Comparing tocilizumab biosimilar BAT1806/BIIB800 with reference tocilizumab in patients with moderate-to-severe rheumatoid arthritis with an inadequate response to methotrexate: a phase 3, randomised, multicentre, double-blind, active-controlled clinical trial

BACKGROUND

Biosimilars provide an opportunity to address unmet medical need by expanding access to biological treatments. This study aimed to show equivalent efficacy, and comparable safety, immunogenicity, and pharmacokinetic profiles of a proposed tocilizumab biosimilar BAT1806/BIIB800, to reference tocilizumab, in participants with rheumatoid arthritis with an inadequate response to methotrexate.

METHODS

This phase 3, multicentre, randomised, double-blind, active-controlled, equivalence study comprised a 24-week initial treatment period (results reported here) and a 24-week secondary treatment period. Participants were recruited at 54 centres across five countries (China, Ukraine, Poland, Georgia, and Bulgaria). Patients with active rheumatoid arthritis with an inadequate response to methotrexate were randomly assigned (1:1:2) to receive reference tocilizumab up to week 48, or reference tocilizumab up to week 24 followed by BAT1806/BIIB800 up to week 48 (the two reference tocilizumab groups were analysed as a single group in this analysis), or BAT1806/BIIB800 up to week 48 (the BAT1806/BIIB800 group), administered by intravenous infusion once every 4 weeks at a starting dose of 8 mg/kg. The primary endpoint was the proportion of participants who had a 20% improvement in American College of Rheumatology criteria (ACR20) at week 12 (for the European Medicines Agency [EMA]) or week 24 (for the US Food and Drug Administration [FDA] and China National Medical Products Administration [NMPA]) using prespecified equivalence margins (95% CI -14·5 to +14·5 [EMA], 90% CI -12·0 to +15·0 [FDA], and 95% CI -13·6 to +13·6 [NMPA]). The International Council for Harmonisation E9(R1) estimand framework, with strategies for addressing intercurrent events, was implemented for the efficacy evaluations with expected differences as per the predefined equivalence margins. This trial is registered at ClinicalTrials.gov (NCT03830203) and EudraCT (2018-002202-31), and is closed to new participants.

FINDINGS

Between Dec 19, 2018, and Jan 5, 2021, we randomly assigned 621 participants: 309 to the reference tocilizumab group and 312 to the BAT1806/BIIB800 group. The mean age was 50·5 years (SD 12·0), 534 (86%) were women, 87 (14%) were men, and 368 (59%) were White. For the primary estimands, estimated ACR20 response rates were 64·8% in the reference tocilizumab group and 69·0% in the BAT1806/BIIB800 group (treatment difference 4·1% [95% CI -3·6 to 11·9]) at week 12, and 67·9% in the reference tocilizumab group and 69·9% in the BAT1806/BIIB800 group (treatment difference 1·9% [90% CI -4·0 to 7·9; 95% CI -5·2 to 9·1]) at week 24. All confidence intervals were contained within the predefined equivalence margins. Comparable pharmacokinetic and immunogenicity profiles were observed for the reference tocilizumab and BAT1806/BIIB800 groups. Adverse events were reported by 201 (65%) participants in the reference tocilizumab group and 206 (66%) in the BAT1806/BIIB800 group; 196 (63%) participants in the reference tocilizumab group and 201 (64%) participants in the BAT1806/BIIB800 group reported a treatment-emergent adverse event. Five participants had a fatal event (reference tocilizumab n=1; BAT1806/BIIB800 n=4).

INTERPRETATION

BAT1806/BIIB800 showed equivalent efficacy, and comparable safety, immunogenicity, and pharmacokinetic profiles as reference tocilizumab.

FUNDING

Bio-Thera Solutions and Biogen.

Guselkumab in Patients With Moderately to Severely Active Ulcerative Colitis: QUASAR Phase 2b Induction Study

BACKGROUND & AIMS

The QUASAR Phase 2b Induction Study evaluated the efficacy and safety of guselkumab, an interleukin-23p19 subunit antagonist, in patients with moderately to severely active ulcerative colitis (UC) with prior inadequate response and/or intolerance to corticosteroids, immunosuppressants, and/or advanced therapy.

