Isolated cerebral mucormycosis: A case discussion

We report a case of a 32-year-old male with a history of type 1 diabetes, inhaled drug use, and alcohol use disorder, who presented with encephalopathy, holocranial headaches, neck pain, confusion, and generalized tonic-clonic seizures. The patient initially presented at a rural community hospital with a fever and was found to be in diabetic ketoacidosis (DKA). He was also hemodynamically stable but stuporous, prompting intubation to protect his airway. Despite initial treatment measures, his neurological condition worsened and he remained ventilator-dependent. Key findings include a high glucose level, presence of ketones, and evidence of drug use. Blood cultures showed no growth, but his febrile state persisted. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, hyperglycorrhachia but normal protein, with no growth. Neuroimaging showed right hemispheric slowing on EEG and diffusion restriction in the right frontal lobe on MRI. The patient's neurological status worsened on the second day of admission, manifesting as sluggish pupillary reflexes, right third nerve palsy, and decerebrate posturing. Emergent MRI suggested cerebral edema, leading to initiation of hypertonic saline. This case highlights the diagnostic challenges and critical management considerations in a patient with multiple comorbidities presenting with unexplained neurological deterioration, emphasizing the importance of a comprehensive and timely approach to diagnosis and treatment.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

POS0444 PROFILING OF CIRCULATING miRNAs IN DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS

Background

Biologic (b-) and targeted synthetic (ts-) disease-modifying antirheumatic drugs (DMARDs) have brought significant progress in the treatment of rheumatoid arthritis (RA), but a significant proportion of RA patients still remain symptomatic despite treatment according to current recommendations. These patients have recently been defined as “difficult-to-treat (D2T)” RA (1). There is evidence that miRNA expression may play a role in the diagnosis and therapy of RA (2).

Objectives

In a retrospective study, we analyzed patients’ blood samples prior to b-/ts-DMARD treatment and profiled circulating miRNAs to predict the development of D2T-RA.

Methods

A total of 36 patients fulfilling the EULAR definition of D2T-RA (1) (mean age 59.1±10.7 yrs, 78% females), 36 patients with RA in sustained clinical remission on b-/ts-DMARDs at two consecutive examinations 12 wks apart (mean age 66.3±9.6 yrs, 78% females), and 36 healthy controls (mean age 61.1±7.7 yrs, 68% females) were included in the study. Blood samples were collected before initiation of b-/ts-DMARD. We profiled circulating miRNAs using the sequencing approach and differential expression analysis was performed using DESeq2 algorithm.

Results

The massive parallel sequencing of circulating miRNAs detected 814 quantifiable miRNAs and DESeq2 algorithm revealed 35 miRNAs with different concentrations in patients who developed D2T-RA compared to patients with RA who achieved sustained remission or healthy controls. Out of these miRNAs, miR-16-5p (1.5x) and miR-451a (2.1x) were downregulated and miR-126-3p (1.4x) was upregulated in D2T RA patients compared to controls. In addition, miR-101-3p (1.5x) was downregulated in D2T RA compared to RA patients. Except for miR-101-3p, these miRNAS have been previously associated with RA and might predict development of D2T disease prior to initiation of b-/ts-DMARD therapy.

Conclusion

We found four miRNAs as potential biomarkers differentiating patients who are at risk to develop difficult-to-treat disease compared to patients who have a chance of sustained remission even before initiation of biological or targeted synthetic DMARDs. Further studies with larger sample size are needed to validated these data.

References

[1]Nagy G, Roodenrijs NMT, Welsing PM, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021 Jan;80(1):31-35.

[2]Filková M, Jüngel A, Gay RE, Gay S. MicroRNAs in rheumatoid arthritis: potential role in diagnosis and therapy. BioDrugs. 2012 Jun 1;26(3):131-41.

Acknowledgements

This work was supported by the project SVV 260 523, BBMRI-CZ LM2018125, and a project of the MHCR for conceptual research development No. 023728.

Disclosure of Interests

None declared.

AB0678 Subclinical Atherosclerosis and Cardiovascular Risk in Myositis Patients and Healthy Controls: Preliminary Data From a Single-center Cross-sectional Study

Background

Idiopathic inflammatory myopathies (IIM) are associated with systemic inflammation, limited mobility, and glucocorticoid (GC) therapy, which can negatively impact metabolic disorders, atherogenesis, and increase the cardiovascular (CV) risk.

Objectives

This study aimed to evaluate CV risk in IIM patients compared to healthy controls (HC) and explore its associations with disease-specific features.

Methods

39 patients with IIM (32 females; mean age 56; mean disease duration 4.8 years; dermatomyositis 16, polymyositis 7, immune-mediated necrotizing myopathy 8, antisynthetase syndrome 8) and 39 age-/sex-matched HC (32 females, mean age 56) were included. Subjects with a history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events) were excluded in both groups. Disease activity, damage, and muscle involvement (Manual Muscle Test (MMT)-8, Myositis Intention to Treat Activity Index (MITAX), Myositis Damage Index (MDI)) were assessed. Comorbidities and current treatment were recorded. All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (densitometry: iDXA Lunar, bioelectric impedance: BIA2000-M). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE and SCORE2, charts for the European population; modified mSCORE according to the 2015 EULAR recommendation for inflammatory arthritis - only in IIM patients).

Results

In IIM, disease activity and damage were predominantly mild (MITAX 0.13, MDI 0.05). Compared to HC, there was no significant difference in the prevalence of traditional risk factors. Only PWV was significantly increased in IIM compared to HC (p=0.015). No other significant difference was observed between the IIM and HC regarding the CV examinations (CIMT, ABI, carotid plaques) and calculated SCORE and SCORE2 (p>0.05 for all). In IIM, age and mean arterial pressure were the most significant parameters that correlated positively with SCORE, SCORE2, and mSCORE; arterial hypertension was significantly associated with a higher SCORE, carotid plaque count/thickness, and PWV. Lipid profile parameters, body composition, and disease activity were significantly associated with CIMT and carotid plaques (p<0.05 for all). Antihypertensive treatment was associated with an increase in carotid plaque count (p=0.020), higher (favorable) ABI (p=0.004), while hypolipidemic treatment was associated with an increase in carotid plaque count/thickness (p=0.009, p=0.008). Diabetes was associated with lower (worse) ABI values (p=0.034), prediabetes with a higher carotid plaque count (p=0.036) and thickness (p=0.011), and a worse ultrasound examination related CV risk (p=0.006). Anti-Jo-1 positivity was associated with a lower (better) CIMT and lower SCORE (p<0.05 for all). There were no significant associations of CV risk with clinical manifestations, immunosuppressive treatment, and GC cumulative dose. However, exposure time to GC therapy was significantly associated with the carotid plaques count (p<0.001) and the carotid plaque thickness (p=0.003). In multivariate analysis, the age of the patients was the most significant factor affecting most of the parameters analyzed (SCORE and its modifications, PVW, CIMT, and the total count of carotid plaques). Other significant predictors were total cholesterol and atherogenic index of plasma (for ABI), mean arterial pressure (for PWV), and disease duration (for the total count of carotid plaques).

Conclusion

No significant differences in CV risk factors between IIM patients and HC were observed.In IIM, CV risk was associated with age, disease duration, duration of glucocorticoid therapy, lipid profile, and body composition, but not with clinical manifestations and disease activity.

Acknowledgements

Supported by AZV NV18-01-00161A, MHCR-00023728, SVV-260523. GAUK 1578119

Disclosure of Interests

None declared

AB1275 SUGGESTED APPROACH TO UBA1 GENE MUTATION TESTING IN PATIENTS WITH SUSPECTED VEXAS SYNDROME

Background

VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is a recently identified autoinflammatory disease caused by de novo somatic mutations in the X-linked gene UBA1 (1). This disease is clinically characterized by inflammatory symptoms and bone marrow failure (2).

Objectives

The aim of our study was to identify genetic variants associated with VEXAS syndrome and to design an algorithm for detection of UBA1 gene mutations in patients with suspected VEXAS syndrome, which could be used for diagnosis.

Methods

We examined the UBA1 gene in 9 patients with clinically suspected VEXAS syndrome. We first focused on variants p.Met41Val, p.Met41Thr and p.Met41Leu with a known association with this disease (1). Samples of individual blood cell populations obtained by magnetic isolation were evaluated using RFLP, tetra-primer ARMS-PCR and Sanger sequencing. Subsequently, we analyzed the remaining exons of the UBA1 gene by Sanger sequencing.

Results

Using the above described method we have identified the previously described variants p.Met41Thr in two and p.Met41Leu in another two patients. In one patient, we discovered a new mutation p.Gly477Ala (c.1430G>C) in exon 14 that has not yet been identified. The presence of these variants and their allelic forms (heterozygous / homozygous) varied between cell populations in individual patients.

Conclusion

The increasing number of reports suggests that VEXAS syndrome is not rare. In patients with clinical suspicion, typically UBA1 sequencing analysis of haematopoietic cells is performed in hot spot sites of p.Met41 in exon 3 only. Our results suggest that other variants, such as the newly identified p.Gly477Ala variant, may also be associated with clinical features of VEXAS syndrome. We propose that an extended analysis of all coding regions of the UBA1 gene may uncover other mutations with putative functional consequences.

References

[1]Beck DB, et al. Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med. 2020 Dec 31;383(27):2628-2638. doi: 10.1056/NEJMoa2026834.

[2]Grayson PC, et al. VEXAS syndrome. Blood. 2021 Jul 1;137(26):3591-3594. doi: 10.1182/blood.2021011455.

Acknowledgements

Supported by MH CZ: DRO (Institute of Rheumatology, 00023728), RVO (VFN, 64165), DRO (IHBT, 00023736), grant NV18-03-00227, and grant NU21-05-00522.

Disclosure of Interests

None declared

OP0160 HLA-DRB1 ASSOCIATIONS WITH AUTOANTIBODY-DEFINED SUBGROUPS IN IDIOPATHIC INFLAMMATORY MYOPATHIES (IIM)

Background

There is a gap between how IIM patients are classified in practice and current validated classification criteria1. Also, different associations with genetic variations in HLA can inform about different T-cell mechanisms involved in disease pathogenesis.

