AB0313 CLINICAL FEATURE OF 100 CASES OF METHOTREXATE ASSOCIATED LYMPHOPROLIFERATIVE DISORDERS WITH RA PATIENT

Background

Lymphoproliferative disorders (LPDs), including malignant lymphoma, are known to occur in RA patients treated with disease modified antirheumatic drugs (DMARDs). In particular, LPD associated with methotrexate (MTX)-treated RA is often referred to as MTX-associated LPD (MTX-LPD). MTX-LPD have various clinical feature and histological findings1). We have accumulated MTX-LPD cases in patients with rheumatoid arthritis (MTX-RA-LPD).

Objectives

We clarified the clinical characteristics of MTX-RA-LPD. In addition, we examine the prognosis of MTX-LPD in RA patients.

Methods

We enrolled 100 RA patients who diagnosed MTX-LPD from 2005 to 2021. We collected as follow data based on clinical reports retrospectively; 1) age, 2) gender, 3) duration from RA onset to LPD onset, 4) total dose of MTX, 5) duration of MTX administration, 6) presence of extranodal lesion 7) histological findings, 8) treatment for LPD, 9) 5-year survival rate.

Results

The mean age of 100 MTX-RA-LPD patients (M:F=30:70) were 66.7 ± 10.7 years old, and the duration from RA onset to LPD onset were 25.2 ± 11.0 years. The total dose of MTX and duration of MTX administration were over 2,600mg and over 5 years, respectively. The extranodal lesions were found in 51%, and diffuse large B cell lymphoma was the most common histological findings. Spontaneous regression was observed in 68%. The 5-year survival rate of MTX-RA-LPD was as high as over 85%.

Conclusion

The clinical features of MTX-RA-LPD were similar to those previous reports. Furthermore, we suggested a good prognosis for MTX-RA-LPD.

References

[1]Harigai M. Lymphoproliferative disorders in patients with rheumatoid arthritis in the era of widespread use of methotrexate: A review of the literature and current perspective. Mod Rheumatol. 2018 Jan;28(1):1-8.

Disclosure of Interests

None declared

POS1220 HUMORAL IMMUNE RESPONSE AGAINST BNT162b2 mRNA COVID-19 VACCINE IN JAPANESE RHEUMATIC DISEASE PATIENTS RECEIVING IMMUNOSUPPRESSIVE THERAPY: A MONOCENTRIC STUDY

Background

Patients with immune-mediated inflammatory diseases are inherently susceptible to infections and are at high risk of developing COVID-19. COVID-19 vaccination in patients with rheumatoid and musculoskeletal disease (RMD) is strongly recommended [1]. BNT162b2 is the most used COVID-19 vaccine in Japan. The safety and efficacy of this vaccine has been demonstrated in the general population [2], but patients receiving immunosuppressive therapy were excluded from the study. Although data on the immunogenicity of COVID-19 vaccine in the immunocompromised adult population is rapidly increasing, the immunogenicity of mRNA COVID-19 vaccine in RMD patients receiving medication has been reported in various and still inadequate ways. Furthermore, the immunogenicity of mRNA COVID-19 vaccine may vary depending on the medication. In addition, most of these data were reported from Western countries, and data on Japanese patients with RMD are limited.

Objectives

To investigate serum antibody titre against SARS-CoV-2 spike protein following BNT162b2 vaccination in Japanese RMD patients on various immunomodulatory treatment.

Methods

Two hundred and twelve RMD outpatients undergoing treatment at Kagawa University Hospital and 43 healthy volunteers, who had received two doses of BNT162b2, were included in the study. Serum sample was collected at least 14 days after the second dose. Antibody titer against SARS-CoV-2 spike protein in serum was measured by ELISA (Elecsys Anti-SARS-CoV-2 S RUO). We analyzed the relationship between clinical characteristics, including the type of disease and treatment of RMD, and antibody titer against SARS-CoV-2 spike protein.

Results

The antibody titer against SARS-CoV-2 spike protein in RMD patients was significantly lower than that in healthy subjects. In the analysis with therapeutic agents, the mean antibody titer in RMD patients treated with rituximab (RTX) was much lower than that in healthy controls. Patients treated with baricitinib, azathioprine, mycophenolate mofetil, abatacept, TNF inhibitors, cyclosporine, IL-6 inhibitors, methotrexate (MTX), or glucocorticoids (GC) had only moderately lower antibody titers. Patients treated with tacrolimus, an immunosuppressive drug commonly used for treatment in Japan, showed a slight decrease in antibody titer, but the difference was not significant compared with healthy subjects. IL-17 and IL-23 inhibitors did not impair the humoral response. In addition, the combination of MTX with various immunosuppressive agents reduced titers, although this was not statistically significant.

Conclusion

Many of the immunosuppressants impaired the immunogenicity to BNT162b2 in Japanese RMD patients. The degree of decline of antibody titers differed according to immunosuppressant. MTX potentially impairs the immunogenicity of BNT162b2 also in the case of concomitant use with other immunosuppressant.

References

[1]Curtis JR, et al. American College of Rheumatology Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 3. Arthritis Rheumatol. 2021;73:e60-e75.

[2]Polack FP, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383:2603–15.

Figure 1.

RMD diagnosis of study patients, n

Table 1.

Serum antibody titre against SARS-CoV-2 spike protein according to the use of immunosuppressive treatments in comparison with controls

Immunosuppressive treatments, nSerum antibody titre, mean±SD, U/mLP valueControl, n=43939 ± 973-Patients with RMD, n=212572 ± 9500.023Without immunosuppressant, n=271074 ± 7580.485IL-17 or IL-23 inhibitors, n=71653 ± 24710.035Tacrolimus, n=32614 ± 9200.095GC, n=103481 ± 9270.009MTX, n=78310 ± 493<0.001IL-6 inhibitors, n=10303 ± 2010.030Cyclosporine, n=8261 ± 2280.035TNF inhibitors, n=26201 ± 252<0.001Abatacept, n=10186 ± 3200.010Mycophenolate mofetil, n=11183 ± 3570.007Azathioprine, n=13150 ± 1590.003Baricitinib, n=6101 ± 970.021RTX, n=620 ± 320.012

Disclosure of Interests

None declared

POS1362 THE EFFICACY AND CYTOKINE PROFILES DURING TREATMENT WITH APREMILAST IN PATIENTS WITH BEHÇET ‘S DISEASE

Background

Apremilast has been shown to be effective in patients with Behçet’s disease (BD) in domains other than oral ulcers; however, its long-term efficacy is yet to be determined. Although serum cytokine modulation by increasing intracellular cAMP levels has been suggested as a mechanism for the efficacy of apremilast on skin areas of psoriasis [1], the relationship between efficacy and cytokine on various domains in BD has not been fully investigated.

Objectives

This study aims to evaluate the long-term clinical efficacy of apremilast in BD and its effect on serum cytokines.

Methods

In this study, patients with BD who received apremilast for active oral ulcers were included. For 12 months, the improvement rates of oral and genital ulcers, skin lesions, and arthritis were assessed every three months. Serum levels of cytokines, including interferon-gamma (IFN-γ), interleukin 10 (IL-10), and IL-17A were determined using Simple Plex (Protein Simple, CA, USA) at baseline and three months after apremilast treatment. Other cytokines, including tumor necrosis factor-alpha (TNF-a), IL-6, IL-8, and IL-23, were also measured in serum using a multiplex immunoassay (Luminex Assay, R&D Systems).

Results

Fifteen patients were included in this study. Table 1 shows the characteristics of the patients who participated in this study. Oral ulcers disappeared in 66.7% and 92.3% of the patients after 3 and 6 months of apremilast treatment, respectively. Genital ulcers disappeared in all patients after 6 months of apremilast treatment and were maintained for 12 months. The efficacy of apremilast in oral ulcers could be divided between two groups: 8 patients in the oral ulcer remission group (OU-R group) whose oral ulcers completely disappeared after 3 months of apremilast administration and persisted for 1 year, and 7 patients in the oral ulcer non-remission group (OU-NR group) whose oral ulcers persisted after 3 months of apremilast treatment. Genital ulcers improved more rapidly in the OU-R group than in the OU-NR group, and completely disappeared within 3 months. Skin and joint lesions generally improved after 6 months, but recurred after 9 months.

Table 1.

Baseline characteristics of the studied patients with Behçet’s disease

CharacteristicsN = 15Age (years), mean ± SD46.7 ± 13.0Sex (female), n (%)11 (73.3)Disease duration (years), mean ± SD10.4 ± 8.8Active Behçet’s disease manifestation at the time of enrollment, n (%) Oral ulcer15 (100) Genital ulcer5 (33.3) Skin lesion (erythema nodosum or pustules)10 (66.7) Arthralgia9 (60.0) Arthritis5 (33.3) Ocular involvement0 (0) Gastrointestinal involvement1 (6.7) Neurological involvement0 (0) Vascular involvement0 (0)

SD, standard deviation; n, number.

Serum cytokines could be analyzed in seven of the 15 cases. There was no significant association between serum baseline cytokine levels and the presence of lesions or severity of disease. Compared to baseline, TNF-α and IL-23 levels were significantly lower after apremilast treatment and IFN-γ levels were trending upwards; however, IL-6, IL-8, and IL-10 levels showed no constant trend (TNF-α and IL-23: p <0.05, IFN-γ: p = 0.078). In addition, the rate of decrease in serum IL-6, IL-10, and IL-23 levels was significantly greater in the OU-R group than in the OU-NR group (Figure 1). However, the rate of change in serum cytokines was not associated with efficacy of apremilast for skin lesions, arthralgia, or arthritis.

Figure 1.

The rate of change in serum interleukin (IL)-6, IL-10, and IL-23 levels up to 3 months after apremilast treatment in the oral ulcer remission group and the oral ulcer non-remission group.

Conclusion

Apremilast has shown long-term efficacy in the treatment of oral and genital ulcers in patients with BD. The efficacy of apremilast against oral ulcers in BD may be attributed to its modulatory effect on serum cytokines as previously reported. Future exploratory studies for biomarkers associated with the presence of efficacy against genital ulcer and arthritis are needed.

References

[1]Gottlieb AB, Matheson RT, Menter AM, et al. J Drugs Dermatol. 2013;12:888-97.

Disclosure of Interests

None declared

AB0442 EVEN IN SYSTEMIC LUPUS ERYTHEMATOSUS THAT HAS ACHIEVED SUSTAINED LLDAS, ADDITIONAL ADMINISTRATION OF HYDROXYCHLOROQUINE SHOULD BE CONSIDERED

Background

Hydroxychloroquine (HCQ) therapy is recommended as a baseline treatment for all patients with systemic lupus erythematosus (SLE) due to its various benefits (1). However, it is not clear to what extent HCQ contributes to improvement in SLE patients with stable disease activity. It has also been reported that HCQ is effective in improving the prognosis of life caused by atherosclerotic lesions in SLE, but the mechanism of this effect has not been fully elucidated.

Objectives

The purpose of this study was to determine the benefit of additional HCQ administration in SLE with controlled disease activity, who achieved the sustained LLDAS.

Methods

The study included patients with SLE who started additional HCQ treatment between January 2016 and December 2019 at our institution, those who sustained LLDAS achievement for at least 3 months prior to starting HCQ treatment. These patients did not change their immunosuppressant and glucocorticoid regimens for more than three months after starting HCQ. The effect of HCQ was assessed at the beginning and 3 months after administration. The disease activity was measured by SELENA-SLEDAI, SLE-DAS, and immunoserological parameters including serum complement levels and anti-DNA antibodies. The factors that are known to associated with pathogenesis of atherosclerosis, such as serum TNF-α, IL-6, IL-8, MCP-1, adiponectin, leptin, resistin, S100A8, and S100A9, were measured by ELISA.

Results

Of the 110 SLE patients who received additional HCQ at our institution, 27 patients who had achieved LLDAS from at least 3 months prior to HCQ administration were included in this study. Patient characteristics are represented in Table 1. SLEDAI scores, SLE-DAS scores and serum anti-dsDNA antibodies were observed to be significantly reduced after HCQ treatment compared to baseline. After 3 months of HCQ treatment, serum lipid markers such as triglyceride (TG), low-density lipoprotein (LDL) cholesterol and atherosclerotic index, which are associated with the development of atherosclerosis, were significantly reduced compared to baseline (TG, LDL and atherosclerotic index: p<0.05). Cytokines such as TNF-α, IL-6, MCP-1, S100A8, S100A9, leptin, and resistin were found to be significantly decreased, and serum adiponectin was significantly increased. (TNF-α, IL-6, MCP-1, leptin: p < 0.05. S100A8, S100A9, adiponectin, resistin: p < 0.0001, Figure 1).

Table 1.

Characteristics of patients with SLE enrolled in this study.