METHODS

In this double-blind, placebo-controlled, dose-ranging, induction study, patients were randomized (1:1:1) to receive intravenous guselkumab 200 or 400 mg or placebo at weeks 0/4/8. The primary endpoint was clinical response (compared with baseline, modified Mayo score decrease ≥30% and ≥2 points, rectal bleeding subscore ≥1-point decrease or subscore of 0/1) at week 12. Guselkumab and placebo week-12 clinical nonresponders received subcutaneous or intravenous guselkumab 200 mg, respectively, at weeks 12/16/20 (uncontrolled study period).

RESULTS

The primary analysis population included patients with baseline modified Mayo scores ≥5 and ≤9 (intravenous guselkumab 200 mg, n = 101; 400 mg, n = 107; placebo, n = 105). Week-12 clinical response percentage was greater with guselkumab 200 mg (61.4%) and 400 mg (60.7%) vs placebo (27.6%; both P < .001). Greater proportions of guselkumab-treated vs placebo-treated patients achieved all major secondary endpoints (clinical remission, symptomatic remission, endoscopic improvement, histo-endoscopic mucosal improvement, and endoscopic normalization) at week 12. Among guselkumab week-12 clinical nonresponders, 54.3% and 50.0% of patients in the 200- and 400-mg groups, respectively, achieved clinical response at week 24. Safety was similar among guselkumab and placebo groups.

CONCLUSIONS

Guselkumab intravenous induction was effective vs placebo in patients with moderately to severely active UC. Guselkumab was safe, and efficacy and safety were similar between guselkumab dose groups.

CLINICALTRIALS

gov number: NCT04033445.

Clinical characteristics of ankylosing spondylitis patients depending on neuropathic pain

Introduction

Neuropathic pain (NP) in ankylosing spondylitis (AS) is an important factor that complicates patients' everyday activities and leads to a decrease of life quality. Detection and diagnosis of NP can be facilitated by the use of screening instruments, and the comparative assessment of the sensitivity of different scales is important for improving the diagnosis and personalizing the treatment of AS.The aim of the study was to analyze prevalence of NP in patients with AS and clinical features of AS patients depending on the presence of NP.

Material and methods

We examined 94 patients with NP and 48 patients without pain in AS using the following questionnaires: LANSS, DN4, StEP, BASFI, BASMI, BASDAI, HAQ, ASAS HI/EF and BAS-G.

Results

The prevalence of NP according to LANSS was 51.7% in women and 32.7% in men (p = 0.048); according to DN4 - 58.6% and 32.7%, respectively (p = 0.010). Disease activity and functional disability of the patients were higher in the group of patients with NP than in the group of patients without NP according to the BASDAI, BASFI, BASMI, HAQ, ASAS HI/EF and BAS-G. Significance of differences between groups was at the level of p < 0.01.

Conclusions

The prevalence of NP in AS is alarmingly high. Even with low scores on screening scales, patients showed signs of NP, which may indicate higher prevalence of NP. Neuropathic pain is more associated with the activity of the disease, greater loss of functional capacity and a decrease in indicators of the general state of health, which allows it to be considered as an aggravating factor regarding these manifestations.

POS0019 CENTRAL SENSITIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS: ASSOCIATION WITH DISEASE ACTIVITY

Background

Rheumatoid arthritis (RA) is the most common inflammatory arthropathy with a predominance of autoimmune mechanisms of pathogenesis and pain as the main clinical manifestation. Recent evidence has found showed that Central Sensitization (CS) may be a new mechanism for the formation of pain [1]. There is insufficient data on this phenomenon in patients with RA [2].

Objectives

To determine the prevalence of the phenomenon of CS in patients with RA and evaluate its association with disease activity.

Methods

The study involved patients with RA according to the ACR / EULAR criteria (2010). RA activity was determined by DAS-28, SDAI, CDAI, and the functional ability of patients - by HAQ. Visual analog scoring (VAS) were used to evaluate the intensity of pain. The radiological stage of RA was determined according to the Kellgren-Lawrence classification. The presence of the CS phenomenon was established using the Central Sensitization Inventory (CSI) (Mayer, T. G. et al., 2012). MS Excel and SPSS22 (© SPSS Inc.) software packages were used for statistical processing of results.

Results

110 patients (84% of women) with RA were included. The participants’ mean age was (M±SD) 53.5 ± 12.2 years, with a disease duration 8.5 ± 8.1 years. Among the examined, radiological stage I was detected in 16 (15%) patients, II - in 59 (53%), III - in 23 (21%), IV - in 12 (11%). According to the DAS28-ESR index, 56 (51%) patients had high activity (DAS 28-ESR: > 5.1) and 54 (49%) patients had moderate activity (3.2 <DAS28-ESR ≤5.1). Mean values of SDAI and CDAI also showed high disease activity: 36.5 ± 10.2 and 33.3 ± 9.8, respectively. The average value of HAQ was 1.4 ± 0.7.