Objectives

We aimed to systematically study associations between HLA-DRB1 alleles, clinical manifestations, and autoantibody-defined IIM subgroups.

Methods

We included 1348 IIM patients from five European countries. An unsupervised cluster analysis was performed using 14 autoantibodies: anti-Jo1, -PL7, -PL12, -EJ, -OJ, -SRP, -U1RNP, -Ro52, -Mi2, -TIF1γ, -MDA5, -PMScl, -SAE1, and -NXP2 to identify patients’ subgroups. Logistic regressions were used to estimate the associations between HLA-DRB1 alleles, clinical manifestations and the identified subgroups.

Results

Eight subgroups were defined by the autoantibody status (Table 1). Three of the subgroups (1, 2 and 6) have overlapping autoantibodies, while four are almost monospecific (3,4,5 and 7), and one (8) has patients negative for tested autoantibodies. Figure 1 represents the significant associations between HLA-DRB1 alleles and the eight subgroups. Heliotrope rash and Gottron’s sign were significantly more frequent in subgroups 3 (OR:2.2 95%CI:[1.1-4.8], OR:2.6 95%CI:[1.3-5.9], respectively), 4 (OR:12 95%CI:[3.6-75], OR:7.8 95%CI:[2.8-33], respectively) and 7 (OR:22 95%CI:[4.5-385], OR:10 95%CI:[3.1-65], respectively), and Raynaud’s phenomenon was significantly more frequent in subgroup 6 (OR:3.3 95%CI:[1.2-11]).

Table 1.

Autoantibody-defined subgroups using an unsupervised cluster analysis.

Subgroups/ MedoidsVariables1 Ro522 U1RNP3 PMScl4 Mi25 Jo16 Jo1/Ro527 TIF18 None*Alln (%)137 (10)183 (14)107 (8)65 (5)119 (9)140 (10)78 (6)519 (39)1348 (100)Female (%)93 (68)116 (63)79 (74)45 (69)76 (64)96 (69)64 (82)313 (60)882 (65)Age at diagnosis, median (IQR)56 (16)51.5 (23)51 (25)57 (22.5)47.5 (23.25)52 (19.5)53.5 (21.75)58 (22)55 (23)AutoantibodiesAnti-Jo106 (3)01 (2)119 (100)140 (100)00266 (20)Anti-PL77 (5)13 (7)00000020 (1.5)Anti-PL125 (4)3 (2)1 (1)01 (1)00010 (0.7)Anti-EJ2 (2)00000002 (0.1)Anti-OJ07 (4)0000007 (0.5)Anti-TIF110 (7)2 (1)2 (2)00078 (100)092 (7)Anti-Mi21 (1)1 (1)1 (1)65 (100)02 (1)0070 (5)Anti-SAE18 (6)23 (13)00000031 (2)Anti-NXP21 (1)23 (13)1 (1)0000025 (2)Anti-MDA59 (7)10 (6)1 (1)1 (2)01 (1)0022 (2)Anti-SRP8 (6)32 (18)00000040 (3)Anti-Ro52137 (100)16 (9)000140 (100)00293 (22)Anti-PMScl11 (8)1 (1)107 (100)00000119 (9)Anti-U1RNP079 (43)0003 (2)0082 (6)

*IIM patients negative for the tested autoantibodies.

Figure 1.

Forest plot of significant associations of HLA. *DRB1 alleles with autoantibody-defined subgroups. Scandinavia includes patients from Denmark, Norway, and Sweden.

Conclusion

Our study reveals that certain subgroups of IIM patients are characterized by overlap of myositis -specific and -associated autoantibodies, which in turn are associated with different HLA-DRB1 alleles including potential novel associations. These results point to different disease mechanisms in the subgroups, as well as suggest that IIM classification could be improved by integrating broader serological and genetic data.

References

[1]Parker MJS, Oldroyd A, Roberts ME, et al. The performance of the European League Against Rheumatism/American College of Rheumatology idiopathic inflammatory myopathies classification criteria in an expert-defined 10 year incident cohort. Rheumatology (Oxford). 2019;58(3):468-475.

Acknowledgements

We thank all the patients who participated in the study.

Disclosure of Interests

Valerie Leclair: None declared, Angeles Shunashy Galindo-Feria: None declared, Simon Rothwell: None declared, Olga Kryštůfková: None declared, Heřman Mann: None declared, Louise Pyndt Diederichsen: None declared, helena andersson: None declared, Martin Klein: None declared, Sarah Tansley: None declared, Neil McHugh: None declared, Janine Lamb: None declared, Jiří Vencovský Speakers bureau: Abbvie, Biogen, Boehringer, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Werfen, Consultant of: Abbvie, Argenx, Boehringer, Eli Lilly, Gilead, Octapharma, Pfizer, UCB, Grant/research support from: Abbvie, Hector Chinoy: None declared, Marie Holmqvist: None declared, Leonid Padyukov: None declared, Ingrid E. Lundberg Shareholder of: Roche and Novartis, Consultant of: Corbus Pharmaceuticals Inc, Astra Zeneca, Bristol Myer´s Squibb, Corbus Pharmaceutical, EMD Serono Research & Development Institute, Argenx, Octapharma, Kezaar, Orphazyme, and Janssen, Grant/research support from: Astra Zeneca, Lina M. Diaz-Gallo: None declared

Outcomes with durvalumab after chemoradiotherapy in stage IIIA-N2 non-small-cell lung cancer: an exploratory analysis from the PACIFIC trial

Background

The phase III PACIFIC trial (NCT02125461) established consolidation durvalumab as standard of care for patients with unresectable, stage III non-small-cell lung cancer (NSCLC) and no disease progression following chemoradiotherapy (CRT). In some cases, patients with stage IIIA-N2 NSCLC are considered operable, but the relative benefit of surgery is unclear. We report a post hoc, exploratory analysis of clinical outcomes in the PACIFIC trial, in patients with or without stage IIIA-N2 NSCLC.

Materials and methods

Patients with unresectable, stage III NSCLC and no disease progression after ≥2 cycles of platinum-based, concurrent CRT were randomized 2 : 1 to receive durvalumab (10 mg/kg intravenously; once every 2 weeks for up to 12 months) or placebo, 1-42 days after CRT. The primary endpoints were progression-free survival (PFS; assessed by blinded independent central review according to RECIST version 1.1) and overall survival (OS). Treatment effects within subgroups were estimated by hazard ratios (HRs) from unstratified Cox proportional hazards models.

Results

Of 713 randomized patients, 287 (40%) had stage IIIA-N2 disease. Baseline characteristics were similar between patients with and without stage IIIA-N2 NSCLC. With a median follow-up of 14.5 months (range: 0.2-29.9 months), PFS was improved with durvalumab versus placebo in both patients with [HR = 0.46; 95% confidence interval (CI), 0.33-0.65] and without (HR = 0.62; 95% CI 0.48-0.80) stage IIIA-N2 disease. Similarly, with a median follow-up of 25.2 months (range: 0.2-43.1 months), OS was improved with durvalumab versus placebo in patients with (HR = 0.56; 95% CI 0.39-0.79) or without (HR = 0.78; 95% CI 0.57-1.06) stage IIIA-N2 disease. Durvalumab had a manageable safety profile irrespective of stage IIIA-N2 status.

Conclusions

Consistent with the intent-to-treat population, treatment benefits with durvalumab were confirmed in patients with stage IIIA-N2, unresectable NSCLC. Prospective studies are needed to determine the optimal treatment approach for patients who are deemed operable.

•

The PACIFIC trial established durvalumab after CRT as standard of care for unresectable, stage III NSCLC.

•

The optimum multimodal treatment strategy for patients with potentially resectable, stage IIIA-N2 NSCLC is unknown.

•

Survival benefit with durvalumab was observed in patients with stage IIIA-N2, unresectable NSCLC in this post hoc analysis.

•

Durvalumab after CRT also exhibited a manageable safety profile in this subpopulation from PACIFIC.

•

Studies of surgical vs. non-surgical strategies are needed to establish the best approach for potentially operable patients.

418 Incidence of Venous Thromboembolism and Perioperative SARS-CoV-2 Infection: Multicentre Prospective International Cohort Study

Background

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism (VTE) in critically ill patients. Since surgical patients are already at higher risk of VTE than general populations, this study aimed to determine if patients with perioperative or previous SARS-CoV-2 were at further risk of VTE.

Method

International, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patient from all surgical specialties were included. The primary outcome measure was VTE (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as perioperative (7-days before to 30-days after surgery), recent (1–6 weeks before surgery), and previous (³7 weeks before surgery).

Results

The postoperative VTE rate was 0.5% (666/123,591) in patients without SARS-CoV-2 diagnosis, 2.2% (50/2,317) in patients with perioperative SARS-CoV-2, 1.6% (15/953) in patients with recent SARS-CoV-2, and 1.0% (11/1,148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with perioperative (adjusted odds ratio 1.48, 95% confidence interval 1.08–2.03) and recent SARS-CoV-2 (OR 1.94, 1.15–3.29) remained at higher risk of VTE, with a borderline finding in previous SARS-CoV-2 (OR 1.65, 0.90–3.02). Overall, VTE was independently associated with 30-day mortality (OR 5.39, 4.33–6.70). In SARS-CoV-2 infected patients, mortality without VTE was 7.4% (319/4,342) and with VTE was 40.8% (31/76).

Conclusions

Patients undergoing surgery with a perioperative or recent SARS-CoV-2 diagnosis are at increased risk of VTE compared to non-infected surgical patients.

Is natural patient preconsultation data medically relevant for outpatient and primary care in cardiology?

 

Digital cardiology may improve the organization and efficiency of outpatient care. The patient direct contribution to medical data is an important cornerstone to save medical time, shorten the decision-making process and improve prevention. However, the medical impact of potential errors in this natural data is unclear.

Purpose

We aimed to evaluate and quantitate the errors and differences between data completed by patient and trained medical teams using a preconsultation medical form in cardiology.

