Searching for a prognostic index in lupus nephritis

BACKGROUND

Currently we do not have an ideal biomarker in lupus nephritis (LN) that should help us to identify those patients with SLE at risk of developing LN or to determine those patients at risk of renal progression. We aimed to evaluate the development of a prognostic index for LN, through the evaluation of clinical, analytical and histological factors used in a cohort of lupus. We have proposed to determine which factors, 6 months after the diagnosis of LN, could help us to define which patients will have a worse evolution of the disease and may be, more aggressive treatment and closer follow-up.

METHODS

A retrospective study to identify prognostic factors was carried out. We have included patients over 18 years of age with a clinical diagnosis of systemic lupus erythematosus (SLE) and kidney involvement confirmed by biopsy, who are followed up in our centre during the last 20 years. A multi-step statistical approach will be used in order to obtain a limited set of parameters, optimally selected and weighted, that show a satisfactory ability to discriminate between patients with different levels of prognosis.

RESULTS

We analysed 92 patients with LN, although only 73 have been able to be classified according to whether or not they have presented poor renal evolution. The age of onset (44 vs. 32; p = 0.024), the value of serum creatinine (1.41 vs. 1.04; p = 0.041), greater frequency of thrombocytopenia (30 vs. 7%; p = 0.038), higher score in the renal chronicity index (2.47 vs. 1.04; p = 0.015), proliferative histological type (100%) and higher frequency of interstitial fibrosis (67 vs. 32%; p = 0.017) and tubular atrophy (67 vs. 32%; p = 0.018) was observed between two groups. The multivariate analysis allowed us to select the best predictive model for poor outcome at 6 months based on different adjustment and discrimination parameters.

CONCLUSION

We have developed a prognostic index of poor renal evolution in patients with LN that combines demographic, clinical, analytical and histopathological factors, easy to use in routine clinical practice and that could be an effective tool in the early detection and management.

POS1212 SARS-CoV-2 VACCINE SAFETY IN ADOLESCENTS WITH INFLAMMATORY RHEUMATIC AND MUSCULOSKELETAL DISEASES AND ADULTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

There is a lack of data on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination safety in children and young people (CYP) with rheumatic and musculoskeletal diseases (RMDs). Current vaccination guidance is based on data from adults with RMDs or CYP without RMDs.

Objectives

To describe the characteristics and outcomes of adolescents with inflammatory RMDs and adults with juvenile idiopathic arthritis (JIA) vaccinated against SARS-CoV-2.

Methods

We described patient characteristics, flares, and adverse events in adolescent cases under 18 with inflammatory RMDs and adult cases aged 18 or above with JIA submitted to the European Alliance of Associations for Rheumatology (EULAR) COVAX registry.

Results

Thirty-six adolescent cases were reported from 4 countries, the most frequent diagnosis was JIA (42%). Over half (56%) reported early reactogenic-like adverse events (AEs) experienced within 7 days of vaccination. One mild polyarthralgia flare and one serious AE (malaise) were reported. No CYP reported SARS-CoV-2 infection post-vaccination.

In addition to the adolescent cases, eleven countries reported 74 adult JIA cases. Among these, 62% reported early reactogenic-like AEs and two flares were reported (mild polyarthralgia and moderate uveitis). No serious AEs of special interest were reported among adults with JIA. Three 20-30 year old females were diagnosed with SARS-CoV-2 post-vaccination; all fully recovered.

Conclusion

In this observational registry dataset, SARS-CoV-2 vaccines appeared safe in adolescents with RMDs and adults with JIA, with a low frequency of disease flares, serious AEs, and SARS-CoV-2 re-infection seen in both populations.

Table 1.

Characteristics of adolescents with RMDs and adults with JIA reported to the EULAR COVAX registry

Adolescents with RMDs (N=36)Adults with JIA (N=74)SexFemale21 (58)54 (73)Male15 (42)20 (27)Age (median [IQR])15 [14.5, 17]26 [23, 31]Primary RMD diagnosisNon-systemic JIA10 (28)63 (85)Systemic JIA5 (14)11 (15)Systemic lupus erythematosus5 (14)Spondyloarthritis/psoriatic arthritis5 (14)Vasculitis/other RMD #11 (30)RMD disease activityRemission23 (64)33 (45)Minimal8 (22)21 (28)Moderate2 (6)12 (16)Severe1 (3)1 (1)Not applicable/missing2 (6)7 (10)RMD medicationNone9 (25)3 (4)b-DMARD9 (25)50 (68)cs-DMARD21 (58)25 (34)ts-DMARD5 (14)2 (3)Systemic glucocorticoids5 (14)1 (1)Colchicine7 (10)Other immunosuppressant *COVAX typePfizer/BioNTech33 (92)50 (68)Moderna2 (6)10 (14)AstraZeneca/Oxford1 (3)10 (14)Janssen1 (1)CoronaVac2 (3)UNK1 (1)COVAX doses111 (31)8 (11)22 (24)61 (82)31 (3)5 (7)RMD flareYes1 (3)2 (3)AEYes20 (56)46 (62)Early AEInjection site pain8 (22)16 (22)Redness6 (17)2 (3)Muscle pain1 (3)9 (12)Joint pain4 (11)3 (4)Headache9 (25)10 (14)Fever1 (3)26 (35)Chills2 (6)5 (7)Fatigue1 (3)13 (18)VomitingAE of special interestNon-serious1 (3)1 (1)Serious – important medical event1 (3)

All data are N(%) of the column unless stated otherwise.

# Other RMD includes Sjogren’s syndrome, systemic sclerosis, undifferentiated connective tissue disease, non-monogenic auto-inflammatory syndrome, chronic recurrent multifocal osteomyelitis, and other inflammatory arthritis

* Other immunosuppressant includes ciclosporin, mycophenolate mofetil/mycophenolic acid.

RMD, rheumatic and musculoskeletal disease; JIA, juvenile idiopathic arthritis; EULAR, European Alliance of Associations for Rheumatology; ANCA-associated vasculitis, anti-neutrophil cytoplasmic antibody-associated vasculitis; cs-, conventional synthetic; b-, biological; ts-, targeted synthetic; DMARD, disease-modifying anti-rheumatic drug; COVAX, Coronavirus vaccine; AE, adverse event.

Acknowledgements

We wish to thank all healthcare providers who entered data into the registry.

Disclosure of Interests

Saskia Lawson-Tovey: None declared, Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, Pfizer, Elsa Mateus: None declared, Laure Gossec Consultant of: AbbVie, Amgen, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, Sandoz, Loreto Carmona: None declared, Pedro Machado Speakers bureau: AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche, UCB, Consultant of: AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche, UCB, BERND RAFFEINER: None declared, Inita Bulina Speakers bureau: AbbVie, Pfizer, Janssen, Boehringer Ingelheim, Daniel Clemente Speakers bureau: Novartis, GSK, Julija Zepa Speakers bureau: AbbVie, Novartis, Janssen/Johnson & Johnson, Ana Maria Rodrigues Speakers bureau: Amgen, AbbVie, Grant/research support from: Amgen, Pfizer, AstraZeneca, Xavier Mariette Consultant of: BMS, Galapagos, Gilead, Janssen, Novartis, Pfizer, Sanofi-Aventis, UCB, Grant/research support from: Ose, Kimme Hyrich Speakers bureau: AbbVie, Grant/research support from: Pfizer, BMS, UCB

OP0252 FACTORS ASSOCIATED WITH SEVERE COVID-19 OUTCOMES IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHY: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRY

Background

There is a paucity of data in the literature about the outcome of patients with idiopathic inflammatory myopathy (IIM) who have been infected with SARS-CoV-2.

Objectives

To investigate factors associated with severe COVID-19 outcomes in patients with IIM.

Methods

Data on demographics, number of comorbidities, region, COVID-19 time period, physician-reported disease activity, anti-rheumatic medication exposure at the clinical onset of COVID-19, and COVID-19 outcomes of IIM patients were obtained from the voluntary COVID-19 Global Rheumatology Alliance physician-reported registry of adults with rheumatic disease (from 17 March 2020 to 27 August 2021). An ordinal COVID-19 severity scale was used as primary outcome of interest, with each outcome category being mutually exclusive from the other:a) no hospitalization, b) hospitalization (and no death), or c) death. Odds ratios (OR) were estimated using multivariable ordinal logistic regression. In ordinal logistic regression, the effect size of a categorical predictor can be interpreted as the odds of being one level higher on the ordinal COVID-19 severity scale than the reference category.

Results

Complete hospitalization and death outcome data was available in 348 IIM cases. Mean age was 53 years, and 223 (64.1%) were female. Overall, 167/348 (48.0%) people were not hospitalized, 136/348 (39.1%) were hospitalized (and did not die), and 45/348 (12.9%) died. Older age (OR=1.59 per decade of life, 95%CI 1.32-1.93), male sex (OR=1.63, 95%CI 1.004-2.64; versus female), high disease activity (OR=4.05, 95%CI 1.29-12.76; versus remission), presence of two or more comorbidities (OR=2.39, 95%CI 1.22-4.68; versus none), prednisolone-equivalent dose >7.5 mg/day (OR=2.37, 95%CI 1.27-4.44; versus no glucocorticoid intake), and exposure to rituximab (OR=2.60, 95%CI 1.23-5.47; versus csDMARDs only) were associated with worse COVID-19 outcomes (Table 1).

Table 1.

Multivariable logistic regression analysis of factors associated with the ordinal COVID-19 severity outcomes. AZA, azathioprine; CI, confidence interval; combo, combination; CSA, ciclosporin; CYC, cyclophosphamide; DMARD, disease-modifying anti-rheumatic drug; b/tsDMARD, biologic/targeted synthetic DMARD, csDMARD, conventional synthetic DMARD; HCQ, hydroxychloroquine; IVIg, intravenous immunoglobulin; LEF, leflunomide; MMF, mycophenolate mofetil; mono, monotherapy; MTX, methotrexate; OR, odds ratio; Ref, reference; RTX, rituximab; SSZ, sulfasalazine; TAC, tacrolimus.

VariableOR (95%CI)P-valueVariableOR (95%CI)P-valueAge (per decade)1.59 (1.32-1.93)<0.001ComorbiditiesMale sex1.63 (1.004-2.64)0.048NoneRefNAPrednisolone-equivalent doseOne1.46 (0.79-2.72)0.228NoneRefNATwo or more2.39 (1.22-4.68)0.011>0 to 7.5mg/day1.10 (0.57-2.11)0.779Physician-reported disease activity>7.5mg/day2.37 (1.27-4.44)0.007RemissionRefNAIVIg0.41 (0.15-1.16)0.093Low/moderate1.23 (0.67-2.28)0.504DMARDsHigh4.05 (1.29-12.76)0.018csDMARD only (mono or combi - HCQ, MTX, LEF, SSZ)RefNARegionNo DMARD1.84 (0.90-3.75)0.094EuropeRefNAb/tsDMARD mono or combi (except RTX)1.60 (0.49-5.26)0.435North America0.89 (0.49-1.61)0.694CSA/CYC/TAC mono or combi (except RTX or b/tsDMARDs)1.55 (0.52-4.58)0.429Other4.25 (2.21-8.16)<0.001AZA mono1.70 (0.69-4.19)0.249Time periodMMF mono1.22 (0.53-2.82)0.634Before 15 June 2020RefNAAZA/MMF combi (except RTX or b/tsDMARDs)0.71 (0.25-2.00)0.51716 June - 30 September 20200.58 (0.26-1.27)0.171RTX mono or combi2.60 (1.23-5.47)0.012After 1 October 20200.58 (0.35-0.95)0.032

Conclusion

These are the first global registry data on the impact of COVID-19 on IIM patients. Older age, male gender, higher comorbidity burden, higher disease activity, higher glucocorticoid intake and rituximab exposure were associated with worse outcomes. These findings will inform risk stratification and management decisions for IIM patients.

References

None

Disclosure of Interests

Su-Ann Yeoh: None declared, Milena Gianfrancesco: None declared, Saskia Lawson-Tovey: None declared, Kimme Hyrich Speakers bureau: AbbVie unrelated to this work, Grant/research support from: Pfizer, BMS, both unrelated to this work, Anja Strangfeld Speakers bureau: AbbVie, Celltrion, MSD, Janssen, Lilly, Roche, BMS, Pfizer, all unrelated to this work, Laure Gossec Consultant of: AbbVie, Amgen, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, all unrelated to this work, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, Sandoz, all unrelated to this work, Loreto Carmona: None declared, Elsa Mateus Consultant of: Boehringer Ingelheim Portugal, not related to this work, Martin Schaefer: None declared, Christophe Richez Speakers bureau: Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this abstract, Consultant of: Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this abstract, Eric Hachulla Speakers bureau: Johnson & Johnson, GlaxoSmithKline, Roche-Chugai, all unrelated to this work, Consultant of: Bayer, Boehringer Ingelheim, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, all unrelated to this work, Grant/research support from: CSL Behring, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, all unrelated to this work, Marie Holmqvist: None declared, Carlo Alberto Scirè Grant/research support from: AbbVie, Lilly, both unrelated to this work, Rebecca Hasseli: None declared, Arundathi Jayatilleke: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Victor Pimentel-Quiroz: None declared, Monica Vasquez del Mercado: None declared, Samuel Katsuyuki Shinjo: None declared, Edgard Reis Neto: None declared, Laurindo Rocha Jr: None declared, Ana Carolina de Oliveira e Silva Montandon Speakers bureau: GSK, not related to this work, Paula Jordan: None declared, Emily Sirotich: None declared, Jonathan Hausmann Speakers bureau: Novartis, Biogen, Pfizer, not related to this work, Consultant of: Novartis, Biogen, Pfizer, not related to this work, Jean Liew Grant/research support from: Pfizer research grant, completed in 2021, not related to this work, Lindsay Jacobsohn: None declared, Monique Gore-Massy Speakers bureau: Aurinia Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, not related to this work, Consultant of: Aurinia Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, not related to this work, Paul Sufka: None declared, Rebecca Grainger Speakers bureau: AbbVie, Janssen, Novartis, Pfizer and Cornerstones, all unrelated to this work, Consultant of: AbbVie, Novartis, both unrelated to this work, Suleman Bhana Shareholder of: Pfizer, Inc, Speakers bureau: AbbVie, Horizon, Novartis, and Pfizer, all unrelated to this work, Consultant of: AbbVie, Horizon, Novartis, and Pfizer, all unrelated to this work, Employee of: Pfizer, Inc, Zachary Wallace: None declared, Philip Robinson Speakers bureau: Abbvie, Janssen, Roche, GSK, Novartis, Lilly, UCB, all unrelated to this work, Paid instructor for: Lilly, unrelated to this work, Consultant of: GSK, Kukdong, Atom Biosciences, UCB, all unrelated to this work, Grant/research support from: Janssen, Pfizer, UCB and Novartis, all unrelated to this work, Jinoos Yazdany Consultant of: Aurinia, Astra Zeneca, Pfizer, all unrelated to this work, Grant/research support from: Astra Zeneca, Gilead, BMS Foundation, all unrelated to this work, Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this work., Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this work.

POS1552-HPR A SYNTHESIS OF GUIDANCE AVAILABLE FOR ASSESSING METHODOLOGICAL QUALITY AND GRADING OF EVIDENCE FROM QUALITATIVE RESEARCH TO INFORM CLINICAL RECOMMENDATIONS: A SYSTEMATIC REVIEW

Background

Qualitative research is crucial to understand key stakeholders experiences and perspectives of care and health services. However, there is a lack of explicit frameworks and guidelines about how best to use qualitative evidence to formulate clinical recommendations. Part of the problem includes uncertainties about the contributions of qualitative research to the evidence, and the empirical and theoretical basis for appraising and synthesizing qualitative evidence in a standardized manner. In addition, most existing grading systems of qualitative research originates from quantitative research, and there is no clear guidance about how to incorporate qualitative research into the evidence hierarchy.

Objectives

To conduct a systematic literature review (SLR) to answer two research questions (RQ):

RQ1) What guidance (e.g., tools, checklists, frameworks) exists to assess the methodological quality of qualitative research employed to inform clinical recommendations?;

RQ2) What methods exist specifically to grade levels of evidence for qualitative research?

Methods

The protocol for this review was registered on www.researchregistry.com (reviewregistry1240). Electronic databases (PubMed/Medline, EMBASE, Web of Science, COCHRANE, Emcare, PsycINFO, ERIC, Academic Search Premier, Sociological Abstracts, ProQuest Dissertations and Thesis Global) were searched for published and unpublished studies. Searches were completed from inception to 23rd October 2020. No restrictions were applied to clinical population. Eligible studies for both questions included primary articles and guideline documents available in English, describing the: i) development; ii) application of validated tools (e.g., checklists); iii) guidance on how to assess methodological quality of qualitive research and iv) guidance on how to grade levels of qualitative evidence. Opinion pieces and conference abstracts were excluded. Manual searches of the reference lists of full text articles were conducted. Two reviewers independently screened the titles, abstracts, and full text. A narrative synthesis was conducted to identify key aspects between the included studies.