CharacteristicsN = 27Female, no. (%)24 (88.9)Age, years, mean ± SD44.4 ± 11.6Disease duration, years, mean ± SD18.3 ± 12.2BMI, mean ± SD21.9 ± 3.0Concomitant immunosuppressive treatmentsPrednisone, no. (%)n = 23Median dosage, mg/day#5 (3.0–5.0)Triglyceride, mg/dL#102 (73–149)High-density lipoprotein cholesterol, mg/dL#59 (43–66.5)Low-density lipoprotein cholesterol, mg/dL#108 (96–122)Arteriosclerotic index#2 (1.7–2.5)Disease activitySLEDAI score#4 (2–4)SLE-DAS score#2.076 (1.12–3.50)Anti-dsDNA antibody, IU/ml#5.2 (5–15.6)dsDNA positive, no. (%)10 (37.0)C3, mg/dL#76 (61–100)C4, mg/dL#14 (10–22)CH50, U/mL#34.1 (29.7–39.6)

#Nonparametric distributions were represented as median (interquartile range). Anti-dsDNA positive means that anti-dsDNA titer increases to >12 IU/mL.

Figure 1.

Serum cytokine levels before and after hydroxychloroquine treatment

Serum levels of the indicated cytokines and factors were measured at baseline and after 3 months (3M) of treatment with HCQ. The gray lines show the values for individual patients, and the thick red line shows the average value. P-values were determined using the Wilcoxon signed-rank test. A p-value of less than 0.05 was considered statistically significant.

Conclusion

The addition of HCQ medication to SLE patients who achieve the clinical therapeutic goal of LLDAS without HCQ may prevent progression of atherosclerosis in addition to further reducing disease activity.

References

[1]Fanouriakis A, Kostopoulou M, Alunno A, et al. Ann Rheum Dis. 2019;78:736-745.

Disclosure of Interests

None declared

POS0915 MYOSITIS-SPECIFIC AND ASSOCIETED ANTIBODIES, ESPECIALLY ANTI-ARS ANTIBODIES AND ANTI-Ro52 ANTIBODY MAY PREDICT THE CHARACTERISTICS AND FIBROSING PROGRESS OF INTERSTITIAL LUNG DISEASE WITH DERMATOMYOSITIS / POLYMYOSITIS

Background

Myositis-associated antibodies (MAA) and myositis-specific antibodies (MSA) have been associated with clinical manifestations of dermatomyositis and polyneuropathy, including interstitial lung disease (ILD), myopathy, malignancy, arthritis, and skin rashes. Among them, anti-ARS and anti-MDA5 antibodies are strongly associated with complications of ILD that are associated with life expectancy. It has been reported that anti-Ro52 antibody affects severity of myositis and ILD. (1) Based on these findings, it is possible that autoantibodies possessing features of ILD associated with dermatomyositis and polymyositis may be predictive.

Objectives

The purpose of this study is to clarify the relationship between MSA/MAA and clinical features of ILD complicated by dermatomyositis and polymyositis.

Methods

We retrospectively analyzed IIMs patients diagnosed according to Peter & Bohan’s diagnostic criteria in our hospital from 2011 to 2018. The presence of 14 MSA / MAA (Jo1, PL12, PL7, EJ, OJ, KS, Mi2, MDA5, TIF1γ, SRP, PM-Scl70, 100, Ku, Ro52) was measured using ELISA (MESACUP, MBL, Japan) and line blot (EUROLINE myositis profile3, EUROimmun, Germany). Clinical characteristics, including HRCT imaging findings, were extracted from medical records. HRCT imaging findings were analyzed by multiple radiologists. The association between the extracted clinical features and the MSA / MAA held was analyzed.

Results

Seventy-eight cases of IIM were included in the analysis. The frequency of ILD complications was 53/78 (68%), and 60% of ILD complications were ARS antibody positive. The complication rate of ILD in MDA5- and ARS-positive cases was 100% (3/3 cases) and 94% (32/34 cases), respectively. These MDA5- and ARS-positive patients with ILD had rapidly progressive ILD. One of the three MDA5 antibody-positive RPILD cases died, but none of the four ARS antibody-positive RPILD cases died. However, in patients with multiple MSA or MAA including ARS, three case had rapidly progressive ILD, and none died. n the analysis of the presence of Ro52 antibody, it was detected in 46% (36 cases) of all cases, but in 74% of anti-ARS antibody positive cases.

In the analysis of ILD patterns by radiologists using HRCT, fibrosing NSIP (fNSIP), fibrosing OP (fOP), and UIP were the most frequent in that order. analysis of the association between ILD patterns and MSA / MAA showed that there was no MSA / MAA associated with each ILD pattern. No MSA/MAA was found to be associated with each ILD pattern. ARS antibody-associated ILD, the most common type of ILD, had a worse prognosis than other MSA / MAA positive ILD. Death due to ILD was observed in 5 patients (PL7: 3cases, PL12: 1case, PM-Scl75: 1case). Oxygen was required for ILD progression in 3 Jo1-positive patients, 1 PL7-positive patients, and 1 PL12-positive patient, respectively. The frequency of UIP, which is considered to have a poor prognosis in other rheumatic diseases, was higher in patients with anti-ARS and anti-Ro52 antibodies.

Conclusion

The prognosis of anti-ARS antibody-positive lLD associated with dermatomyositis and polymyositis was associated with fibrosis by analysis of HRCT patterns, and the prognosis was confirmed to be poor.In addition, the UIP pattern, which is strongly associated with fibrosis, was found to be associated with anti-Ro52 antibody. In the treatment of ILD, which is strongly associated with the prognosis of dermatomyositis and polymyositis, it may be necessary to consider antifibrotic treatment for patients with anti-ARS antibody and anti-Ro52 antibody positivity.

References

[1]Tamara Vojinovic et al. Predictive Features and Clinical Presentation of Interstitial Lung Disease in Inflammatory Myositis. Clinical Reviews in Allergy & Immunology (2021) 60:87–94

Disclosure of Interests

None declared

POS0939 BIMEKIZUMAB IN PATIENTS WITH ACTIVE NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 24-WEEK EFFICACY & SAFETY FROM BE MOBILE 1, A PHASE 3, MULTICENTRE, RANDOMISED, PLACEBO‑CONTROLLED STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. BKZ has shown rapid and sustained efficacy and was well tolerated up to 156 weeks (wks) in a phase 2b study in patients (pts) with active ankylosing spondylitis.1,2

Objectives

To assess efficacy and safety of BKZ vs placebo (PBO) in pts with active non-radiographic axial spondyloarthritis (nr-axSpA) up to Wk 24 in the ongoing pivotal phase 3 study, BE MOBILE 1.

Methods

BE MOBILE 1 (NCT03928704) comprises a 16-wk double-blind, PBO-controlled period and 36-wk maintenance period. Pts were aged ≥18 yrs, had BASDAI ≥4 and spinal pain ≥4 at BL, and sacroiliitis on MRI and/or elevated CRP at screening. Pts were randomised 1:1, BKZ 160 mg Q4W:PBO. From Wk 16, all pts received BKZ 160 mg Q4W. Primary and secondary efficacy endpoints were assessed at Wk 16.

Results

Of 254 randomised pts (BKZ: 128; PBO: 126), 244 (96.1%) completed Wk 16, 240 (94.5%) Wk 24. BL characteristics were comparable between groups: mean age 39.4 yrs, symptom duration 9.0 yrs; 54.3% pts male, 77.6% HLA-B27+, 10.6% TNFi-experienced. At Wk 16, the primary (ASAS40: 47.7% BKZ vs 21.4% PBO; p<0.001) and all ranked secondary endpoints were met (Table 1). Responses were rapid with BKZ, including in PBO pts who switched to BKZ at Wk 16, and increased to Wk 24 (Figure 1; Table 1). Substantial reductions of hs-CRP by Wk 2 and MRI SIJ inflammation by Wk 16 were achieved with BKZ vs PBO (Table 1). At Wk 24, >50% of pts initially randomised to BKZ had achieved ASDAS <2.1 (Figure 1).

Table 1.

Efficacy at Wks 16 and 24

BLWk 16Wk 24PBO N=126BKZ 160 mg Q4W N=128PBO N=126BKZ 160 mg Q4W N=128p valuePBO→BKZ 160 mg Q4W N=126BKZ 160 mg Q4W N=128Ranked endpoints in hierarchical orderASAS40* [NRI] n (%)--27 (21.4)61 (47.7)<0.00159 (46.8)67 (52.3)BASDAI CfB† [MI] mean (SE)6.7 (0.1)6.9 (0.1)–1.5 (0.2)–3.1 (0.2)<0.001–3.2 (0.2)–3.4 (0.2)ASAS20† [NRI] n (%)--48 (38.1)88 (68.8)<0.00187 (69.0)96 (75.0)ASAS PR† [NRI] n (%)--9 (7.1)33 (25.8)<0.00135 (27.8)37 (28.9)ASDAS-MI† [NRI] n (%)--9 (7.1)35 (27.3)<0.00137 (29.4)41 (32.0)ASAS 5/6† [NRI] n (%)--21 (16.7)49 (38.3)<0.00151 (40.5)57 (44.5)BASFI CfB† [MI] mean (SE)5.3 (0.2)5.5 (0.2)–1.0 (0.2)–2.5 (0.2)<0.001–2.3 (0.2)–2.8 (0.2)Nocturnal spinal pain CfB† [MI] mean (SE)6.7 (0.2)6.9 (0.2)–1.7 (0.2)–3.6 (0.3)<0.001–3.5 (0.2)–4.0 (0.3)ASQoL CfB† [MI] mean (SE)9.4 (0.4)9.5 (0.4)–2.5 (0.4)–5.2 (0.4)<0.001–4.8 (0.4)–5.7 (0.4)SF-36 PCS CfB† [MI] mean (SE)33.6 (0.8)33.3 (0.7)5.5 (0.7)9.5 (0.7)<0.00110.1 (0.8)10.6 (0.8)Other endpointsdEnthesitis-free state†a [NRI] n (%)--22 (23.9)b48 (51.1)c-40 (43.5)b45 (47.9)cASAS40 in TNFi-experienced [NRI] n (%)--2 (11.8)e6 (60.0)f---ASDAS-CRP CfB [MI] mean (SE)3.7 (0.1)3.8 (0.1)–0.6 (0.1)–1.5 (0.1)-–1.5 (0.1)–1.6 (0.1)hs-CRP, mg/L [MI] geometric mean (median)5.0 (6.5)4.6 (6.1)3.8 (4.1)2.0 (1.8)-2.3 (2.6)1.9 (1.8)MRI spine Berlin CfBg [OC] mean (SD)1.9 (3.2)h1.6 (2.9)i–0.1 (1.7)j–0.7 (2.2)k---SPARCC MRI SIJ score CfBg [OC] mean (SD)10.5 (13.8)l8.5 (10.3)m–1.5 (9.2)n–6.3 (10.0)o---

Randomised set. *Primary endpoint; †Secondary endpoint; aMASES=0 in pts with BL MASES >0; bn=92; cn=94; dNominal p values not shown; en=17; fn=10; gIn pts in MRI sub-study; hn=65; in=75; jn=58; kn=73; ln=68; mn=79; nn=60; on=77.

Over 16 wks, 80/128 (62.5%) pts had ≥1 TEAE on BKZ vs 71/126 (56.3%) on PBO; most frequent were nasopharyngitis (BKZ: 9.4%; PBO: 4.8%), upper respiratory tract infection (BKZ: 7.0%; PBO: 7.1%) and oral candidiasis (BKZ: 3.1%; PBO: 0%). No systemic candidiasis was observed. Up to 16 wks, incidence of SAEs was low (BKZ: 0.0%; PBO: 0.8%); no MACE or deaths were reported; 0 IBD cases occurred in pts on BKZ vs 1 (0.8%) in a pt on PBO.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in pts with active nr-axSpA resulted in rapid, clinically relevant improvements in efficacy outcomes vs PBO. No new safety signals were observed.1,2

References

[1]van der Heijde D. Ann Rheum Dis 2020;79:595–604;

[2]Gensler L. Arthritis Rheumatol 2021;73(suppl 10):0491.