Methods

476 consecutive patients scheduled for an outpatient cardiology consultation (January 2020) were included in the study in one medical center (among a database of more than 13000 patients). All patients had access to a secure digital platform and were encouraged to fill a preconsultation form (risk factors, symptoms and prior medical results). This data was completed and corrected, if necessary, during the medical consultation by a trained outpatient care team and compared to the information provided by patients. An error was defined as either a missing or a wrong value, and a percentage was calculated for each parameter.

Results

387 patients (83%) were included in the analysis (72 did not fill the preconsultation form, 8 did not show up for the appointment). The filling rate averaged 83.6±12%. The global error % averaged 16.5±5% (13.4% missing values). The following parameters had an error % of more than 10%: results of prior cardiac tests (echocardiography 43%, exercise test 25%, arterial Doppler 24%), history of renal failure (32%), Blood pressure value (23%), cholesterol level (20%), family cardiac history (15%), personal cardiac history (12%), history of diabetes (11%). All other parameters had an error % of less than 5% (symptoms, smoking, alcohol consumption, BMI). Despite these significant missing or erroneous data, the availability of this information allowed significant improvement of the care path and more than 80% of patients reported improved commitment and understanding of medical decisions.

Conclusion

Actively including patient in the medical care process is an important issue and is made easy using e-cardiology tools. The results of this study should be considered when building digital medical platforms. Some of the parameters with important errors should be verified from multiple sources before using them in the future decision-making algorithms.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): izyCardio digital e-cardiology companyCardioParc medical centers

AB0412 LIPID PROFILE IN IIM PATIENTS AND ITS ASSOCIATION WITH DISEASE ACTIVITY, DURATION, AND GLUCOCORTICOID TREATMENT

Background:

Systemic inflammation, limited mobility, and glucocorticoid treatment in idiopathic inflammatory myopathies (IIM) can have a negative impact on intermediate metabolic pathways, especially on lipid metabolism.

Objectives:

The aim of this study was to assess the differences in the lipid profile of IIM patients and healthy controls (HC) and the association with disease-specific features.

Methods:

133 patients with IIM (106 females; mean age 60.3; disease duration 2.2 years; DM 47 / PM 41 / IMNM 45) and 133 age-/sex-matched HC (106 females, mean age 60.2) were included. Patients with DM and PM fulfilled the Bohan/Peter criteria for PM/DM; patients with IMNM fulfilled the ENMC criteria. Levels of selected parameters of lipid metabolism were measured in sera. In IIM patients, disease activity, damage, and muscle involvement were evaluated (MITAX, MDI, MMT-8); comorbidities and current treatment were recorded. Data are presented as median.

Results:

Several differences in disease activity, the dose of glucocorticoids, prevalence of comorbidities, and serum lipid levels were observed in IIM compared to HC, and among the three subtypes of IIM; the most significant changes were observed in IMNM. All the differences in lipid profile between IIM and HC, as well as the correlations of lipid profile parameters with disease-specific features in IIM patients, are demonstrated in the table 1.

Conclusion:

We have observed significant alterations in serum lipid parameters in our IIM patients compared to healthy age-/sex-matched individuals. Differences were also found among the three subtypes of IIM. These alterations were associated with laboratory parameters of disease activity and the current dose of corticosteroids.

Table 1.

Lipidogram in IIM patients compared to healthy controls

Parameter of lipidogram, medianIIM(n = 133)DM(n = 47)PM(n = 41)IMNM(n = 45)HC(n = 133)p-valueIM-HC; DM-HC;PM-HC; IMNM-HCTC (mmol/L);5.795.365.656.35.14<0.001; 0.135; 0.040; <0.001TG (mmol/L);2.021.911.882.271.28<0.001; <0.001; 0.002; <0.001LDL-C (mmol/L);3.132.953.123.582.820.005; 0.436; 0.131; <0.001Apo-B (g/L);1.061.020.981.260.91<0.001; 0.160; 0.017; <0.001Non-HDL-C (mmol/L);4.44.254.155.13.9<0.001; 0.262; 0.040; <0.001Lp(a) (g/L);0.10.10.10.120.150.098; 0.733; 0.242; 0.032HDL-C (mmol/L);1.1221.131.181.361.20.913; 0.917; 0.503; 0.928Apo-A (g/L);1.71.761.751.681.80.073; 0.782; 0.267; 0.025AI (log(TG/ HDL-C);3.853.93.853.73.150.003; 0.425; 0.071; 0.002Significant correlations of lipid profile parameters and disease-specific features in all IIM patients (n=133)Correlated parametersSpear-man’s rp-valueCorrelated parametersSpearman’s rp-valueTC: Disease duration; LD; PED; Age; CK; Myoglobin-0.322; 0.343; 0.292; 0.193; 0.198; 0.249<0.001; <0.001; <0.001; 0.027; 0.025; 0.007non-HDL-C: Disease duration; LD; BMI; CK; Myoglobin; PED-0.303; 0.322; 0.202; 0.214;0.270; 0.275<0.001; <0.001; 0.027; 0.015;0.003; 0.002TG: Disease duration; PED; BMI-0.326; 0.316; 0.271<0.001; <0.001; 0.003HDL-C: CRP-0.2300.010LDL-: Disease duration; LD; Age; CK; Myoglobin;-0.310; 0.359; 0.212; 0.257; 0.289<0.001; <0.001; 0.015; 0.003; 0.002Apo-A: CRP; CK; Myoglobin-0.293; -0.214; -0,258<0.001; 0.016; 0.005Apo-B: Disease duration; LD; PED; Age; BMI; MMT-8; CK; Myoglobin; Glycemia-0.311; 0.348; 0.307; 0.220; 0.239; -0.214; 0.256; 0.307; 0.201<0.001; <0.001; <0.001; 0.012; 0.009; 0.017; 0.004; <0.001; 0.031AI: BMI0.2090.021

Acronyms: TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein; Apo-B, apolipoprotein B; non-HDL-C, non-high-density lipoprotein (TC minus measured HDL-C); Lp(a), lipoprotein A; HDL-C, high-density lipoprotein; Apo-A, apolipoprotein A; AI, atherogenic index of plasma = log(TG/ HDL-C); LD, lactate dehydrogenase; PED, current prednisolone equivalent dose; CK, creatine kinase; BMI, body mass index; MMT-8, manual muscle testing-8; CRP, C-reactive protein

Acknowledgements:

AZV NV18-01-00161A, MHCR-00023728, GAUK-312218

Disclosure of Interests:

None declared

AB0063 DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: A BIOMARKER SCREENING PILOT STUDY

Background:

Despite modern therapeutic approaches, many patients with rheumatoid arthritis (RA) remain symptomatic after several cycles of treatment and may become so called Difficult-To-Treat (D2T)1. D2T RA is a multifactorial condition in which different factors may be major determinants of the persistence of signs and symptoms, which is seldom caused by drug resistance only2. Discovering new biomarkers is necessary to develop tailored therapies that will be effective in an individual patient at each stage of the disease.

Objectives:

The primary aim of this pilot study was to validate a target proteomic technique for the proteome profiling of the two cohorts of RA patients and controls. Moreover, we searched for potential plasma biomarker(s) predicting D2T RA.

Methods:

Seven RA patients with persistent remission on biological therapy in two consecutive examinations 12 wks apart (mean age 59.6±14 yrs), seven D2T RA patients fulfilling proposed EULAR definition of D2T RA1 (mean age 59.3±13 yrs), and six healthy controls (mean age 58.8±15 yrs) were included in this study. All subjects were females and their samples were collected before starting biological therapy. We employed Thermo Orbitrap Fusion paired with nano-flow UHPLC Dionex Ultimate 3000. Prior to quantification, 125 plasma proteins were modified by Peptiquant Plus Human kit to increase the sensitivity. Data were analysed by ANOVA and Tukey`s posthoc test with false-discovery-rate adjustment.

Results:

The target proteome profiling reliably quantified 92 from 125 labelled proteins. Our follow-up statistical analysis revealed ten plasma proteins, which significantly differed among groups. Notably, we found significantly different plasma levels of paraoxonase/arylesterase 1 (PON1), an esterase with an antioxidant characteristic preventing lipid peroxidation3, between RA patients and controls and between RA patients with persistent remission and D2T RA patients.

Conclusion:

Using target proteome profiling technique, we demonstrated PON1 as a potential biomarker of D2T RA. However, these results have to be validated on a larger cohort.

References:

[1]Nagy G, Roodenrijs NMT, Welsing PMJ, et al. EULAR definition of difficult-To-Treat rheumatoid arthritis. Annals of the Rheumatic Diseases 2021;80:31-5.

[2]de Hair MJH, Jacobs JWG, Schoneveld JLM, van Laar JM. Difficult-to-treat rheumatoid arthritis: an area of unmet clinical need. Rheumatology (Oxford, England) 2018 Jul 1;57(7):1135-1144.

[3]Isik A, Koca SS, Ustundag B, Celik H, Yildirim A. Paraoxonase and arylesterase levels in rheumatoid arthritis. Clinical Rheumatology 2007;26:342-8.

Acknowledgements:

This research was supported by MHCR No. 023728 and authors thank Proteomics Service Laboratory, Faculty of Science, Charles University for performing the LC–MS/MS analysis.

Disclosure of Interests:

None declared

POS0849 SEXUAL FUNCTION IS IMPAIRED IN WOMEN WITH IDIOPATHIC INFLAMMATORY MYOPATHIES COMPARED TO HEALTHY CONTROLS

Background:

Idiopathic inflammatory myopathies (IIM) are rare diseases characterized by chronic muscle inflammation and multiple organ involvement. These serious clinical manifestations can be associated with significant impairment of quality of life, including sexual life.

Objectives:

This study aimed to compare sexual function in patients with IIM to age-/sex-matched healthy controls (HC) and determine the potential impact of clinical features on sexual function.