CS (CSI>40) was revealed in 40 (36%) patients. Correlation analysis showed that CSI was significantly correlated with disease activity, VAS pain and HAQ: DAS28-ESR (r = 0.477; p <0.01), SDAI (r = 0.559; p <0.01), CDAI (r = 0.544; p <0.01), VAS (r = 0.575; p <0.01), HAQ (r = 0.694; p <0.01). It was found that the group of patients with CS had higher rates of disease-specific values compared to patients without CS. Significance of differences between groups was at the level of p <0.01 (Table 1).

Table 1.

Characteristics of the RA patients with and without CS on the indices disease activity, VAS pain and HAQ.

CSI<40(n=70)CSI>40(n=40)РCDAI29,7±7,838,9±9,7<0,01SDAI32,9±8,642,3±9,6<0,01HAQ1,1±0,61,9±0,6<0,01DAS28-ESR4,9±0,95,7±0,8<0,01VAS6,3±1,37,8±1,2<0,01

Notes: SDAI – The Simple Disease Activity Index, CDAI - The Clinical Disease Activity Index, DAS-28 - The Disease Activity Score-28, HAQ-DI - Health Assessment Questionnaire,VAS - Visual Analog Scoring, p – the significance of differences between groups.

Conclusion

Central sensitization is common in RA patients. The phenomenon of central sensitization is associated with higher disease activity, loss of functional ability and severity of pain.

References

[1]Meeus, M., Vervisch, S., De Clerck, L. S., Moorkens, G., Hans, G., & Nijs, J. (2012). Central sensitization in patients with rheumatoid arthritis: a systematic literature review. Seminars in arthritis and rheumatism, 41(4), 556–567. https://doi.org/10.1016/j.semarthrit.2011.08.001

[2]Phillips, K., & Clauw, D. J. (2013). Central pain mechanisms in the rheumatic diseases: future directions. Arthritis and rheumatism, 65(2), 291–302. https://doi.org/10.1002/art.37739

Disclosure of Interests

None declared

AB1527-HPR FUNCTIONAL SOMATIC SYNDROMES AND INSOMNIA IN PATIENTS WITH FIBROMYALGIA, RELATIONSHIP WITH THE INTENSITY OF THE PAIN SYNDROME

Background

Fibromyalgia (FM) is a chronic diffuse musculoskeletal pain manifested by numbers of functional somatic syndromes (1). The pathogenesis and pathophysiology of fibromyalgia includes changes of autonomic nervous system, which can be realized in the abnormal functioning of many organs and systems.

Objectives

Analyze the frequency and spectrum of functional somatic syndromes and insomnia in patients with fibromyalgia, relationship with the intensity of pain.

Methods

We examined 102 women with FM according criteria ACR (1990), mACR (2010) with mean age 41.7±9.4 years (M±σ), duration of the disease was 8.4 ± 6.28 years. The severity of pain, fatigue, sleep disorders was assessed with a visual analog scale (VAS).

Results

The severity of pain (VAS) in patients with FM ranged from 2.1 to 8.5 and averaged 5.1±1.5. The severity of fatigue was estimated at 6.5 ± 1.7, sleep disorders - 6.3 ± 2.7. In the examined group of patients with FM, in addition to typical clinical manifestations, significant numbers of functional disorders were diagnosed: insomnia - 86.3%, irritable bowel syndrome – 59,8%, postural tachycardia syndrome - 53.9%, hyperventilation syndrome - 52.9%, bladder pain syndrome – 50,0%. According to the intensity of pain, patients were divided into 3 groups. The 1th group included patients with pain less than 4 points (<25th percentile, n = 21), the 2nd - with the pain severity 4-6 points (25-75th percentile, n = 58), the third group - patients with pain more than 6 points (>75th percentile, n = 23). According to the study, the frequency of functional somatic syndromes was not related to the intensity of pain. There was a positive correlation between the severity of insomnia and the intensity of pain (r=0.36; p<0.05). The same relationship was revealed between fatigue and pain (r=0.41; p<0.05).