Acknowledgements

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests

Atul Deodhar Speakers bureau: Janssen, Novartis, and Pfizer, Consultant of: AbbVie, Amgen, Aurinia, BMS, Celgene, Eli Lilly, GSK, Janssen, MoonLake, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, and UCB Pharma, Employee of: Imaging Rheumatology BV (Director), Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB Pharma, Grant/research support from: Novartis, Pfizer and UCB Pharma, Huji Xu: None declared, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, and UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, and UCB Pharma, Hiroaki Dobashi Speakers bureau: BMS, Chugai, Eli Lilly, GSK, MSD, Novartis, Pfizer, UCB Pharma, Walter P Maksymowych Consultant of: AbbVie, Boehringer-Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Janssen, Novartis and Pfizer, Employee of: Chief Medical Officer for CARE Arthritis, Martin Rudwaleit Speakers bureau: AbbVie, BMS, Boehringer Ingelheim, Chugai, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma, Paid instructor for: Janssen, Novartis, and UCB Pharma, Consultant of: AbbVie, Novartis, and UCB Pharma, Marina Magrey Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie and UCB Pharma, Dirk Elewaut Speakers bureau: AbbVie, Eli Lilly, Galapagos, Novartis and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Galapagos, Novartis and UCB Pharma, Marga Oortgiesen Employee of: Employee of UCB Pharma, Carmen Fleurinck Employee of: Employee of UCB Pharma, Alicia Ellis Employee of: Employee of UCB Pharma, Thomas Vaux Employee of: Employee of UCB Pharma, julie smith Employee of: Employee of UCB Pharma, Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma

AB0438 EFFICACY OF BELIMUMAB TREATMENT FOR SYSTEMIC LUPUS ERYTHEMATOSUS AT OUR HOSPITAL

Background

Belimumab (BEL), a monoclonal antibody against the soluble counterpart of B-cell activating factor (BAFF) has been recommended to be added in patients with SLE who do not respond adequately to standard therapy [1]. In addition to antibody production, belimumab may also affect other functions of B cells, such as antigen presentation and excretion of inflammatory cytokines. Belimumab may also have an effect on immune cells other than B cells, as they express BAFF receptors. These facts suggest that BEL administration in SLE may have an effect on various pathological conditions including cytokine production, not just antibody production. However, there are few reports on whether cytokine production is actually related to the efficacy of BEL administration in SLE.

Objectives

The purpose of this study was to determine the efficacy of BEL administration in patients with SLE and its effect on cytokines.

Methods

Patients with SLE who were started on BEL between December 2018 and December 2021 at our institution were included in this study. We retrospectively analyzed the reasons for additional BEL administration, adverse events, disease activity indicators (SLE Disease Activity Index (SLEDAI)-2K, lupus low disease activity state (LLDAS) achievement rate, anti-dsDNA antibody titer, serum complement titer, and treatment agents including glucocorticoid dose. Serum cytokine (interferon-alpha, interleukin (IL)-6, IL-10, and IL-17A) levels were measured using ELISA at the start of BEL administration, 3 months, and 6 months later.

Results

Five cases of SLE were included in the study. Four of the five patients were female, with a mean age of 51.4±9.6 years and a mean duration of disease of 17.4±10.0 years.

The reasons for additional BEL administration were glucocorticoid reduction in five patients, refractory pericarditis in one patient, skin rash and arthritis in two patients, and immunological activity in two patients. Four of the five patients had decreased renal function below eGFR50 at the baseline. Concomitant medications at the time of BEL induction included steroids in five patients (mean prednisolone dose 12.2±12.2 mg/day), hydroxychloroquine in three patients, mycophenolate mofetil in three patients, tacrolimus in one patient, and methotrexate in one patient. The mean disease activity before the introduction of BEL was SLEDAI 4±4, and LLDAS was achieved in three patients.

Twelve weeks after the start of BEL treatment, two patients had improved SLEDAI, including one patient who achieved LLDAS.

Immunological activity parameters improved in one of the two patients.

However, two patients flared after BEL administration and were treated with increased glucocorticoid doses.

One patient with SLE on hemodialysis had thrombocytopenia, an adverse event that may have been related to belimumab treatment.

Conclusion

At our institution, BEL was additionally administered to SLE patients with refractory disease and was effective; with the exception of one case. Serum cytokine analysis before and after BEL treatment will be included in the discussion.

References

[1]Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann. Rheum. Dis. 2019;78:736–745.

[2]Parodis I, Åkerström E, Sjöwall C, et al. Autoantibody and Cytokine Profiles during Treatment with Belimumab in Patients with Systemic Lupus Erythematosus. Int J Mol Sci. 2020;21:3463.

Disclosure of Interests

None declared

AB0397 DISEASE ACTIVITY OF RHEUMATOID ARTHRITIS WERE SIGNIFICANTLY DECREASED BY SWITCHING JAK INHIBITOR TO ANOTHER JAK INHIBITOR

Background

With the availability of multiple Jak inhibitors (JAKi) for treatment, patients with RA who have had inadequate response to conventional therapies, including biologics, can now achieve favorable outcomes such as remission and low disease activity.

However, it is also true that no single JAKi therapy is effective for all RA.

Some RA treatment guidelines recommend a switch strategy from current JAKi to other JAKi or biologics in patients with inadequate response to JAKi therapy [1].

There is insufficient evidence to support the efficacy of switching to another JAKi in patients with inadequate JAKi response (JAKi-IR).

Objectives

The aim of this study is to clarify the effectiveness of the strategy of controlling disease activity by switching to other JAKi in RA cases with JAKi-IR and to analyze the effect on serum cytokines related to the pathogenesis of RA.

Methods

RA patients who switched to other JAKi during treatment with JAKi between September 2017 and January 2022 were included in this retrospective study.

The clinical characteristics of the included RA patients were collected from their medical records.

The efficacy of the JAKi switch strategy was assessed by changes in composite measure scores of disease activity, including DAS28-CRP, SDAI, and CDAI, at 4 and 12 weeks after the switch.

In addition, changes of serum cytokines associated with RA pathogenesis (IL-6, TNF-α) were measured and analyzed by ELISA (Simple Plex, Protein Simple).

Results

Twenty-nine RA patients who received the JAKi switch treatment strategy were included in the analysis. The clinical characteristics of the included patients are shown in Table 1. All patients were receiving JAKi due to inadequate response to biologics. JAKi were switched to control disease activity including 3 cases (10%) who achieved temporary remission.

Table 1.

Baseline characteristics of the 29 patients enrolled this study

Clinical characteristicsn=29Age57 [48.0-66.0]Sex (F/M)22/7 (75.9)Disease duration, years13 [8.6-18.8]RF positive26 (89.7)ACPA positive, (n=22)20(90.0)Concomitant medicationsMethotrexate, dose(mg/week)10 (34.5), 8.0 [6.0-10.5]Corticosteroid, dose(mg/day)17 (59.0), 4.0 [2.0-5.0]Disease activity  DAS28-CRP3.77 [3.2-4.6]  SDAI15.5 [9.8-21.1]  CDAI14.5 [9.5-20.0]Patient global assessment of disease activity (mm)40 [25-58]Provider global assessment of disease activity (mm)32 [15-40]CRP (mg/dl)0.9 [0.1-1.7]TJC/SJC4 [2-5], 2[2-5]Date are n (%) or median [IQR].

Figure 1 shows the effect of the JAKi switch strategy on the disease activity category.

Evaluation using SDAI showed that 65% of patients achieved the immediate treatment goal of low disease activity at 4 weeks after switch, and 69% of patients maintained this goal at 12 weeks. SDAI remission was also observed in 17% of patients at 4 weeks and 31% at 12 weeks, demonstrating the efficacy of the JAKi switch strategy. The efficacy of the JAKi switch strategy was also observed in other measures of disease activity.

Changes in serum cytokines (IL-6, TNF-α) associated with disease activity in RA before and after JAKi switch were analyzed in 10 patients. Regardless of the type of JAKi, serum IL-6 was decreased by JAKi switch in most cases at 12weeks (average change of serum IL-6: -27.25pg/ml).

However, no trend was observed for changes in serum TNF- disease acti（average change of serum TNF-ed for change）.

There was no clear association between changes in these two cytokines and the efficacy of the JAKi switch strategy.

Conclusion

The composite disease activity index showed that about 60% of JAKi-IR patients achieved low disease activity, one of the treatment goals, at 4 weeks after switching to JAKi, and the effect was maintained up to 12 weeks. This effect did not appear to be related to the type of JAKi.

The effects of biologic therapy on serum cytokines associated with RA activity differed from the effects of the JAKi switch strategy.

References

[1]György Nagy, et al. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases 2022;81:20-33.

Disclosure of Interests

None declared

AB0689 Clinical courses and pregnancy outcomes of eight cases complicated with Polymyositis/Dermatomyositis (PM/DM) in single center

Background

Pregnancies complicated by a number of rheumatic diseases are known to be at high risk for the occurrence of adverse pregnancy outcomes (APOs). There have been several reports on the risk of APOs in systemic lupus erythematosus and rheumatoid arthritis, but few reports on polymyositis (PM)/dermatomyositis (DM) pregnancies. There are also insufficient reports on changes in the activity of PM/DM during pregnancy. Based on the findings reported in other rheumatic diseases, it is suggested that increased activity during pregnancy is associated with APOs in PM/DM (1-3).

However, the risk factors for pregnancy outcome in pregnancies complicated by PM/DM, including the presence or absence of worsening of disease activity, have not been clarified.

Objectives

The purpose of this study was to analyze a case series of PM/DM complicated pregnancies in a single center to determine the changes in disease activity during pregnancy and pregnancy outcomes.

Methods

PM/DM patients who were managed from pregnancy to delivery at Kagawa University Hospital from March 2006 to May 2021 were included in this study. Clinical indices including duration of illness, disease activity, and treatment were extracted from medical records and retrospectively analyzed for association with pregnancy outcome.

Results

Eight PM/DM pregnancies were included in the analysis. The mean age at delivery was 28.3±3.8 years and the mean duration of disease was 6.3±3.2 years.

Treatment at the time of pregnancy included glucocorticoids (GC) in 7 cases and immunosuppressive drugs in 5 cases.

Creatinine phosphokinase (CK) levels were normal in all patients at the time of pregnancy, but increased during pregnancy in 4 (50%) patients. These 4 patients with elevated CK required treatment with increasing doses of GC, and the mean GC dose during pregnancy was 10.9 ± 6.0 mg/day.

Table 1 shows the pregnancy outcomes of the 8 patients. There was one spontaneous abortion and seven live births. Among the live births, 2 were preterm and 4 were low birth weight. The mean gestational age at delivery was 35.3±5.2 weeks and the mean birth weight was 2297.7±1041.4g.

Table 1.

Pregnancy outcomes of eight cases

Case no.OutcomeMode of deliveryGestational age at delivery (weeks)Birth weight of the newborn (grams)Adverse pregnancy outcomes1Live birthCesarean section26590Preterm birth, LFD, HELLP syndrome2Spontaneous abortion3Live birthTransvaginal delivery301,299Preterm birth, LBW4Live birthCesarean section382,765Hypertensive disorder5Live birthTransvaginal delivery373,290−6Live birthTransvaginal delivery372,492LBW7Live birthTransvaginal delivery393,456−8Live birthTransvaginal delivery402,192LBW7 live births 1 abortion35.3±5.22,297.7±1,041.4

The birth outcomes of the 2 patients who received continuous immunosuppressive therapy were full-term and normal weight infants. APOs, such as preterm delivery and low birth weight, occurred in cases with increased CK levels and increased GC doses.

Conclusion

In pregnancies of PM/DM patients, pregnancy outcome was less than favorable.

An association between disease activity and the development of APOs during pregnancy in PM/DM was suggested. An association was also suggested between GC dose and the risk of developing APOs.

As in other rheumatic disease pregnancies, continued use of pregnancy-appropriate immunosuppressive drugs and control of disease activity with lower glucocorticoid doses in PM/DM pregnancies may be important to achieve good pregnancy outcomes.

References

[1]Nagy-Vincze M, Vencovsky J, Lundberg IE, Danko K (2014) Pregnancy outcome in idiopathic inflammatory myopathy patients in a multicenter study. J Rheumatol 41:2492-2494.

[2]Zhong Z, Lin F, Yang J, Zhang F, Zeng X, You X (2017) Pregnancy in polymyositis or dermatomyositis: retrospective results from tertiary centre in China. Rheumatology (Oxford) 56:1272-1275.

[3]Kolstad KD, Fiorentino D, Li S, Chakravarty EF, Chung L (2018) Pregnancy outcomes in adult patients with dermatomyositis and polymyositis. Semin Arthritis Rheum 47:865-869.

Disclosure of Interests

None declared

AB0497 IMMUNOLOGICAL DISEASE ACTIVITY PARAMETERS AT CONCEPTION ARE RISK FACTORS FOR PRETERM BIRTH AND LOW BIRTH WEIGHT IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background

Women with systemic lupus erythematosus (SLE) are known to have more difficulty in achieving a successful pregnancy than healthy women. They have a higher risk for adverse pregnancy outcomes (APOs) including preterm birth (PB), low birth weight (LBW). (1,2). Many reports revealed that these APOs are related to uncontrolled high disease activity (3,4). Therefore, it is important for SLE women who hope to conceive to control disease activity strictly. However, it is not clear to what extent disease activity should be strictly controlled, including serum parameters such as complement levels and anti-dsDNA antibodies.

Objectives

The purpose of this study was to determine whether disease activity parameters at conception could be a risk factor for PB or LBW among APOs in patients with SLE.

Methods

Disease activity parameters including SLEDAI score, LLDAS achievement rate, serum complement levels (C3, C4, CH50), and anti-dsDNA antibody titer were retrospectively collected from medical records. We then collected information related to each APOs (PB and LBW), and analyzed the association with disease activity parameters.