Results

9071 records were retrieved (Figure 1). After de-duplication and title/abstract screening, 51 full-articles articles were assessed for eligibility yielding 15 included articles. For RQ1, six articles were included that described six tools (1) The society for Critical Care Medicine Family – Cantered Care Guidelines; 2) Nursing Management of the Second Stage of Labour evidence based clinical practice guidelines; 3) Jonna Briggs Institute Critical Appraisal of Qualitative Studies; 4) Critical Skill’s Appraisal Programme (CASP) and 6) the Modified CASP checklist). All tools ranged from 10 to 30 items, and evaluated research design, recruitment, ethical rigour, data collection and data analysis. Seven articles described one approach (GRADE CER-Qual) to assess methodological quality of qualitative research. This approach advised on the importance for assessing methodological limitations. For RQ2, two articles were included, one described a qualitative hierarchy of evidence, and another described a research pyramid that included a section on qualitative research.

Figure 1.

PRISMA diagram of included papers

Conclusion

This review highlights lack of consensus and limited availability of tools, checklists, and approaches to 1) appraise the methodological quality of qualitative research used to inform clinical recommendations and 2) grade levels of evidence for qualitative research. Current research agendas will need to determine the most relevant and appropriate method for the quality appraisal of qualitative research. This way, qualitative research could be more consistently and appropriately applied to the development of clinical recommendations.

References

N/A

Disclosure of Interests

Mandeep Sekhon: None declared, Annette de Thurah: None declared, George E. Fragoulis: None declared, Tanja Stamm: None declared, T.P.M. Vliet Vlieland: None declared, Bente Appel Esbensen: None declared, Heidi Lempp: None declared, Lindsay Bearne: None declared, Marios Kouloumas: None declared, Polina Pchelnikova: None declared, Thijs W. Swinnen: None declared, Chris Blunt: None declared, Ricardo J. O. Ferreira: None declared, Loreto Carmona: None declared, Elena Nikiphorou Speakers bureau: Celltrion, Pfizer, Sanofi, Gilead, Galapgos, AbbVie, Eli Lilly, Grant/research support from: Pfizer, Eli Lilly

POS0156 PATIENT INVOLVEMENT IN REGISTRIES BASED RESEARCH

Background

Patient research partners (PRPs) are increasingly included in research as well as guideline development task forces in rheumatology. In observational and registry studies the role and involvement of PRPs is not clear.

Objectives

We aimed to evaluate current PRP involvement in registry research as well as benefits and barriers of implementation in practice.

Methods

Based on a round table discussion during the EULAR Registries and observational drug studies meeting (RODS) in 2019 we used mixed methods methodology (survey and focus groups) to study the role of PRPs and involvement in research. The survey was sent to investigators of registries across Europe, participants of RODS meetings and members of the EULAR PARE (People with Arthritis / Rheumatism across Europe) network. Interested survey participants were further invited to one of three focus groups. The conduction of the focus groups (FG) was guided by a semi-structured guide based on the survey results. An inductive thematic analysis approach was applied to qualitative data.

Results

We received 45 survey responses with around half of them from patients. The mean importance of PRP involvement was scored VAS±SD: 75±24mm (on a 100mm VAS), but the actual involvement was rather low (VAS: 32±20mm) and 12 participants had no experience with PRPs. The most common current practice was patient involvement in design of studies (32%), cooperation with patient organisation for recruitment (32%) and involvement of PRPs in the management board (32%). The most important need of PRP integration was attributed in the stages of design and preparation before recruitment. 11 survey participants even indicated that PRPs should be involved in all stages/tasks of research. During the focus groups 5 main themes (Table 1) could be identified. Complementary perspectives lead to greater synergy between researchers and patients and further the aim of deriving more valid outcomes. For successful involvement of PRPs, ideally PRPs should be heterogeneous in regard to their lived experience, education ought to be provided and researchers are responsible to offer an environment where PRPs feel comfortable. All FGs elaborated on different roles that PRPs can take on, although the researcher FGs outlined more different tasks of involvement than the PRP group. One theme summarised different barriers for PRP involvement, which have not been a topic of discussion in the FG composed of PRPs only.

Table 1.

Overview of themes, sub-themes, and presence of theme according to which focus group discussion.

ThemeSub themeFocus GroupsResearcherResearcher and ProfessionalsPRPs1.Current experiences of PRPs involvement in researchResearcher experiences of involving PRPsXXPatient experiences of being involved as PRPsXX2.The role of PRP in registries and researchComplementary perspectives between researchers and PRPsXXXThe aim of patient involvement in researchX3.Points to consider for involving PRPs in researchConsider professional and social backgroundsXProvide PRPs education and trainingXXA welcoming environment for PRPs to contributeXX4.PRP involvement in different phases of the research processGive PRPs a voice in research committeesXXIdentify questions that are most relevant to patientsXXSelect the most relevant outcomes to patientsXXImprove recruitment strategiesXanalysis, interpretation and dissemination of resultsXX5.Barriers to involving PRPs in researchRecruiting PRPs from ethnic minoritiesXResearchers’ preconceptions of patients’ ability to be involved in researchXChallenging to ask patients to help analyse quantitative dataXLimited financial resourcesXFigure 1.

the empirical research cycle - basis for discussion of the role, opportunities & challenges for patient research partners in registry and observational drug study research. X/Y indicates the number of votes for including PRPs at the respective stage.

Conclusion

There is room and much appreciation of PRP involvement in registry research. Researchers and PRPs could use the strategies proposed in this study to define PRP roles and plans of ongoing and future studies.

Disclosure of Interests

Paul Studenic: None declared, Mandeep Sekhon: None declared, Loreto Carmona: None declared, Maarten de Wit: None declared, Elena Nikiphorou Speakers bureau: Celltrion, Pfizer, Sanofi, Gilead, Galpagos, Abbvie, Eli Lilly, Grant/research support from: Pfizer, Eli Lilly

OP0213-HPR RECOMMENDATIONS FOR NURSES IN THE MANAGEMENT OF RA PATIENTS ON TREATMENT WITH JAKINIBS

Background

The number of new treatments available in rheumatology continues to increase. Kinase inhibitors, or jakinibs, pose an added challenge due to their variety and because they are oral. The most important role of the rheumatology nurse is patient education, especially on how to take the medication. The better the nurse understands the drugs, the better their practical recommendations and decisions will be and the better they will be able to respond to the patient. Guidelines or recommendations for inflammatory diseases do not usually include key practical details for nurses. It is our understanding that these points that will subsequently determine adherence and safety should be specially addressed in a specific document for nurses.

Objectives

To establish practical, evidence-based nursing recommendations for the management of people with RA undergoing treatment with jakinibs.

Methods

To reach an evidence-based consensus we used systematic review and Delphi survey. A multidisciplinary panel of experts was formed with 6 rheumatology nurses, 2 rheumatologists, 1 psychologist, 1 dietician-nutritionist and 1 patient on treatment with jakinibs. This panel met on 2 occasions and was kept informed at all times of the progress of the project through the Miro platform. At the preparatory meeting the scope and users, structure and PICOt questions were established (these included efficacy and adverse effects, infections, cardiovascular risk, surgery, vaccination, pregnancy and breastfeeding, interactions and switches between jakinibs).

The steering group made recommendations based on the issues raised at the first meeting. Only those that achieved 65% in favour were included as items in a Delphi survey. The Delphi survey was sent to all members of the society nurses and rheumatologists (n=60). Voting ranged from 0 to 10 (strongly disagree to strongly agree). Items with more than 75% agreement in the first round did not proceed to a second round.

Results

The Table 1 shows the recommendations with their level of evidence and level of agreement after the Delphi (n=40; 67%). One item with only 50% agreement was rejected and did not proceed to a second round.

Table 1.RecommendationLevel of evidenceDegree of agreementBefore starting treatment with a jakinib, it should be confirmed that the patient has no contraindications.5100%The patient’s efficacy and outcome expectations for the drug should be explored and those that need to be adjusted.585%It should be indicated that a double dose should not be taken if one is missed.4100%As with other DMARDs, the patient should be instructed that close management will follow.599%The use of contraception and discontinuation of the drug is recommended in case of gestational desire or unplanned pregnancy.396%It is recommended to explain the warning signs of infection: fever, blisters, burning pain in the ribs, itching when urinating, productive cough, diarrhoea, pus-filled wounds, phlegmon.1a100%It is recommended to instruct the patient on preventive measures for infectious diseases (dental and hand hygiene, HPV, social distance, etc.).1a89%Vaccination against common germs in immunocompromised persons and shingles with the current vaccine is recommended.1a93%CV risk factors should be monitored, and the patient trained for signs of thrombosis, HF or ischaemic heart disease.1a89%Close monitoring of elderly patients (CV risk, infections) is recommended.2100%Emphasis on adherence is recommended for jakinibs to be effective.3100%Before surgery, discontinuation of jakinib should be scheduled depending on the type of surgery and comorbidities.389%

Conclusion

These recommendations will allow a practical approach to the management of jakinibs by nurses and enjoy an adequate consensus among potential users.

Disclosure of Interests

José Maria Martín Martín Speakers bureau: Lilly, Consultant of: Lilly, Grant/research support from: Galapagos, Silvia García-Díaz Grant/research support from: Galapagos, Amparo Molina Grant/research support from: Galapagos, Carmen Dominguez Grant/research support from: Galapagos, Loreto Carmona: None declared, Laura Cano Garcia Grant/research support from: Galapagos

OP0249 CHARACTERISTICS ASSOCIATED WITH POOR COVID-19 OUTCOMES IN PEOPLE WITH PSORIASIS AND SPONDYLOARTHRITIS: DATA FROM THE COVID-19 PsoProtect AND GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRIES

Background

Some factors associated with severe COVID-19 outcomes have been identified in patients with psoriasis (PsO) and inflammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specificities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifically licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking.

Objectives

To determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA.

Methods

This study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defined as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, leflunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects.

Results

A total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56; other CVD alone: 1.89, 1.22-2.94; vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71; DM alone: 1.85, 1.39-2.47; obesity and DM: 1.89, 1.34-2.67; vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82; moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72; moderate/severe disease activity and GC intake 2.30, 1.41-3.74; vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51; 1 January 2021 onwards: 0.52, 0.41-0.67; vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65; vs PsA), and exposure to TNFi (0.58, 0.45-0.75; vs no DMARDs), IL17i (0.63, 0.45-0.88; vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997; vs no DMARDs) and NSAIDs (0.77, 0.60-0.98; vs no NSAIDs).

Conclusion

More severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.

Acknowledgements

We thank all the contributors to the COVID-19 PsoProtect, GRA and EULAR Registries.

Disclosure of Interests

None declared

AB0373 PSYCHOMETRIC PROPERTIES OF OUTCOME MEASUREMENT INSTRUMENTS FOR LARGE VESSEL VASCULITIS: A SYSTEMATIC LITERATURE REVIEW

Background:

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are two forms of chronic progressive large-vessel vasculitis (LVV) of unknown etiology. In 2016, the OMERACT Vasculitis Working Group proposed the development of a Core Domain Set of outcome measures for LVV including organ and arterial function, fatigue, pain, biomarkers, and death (1). Understanding the psychometric properties of outcome measurement instruments is essential when selecting among instruments to use in research; a summary of such properties for measures of LVV has not been developed.

Objectives:

To systematically review and summarize the psychometric properties of outcome measurement instruments used to measure the domains of the OMERACT core domain set for LVV.

Methods:

A comprehensive search of several databases (Medline, EMBASE, Cochrane, among others) from inception to July 14, 2020 was conducted. Articles were included if they covered psychometric properties of instruments used in LVV. Following the COSMIN and OMERACT frameworks, different psychometric properties (validity, inter- and intra-observer reliability, sensitivity to change, and feasibility) of outcome measurement instruments used in LVV (GCA and TAK) were assessed. Risk of bias was assessed according to the COSMIN checklist.

Results:

Among the 3534 articles identified, 15 studies focusing on the development or validation of psychometric properties on LVV met the predefined criteria. Two were development studies and 13 were validation studies. These studies provided information on 13 instruments: 5 instruments specific to TAK, 2 specific to systemic vasculitides, and 6 general, non-disease-specific instruments. No instruments specific to GCA were identified.

Of the main psychometric properties assessed in the included studies, 40% had a low, 47% had moderate, and 13% had high risk of bias. Construct validity was the property most frequently assessed (in 93% of the tools) (Figure 1).

In TAK, the Indian Takayasu Clinical Activity Score 2010 (ITAS2010) showed good consistency (r=0.97), reliability (intra-observer, ICC=0.60; inter-observer, ICC=0.92) and validity (correlation with Physician Global Assessment (PGA) (r=0.73)) for disease activity. Regarding disease damage, the Disease Extent Index-Takayasu (DEI-Tak) showed good validity (correlation with NIH score 94%, k=0.85). Non-specific vasculitis instruments such as the Vasculitis Damage Index (VDI) and the Birmingham Vasculitis Activity Score (BVAS) showed moderate validity in the assessment of disease damage in GCA (cumulative glucocorticoid dose and disease duration, r=0.30 and r=0.29) and TAK (cumulative glucocorticoid dose and disease duration, r=0.29 and r=0.25) in the former and disease activity in GCA in the later (PGA, r=0.50).

Six non-vasculitis-specific patient-reported outcomes (PROs) instruments were identified, all showing low to moderate validity in GCA/TAK.

Conclusion:

The psychometric properties of 13 outcome measures to study LVV covering the OMERACT domains of disease activity, damage, and patient-reported outcomes were assessed. ITAS2010, DEI-Tak, VDI, and BVAS were the instruments with better psychometric properties for disease activity and/or damage. Disease activity and/or damage instruments specific for GCA, and validated PROs for both GCA and TAK are needed.

References:

[1]Sreih GA, Alibaz-Oner F, Kermani TA, Aydin SZ, Cronholm PF, Davis T, et al. Development of a Core Set of Outcome Measures for Large-vessel Vasculitis: Report from OMERACT 2016 | The Journal of Rheumatology [Internet]. [cité 26 avr 2020]. Disponible sur: http://www.jrheum.org/content/44/12/1933.long

Disclosure of Interests:

None declared

OP0286 CHARACTERISTICS ASSOCIATED WITH SEVERE COVID-19 OUTCOMES IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE (COVID-19 GRA)

Background:

An increased risk of severe COVID-19 outcomes may be seen in patients with autoimmune diseases on moderate to high daily doses of glucocorticoids, as well as in those with comorbidities. However, specific information about COVID-19 outcomes in SLE is scarce.

Objectives:

To determine the characteristics associated with severe COVID-19 outcomes in a multi-national cross-sectional registry of COVID-19 patients with SLE.

Methods:

SLE adult patients from a physician-reported registry of the COVID-19 GRA were studied. Variables collected at COVID-19 diagnosis included age, sex, race/ethnicity, region, comorbidities, disease activity, time period of COVID-19 diagnosis, glucocorticoid (GC) dose, and immunomodulatory therapy. Immunomodulatory therapy was categorized as: antimalarials only, no SLE therapy, traditional immunosuppressive (IS) drug monotherapy, biologics/targeted synthetic IS drug monotherapy, and biologic and traditional IS drug combination therapy. We used an ordinal COVID-19 severity outcome defined as: not hospitalized/hospitalized without supplementary oxygen; hospitalized with non-invasive ventilation; hospitalized with mechanical ventilation/extracorporeal membrane oxygenation; and death. An ordinal logistic regression model was constructed to assess the association between demographic characteristics, comorbidities, medications, disease activity and COVID-19 severity. This assumed that the relationship between each pair of outcome groups is of the same direction and magnitude.

Results:

Of 1069 SLE patients included, 1047 (89.6%) were female, with a mean age of 44.5 (SD: 14.1) years. Patient outcomes included 815 (78.8%) not hospitalized/hospitalized without supplementary oxygen; 116 (11.2) hospitalized with non-invasive ventilation, 25 (2.4%) hospitalized with mechanical ventilation/extracorporeal membrane oxygenation and 78 (7.5%) died. In a multivariate model (n=804), increased age [OR=1.03 (1.01, 1.04)], male sex [OR =1.93 (1.21, 3.08)], COVID-19 diagnosis between June 2020 and January 2021 (OR =1.87 (1.17, 3.00)), no IS drug use [OR =2.29 (1.34, 3.91)], chronic renal disease [OR =2.34 (1.48, 3.70)], cardiovascular disease [OR =1.93 (1.34, 3.91)] and moderate/high disease activity [OR =2.24 (1.46, 3.43)] were associated with more severe COVID-19 outcomes. Compared with no use of GC, patients using GC had a higher odds of poor outcome: 0-5 mg/d, OR =1.98 (1.33, 2.96); 5-10 mg/d, OR =2.88 (1.27, 6.56); >10 mg/d, OR =2.01 (1.26, 3.21) (Table 1).