Conclusion

Patients with FM have a wide spectrum of functional somatic syndromes. The changes described were not related to the severity of the pain syndrome. The presence of correlations between the severity of insomnia and the intensity of pain requires further research to develop algorithms for comprehensive treatment of identified disorders.

References

[1]Donnachie, E., Schneider, A., & Enck, P. (2020). Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data. Scientific reports, 10(1), 9810. https://doi.org/10.1038/s41598-020-66685-4

Disclosure of Interests

None declared

AB0271 ALEXITHYMIA IN A PATIENT WITH RHEUMATOID ARTHRITIS: CONNECTION WITH DISEASES AND FUNCTIONAL ABILITY

Background

Rheumatoid arthritis (RA) is the chronic, destructive, immune-mediated inflammatory disease that has a progressive course and causes the early disability of approximately 50% over the next five years. Acute pain syndrome in RA often leads to a violation of the psycho-emotional sphere with manifestations in the form of depression, anxiety and alexithymia.1 Alexithymia is defined as a personal emotional disorder characterized by difficulty in identifying and describing subjective feelings and related to cognitive impairment.

There is insufficient data regarding the prevalence of alexithymia in patients with RA.

Objectives

To investigate the prevalence of alexithymia and the relationship with disease activity and functional ability in patients with RA.

Methods

RA patients diagnosed according to the ACR/EULAR 2010 classification criteria. The presence of alexithymia was determined by the «Toronto Alexithymia Scale» questionnaire (TAS-20). RA activity was assessed by the Disease Activity Score (DAS28-ESR), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI). Functional ability - by the Health Assessment Questionnaire (HAQ). In the study were included 98 patients with RA (83.7% of women). The mean age was (M±SD) 49.5 ± 11.7 years, the duration of the disease ranged from 1 to 21 years, and averaged 7.8 ± 4.9 years. Statistical analysis was performed by IBM Statistics SPSS 20.

Results

Among 98 examined, alexithymia (≥ 61) was detected in 24 persons (24.5%), including 23 women, mean age (M±SD) 54 ± 7.16 years with disease duration 9.96 ± 5.23 years. The activity of RA in persons with alexithymia was: DAS-28 (6.4 ± 0.71); SDAI (41.15 ± 8.64); CDAI (39.46 ± 9.03) and ESR (27.6 ± 15.1), which was significantly higher than in patients without alexithymia: DAS-28 (5.52 ± 1.05); SDAI (32.72 ± 11.28); CDAI (31.98 ± 11.07) and ESR (22.7 ± 15.27). Functional disability in individuals with RA and alexithymia according to HAQ was (1.7 ± 0.59) in contrast to the group of patients with RA without alexithymia - (1.04 ± 0.62). The value of TAS-20 had a direct correlation with the activity by DAS-28 (0,379; p < 0,01), SDAI (0,39; p < 0,01) and CDAI (0,359; p < 0,01)), radiological stage (0.260; p < 0.01) and HAQ (0.393; p < 0.01).

Conclusion

Alexithymia is quite common comorbid condition in patients with RA associated with disease activity and functional disability. Further studies are needed to assess the clinical significance of alexithymia in this category of patients.

References

[1]Larice, S., Ghiggia, A., Di Tella, M., Romeo, A., Gasparetto, E., Fusaro, E., Castelli, L., & Tesio, V. (2020). Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis. Scandinavian journal of psychology, 61(2), 271–280. https://doi.org/10.1111/sjop.12592

Disclosure of Interests

None declared

AB1052 ASSOCIATION BETWEEN BODY MASS INDEX AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH GOUT

Background

Gout is an inflammatory disease that may cause decreased function and health-related quality of life (HRQoL) [1]. In a few studies, it was demonstrated a negative relationship between body mass index (BMI) and HRQoL in individuals with gout; in the others, it was not confirmed.

Objectives

This study aimed to assess the BMI and quality of life in patients with gout and to value the association between these variables.

Methods

All 151 patients were male with mean age (M±SD) 52.4±9.2 years. Diagnosis of gout was based on the ACR/EULAR 2015 criteria [2]. Tophi was present in 51 (33.7%), and the median duration of gout was 7 years (25th to 75th interquartile range (IQR), 4 to 14.0). The mean uric acid in serum was (sUA) (M±SD) 477.2 ±120.5 µmol/l. HRQoL was evaluated by the SF-36 and calculated summary physical (PCS) and mental component (MCS) scores of the SF-36.