Methods:

In total, 62 women with IIM [mean age: 53.1, disease duration: 5.2 years, dermatomyositis (DM, 29)/ polymyositis (PM, 27)/ necrotizing myopathy (IMNM, 5)/ inclusion body myositis (IBM, 1)], who fulfilled the Bohan/Peter 1975 criteria for DM/PM, or ENMC criteria for IMNM or IBM, and 62 healthy controls (HC) (mean age: 53.1) without rheumatic diseases filled in 11 well-established and validated questionnaires assessing sexual function (FSFI, SFQ28, BISF-W, SQoL-F), pelvic floor function (PFIQ-7, PISQ-12), fatigue (FIS, Fatigue Impact Scale), physical activity (HAP, Human Activity Profile), disability (HAQ, Health Assessment Questionnaire), depression (BDI-II, Beck’s Depression Inventory-II), and quality of life (SF-36, Medical outcomes study Short Form 36 – PCS, Physical Component Summary; MCS, Mental Component Summary). A routine laboratory testing was performed. Data are presented as median (IQR).

Results:

Patients with IIM reported significantly greater prevalence and severity of sexual dysfunction (FSFI, BISF-W, SFQ28, SQoL-F) and pelvic floor dysfunction (PISQ-12, PFIQ-7) compared to HC (Table 1). The prevalence of sexual dysfunction in patients with IIM according to the FSFI cut-off score was 59%. Worse scores in IIM patients were associated with greater muscle weakness of m. gluteus maximus [MMT: FSFI (r=0.289, p=0.035), PFIQ-7 (r=-0.407, p=0.003)], m. gluteus medius [MMT: PFIQ-7 (r=-0.381, p=0.005)], more pronounced fatigue [FIF: SQoL-F (r=-0.412, p=0.003)], severer depression [BDI-II: SQoL-F (r=-0.459, p=0.0007)], worse functional disability [HAQ: FSFI (r=-0.436, p=0.005)], reduced physical activity [HAP: FSFI (r=0.403, p=0.001), SQoL-F (r=0.368, p=0.007)], and decreased quality of life [SF-36 PCS: FSFI-total (r=0.381,p=0.002), SF-36 MCS: SQoL-F (r=0.407, p=0.002)]. We did not observe any associations with disease duration, the current prednisone dose, or serum levels of muscle enzymes.

Conclusion:

Women with IIM reported significantly impaired sexual function and pelvic floor function compared to age-/sex-matched healthy controls. Worse scores in IIM were associated with disease-related features.

Table 1.

Sexual function and pelvic floor function in women with IIM and healthy controls

Questionnaire: score range (meaning)IIM (n=62)HC (n=62)p-valueFSFI: Female Sexual Function Index: 2 (worst) - 36 (best)18.2 (3.2-28.5)28.4 (14.4-32.1)p=0.006BISF-W: Brief Index of Sexual Function forWomen: -16 (worst) - 75 (best)18.6 (2.7-32.3)34.0 (8.0-44.7)p=0.004SQoL-F: Sexual Quality of Life Questionnaire – Female: 0 (worst) - 100 (best)60.0 (41.4-83.6)86.7 (70.8-95.6)p<0.0001PISQ–12: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form: 0 (best) - 48 (worst)14.5 (9.0-18.0)8.0 (5.0-12.0)p<0.0001PFIQ7: Pelvic Floor Impact Questionnaire – short form 7: 0 (best) - 300 (worst)4.8 (0.0-23.8)0.0 (0.0-4.8)p=0.052SFQ-28: Sexual Functioning Questionnaire-28 desire: 5 (worst) - 31 (best)18.0 (13.3-20.0)19.0 (17.0-22.0)p=0.042SFQ-28 arousal sensation: 4 (worst) - 20 (best)9.5 (7.0-11.0)12.0 (9.0-14.3)p=0.082SFQ-28 arousal lubrication: 2 (worst) - 10 (best)6.0 (4.0-8.0)7.0 (5.0-9.0)p=0.112SFQ-28 arousal cognitive: 2 (worst) - 10 (best)6.0 (4.3-7.0)6.0 (5.0-7.3)p=0.235SFQ-28 orgasm: 1 (worst) - 15 (best)11.0 (8.0-13.0)12.0 (9.8-13.0)p=0.279SFQ-28 pain: 2 (worst) - 15 (best)12.0 (10.0-15.0)15.0 (13.0-15.0)p=0.004SFQ-28 enjoyment: 6 (worst) - 30 (best)19.0 (14.3-24.3)23.0 (19.0-25.0)p=0.027SFQ-28 partner: 2 (worst) - 10 (best)9.0 (8.0-10.0)10.0 (9.0-10.0)p=0.012

Acknowledgements:

Supported by MHCR 023728, GA UK 1578119, and SVV 260373

Disclosure of Interests:

None declared

Association of altered lipid profile with disease activity, duration, and glucocorticoid treatment in patients with idiopathic inflammatory myopathies

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): AZV CR, Czech health research council MHCR, Ministry of Health Dzech republic

Background

Systemic inflammation, limited mobility, and glucocorticoid treatment in Idiopathic inflammatory myopathies (IIM) can have a negative impact on intermediate metabolic pathways, especially on lipid metabolism.

Purpose

The aim of this study was to assess the differences in the lipid profile of IIM patients and healthy controls (HC) and the association with disease-specific features.

Methods

133 patients with IIM (106 females; mean age 60.3; disease duration 2.2 years; dermatomyositis, DM 47 / polymyositis, PM 41 / immune-mediated necrotizing myopathy, IMNM 45) and 133 age-/sex-matched HC (106 females, mean age 60.2) were included. Data are presented as median (IQR).

Results

Several differences in disease activity, the dose of glucocorticoids, prevalence of comorbidities, and serum lipid levels were observed among the three subtypes of IIM. Lipid profile parameters, especially levels of negative cardiovascular predictive markers such as TC, TG, LDL-C, Apo-B, and the atherogenic index were significantly higher compared to HC. The most significant changes were observed in IMNM compared to age-/sex-matched HC. Levels of TC, TG, LDL-C, apo-B, and non-HDL negatively correlated with disease duration but positively with laboratory markers of disease activity and the current prednisone equivalent dose. Higher levels of HDL-C were associated with decreased levels of CRP, which is in line with the negative correlation of apo-A levels with CRP, CK, and myoglobin. Conclusions: We have observed significant alterations in serum lipid parameters in our IIM patients compared to healthy age-/sex-matched individuals. Differences were also found among the three IIM subtypes. These alterations were associated with laboratory parameters of disease activity and the current dose of corticosteroids.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

SAT0430 SECUKINUMAB EFFECTIVENESS IN 1543 PATIENTS WITH PSORIATIC ARTHRITIS TREATED IN ROUTINE CLINICAL PRACTICE IN 13 EUROPEAN COUNTRIES IN THE EuroSpA RESEARCH COLLABORATION NETWORK

Background:

There is a lack of real-life evidence on secukinumab effectiveness in psoriatic arthritis (PsA) patients.

Objectives:

To assess the real-life 6- and 12-month secukinumab retention rates and proportions of patients in remission/low disease activity (LDA) overall, and by prior biologic disease-modifying anti-rheumatic drug (bDMARD)/targeted synthetic (ts)DMARD use.

Methods:

Data from PsA patients treated with secukinumab in routine care from 13 countries in the European Spondyloarthritis (EuroSpA) Research Collaboration Network were pooled. Patients started secukinumab ≥12 months before date of datacut. Crude and LUNDEX adjusted (crude value adjusted for drug retention) 28-joint Disease Activity index for PSoriatic Arthritis (DAPSA28) and 28-joint Disease Activity Score with CRP (DAS28CRP) remission and LDA rates were calculated. Group comparisons between b/tsDMARD naïve, 1 prior and ≥2 prior b/tsDMARD users were done with ANOVA, Kruskal-Wallis, Chi-square or Kaplan-Meier analyses with log-rank test, as appropriate.

Results:

A total of 1543 PsA patients were included (Table 1). b/tsDMARD naïve patients had shorter time since diagnosis, higher baseline disease activity, a higher proportion were men and a higher proportion achieved remission. Overall 6/12-month secukinumab retention rates were 86%/74% and significantly higher in b/tsDMARD naïve patients at 12, but not 6 months (Table 2, Figure). Overall, crude 6- and 12-month DAPSA28≤4/DAS28CRP<2.6 were achieved by 13%/34% and 11%/39% of the patients, respectively.

Table 1.All patients (n=1543)b/tsDMARD naïve (n=287)1 prior b/tsDMARD (n=333)≥2 prior b/tsDMARDs (n=923)p *Age (years), mean (SD)52 (11)49 (12.3)51 (11)53 (11)<0.001Male, %42%49%46%39%0.003Years since diagnosis, mean (SD)9 (8)7 (8)8 (7)10 (8)<0.001Current smokers, %19%21%22%18%0.23CRP (mg/L), median (IQR)5 (2-12)7 (2-19)4 (2-8)5 (2-11)<0.001DAPSA28, median (IQR)26 (18-37)28 (19-38)22 (13-32)27 (19-38)<0.001DAS28CRP, median (IQR)4.2 (3.3-5.0)4.4 (3.5-5.2)3.8 (2.6-4.5)4.2 (3.4-5.0)<0.001

*Comparisons across number of prior b/tsDMARD were done with ANOVA, Kruskal-Wallis or Chi-square test, as appropriate

Table 2.MonthsAll patients (n=1543)b/tsDMARD naïve (n=287)1 prior b/tsDMARD (n=333)≥2 prior b/tsDMARDs (n=923)p *Secukinumab retention rate, % (95%CI)686% (84-87%)89% (86-93%)85% (81-89%)85% (82-87%)0.111274% (72-76%)81% (76-86%)76% (71-80%)72% (69-75%)0.006DAPSA28≤4 Crude613%25%11%11%<0.001 LUNDEX11%22%9%9%<0.001 Crude1211%22%11%8%<0.001 LUNDEX7%17%7%5%0.001DAS28CRP<2.6 Crude634%51%33%30%<0.001 LUNDEX29%45%27%24%<0.001 Crude1239%55%41%34%<0.001 LUNDEX26%41%27%21%<0.001DAPSA28 >4 and ≤14 Crude633%42%32%30%0.04 LUNDEX27%37%27%25%0.02 Crude1235%48%36%32%0.009 LUNDEX24%36%24%20%0.004DAS28CRP ≤3.2 Crude652%69%53%47%<0.001 LUNDEX43%61%45%38%<0.001 Crude1255%72%55%50%<0.001 LUNDEX37%54%37%32%<0.001

*Comparisons across number of prior b/tsDMARDs were done with Kaplan-Meier with log-rank test or Chi-Square test, as appropriate

Conclusion:

In this real-life study of 1543 patients with PsA in 13 European countries 12-month secukinumab retention was high, and significantly higher for b/tsDMARD naïve patients. Overall, a higher proportion of bionaïve than previous b/tsDMARD users achieved remission, regardless of remission criteria.