Table 1.

Characteristics associated with more severe COVID-19 outcomes in SLE. (N=804)

OR (95% CI)Age, years1.03 (1.01, 1.04)Sex, Male1.93 (1.21, 3.08)Race/Ethnicity, Non-White vs White1.47 (0.87, 2.50)RegionEuropeRef.North America0.67 (0.29, 1.54)South America0.67 (0.29, 1.54)Other1.93 (0.85, 4.39)Season, June 16th 2020-January 8th 2021 vs January-June 15th 20201.87 (1.17, 3.00)Glucocorticoids0 mg/dayRef.0-5 mg/day1.98 (1.33, 2.96)5-10 mg/day2.88 (1.27, 6.56)=>10 mg/day2.01 (1.26, 3.21)Medication CategoryAntimalarial onlyRef.No IS drugs2.29 (1.34, 3.91)Traditional IS drugs as monotherapy1.17 (0.77, 1.77)b/ts IS drugs as monotherapy1.00 (0.37, 2.71)Combination of traditional and b/ts IS1.00 (0.55, 1.82)Comorbidity BurdenNumber of Comorbidities (excluding renal and cardiovascular disease)1.39 (0.97, 1.99)Chronic renal disease2.34 (1.48, 3.70)Cardiovascular disease1.93 (1.34, 3.91)Disease Activity, Moderate/ high vs Remission/ low 2.24 (1.46, 3.43)

IS: immunosuppressive. b/ts: biologics/targeted synthetics

Conclusion:

Increased age, male sex, glucocorticoid use, chronic renal disease, cardiovascular disease and moderate/high disease activity at time of COVID-19 diagnosis were associated with more severe COVID-19 outcomes in SLE. Potential limitations include possible selection bias (physician reporting), the cross-sectional nature of the data, and the assumptions underlying the outcomes modelling.

Acknowledgements:

The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the ACR, EULAR) the UK National Health Service, the National Institute for Health Research (NIHR), or the UK Department of Health, or any other organization.

Disclosure of Interests:

Manuel F. Ugarte-Gil Grant/research support from: Pfizer, Janssen, Graciela S Alarcon: None declared, Andrea Seet: None declared, Zara Izadi: None declared, Cristina Reategui Sokolova: None declared, Ann E Clarke Consultant of: AstraZeneca, BristolMyersSquibb, GlaxoSmithKline, Exagen Diagnostics, Leanna Wise: None declared, Guillermo Pons-Estel: None declared, Maria Jose Santos: None declared, Sasha Bernatsky: None declared, Lauren Mathias: None declared, Nathan Lim: None declared, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum unrelated to this work., Grant/research support from: Amgen and Bristol-Myers Squibb, Zachary Wallace Consultant of: Viela Bio and MedPace, Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi, Kimme Hyrich Speakers bureau: Abbvie, Grant/research support from: MS, UCB, and Pfizer, Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, Pfizer, Grant/research support from: AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB, Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, Grant/research support from: Lilly, Mylan, Pfizer, Loreto Carmona: None declared, Elsa Mateus Grant/research support from: Pfizer, Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA, Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Patti Katz: None declared, Lindsay Jacobsohn: None declared, Samar Al Emadi: None declared, Emily Gilbert: None declared, Ali Duarte-Garcia: None declared, Maria Valenzuela-Almada: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Philippe Dieudé Consultant of: Boerhinger Ingelheim, Bristol-Myers Squibb, Lilly, Sanofi, Pfizer, Chugai, Roche, Janssen unrelated to this work, Grant/research support from: Bristol-Myers Squibb, Chugaii, Pfizer, unrelated to this work, Elena Nikiphorou: None declared, Vanessa Kronzer: None declared, Namrata Singh: None declared, Beth Wallace: None declared, Akpabio Akpabio: None declared, Ranjeny Thomas: None declared, Suleman Bhana Consultant of: AbbVie, Horizon, Novartis, and Pfizer (all <$10,000) unrelated to this work, Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones, Jonathan Hausmann Consultant of: Novartis, Sobi, Biogen, all unrelated to this work (<$10,000), Jean Liew Grant/research support from: Pfizer outside the submitted work, Emily Sirotich Grant/research support from: Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer based organization whose activities are largely supported by independent grants from pharmaceutical companies, Paul Sufka: None declared, Philip Robinson Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000), Milena Gianfrancesco: None declared, Jinoos Yazdany Consultant of: Eli Lilly and AstraZeneca unrelated to this project

AB0677 GENDER DIFFERENCES ON THE IMPACT OF THE COVID-19 PANDEMIC AND LOCKDOWN IN PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The COVID-19 pandemic has impacted health, lifestyle, treatment and healthcare of European patients with rheumatic and musculoskeletal diseases (RMDs).

Objectives:

The aim is to evaluate gender differences on the impact of the first wave of the COVID-19 pandemic in the wellbeing, life habits, treatment, and healthcare access of European patients with RMDs.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs, recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom during the first phase of the pandemic (April-July 2020). Mann-Whitney and χ2 tests were used to analyse differences between gender regarding sociodemographic characteristics, life style, treatment, healthcare, and patient-reported outcomes.

Results:

1,797 patients were included in this analysis. 80.2% were female and a mean age of 52.6 years. The most common diagnosis was inflammatory arthritis (81.7% male vs 73.8% female). There was a higher prevalence of fibromyalgia among females (20% vs 7.0% male). Overall, females reported worse self-perceived health (67.0% vs 51.4%, p<0.001), higher risk of anxiety (59.5% vs 48.1%, p<0.001), and depression (48.0% vs 37.2%, p<0.001). Females reported a greater increase in smoking (26.5% vs 17.5%, p=0.001), although they were less likely to drink alcohol (34.5% vs 25.4%, p=0.013), and also engaged less in physical activity (53.0% vs 60.3%, p=0.045). Overall, females were more likely to keep their scheduled rheumatology appointment (43.3% vs 34.1% of males (p=0.049; Table 1) with a higher proportion of females having their rheumatic treatment changed (17.0% vs 10.7%, p=0.005).

Conclusion:

The first wave of the COVID-19 pandemic and the containment measures have worsened self-perceived health status of patients with RMDs, affecting genders differently. Females reported worse psychological health and life habits such as increased smoking and reduced physical activity, while males increased their alcohol consumption and were less likely to attend their rheumatology appointments.

Table 1.

Bivariate analysis by gender (N= 1,797 unless specify)

Mean ± SD or n (%)P- valueMale(N= 355)Female(N= 1,442)Sociodemographic characteristicsDiseaseInflammatory arthritis1290 (81.7)1,064 (73.8)Fibromyalgia25 (7.0)287 (19.9)Connective tissue disease218 (5.1)195 (13.5)Osteoarthritis52 (14.6)255 (17.7)Osteoporosis10 (2.8)104 (7.2)Vasculitis37 (2.0)29 (2.0)SAPHO1 (0.3)14 (1.0)Age, years52.8 ± 14.252.5 ± 12.90.896Educational levelUniversity162 (45.6)711 (49.3)0.215Marital statusMarried or in relationship269 (75.8)983 (68.2)0.002*Member of a Patient organisation, N=1,795Yes188 (53.0)559 (38.8)<0.001*Patient-reported outcomesHADS Anxiety, N=1,766Risk168 (48.1)843 (59.5)<0.001*HADS Depression, N=1,766Risk130 (37.2)680 (48.0)<0.001*Wellbeing, N=1,774WHO-5 ≤ 50188 (53.4)681 (47.9)0.064Self-perceived health, N=1,783Fair or bad182 (51.4)958 (67.0)<0.001*Change in health status during COVID-19 pandemic, N=1,783Worse333 (94.1)1,339 (93.7)0.799Life style during COVID-19 pandemicSmoking, N=555More than before20 (17.5)117 (26.5)0.001*Alcohol consumption, N=1,083Quit drinking71 (25.4)277 (34.5)0.013Physical activity, N=1,126Yes144 (60.3)470 (53.0)0.045*Treatment and healthcareAble to meet rheumatologist, N= 721No89 (65.9)332 (56.7)0.049*Access to GP, N=688No43 (39.4)248 (42.8)0.512

1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, LAURENT GRANGE: None declared, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB., Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

POS0248 PSYCHOMETRIC PROPERTIES OF OUTCOME MEASUREMENT INSTRUMENTS FOR ANCA-ASSOCIATED VASCULITIS: A SYSTEMATIC LITERATURE REVIEW

Background:

The OMERACT Vasculitis Working Group has defined a Core Domain Set of outcome measures for ANCA-associated vasculitis (AAV). However, the psychometric properties of available outcome measurement instruments in AAV, an essential consideration when choosing among instruments, have not been summarized.

Objectives:

To systematically review and summarize the psychometric properties of outcome measurement instruments used in AAV.

Methods:

A comprehensive search of several databases (Medline, EMBASE, Cochrane, Scopus, among others) from inception to July 14, 2020 and without language limitations was conducted. Articles were included if they covered psychometric properties of instruments used in AAV (granulomatosis with polyangiitis, GPA; microscopic polyangiitis, MPA; eosinophilic granulomatosis with polyangiitis, EGPA); articles encompassing other systemic vasculitides and not presenting the data for AAV separately were excluded. Following the COSMIN and OMERACT frameworks, different psychometric properties (validity, inter- and intra-observer reliability, sensitivity to change, and feasibility) of outcome measurement instruments used in AAV were assessed. Risk of bias was assessed according to the COSMIN checklist.

Results:

From 2505 articles identified, 20 met the predefined criteria. Three were identified as development studies, 14 were validation studies, and 3 pursued both objectives.

These studies provided information on 16 instruments: 8 assessing disease activity, 1 assessing disease damage, 3 assessing patient-reported outcome, 4 assessing function (Figure 1). Overall, a few psychometric properties have been considered in each study, ranging from one to five. Most of the instruments were tested in GPA only (n=7), followed by AAV as a group (GPA, MPA and EGPA; n=5), MPA and GPA (n=3), and EGPA only (n=1). Sample sizes of the studies ranged between 27 and 626 patients. The studies with a higher risk of bias, according to COSMIN definitions, were those assessing RAPID3, MVIA, ENT/GPA DAS, and ODSS.

There was a wide heterogeneity of the psychometric proprieties assessed for each instrument. Validity was the most frequently assessed domain in 88% of the instruments, and few properties other than construct validity were reported (Figure 1).

Within each domain, BVAS/WG for activity, VDI for damage, AAV-PRO for patient-reported outcomes, and ODSS for function were the instruments with more psychometric features assessed. For the disease activity domain, BVAS/WG showed a good validity having the highest correlation with physician global assessment (r=0.90), a good reliability (intra-observer ICC=0.62; inter-observer ICC=0.97), and good feasibility and responsiveness. For disease damage, VDI showed moderate validity (correlations with BVAS/WG at 5-year with r=0.20 and BVAS/WG at 1-year with r=0.40) and good feasibility. Among patient-reported outcomes, AAV-PRO had the best performance in terms of validity (construct validity: correlations of the 6 disease domains and EQ-5D-5L, with r ranging between -0.78 and -0.55; discriminating validity between active disease versus remission of the 6 disease domains, p<0.0001 for all comparisons). The performance of instruments assessing function domain was low-to-moderate.

Conclusion:

Sixteen instruments covering the OMERACT domains of disease activity, damage, patient-reported outcome, and function had their psychometric properties assessed in the study of AAV. The majority were developed or validated for GPA only or AAV as a group. Overall, validity was the domain most frequently assessed. BVAS/WG, VDI, AAV-PRO, and ODSS were the instruments with more psychometric features assessed. More rigorous studies aimed at estimating a wider range of psychometric properties in larger numbers of patients with AAV are warranted.

References:

[1]Castrejon I, et al. Clin Exp Rheumatol. 2015

[2]Merkel PA, Journal of Rheumatology, July 2011

Disclosure of Interests:

None declared

OP0288 MACHINE LEARNING ALGORITHMS TO PREDICT COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME IN PATIENTS WITH RHEUMATIC DISEASES: RESULTS FROM THE GLOBAL RHEUMATOLOGY ALLIANCE PROVIDER REGISTRY

Background:

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening complication of COVID-19 and has been reported in approximately one-third of hospitalized patients with COVID-191. Risk factors associated with the development of ARDS include older age and diabetes2. However, little is known about factors associated with ARDS in the setting of COVID-19, in patients with rheumatic disease or those receiving immunosuppressive medications. Prediction algorithms using traditional regression methods perform poorly with rare outcomes, often yielding high specificity but very low sensitivity. Machine learning algorithms optimized for rare events are an alternative approach with potentially improved sensitivity for rare events, such as ARDS in COVID-19 among patients with rheumatic disease.

Objectives:

We aimed to develop a prediction model for ARDS in people with COVID-19 and pre-existing rheumatic disease using a series of machine learning algorithms and to identify risk factors associated with ARDS in this population.

Methods:

We used data from the COVID-19 Global Rheumatology Alliance (GRA) Registry from March 24 to Nov 1, 2020. ARDS diagnosis was indicated by the reporting clinician. Five machine learning algorithms optimized for rare events predicted ARDS using 42 variables covering patient demographics, rheumatic disease diagnoses, medications used at the time of COVID-19 diagnosis, and comorbidities. Model performance was assessed using accuracy, area under curve, sensitivity, specificity, positive predictive value, and negative predictive value. Adjusted odds ratios corresponding to the 10 most influential predictors from the best performing model were derived using hierarchical multivariate mixed-effects logistic regression that accounted for within-country correlations.

Results:

A total of 5,931 COVID-19 cases from 67 countries were included in the analysis. Mean (SD) age was 54.9 (16.0) years, 4,152 (70.0%) were female, and 2,399 (40.5%) were hospitalized. ARDS was reported in 388 (6.5% of total and 15.6% of hospitalized) cases. Statistically significant differences in the risk of ARDS were observed by demographics, diagnoses, medications, and comorbidities using unadjusted univariate comparisons (data not shown). Gradient boosting machine (GBM) had the highest sensitivity (0.81) and was considered the best performing model (Table 1). Hypertension, interstitial lung disease, kidney disease, diabetes, older age, glucocorticoids, and anti-CD20 monoclonal antibodies were associated with the development of ARDS while tumor necrosis factor inhibitors were associated with a protective effect (Figure 1).

Table 1.

Performance of machine learning algorithms.

GBMSVMGLMNETNNETRFAccuracy0.790.680.660.660.67AUC0.750.700.740.580.74Sensitivity0.810.680.650.680.67Specificity0.490.600.730.480.68PPV0.960.960.970.950.97NPV0.160.120.130.090.13

GBM: Gradient Boosting Machine, SVM: Support vector machines, GLMNET: Lasso and Elastic-Net Regularized Generalized Linear Models, NNET: Neural Networks, RF: Random Forest. AUC: Area Under Curve; PPV: Positive Predictive Value; NPV: Negative Predictive Value.

Conclusion:

In this global cohort of patients with rheumatic disease, a machine learning model, GBM, predicted the onset of ARDS with 81% sensitivity using baseline information obtained at the time of COVID-19 diagnosis. These results identify patients who may be at higher risk of severe COVID-19 outcomes. Further studies are necessary to validate the proposed prediction model in external cohorts and to evaluate its clinical utility. Disclaimer: The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance, and do not necessarily represent the views of the ACR, NIH, (UK) NHS, NIHR, or the department of Health.

References:

[1]Tzotzos SJ, Fischer B, Fischer H, Zeitlinger M. 2020;24(1):516.

[2]Wu C, Chen X, Cai Y, et al. JAMA Intern Med. 2020;180(7):934-943.

Acknowledgements:

The COVID-19 Global Rheumatology Alliance.

Disclosure of Interests:

Zara Izadi: None declared, Milena Gianfrancesco: None declared, Kimme Hyrich Speakers bureau: Abbvie and grant income from BMS, UCB, and Pfizer, all unrelated to this study., Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work., Grant/research support from: A consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB) supporting the German RABBIT register., Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB., Grant/research support from: Lilly, Mylan, Pfizer, all unrelated to this study., Loreto Carmona Consultant of: Loreto Carmona’s institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis, Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH, and UCB Pharma., Elsa Mateus Grant/research support from: LPCDR received grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA and Pfizer., Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Lindsay Jacobsohn: None declared, Patti Katz: None declared, Samar Al Emadi: None declared, Leanna Wise: None declared, Emily Gilbert: None declared, Maria Valenzuela-Almada: None declared, Ali Duarte-Garcia: None declared, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum unrelated to this work., Grant/research support from: Amgen and Bristol-Myers Squibb., Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Suleman Bhana Employee of: Suleman Bhana reports non-branded marketing campaigns for Novartis (<$10,000)., Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones and travel assistance from Pfizer (all < $10,000)., Jonathan Hausmann Consultant of: Novartis, unrelated to this work (<$10,000)., Jean Liew Grant/research support from: Pfizer, outside the submitted work., Emily Sirotich Grant/research support from: Emily Sirotich is a Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer-based organization whose activities are largely supported by independent grants from pharmaceutical companies., Paul Sufka: None declared, Zachary Wallace Consultant of: Viela Bio and MedPace, outside the submitted work., Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi., Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Philip Robinson Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB and travel assistance from Roche (all < $10,000)., Jinoos Yazdany Consultant of: Eli Lilly and Astra Zeneca, unrelated to this project.