Results

About 67.5% of the surveyed patients had BMI > 30 kg/m2, while the average index was 31.9±3.4. The overall median SF-36 PCS score was 33.9 (IQR 28.8 to 38.4), and the overall median SF-36 MCS score was 41.1 (IQR 34.2 to 47.4). Among the eight subscales of SF-36, there was a correlation between BMI and role physical functioning (RP) r = -0.22 (p<0.01), general health (GH) r = -0.17 (p<0.05), but others were statistically not significant (P>0.05). Our analysis showed negative associations between BMI and physical and mental HRQoL. BMI correlated with PCS r = -0.19 (p<0.05) and MCS r = -0.17(p<0.05).

Conclusion

This analysis provides further evidence to support the injurious effects of obesity on different aspects of health patients with gout and underline the importance of weight loss.

References

[1]Chandratre, P., Mallen, C., Richardson, J., Muller, S., Hider, S., Rome, K., & Roddy, E. (2018, August). Health-related quality of life in gout in primary care: Baseline findings from a cohort study. In Seminars in arthritis and rheumatism (Vol. 48, No. 1, pp. 61-69). WB Saunders.

[2]Neogi, T., Jansen, T. L. T. A., Dalbeth, N., Fransen, J., Schumacher, H. R., Berendsen, D., & Taylor, W. J. (2015). 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & rheumatology, 67(10), 2557-2568.

Disclosure of Interests

None declared

POS0287 A PHASE III, RANDOMISED, DOUBLE-BLIND, ACTIVE-CONTROLLED CLINICAL TRIAL TO COMPARE BAT1806/BIIB800, A PROPOSED TOCILIZUMAB BIOSIMILAR, WITH TOCILIZUMAB REFERENCE PRODUCT IN SUBJECTS WITH MODERATE TO SEVERE RHEUMATOID ARTHRITIS WITH AN INADEQUATE RESPONSE TO METHOTREXATE THERAPY

Background

BAT1806/BIIB800 is a proposed biosimilar to reference tocilizumab (TCZ). A Phase III randomised, double-blind, active-controlled clinical trial was conducted as part of a biosimilar development programme.

Objectives

To evaluate the efficacy, pharmacokinetics (PK), safety and immunogenicity of BAT1806/BIIB800 in comparison with EU-sourced TCZ in subjects with moderate to severe rheumatoid arthritis with inadequate response to methotrexate (MTX).

Methods

The study was conducted at 55 centres in China and Europe, between June 2018 and January 2021. Eligible subjects were randomised in a 2:1:1 ratio to one of three treatment groups: (1) BAT1806/BIIB800 up to Week 48, (2) TCZ up to Week 48, or (3) TCZ up to Week 24, followed by BAT1806/BIIB800 from Week 24 to Week 48, administered intravenously every 4 weeks at a dose of 8mg/kg. The primary endpoint was the proportion of subjects achieving an ACR20 response at timepoints pre-specified to meet the requirements of different Regulatory Agencies: Week 12, for EMA; Week 24, for FDA and NMPA. Equivalence margins applied to differences in ACR20 response rates in the BAT1806/BIIB800 and TCZ treatment groups were pre-specified as follows: +/- 14.5% for EMA (95% confidence interval (CI)); -12.0%,15% for FDA (90% CI); +/- 13.6% for NMPA (95% CI). Secondary endpoints included pharmacokinetics, safety and immunogenicity.

The ICH E9(R1) estimands framework including intercurrent events (related or unrelated to the COVID19 pandemic) was implemented for the ACR20 evaluation. A logistic regression model including ‘region’ (China and Eastern Europe) and ‘previous biologic or targeted synthetic DMARD use’ (Yes/No) as captured in Interactive Web Response System as stratification factors was utilised to assess equivalence for the primary endpoint. The difference in response rates was estimated and corresponding confidence intervals were derived to assess equivalence for the primary endpoint. This abstract presents results up to Week 24.

Results

In total, 621 subjects were randomised to receive BAT1806/BIIB800 (N=312), TCZ (N=155), or TCZ followed by BAT1806/BIIB800 (N=154). The groups were comparable in terms of baseline demographics and disease characteristics, including age, gender, disease activity and disease duration. The estimated proportions of subjects achieving an ACR20 response in the BAT1806/BIIB800 vs. the TCZ groups, respectively, were 68.97% vs. 64.82% at Week 12 and 69.89% vs. 67.94% at Week 24. The estimated difference between ACR response rates was 4.15% (95% CI -3.63, 11.93) at week 12, and 1.94% (90% CI -4.04, 7.92; 95% CI -5.18, 9.07) at Week 24. The CIs for the estimated differences between the treatment groups were within the pre-defined equivalence margins (Figure 1). The treatment groups were comparable in terms of serum trough levels, incidence of TEAEs and ADA/NAb positivity (Table 1).