Results

The subjects were 60 pregnancies of 45 patients. As for a comprehensive disease activity index at conception, SLEDAI score or the rate of LLDAS achievement became risk factors for PB (both of p<0.01, Table 1), and SLEDAI score was also a risk factor for LBW (P=0.04, Table 1). Analysis of immunological disease activity parameters showed that low C3 or high titer of anti-dsDNA antibody were risk factors for PB (P=0.03 and 0.01, respectively, Table 1). In the logistic regression analysis of PB, the cut-off levels of C3 and anti-dsDNA antibody were 62 mg/dl and 5.4 IU/ml, respectively (Figure 1 [1]-A, [1]-D). The risk of PB was significantly higher in the cases with low serum C3 and high anti-dsDNA antibody titer at conception (P=0.02).Similarly, low C3 or CH50 were risk factors for LBW (P=0.02 and 0.03, respectively, Table 1). Logistic regression analysis for LBW showed the cut-off level of C3 as 87 mg/dl, and CH50 as 41.8 IU/ml (Figure 1 [2]-A, [2]-C). Cases with low C3 and low CH50 were at higher risk for LBW (P=0.03).

Table 1.

Association between disease activity parameters and PB or LBW

Preterm birth (PB)Low birth weight (LBW)PB (+)(n = 14)PB (-)(n = 46)P valueLBW (+)(n = 23)LBW (-)(n = 37)P value Achievement of LLDAS, n (%)##5 (41.7)30 (71.4)0.0912 (63.2)23 (65.7)1.00 Achievement of LLDAS without a glucocorticoid dose, n (%)##5 (41.7)37 (88.1)< 0.01*13 (68.4)29 (82.9)0.31 SLEDAI score#3.5±2.91.1±1.3<0.01*2.3±2.11.3±2.00.04* C3, mg/dl#77.3±19.094.7±21.20.03*80.5±16.396.7±22.70.02* C4, mg/dl#16.1±9.019.2±6.30.1617.6±6.319.1±7.40.56 CH50, IU/ml#37.3±10.641.1±8.50.1736.5±6.642.2±9.70.03* Anti-dsDNA antibody, IU/ml#32.5±68.55.5±11.10.01*20.7±55.87.0±12.20.34

(Values are presented as mean ± standard deviation or number (%). #Wilcoxon rank sum test; ##Fisher’s exact test; *P < 0.05.)

Figure 1.

Logistic regression analysis of cut-off value of PB and LBW for C3, C4, CH50 and anti-dsDNA antibody.

(ROC curves based on logistic regression analysis of cut-off levels for disease activity parameters, including C3, C4, CH50, and anti-dsDNA antibody titer. [1] showed ROC curves for PB, and [2] showed those for LBW.)

Conclusion

We revealed that disease activity parameters of SLE at coception are strongly associated with negative pregnancy outcomes; PB and LBW. These include low serum C3 and CH50 levels and high anti-dsDNA antibody titers. In particular, low serum complement is a risk factor for both PB and LBW. Therefore, it is important to strictly control these disease activity parameters at conception in women with SLE.

References

[1]Clowse ME, Jamison M, Myers E, James AH. Am J Obstet Gynecol. 2008;199:127.e1-6.

[2]Bundhun PK, Soogund MZ, Huang F. J Autoimmun. 2017;79:17-27.

[3]Deguchi M, Maesawa Y, Kubota S, Morizane M, Tanimura K, Ebina Y, et al. J Reprod Immunol. 2018;125:39-44.

[4]Clowse ME, Magder LS, Petri M. J Rheumatol. 2011;38:1012-6.

Disclosure of Interests

None declared

Comparison of adherence tendencies of pesticide residues sprayed on small-, medium-, and large-sized tomatoes

Crop field trials were conducted to investigate the residues of sprayed pesticides on the different sizes of tomatoes. Pesticide residue data in tomatoes varied due to different locations of the three crop fields selected and/or physicochemical properties of the three pesticides tested. The pesticide residue levels in the medium- and small-sized tomatoes were 1.5 and 2.4 times higher than the level in large-sized tomatoes under similar spray conditions, whereas amount of pesticides adhered per unit surface area were approximately equal among all three sizes of tomatoes. The results of this study suggested that the differences in pesticide residue levels were due to differences in the degree of specific surface area of each tomato size. Resultant residue data of medium-sized tomatoes demonstrated a proportional relationship between pesticide residue levels and the specific surface area of tomatoes.

POS1358 THE EFFECTS AND SAFETY OF APREMILAST AND CYTOKINE EXPRESSION IN BEHCET’S DISEASE PATIENTS

Background:

Apremilast, the small-molecule phosphodiesterase (PDE) -4 inhibitor, was approved for the treatment of recurrent oral ulcers associated with Behcet’s disease (BD) in Japan from September 2019, following the success of the phase 3 RELIEF study (1). However, the efficacy of apremilast on domains other than oral ulcers in BD patients is unclear. On the other hand, it has been reported that apremilast may decrease the production of proinflammatory cytokine and increase the production of anti-inflammatory mediators in psoriasis (PS) and psoriatic arthritis (PsA) (2).

Objectives:

To evaluate the effects and safty of apremilast on clinical symptoms and the changing of serum cytokine expression.

Methods:

BD patients who had treated with apremilast for active oral ulcers were included in the study. We investigated the improvement rate of oral and genital ulcers, skin lesions, arthritis. In addition, serum cytokines (IFN-γ, IL-10, IL-8, and TNF-α) before and after apremilast treatment were measured using a multiplex immunoassay (Luminex Assay, R&D Systems).

Results:

Fourteen patients (3 males and 11 females) were enrolled in this study. The mean age was 46.6 ± 13.0 years and the mean duration of disease was 10.2 ± 8.8 years. All patients had active oral ulcers, five had genital ulcers, six had skin lesions, and four had arthritis. Three months after the treatment with apremilast, oral ulcers improved in 13 patients (92.9%). The improvement rates of genital ulcers, skin lesions and arthritis were 60%, 25% and 25%, respectively. Changes in serum cytokines were different from those previously reported in PS. Adverse events were gastrointestinal symptoms such as nausea and diarrhea in 6 patients and sensorineural deafness in 1 patient. Medication was reduced in 2 patients, and discontinued in 1 patient due to nausea and diarrhea.

Conclusion:

Apremilast is useful not only for oral ulcers, but also for other lesions in BD patients. The effect of apremilast for other domain such as genital ulcers, skin lesions, arthritis was not comparable to that of active oral ulcers. Additionally, BD may have different cytokine profile from PS and PsA.

References:

[1]Hatemi G, Mahr A, Ishigatsubo Y, et al. Trial of Apremilast for Oral Ulcers in Behcet’s Syndrome. N Engl J Med. 2019;381(20):1918-28

[2]Schafer P. Apremilast mechanism of action and application to psoriasis and psoriatic arthritis. Biochem Pharmacol. 2012;83(12):1583-1590

Disclosure of Interests:

None declared

POS0556 USEFULNESS OF FDG-PET/CT FOR PREDICTING SPONTANEOUS REGRESSION IN MTX ASSOCIATED LYMPHOPROLIFERATIVE DISORDER WITH RHEUMATOID ARTHRITIS

Background:

Recently, there are many reports from Japan about methotrexate associated lymphoproliferative disorder (MTX-LPD). We are investigating the predictive factor of spontaneous regression (SR) in MTX-LPD. On the other hand, FDG-PET/CT is used for diagnosis of LPD including malignant lymphoma. In addition, it was reported that imaging biomarkers such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) could predict the prognosis of malignant tumor (1, 2). However, there is no report that these imaging biomarkers could predict the SR of MTX-LPD.

Objectives:

We investigate the usefulness of FDG-PET/CT for predictive factor of SR in MTX-LPD.

Methods:

We enrolled 24 RA patients who diagnosed MTX-LPD and performed FDG-PET/CT from 2005 to 2019. We divided these cases into spontaneous regression cases (SR group; 15 cases) and cases that treated with chemotherapy after MTX discontinuation (CTx group; 9 cases), and compared the difference as follow subjects between two groups; clinical data including histopathological findings, SUVmax to evaluate malignant tumor activity by FDG-PET/CT, MTV and TLG which refer to metabolically active volume of the tumor segmented FDG-PET/CT. In addition, we analyzed cut off levels, sensitivity and specificity using statistical software JMP.

Results:

Diffuse large B cell lymphoma (DLBCL) and Hodgkin lymphoma (HL) were 5 and 1 cases in SR group, and 1 and 5 cases in CTx group. In addition, MTV and TLG by FDG-PET/CT was significantly lower in SR group, although SUVmax is no difference between two groups (figure 1). Cut off levels of MTV and TLG were 103.12 ml (sensitivity; 88.9%, specificity; 86.7%) and 361.75 ml (sensitivity; 88.9%, specificity; 86.7%), respectively.

Conclusion:

We suggested that MTV and TLG were useful for predict of SR in MTX-LPD.

References:

[1]Chen HH, Chiu NT, Su WC. et al. Prognostic value of whole-body total lesion glycolysis at pretreatment FDG PET/CT in non-small cell lung cancer. Radiology. 2012 Aug;264(2):559-66.

[2]Chu KP, Murphy JD, La TH. et al. Prognostic value of metabolic tumor volume and velocity in predicting head-and-neck cancer outcomes. Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1521-7.

Figure 1.

Comparison of the level of MTV(a) and TLG (b).

Disclosure of Interests:

None declared

AB0443 BIOMARKER SUCH AS IL-17, IL-21 AND TIMP-1, IS USEFUL FOR PREDICTING THE PATHOPHYSIOLOGY OF CONNECTIVE TISSUE DISEASE-ASSOCIATED PULMONARY HYPERTENSION

Background:

Connective tissue disease-associated pulmonary hypertension (CTD-PH) is constructed by a variety of pathologies, including cardiac, pulmonary, and vascular involvement, as well as immune abnormalities. Because of its various constructs, it is difficult for many respiratory physicians, cardiologists, and rheumatologists to determine a treatment strategy for CTD-PH. In addition, CTD-PH has different pathologies from iPAH, and there are cases in which immunosuppressive therapy is effective. These suggests that the two PAHs may have different pathogenesis, including inflammation in the pulmonary artery. However, there are not enough biomarkers to distinguish pathologies. On the other hand, it has been reported that various cytokines such as TIMP-1, Interleukin (IL)-6, IL-17, and IL-21 are involved in the pathogenesis of CTD-PH or vasculitis. (1,2) However, the relationship between these cytokine expression and the pathogenesis or treatment of CTD-PH has not been fully clarified.

Objectives:

To clarify the relationship between cytokine profile and clinical features, change in cytokines and hemodynamics by treatment, association with the effectiveness of immunosuppressive therapy.

Methods:

Patients suspected PH was included. At the time of cardiac catheterization(RHC), sera in pulmonary pre and post-capillary were collected and TIMP-1, MCP-1, IL-17 and IL-21, IL-12p70 and IL-6 were analyzed by ELISA(ABCAM UK, Ella simple plex USA). The following clinical data were collected: age, gender, underlying disease, complication of interstitial lung disease, treatment (immunosuppressant and pulmonary vasodilator), hemodynamics. Furthermore, we investigated the relationship between cytokines and clinical data.

Results:

15 cases of CTD-PH, 13 cases of non-CTD-PH, and 6 cases of non-PH were analyzed. (SSc 12 cases, MCTD 7cases, SLE 2 cases, and others 13 cases) 28 cases were diagnosed with PH by RHC. There was a positive correlation between IL-6 and mean pulmonary arterial pressure in all PH case. In addition, MCP-1, IL-6, and TIMP-1 tend to be high in SSc-PH cases. On the other hand, in Non-SSc-PH, IL-12p70 and IL-17 were high. In cases who pulmonary vascular hemodynamics improved by treatment, IL-17, IL-21, and TIMP-1 decreased.

Conclusion:

Biomarker profiles in pulmonary capillaries may differ depending on the disease. Furthermore, it suggested that IL-17, IL-21 and TIMP-1 may be biomarkers of therapeutic effect.

References:

[1]Hashimoto-Kataoka T. et al. Proc Natl Acad Sci U S A. 2015 May 19;112(20):E2677-86.

[2]Jun Ishizaki et al. Arthritis Res Ther. 2017 Sep 29;19(1):218.

Disclosure of Interests:

None declared.

POS0336 PATTERNS OF LARGE-VESSEL LESIONS AND POOR TREATMENT OUTCOMES IN PATIENTS WITH LARGE-VESSEL GIANT CELL ARTERITIS

Background:

Giant cell arteritis (GCA) is characterized by cranial symptoms and large-vessel lesions (LVL) in the aorta or its branches. We retrospectively analyzed the Japanese patients newly diagnosed as GCA between 2007 and 2014, and subsequently treated with glucocorticoid (GC). The imaging studies revealed that LVLs were observed in approximately half of the GCA patients, and the LVLs were significantly associated with the increased probability of poor treatment outcomes (1).

Objectives:

The objective of this study is to evaluate whether the distribution of LVLs of GCA was associated with poor treatment response.