Acknowledgments:

Novartis and IQVIA for supporting the EuroSpA RCN

Disclosure of Interests:

Brigitte Michelsen Grant/research support from: Research support from Novartis, Consultant of: Consulting fees Novartis, Stylianos Georgiadis Grant/research support from: Novartis, Daniela Di Giuseppe: None declared, Anne Gitte Loft Grant/research support from: Novartis, Consultant of: AbbVie, MSD, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer and UCB, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Manuel Pombo-Suarez Consultant of: Janssen, Lilly, MSD and Sanofi., Speakers bureau: Janssen, Lilly, MSD and Sanofi., Heřman Mann: None declared, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Kari Eklund Consultant of: Celgene, Lilly, Speakers bureau: Pfizer, Roche, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Maria Jose Santos Speakers bureau: Novartis and Pfizer, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Sema Yilmaz: None declared, Johan K Wallman Consultant of: AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma, Cecilie Heegaard Brahe Grant/research support from: Novartis, Burkhard Moeller: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Carlos Sánchez-Piedra: None declared, Lucie Nekvindova: None declared, Matija Tomsic: None declared, Nina Trokovic: None declared, Eirik kristianslund: None declared, Helena Santos Speakers bureau: AbbVie, Eli-Lilly, Janssen, Pfizer, Novartis, Thorvardur Love: None declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Yavuz Pehlivan: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene and GSK., Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis

OP0138 CLUSTERIN ASSOCIATES WITH DISEASE MECHANISMS AND INFLAMMATION IN MYOSITIS PATIENTS

Background:

Idiopathic inflammatory myopathies (IIM, myositis) are a heterogeneous group of autoimmune muscle disorders characterized by skeletal muscle weakness and damage, inflammation and extramuscular manifestations. Recent findings suggest that immunological as well as nonimmunological processes, such as endoplasmic reticulum stress, hypoxia, mitochondrial and metabolic dysfunction are involved in the pathogenesis of IIMs [1]. Clusterin (CLU) has been reported to play a protective function in the development of tissue injury, inflammation and autoimmunity, and is involved in the maintenance of immune homeostasis [2].

Objectives:

This study aimed to explore a potential involvement of the circulating levels and skeletal muscle expression of CLU in pathogenic mechanisms of IIM.

Methods:

A total of 85 IIM patients and 86 healthy controls (HC) were recruited. In addition, 20 IIM patients and 21 HC underwent a muscle biopsy. Circulating concentrations of CLU were measured by ELISA. Serum cytokine profile of patients and HC was assessed by Cytokine 27-plex Assay. Immunohistochemical localisation of CLU was assessed in 10 IIM and 4 control muscle tissue specimens. The expression of CLU and myositis related cytokines in muscle tissue was determined by real-time PCR.

Results:

We observed a significant increase of circulating CLU in all IIM patients compared to HC (86.2 (71.6-99.0) vs. 59.6 (52.6-68.4) μg/mL, p < 0.0001). Moreover, CLU serum levels were positively correlated with myositis disease activity assessment (MYOACT) (r = 0.337, p = 0.008), myositis intention-to-treat activity index (MITAX) (r = 0.357, p = 0.004) and global disease assessment evaluated by physician (r = 0.309, p = 0.015). In addition to that, a multivariate redundancy analysis revealed a combined effect of serum CLU and cytokine profile (represented by cytokines and chemokines known to be involved in IIM) on disease activity measures. In muscle tissue, CLU mRNA was significantly increased in IIM patients compared to controls (p = 0.032) and correlated with IL-1β (r = 0.489, p = 0.034), IL-6 (r = 0.581, p = 0.009), TNF (r = 0.485, p = 0.035) and PGC-1α (r = 0.709, p = 0.001) mRNA. Immunohistochemistry revealed CLU accumulation in the cytoplasm of regenerating myofibers.

Conclusion:

Our results show an up-regulation of clusterin in circulation and skeletal muscle of IIM patients that associates with disease activity and inflammation, and its specific expression in regenerating myofibres. Based on our data and the known cytoprotective function of CLU we suggest an attempt of the organism to limit further muscle damage induced by myositis disease mechanisms.

References:

[1]Ernste FC, Reed AM. Idiopathic inflammatory myopathies: current trends in pathogenesis, clinical features, and up-to-date treatment recommendations. Mayo Clin Proc. 2013;88:83-105.

[2]Savkovic V, Gantzer H, Reiser U, Selig L, Gaiser S, Sack U, et al. Clusterin is protective in pancreatitis through anti-apoptotic and anti-inflammatory properties. Biochem Biophys Res Commun. 2007;356:431-7.

Acknowledgments:

This work was supported by GAUK 534217 and the Ministry of Health of the Czech Republic grants nr. 16-33746A and 16-33574A.

Disclosure of Interests:

None declared

THU0365 INCREASED HSP90 IN MUSCLE TISSUE AND PLASMA ASSOCIATES WITH DISEASE ACTIVITY AND SKELETAL MUSCLE INVOLVEMENT IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES

Background:

Heat shock proteins (Hsps) are chaperones playing important roles in skeletal muscle physiology, adaptation to exercise or stress, and activation of inflammatory cells

Objectives:

The aim of our study was to assess Hsp90 expression in muscle biopsies and plasma of patients with idiopathic inflammatory myopathies (IIM) and to characterize its association with IIM-related features.

Methods:

Total of 277 patients with IIM (198 females, 79 males; mean age 54.8; disease duration 4.1 years; DM, 104/PM, 108/CADM, 31/IMNM, 25) and 157 healthy individuals (92 females, 65 males; mean age 47.0) were included in plasma analysis. Muscle biopsy samples (PM, DM, IMNM, myodystrophy, myasthenia gravis) were stained for Hsp90α (Thermo Fisher Scientific, USA) and Hsp90β (Abcam, UK). Plasma Hsp90 was measured by ELISA kit (eBioscience, Vienna, Austria). The cytokines/chemokines were analysed by using Bio-Plex ProTMhuman Cytokine 27-plex Assay (BIO-RAD, California, USA.Data are presented as median(IQR).

Results:

In muscle biopsies, Hsp90 expression of both subunits (alpha and beta) was higher in IIM than in controls. Increased Hsp90 was detected in perifascicular degenerating and regenerating fibers, inflammatory cells (DM, PM), and necrotic and regenerating fibers (IMNM). Plasma Hsp90 levels were increased in IIM patients compared to healthy controls (55.9 (46.9 – 62.5)vs 9.76(7.5 – 13.8), p<0.0001), and in individual subgroups of IIM vs. healthy controls (DM-22.01(14.1 – 41.2), PM-19.7(14.3 – 42.2), CADM-18.9(11.7 – 29.7), IMNM-19.6(16.3 – 45.5), p<0.0001 for all). Hsp90 was higher in males compared to females (p=0.040) and in patients with ILD (p=0.003), cardiac involvement (p=0.004), dysphagia (p=0.018) and presence of anti-Ro52 (p=0.036). Hsp90 levels in all patients positively correlated with muscle enzymes (Tab.1). Hsp90 was associated with disease activity and skeletal muscle involvement (Tab.1). Out of all clinical parameters listed in above-mentioned univariate analysis, in multiple regression analysis Hsp90 levels in IIM patients were significantly affected by muscle enzymes only (p<0.0001, β=0.345). Furthermore, Hsp90 positively correlated with some crucial cytokines involved in pathogenesis of myositis (Tab. 1).

Tab 1Clinical parametersSpearman’s rp – valueLDH; AST; ALT0.554; 0.383; 0.181< 0.0001; < 0.0001; 0.003PtDGA; PhDGA; MITAX; MYOACT0.223; 0.217; 0.175; 0.159< 0.001; < 0.001; 0.004; 0.012Pulmonary disease activity0.2010.001Muscle disease activity0.1460.018MMT8, total score; m. biceps brachii; m. gluteus maximus; m. iliopsoas-0.126; -0.125; -0.159; -0.1430.042; 0.043; 0.011; 0.023MDI – Myositis damage index – severity0.1500.041Current Prednisone equivalent dose0.1830.006Cytokines:IL-1b; IL-2; IL-4; IL-6; IFN-γ0.188; 0.269; 0.190; 0.182; 0.2290.002; < 0.0001; 0.002; 0.003; < 0.0001

Conclusion:

We demonstrate increased Hsp90 expression in IIM muscle biopsy samples, specifically in inflammatory cells, degenerating, regenerating and/or necrotic fibers. Increased Hsp90 plasma levels in IIM patients are associated with disease activity and damage, and with the involvement of proximal skeletal muscles, heart and lungs.

Acknowledgments:

Supported by AZV-16-33542A, MHCR 023728 and SVV – 260373.

Disclosure of Interests:

Hana Štorkánová: None declared, Sabina Oreska: None declared, Maja Špiritović: None declared, Barbora Heřmánková: None declared, Olga Kryštůfková: None declared, Heřman Mann: None declared, Martin Komarc: None declared, Josef Zámečník: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Jiří Vencovský: None declared, Ladislav Šenolt: None declared, Michal Tomcik: None declared

FRI0255 BODY COMPOSITION IN SCLERODERMA PATIENTS IS ASSOCIATED WITH DISEASE ACTIVITY, SERUM LEVELS OF INFLAMMATORY CYTOKINES AND PARAMETERS OF NUTRITION AND LIPID METABOLISM

Background:

Fibrosis of the skin and visceral organs, especially digestive tract, and musculoskeletal involvement in systemic sclerosis (SSc) can have a negative impact on body composition, physical activity and nutritional status.

