8% female) in B. The median age at baseline was 55 in both groups. Among a total of 3,217 patients, 486 (15.1%) patients were lost during 5-year follow-up; 213 (13.2%) in the group A and 273 (17.0%) in B, respectively. During the observational period, deaths were confirmed in 47 cases (2.9%) in the group A and 45 (2.8%) in B. Major causes of death included malignancies (28% in the group A, 38% in B), respiratory involvement (23% in the group A, 40% in B), cerebrovascular disorders (11% in the group A, 2% in B), and cardiovascular disorders (11% in the group A, 0% in B). The five-year survival rate was 88.8% for the group A and 87.8% for B, and the SMR was 0.81 (95%CI: 0.59-1.08) for the group A and 0.78 (0.57-1.04) for B when assuming all the lost to follow-up patients were alive for 5 years. In the sensitivity analysis assuming that the mortality rate of patients who were lost to follow-up was twice as that of the general population, the SMR was 0.90 (0.68-1.19) for the group A and 0.92 (0.68-1.23) for B.

Conclusion:

The mortality of patients with early RA in the past twenty years has been comparable to that of the Japanese general population. In addition, the SMR and the five-year survival rate did not change overtime.

References:

[1]Cobb, S., et al. N Engl J Med 1953; 249(14): 553-556.

[2]Nakajima, A., et al. Scand J Rheumatol 2010; 39(5): 360-367.

[3]Smolen, J. S., et al. Ann Rheum Dis 2014; 73(3): 492-509.

[4]Singh, J. A., et al. Arthritis Care Res 2016; 68(1): 1-25.

[5]Lacaille, D., et al. Ann Rheum Dis 2017; 76(6): 1057-1063.

[6]Humphreys, J. H., et al. Arthritis Care Res 2014; 66(9): 1296-1301.

Disclosure of Interests:

Naohiro Sugitani: None declared, Eiichi Tanaka Consultant of: Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: EI has received speaker fee from Bristol-Meyers, Pfizer, Merck serono., Mai Abe: None declared, Eri Sugano: None declared, Kumiko Saka: None declared, Moeko Ochiai: None declared, Yoko Shimizu: None declared, Rei Yamaguchi: None declared, Naoki Sugimoto: None declared, Katsunori Ikari Speakers bureau: Asahi Kasei Pharma Corp., Astellas Pharma Inc., AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eis, ai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp.Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Ltd and UCB Japan Co. Ltd., Ayako Nakajima Grant/research support from: AN has received research grants from Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Consultant of: AN has consultant fee from Nippon Kayaku Co. Ltd., Speakers bureau: AN has received speaker’s fee from AbbVie Japan GK, Actelion Pharmaceuticals Japan LTD., Asahi Kasei Pharma Co., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Hisamitsu Pharmaceutical Co. Inc., Kyorin Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., Otsuka Pharmaceutical Co. Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd., Atsuo Taniguchi: None declared, Hisashi Yamanaka Grant/research support from: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., Speakers bureau: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.

THU0086 FACTORS ASSOCIATED WITH TREATMENT RESPONSE IN PATIENTS WITH ELDERLY-ONSET RHEUMATOID ARTHRITIS: 3-YEAR OBSERVATION USING THE IORRA COHORT

Background:

Patients with elderly-onset rheumatoid arthritis (EORA) are on the rise in the aging or super-aging society, especially in Japan. Patients with EORA have more comorbidities than those with younger-onset RA, a higher risk of adverse drug reactions due to reduced drug metabolism, and a higher risk of infections1). Therefore, patients with EORA tend to receive suboptimal treatment, resulting in insufficient control of disease activity2). Although several studies reported treatment responsiveness in patients with EORA, many of them have a limited observation period3-8), and long-term treatment responses and their associated factors need to be clarified.

Objectives:

We retrospectively evaluated treatment responses of patients with EORA for 3 years and their associated factors in a clinical setting.

Methods:

The Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort is a large, single institute-based, observational cohort of RA patients established at Institute of Rheumatology, Tokyo Women’s Medical University, in 2000. The subjects were RA patients who first enrolled in the IORRA cohort from 2010 to 2014, were over 60 years old with less than 1-year disease duration, and had a DAS28-ESR over 3.2 at entry. The primary endpoint was DAS28-ESR <3.2 after 3-year observation. A multivariate logistic regression analysis was conducted to identify factors at baseline associated with the primary endpoint. The missing values of DAS28-ESR were imputed by using the last observation carried forward method.