POS1213 IMPACT OF THE COVID-19 PANDEMIC AND LOCKDOWN ON WELLBEING ON PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The COVID-19 pandemic has impacted the wellbeing of patients with Rheumatic and Musculoskeletal Diseases (RMDs).

Objectives:

The aim is to assess emotional well-being and its associated factors in patients with RMDs during the first wave of the COVID-19 pandemic.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. 1,800 participants were recruited by patient organisations. Data was collected between April and July 2020. Participants were divided into two groups: 1) Participants with poor wellbeing (World Health Organization-Five Wellbeing Index (WHO-5) ≤ 50), 2) Participants with good wellbeing (WHO-5 >50). The Mann-Whitney and χ2 tests were used to analyse possible relations between sociodemographic characteristics, lifestyle, and outdoor contact with wellbeing during the first wave of the COVID-19 pandemic. Univariate and multivariate binary logistic regression was used to determine the impact of the independent variables associated with poor wellbeing.

Results:

1,777 patients with 15 different RMDs were included. The mean age was 52.7, 80.2% female, 48.7% had a university degree, and 69.7% were married or in a relationship. The most frequent diagnoses were inflammatory arthritis (75.4%). 49.0% reported poor wellbeing. 57.7% of patients who belonged to a patient organisation reported good wellbeing (vs 46.3% who did not, p<0.001). Those who reported poor wellbeing had higher disease activity (51.4% vs 41.3%, p<0.001), a higher risk of anxiety (54.3% vs 41.7%, p<0.001) and depression (57.0% vs 42.1%, p<0.001), and poorer self-perceived health (53.0% vs 41.8%, p<0.001), compared to those who did not. A higher proportion of those who engaged in physical activity presented good wellbeing (54.0% vs 46.5%, p=0.012). 57.4% of the patients who were unable to attend their appointment with their rheumatologist reported poor wellbeing, compared to 48.2% who did attend (p=0.027). Patients who did not walk outside (56.2%) or who lacked elements in their home to facilitate outside contact (63.3%) experienced poor wellbeing (p<0.001). The factors associated with poor wellbeing were lack of elements in the home enabling contact with the outside world (OR=2.10), not belonging to a patient organisation (OR=1.51), risk of depression (OR=1.49), and not walking outside (OR=1.36) during the COVID-19 pandemic (Table 1).

Conclusion:

Almost half of the patients with RMDs reported poor emotional wellbeing during the first wave of the COVID-19 pandemic. The lack of elements in the home that facilitate outdoor contact, not belonging to a patient organisation, the presence of anxiety, and not walking outside during the pandemic increase the probability of poor emotional well-being. These results highlight the importance of environmental factors and the role of patient organisations in addressing the effects of the pandemic and its containment measures.

Table 1.

Logistic regression for poor wellbeing WHO-5 (N=1,104)

Univariate logistic analysisMultivariate logistic analysisOR95% CI1OR95% CI1Patient organisation. Non-member1.571.30, 1.891.511.18, 1.93Disease activity (VAS ≥ 4)1.501.21, 1.861.160.85, 1.56Risk of anxiety (HADs, 0-21)1.671.38, 2.021.200.92, 1.58Risk of depression (HADs, 0-21)1.831.51, 2.211.491.12, 1.99Self-reported health. Fair to very bad1.581.30, 1.911.260.94, 1.68Change in health status. Worse1.271.06, 1.531.050.80, 1.38Physical activity. No1.351.07, 1.711.080.83, 1.40Talked with rheumatologist during the pandemic. No1.451.04, 2.031.040.68, 1.61Walk outside during COVID-19 pandemic. No1.471.19, 1.831.361.02, 1.81Element in home with outdoor contact. No1.931.42, 2.622.101.41, 3.15

195% CI for test H0: OR = 1

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB., Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Clare Jacklin Grant/research support from: has received grant funding from Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

AB0120 IDENTIFYING CORE VARIABLES TO DEVELOP A SEVERITY INDEX IN RHEUMATOID ARTHRITIS: A NATIONWIDE DELPHI CONSENSUS

Background:

Early interventions during the “window of opportunity” have been shown to improve clinical outcomes in rheumatoid arthritis (RA). However, intensive treatment can induce toxicity so identifying patients most likely to benefit from it is of great importance. Hence, tools for guiding therapeutic decisions in early disease stages are needed.

Objectives:

To identify core variables to develop a RA severity index according to an expert panel.

Methods:

An expert panel was prompted to analyze relevant variables to define a “severity” construct, specified as “early severe disease”, able to classify patients with data collected on the first 2 years of the disease. They were also asked to identify potential modifying factors and external criteria to evaluate criterion validity.

An anonymous nationwide 2-round Delphi survey was applied to look for consensus about: (1) the priority of inclusion of each variable, (2) the feasibility to obtain them from usual sources (e.g., medical records) and (3) their definition. Each item was rated on a 10-point (priority) or 5-point (feasibility and definition) Likert scales were 0=complete disagreement and 5-10=complete agreement.

After the 1st round, any item rated from 5 to 10 in priority and 3 to 5 for feasibility by at least 70% of responders was included in the final variable list. Items not reaching at least 20% consensus were discarded. The remaining ones would be voted again in the 2nd round and adopted if they reached at least 50% consensus or else discarded.

Results:

The task force identified 17 variables to define the “severity” construct (Table 1). Socio-economic status, knowledge of their own disease, type or work adherence to treatment, among others were proposed modifying factors. Rheumatoid factor or anti-citrullinated peptide antibody seropositivity as predictive factors The physician global assessment and the “burden of treatment” (lines of treatment, number and dose of DMARDs and cumulative steroid dose received) were proposed for evaluating criterion validity.

A total of 61 stakeholders from across Spain took the survey, 56% were female and had 19.8 years of average experience after training. All variables were included after 1st round. Nonetheless, definitions were submitted for a 2nd round after rephrasing, including comments received on the survey. The final list was reduced to 15 items after merging 3 of the initial variables into a new one called “refractoriness”(Table 1).

Conclusion:

The consensus process resulted in a list of variables and modifying factors deemed of relevance for the severity construct as we defined it. These items will be used to develop a severity index to guide treatment decisions in early disease stages.

Table 1.

Variables proposed for the severity construct.

NInitially proposed variablesNFinal variables after Delphi1Polyarthritis1Polyarthritis2Big joint involvement2Big joint involvement3High disease activity at 2 years of follow-up3High disease activity at 2 years of follow-up4Maintained disease activity in the first 2 years4Maintained disease activity in the first 2 years5Acute phase reactants persistently elevated5Acute phase reactants persistently elevated6Extra-articular manifestations6Extra-articular manifestations7Failure to reach remission7Failure to reach remission8Need for aggressive therapy in the first 2 years8Need for aggressive therapy in the first 2 years9Presence of erosions at diagnosis9Presence of erosions by at diagnosis10Number of erosions at 2 years of follow-up10Number of erosions at 2 years of follow-up11Lack of improvement in the HAQ-DI11Lack of improvement in the HAQ-DI12Need for prosthetic surgery12Need for prosthetic surgery13Hospital Admissions13Hospital Admissions14Cortico-dependence14Cortico-dependence15MTX withdrawal due to loss of efficacy15Refractoriness16Completely absent response to MTX17Number of drugs with lack of efficacy

Underlined variables on the left were merged into a new variable called “Refractoriness”. HAQ-DI: Health Assessment Questionnaire-Disability Index

Disclosure of Interests:

Sebastián C Rodriguez-García Speakers bureau: Roche, Sanofi, MSD, UCB-Pharma, Bristol-Myers-Squibb, Novartis, janssen, Consultant of: Bristol-Myers-Squibb, Galapagos, ESTHER TOLEDANO MARTINEZ: None declared, María Jesús García de Yébenes: None declared, Loreto Carmona Grant/research support from: Novartis Farmacéutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA, Isidoro González-Álvaro Speakers bureau: Abbvie, MSD, Roche, Lilly, Paid instructor for: Lilly, Consultant of: Lilly, Sanofi, Grant/research support from: Roche

POS0181 HOW FIT ARE THE SOCIAL SUPPORT INSTRUMENTS USED IN RMDS: A SYSTEMATIC REVIEW OF VALIDATION STUDIES

Background:

Rheumatic and musculoskeletal diseases (RMDs) diminish psychosocial well-being. Social support (SS) is considered to improve this psychosocial wellbeing. Therefore, SS is an important construct to measure in RMDs.

Objectives:

To systematically review and summarize the psychometric properties of SS instruments developed or validated in RMDs.

Methods:

A comprehensive search in Medline, Embase, PsycINFO, CINAHL and Epistemonikos was performed from inception to June 8, 2020, with the aid of an experienced librarian (LF). Two researchers (DDC and DB) independently screened articles on title+abstract and next on full text. Reference lists of included studies were reviewed for additional references. Articles were included if covering psychometric properties (detailed in the Table 1) of SS instruments used in RMDs. Studies on questionnaires lacking an English version, unpublished material, case reports, editorials, letters, or reviews were excluded. Risk of bias of studies and instruments was assessed via the COSMIN checklist.

Table 1.

psychometric properties per social support instrument

InstrumentFace validityContent ValidityStructural validityCriterion validityInternal consistencyReliabilityMeasurement errorHypothesis testing for construct validityCross-cultural validity/Measurement invarianceResponsivenessAIMS44444 AIMS2444444 AIMS2-SF444Brief Screening Questions444Dyadic Efficacy Scale4444EIS4444Flanagan QOL4444FS4444444IRGL44444ISSI444LISRES444MEPS444444MWA444OAKHQOL4444444 e-OAKHQOL444 Mini-OAKHQOL444444PFSSADI4444RASP4444SIP44SPQ4444SSQT44444

Arthritis Impact Measurement Scales (AIMS); Short Form (SF); Emotional Intimacy Scale (EIS); Quality of Life (QOL); Friendship Scale (FS); Impact on Rheumatic diseases and General health and Lifestyle (IRGL); Interview Schedule for Social Interactions (ISSI); Life Stressors and Social Resources Inventory (LISRES); Medical Issues, Exercise, Pain, and Social Support (MEPS); Modified Work APGAR (MWA); Osteoarthritis Knee and Hip Quality of Life (OAKHQOL); preferences for formal social support of autonomy and dependence in pain inventory (PFFSADI); Responses and Attitudes to Support during Pain questionnaire (RASP); Sickness Impact Profile (SIP); Social support and Pain Questionnaire (SPQ); Social Support Questionnaire for Transactions (SSQT).

Results:

From 4986 articles captured, 30 met the predefined inclusion criteria. These articles included 21 SS instruments used in 8 RMDs, mainly rheumatoid arthritis and osteoarthritis.

Table 1 shows the psychometric properties per instrument. Construct validity, structural validity, and internal consistency were assessed for most instruments, while measurement invariance, measurement error, criterion validity and responsiveness in ≤3 instruments each. Development and content validity of the instruments gave consistently high risk of bias by the COSMIN checklist.

The most widely validated instruments were the Arthritis Impact Measurement Scales (AIMS) and the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL), with their respective derived instruments (AIMS2, AIMS2-SF, mini-OAKHQOL and e-OAKHQOL). For the AIMS SS scale, internal consistency ranged between 0.33-0.69 (Cronbach’s α) and test-retest reliability was estimated 0.92 (Guttman reproducibility coefficient). For the OAKHQOL SS scale, internal consistency ranged between 0.78-0.81 (Cronbach’s α) and test-retest reliability ranged between 0.5-0.85 (ICC). Responsiveness was only investigated in AIMS and the Sickness Impact Profile (SIP) instrument. Relative efficiency for SS for the SIP was considerably higher than for AIMS (0.74 vs 0.18).

Conclusion:

This review gives a summary of the psychometric properties of SS instruments in RMDs. Most instruments show sufficient structural validity internal consistency and reliability, but some psychometric properties such as criterion validity, measurement error and invariance, need to be investigated before choosing an optimal SS instruments.

Disclosure of Interests:

None declared

AB0676 FEARS AND HOPES DURING THE COVID-19 PANDEMIC IN PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The first wave of the COVID-19 pandemic led to a rapidly evolving global crisis characterized by major uncertainty.

Objectives:

The objective is to assess COVID-19-related fears and hopes in patients with rheumatic and musculoskeletal diseases (RMDs) during the first wave of the pandemic.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain and, the United Kingdom. Data are collected in two phases, the first phase between April and July 2020, the second in 2021. Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, job loss, civil disorder) on a Likert scale from zero (“no concern at all”) to five (“extremely concerned”) and their hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a Likert scale from zero (“not hopeful at all”) to five (“extremely hopeful”). The Mann-Whitney and Kruskal-Wallis tests were used to analyse the different fears and hopes according to socio-demographics characteristics, disease and health status.

Results:

1,800 patients participated in the first phase of REUMAVID. The most frequent RMDs group was inflammatory arthritis (75.4%), the mean age was 52.6 years and 80.1% were female. The most important fear for patients was the impact of the COVID-19 pandemic on healthcare (3.1 out of 5), particularly for those younger in age (3.0 vs 3.2, p=0.004), female gender (3.2 vs 2. 9 of men, p=0.003), experiencing greater pain (3.1 vs 2.8, p=0.007), with higher risk of anxiety (3.3 vs 2.9 of without anxiety, p<0.001) and depression (3.3 vs 2.9 without depression, p<0.001). The possible impact of anti-rheumatic medication and the development of severe disease if they became infected with COVID-19,was mostly feared (2.8 out of 5), by those receiving biological therapy (3.1 vs 2.5 not biological therapy, p<0.001) or those with underlying anxiety (2.9 vs 2.6 without anxiety, p=0.007). The risk of contracting COVID-19 due to their condition (2.8 out of 5), was especially feared by those with vasculitis (3.2 out of 5), who were female (2.9 vs 2.5, p<0.001), using biologics (2. 9 vs 2.7 of no use, p=0.003), in greater pain (2.8 vs 2.4, p<0.001), with a risk of anxiety (3.0 vs 2.6 without anxiety, p=0.004), and risk of depression (3.0 vs 2.6 without depression, p<0.001). The major hopes were to be able to continue with their treatment as usual (3.7 out of 5), particularly for those taking biologics (3.8 vs 3.6 not taking, p=0.026), those with a better well-being (3.8 vs 3.6 with worse well-being, p=0.021), without anxiety (3.8 vs 3.6 at risk, p=0.004) and without depression (3.8 vs 3.6 at risk, p=0.007). Hoping not to become infected with COVID-19 and to maintain the same health status, were especially those who were older (3.6 vs 3.4 p=0.018) without anxiety (3.4 vs 3.6 at risk, p=0.005), and without depression (3.6 vs 3.4 at risk, p=0.006). Another important hope was the availability of a treatment or vaccine for COVID-19, which was important for patients experiencing better well-being (3.3 vs 3.0 with worse well-being, p<0.001; Figure 1).

Conclusion:

The outstanding COVID-19-related fear expressed by European patients with RMDs was its impact on healthcare, while the greatest hope was to be able to continue treatment. Younger patients reported more fears while older patients were more hopeful. Those receiving biologics had greater fears and hopes associated with their treatment. In addition, patients at risk of mental disorders presented greater fears and less hopes.

Figure 1.

Fears and Hopes of REUMAVID participants

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, LAURENT GRANGE: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

AB0675 COUNTRY COMPARISON ON THE IMPACT OF THE COVID-19 PANDEMIC ON PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The COVID-19 pandemic has impacted every aspect of life of European patients with rheumatic and musculoskeletal diseases (RMDs).

Objectives:

The aim is to evaluate country differences on the impact of the first wave of the COVID-19 pandemic on life habits, healthcare access, health status, mental health and wellbeing in European patients with RMDs.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. Participants were recruited by patient organisations (April-July 2020). The Kruskal-Wallis and χ2 tests were used to analyse differences between countries and independent variables.

Results:

1,800 patients participated in the first wave of the COVID-19 pandemic (REUMAVID). 37.8% of Spanish patients increased their smoking consumption during the pandemic followed by Cyprus (32.1%) and Portugal (31.0%), while alcohol consumption was higher in the UK (36.3%) and France (27.0%). 82.3% of patients in Spain unable to attend their appointment with their rheumatologist, either due to cancellations or other personal reasons. Access to primary care was most limited in Portugal and Italy, where only 45.0% and 51.6% got access. 61.9% in Italy and 53.3% in Spain experienced a worsening of their health during the pandemic. 68.5% in Spain and 67.8% in Portugal were at risk of anxiety. The highest proportion at risk of depression was found in Greece (55.4%), Cyprus (55.1%), and Italy (54.8%). 66.9% of patients in Spain reported poor wellbeing, compared to 23.8% in Italy and 30.1% in Portugal (Table 1).