Objectives:

The aim was to assess body composition and physical activity of SSc patients and healthy controls (HC) and the association with selected inflammatory cytokines/chemokines and laboratory markers of nutritional status and lipid metabolism in SSc.

Methods:

59 patients with SSc (50 females; mean age 52.5; disease duration 6.7 years; lcSSc: 34/dcSSc: 25) and 59 age-/sex-matched HC (50 females, mean age 52.5) without rheumatic or tumour diseases were included. SSc patients fulfilled ACR/EULAR 2013 criteria. We assessed body composition (densitometry: iDXA Lunar, bioelectric impedance: BIA-2000-M), physical activity (Human Activity Profile, HAP questionnaire), disease activity (ESSG activity index), serum levels of 27 cytokines/chemokines (commercial multiplex ELISA kit, Bio-Rad Laboratories) and serum levels of chosen parameters of nutrition and lipidogram. Data are presented as mean±SD.

Results:

Compared to HC, patients with SSc had significantly lower body mass index (BMI, 27.4±8.3 vs. 22.4±4.3 kg/m2, p<0,001), body fat % (BF%, iDXA: 38.0±7.6 vs. 32.6±8.2 kg, p<0,001; BIA: 31.3±7.6 vs. 24.3±7.9 kg, p<0,001) and visceral fat weight (VF, 1.0±0.8 vs. 0.5±0.5 kg, p=0,001), and also significantly decreased lean body mass (LBM, iDXA: 51.9±8.4 vs. 47.8±7.0 kg, p=0,005; BIA: 45.4±7.3 vs. 40.9±6.8 kg, p=0,005), and bone mineral density (BMD, 1.2±0.1 vs. 1.0±0.1 g/cm2, p<0,001). Compared to HC, patients with SSc had increased extracellular mass/body cell mass (ECM/BCM, 1.03±0.1 vs. 1.28±0.4, p<0,001) ratio, reflecting deteriorated nutritional status and worse muscle predispositions for physical activity. Increased ECM/BCM in SSc was associated with higher disease activity (ESSG), increased skin score (mRSS) and inflammation (CRP, ESR), and with worse quality of life (HAQ, SHAQ), fatigue (FSS), and decreased physical activity (HAP). ESSG negatively correlated with BF%. HAP positively correlated with BMD. Serum levels of several inflammatory cytokines/chemokines (specifically IL-1b, IL-5, IL-6, IL-8, IL-17, TNF, Eotaxin) and markers of nutrition (specifically total protein, albumin, insulin and C-peptide) and lipid metabolism (specifically triglycerides, high-density lipoprotein, apolipoprotein A, atherogenic index of plasma) were significantly associated with alterations of body composition in patients with SSc (p<0.05 for all correlations).

Conclusion:

Compared to healthy age-/sex-matched individuals we found significant negative changes in body composition of our SSc patients, which are associated with the disease activity and physical activity, and could reflect their nutritional status, and gastrointestinal and musculoskeletal involvement. Detected alterations of body composition in SSc patients were significantly associated with serum levels of several inflammatory cytokines/chemokines and markers of nutrition and lipid metabolism, which might further support the role of systemic inflammation and nutritional status on the negative changes in body composition of SSc patients

Acknowledgments:

Supported by AZV NV18-01-00161A, MHCR 023728, SVV 260373 and GAUK 312218

Disclosure of Interests:

Sabina Oreska: None declared, Maja Špiritović: None declared, Petr Česák: None declared, Michal Cesak: None declared, Hana Štorkánová: None declared, Hana Smucrova: None declared, Barbora Heřmánková: None declared, Olga Růžičková: None declared, Heřman Mann: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Ladislav Šenolt: None declared, Jiří Vencovský: None declared, Radim Bečvář Consultant of: Actelion, Roche, Michal Tomčík: None declared

THU0358 NEGATIVE CHANGES OF BODY COMPOSITION IN MYOSITIS PATIENTS AND THEIR ASSOCIATION WITH DISEASE SPECIFIC CHARACTERISTICS, PHYSICAL ACTIVITY AND NUTRITIONAL STATUS

Background:

Skeletal muscle, pulmonary and articular involvement in idiopathic inflammatory myopathies (IIM) limit the mobility/self-sufficiency of patients, and can have a negative impact on body composition.

Objectives:

The aim was to assess body composition and physical activity of IIM patients and healthy controls (HC) and the association with selected inflammatory cytokines/chemokines and laboratory markers of nutrition and lipid metabolism.

Methods:

54 patients with IIM (45 females; mean age 57.7; disease duration 5.8 years; polymyositis (PM, 22) / dermatomyositis (DM, 25) / necrotizing myopathy (IMNM, 7)) and 54 age-/sex-matched HC (45 females, mean age 57.7) without rheumatic/tumor diseases were included. PM/DM patients fulfilled Bohan/Peter criteria for PM/DM. We assessed body composition (densitometry: iDXA Lunar, bioelectric impedance: BIA2000-M), physical activity (Human Activity Profile, HAP questionnaire), serum levels of 27 cytokines/chemokines (commercial multiplex ELISA kit, Bio-Rad Laboratories) and serum levels of selected parameters of nutrition and lipidogram. Disease activity (MITAX and MYOACT activity score) and muscle involvement (manual muscle testing, MMT-8, and functional index 2, FI2) were evaluated. Data are presented as mean±SD.

Results:

Compared to HC, patients with IIM had a trend towards significantly increased body fat % (BF%; iDXA: 39.9±7.1 vs. 42.4±7.1 %, p=0.077), but significantly decreased lean body mass (LBM; iDXA: 45.6±8.1 vs. 40.6±7.2 kg, p=0.001; BIA: 52.6±8.8 vs. 48.7±9.0 kg, p=0.023), increased extracellular mass/body cell mass (ECM/BCM) ratio (1.06±0.15 vs. 1.44±0.42, p<0.001), reflecting deteriorated nutritional status and predisposition for physical activity, and significantly lower bone mineral density (BMD: 1.2±0.1 vs. 1.1±0.1 g/cm2, p<0.001). Disease duration negatively correlated with BMD and LBM-BIA. Disease activity (MITAX, MYOACT) positively correlated with LBM (by BIA and DXA), similarly as with basal metabolic rate (BMR), and fat free mass (FFM). CRP was positively associated with BF% (BIA and DXA). Higher BF%-DEXA was associated with worse physical endurance (FI2) and worse ability to perform physical activity (HAP). MMT-8 score negatively correlated with ECM/BCM ratio. Serum levels of several inflammatory cytokines/chemokines (specifically IL-1ra, MCP, IL-10) and markers of nutrition (specifically albumin, C3-, C4-complement, cholinesterase, amylase, insulin and C-peptide, vitamin-D, orosomucoid), and lipid metabolism (specifically triglycerides, high-density lipoprotein, apolipoprotein A and B, atherogenic index of plasma) were significantly associated with alterations of body composition in IIM patients. (p<0.05 for all correlations)

Conclusion:

Compared to healthy age-/sex-matched individuals we found significant negative changes in body composition of our IIM patients associated with their disease activity and duration, inflammatory status, skeletal muscle involvement, and physical activity. These data could reflect their impaired nutritional status and predispositions for physical exercise, aerobic fitness and performance.

Serum levels of certain inflammatory cytokines/chemokines and markers of nutrition and lipid metabolism were associated with alterations of body composition in IIM patients. This might further support the role of systemic inflammation and nutritional status on the negative changes in body composition of IIM patients.

Acknowledgments:

Supported by AZV NV18-01-00161A, MHCR 023728, SVV 260373 and GAUK 312218

Disclosure of Interests:

Sabina Oreska: None declared, Maja Špiritović: None declared, Petr Česák: None declared, Ondrej Marecek: None declared, Hana Štorkánová: None declared, Barbora Heřmánková: None declared, Kateřina Kubinova: None declared, Martin Klein: None declared, Lucia Vernerová: None declared, Olga Růžičková: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Ladislav Šenolt: None declared, Heřman Mann: None declared, Jiří Vencovský: None declared, Michal Tomčík: None declared

FRI0041 ULTRASOUND-DETECTED SYNOVITIS AMONG INDIVIDUALS AT RISK OF RHEUMATOID ARTHRITIS INCREASES THE RISK OF DEVELOPING CLINICAL ARTHRITIS

Background:

During the transition to rheumatoid arthritis (RA) patients pass through several phases. In the preclinical phase, the presence of anti citrullinated protein antibodies (ACPA) can be detected [1]. A set of clinical characteristics for patients with arthralgia who are at risk of progression to RA was established (clinically suspected arthralgia; CSA) [2]. Ultrasound (US) is more sensitive diagnostic tool in detecting synovitis than clinical assessment and was recommended to use in diagnostics of RA.

Objectives:

To test if ultrasound-detected synovitis among patients at risk of progression to RA increases the risk of developing clinical arthritis (CA) in the future.

Methods:

ACPA+ individuals with arthralgia and/or those fulfilling CSA criteria were enrolled into the study and were assessed in 3 months interval (routine clinical investigation with laboratory tests, 68-joint count, US assessment). Tender and swollen joint counts were provided by an independent investigator. Sonographer was blinded to all clinical and laboratory data. CA was defined as clinically swollen and tender joint. All US assessments were provided by a single experienced investigator. Thirty joints US score was assessed bilaterally in wrist, MCP I-V, PIP II-V (dorsal and palmar approach), MTP II-V (dorsal approach), ankle (dorsal, medial and lateral approach). US synovitis was defined according the EULAR-OMERACT and scored separately in gray-scale (GS) 0-3 (zero to severe synovitis) and Power Doppler (PD) 0-3 (zero to high activity). Scores were calculated as sum scores. For the statistical analysis, we used GraphPad Prism 8.0.0 software (Wilcoxon-Mann-Whitney test), and relative risk ratio (RR).