Results:

Among a total of 250 patients in this study, 152 patients (60.8%) achieved DAS28-ESR <3.2 after 3-year observation (remission/low disease activity (RL) group), and 98 patients did not (moderate/high disease activity (MH) group). Baseline characteristics of the patients were as follows (average ± SD or %): the RL group, age 69.9 ± 6.5, female 77%, DAS28-ESR 4.3 ± 0.8, J-HAQ 0.9 ± 0.7, PSL user 23.7%, MTX user 64.5%, and biologics user 4.0%; the MH group, age 69.4 ± 6.7, female 80.6%, DAS28-ESR 4.4 ± 0.8, J-HAQ 1.0 ± 0.7, PSL user 36.7%, MTX user 64.3%, and biologics user 6.1%. Proportions of the patients with cardiovascular disease and malignancy were 13.3% and 11.2% in the MH group and 5.9% and 1.3% in the RL group, respectively. DAS28-ESR and J-HAQ score after 3-year observation of the RL group were 2.3±0.5 and 0.4±0.5, respectively, and those of the MH group were 3.4±0.9 and 1.0±0.8, respectively. Corticosteroid use and having malignancy at baseline were associated with not achieving DAS28-ESR <3.2 after 3-year observation using multivariate analysis (Table 1). Similar results were obtained when MTX use and corticosteroid use were replaced by the average dose of each drug.

Conclusion:

The majority of the patients with EORA achieved DAS28-ESR <3.2 after 3-year observation, and no use of corticosteroid and absence of malignancy at baseline were associated with the good outcome.

References:

[1]Nat Rev Rheumatol 2013;9:604-613

[2]Ann Rheum Dis 2006;65:1226-1229

[3]Ann Rheum Dis 2009;68:1470–1473

[4]Joint Bone Spine 2015;82:25-30

[5]J Rheumatol 2016;43:1974-1983

[6]Rheumatology 2015;54:798-807

[7]Rheumatology 2014;53:1075-1086

[8]Japanese Journal of Geriatrics 2018;55:251-258

Acknowledgments:

We thank all patients who participated in the IORRA survey and all of the members of the Institute of Rheumatology, Tokyo Women’s Medical University, for the successful management of the IORRA cohort.

Disclosure of Interests:

Mai Abe: None declared, Eiichi Tanaka Consultant of: Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: EI has received speaker fee from Bristol-Meyers, Pfizer, Merck serono., Eri Sugano: None declared, Naohiro Sugitani: None declared, Kumiko Saka: None declared, Moeko Ochiai: None declared, Yoko Shimizu: None declared, Rei Yamaguchi: None declared, Naoki Sugimoto: None declared, Katsunori Ikari Speakers bureau: Asahi Kasei Pharma Corp., Astellas Pharma Inc., AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eis, ai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp.Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Ltd and UCB Japan Co. Ltd., Ayako Nakajima Grant/research support from: AN has received research grants from Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Consultant of: AN has consultant fee from Nippon Kayaku Co. Ltd., Speakers bureau: AN has received speaker’s fee from AbbVie Japan GK, Actelion Pharmaceuticals Japan LTD., Asahi Kasei Pharma Co., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Hisamitsu Pharmaceutical Co. Inc., Kyorin Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., Otsuka Pharmaceutical Co. Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd., Atsuo Taniguchi: None declared, Hisashi Yamanaka Grant/research support from: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., Speakers bureau: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.

Follicular dendritic cell-secreted protein gene expression is upregulated and spread in nifedipine-induced gingival overgrowth

Follicular dendritic cell-secreted protein (FDC-SP) is secreted protein expressed in follicular dendritic cells, periodontal ligament and junctional epithelium (JE). Its expression could be controlled during inflammatory process of gingiva; however, responsible mechanism for gingival overgrowth and involvement of FDC-SP in clinical condition is still unclear. We hypothesized that JE-specific genes are associated with the initiation of drug-induced gingival enlargement (DIGE) called gingival overgrowth, and investigated the changes of JE-specific gene's expression and their localization in overgrown gingiva from the patients. Immunohistochemical analysis revealed that the FDC-SP localization was spread in overgrown gingival tissues. FDC-SP mRNA levels in GE1 and Ca9-22 cells were increased by time-dependent nifedipine treatments, similar to other JE-specific genes, such as Amelotin (Amtn) and Lamininβ3 subunit (Lamβ3), whereas type 4 collagen (Col4) mRNA levels were decreased. Immunocytochemical analysis showed that FDC-SP, AMTN, and Lamβ3 protein levels were increased in GE1 and Ca9-22 cells. Transient transfection analyses were performed using luciferase constructs including various lengths of human FDC-SP gene promoter, nifedipine increased luciferase activities of -345 and -948FDC-SP constructs. These results raise the possibility that the nifedipine-induced FDC-SP may be related to the mechanism responsible for gingival overgrowth does not occur at edentulous jaw ridges.