Methods:

In a retrospective, multi-centric, nationwide registry of GCA patients treated with GCs between 2007 and 2014, 68 newly-diagnosed GCA with LVLs by imaging were detected. All investigators were members of Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS). Poor treatment outcomes (non-achievement of clinical remission by week 24 or relapse during 104 weeks) were primarily evaluated. Cumulative rates and median time to the first event were analyzed by the Kaplan-Meier method and the log-rank test. Associated factors with the outcomes were analyzed by using the Cox proportional hazard model.

Results:

The mean age was 70.5 years, and 70.6% were women. Twenty-seven (39.7%) of the 68 patients were diagnosed as having GCA by both positive temporal artery biopsy and positive imaging, and 41 (60.3%) by positive imaging. Aortic lesions were detected in 72.1% (group 2, n=49) of the 68 GCA patients with LVLs. Patients without aortic lesions were categorized into two phenotypes: large-vessel GCA with subclavian lesions (group 1, n=9) and atypical large-vessel GCA without subclavian lesions (group 3, n=10). Cranial lesions were observed in 66.7%, 55.1%, and 80.0% in the group 1, 2, and 3, respectively. The initial mean dose (SD) of prednisolone was 0.74 (0.26) mg/kg/day, and 20.6 % received methotrexate for remission induction therapy. Baseline dose of GCs and mean time to achievement of low-dose GCs (prednisolone ≤ 5 mg/day) was not significantly different among the three groups.

Overall, 35 (51.5%) of the 68 patients had the event of poor treatment outcomes. Eleven patients were not able to achieve clinical remission by week 24. Relapse after achievement of clinical remission was reported in total of 24 patients; 9 between week 0 and 24, 12 between week 24 and 52, 3 between week 52 and 104. The cumulative rate of events of poor treatment outcomes over the two years was 11.1% in patients with group 1, 55.3% in those with group 2, and 88.0% in those with group 3. Mean time to events was significantly different among the three groups. Multivariable analysis showed the risk of poor treatment outcomes was likely to decrease in the group 1 (hazard ratio 0.14 [95% CI 0.02-1.03], p=0.054), while it increased in the group 3 (hazard ratio 2.22 [95% CI 1.06-4.68], p=0.035).

Conclusion:

The distribution of LVLs were associated with poorer treatment outcomes. A half of the patients with aortic lesions had poor treatment outcomes while subclavian arteritis without aortic lesions had better clinical outcomes. Atypical large vessel-GCA without the aortic and subclavian artery involvement was the worst prognostic phenotype of LV-GCA. Extent of LVLs by imaging should be considered when determining the treatment strategy for GCA.

References:

[1]Sugihara T, et al. Arthritis Res Ther. 2020;22(1):72

Acknowledgements:

The authors would like to acknowledge Mitsuaki Isobe (Sakakibara Heart Institute), Yoshihiro Arimura (Kichijoji Asahi Hospital), and all the investigators in the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS). In addition to the authors, the following investigators and institutions participated in this study: Department of Internal Medicine, Juntendo University Koshigaya Hospital (Shigeto Kobayashi); Niigata Rheumatic Center (Satoshi Ito); Niigata Prefectural Shibata Hospital (Noriyuki Homma).

Disclosure of Interests:

takahiko sugihara Speakers bureau: TS has received honoraria from Abbvie Japan Co., Ltd., AsahiKASEI Co., Ltd., Astellas Pharma Inc., Ayumi Pharmaceutical, Bristol Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Mitsubishi-Tanabe Pharma Co., Ono Pharmaceutical, Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., and UCB Japan Co. Ltd., Grant/research support from: TS has received research grants from AsahiKASEI Co., Ltd., Daiichi Sankyo., and Ono Pharmaceutical., Haruhito A. Uchida Grant/research support from: HAU belongs to the Department of Chronic Kidney

Disease and Cardiovascular Disease which is endowed by Chugai Pharmaceutical, MSD, Boehringer Ingelheim, and Kawanishi Holdings., Hajime Yoshifuji Speakers bureau: HY has received lecture fees from Chugai Pharmaceutical Co., Ltd. and Nihon Medi-Physics Co., Ltd., Yasuhiro Maejima Speakers bureau: YM have received honoraria from Chugai Pharmaceutical Co., Ltd.., Taio Naniwa Speakers bureau: TN has received lecture fees from Chugai Pharmaceutical Co., Ltd.., Grant/research support from: TN has received research grants from Chugai Pharmaceutical Co., Ltd.., Yasuhiro Katsumata Speakers bureau: YK has received honoraria from Chugai Pharmaceutical Co., Ltd., Glaxo-Smithkline K.K., Sanofi K.K., Pfizer Japan Inc., and Asahi Kasei Pharma Corp., Takahiro Okazaki Grant/research support from: TO has received research grants from Chugai Pharmaceutical Co., Ltd., Eisai Pharmaceutical., and Actelion, Jun Ishizaki: None declared, Yohko Murakawa Speakers bureau: YM has received honoraria from Abbvie, Astellas, Ayumi Pharmaceutical, Bristol Myers Squibb, Chugai Pharmaceutical, Eisai Pharmaceutical, Janssen Pharmaceutical, Kissei Pharmaceutical, Nippon Kayaku, Pfizer Pharmaceutical, Takeda Pharmaceutical, UCB Pharmaceutical, Grant/research support from: YM has received research grant support from Asahi Kasei Pharma, AbbVie Japan, Chugai Pharmaceutical, Daiichi Sankyo, Eisai Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Kayaku, Gilead Sciences Inc, Janssen Pharmaceutical, and Teijin Pharma., Noriyoshi Ogawa: None declared, Hiroaki Dobashi: None declared, Tetsuya Horita: None declared, Yoshiya Tanaka Speakers bureau: YT has received consulting fees, speaking fees, and/or honoraria from Daiichi-Sankyo, Astellas, Pfizer, Mitsubishi-Tanabe, Bristol-Myers, Chugai, YL Biologics, Eli Lilly, Sanofi, Janssen, UCB, Grant/research support from: YT has received research grants from Mitsubishi-Tanabe, Takeda, Bristol-Myers, Chugai, Astellas, Abbvie, MSD, Daiichi-Sankyo, Pfizer, Kyowa- Kirin, Eisai, Ono., Shunsuke Furuta: None declared, Tsutomu Takeuchi Speakers bureau: TT has served on speakers’ fees for AbbVie, Bristol-Myers Squibb, Chugai, Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Teijin, Takeda, and Novartis., Consultant of: TT has received consulting fees from Astra Zeneca, Eli Lilly, Novartis, Mitsubishi Tanabe, AbbVie, Nippon Kayaku, Janssen, Astellas, Taiho, Chugai, Taisho Toyama, GlaxoSmithKline, and UCB., Grant/research support from: TT has received research grants from Astellas, Chugai, Daiichi Sankyo, Takeda, AbbVie, Asahi Kasei, Mitsubishi Tanabe, Pfizer, Eisai, AYUMI, Nippon Kayaku, and Novartis., Yoshinori Komagata Speakers bureau: YK has received speakers’ fees from Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Daiichi Sankyo, AbbVie, Nippon Shinyaku, Towa., Consultant of: YK has received consulting fees from Chugai, Kyowa Hakko Kirin, Asahi Kasei, UCB, Yoshikazu Nakaoka Speakers bureau: YN has received lecture fees from Astellas, Takeda, Daiichi Sankyo, Actelion, and Japan Blood Products Organization (JB)., Consultant of: YN has received consulting fees and/or lecture fees from AbbVie and Chugai, Grant/research support from: YN has received research grants from Chugai and Bayer Yakuhin, Ltd, masayoshi harigai Speakers bureau: MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc.,Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Consultant of: MH is a consultant for AbbVie, Boehringer-ingelheim, Bristol Myers Squibb Co., Kissei Pharmaceutical Co.,Ltd. and Teijin Pharma., Grant/research support from: MH has received research grants from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc.,Eisai Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., Sekiui Medical, Shionogi & Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd.

AB0287 EFFECTS OF HYDROXYCHLOROQUINE ON PERIPHERAL BLOOD CYTOKINE EXPRESSION ASSOCIATED WITH ATHEROSCLEROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

In systemic lupus erythematosus(SLE), a higher frequency of atherosclerotic lesions is associated with a poor life prognosis (1). Hydroxychloroquine (HCQ) has been reported to improve the prognosis of life and dyslipidemia in SLE (2), and the mechanism has been unclear.

Objectives:

To determine the effect of HCQ treatment on serum cytokines associated with atherosclerosis in SLE.

Methods:

SLE patients who received additional HCQ and maintained low disease activity between January 2016 and September 2020 were included in this study. Disease activity was assessed by SLEDAI, CLASI and LLDAS, and serum complement titers, anti-ds-DNA antibodies, serum insulin and serum cytokines (adiponectin, resistin and leptin) were analyzed before and after HCQ treatment.

Results:

Fifty-four patients (3 males, 51 females, mean age 41.9±12.8 years) were included (Table 1). Thirty-two patients achieved LLDAS at baseline. Serum adiponectin and insulin levels were significantly increased after 3 months of HCQ treatment compared to baseline, and serum resistin levels were significantly lower (Figure 1). Patients with a history of renal disease had greater degree of changes in serum adiponectin and resistin levels. Among SLE patients who did not achieve LLDAS at baseline, those who still did not achieve LLDAS after 3 months had significantly lower serum leptin levels before HCQ treatment than those who achieved it after 3 months.

The change of serum resistin levels correlated with those of serum S100A8 levels (r=0.5, p=0.0001).

Conclusion:

Additional HCQ treatment in SLE patients improves lipid abnormalities. HCQ may improve prognosis by controlling disease activity in SLE and reducing risk factors for atherosclerosis.

References:

[1]Gregory Katz, et al. Systemic Lupus Erythematosus and Increased Prevalence of Atherosclerotic Cardiovascular Disease in Hospitalized Patients. Mayo Clin Proc. 2019; 94:1436-1443.

[2]Laura Durcan, et al. Longitudinal Evaluation of Lipoprotein Parameters in Systemic Lupus Erythematosus Reveals Adverse Changes with Disease Activity and Prednisone and More Favorable Profiles with Hydroxychloroquine Therapy. J Rheumatol. 2016; 43: 745–750.

Table 1.

Characteristics of SLE patients enrolled in this study

Characteristicsn=54, no.(%)Female, no(%)51(94)Age, years, mean±SD41.9±12.8Disease duration, years, mean±SD15.1±11.1Past involvementRenal involvement23 (43)NPSLE5 (9)ComplicationAPS10 (19)Dyslipidemia2 (4)Diabetes 1 (2)Concomitant immunosuppressive treatmentsPrednisone No.(%)46 (85) Median Dosage, mg/day (range)5.0 (1-10)Disease activitySLENA-SLEDAI score3.9±2.0 Current skin involvement30 (56) anti-dsDNA positive, no(%)21 (39)low complement, no(%)29 (54)

Anti-dsDNA positive means anti ds-DNA titer increases over 12 IU/ml

Low complement means any of C3, C4 and CH50 decreases to less 68mg/dl, less 12mg/dl, 30U/ml.

APS: Anti-phospholipid antibody syndrome, NPSLE: neuropsychiatric SLE,

Disclosure of Interests:

None declared

AB0390 CHARACTERISTICS AND PROGNOSIS OF AGE-DEPENDED ANCA-ASSOCIATED VASCULITIS IN JAPAN

Background:

It is known that most of ANCA-associated vasculitis (AAV) patients are elderly. A cohort study showed that the mean age of onset was 71.1 years, especially in patients with microscopic polyangiitis (MPA)1). However, the characteristics and prognosis of age-depended AAV patients are still unclear.

Objectives:

To clarify the differences in age-related characteristics and prognosis between Japanese patients with AAV.

Methods:

We enrolled 44 patients with AAV who underwent remission induction therapy at our hospital from January 2016 to December 2020. They were divided with under 70 years old group (<70 yo group, n=12) and over 70 years old group (≥70 yo group, n=32). We investigated between two groups as follows; clinical characteristics and laboratory data at diagnosis, rates of complete remission (CR) at 6 months, defined as Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone ≤7.5 mg/day, adverse events, and relapse free survival.

Results:

Mean age were 61.9 ± 9.74 years old in <70 yo group and 77.5 ± 4.61 years old in ≥70 yo group (p<0.01). There were significantly fewer newly diagnosed cases in the <70 yo group, and half of the patients with relapsing disease. There was no difference in the type of ANCA, organ involvement, or BVAS. Remission induction therapy was performed with CY or RTX, and no difference was observed between these two groups. In addition, there was also no difference in maintenance therapy (Table 1). CR rate in <70 yo group and in ≥70 yo group were 55% and 46 % respectively (p=0.73). Severe infections occurred with no patient (0%) in <70 yo group and with 5 patients (16%) in ≥70 yo group (p=0.30). 5 patients of relapse were observed in the <70 yo group and 1 patient in the ≥70 yo group, and relapse free survival was significantly lower in the <70 yo group (p=0.001) (Figure 1).