Results:

93 patients were enrolled into the study (95% female). 58 patients were ACPA+ (all of them RF+), 35 were ACPA- (10 of them RF+). Of ACPA+ individuals, 100% fulfilled the CSA criteria, all seronegative individuals met the CSA criteria. At baseline, GS≥1 was detected in 69 patients (74%), PD≥1 was in 26 (28 %) patients. Single erosion was found by US in 1 patient (0,9%) at baseline. 14 patients (15%) developed CA within 30 months, 77% of them till month 10 from the baseline. No statistical difference in US synovitis score was found between ACPA+ vs. ACPA- and CSA+ vs. CSA- groups at baseline. RR to develop CA at the joint level in patients with GS≥1 at baseline was 1.37 (95% CI 0.99-1.89; p<0.05), with PD≥1 the RR was 2.5 (95% CI 1.3-4.8; p<0.05), in GS≥2 RR was 3.8 (95% CI 2.6-5.6; p<0.0001), in PD≥2 RR was 5.3 (95% CI 2.4-11.7; p<0.0001). US-detected synovitis preceded clinical finding of arthritis by 3 months (SD 1.2).

Conclusion:

US-detected synovitis in patients at risk of RA further increases the risk of developing clinical arthritis in the future. US detected synovitis in joints appear about 3 months prior synovitis detected by routine clinical assessment.

References:

[1]Bos, W. H., Wolbink, G. J., Boers, et al. Arthritis development in patients with arthralgia is strongly associated with anti- citrullinated protein antibody status: a prospective cohort study. Annals of the Rheumatic Diseases, 2010;69(3):490-4.

[2]van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJJ, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Annals of the Rheumatic Diseases 2017;76:491-6.

Acknowledgments:

Project AZV-17-32612A

Disclosure of Interests:

Petra Hanova: None declared, Klára Prajzlerová: None declared, Nora Petrovská: None declared, Monika Gregová Consultant of: Novartis, Abbvie, Paid instructor for: Novartis, Speakers bureau: Novartis, Abbvie, MSD, Heřman Mann: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Jiří Vencovský: None declared, Ladislav Šenolt: None declared, Mária Filková: None declared

SAT0627-HPR SEXUAL QUALITY OF LIFE IN 39 FEMALE PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES

Background:

Symptoms related to idiopathic inflammatory myopathies (IIM) such as weakness of skeletal muscles, pulmonary and articular involvement may have a negative impact on all aspects of life including sexual life.

Objectives:

To assess sexual functioning in female IIM patients compared to age-/sex-matched healthy controls (HC) and to analyze the potential impact of clinical features on sexual health.

Methods:

In total, 39 women (29 currently have a partner) with IIM [mean age: 54.7, disease duration: 11.8 years, dermatomyositis (DM, 19)/ polymyositis (PM, 16)/ necrotizing myopathy (IMNM, 3)/ inclusion body myositis (IBM, 1)] and 39 healthy controls (30 currently have a partner, mean age: 54.7 years) without rheumatic diseases filled in 11 well-established and validated questionnaires assessing sexual function (FSFI, SFQ28, BISFW), quality of sexual life (SQoL-F), pelvic floor function (PISQ-12, PFIQ-7), fatigue (FIS, MAF), physical activity (HAP), and depression (BDI-II). A standard laboratory testing was performed. Data are presented as mean ± SEM.

Results:

Patients with IIM reported significantly higher prevalence and greater severity of sexual dysfunction (FSFI, BISF-W, SFQ28) and worse sexual quality of life (SQoL-F) compared to HC (table 1). Worse scores in IIM patients were associated with increased inflammation [CRP: FSFI (r=-0.378, p=0.0190), SFQ-28 Satisfaction domain (r=-0.346, p=0.0356), SQoL-F (r=-0.331, p=0,0479], greater muscle weakness of m. gluteus maximus/ m. gluteus medius/ m. iliopsoas [FSFI: (r=0.426, p=0.0368), (r=0.370, p=0.0368), (r=0.394, p=0.0252), SQoL-F (r=0.504, p=0.0044), (r=0.421, p=0.0204), (r=0.462, p=0.0100)], greater fatigue [FIS: FSFI (r=-0.358, p=0.0154), BISF-W (r=-0.415, p=0.0084), SQoL-F (r=-0.327, p=0.0481)], more severe depression [BDI-II: FSFI Arousal domain (r=-0.357, p=0.0299)], deteriorated quality of life [HAQ: BISF-W (r=-0.464, p=0.0033)], and worse ability to perform physical activities [HAP: FSFI (r=0.405, p=0.0105), BISF-W (r=0.480, p=0.0019)]. No associations were found with disease duration, prednisone dose or serum levels of muscle enzymes.

Table 1.Questionnaire: score range (meaning)IIM (n=39)HC (n=39)p-valueFSFI: Female Sexual Function Index: 2(worst)-36(best)15.7±2.120.7±2.0p=0.0421BISF-W: Brief Index of Sexual Function for Women: -16 (worst)-75(best)14.6±2.824.5±3.0p=0.0134SFQ28 Desire domain: Sexual Function Questionnaire: 5(worst)-31(best)11.7±1.014.7±1.0p=0.0457PISQ–12: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form: 0(best)-48(worst)14.9±0.810.1±1.0p=0.0005SQoL-F:Sexual Quality of Life Questionnaire – Female: 0(worst)-100(best)31.8±5.180.7±2.5p<0.0001PFIQ7: Pelvic Floor Distress Inventory Questionnaire – short form 7:0(best)-300(worst)24.7±6.310.1±2.7p=0.0820FIS:Fatigue Impact Scale: 0(best)-160(worst)55.3±5.533.2±4.3p=0.0025MAF:Multidimensional Assessment of Fatigue Scale: 1(best)-50(worst)22.0±2.015.7±1.4p=0.0021BDI-II:Beck’s Depression Inventory II: 0(best)-63(worst)12.8±1.56.6±0.9p=0.0013HAP:Human Activity Profile – adjusted activity score: 0(worst)-94(best)51.0±3.580.2±1.6p<0.0001HAQ:Health Assessment Questionnaire: 0(best)-3(worst)1.1±0.10.1±0.1p<0.0001

Conclusion:

Women with IIM reported significantly impaired sexual function and sexual quality of life compared to age-matched healthy controls. Worse scores in IIM were associated with disease activity, physical activity, fatigue, depression and quality of life.

Acknowledgments:

Supported by MHCR 023728, SVV 260373 and GAUK 1578119.

Disclosure of Interests:

Barbora Heřmánková: None declared, Maja Špiritović: None declared, Sabina Oreska: None declared, Hana Štorkánová: None declared, Martin Klein: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Ladislav Šenolt: None declared, Heřman Mann: None declared, Jiří Vencovský: None declared, Michal Tomčík: None declared

OP0109 CO-MEDICATION WITH A CONVENTIONAL SYNTHETIC DMARD IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS IS ASSOCIATED WITH IMPROVED RETENTION OF TNF INHIBITORS: RESULTS FROM THE EUROSPA COLLABORATION

Background:

Axial spondylarthritis (axSpA) patients treated with a tumour necrosis factor inhibitor (TNFi) may receive a concomitant conventional synthetic disease-modifying anti-rheumatic drug (csDMARD), although the value of combination therapy remains unclear.

Objectives:

Describe the proportion and phenotype of patients with axSpA initiating their first TNFi as monotherapy compared to TNFi+csDMARD combination therapy, and to compare the 1-year TNFi retention between the two groups.

Methods:

Data from 13 European registries was collected. Two exposure treatment groups were defined: TNFi monotherapy at baseline (=TNFi start date) and TNFi+csDMARD combination therapy. TNFi retention rates were assessed with Kaplan-Meier curves for each country and combined. Hazard ratios (HR, 95% CI) for discontinuing the TNFi were obtained with Cox models: (i) crude; adjusted for (ii) country, and (iii) country, sex, age, calendar year, disease duration and BASDAI. Participating countries were dichotomized into two strata, depending on their 1-year retention rate being above (stratum A) or below (stratum B) the average retention rate across all countries.

Results:

22,196 axSpA patients were included with 34% on TNFi+csDMARD combination therapy. Baseline characteristics are presented in table 1. Overall, the crude TNFi retention rate was marginally longer in the combination therapy group (80% (79-81%)) compared to the monotherapy group (78% (77-79%)) and was primarily driven by differences in stratum B (fig. 1). TNFi retention rates varied significantly across countries (range:-11.0% to +11.3%), with a clear distinction between the 2 strata. The HRs for discontinuation over 1-year (reference=TNFi monotherapy) in the 3 models were: (i) 0.88 (0.82-0.93), (ii) 0.87 (0.82-0.92), (iii) 0.88 (0.82-0.93).

Table 1Baseline characteristicsAll patients(n=22196)Country stratum ACountry stratum BTNFi mono(n=4940)csDMARD + TNFi(n=2547)TNFi mono(n=9693)csDMARD + TNFi(n=5016)Age (years), mean (SD)42.6 (12.5)43.4 (12.0)42.8 (12.2)41.6 (12.7)43.7 (12.7)Females, %41.137.738.242.044.2Disease duration (yrs), mean (SD)5.7 (8.0)6.2 (7.7)6.7 (7.4)4.9 (8.2)6.1 (8.2)Enthesitis, %50.316.733.957.859.7SJC-28, median (IQR)0 (0-1)0 (0-0)0 (0-2)0 (0-0)0 (0-2)VAS pain (0-100), mean (SD)60.9 (24.5)63.3 (26.5)67.8 (23.3)60.2 (23.4)57.2 (24.3)CRP (mg/L), median (IQR)8 (3-20)7.8 (2-20)18 (6.7-32.6)6.0 (2.7-15)8.0 (3-22)BASDAI (0-10), mean (SD)5.7 (2.1)5.7 (2.2)6.2 (2.1)5.6 (2.0)5.4 (2.2)BASFI (0-10), mean (SD)4.4 (2.5)4.4 (2.6)4.9 (2.5)4.3 (2.4)4.2 (2.9)ASDAS, mean (SD)3.5 (1.1)3.7 (1.0)4.0 (1.0)3.3 (1.0)3.3 (1.1)On Infliximab, %25.721222436Baseline csDMARD use, %-Methotrexate045063-Sulfasalazine068033-Leflunomide0801

Conclusion:

Considerable differences were observed across countries in the use of combination therapy and TNFi retention in axSpA patients. The overall 1-year TNFi retention was higher with csDMARD co-therapy compared to TNFi monotherapy. TNFi monotherapy had a 12-13% higher risk of treatment discontinuation.