Evaluation of a novel immunochromatographic device for rapid and accurate clinical detection of Porphyromonas gingivalis in subgingival plaque

An important goal for the improved diagnosis and management of infectious and inflammatory diseases, such as periodontitis, is the development of rapid and accurate technologies for the decentralized detection of bacterial pathogens. The aim of this prospective multicenter study was to evaluate the clinical use of a novel immunochromatographic device with monoclonal antibodies for the rapid point-of-care detection and semi-quantification of Porphyromonas gingivalis in subgingival plaque. Sixty-three patients with chronic periodontitis and 28 periodontally healthy volunteers were subjected to clinical and microbiological examinations. Subgingival plaque samples were analyzed for the presence of P. gingivalis using a novel immunochromatography based device DK13-PG-001, designed to detect the 40k-outer membrane protein of P. gingivalis, and compared with a PCR-Invader method. In the periodontitis group, a significant strong positive correlation in detection results was found between the test device score and the PCR-Invader method (Spearman rank correlation, r=0.737, p<0.0001). The sensitivity, specificity, and positive and negative predictive values of the test device were 96.2%, 91.8%, 90.4% and 96.7%, respectively. The detection threshold of the test device was determined to be approximately 10(4) (per two paper points). There were significant differences in the bacterial counts by the PCR-Invader method among groups with different ranges of device scores. With a cut-off value of ≥0.25 in device score, none of periodontally healthy volunteers were tested positive for the subgingival presence of P. gingivalis, whereas 76% (n=48) of periodontitis subjects were tested positive. There was a significant positive correlation between device scores for P. gingivalis and periodontal parameters including probing pocket depth and clinical attachment level (r=0.317 and 0.281, respectively, p<0.01). The results suggested that the DK13-PG-001 device kit can be effectively used for rapid, chair-side detection and semi-quantification of P. gingivalis in subgingival plaque.

TRIAL REGISTRATION

UMIN Clinical Trials Registry (UMIN-CTR) UMIN000011943.

Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture

Despite improvements in rheumatoid arthritis disease activity of in the past 10 years, the incidence of self-reported non-vertebral fractures did not decrease in our cohort of 9,987 patients. This study may indicate that osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the rheumatoid arthritis disease activity.

INTRODUCTION

Although rheumatoid arthritis (RA) is a risk factor for osteoporosis and fractures, few studies have described the association between disease activity and the fracture incidence in patients with RA. This study aimed to investigate changes in the non-vertebral fracture incidence between 2001 and 2010 in our Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort.

METHODS

The IORRA is a prospective observational cohort study of Japanese RA patients. A total of 9,987 patients with RA were enrolled in this cohort from 2000 to 2010. The clinical parameter and non-vertebral fracture occurrence data were collected biannually through self-reported questionnaires. Incidences of self-reported non-vertebral fractures were also analyzed via standardization according to gender, age, and disease activity during each 2-year period.

RESULTS

From 2001 to 2010, the percentage of patients with 28-joint disease activity score remission increased from 7.8 to 39.7%, prednisolone intake decreased from 51.4 to 41.3%, and bisphosphonate intake increased from 5.0 to 23.4%. The non-vertebral fracture incidence rates were 24.6/1,000 person-years in 2001 and 35.5/1,000 person-years in 2010, with no apparent change even after standardization. The overall non-vertebral fracture incidence was significantly higher in the autumn/winter than in the spring/summer (p = 0.02).

CONCLUSION

Despite improvements in disease activity and functional disability, the non-vertebral fracture incidence exhibited no apparent change between 2001 and 2010 in our patients with RA. Osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the disease control in patients with RA.

Vaccination against seasonal influenza is effective in Japanese patients with rheumatoid arthritis enrolled in a large observational cohort

OBJECTIVE

To investigate the effectiveness of influenza vaccination in patients with rheumatoid arthritis (RA) from a large practice-based cohort.

METHOD

Patients with RA enrolled in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort completed self-administered questionnaires as part of the April IORRA surveys of 2001, 2002, 2003, and 2007, which included their influenza vaccination status and occurrence of an actual influenza attack. Vaccine coverage rate and attack rates were calculated in each season. Relative risks (RRs) of vaccination for an actual influenza attack were evaluated and risk factors for influenza infection were determined by multiple logistic regression analysis.

RESULTS

Data from 3529, 4518, 4816, and 4872 patients in the 2000/01, 2001/02, 2002/03, and 2006/07 seasons, respectively, were analysed. Coverage rates were increased from 12.2% in the 2000/01 season to 38.7% in the 2006/07 season. For each season, the attack rates in vaccinated patients trended lower than the rates in unvaccinated patients but the differences were not significant; however, by combining these four seasonal results, the attack rate was significantly lower for vaccinated patients [RR 0.83, 95% confidence interval (CI) 0.71-0.95, p < 0.01]. Male gender [odds ratio (OR) 1.48, 95% CI 1.25-1.76, p < 0.001] was associated with increased risk whereas vaccination was associated with reduced risk for influenza attack (OR 0.76, 95% CI 0.63-0.91, p < 0.01). There were no associations between influenza attacks and RA disease activity, treatment with methotrexate (MTX) or corticosteroids.

CONCLUSION

Influenza vaccination was effective in patients with RA regardless of disease activity or treatment.