<70 yo (n=12)≥70 yo (n=32)p valueAge (year)61.9 ± 9.7477.5 ± 4.61< 0.01*Female, n (%)10 (83)28 (87)0.66AAV typeMPA, n (%) / GPA, n (%)6 (50) / 6 (50)26 (81) / 6 (19)0.06Newly diagnosed, n (%)6 (50)27 (84)0.045*ANCA positivity MPO, n (%) / PR3, n (%)11 (92) / 0 (0)30 (94) / 3 (9)1 / 0.55 negative, n (%)1 (8)1 (3)0.48CRP (mg/dl)3.34 ± 4.018.15 ± 6.860.03*eGFR (mL/min)55.8 ± 25.357.7 ± 24.70.93BVAS12.0 ± 8.014.8 ± 6.80.23Remission induction therapyCY, n (%) / RTX, n (%)5 (42) / 7 (58)16 (50) / 16 (50)0.74Maintenance therapy AZA, n (%)7 (58)14 (44)0.50 RTX, n (%)1 (8)6 (19)0.65 others, n (%)2 (17)3 (9)0.60 without IS, n (%)2 (17)9 (28)0.70

The p-value was estimated using Fisher’s exact or Wilcoxson rank sum test. yo, years old; AAV, ANCA-associated vasculitis; MPA, microscopic polyangiitis; GPA, granulomatosis with polyangiitis; CY, cyclophosphamide; RTX, rituximab; AZA, azathioprine; IS, immunosuppressants. *p<0.05

Conclusion:

There was no difference in remission rate between two groups. Severe infections were observed only in the ≥70 yo group. We suggest that younger AAV patients need attention to relapse after the remission because of lower relapse free survival in <70 yo group.

References:

[1]Sada KE, et al. Arthritis Res Ther 2014; 16: R101.

Figure 1.

Relapse free survival Relapse free survival was calculated by Kaplan-Meier method and compared by log-rank test. *p<0.05

Disclosure of Interests:

None declared

AB0826 IMPORTANCE OF PRECONCEPTION CARE AND PLANNING FOR PREGNANCY IN WOMEN OF CHILDBEARING AGE COMPLICATED WITH CONNECTIVE TISSUE DISEASES

Background:

Previous reports showed that connective tissue disease (CTD) have a high risk for adverse pregnancy outcomes (APOs) such as preterm birth, light-for-date, or preeclampsia1). It was revealed that these APOs were associated with high disease activity or treatment agents, particularly in glucocorticoid2). Some patients, who have no or insufficient preconception care and became unplanned pregnant, exacerbate the underlying disease, and lead to disappointing pregnancy outcomes. Therefore, preconception care and planning for pregnancy is very important to control disease activities and manage the appropriate treatment agents, including glucocorticoid, immunosuppressants, biologics, hydroxychloroquine, and anticoagulants3).

Objectives:

We investigate whether the presence or absence of preconception care before pregnancy affects clinical disease course and pregnancy outcomes.

Methods:

We examined 200 CTD women who delivered their newborns in our institution from March 2006 to January 2021. We analyzed the association between preconception care and the clinical course of underlying diseases during pregnancy or pregnancy outcomes.

Results:

Of all 200 cases, 133 (55.9%) cases had preconception care in our institution, while the others had no or insufficient preconception care. We showed the comparison of treatment agents and pregnancy outcomes between the cases with and without preconception care in Table 1. There was no significant difference in the rate of glucocorticoid use and the mean prednisolone dose during pregnancy between these two groups. However, the rate of increased dose of glucocorticoid or pulse therapy was significantly higher in the cases without preconception care. As for pregnancy outcomes, there was no significant difference in the live birth rate. On the other hand, the gestational weeks at delivery were significantly shorter, and the rate of preterm birth was higher in the cases without preconception care. In addition, the rate of the hospitalization of neonatal intensive care unit (NICU) was also significantly higher in the cases without preconception care.

Conclusion:

We revealed that preconception care before pregnancy reduced the need for intensified treatment such as increasing dose of glucocorticoid or pulse therapy. The rate of preterm birth and NICU hospitalization was also shown to decrease. Therefore, it is important for our rheumatologists to provide an appropriate preconception care for CTD women of childbearing age and to make a plan for pregnancy.

References:

[1]Tsuda S, Sameshima A, Sekine M, Kawaguchi H, Fujita D, Makino, et al. Mod Rheumatol 2019:24;1-10.

[2]Clowse ME, Magder LS, Petri M. J Rheumaotol 2011;38:1012-1016.

[3]Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. Arthritis Care Res 2020;72:461-488.

Table 1.

Comparison of treatment agents and pregnancy outcomes between the cases with and without preconception care

Preconception care (+) (n=113)Preconception care (-) (n=89)P valueTreatment agents during pregnancy Glucocorticoid use (n (%))64 (56.6)50 (56.2)1.00  Mean glucocorticoid dose (mg/day)6.3±3.98.4±6.10.09  Dose-up of glucocorticoid (n (%))11 (9.7)26 (29.2)<0.01*  Glucocorticoid pulse therapy (n (%))0 (0)8 (9.0)0.01* Immunosuppressant (n (%))14 (12.5)4 (4.5)0.08 Hydroxychloroquine (n %))7 (6.2)6 (6.7)1.00 Anticoagulant therapy (n (%))21 (18.8)16 (17.8)1.00Pregnancy outcome Spontaneous abortion (n (%))8 (7.1)6 (6.7)1.00 Live birth (n (%))100 (88.5)78 (87.6)1.00  Gestational weeks at delivery (week)38.7±1.437.3±3.50.01*  Birth weight of newborn (gram)2888.8±453.72678.4±732.60.25 Adverse pregnancy outcomes (n (%))26 (26.0)28 (35.0)0.20  Preterm birth (n (%))5 (5.0)19 (23.8)<0.01*  Light-for-date (n (%))10 (10.0)9 (11.3)0.81  Hypertensive disorder (n (%))5 (5.0)8 (10.0)0.25  NICU management (n (%))13 (13.0)24 (30.0)<0.01*

Disclosure of Interests:

None declared

AB0787 EFFECTIVENESS OF IL-17 INHIBITORS REVEALED BY MINIMAL DISEASE ACTIVITY (MDA) ACHIEVEMENT OF PSORIATIC ARTHRITIS PATIENTS

Background:

Recently, several type of biologics such as TNF inhibitors, IL-17 inhibitors, IL-12/23 (p40) inhibitors and IL-23 (p19) inhibitors are approved for PsA. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2015 Treatment Recommendation suggests the treat-to-target strategy for PsA1), however, this recommendation does not indicate how to determine which biologics to use. Recent reports revealed that IL-17 inhibitors were as effective as TNF inhibitors2). On the other hand, based on the Tight Control of Psoriatic Arthritis (TICOPA) study, present treatment strategies for PsA aim to reach on minimal disease activity (MDA)3).

Objectives:

We investigate the effectiveness of IL-17 inhibitors focusing on MDA achievement which were administered for the Psoriatic Arthritis (PsA) patients in our institution.

Methods:

We examined 46 patients whom were diagnosed and treated in our institution. We analyzed DAS28-CRP as the evaluation of arthritis and Minimal Disease Activity (MDA) achievement as that of overall disease activity.

Results:

Biologics were administered in 30 cases (65.2%) of all 46 cases. In 30 cases, 19 cases (63.3%) initiated TNF inhibitors (TNFi) and 7 cases (23.3%) were IL-17 inhibitors (naïve group). In 9 cases, TNFi were switched into Il-17 inhibitors (switch group), 7 cases continued TNFi (TNFi group). Patients characteristics in the cases which could collect the data were shown in Table 1. As for arthritis, DAS28-CRP has significantly improved at fourth weeks in naïve and TNFi group. In switch group, DAS28-CRP has not demonstrated significant improvement, however, IL-17 inhibitors were effective for the cases to which they were initiated for arthritis. As for MDA, 71% and 78% have also achieved MDA at twentieth weeks in both naïve and switch groups. In the TNFi group, 67% have not achieved MDA at twentieth weeks because of no improvement of rash (Figure 1). In switch group, all cases to which IL-17 inhibitors were initiated for either arthritis or rash have achieved MDA, however, 40% of cases which were introduced for both arthritis and rash have not achieved MDA.

Table 1.

Comparison of clinical characteristics at baseline in 3 groups.

Il-17 naïve group (n=7)IL-17 switch group (n=9)TNF group (n=7)p valueAge, year60.7 ± 18.953.8 ± 15.450.7 ± 13.6N.SDisease duration, year20.3 ± 25.817.4 ± 9.59.9 ± 12.4N.SMale, n (%)3 (43)6 (67)5 (71)N.SMTX, n (%)2 (29)4 (44)5 (71)N.SCRP(mg/dl)0.41 ± 0.501.87 ± 3.131.07 ± 1.77N.SSwollen joint count6.7 ± 7.33.6 ± 4.26.2 ± 6.9N.STender joint count6.6 ± 7.02.2 ± 2.66.9 ± 9.0N.SPatient pain VAS55.7 ± 22.347.1 ± 34.935.4 ± 13.6N.SBSA (%)12.5± 17.37.7 ± 14.87.4 ± 7.2N.SBiologics, nSecukinumab: 2Ixekizumab: 5secukinumab: 3Ixekizumab: 5Brodalumab: 1Infliximab: 3Adalimumab:3Etanercept:1

TNF: Tumor Necrosis Factor, MTX: Methotrexate, VAS: visual analog scale, BSA: body surface area, N.S: not significant

Conclusion:

In our study, IL-17 inhibitors could bring high rate of MDA achievement for both naïve and switch from TNFi. We suggest that TNFi should be switched into IL-17 inhibitors rapidly in the case of ineffective for TNFi.

References:

[1]Coates LC, Kavanaugh A, Mease PJ, et al. Arthritis Rheumatol. 2016;68:1060-71.

[2]Miyagawa I, Nakayamada S, Tanaka Y. Curr Rheumatol Rep. 2019 20;21:21.

[3]Coates LC, Moverley AR, McParland L, et al. Lancet. 2015 19;386:2489-98.

Disclosure of Interests:

None declared

FRI0065 CLINICAL FEATURES OF METHOTREXATE ASSOCIATED LYMPHOPROLIFERATIVE DISORDER IN RHEUMATOID ARTHRITIS PATIENTS AND INFLUENCE OF CD8 POSITIVE LYMPHOCYTE INFILTRATION

Background:

Lymphoproliferative disorders (LPD) that develop in rheumatoid arthritis (RA) patients treated with MTX (MTX-LPD) is one of the important complications for RA patients. We have previously epidemiologically demonstrated an association between MTX and the development of LPD in RA patients1). MTX-LPD has varied pathologies including various clinical symptom and histological finding. Therefore, we need more information about MTX-LPD. In addition, it is one of the characteristics for MTX-LPD that spontaneous regression (SR) after MTX discontinuation. However, the mechanism of SR is not clarified.

Objectives:

We collect the information such as clinical symptom and histological finding of MTX-LPD with RA patients, and clarify the clinical features of MTX-LPD. In addition, we investigated the difference between SR cases and cases that treated with chemotherapy after MTX discontinuation (CTx cases).

Methods:

We enrolled 90 MTX-LPD patients from Kagawa Prefecture, Japan between June 2005 and December 2019. Patients were diagnosed according to American College of Rheumatology (ACR) 1987 classification criteria or ACR/European League Against Rheumatism (EULAR) 2010 classification criteria, and treated with disease modifying antirheumatic drugs (DMARDs) including MTX. We collected as follow information; age, gender, duration of RA, laboratory data (lymphocyte counts and sIL-2R) and treatment of MTX-LPD. In addition, we divided 16 MTX-LPD cases diagnosed histological into two groups (SR:CTx group; n=10:6), and analyzed the histological findings (CD4, CD8, CD163 and CD47) using the staining in immunohistochemistry (IHC) between the two groups. Each positive cell analyzed using virtual viewer soft ImageScope.

Results:

Characteristics of 90 MTX-LPD patients are as follow; mean age 66.5±11.2 years,63 female, duration of RA 18.5±19.4 years. 65 patients (72.2%) were spontaneously improved by discontinuing MTX. 58 patients (64.4%) were proven MTX-LPD histologically. In these patients, diffuse large B-cell lymphoma (DLBCL) was the most frequent histological type of MTX-LPD (56.9%). Infiltration of CD8 positive lymphocyte in the lesion was significant less in the SR cases than in the CTx cases (Figure 1). However, CD4, CD163 and CD47 positive cells had no significant difference between two groups.

Figure 1.

CD8 positive lymphocytes in the specimen of lesion using the staining in immunohistochemistry (IHC) between SR and CTxgroup.

Conclusion:

We revealed clinical features of MTX-LPD with RA patients. In addition, CD8 positive lymphocytes are involved in tumor immunity. In this study, we suggested that the extent of CD8 positive lymphocyte infiltration may predict SR of MTX-LPD. Further study is necessary on revealing the mechanism of SR in MTX-LPD.