Conclusion:

The first wave of the pandemic and the related containment measures heterogeneously affected patients with RMDs across European countries, who overall increased harmful habits, experienced more difficulties in accessing healthcare and, reported poor mental health and well-being.

Table 1.

Bivariate analysis between European countries (N=1,800, unless specified)

Mean ± SD or n (%)UKn: 558Spainn: 464Francen: 229Greecen: 57Cyprusn: 101Italyn: 127Portugaln: 264- Inflammatory arthritis1509 (91.2)402 (86.6)147 (64.2)33 (57.9)57 (56.4)89 (70.1)120 (45.5)- Fibromyalgia53 (9.5)14 (3.0)26 (11.4)14 (24.6)28 (27.7)53 (41.7)124 (47.0)- Connective tissue disease236 (6.5)15 (3.2)13 (5.7)25 (43.9)33 (32.7)30 (23.6)61 (23.1)- Osteoarthritis140 (25.1)29 (6.3)102 (44.5)0 (0.0)8 (7.9)15 (11.8)13 (4.9)- Osteoporosis50 (9.0)3 (0.6)20 (8.7)2 (3.5)9 (8.9)18 (14.2)12 (4.5)- Vasculitis39 (1.6)1 (0.2)6 (2.6)3 (5.3)3 (3.0)5 (3.9)9 (3.4)- Sapho (only France)15 (6.6)Smoking, More than before.N= 55616 (10.3)48 (37.8)22 (24.7)8 (23.5)9 (32.1)8 (20.5)26 (31.0)Alcohol consumption, More than before. N= 1,08599 (36.3)48 (10.3)27 (27.0)4 (7.0)4 (4.0)4 (13.3)11 (18.3)Unable to meet rheumatologist. N= 72283 (48.8)186 (82.3)27 (30.3)18 (64.3)22 (51.2)9 (31.0)77 (56.2)Access to primary care. N= 68987 (76.3)65 (67.7)32 (76.2)14 (60.9)17 (60.7)65 (51.6)117 (45.0)Change in health status, Much worse or worse. N=1,786214 (38.4)245 (53.3)98 (43.0)24 (42.9)38 (38.4)78 (61.9)135 (51.9)WHO-5. Poor well-being (≤50).N= 1,777292 (52.5)303 (66.9)100 (43.9)21 (37.5)46 (46.5)30 (23.8)78 (30.1)Risk of anxiety. N= 1,769241 (43.6)309 (68.5)118 (52.0)31 (55.4)61 (62.2)78 (61.9)175 (67.8)Risk of depression. N= 1,769186 (33.6)232 (51.4)101 (44.5)31 (55.4)54 (55.1)69 (54.8)138 (53.8)

Note: all relations were significant at the 0.001 level. 1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

OP0006 ASSOCIATIONS OF BASELINE USE OF BIOLOGIC OR TARGETED SYNTHETIC DMARDS WITH COVID-19 SEVERITY IN RHEUMATOID ARTHRITIS: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE

Background:

Targeted DMARDs may dampen the inflammatory response in COVID-19, perhaps leading to a less severe clinical course. However, some DMARD targets may impair viral immune defenses. Due to sample size limitations, previous studies of DMARD use and COVID-19 outcomes have combined several heterogeneous rheumatic diseases and medications, investigating a single outcome (e.g., hospitalization).

Objectives:

To investigate the associations of baseline use of biologic or targeted synthetic (b/ts) DMARDs with a range of poor COVID-19 outcomes in rheumatoid arthritis (RA).

Methods:

We analyzed voluntarily reported cases of COVID-19 in patients with rheumatic diseases in the COVID-19 Global Rheumatology Alliance physician registry (March 12, 2020 - January 6, 2021). We investigated RA treated with b/tsDMARD at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAK), interleukin-6 inhibitors (IL6i), or tumor necrosis factor inhibitors (TNFi). The outcome was an ordinal scale (1-4) for COVID-19 severity: 1) no hospitalization, 2) hospitalization without oxygen need, 3) hospitalization with any oxygen need or ventilation, or 4) death. Baseline covariates including age, sex, smoking, obesity, comorbidities (e.g., cardiovascular disease, cancer, interstitial lung disease [ILD]), concomitant non-biologic DMARD use, glucocorticoid use/dose, RA disease activity, country, and calendar time were used to estimate propensity scores (PS) for b/tsDMARD. The primary analysis used PS matching to compare each drug class to TNFi. Ordinal logistic regression estimated ORs for the COVID-19 severity outcome. In a sensitivity analysis, we used traditional multivariable ordinal logistic regression adjusting for covariates without matching.

Results:

Of the 1,673 patients with RA on b/tsDMARDs at the onset of COVID-19, (mean age 56.7 years, 79.6% female) there were n=154 on ABA, n=224 on RTX, n=306 on JAK, n=180 on IL6i, and n=809 on TNFi. Overall, 498 (34.3%) were hospitalized and 112 (6.7%) died. Among all patients, 353 (25.3%) were ever smokers, 197 (11.8%) were obese, 462 (27.6%) were on glucocorticoids, 1,002 (59.8%) were on concomitant DMARDs, and 299 (21.7%) had moderate/high RA disease activity. RTX users were more likely than TNFi users to have ILD (11.6% vs. 1.7%) and history of cancer (7.1% vs. 2.0%); JAK users were more likely than TNFi users to be obese (17.3% vs. 9.0%). After propensity score matching, RTX was strongly associated with greater odds of having a worse outcome compared to TNFi (OR 3.80, 95% CI 2.47, 5.85; Figure). Among RTX users, 42 (18.8%) died compared to 27 (3.3%) of TNFi users (Table). JAK use was also associated with greater odds of having a worse COVID-19 severity (OR 1.52, 95%CI 1.02, 2.28). ABA or IL6i use were not associated with COVID-19 severity compared to TNFi. Results were similar in the sensitivity analysis and after excluding cancer or ILD.

Table 1.

Frequencies for the ordinal COVID-19 severity outcome for patients with RA on biologic or targeted synthetic DMARDs (n=1673).

COVID-19 outcomes by severity scale (n,%)ABAn=154RTXn=224JAKn=306IL6in=180TNFi n=8091)Not hospitalized113 (73.3%)121 (54.0%)220 (71.9%)150 (83.3%)666 (82.3%)2)Hospitalization without oxygenation10 (6.5%)14 (6.2%)11 (3.6%)9 (5.0%)53 (6.5%)3)Hospitalization with any oxygenation or ventilation16 (10.4%)47 (21.0%)52 (17.0%)16 (8.9%)63 (7.8%)4)Death15 (9.7%)42 (18.8%)23 (7.5%)5 (2.8%)27 (3.3%)

Conclusion:

In this large global registry of patients with RA and COVID-19, baseline use of RTX or JAK was associated with worse severity of COVID-19 compared to TNFi use. The very elevated odds for poor COVID-19 outcomes in RTX users highlights the urgent need for risk-mitigation strategies, such as the optimal timing of vaccination. The novel association of JAK with poor COVID-19 outcomes requires replication.

Acknowledgements:

The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the ACR, EULAR, the UK National Health Service, the National Institute for Health Research, the UK Department of Health, or any other organization.

Disclosure of Interests:

Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum, unrelated to this work, Grant/research support from: Amgen and Bristol-Myers Squibb, unrelated to this work, Zachary Wallace Consultant of: Viela Bio and MedPace, outside the submitted work., Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi, Andrea Seet: None declared, Milena Gianfrancesco: None declared, Zara Izadi: None declared, Kimme Hyrich Speakers bureau: Abbvie unrelated to this study, Grant/research support from: BMS, UCB, and Pfizer, all unrelated to this study, Anja Strangfeld Paid instructor for: AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work, Grant/research support from: grants from a consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB) supporting the German RABBIT register, outside the submitted work, Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, unrelated to this study, Grant/research support from: Lilly, Mylan, Pfizer, all unrelated to this study, Loreto Carmona: None declared, Elsa Mateus Grant/research support from: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer, outside the submitted work, Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Patti Katz: None declared, Lindsay Jacobsohn: None declared, Samar Al Emadi: None declared, Leanna Wise: None declared, Emily Gilbert: None declared, Ali Duarte-Garcia: None declared, Maria Valenzuela-Almada: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Philippe Dieudé Consultant of: Boerhinger Ingelheim, Bristol-Myers Squibb, Lilly, Sanofi, Pfizer, Chugai, Roche, Janssen unrelated to this work, Grant/research support from: Bristol-Myers Squibb, Chugaii, Pfizer, unrelated to this work, Elena Nikiphorou: None declared, Vanessa Kronzer: None declared, Namrata Singh: None declared, Manuel F. Ugarte-Gil Grant/research support from: Janssen and Pfizer, Beth Wallace: None declared, Akpabio Akpabio: None declared, Ranjeny Thomas: None declared, Suleman Bhana Consultant of: AbbVie, Horizon, Novartis, and Pfizer (all <$10,000) unrelated to this work, Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones, Jonathan Hausmann Consultant of: Novartis, Sobi, Biogen, all unrelated to this work (<$10,000), Jean Liew Grant/research support from: Yes, I have received research funding from Pfizer outside the submitted work., Emily Sirotich Grant/research support from: Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer based organization whose activities are largely supported by independent grants from pharmaceutical companies, Paul Sufka: None declared, Philip Robinson Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Pedro Machado Speakers bureau: Yes, I have received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Consultant of: Yes, I have received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Jinoos Yazdany Consultant of: Eli Lilly and AstraZeneca unrelated to this project

LB0002 COVID-19 VACCINE SAFETY IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASE

Background:

The consequences of the COVID-19 outbreak are unprecedented and have been felt by everyone around the world, including people with rheumatic and musculoskeletal diseases (RMDs). With the development of vaccines, the future is becoming brighter. Vaccines are a key pillar of public health and have been proven to prevent many serious diseases. However, vaccination also raises questions, especially for patients with inflammatory RMDs and/or treated with drugs that influence their immune system.

Objectives:

Our aim was to collect safety data among RMD patients receiving COVID-19 vaccines.

Methods:

The EULAR COVID-19 Vaccination (COVAX) Registry is an observational registry launched on 5 February 2021. Data are entered voluntarily by clinicians or associated healthcare staff; patients are eligible for inclusion if they have an RMD and have been vaccinated against SARS-CoV-2. Descriptive statistics are presented.

Results:

As of 27 April 2021, 1519 patients were reported to the registry. The majority were female (68%) and above the age of 60 (57%). Mean age was 63 years (SD 16), ranging from 15 to 97 years. A total of 28 countries contributed to the registry, with France (60%) and Italy (13%) as the highest contributors. The majority (91%) had inflammatory RMDs. Inflammatory joint diseases accounted for 51% of cases, connective tissue diseases 19%, vasculitis 16%, other immune mediated inflammatory diseases 4%, and non-inflammatory/mechanical RMDs 9%. The most frequent individual diagnoses were rheumatoid arthritis (30%), axial spondyloarthritis (8%), psoriatic arthritis (8%), systemic lupus erythematosus (SLE, 7%) and polymyalgia rheumatica (6%). At the time of vaccination, 45% were taking conventional synthetic DMARDs, 36% biological DMARDs, 31% systemic glucocorticoids, 6% other immunosuppressants (azathioprine; mycophenolate; cyclosporine; cyclophosphamide; tacrolimus), and 3% targeted synthetic DMARDs. The most frequent individual DMARDs were methotrexate (29%), TNF-inhibitors (18%), antimalarials (10%) and rituximab (6%). The vaccines administered were: 78% Pfizer, 16% AstraZeneca, 5% Moderna and 1% other/unknown; 66% of cases received two doses and 34% one dose. Mean time from 1st and 2nd dose to case report was 41 days (SD 26) and 26 days (SD 23), respectively. COVID-19 diagnosis after vaccination was reported in 1% (18/1519) of cases. Mean time from first vaccination until COVID-19 diagnosis was 24 days (SD 17). Disease flares were reported by 5% (73/1375) of patients with inflammatory RMDs, with 1.2% (17/1375) classified as severe flares. Mean time from closest vaccination date to inflammatory RMD flare was 5 days (SD 5). The most common flare types were arthritis (35/1375=2.5%), arthralgia (29/1375=2.1%), cutaneous flare (11/1375=0.8%) and increase in fatigue (11/1375=0.8%). Potential vaccine side effects were reported by 31% of patients (467/1519). The majority were typical early adverse events within 7 days of vaccination, namely pain at the site of injection (281/1519=19%), fatigue (171/1519=11%) and headache (103/1519=7%). Organ/system adverse events were reported by 2% (33/1519) but only 0.1% (2/1519) reported severe adverse events, namely a case of hemiparesis in a patient with systemic sclerosis/SLE overlap syndrome (ongoing at the time of reporting), and a case of giant cell arteritis in a patient with osteoarthritis (recovered/resolved without sequelae).

Conclusion:

The safety profiles for COVID-19 vaccines in RMD patients was reassuring. Most adverse events were the same as in the general population, they were non-serious and involved short term local and systemic symptoms. The overwhelming majority of patients tolerated their vaccination well with rare reports of inflammatory RMD flare (5%; 1.2% severe) and very rare reports of severe adverse events (0.1%). These initial findings should provide reassurance to rheumatologists and vaccine recipients, and promote confidence in COVID-19 vaccine safety in RMD patients, namely those with inflammatory RMDs and/or taking treatments that influence their immune system.

Acknowledgements:

EULAR COVID-19 Task Force; European Reference Network on rare and Complex Connective Tissue and Musculoskeletal Diseases; European Reference Network on Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases Network; all rheumatologists contributing to the EULAR COVAX Registry.

Disclosure of Interests:

Pedro M Machado Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript., Grant/research support from: Orphazyme, unrelated to this manuscript., Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript., Saskia Lawson-Tovey: None declared, Kimme Hyrich Grant/research support from: BMS, UCB, and Pfizer, all unrelated to this manuscript., Speakers bureau: Abbvie, Loreto Carmona Consultant of: her institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH, and UCB Pharma, all unrelated to this manuscript., Laure Gossec Grant/research support from: AbbVie, Amgen, BMS, Biogen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, all unrelated to this manuscript., Speakers bureau: Amgen, Lilly, Janssen, Pfizer, Sandoz, Sanofi, Galapagos, all unrelated to this manuscript., Elsa Mateus Grant/research support from: LPCDR received support for specific activities: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work., Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, and Pfizer, all unrelated with this manuscript., BERND RAFFEINER: None declared, Tiphaine Goulenok: None declared, Olilvier Brocq: None declared, Martina Cornalba: None declared, José A Gómez-Puerta Speakers bureau: AbbVie, BMS, GSK, Janssen, Lilly, MSD, Roche and Sanofi., Eric Veillard: None declared, Ludovic Trefond: None declared, Jacques-Eric Gottenberg: None declared, Julien Henry: None declared, Patrick Durez: None declared, Gerd Rüdiger Burmester: None declared, Marta Mosca: None declared, Eric Hachulla: None declared, Hans Bijlsma: None declared, Iain McInnes: None declared, Xavier Mariette Consultant of: BMS, Galapagos, Gilead, Janssen, Novartis, Pfizer, Sanofi-Aventis, UCB, and grant from Ose, all unrelated to this manuscript.

AB0579 ANTI-JO1 ANTIBODIES IN A REAL-WORLD POPULATION

Background:

The presence of anti-aminoacyl transfer RNA synthetase (ARS) autoantibodies is essential for the antisynthetase syndromes (ASSD) diagnosis; as well, Anti-Jo1 ARS positivity is the highest weighted criterion in the 2017 EULAR/ACR criteria for idiopathic inflammatory myopathies (IIM).

Previous studies have shown differences in ARS specificity between different blot assays. Nevertheless, an adequate clinical correlation and its detection by another monospecific-assays or indirect immunofluorescence assay (IIFA), can safeguard it.

Objectives:

To evaluate the prevalence of Anti-Jo1 ARS and their performance in the ASSD and IIM diagnosis criteria fulfillment in a real-world population.

Methods:

We performed an observational retrospective study in one center in which IIFA and a blot assay (EUROLINE ANA Profile 3-IgG that include Anti-Jo1 but not other ARS) were performed in all cases with autoimmune disease suspicion (03/2007-07/2019).

We assessed: 1) Anti-Jo1 ARS prevalence, 2) The rate of Anti-Jo1 positivity in the performed blot assays, 3) The rate of patients with Anti-Jo1 ARS meeting ASSD or IIM criteria, and 4) The rate of true and false positive Anti-Jo1 ARS considering the IIFA and clinical correlation.

Results:

A total of 419.361 inhabitants are under the center coverage area at the date, a total of 12.711 blot assays were performed during the observation period, and 61 cases presented Anti-Jo1 ARS positivity. The Anti-Jo1 ARS prevalence in the whole studied population was 0.00014, representing 0.04% positivity of the performed blot assays.