Table 1.

Safety and Immunogenicity up to Week 24, and Pharmacokinetics at Week 24

TCZ (N =309) n (%)BAT1806/BIIB800 (N=312) n (%)TEAE196 (63.4)201 (64.4)Related TEAE151 (48.9)148 (47.4)Serious TEAE13 (4.2)11 (3.5)Related Serious TEAE7 (2.3)2 (0.6)Fatal TEAE1 (0.3)3 (1.0)ADA positive a42 (13.6%)64 (20.5%)NAb positive a42 (13.6%)63 (20.2%)PK, n271276Serum trough level (ug/mL), mean (SD)15.4 (17.1)15.8 (12.3)Serum trough level (ug/mL), geometric mean (CV%)12.3 (140.3)12.9 (121.3)Below limit of quantification, n (%)43 (15.9)28 (10.1)

TEAE, treatment emergent adverse events

a subjects with ≥1 ADA/NAb positive results up to week 24

Conclusion

BAT1806/BIIB800 has demonstrated equivalent efficacy at Week 12 and Week 24 and a similar PK, safety and immunogenicity profile as reference tocilizumab up to Week 24.

Disclosure of Interests

Xiaomei Leng: None declared, Piotr Leszczynski: None declared, Sławomir Jeka: None declared, Shengyun Liu: None declared, Huaxiang Liu: None declared, Malgorzata Miakisz: None declared, Jieruo Gu: None declared, Lali Kilasonia Speakers bureau: Sandoz, Amgen, Takeda, Mykola Stanislavchuk Speakers bureau: Pfizer, Orion, Boehringer Ingelheim, Xiaolei Yang Shareholder of: Employee of the Bio-thera Solutions Ltd. with shares as a part of Stock incentive plan., Employee of: Employee of the Bio-thera Solutions Ltd., Yinbo Zhou Shareholder of: Employee of Bio-thera Solutions Ltd. with share as part of Stock incentive plan, Employee of: Employee of Bio-thera Solutions Ltd., Qingfeng Dong Shareholder of: Employee of Bio-thera Solutions Ltd. with shares as part of Stock incentive plan, Employee of: Employee of Bio-thera Solutions Ltd., Marian Mitroiu Shareholder of: Employee of Biogen and may hold stocks, Employee of: Employee of Biogen, Janet Addison Shareholder of: Employee of Biogen and holds stock in Biogen, Employee of: Employee of Biogen, Xiaofeng Zeng: None declared

POS0552 RELATIONSHIP BETWEEN PAINLESS MYOCARDIAL ISCHEMIA WITH LEVEL WILLEBRAND FACTOR AND INFLAMMATORY MARKERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

In a patient with rheumatoid arthritis (RA) manifestations of coronary heart disease occur gradually, at the same time “painless” myocardial ischemia is detected in 50 - 70% of cases according to the literature. According to modern ideas, the formation of endothelial dysfunction, development of early atherosclerosis and vascular thrombosis are closely associated with the increase level of von Willebrand factor (VWF) and inflammatory markers.

Objectives

The aim of this study was to investigate the frequency and duration of painless myocardial ischemia and its association with VWF levels and inflammatory markers in patients with RA.

Methods

63 patients with RA (44 women) aged 27 - 65 years (mean age - 46.8 ± 9.8 years) and 69 ages and sex-matched controls were examined. Serum levels of VWF, CRP and TNF-α were determined by enzyme-linked immunosorbent assays. Daily (Holter) ECG monitoring was performed by Holter ECG monitoring systems “DiaCard”, registrar: model 02100, software version 1.0.40, developed by JSC “Solveig” (Ukraine).

Results

It was found, that the part of patients with painless myocardial ischemia among patients with RA was significantly higher (58.7%) than in the control group (13%). At the same time, in patients with RA the duration of painless myocardial ischemia was in averaged 10.9 ± 8.1 minutes per day. It was significantly more than in the control group 2.88±1.25 minutes per day (p <0,05). It was found, that in patients with RA there was an increased levels of VWF (162.2 ± 9.3% vs. 86.2 ± 2.7% in control). It was found, that the duration of painless myocardial ischemia had close correlations with VWF (r = 0.28), CRP (r = 0.41) and TNF-α (r = 0.40).