References:

[1]Kameda T. et al. Arthritis Care Res (Hoboken). 2014 Sep;66(9):1302-9.

Disclosure of Interests:

None declared

AB0391 EFFECT OF HCQ ON LLDAS ACHIEVEMENT IN SLE PATIENTS

Background:

HCQ for SLE in Japan has been administered in many cases after approval. Therefore, the effect of additional administration of HCQ on low disease activity of SLE was considered to be clearer.

Objectives:

To clarify the effect of HCQ treatment on the control of disease activity in SLE patients.

Methods:

All SLE patients with low disease activity (LDA) enrolled in this study started additional HCQ treatment from January 2016. All patients with LDA enrolled in this study started HCQ treatment and had been receiving oral HCQ continuously for at least 3 months without using other immunosuppressive treatments or glucocorticoids. Disease activity was evaluated by SLEDAI, CLASI, and LLDAS, and serum complement values, anti-DNA antibodies, and pro-inflammatory cytokines were analyzed as immunological biomarkers before and after HCQ treatment.

Results:

52 of 100 patients were enrolled in this study (M:F; 4:48, average age; 40.6±13.4). 24 lupus nephritis patients were in sustained remission. 29 patients (56%) achieved LLDAS and 3 patients (6%) achieved clinical remission (CR) before HCQ administration.

Of the 20 patients (38%) who did not achieve LLDAS before HCQ administration, the LLDAS achievement rates at 3, 6, and 12 months after additional HCQ were 47%, 59%, and 81% (including 12.5% of CR achievement rates), respectively.

Serum levels of MRP8, MRP14, TNF-α, IL-6, VEGF-A, IL-1ra, MIP-1a and IL-2 decreased significantly 3 months after additional HCQ treatment. In addition, serum levels of MRP8, MRP14, TNF-α, IL-6 and IL-2 also decreased significantly 3 months after additional HCQ treatment despite achieving LLDAS or CR. The expressions of IFN-α didn’t decrease significantly in 9 cases that could be detected.

The magnitude of the changes in serum MRP8, MRP14, IL-8 and Il-1ra levels in patients with a history of LN was significantly higher than in those without a history of LN. The magnitude of the reduction in serum MCP-1 levels in patients not achieving LLDAS with a history of LN was significantly higher than in those without a history of LN(p=0.046).

The change of CLASI activity score was correlated with the change in serum levels of MRP14 and MCP-1 with univariate analysis (MRP14: r=-0.41, p=0.017, MCP-1: r=-0.58, p=0.0006). The change of serum C3 levels had a negative correlation with MCP-1(r=-0.33, p=0.022).

The magnitude of the change in serum levels of MRP14, TNF-α, IL-8, MCP-1, MIP-1a and IL-1ra in patients achieving LLDAS were correlated with the change of CLASI activity score with univariate analysis (MRP14: r=-0.49, p=0.041, TNFα: r=0.74, p=0.0038, IL-1ra: r=0.66, p=0.038, MIP-1a: r=0.63, p=0.037, Figure 1). Moreover, the change of serum C3 and C4 levels in them had a negative correlation with the change of serum MCP-1 levels (Figure 2).

Figure 1.

Correlation between change of CLASI activity scores and serum MCP-1 levels in SLE patients with LLDAS (IL-8: r=0.77,p=,0.0007, MCP-1: r=0.80,p=,0.0001).

Figure 2.

Correlation between change of serum C3 and C4 levels and serum MCP-1 levels in SLE patients with LLDAS (C3: r=-0.40, p=0.028, C4: r=-0.37, p=0.047).

Conclusion:

Additional administration of HCQ is useful for cytokine control even in LLDAS-achieved cases, and particularly contributes to the improvement of skin lesion.

In addition, regulation of IL-8 and MCP-1 is important for control of renal lesions of SLE, and more control of the activity of SLE

The effect of HCQ on IL-8 and MCP-1 is related to the control of renal lesions in SLE, so that disease activity of more SLE patients might be more controlled disease activity.

References:

[1]R Wakiya, et al. Hydroxychloroquine modulates elevated expression of S100 proteins in systemic lupus erythematosus. Lupus. 2019;28:826-833

Disclosure of Interests:

None declared

FRI0254 SERUM IL-17 AND IL-21 AFFECT THE HEMODYNAMICS IN CONNECTIVE TISSUE DISEASE ASSOCIATED-PULMONARY HYPERTENSION

Background:

Pulmonary hypertension associated with connective tissue disease (CTD-PH) has complicated pathology including immune abnormalities, cardiac and pulmonary lesions. Therefore, it is difficult for rheumatologist to manage CTD-PH. We hesitate to use immunosuppressants in addition to pulmonary vasodilators to treat CTD-PH. Although there is a report that the cytokine such as Interleukin (IL)-6, IL-17 and IL-21 are involved in the development of PH1), changes in the hemodynamics of theses cytokines with treatment are not clear.

Objectives:

We investigate serum cytokine profile and clinical appearance in CTD-PH, and clarify the relationship between change in cytokines and hemodynamics before and after treatment.

Methods:

14 cases of CTD-PH (8 cases in Scleroderma; SSc-PH group, 4 cases in Mixed connective tissue disease; MCTD-PH group, 2 cases in Systemic lupus erythematosus; SLE-PH group), 6 cases in Other-PH group, and 2 cases of SSc without PH as controls were included. The following clinical data were collected: age, gender, underlying disease, complication of interstitial lung disease, treatment (immunosuppressant and pulmonary vasodilator). Serum samples in pre- and post-capillary before and after treatment were collected during cardiac catheterization examination. Serum cytokines (MCP-1, IL-6, IL-17 and IL-21) of these samples were measured by ELISA (ABCAM, UK).

Results:

Serum MCP-1, IL-6, and IL-21 levels were higher in SSc-PH group than in the other groups. Conversely, serum IL-17 levels tended to be higher in non-SSc group compared to SSc-PH group. Additionally, serum MCP-1 levels in SSc-PH group decreased in post-capillary as compared to pre-capillary. Furthermore, patients with decreased serum IL-17 and IL-21 levels before and after treatment showed improved pulmonary hemodynamics.

Conclusion:

SSc-PH had a different cytokine profile compared with non-SSc-PH. We suggested that the serum IL-17 and IL-21 levels effect the hemodynamics in CTD-PH.

References:

[1]Hashimoto-Kataoka T. et al. Proc Natl Acad Sci U S A. 2015 May 19;112(20):E2677-86.

Disclosure of Interests:

None declared

AB0392 THE EFFECT OF HYDROXYCHLOROQUINE ON THE RISK FACTORS FOR ATHEROSCLEROSIS DEVELOPMENT

Background:

Systemic lupus erythematosus(SLE) patients, especially patients with lupus nephritis have poor vascular endothelial function and increased cardiovascular(CV) mortality.

Meanwhile, several studies showed hydroxychloroquine(HCQ) has effect on reduction in lipids and thrombosis(1), but the mechanism is unclear.

Objectives:

We examined effect of HCQ on adipocytokine expression in SLE patients.

Methods:

52 SLE patients with low disease activity started with HCQ were analyzed before and 3 months after HCQ treatment. 21 SLE patients has past history of lupus nephritis. Serum S100 proteins and adipocytokines were measured by ELISA, and serum inflammatory ctytokine levels were evaluated by Multiplex assay (TNF-α, IL-6, VEGF-A).

Results:

Serum adiponectin level was increased significantly 3 months after HCQ treatment compared with those at baseline (mean change 1.35, Figure 1). SLE patients who achieved LLDAS had a greater increase than those who did not. Additionally, the changes of serum adiponectin levels were associated with those of TNF-α, IL-6, VEGF-A and S100A9 protein, which plays an important role of SLE pathogenesis.

Figure 1.

Serum adiponectin levels at baseline were compared with levels after 3 months of HCQ treatment. Serum adiponectin levels significantly decreasing during HCQ treatment in SLE patients. For statistical analyses *p<0.0001,Pvalue: Wilcoxon signed-rank test

Conclusion:

A HCQ could reduce the risk factors for atherosclerosis along with control of SLE disease activity.

References:

[1]Wallace DJ, et al. Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of steroids on lipids. Am J Med. 1990; 89: 322-6.

Disclosure of Interests:

None declared

AB0493 COMPARISON OF EFFICACY AND SAFETY BETWEEN RITUXIMAB AND CYCLOPHOSPHAMIDE IN REMISSION INDUCTION THERAPY FOR JAPANESE ANCA-ASSOCIATED VASCULITIS(AAV) PATIENTS; A SINGLE CENTER RETROSPECTIVE ANALYSIS

Background:

Rituximab(RTX) and Cyclophosphamide(CY) has been indicated for ANCA-associated vasculitis(AAV) as remission induction therapy. However, older age and renal disfunction were independent predictor of treatment related adverse effects in remission induction with CY in recent reports1). Japanese AAV patients are characterized by the predominance of elderly, and the study about comparison of efficacy and safety between RTX and CY in elderly Japanese AAV patients are limited.

Objectives:

To compare the efficacy and safety between RTX versus CY as remission induction therapy in Japanese AAV patients.

Methods:

We analyzed 40 cases (20 cases received RTX and 20 cases received CY) who received remission induction therapy in our hospital between January 2016 and August 2019. Clinical and laboratory variables at diagnosis, rates of complete remission(CR) at 6 months, defined as Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone 7.5 mg/day, AAV relapse at 12 months, and adverse effects were investigated.

Results:

Of 40 patients, mean age was 73.5±9.6 years (6 males and 34 females). Diagnosis of MPA and GPA were 30 cases and 10 cases, respectively. 37 cases (93%) were positive for MPO-ANCA. Treatment regimen was determined by attending physician. Baseline characteristic of each group (RTX group and CY group) are shown in Table1. Baseline charactor, disease activity, organ involvement, and the proportion of patients with relapsing disease were similar in the two treatment groups. At 6 months, there was no difference of remission rate between two groups (RTX: CY = 62%: 44%, p=0.35) (Figure 1). However, mean PSL dosage at 3 months was significantly lower in RTX group (10.0±4.6mg/day) as compared to CY group (15.8±9.5mg/day; p=0.025) (Figure 2). At 12 months, 1 case in CY group and no case in RTX group had relapse. Adverse effects through 12 months are shown in Table 2. 8 infections (30%) in CY group and 7 infections (35%) occurred in RTX group (p=0.64), respectively. 1 case in RTX group had died due to renal failure.

Table 1.

Comparison of clinical characteristics at baseline between RTX and CY groups.

RTX(n=20)CY(n=20)p valueDeath, n (%)1 (5)0 (0)0.50Infections, n (%)7 (35)8 (30)0.46Serious (grade 3), n (%)4 (15)3 (10)0.50Malignancy, n (%)1 (5)0 (0)0.50VTE, n (%)1 (5)0 (0)0.50AMI, n (%)1 (5)0 (0)0.50Leukopenia, n (%)3 (15)3 (10)0.70Necrosis of femoral head, n (%)0 (0)1 (5)0.50Mediastinal emphysema0 (0)1 (5)0.50

VTE: venous thrombotic emboli, AMI: acute myocardial infarction

Conclusion:

We indicated that PSL was tapered more rapidly in RTX group, although there was no difference of remission rate at 6 months and infection at 12 months between RTX and CY therapy. Therefore, remission induction therapy with RTX might be more safety for elderly Japanese AAV patients.

References:

[1]Little MA, Nightingale P, Verburgh CA, Hauser T, et al. Ann Rheum Dis 2010; 69:1036–1043.

Table 2.

Adverse effects through 12 months. % = patients with 1 effects

RTX(n=20)CY(n=20)p valueAge, year72.3 ± 11.074.8 ± 8.010.55female, n (%)16 (80)18 (90)0.33AAV type0.14 MPA, n (%)13 (65)17 (85) GPA, n (%)7 (35)3 (15)Newly diagnosis, n (%)7 (35)4 (20)0.24ANCA positivity MPO, n (%)20 (100)17 (85)0.12 PR3, n (%)1 (5)2 (10)0.50 negative, n (%)0 (0)2 (10)0.24 eGFR (mL/min)55.0 ± 29.558.1 ± 21.50.45Organ involvement General, n (%)14 (70)19 (95)0.046* Cutaneous, n (%)1 (5)3 (15)0.30 Eyes, n (%)4 (20)1 (5)0.17 ENT, n (%)5 (25)5 (25)1.00 Pulmonary, n (%)14 (70)15 (75)0.50 Renal, n (%)14 (70)13 (65)0.50 Neurologic, n (%)8 (40)4 (20)0.15BVAS13.8 ± 6.614.1 ± 7.60.73

RTX: Rituximab, CY: Cyclophosphamide, ANCA: antineutrophil cytoplasmic autoantibody, AAV: ANCA-associated vasculitis, GPA: granulomatosis with polyangiitis, MPA: microscopic polyangiitis, ENT: Ear, Nose, and Throat, BVAS Birmingham Vasculitis Activity Score, * p <0.05

Disclosure of Interests:

None declared

AB0592 NAILFOLD CAPILLARY ABNORMALITIES PREDICT INTERSTITIAL LUNG DISEASE (ILD) COMPLICATION IN SYSTEMIC SCLEROSIS PATIENTS

Background:

Systemic sclerosis (SSc) have various organ involvements including pulmonary hypertension (PH), digital ulcers (DU), and interstitial lung disease (ILD). On the other hand, Nailfold capillary (NFC) abnormalities (enlarged/giant capillaries, fresh or old hemorrhages, avascular areas, ramified/bushy capillaries) detected by capillaroscopy are included in ACR/EULAR classification criteria for SSc as one of important findings. In addition, many studies have reported the relationship between NFC abnormalities and organ involvements (DU, PH) [1][2]. However, there are a few reports about the relationship between NFC abnormalities and ILD.