Of those with Anti-Jo1 positivity:

– Only 4 patients (6.6%) met Solomon´s ASSD criteria and 26 (42.6%) met Connors ASSD criteria (less strict), representing the 0.0009% and 0.006% of the whole population respectively.

– Five cases (8.2%) presented a possible or probable IIM by Bohan and Peter criteria and 55 cases (90.16%) presented a probable or definitive IIM by EULAR/ACR criteria, representing 0.001% and the 0.013% of the whole population respectively.

– The Anti-Jo1 positivity was not confirmed by a monospecific-assay. Nevertheless, 52 cases (85.25%) presented positive IIFA (>1/80): 27 (51.92%) nuclear, 12 (23.08%) cytoplasmic and 12 (25%) with both patterns. A total of 23 cases presented a fine speckled AC-19/AC-20 pattern; representing the 40.98% of all Anti-Jo1 ARS cases.

– Only 4 cases (6.56%) did not meet any of the ASSD or IIM classification criteria. And only 4 cases (6.56%) fulfilled Solomon ASSD criteria or presented a probable IIM by Bohan and Peter criteria, or a definite IIM by EULAR/ACR criteria. Thus, we can estimate that 6.56% of the cases were clinically false positives and other 6.56% were clinically true positive; leading a gap of 86.88% of cases with Anti-Jo1 ARS that only fulfill Connors ASSD criteria (less strict) or a not complete score to confirm the IIM diagnosis by Bohan and Peter or EULAR/ACR criteria.

Conclusion:

The low prevalence of Anti-Jo1 ARS positivity observed and the low number of cases with confirmed ASSD or IIM in the Anti-Jo1 positive detected cases, suggest that:

– It is not efficient to test it by screening.

– It should be tested only under adequate clinical suspicion.

– Probably it is not convenient to include it in not myositis specific blot assays. Despite it is desirable to incorporate the evaluation of myositis specific antibodies in the IIM classification criteria; the differences observed between Bohan and Peter and 2017 EULAR/ACR criteria fulfillment in our series, suggest that the latter could be overweighting the Anti-Jo1 ARS positivity.

Disclosure of Interests:

Martín Greco: None declared, María Jesús García de Yébenes: None declared, Francisco Javier Nóvoa Medina Speakers bureau: I have been paid as a speaker for a few medical talks, José A Hernandez Beriain: None declared, Marta María Riaño Ruiz: None declared, María Jesús Montesa: None declared, Iñigo Rua-Figueroa: None declared, Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

AB0698 REAL CLINICAL PRACTICE IN THE CONTROL OF REPORTED OUTCOMES BY THE PATIENT (PROS) DIAGNOSED WITH PSORIATIC ARTHRITIS AND/OR ANKYLOSING SPONDYLITIS WHO BEGIN TREATMENT WITH SECUKINUMAB. A PROSPECTIVE MULTICENTRIC STUDY

Background:

Objectives:

Analyse the effect of secukinumab in terms of the patient´s own variables, specifically: fatigue, sleep, pain and quality of life in patients with psoriatic arthritis or spondyloarthritis.

Methods:

A multicentric longtitudinal observational prospective study was carried out at 6 months in patients who begin treatment with secukinumab. At the start and after 6 months the following data was collected on the outcome: pain through an visual analogue scale (VAS), fatigue using the FACIT-fatigue scale, sleeping problems using the insomnia severity index (ISI) and quality of life with the EuroQol-3L-5D and the PsAQoL.

The sample can be described in terms of the distribution of the variables through measures of central tendency.It was analysed if the change after 6 months was statistically relevant using Student´s t-test for paired data in the case of FACIT, VAS, PsAQoL and ISI and chi-squared for the dimensions of the EQ-5D. The size of the effect of each of the measurements taken was calculated using Cohen’s D. the results are given grouped by disease and globally. The analysis was carried out using Stata v12 (College Station Tx, USA)

Results:

In table 1, the changes in the scales of normal distribution can be seen. Apart from general VAS, all the scales experience significant relevant changes. The PROs preferred by the patient with the best therapeutic response is the quality of sleep. The adjustment of the regression models does not produce changes in the results, apart from small adjustments to the condidence intervals (final column table 1). The subdomain in which the most significant change in the EQ-5D is produced is in that of pain and discomfort.

Conclusion:

After 6 months patients who begin treatment with secukinumab, present with improvements in all sizes of the effects of the treatment in the various studied scales. The improvement achieves global and generalised statistical significance after 6 months of study. The greatest effect is on sleep, quality of life and fatigue.

The measurements of the outcomes reported by the patients are a clinical value added to our objective evaluations of the health and activity of the disease, and allow us, in a more integrated and comprehensive manner, to undertake a more exact and close evaluation of their state of health and wellbeing.

Disclosure of Interests:

JUAN JOSE LERMA: None declared, Antonio Gracia: None declared, Antonio Perez: None declared, Amalia Rueda: None declared, Clara Molina: None declared, M. Dolores Pastor: None declared, Isabel Balaguer Trull: None declared, Inmaculada Valiente: None declared, Cristina Campos Fernández: None declared, Javier Calvo: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

SAT0608-HPR EULAR POINTS TO CONSIDER FOR THE DETECTION, ASSESSMENT AND MANAGEMENT OF NON-ADHERENCE IN PEOPLE WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background:

Non-adherence to medication and non-pharmacological interventions precludes reaching an optimal outcome. 30 to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to their recommended treatment regimens.

Objectives:

The objective of this EULAR task force was to establish recommendations/points to consider (PtC) for the detection, assessment and management of non-adherence in people with RMDs.

Methods:

A EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included rheumatologists, health professionals in rheumatology (HPRs), and patient-representatives from 12 countries. A systematic literature review of reviews was conducted in advance to support the TF in formulating the PtC. Agreement was obtained by Delphi technique in three rounds (0-10 rating scale).

Results:

A definition of adherence, 4 overarching principles and 9 PtC were formulated (table).

Conclusion:

The PtCs can help health-care providers to support people with RMDs to adhere to the agreed treatment plan.

Table.

Overarching principles and points to consider.

Definition of AdherenceAdherence is defined as the extent to which a person’s behaviour corresponds with the agreed prescription.Overarching principlesAgreement1Adherence impacts the outcomes of people with RMDs.992Shared decision making is key, since adherence is a behaviour following an agreed prescription.963Adherence is influenced by multiple factors.984Adherence is a dynamic process that requires continuous evaluation.96Points to considerAgreement1All HCPs involved in the management of people with RMDs should take responsibility for promoting adherence.992Effective patient-health professional communication should be applied to enhance adherence.993Barriers and facilitators of adherence of a specific patient to a specific prescription should be appropriately evaluated.954Patient education should be provided for people with RMDs as an integral part of standard care.965Care should be tailored to patient preferences and goals to enhance adherence.986Adherence should be discussed regularly based on open questions and particularly when disease is not well controlled.997The HCP should explore which factors might negatively influence adherence, including: opportunity (e.g., availability or cost), capability, (e.g., memory problems), motivation (e.g., concerns).948Together with the patient, the HCP should tailor the approach to overcome individual barriers to adherence, e.g.,98- simplifying the regimen,- using reminders,- providing education,- discussing the patient’s beliefs on treatments.9When specific expertise or interventions for adherence are needed, they should be made available to patients.98

HCP, health-care providers; RMDs, rheumatic and musculoskeletal diseases

Disclosure of Interests:

Valentin Ritschl: None declared, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Daniel Aletaha Grant/research support from: AbbVie, Novartis, Roche, Consultant of: AbbVie, Amgen, Celgene, Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, Speakers bureau: AbbVie, Celgene, Lilly, Merck, Novartis, Pfizer, Sanofi Genzyme, UCB, Johannes WJ Bijlsma Grant/research support from: Roche, Speakers bureau: Roche, Lilly, Peter Boehm: None declared, Razvan Dragoi Speakers bureau: MSD, AbbVie, Novartis, Roche, Pfizer, Myllan, Sandoz, Emma Dures Grant/research support from: Independent Learning Grant from Pfizer, combined funding for a research fellow from Celgene, Abbvie and Novartis, Paid instructor for: A fee from Novartis to deliver training to nurses., Fernando Estévez-López: None declared, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi, Michal Nudel: None declared, Andrea Marques: None declared, Ellen Moholt: None declared, Bart van den Bemt Grant/research support from: UCB, Pfizer and Abbvie, Consultant of: Delivered consultancy work for UCB, Novartis and Pfizer, Speakers bureau: Pfizer, AbbVie, UCB, Biogen and Sandoz., Kirsten Viktil: None declared, Marieke Voshaar Grant/research support from: part of phd research, Speakers bureau: conducting a workshop (Pfizer), Annette de Thurah Grant/research support from: Novartis (not relevant for the present study)., Speakers bureau: Lily (not relevant for the present study)., Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

AB1362-HPR COMMON PRACTICE IN DELIVERY OF INTRA-ARTICULAR THERAPIES IN RMDS BY HEALTH PROFESSIONALS: RESULTS FROM A EUROPEAN SURVEY

Background:

Intra-articular therapies (IAT) are routinely used in rheumatic and musculoskeletal diseases (RMDs); however large variability exists regarding current practice of delivery amongst health professionals.

Objectives:

To inquire about common practice aspects to inform the EULAR Taskforce for the IAT of arthropathies.

Methods:

A steering committee prepared a 160-item questionnaire based on the information needs of the Taskforce. The survey was disseminated via EULAR professional associations and social media and it was open to any health professional treating persons with RMDs, regardless of using IAT personally.

Results:

The survey was answered by 186 health professionals from 26 countries, the large majority of whom (77%) were rheumatologists, followed by nurses (12%), general practitioners (2%) and orthopaedic surgeons (2%). The two collectives that perform IAT routinely are rheumatologists (97%) and orthopaedic surgeons (89%), with other professionals <50%. Specific training was compulsory for 32%. The most frequent indication for IAT is inflammatory arthritis (76%), followed by osteoarthritis (74%), crystal arthritis (71%) and bursitis (70%); and all joints are injected, with knee (78%) and shoulder (70%) being the most frequent. When questioned about specific contexts, such as pre-surgical, diabetic or hypertensive patients, variability among respondents was evident, with around 30 to 69% of professionals considering it acceptable to inject glucocorticoids (GC), while in others there was less variability (prosthetic or septic joints, <1%). GCs are the most used compounds, followed by hyaluronic acid and saline/dry puncture. Only 66 (36%) use ultrasound to guide IAT. In their opinion, to be accurately in the joint is moderately to largely important for large joints (80%) and very important in small joints. The maximum number of injections to perform safely in the same joint within one year was “2 to 3” for 65% (2% thought there is “No limit”). The majority reported that they informed patients about side-effects (73%), benefits (72%), and the nature of the procedure (72%), and less frequently about other aspects; with 10% obtaining written consent and 56% oral consent (mandatory only for 32%). Other questions help to understand the setting and procedures followed, including use of local anaesthetics and care after injection.

Conclusion:

Although often performed in clinical practice for RMDs, there is apparent variability in several elements related to delivery of this treatment. This information, together with patient input, will help design current recommendations where research evidence is not available.

Acknowledgments:

Eular Taskforce grant CL109

Disclosure of Interests:

Jenny de la Torre-Aboki: None declared, IRENE Pitsillidou: None declared, Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Lene Terslev: None declared, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Hemant Pandit Grant/research support from: Glaxo Smith Kline (GSK) for work on Diclofenac Gel, Speakers bureau: Bristol Myers Squibb for teaching their employees about hip and knee replacement, Ingrid Möller: None declared, Maria Antonietta D’Agostino Consultant of: AbbVie, BMS, Novartis, and Roche, Speakers bureau: AbbVie, BMS, Novartis, and Roche, Willm Uwe Kampen: None declared, Terence O’Neill: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Francis Berenbaum Grant/research support from: TRB Chemedica (through institution), MSD (through institution), Pfizer (through institution), Consultant of: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Bone Therapeutics, Regulaxis, Peptinov, 4P Pharma, Paid instructor for: Sandoz, Speakers bureau: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Sandoz, Valentina Vardanyan: None declared, Elena Nikiphorou: None declared, Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

FRI0291 SAFETY AND SURVIVAL OF SECUKINUMAB IN SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS: REAL-LIFE DATA. A MULTICENTER STUDY

Background:

Secukinumab is a human monoclonal antibody directed against IL-17A, approved for the treatment of psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The safety profile of secukinumab was favourable in clinical studies, but there is still scarce evidence in clinical practice. Similarly, we currently have less data regarding the real survival of secukinumab compared to other biological therapies such as anti-TNF.

Objectives:

To analyze the retention rate and safety of secukinumab as well as the causes and factors associated with its survival in patients with ankylosing spondylitis and psoriatic arthritis in real clinical practice.

Methods:

we conducted a retrospective longitudinal observational multicenter study of all patients with PsA and Spondyloarthritis (SpA) who had received at least one dose of secukinumab. Adverse events and drug retention were considered the main variables. In addition, we collected variables predicting drug retention. We estimated the total adverse event rate, by severity and type of event, and drug retention (mean duration and retention at 6 months, 1 year and 2 years), all with 95% confidence intervals (95% CI). Survival was analyzed using Kaplan-Meier curves and predictive factors using Cox regression, with the Hazard Ratio (HR) as a measure of the association.

Results:

154 patients were included, 59 with PsA (38%) and 95 with SpA (62%), with a mean age of disease onset of 49 years (SD ± 11), being 55% men. The mean disease duration was 6.5 years (ICR 2-8). The median number of previous biologics was 2 (SD ± 1). Secukinumab was the first line of treatment in 13 patients (8%), the second line in 46 (30%), the third line in 54 (35%) and subsequent lines in 41 (27%). The median survival of secukinumab was 23 months (ICR 5-32), with a 1-year retention rate of 66% and a 2-year retention rate of 43%. The most frequent cause of discontinuation was inefficacy (59%) and the second one was adverse events (AE) (36%). Most patients who discontinued due to AEs (71%) did so during the first 6 months of treatment. Only 2 major cardiovascular events were collected, and 2 cases of Crohn’s disease occurred during the exposure. The factors identified as predictors of survival for secukinumab were: duration of disease (HR 0.96, 95% CI 0.93-0.99 p=0.012), number of previous biologics (HR 1.18, 95% CI 1.04-1.34 p=0.011), male gender (HR 0.63, 95% CI 0.43-0.90 p=0.013), obesity (HR 0.31, 95% CI 0.18-0.54 p=0.000) and depression (HR 2.54, 95% CI 1.64-3.94 p=0.000).

Conclusion:

In this study of real clinical practice, secukinumab showed a 66% retention rate at one year in a population mostly refractory to biological therapy. The main cause of discontinuation was lack of efficacy. The AAs that led to drug discontinuation occurred mainly in the first 6 months of treatment

Acknowledgments:

Raquel Linge, Agnes Díaz and Juan Calatayud

Disclosure of Interests:

Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Sara Alonso Castro: None declared, Sabela Fernández: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Lilian Consuelo Charca Benavente: None declared, Marina Pino Martínez: None declared, Leyre Riancho-Zarrabeitia Grant/research support from: Yes, Speakers bureau: Yes, Isla Morante Bolado: None declared, Montserrat Santos Gómez: None declared, Anahy Brandy-Garcia: None declared, Elena Aurrecoechea: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Rubén Queiró Silva: None declared

SAT0063 THE COMBINED VACCINATION SCHEME AGAINST STREPTOCOCCUS PNEUMONIAE IS EFFECTIVE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH DMARD: DATA FROM BIOBADASER 3.0

Background:

Respiratory tract infections are among the leading causes of hospitalization in rheumatoid arthritis (RA) and Streptococcus Pneumoniae (Sp) is one of the most frequent pathogens involved. For these patients, the CDC recommends a combined vaccination scheme (CVS) using two types of Sp vaccines but evidence on its effectiveness remains insufficient.1

Objectives:

To assess the impact of the combined vaccination scheme on the incidence of Sp infections in patients with RA treated with DMARD.

Methods:

A cohort was nested in a register including patients with RA who were prescribed a bDMARD or tsDMARD -either naïve or switch- from 2000 to March 2019.

The target outcomes were invasive pneumococcal disease (IPD) and all-cause community-acquired pneumonia (CAP), as defined by relevant MedDRA codes. Demographic and clinical features were also retrieved. Each participant centre informed about the date when they implemented a systematic Sp vaccination protocol and whether they were using the CVS. Those not adopting this practice were excluded from the analysis.

Crude incidence rates (IRs) were calculated for each outcome as well as for its combination (combined variable defined as “Sp infections”). Exposure was split into two periods, considering the date when the CVS was officially recommended in Spain (May 2015). The incidence rate ratio (IRR) comparing pre and post implementation periods was estimated with a Poisson regression model adjusted for sex, age and comorbidities (Charlson Index).