Conclusion

The severity the duration of painless myocardial ischemia in RA patients is associated with elevated levels of VWF, CRP, and TNF-α, indicating the possible involvement of VWF and inflammatory markers in cardiovascular disease in RA patients.

References

[1]Hannawi, S., Hannawi, H., Al Salmi I. (2020). Cardiovascular disease and subclinical atherosclerosis in rheumatoid arthritis. Hypertension Research, 43, 982–984

Disclosure of Interests

None declared.

AB0049 ASSOCIATION WITH LEPTINEMIA AND Q223R (rs1137101) POLYMORPHISM OF LEPR GENE IN FEMALE PATIENTS WITH KNEE OSTEOARTHRITIS

Background

Knee Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. Poor early diagnostics, growing share of seniors in the population structure, the need for genetic or other molecular biomarkers to improve safety, efficacy, and outcome of treatment of OA patients make up the key issues of scientific interest.

Objectives

To assess the association between serum leptin concentrations, the LEPR gene Q223R(rs1137101) polymorphism in patients with knee OA.

Methods

The participants in this study (knee OA patients = 99, control group (healthy women) = 62) underwent blood measurement to LEPR Q223R(rs1137101) genotyping assay and leptin serum levels. We analyzed the relationship with multivariate regression models using generalized linear models with binomial link function.

Results

In this way, allele frequency and genotypic variant specificity for polymorphic variant Q223R(rs1137101) of LEPR gene in women with OA of knee joints were determined. The frequency of the variant allele G(Arg) in the group of patients with OA of the knee joints was 0.54 and in the control group 0.43. The results were unreliable, although the nature of the trend was small (p = 0.06). In patients with OA, the genotype Q223R(rs1137101) of the LEPR gene was significantly subdivided according to the Hardy-Weinberg law (p = 0.002), which was due to the higher frequency of homozygotes of both types, while theoretically scoring with the same status. The association of the Q223R(rs1137101) polymorphism of the LEPR gene with the risk of developing OA of the knee joints in the recessive model of decay (GG/AA + AG) was revealed: odds ratio (OR) = 2.15 (95% CI: 1.03-4.50), p = 0.04. There was no correlation between the Q223R(rs1137101) polymorphism of the LEPR gene and such clinical and laboratory indicators as clinical form, body mass index, and blood serum leptin concentration. Carriers of AG (Gln/Arg) + GG(Arg/Arg) genotypes have a significantly higher risk of developing rapid X-ray progression of OA (II and III X-ray stages, due to I) after 5 years of diseases: OR = 5.17 (95% CI: 1.04 - 25.57), р = 0.03.

Conclusion

Our results suggest that the patients with knee OA the AG (Gln/Arg) and GG (Arg/Arg) genotype carriers have statistically significant higher risk of OA.

Further study of this issue is needed.

Disclosure of Interests

None declared

AB0284 COGNITIVE AND DEPRESSIVE DISORDERS IN PATIENTS WITH RA, THEIR CONNECTION WITH THE LEVEL OF BRAIN - DERIVED NEUROTROPHIC FACTOR

Background

Rheumatoid arthritis (RA) is a common pathology among other rheumatic diseases. Chronic inflammation, prolonged pain, early disability of patients - all these factors contribute to the development of depressive and cognitive disorders in this category of patients. Still, the mechanisms of these disorders remain poorly understood. Recently, the role of brain-derived neurotrophic factor (BDNF) as one of the factors of cognitive and depressive disorders in various pathological conditions has been widely discussed in the literature.

Objectives

To study cognitive and depressive disorders in RA patients and their association with serum BDNF levels.

Methods

79 women with RA, aged 21 to 74 years, on average (M ± SD) 48.7 ± 10.2 were examined. Diagnosis RA was established according to EULAR / ACR criteria (2010). Patients’ cognitive function was assessed by the MMSE (Mini Mental State Examination). The presence and severity of depression were determined by the QIDS-SR16 (Quick Inventory of Depressive Symptomatology Self-Report). Serum BDNF was detected by enzyme-linked immunosorbent assay (ELISA) using standard BDNF Quantikine ELISA kits (R&B Systems, USA). The control group consisted of 30 age matched healthy women.