Objectives:

We clarify the association with NFC abnormalities and ILD in SSc patients.

Methods:

We enrolled SSc patients without PH from January 2016 to December 2019 in our institution. SSc patients were diagnosed according to EULAR classification criteria in 2013. ILD was detected by chest CT scans. We assessed severity of ILD with pulmonary function tests (PFT). Abnormal PFT was defined as vital capacity (%VC) or diffusion capacity (DLCO) < 70%. NFC abnormalities were detected with “OptiPiX capillaroscopy Clinic 1.7.x” and the number of capillaries was measured per 1mm in 2nd to 5th fingers of both hand. We defined enlarged and giant capillaries as >30 µm and >50 µm, respectively.

Results:

We enrolled 59 SSc patients (54 females, 5 males). Mean age is 65.0 ± 8.0 years. Thirty-one patients (52.5%) were complicated with ILD. Mean capillary counts are 6.6/mm. The number of patients with each NFC abnormalities (enlarged capillaries, giant capillaries, microhemorrhages, ramified, avascular areas) are 42, 32, 48, 38, and 33 cases, respectively. Two cases did not have NFC abnormalities. SSc patients with giant capillaries had fewer ILD complications (p <0.05, odds ratio 0.183 [0.059 – 0.57]). Other NFC abnormalities were not associated with ILD in SSc patients. We inspected %VC of 23 patients and DLCO of 20 patients with ILD. Eleven patients had abnormal PFT (5 patients had abnormal %VC and 9 patients had abnormal DLCO). Most of them had not enlarged capillaries than patient with normal PFT (odds ratio 0.11 [0.016 – 0.81]). Other NFC abnormalities including giant capillaries were not associated with abnormal PFT.

Conclusion:

We investigated the relationship between NFC abnormalities and ILD conplications in SSc patients. NFC abnormalities are associated with ILD complicacion and severity of ILD. It was suggested that no giant capillary in SSc patients may predict ILD complication. Moreover, no enlarged capillary may predict the severe ILD.

References:

[1]Valeria Riccieri et al. Systemic sclerosis patients with and without pulmonary arterial hypertension: a nailfold capillaroscopy study. Rheumatology, Volume 52, Issue 8, 1 August 2013, Pages 1525–1528

[2]Maurizio Cutolo et al. Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study. Arthritis Rheumatol. 2016 Oct; 68(10): 2527–2539.

Disclosure of Interests:

None declared

Complement profile in microscopic polyangiitis and granulomatosis with polyangiitis: analysis using sera from a nationwide prospective cohort study

OBJECTIVE

The complement cascade, especially the alternative pathway of complement, has been shown in basic research to be associated with anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV). We aimed to elucidate relationships between serum complement components and clinical characteristics in AAV.

METHOD

In a nationwide prospective cohort study (RemIT-JAV-RPGN), we measured the serum levels of C1q, C2, C3, C3b/iC3b, C4, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, mannose-binding lectin, and properdin in 52 patients with microscopic polyangiitis (MPA) and 39 patients with granulomatosis with polyangiitis (GPA).

RESULTS

The properdin level of MPA and GPA was significantly lower than that of healthy donors. The properdin level was negatively correlated with the Birmingham Vasculitis Activity Score (BVAS) (ρ = -0.2148, p = 0.0409). The factor D level at 6 months was significantly positively correlated with the Vasculitis Damage Index (VDI) at 6, 12, and 24 months (ρ = 0.4207, 0.4132, and 0.3115, respectively). Patients with a higher ratio of C5a to C5 had higher neutrophil percentage and serum immunoglobulin G levels, and significantly lower creatinine levels. Cluster analysis divided the MPA and GPA patients into three subgroups. A principal component (PC) analysis aggregated 15 types of complements into alternative pathway-related PC 1 and complement classical pathway and common pathway-related PC 2.

CONCLUSIONS

The serum levels of properdin and factor D were correlated with the BVAS and the VDI in MPA and GPA, respectively. Our analyses suggested the pathological heterogeneity of MPA and GPA from the aspect of complement components.

Hydroxychloroquine modulates elevated expression of S100 proteins in systemic lupus erythematosus

Objectives

We investigated the effect of hydroxychloroquine (HCQ) on S100A8 and S100A9 serum levels in systemic lupus erythematosus (SLE) patients with low disease activity receiving immunosuppressants.

Methods

SELENA-SLEDAI, Cutaneous Lupus Erythematous Disease Area and Severity Index (CLASI) and serum levels of complement factors, anti-dsDNA antibodies, and white blood cell, lymphocyte, and platelet counts were used to evaluate disease activity, cutaneous disease activity, and immunological activity, respectively. Serum S100A8 and S100A9 were measured at HCQ administration and after 3 or 6 months using ELISA.

Results

S100A8 and S100A9 serum levels were elevated at baseline and the magnitude of decrease from baseline at 3 and 6 months after HCQ administration was greater in patients with renal involvement than in those without (baseline: S100A8, p = 0.034; S100A9, p = 0.0084; decrease: S100A8, p = 0.049; S100A9, p = 0.023). S100 modulation was observed in patients with ( n = 17; S100A8, p = 0.0011; S100A9, p = 0.0002) and without renal involvement ( n = 20; S100A8, p = 0.0056; S100A9, p = 0.0012), and was more apparent in patients with improved CLASI activity scores (improved: S100A8, p = 0.013; S100A9, p = 0.0032; unimproved: S100A8, p = 0.055; S100A9, p = 0.055). No associations were observed for immunological biomarkers.

Conclusion

HCQ may improve organ involvement in SLE by modulating S100 protein levels, especially in patients with renal or skin involvement.

A case of Evans syndrome combined with systemic lupus erythematosus successfully treated with rituximab

Evans syndrome is a rare autoimmune disorder with unknown aetiology. Although corticosteroids and/or intravenous immunoglobulin (IVIG) are commonly used in its treatment, no standard strategy has been established. We report here a 44-year-old male with refractory Evans syndrome combined with systemic lupus erythematosus (SLE) who responded well to rituximab. He was admitted to our hospital with severe bleeding caused by worsening of Evans syndrome. Despite treatment with a high-dose corticosteroid and IVIG, his thrombocytopaenia and haemolytic anaemia did not improve. We started rituximab at a dose of 375 mg/m(2) once a week for a total of two doses. There was significant improvement in his thrombocytopaenia and anaemia 1 month after administration of rituximab. Although the total immunoglobulin G (IgG) level did not change, the titres of platelet-associated IgG (PA-IgG) and of an indirect antiglobulin test (IAT) decreased under the treatment with rituximab. It is suggested that rituximab would be a powerful candidate in the treatment of refractory Evans syndrome by depleting abnormal clone-producing autoantibody.

Phosphatidylserine receptor cooperates with high-density lipoprotein receptor in recognition of apoptotic cells by thymic nurse cells

The thymus contains many apoptotic cells that arise from the process of positive and negative selection. Both thymic macrophages and thymic nurse cells/nursing thymic epithelial cells (nursing TECs), non-professional phagocytes, recognize and ingest apoptotic cells without inflammation or tissue damage. Previously we reported that human scavenger receptor class B (SR-B1) is involved in recognition of apoptotic thymocytes by nursing TECs. In this study, we examined the expression and role of a phosphatidylserine receptor (PSR). This receptor is believed to participate in the clearance of apoptotic cells. PSR was strongly expressed in nursing TECs. Transforming growth factor-beta augmented the expression of PSR leading to enhanced binding of apoptotic cells to nursing TECs. In nursing TECs, suppressed expression of human SR-B1 with anti-PSR antibody decreased binding of apoptotic thymocytes to nursing TECs. Our results suggest that both PSR and SR-B1 are expressed in nursing TECs and these receptors appear to play a major role in the clearance of apoptotic cells from the thymus.

The multiple endocrine neoplasia type 1 gene product, menin, inhibits the human prolactin promoter activity

Menin is a protein encoded by the gene mutated in multiple endocrine neoplasia type 1 (MEN1) characterized by multiple endocrine tumors of the parathyroid glands, pancreatic islets and the anterior pituitary, especially prolactinoma. In this study, we examined the effects of menin on human prolactin (hPRL) expression. In rat pituitary GH3 cells stably expressing menin, both PRL gene expression/secretion and thymidine incorporation into DNA were inhibited as compared with mock-transfected cells. The transcriptional activity of PRL promoter in GH3 cells co-transfected with menin was significantly decreased. A deletion mutation (569 delC), which we identified in a Japanese MEN1 family, was introduced into menin. When GH3 cells were transfected with a mutant menin expression vector, inhibition of hPRL promoter activity was partially reversed. These observations suggest that menin inhibits hPRL promoter activity and cell proliferation, raising the possibility that menin might play an important role in the tumorigenesis of prolactinoma.

Clinical features of polymyositis/dermatomyositis associated with silicosis and a review of the literature

There are few reports which describe the association of polymyositis/dermatomyositis (PM/DM) and silicosis. The purpose of this study is to describe the clinical features of PM/DM associated with silicosis. We first describe clinical features of two cases and provide a review of the literature. Finally, seven patients with PM/DM associated with silicosis are retrospectively evaluated. There were one female and six males. Histological specimens were obtained by open lung biopsy in five cases and not examined in two. The mechanism of the association between silicosis and PM/DM is discussed.

Systematic characterization of human CD8+ T cells with natural killer cell markers in comparison with natural killer cells and normal CD8+ T cells

We investigated the function of CD56+ CD8+ T cells (CD56+ T cells) and CD56- CD57+ CD8+ T cells (CD57+ T cells; natural killer (NK)-type T cells) and compared them with those of normal CD56- CD57- CD8+ T cells (CD8+ T cells) and CD56+ NK cells from healthy volunteers. After the stimulation with immobilized anti-CD3 antibodies, both NK-type T cells produced much larger amounts of interferon-gamma (IFN-gamma) than CD8+ T cells. Both NK-type T cells also acquired a more potent cytotoxicity against NK-sensitive K562 cells than CD8+ T cells while only CD56+ T cells showed a potent cytotoxicity against NK-resistant Raji cells. After the stimulation with a combination of interleukin (IL)-2, IL-12 and IL-15, the IFN-gamma amounts produced were NK cells > or = CD56+ T cells > or = CD57+ T cells > CD8+ T cells. The cytotoxicities against K562 cells were NK cells > CD56+ T cells > or = CD57+ T cells > CD8+ T cells while cytotoxicities against Raji cells were CD56+ T cells > CD57+ T cells > or = CD8+ T cells > or = NK cells. However, the CD3-stimulated proliferation of both NK-type T cells was smaller than that of CD8+ T cells partly because NK-type T cells were susceptible to apoptosis. In addition to NK cells, NK-type T cells but not CD8+ T cells stimulated with cytokines, expressed cytoplasmic perforin and granzyme B. Furthermore, CD3-stimulated IFN-gamma production from peripheral blood mononuclear cells (PBMC) correlated with the proportions of CD57+ T cells in PBMC from donors. Our findings suggest that NK-type T cells play an important role in the T helper 1 responses and the immunological changes associated with ageing.

Growth hormone prevents Fas-induced apoptosis in lymphocytes through modulation of Bcl-2 and caspase-3

OBJECTIVE

Growth hormone (GH) has been reported to have a potent effect on the immune system. However, the detailed mechanism of the effect of GH on the immune system has not yet been clarified. This study was designed to investigate the nature of this mechanism.

METHODS

In the present study, we investigated the effects of GH on the susceptibility of both human CEM/C7 lymphocytes and human IM-9 lymphocytes to Fas-induced apoptosis.

RESULTS

Both cell lines expressed GH receptor mRNA. GH rescued Fas-induced suppression of [(3)H]-thymidine incorporation into each cell line. GH prevented Fas-induced apoptosis in each cell line without changing Fas antigen expression. We next investigated the mechanisms of the prevention of Fas-induced apoptosis, by focusing on intracellular molecules related to the apoptotic signal. Bcl-2 expression was increased by GH treatment in both CEM/C7 and IM-9 lymphocytes. GH also downregulated caspase-3 expression and inhibited activation of caspase-3 in both cell lines.

CONCLUSION

These findings suggest that GH regulates the human immune system through inhibition of Fas-induced apoptosis in activated T and B lymphocytes.