Results:

1704 patients were included, their characteristics are shown in table 1. One centre was excluded for not using any Sp vaccination protocol while the remaining ones reported using the CVS. Crude IRs by periods (pre and post CVS implementation) and age groups are shown in table 2. The IRR of the post-vaccination period after adjusting for age, sex and comorbidities (Charlson index) was 0.40 (95% CI: 0.29 - 0.56), p<0.001.

Table 1.

Baseline features of the cohort.

DemographicsAge, years *60.6 (12.5)Female1356 (79.6%)Current smoking287 (16.8%)RA clinical characteristicsDisease duration, years*9.1 (7.9)RF positive875 (74%)ACPA positive831 (71%)DAS28*4.6 (1.4)Other clinical characteristicsBody Mass Index*27.5 (5.2)Charlson index*2.3 (1.5)Chronic pulmonary Disease125 (9.3%)Diabetes mellitus147 (9%)

*Data presented as mean (standard deviation).

Table 1

Characteristics of patients with RA at time of RA diagnosis and patients with SAB with/without RA at time of SAB diagnosis

Characteristic, n (%)At RA diagnosisAt first-time SABRA (n=34,627)RA (n=228)Non-RA (n=25,268)Age, years (IQR)59.8 (48.8-70.3)71.8 (62.3-79.2)69.7 (57.7-79.7)Female, %69%59%38%Diabetes mellitus2,467 (7.1%)51 (22.4%)5,678 (22.5%)Heart failure1,018 (2.9%)42 (18.4%)4,718 (18.7%)Liver disease454 (1.3%)12 (5.3%)2,189 (8.7%)Chronic obstructive pulmonary disease1,677 (4.8%)36 (15.8%)3,412 (13.5%)Cancer2,124 (6.1%)60 (26.3%)6,742 (26.7%)HIV11 (0.0%)0 (0%)127 (0.5%)Solid organ transplant8 (0.0%)0 (0%)357 (1.4%)Alcohol abuse642 (1.9%)12 (5.3%)3,356 (13.3%)Chronic dialysis29 (0.1%)11 (4.8%)2,256 (8.9%)Orthopedic implant3,807 (11.0%)89 (39.0%)5,422 (21.5%)Cardiac or vascular implant731 (2.1%)18 (7.9%)1,940 (7.7%)Glucocorticoid (0-90 days prior)7,062 (20.4%)99 (43.4 %)2,911 (11.5%)Invasive surgery (0-30 days prior)1,962 (5.7%)62 (27.2%)8,451 (33.5%)Table 2.

Crude IRs (95% CI) of the outcomes of interest split by age.

Overall<65≥65PrePostPrePostPrePostSP-Infections33 (27.4-39.9)12.7 (9.8-16.4)28 (22.4-35)11.8 (8.9-15.6)60.3 (42.4-85.8)19.5 (10.8-35.2)IPD–0.4 (0.1-1.6)–0.4 (0.1-1.8)––All cause CAP23.6 (19.0-29.3)11.5 (8.8-15)18.7 (14.4-24.4)10.4 (7.7-14)50.8 (34.8-74)19.5 (10.8-35.2)

Conclusion:

The incidence of Sp infections experienced a decrease in RA patients taking bDMARD or tsDMARD after the introduction of the stepwise combined vaccination scheme that is not related to age, sex or comorbidities.

References:

[1] Furer V,et al.Ann Rheum Dis2019;0:1–14

Disclosure of Interests:

Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Carlos Sánchez-Piedra: None declared, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Dolores Ruiz-Montesinos: None declared, Victoria Hernandez: None declared, Manuel Pombo: None declared, Fernando Sánchez-Alonso: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Juan Jesús Gómez-Reino: None declared

SAT0636-HPR PATIENT EXPERIENCE WITH THE PRESCRIPTION, INFORMATION AND USE OF METHOTREXATE

Background:

Methotrexate (MTX) is currently a mainstream drug in the treatment of rheumatic diseases. However, the response to MTX is not universal and may be conditioned by a number of factors, among which adherence could be crucial.

Objectives:

The aim of this study is to explore adherence to MTX in patients with rheumatic diseases, facilitators and perceived when taking and maintaining the prescription.

Methods:

A qualitative study of content analysis was performed. Focus groups with patients taking either oral or subcutaneous MTX (being the main or coadjuvant treatment) for any rheumatic disease was performed. The groups were moderated by a rheumatologist that was unknown for the patients. The speech was recorded and transcribed. Subsequently, an inductive coding was performed with the help of Atlas.ti and main themes and sub-themes were extracted, with examples of verbatim anonymized speech.

Results:

Three focus groups were conducted, with a total of 12 participants, of whom eight were women, seven had rheumatoid arthritis, three had psoriatic arthritis, one had spondyloarthritis, and one had systemic lupus erythematosus. All patients reported an adequate adherence to treatment. The barriers identified were: information in the leaflet, technical language in the consults, difficult access to doctor´s appointment, social environment, side effects and the subcutaneous device. As facilitators, the following aspects were discussed: good predisposition of the physician, reliable graphic information, role of associations and partners support.

The unmet needs detected were: problems with travelling, protocols for eventualities, absence of a plan of care, neglection of “non-physical” symptoms, disinformation on side effects and training in complementary aspects.

Conclusion:

Getting reliable information was the main barrier identified. The environment and side effects may also negatively impact on adherence. Shared decision making is a goal to be achieved in the future in these patients.

Disclosure of Interests:

Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), José Luis Andréu Sánchez: None declared

AB1252 CAN THE HUPI BE MORE USEFUL THAN OTHER INDICES IN THE SEARCH OF BIOMARKERS FOR RA?

Background:

The Hospital Universitario La Princesa Index (HUPI) was developed to tackle metric shortcomings of DAS28 and SDAI, and has shown better accuracy and responsiveness than these widespread indices.1

Objectives:

To compare the performance of HUPI, DAS28, and SDAI in explaining the variability of radiographic progression, HAQ and the distribution of a biomarker of damage such as IL6.

Methods:

Two cohorts were assembled with data from a clinical trial (ACT-RAY) and an early arthritis register (PEARL). Radiographic progression, measured as the change (Δ) of Genant or Sharp/Van der Heijde indices at week 52 in ACT-RAY and PEARL respectively, Δ HAQ and serum IL6 (ELISA; R&D Systems) levels, the latter only available in PEARL, were the outcome variables. HUPI, DAS28, SDAI, sex and age were the independent variables.

For each index, linear regression models adjusted for sex and age were developed using standardized variables. The overall performance of the model, as well as that of the specific index it included, were evaluated using the adjusted R2. Differences between models were assessed with the likelihood ratio test. Also, Thefpfitcicommand (Stata v14) was used to estimate the predicted distribution of the described variables using fractional polynomials and plotting the resulting curves.

Results:

The performance of the models and indices are shown in table 1. The variability of radiographic progression was better explained by the SDAI model in ACT-RAY whereas HUPI did it so in PEARL. The latter also performed better for explaining HAQ in ACT-RAY (figure 1) and IL6. Sex modified the performance of DAS28 and SDAI in their respective models. The relation between all the described outcomes predicted using fractional polynomials and each index was also more linear for HUPI than its comparators. (see an example in figure 2).

Table 1.

Adjusted R2of the models and indices. R2m: adjusted R2of the models; R2I: adjusted R2of the index included in the model; LR: Likelihood-Ratio test comparing HUPI models vs other indices’.

OUTCOMEINDEXACT-RAYLRPEARLLRR2mR2IR2mR2IRADIOGRAPHIC PROGRESSIONHUPI0.0250.024ref0.1100.020refDAS280.0310.030<0.0000.1020.011<0.000SDAI0.0510.050<0.0000.1090.019<0.000HAQHUPI0.3530.323ref0.4770.448refDAS280.3290.298<0.0000.4720.442<0.000SDAI0.3340.303<0.0000.4860.457<0.000IL6HUPI---0.2120.184refDAS28---0.2040.176<0.000SDAI---0.2010.172<0.000Figure 1.

Box plots comparing the adjusted R2of each index estimated in models for HAQ in ACT-RAY.

Figure 2.

Curves for comparison of predicted serum IL6 using fractional polynomials for HUPI and DAS28.

Conclusion:

Although all indices explained the outcomes’ variability similarly, HUPI did it better than DAS28 and SDAI for almost all outcomes except for Δ Genant and HAQ in PEARL.

References:

[1]Gonzalez-Alvaro I,et al.PLoS ONE 14(4): e0214717

Disclosure of Interests:

Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Nuria Montes: None declared, José Ivorra: None declared, Ana Triguero-Martinez: None declared, Luis Rodriguez Rodriguez: None declared, Isabel Castrejon: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly

THU0468 EFFICACY AND SAFETY OF INTRA-ARTICULAR THERAPIES IN RHEUMATIC AND MUSCULOSKELETAL DISEASES: AN OVERVIEW OF SYSTEMATIC REVIEWS INFORMING THE 2020 EULAR RECOMMENDATIONS FOR INTRA-ARTICULAR THERAPIES INCLUDING SYNOVIORTHESIS

Background:

Intra-articular therapy (IAT) is subject to wide variability and there are gaps in the evidence on its efficacy and safety.

Objectives:

To assess the efficacy and safety of frequently used IATs to inform a EULAR Taskforce.

Methods:

We performed an overview of systematic reviews (SR) of randomised clinical trials (RCT) assessing efficacy and safety of IAT in adults with RMDs. MEDLINE was searched until January 2019. SRs were assessed with the AMSTAR-2 tool. Critically low-confidence SRs were excluded.

Results:

Of 159 articles identified, 42 were reviewed in detail and 15 met the inclusion criteria (146 RCTs). The populations included were mainly knee osteoarthritis (OA) in 10 SRs, rheumatoid arthritis (RA) in 3, hip and temporo-mandibular (TM) OA and shoulder adhesive capsulitis in 1 SR each.

In knee OA, Hyaluronic Acid (HA) showed a modest benefit over placebo for pain and function but with unclear clinical significance in some studies. Platelet rich plasma (PRP) showed a small effect over HA only for function. Mesenchymal stem cells (MSC) performed better than PRP and HA for some outcomes, however, in studies with high risk of bias. Intra-articular Glucocorticoids (GC) were better than placebo (PBO) for pain and function.

More adverse events (AE) were seen in the PRP group compared with HA and for HA compared with PBO including serious AE each in 1 SR on knee OA.

Results for other included diseases are shown in table 1.

Table 1.

Summary of SR. P: population; C: comparation; H: High, M: Moderate; L: Low confidence; MA: meta-analysis; SOC: standard of care; PRO: patient reported outcomes; ROM: range of motion; MPA: methylprednisolone acetate; TA/TH: triamcinolone acetonide/ hexacetonide; MW: molecular weight; YR: Yttrium synoviorthesis *Same SR assessed knee arthritis in OA and RA separately

SRPCAMSTAR2EfficacySafetyNewberryknee OAHA vs PBO; HA; LavageHMA.HA better than PBOin function in older patients (small effect).No diff in AEJuniGC vs Sham; PBO; SOCHMA.GC betterin pain and function until 6w. No diff at 12-24w.No diff in AEPasMSC vs PBO; PRP; HAMNo MA.MSC betterin pain, PRO, MRI, etcHigh risk of bias.No diff in AETrojianHA vs PBO; GCMNMA.HA better vs GC or PBOin WOMAC pain, stiffness, function and OARSI criteria.No diff in AEGallagherHA vs PBOMNo MA.No diffin joint space width.High risk of bias.Not reportedSamsonHA vs Glucosamine; Chondroitin; LavageMMA.HA betterin pain (small effect), unclear clinical benefitMA. More AE with HA.SAE in 3/1002 knees with HA(severe swelling, hypersensitivity reaction)DiPRP vs HALNo MA.PRP betteronly in WOMAC function.More AE with PRP(p<0.05) SAE in 2 knees with HA (severeswelling)Silvinato*MPA vs TA; THLMA.MPA better vs TA in pain until w6No diff. in pain or function at 12w.No diff in AETrigkilidasHA vs PBO; GCLNo MA.HA (small effect) better in mild-moderate OANo diff in AELoHA vs PBOLNo MA.HA (small effect) better in pain. (publication bias).High heterogeneityNo diff in AEDe SouzaTM OAHA vs GCMHA better in pain at w24Not reportedFigueiredoHip OAHA vs GC; PBO; PRP; AnaestheticsLMA.No diffin HA vs comparators in pain and OARSI criteriaNo diff in AELeeShoulder capsulitisHA vs SOCMNo MA.No diffin HA vs SOC.No diff in AEHeuftRA (knee)YR vs PBO; GCMNo MA.YR better vs PBO, TH better vs YR in ROM and knee circumference.SR inconclusiveNot reportedSilvinato*MPA vs TA; THLMA.No diffin pain or function.No diff in AESaitoHA vs PBOLMA.HA better in global effectiveness, pain and inflammation.No diff in AE

Conclusion:

Most of the SRs assessed had results of low confidence. HA and GC showed a small, short term benefit in knee arthritis in OA and RA compared to PBO. High risk of bias prevents conclusions on the efficacy of PRP and MSC in knee OA. More AE were reported in PRP and HA treated groups.

Disclosure of Interests: :

Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

FRI0071 ANALYSIS OF DATA GAPS IN RHEUMATOID ARTHRITIS

Background:

Although ideally Recommendations for the management of rheumatoid arthritis (RA) should be supported by the highest level of evidence, many of which are based on “expert opinion”. This means that there are knowledge gaps to which a part of the research efforts in this disease should be directed.

Objectives:

1.- Analyze the causes of the low level of evidence in some of the recommendations on diagnosis and management of RA in the main published documents

2.- Identify the knowledge gaps that justify said low level of evidence

3.- Design actions to respond to the knowledge gaps identified.

Methods:

Qualitative study. A group of six experts in systematic review of the literature was selected. Fourteen documents of national and international recommendations on RA (EULAR, ACR and SER) of the last 5 years were analyzed by a peer review. They selected recommendations with low level of evidence (Oxford 4 and 5) / grade of recommendation (C and D), and classified by areas (diagnosis, monitoring, treatment, others) and then possible causes of low level of evidence were analyzed. These were submitted to a Delphi to select the 10 recommendations in which participants considered it more critical to obtain quality evidence. Subsequently, actions were proposed to improve the levels of evidence in general and, through the PICOS structure (population, intervention, comparator, study design) specific studies were proposed to respond to the issues raised in these 10 recommendations

Results:

185 recommendations were found that had a low level of evidence / grade of recommendation, most related to the treatment of RA. The two most frequent causes of this low level of evidence and / or the degree of recommendation were the absence of studies and an incorrect classification of the level of evidence and / or degree of recommendation. In addition, other reasons and methodological barriers were found for which nine critical recommendations were finally selected for which new PICOs were developed with which to propose targeted research projects

Conclusion:

It is necessary to improve the methodological approach in the RA recommendations guidelines to correct errors and fill gaps with appropriate studies.

Table 1.

Actions to increase the level of evidence / recommendation.

#Action1Prioritization of research towards knowledge gaps with the design and development of specific studies2Increase knowledge of experts in the methodology of consensus documents (including RSL, formulation of recommendations, etc.)3Supervision of the entire process by expert methodologists, to ensure a correct allocation of the levels of evidence and degree of recommendation4Review and select those topics that are really of interest and should be reviewed and can be answered5Expert opinion should never become a recommendation, but will be included in the text that accompanies that recommendation.6Clear syntax will be used and short recommendations will be made7Establishment and application of homogeneous criteria to formulate recommendations

Key words: Rheumatoid arthritis, recommendations, data gaps

Disclosure of Interests:

gloria candelas: None declared, Lucía Silva-Fernández: None declared, Maria Montoro Employee of: Pfizer employee, Abad Hernández: None declared, Jose Ramón Maneiro: None declared, Virginia Villaverde: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi, Susana Gómez Employee of: Pfizer employee, Monica Valderrama Consultant of: Pfizer employee, Ana Ortiz: None declared

THU0653-HPR BARRIERS FOR THE UPTAKE OF EULAR POSTGRADUATE EDUCATION FOR HEALTH PROFESSIONALS IN RHEUMATOLOGY IN EASTERN EUROPEAN COUNTRIES: RESULTS FROM 3 NATIONAL SURVEYS

Background:

Health professionals play an important role in the care for people with rheumatic and musculoskeletal diseases. In order to improve and maintain the quality of their work, appropriate professional education is needed. EULAR has developed several educational products and activities specifically targeted at Health Professionals in Rheumatology (HPR), but particularly in Eastern European countries, their uptake is limited. The overarching aim of a EULAR project (named HEE4ALL: Health professionals Education in Eastern European countries for All) is to develop and execute implementation strategies for EULAR educational activities in 3 eastern European countries.

Objectives:

The aim of the present analysis was to identify barriers and facilitators for the uptake of EULAR educational activities among HPR in Eastern European countries.

