POS0662 BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS PRESCRIPTION OVER TIME IN A COHORT OF EARLY RHEUMATOID ARTHRITIS PATIENTS

Background

According to 2019 updated EULAR recommendations, therapy of Early Rheumatoid Arthritis (ERA) with biological disease-modifying antirheumatic drugs(bDMARDs) is adviced in presence of poor prognostic factors,i.e. persistently moderate/high disease activity, high acute phase reactants, high swollen joint count, autoantibody positivity, presence of early erosions, failure of two/more conventional synthetic DMARD.

Objectives

To evaluate over time prevalence of bDMARD therapy and factors associated to rapid initiation in our EA Clinic (EAC), comparing two different periods: from 2004 to 2012 and from 2012 to 2020.

The last two years were not considered because of the adverse influence of COVID19 pandemia on early access to EAC and on timely scheduled visits.

Methods

A total of 281 ERA patients with less than 12 months of disease duration (53.9 years mean age, 75% female, 77% seropositive), followed according to the treat-to-target (T2T) strategy, were enrolled in the study. At baseline, and every three months, the ACR/EULAR core data set variables were recorded. At baseline and every year, hand and foot radiographs were examined according to modified Total Sharp score (mTSS). At each visit, clinical improvement and remission were evaluated according to EULAR criteria. The achievement of Comprehensive Disease Control (CDC) (28-joint Disease Activity Score using C reactive protein <2.6, Health Assessment Questionnaire <0.5 and change from baseline in mTSS ≤0.5) was assessed every year.

Results

We examined 164 patients from 2004 to 2012 and 117 subjects from 2012 to 2020. In the first group 72 patients (43.9%) initiated bDMARDs during the 8-year FU, with a mean delay of 41.8 months. In the second group 37 patients (31.6%) started biotechnological drugs over time, with a mean delay of 50.4 months.

Analyzing the period from 2004 to 2012, ERA patients starting bDMARDs were younger (p<0.0001), had longer disease duration (p=0.02) and higher body mass index (BMI) (p=0.01) compared to subjects not undergoing to biological therapy. Moreover, ERA patients in bDMARDs were in higher percentage anti-citrullinated peptide antibody (ACPA) positive (80.6%) and reached to a lesser extent CDC at 12months of FU (26.1%) compared to patients that didn’t initiate bDMARDs (60.9% ACPA positive, p=0.01; 63% achieving CDC, p<0.0001, respectively).

Examining the period from 2012 to 2020, bDMARD-treated ERA patients were younger (p=0.06),in higher percentage ACPA positive (81.1%) and erosive at baseline (35.1%) compared to patients that didn’t initiate bDMARDs (64% ACPA positive, p=0.02; 17.5% erosive, p=0.04, respectively). As previously, patients in bDMARD reached to a lesser extent CDC at 12 month of FU (35.1%) compared to subjects not undergoing to biological therapy (55% achieving CDC, p=0.05).

On multivariate analysis, ACPA positivity was associated with initiation of bDMARD in both patient groups (p=0.02), whereas older age at onset and reaching CDC at 12 month were inversely associated (p=0.001; p<0.0001, respectively).

Conclusion

Despite the widest choice of bDMARDs currently available in the last 8 years, we did not observe an increase in the prescription of these drugs from 2012 to 2020.

As in other ERA cohorts, bDMARD initiation is associated to poor prognostic factors, in particular ACPA positivity, presence of erosions at baseline and not achieving CDC at 12 months of FU.

In the last 8 years, the decreased influence of disease duration at onset and of BMI could be a consequence of the improvement in strategies of early referral and control of modifiable risk factors.

Disclosure of Interests

None declared

AB0640 PREVALENCE AND DETERMINANT FACTORS OF ENDOTHELIAL DYSFUNCTION IN ANCA ASSOCIATED VASCULITIS

Background

Atherosclerosis and its complications are one the leading cause of death in patients with anti-neutrophil cytoplasmic antibodies (ANCA)- associated vasculitis (AAVs), despite the recent remarkable improvements in prognosis. The mechanism by which atherosclerosis is accelerated in these diseases is not explained by the classical cardiovascular risk factors (CVRFs) and is still under investigation.

Objectives

To evaluate the prevalence of endothelial dysfunction (ED) in AAV patients and to identify the determinant factors of endothelial responses among vasculitis characteristics, such as ANCA status and organ involvement.

Methods

Thirty patients (15 men and 15 women) with AAVs [13 with eosinophilic granulomatosis with polyangiitis (EGPA), 7 with granulomatosis with polyangiitis (GPA), 10 with microscopic polyangiitis (MPA)] were enrolled in the study. For all subjects CVRFs, blood pressure, lipid profile, renal function, acute phase reactants, ANCA status and titers were recorded at diagnosis and at the enrollement in the study. Vasculitis disease activity was measured using the Birmingham Vasculitis Activity Score (BVAS) and organ damage was assessed with the vasculitis damage index (VDI). The prognosis was evaluated through the Five Factor Score (FFS). Patients were excluded from the study if they had previous cardiovascular or cerebrovascular events, liver failure, end stage renal disease under hemodyalisis, or cancer.

Microvascular peripheral dysfunction was assessed by pulse amplitude tonometry (PAT) of the small digital artery. In particular, Log-transformed reactive hyperemia index (LnRHI) was evaluated using the EndoPAT2000 device: values of Ln-RHI < 0.51 were considered indicative of peripheral ED.

Results

At diagnosis, 23 subjects (76.7%) were ANCA positive (8 c-ANCA+, 15 pANCA+), and at the enrollment in the study 10 patients (33.3%) were still seropositive. Nineteen patients (63.3%) had inactive disease (BVAS=0), 7 (23.3%) were in low disease activity (1≤BVAS≤2) and 4 (13.3%) had an active disease (BVAS≥3).

The presence of ED was documented in 9 AAV patients (30%).

AAV patients with ED had higher C-reactive protein (CRP) values at diagnosis compared to subjects without ED (p=0.05). Moreover, patients with altered endothelial response were in higher percentage smokers (55.6%) and ANCA positive at enrollment (44.4%), compared to subjects with normal Ln-RHI (28.6%- p=0.12; 19%, p=0.15 respectively).

There were no differences regarding age and other traditional CVRFs, disease duration, BMI, BVAS, VDI, FFS.

There was an inverse correlation between CRP values at diagnosis and LnRHI (r=-0.42, p=0.04).

In multiple logistic regression analysis, ANCA positivity at enrollment [OR (95% CI) = 15.68 (0.98-250.28)] (p=0.05), and higher CRP concentrations [OR (95% CI) = 1.03 (1.00–1.06)] (p=0.03) were independently associated with the presence of peripheral ED.

Conclusion

As observed in other chronic inflammatory autoimmune diseases, ED occurs in AAVs and is mainly related to the chronic systemic inflammation and seems to be also influenced by ANCA positivity, which is probably involved in the accelerated endothelial cell damage.

Further studies are needed to clarify the role of vasculitis related characteristics in the atherosclerotic process.

Disclosure of Interests

None declared