Acknowledgments:

Novartis Pharma AG and IQVIA

MN and BD participated equally

Disclosure of Interests:

Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Bénédicte Delcoigne: None declared, Daniela Di Giuseppe: None declared, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer, Karen Fagerli: None declared, Anne Gitte Loft Grant/research support from: Novartis, Consultant of: AbbVie, MSD, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer and UCB, Adrian Ciurea Consultant of: Consulting and/or speaking fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis and Pfizer., Dan Nordström Consultant of: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Speakers bureau: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Maria Jose Santos Speakers bureau: Novartis and Pfizer, Manuel Pombo-Suarez Consultant of: Janssen, Lilly, MSD and Sanofi., Speakers bureau: Janssen, Lilly, MSD and Sanofi., Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Heřman Mann: None declared, Nurullah Akkoc: None declared, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Brigitte Michelsen: None declared, Gary Macfarlane: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Matija Tomsic: None declared, Burkhard Moeller: None declared, Pedro Ávila-Ribeiro Grant/research support from: Novartis, Carlos Sánchez-Piedra: None declared, Heikki Relas Grant/research support from: Abbvie., Consultant of: Abbvie, Celgene, and Pfizer., Speakers bureau: Abbvie, Celgene, and Pfizer., Arni Jon Geirsson: None declared, Lucie Nekvindova: None declared, Gozde Yildirim Cetin Speakers bureau: AbbVie, Novartis, Pfizer, Roche, UCB, MSD, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Niels Steen Krogh: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Ulf Lindström: None declared

THU0083 THE DISPROPORTION OF NK CELLS AND NON-CONVENTIONAL NK-T CELLS AND ΓΔ-T CELLS IN INDIVIDUALS AT RISK OF DEVELOPING RHEUMATOID ARTHRITIS

Background:

Natural killer (NK) cells and non-conventional T cells (NK-T and γδ-T cells) are involved in the regulation of immune system and their alteration was previously described in patients with established rheumatoid arthritis (RA). The positivity of antibodies against citrullinated proteins (ACPA) significantly increases the risk of progression to RA. The clinical characteristics of individuals at risk of progression to RA (clinically suspect arthralgia, CSA) has recently been established by EULAR irrespective of the ACPA status.

Objectives:

We aimed to study lymphocyte subpopulations in individuals at risk of developing RA.

Methods:

Our study included 95 individuals with arthralgia at risk of developing RA based on ACPA positivity and/or meeting CSA definition and 70 age and gender matched healthy controls (HC). Whole blood samples were analysed by flow cytometry. The percentage and absolute count of CD3+ T cells, CD3-CD16/56+ NK cells, CD3+CD16/56+ NK-T cells and CD3bright γδ-T cells were evaluated in CD45+CD14- lymphocyte populations.

Results:

Out of 95 individuals with arthralgia (median age 47 years [IQR=16], 92% females), 58 were ACPA+ and 62 met CSA definition (26 of them were ACPA+). Median symptom duration was 12 months [IQR=53], CRP 2.43 [IQR=3.32]. As per definition, there was no evidence of clinical arthritis on examination of 66 joints at baseline. Fourteen individuals developed RA within a median of 3 months of follow up with CRP 4.34 [IQR=17.46] and DAS28(CRP) score 4.84 [IQR=2.43].

Analysis of lymphocyte subpopulations showed higher %CD3+ T cells (p=0.001) and lower %NK (p=0.002) as well as absolute count of NK (p≤0.001), NK-T (p=0.016) and γδ-T cells (p=0.025) and trend to lower %NK-T (p=0.054) in all individuals with arthralgia compared to HC. Similarly, higher %CD3+ T cells (p=0.005) and lower %NK (p=0.004), %NK-T (p=0.027), %γδ-T cells (p=0.050) and absolute count of NK (p=0.002), NK-T (p=0.016) and γδ-T cells (p=0.019) were confirmed in a subgroup of ACPA+ individuals compared to HC. In addition, individuals who met CSA criteria irrespective of ACPA status had higher %CD3 T cells (p=0.004) and lower %NK cells (p=0.002) and absolute count of NK (p≤0.001), NK-T (p=0.019) and γδ-T cells (p=0.042) compared to HC. We observed no differences either between ACPA- or CSA- and HC or between ACPA+ and ACPA- or CSA+ and CSA- individuals with arthralgia. In addition, there were no differences in lymphocyte subsets in individuals who have developed RA so far and patients with arthralgia or at the time of RA manifestation.

Conclusion:

We identified lower number of NK cells as well as NK-T and γδ-T cells in individuals at risk of developing of RA. The decrease in non-conventional T cells was observed despite the increased percentage of the classical T cells. We hypothesize that the disproportion of these lymphocyte subpopulations, described previously in established RA, observed here in at-risk individuals may reflect their predisposition for further development of RA.

Acknowledgments:

Projects AZV-17-32612A and MHCR 023728

Disclosure of Interests:

Klára Prajzlerová: None declared, Olga Kryštůfková: None declared, Nora Petrovská: None declared, Petra Hánová: None declared, Hana Hulejova: None declared, Monika Gregová Consultant of: Novartis, Abbvie, Paid instructor for: Novartis, Speakers bureau: Novartis, Abbvie, MSD, Heřman Mann: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Jiří Vencovský: None declared, Ladislav Šenolt: None declared, Mária Filková: None declared

Durvalumab with or without tremelimumab in patients with recurrent or metastatic head and neck squamous cell carcinoma: EAGLE, a randomized, open-label phase III study

BACKGROUND

Targeting the programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) axis has demonstrated clinical benefit in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Combining immunotherapies targeting PD-L1 and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) has shown evidence of additive activity in several tumor types. This phase III study evaluated the efficacy of durvalumab (an anti-PD-L1 monoclonal antibody) or durvalumab plus tremelimumab (an anti-CTLA-4 monoclonal antibody) versus standard of care (SoC) in R/M HNSCC patients.

PATIENTS AND METHODS

Patients were randomly assigned to receive 1 : 1 : 1 durvalumab (10 mg/kg every 2 weeks [q2w]), durvalumab plus tremelimumab (durvalumab 20 mg/kg q4w plus tremelimumab 1 mg/kg q4w × 4, then durvalumab 10 mg/kg q2w), or SoC (cetuximab, a taxane, methotrexate, or a fluoropyrimidine). The primary end points were overall survival (OS) for durvalumab versus SoC, and OS for durvalumab plus tremelimumab versus SoC. Secondary end points included progression-free survival (PFS), objective response rate, and duration of response.

RESULTS

Patients were randomly assigned to receive durvalumab (n = 240), durvalumab plus tremelimumab (n = 247), or SoC (n = 249). No statistically significant improvements in OS were observed for durvalumab versus SoC [hazard ratio (HR): 0.88; 95% confidence interval (CI): 0.72-1.08; P = 0.20] or durvalumab plus tremelimumab versus SoC (HR: 1.04; 95% CI: 0.85-1.26; P = 0.76). The 12-month survival rates (95% CI) were 37.0% (30.9-43.1), 30.4% (24.7-36.3), and 30.5% (24.7-36.4) for durvalumab, durvalumab plus tremelimumab, and SoC, respectively. Treatment-related adverse events (trAEs) were consistent with previous reports. The most common trAEs (any grade) were hypothyroidism for durvalumab and durvalumab plus tremelimumab (11.4% and 12.2%, respectively), and anemia (17.5%) for SoC. Grade ≥3 trAE rates were 10.1%, 16.3%, and 24.2% for durvalumab, durvalumab plus tremelimumab, and SoC, respectively.

CONCLUSION

There were no statistically significant differences in OS for durvalumab or durvalumab plus tremelimumab versus SoC. However, higher survival rates at 12 to 24 months and response rates demonstrate clinical activity for durvalumab.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02369874.

Isolation of Unusually Composed Sialyl-Compounds from Hemofiltrate

Sialyl compounds are essential components of various biological fluids but relatively little is known about their occurrence in the extracellular fluid of patients with end-stage renal disease. As we have developed a macropreparative method for concentrating and desalting a wide range of fractions from diluted biological fluids we have been able to isolate and identify 5 sialooligosaccharides, 3 sialosugarphosphates, 2 monosialoglycopeptides and 1 disialoglycopeptide. The structures have been elucidated predominantly by one and two-dimensional NMR spectroscopy, enzymatic degradation and FAB mass spectrometry.

The accumulation of these compounds in uremic sera may be of particular interest as they may interact in the molecular biology of diseases typically associated with the uremic state, e.g., immune deficiency, neurological disorders, receptor binding abnormalities, complement system disturbances and cell membrane alterations.

Short Time Dialysis with Continuous Blood Volume Control

Continuous measurement of haemoglobin concentration is used to control changes of blood volume during haemodialysis. Ultrafiltration is either kept constant throughout the session or after starting with a rate (1.5 to 2 l/h), is manually controlled in order to limit blood volume reduction to a preset percentage. Ultrafiltration is step-wise decreased (a) or switched on and off (b) accordingly. Blood volume decrease with constant ultrafiltration is compared with method (a) and (b) in 4 stable haemodialysis patients. Constant ultrafiltration rate and the same total amount of ultrafiltrate causes a nearly 3% (mean) greater volume reduction as compared with method (a) and (b). No difference was observed in blood pressure and heart rate. We conclude that ultrafiltration in stable haemodialysis patients can be completed in short time without consequences for cardiovascular stability.