Methods:

First, a questionnaire was sent to representatives of national health professionals’ or patients’ organization in 17 Eastern European countries, in order to determine their eligibility to participate in the implementation project. Eligibility criteria were: Having a national HPR organization; Willing and able to compose a team with HPR, Patients, and Rheumatologists; and Interested to participate in the project. Selected countries (minimum 3) were requested to set up a national implementation team, and conduct a national, electronic survey among HPR on anticipated barriers and needs regarding educational activities. The survey included the following elements: a. characteristics of the responding HPRs; b. Familiarity with EULAR educational offerings; c. Anticipated barriers and facilitators (score 0=no barrier at all to10 very important barrier); d. Ability to pay for the HPR online course.

Results:

Representatives from 10/17 Eastern European countries responded to the first questionnaire, with 3 countries meeting the selection criteria: Hungary, Serbia and Turkey. Subsequently, 216 (H:106, S:42 and T:68) HPR completed the 3 national surveys. In all 3 countries, the majority of the respondents was female (93.1%), and nurse (70.8%) or physical therapist (19.0). Familiarity with EULAR educational offerings was poor, with the lowest proportions of HPR being familiar with postgraduate face-to-face courses (13.9%), educational visits (19.0%) and the EULAR online course for HPR (25.0%). The highest ranked barriers in all 3 countries included the costs of EULAR annual congress, the costs of the EULAR HPR online course and a lack of mastery of English language.The maximum amount of money HPR were able to pay for the EULAR online course was on average €66, €29 and €83 in Hungary, Serbia and Turkey, respectively.

Conclusion:

Based on a survey in 3 Eastern European countries, it appears that familiarity with EULAR educational offerings is suboptimal. However, when HPR are aware of the educational offerings, their costs and a lack of mastery of the English language seem to be the most important barriers for participation. Based on these results, the 3 national teams developed implementation plans during a 2-day meeting (October 2019). The implementation plans are now executed and a process and effect evaluation is planned by November, 2020.

Acknowledgments:

Supported by EULAR; Project HPR 042

Disclosure of Interests:

Leti van Bodegom-Vos: None declared, T.P.M. Vliet Vlieland: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Andrea Domjan: None declared, Alzbeta Goehmann: None declared, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi, Marija Kosanovic: None declared, Rikke Helene Moe: None declared, Wilfred Peter: None declared, Marija Segrt: None declared, Eda Tonga: None declared, Codruta Zabalan: None declared

PARE0027 PATIENT PERSPECTIVE ON INTRA-ARTICULAR THERAPIES IN RMDS: RESULTS FROM A EUROPEAN SURVEY

Background:

Intra-articular therapy (IAT) is routinely used in rheumatic and musculoskeletal diseases (RMDs). In order to improve the effectiveness and safety of IAT, it is essential to understand patients’ perceptions and needs.

Objectives:

To assess the perspective of persons who have experienced IAT, including perceptions on benefits and safety.

Methods:

A steering committee (including a patient research partner) prepared a 44-item questionnaire based on the information needs of a Taskforce on IAT in adult patients with RMDs. The questionnaire was translated into 11 languages and disseminated via EULAR PARE associations and social media. Persons who had experienced at least two IAT procedures were eligible for the survey. Descriptive statistics were used to summarise results as well as inductive codification of open-ended questions.

Results:

The survey was answered by 200 individuals diagnosed with rheumatoid arthritis (66%), osteoarthritis (21%), spondyloarthritis (10%), psoriatic arthritis (9%), and others (16%). The mean number of IATs received was 7 (SD 8), mainly in the knee (66%), shoulder (42%), and wrist (28%), and primarily with corticosteroids (83%) or hyaluronic acid (16%). Twenty-seven percent had not been informed about benefits or potential complications of IAT, and 73% had not been asked whether they wanted local anaesthetic. Consent was deemed necessary by 82 (41%). Most (65%) had never received an ultrasound (US)-guided injection, and of those who had experienced blinded and guided injections, 42 (63%) preferred US-guided because of increased perceived accuracy and confidence in the procedure. Only 50% reported a clear benefit of IAT, mainly in terms of reduced pain and increased joint mobility, but also perceived reduced inflammation, with effect from immediate to 36 hours or even 3 weeks post-injection, and that lasted from as little as less than one week to years. Regarding safety, 40 (20%) had experienced some complications from IAT, including but not limited to increased pain, impaired mobility, rashes, or swelling.

Finally, the respondents suggested improvements in the procedure, including: (1) wider availability; (2) less painful procedures; (3) greater efficacy, faster and longer-lasting; (4) fewer side effects; (5) a clear diagnosis beforehand; (6) better shared decision-making, including better information; (7) follow-up, (8) better accuracy; and (9) more expertise.

Conclusion:

The survey has identified gaps in the IAT procedures, such as a need for clearer information. Patients perceive IAT as relatively safe, though painful, and with varying effect. Suggestions for improving the procedure, including more expertise, should be relayed to professionals and relevant organisations.

Acknowledgments:

Eular Taskforce grant CL109

Disclosure of Interests:

IRENE Pitsillidou: None declared, Jenny de la Torre-Aboki: None declared, Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Lene Terslev: None declared, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Hemant Pandit Grant/research support from: Glaxo Smith Kline (GSK) for work on Diclofenac Gel, Speakers bureau: Bristol Myers Squibb for teaching their employees about hip and knee replacement, Ingrid Möller: None declared, Maria Antonietta D’Agostino Consultant of: AbbVie, BMS, Novartis, and Roche, Speakers bureau: AbbVie, BMS, Novartis, and Roche, Willm Uwe Kampen: None declared, Terence O’Neill: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Francis Berenbaum Grant/research support from: TRB Chemedica (through institution), MSD (through institution), Pfizer (through institution), Consultant of: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Bone Therapeutics, Regulaxis, Peptinov, 4P Pharma, Paid instructor for: Sandoz, Speakers bureau: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Sandoz, Valentina Vardanyan: None declared, Elena Nikiphorou: None declared, Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

SAT0138 DRUG-RELATED PANCYTOPENIA AND LEUKOPENIA IN RHEUMATOID ARTHRITIS: ARE ALL CSDMARDS EQUAL?

Background:

Cytopenia is a known side-effect of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) in rheumatoid arthritis (RA). There is a lack of data on the comparative risk of cytopenia with different csDMARDs.

Objectives:

To assess the comparative risk of leukopenia and pancytopenia for the most frequently used first-line csDMARDs: methotrexate (MTX), hydroxychloroquine (HCQ), sulphasalazine (SSZ), and leflunomide (LEF).

Methods:

The study used data from 7 databases from 4 countries: CCAE, MDCR, Optum, IQVIA Ambulatory EMR (US); IQVIA THIN IMRD EMR (UK); IQVIA Disease Analyzer EMR (Germany); and SIDIAP (Spain). Cohorts included adult patients with a diagnosis of RA from 2005 to 2019 with at least one-year prior follow-up, no prior inflammatory arthritis, initiaton of first-line csDMARD, and no cytopenia in the preceding 30 days. Participants were followed from one day after treatment initiation to the earliest of event occurrence, treatment discontinuation/switching plus 14 days in the on-treatment analysis, five years in the intent-to-treat (ITT) analysis, or loss to follow-up. MTX was used as reference group. Cox models were fitted with propensity score stratification for observed confounding and negative control outcomes calibration for residual error. Estimates across database were pooled where I2<40% was seen.

Results:

Overall 166,347 patients were included. Pooled rates of leukopenia and pancytopenia for MTX were 10.9 and 3.2 per 1,000 person years, respectively. Figure 1 and 2 show the results for the different databases and pooled estimates where applicable. Database estimates are not reported where adequate covariate balance not attained, and meta-analysis not shown where I2>0.4. MTX showed slightly higher hazards of leukopenia and of pancytopenia compared to LEF but no consistently differential risks compared to HCQ or SSZ.

Figure 1.

Calibrated hazard ratios (95% CI) vs MTX, on-treatment analysis

Conclusion:

Cytopaenia is rare, and apparently more frequent with MTX and less with LEF. Since prior full blood counts were inconsistently obtained in fewer than 50% of csDMARD new users (e.g. more frequent in MTX [42%] than HCQ [32%] in CCAE and Optum; roughly equal in MDCR), these results should inform future monitoring recommendations.

Figure 2.

Calibrated hazard ratios (95% CI) vs MTX, ITT analysis

Disclosure of Interests:

Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), James Weaver Shareholder of: J&J Shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen, Paid instructor for: Janssen employee, have instructed at conferences, Speakers bureau: Janssen employee, have spoken at conferences, Edward Burn: None declared, Ben Illingens: None declared, David Vizcaya Employee of: Bayer, Ruta Sawant Shareholder of: AbbVie, Employee of: AbbVie, Talita Duarte-Salles: None declared, Patrick Ryan: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen

THU0469 QUANTIFYING THE PLACEBO EFFECT AFTER INTRA-ARTICULAR INJECTIONS: IMPLICATIONS FOR TRIALS AND PRACTICE

Background:

In recent years, diverse compounds for intra-articular administration were brought into the market with a subsequent significant and heterogeneous literature production. Understanding the efficacy of intra-articular therapies (IAT) on pain implies bearing in mind the related placebo (PBO) effect. To date, most studies analyzing it were focused on the compound being administered rather than the route of administration.

Objectives:

We aimed at evaluating the size of the PBO effect after intra-articular injections.

Methods:

We conducted an overview of systematic reviews (SRs) including randomized-controlled trials (RCTs) of frequently used IAT. SRs with a saline solution PBO arm and high-confidence results according to the AMSTAR-2 tool were selected for analysis.

Data on the change in pain in the PBO arms from baseline to 3-6 and 12-16 weeks after the IA procedure was extracted. The standardized mean differences (SMD) from baseline were calculated as the ratio between the size of the intervention effect in each study and the variability observed in that study. A meta-analysis was then performed using an inverse-variance random-effects model in Review Manager 5.3. The overall effect sizes obtained refer to versions of the SMD, which corresponds to the Hedges’ (adjusted) g. e.g. a “g” of 1 indicates the two groups being compared differ by 1 standard deviation and so on.

Results:

Two SR were included comprising 50 RCTs, 44 not meeting inclusion criteria were excluded so pain, measured by visual analogue scale (VAS) and Lequesne index, was retrieved from 6 RCT.

At 3-6 weeks, an SMD [95%CI] = 0.74 [0.47-1.00] was found. One study showing too large an effect was excluded after conducting sensitivity analysis resulting in a significant reduction of heterogeneity with an SMD = 0.62 [0.45-0.79] (Fig.1). At 12-16 weeks, we found a SMD = 0.33 [0.13-0.52] (Fig.2)

Figure 1.

Forest plot for intra-articular PBO effect at 3-6 weeks after injection.

Figure 2.

Forest plot for intra-articular PBO effect at 12-16 weeks after injection.

Using the interpretation suggested by Cohen1, our results would confirm a moderate to large effect of IA saline (PBO) at 3-6 weeks with a subsequent reduction to a small but persistent effect at 12-16 weeks.

Conclusion:

Our results showed a moderate to large short-term effect of intra-articular PBO that persisted on the mid-term although reduced. Based on these findings we suggest this effect should be considered when assessing the efficacy of IAT in RCTs and also in clinical practice where it could be maximized as well.

References:

[1]Cohen J. Statistical Power Analysis in the Behavioural Sciences (2nd edition). Hillsdale (NJ): Lawrence Erlbaum Associates, Inc., 1988.

Disclosure of Interests: :

Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

FRI0427 EULAR RECOMMENDATIONS FOR INTRA-ARTICULAR TREATMENTS FOR ARTHROPATHIES

Background:

Intra-articular therapies (IAT) are widely used in clinical practice to treat patients with rheumatic and musculoskeletal diseases (RMDs). Many factors influence their efficacy and safety. There is a wide variation in the way IATs are delivered by health professionals. In an attempt to standardise these procedures, evidence-based recommendations are the right way forward.

Objectives:

To establish evidence-based recommendations to guide health professionals using IAT in adult patients with peripheral arthropathies.

Methods:

At a first face-to-face meeting, the results of an overview of systematic reviews were presented to the multidisciplinary task force of members from 8 countries. The aim, scope and outline of the taskforce were also established at this meeting. Thirty-two clinical questions ranked for priority (relevance for practice plus feasibility) drove the systematic reviews performed by two fellows. In addition, two surveys addressed to physicians, health professionals and patients throughout Europe were agreed to acquire more background information. At the second face-to-face meeting, the evidence for each research question was discussed, and each recommendation shaped and voted in a first Delphi round. Level of agreement was numerically scored 0 to 10 (0 completely disagree, 10 completely agree). All panellists voted anonymously using a sli.do app. Agreement needed to be greater than 80% to be included in a second Delphi round, which also allowed reformulation of statements. Finally, a third Delphi round was sent to the taskforce. The level of evidence was assigned to each recommendation according to the EULAR SOP for establishing recommendations.

Results:

Recommendations focus on practical aspects for daily practice to guide health professionals before, during and after IAT in adult patients with peripheral arthropathies. Five overarching principles were established, together with 11 recommendations that address the following issues: (1) patient information; (2) procedure and setting; (3) accuracy issues; (3) routine and special antiseptic care; (4) safety issues and precautions to be addressed in special populations; (5) efficacy and safety of repeated joint injections; (6) the usage of local anaesthetics; and (7) aftercare. The document includes the supporting evidence and results from the surveys, level of evidence and agreement.

Conclusion:

We have developed the first evidence and expert opinion based recommendations to guide health professionals using IAT.

Acknowledgments:

Eular Taskforce grant CL109

Disclosure of Interests:

Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira: None declared, Terence O’Neill: None declared, Hemant Pandit Grant/research support from: Glaxo Smith Kline (GSK) for work on Diclofenac Gel, Speakers bureau: Bristol Myers Squibb for teaching their employees about hip and knee replacement, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Ingrid Möller: None declared, Valentina Vardanyan: None declared, Jenny de la Torre-Aboki: None declared, Lene Terslev: None declared, Francis Berenbaum Grant/research support from: TRB Chemedica (through institution), MSD (through institution), Pfizer (through institution), Consultant of: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Bone Therapeutics, Regulaxis, Peptinov, 4P Pharma, Paid instructor for: Sandoz, Speakers bureau: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Sandoz, Maria Antonietta D’Agostino Consultant of: AbbVie, BMS, Novartis, and Roche, Speakers bureau: AbbVie, BMS, Novartis, and Roche, Willm Uwe Kampen: None declared, Elena Nikiphorou: None declared, IRENE Pitsillidou: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

Effect of an abdominal hypopressive technique programme on pelvic floor muscle tone and urinary incontinence in women: a randomised crossover trial

OBJECTIVES

To test the effect of a structured abdominal hypopressive technique (AHT) programme on pelvic floor muscle (PFM) tone and urinary incontinence (UI) in women.

DESIGN

Crossover trial with random assignment of women to one of two groups: Group 1 (AHT followed by rest) and Group 2 (rest followed by AHT).

SETTING

Two cultural centres in Madrid, Spain.

PARTICIPANTS

Women aged 20-65 years.

INTERVENTIONS

Two months of supervised AHT exercises compared with 2 months of rest.

MAIN OUTCOME MEASURES

Variation in PFM tone and score on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)].

RESULTS

Forty-two women were randomised to two groups (both n=21). No sequence or period effect was noted. The mean difference in PFM tone after the 2-month AHT programme was 59g/cm² [95% confidence interval (CI) 37 to 82]; the between-group difference was 83g/cm² (95% CI 50 to 116; P<0.001). After 2 months, the between-group difference in the ICIQ-SF score was 3.3 points (P<0.001). The majority of participants reported improved body image and sense of well-being.

CONCLUSIONS

A structured 2-month AHT programme for women showed short-term benefits in PFM tone and UI. In addition, study participants reported improved body image and sense of well-being, and programme satisfaction, as demonstrated by questionnaire at the end of the intervention period. Further research is needed to test the long-term effects and effectiveness of AHT compared with other PFM exercises. ClinicalTrials.gov Identifier NCT0221241.

Protein analysis of moro blood orange pulp during storage at low temperatures

A protein analysis in the pulp of Moro blood oranges (Citrus sinensis L. Osbeck) at the onset and after 30 days of storage at either 4 or 9 °C was performed. All differential proteins belonged to different functional classes (sugar, amino acid and secondary metabolism, defense, stress response, oxidative process, transport and cellular component biogenesis), displaying a differential accumulation in those Moro oranges kept at 9 versus 4 °C, and in those stored at 4 °C versus onset. Anthocyanin biosynthesis structural proteins chalcone synthases and flavonone 3-hydroxylase and different glutathione S-transferases related with their vacuolar transport were up-accumulated in fruits kept at 9 versus 4 °C and versus the onset. Proteins related with defense and oxidative stress displayed a similar pattern, concomitant with a higher anthocyanin content, denoting a possible role of defense and other stress response pathways in anthocyanin production/accumulation.