Results

It was found that the level of BDNF in the serum of women with RA was 1.5 times higher than in healthy individuals and was 16.8 ± 10.8 ng/ml and 11.32 ± 4.89 ng/ml, respectively. Cognitive disorders (MMSE ˂28 points) were registered in the majority (78.5%) of patients with RA, while in the control group, there were only 10%. The mean MMSE values in RA patients and the control group were 27.2 ± 1.45 and 29.1 ± 0.99, respectively. Depressive disorders (QIDS-SR16 ≥ 6 points) were reported in 53% of patients, while in the control group, it was 3.3%. It was found that depressive disorders in RA patients were associated with BDNF levels (r = 0.208; p˂0.05) and age (r = 0.159; p˂0.05). There was no significant association between BDNF levels and MMSE in RA patients. In the control group it was found negative correlation (-0.257; p <0.05). We found also close negative correlation between MMSE and age in patients with RA (r = -0.689; p˂0.001). A significant relation with age was also registered in the healthy group (r = -0.257; p˂0.05).

Conclusion

Patients with RA had an increased level of BDNF compared with the control group. Most of them had cognitive and depressive disorders. Depressive disorders in RA patients are associated with higher levels of BDNF in the blood and with age. No association of cognitive impairment with BDNF has been established in patients. Cognitive disorders in RA patients are most closely associated with age. Moderate association between MMSE and BDNF levels was established in control group.

References

[1]Cheon, Y. H., Lee, S. G., Kim, M., Kim, H. O., Suh, Y. S., Park, K. S., & Lee, S. I. (2018). The association of disease activity, pro-inflammatory cytokines, and neurotrophic factors with depression in patients with rheumatoid arthritis. Brain, behavior, and immunity, 73, 274-281.

[2]Pedard, M., Quirié, A., Tessier, A., Garnier, P., Totoson, P., Demougeot, C., & Marie, C. (2021). A reconciling hypothesis centered on brain-derived neurotrophic factor to explain neuropsychiatric manifestations in rheumatoid arthritis. Rheumatology, 60 (4), 1608-1619.

Disclosure of Interests

None declared

Efficacy, pharmacokinetics and safety of subcutaneous versus intravenous CT-P13 in rheumatoid arthritis: a randomized phase I/III trial

Objective

To assess non-inferiority of s.c. to i.v. CT-P13 in RA.

Methods

Patients with active RA and inadequate response to MTX participated in this phase I/III double-blind study at 76 sites. Patients received CT-P13 i.v. 3 mg/kg [week (W) 0 and W2] before randomization (1:1) at W6 to CT-P13 s.c. via pre-filled syringe (PFS) 120 mg biweekly until W28, or CT-P13 i.v. 3 mg/kg every 8 weeks until W22. Randomization was stratified by country, W2 serum CRP and W6 body weight. From W30, all patients received CT-P13 s.c. In a usability sub-study, patients received CT-P13 s.c. via auto-injector (W46–54) then PFS (W56–64). The primary endpoint was change (decrease) from baseline in disease activity score in 28 joints (DAS28)-CRP at W22 (non-inferiority margin: −0.6).

Results

Of 357 patients enrolled, 343 were randomized to CT-P13 s.c. (n = 167) or CT-P13 i.v. (n = 176) at W6. The least-squares mean change (decrease) from baseline (standard error) in DAS28-CRP at W22 was 2.21 (0.22) for CT-P13 s.c. (n = 162) and 1.94 (0.21) for CT-P13 i.v. [n = 168; difference 0.27 (95% CI: 0.02, 0.52)], establishing non-inferiority. Efficacy findings were similar between arms at W54. Safety was similar between arms throughout: 92 (54.8%; CT-P13 s.c.) and 117 (66.9%; CT-P13 i.v.) patients experienced treatment-emergent adverse events (from W6). There were no treatment-related deaths or new safety findings. Usability was similar for CT-P13 s.c. via auto-injector or PFS.

Conclusion

CT-P13 s.c. was non-inferior to CT-P13 i.v. in active RA. The convenience of s.c. administration could benefit patients.

Trial registration

ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT03147248.

POS0414 INCREASED BDNF LEVELS AS A PREDICTOR OF CENTRAL SENSITIZATION IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Ankylosing spondylitis (AS) is a chronic rheumatic disease that manifests itself in a range of inflammatory changes, severe pain and rapid progression with the development of osteoproliferation and the formation of ankylosis. Prerequisites are created for the emergence of signs of central sensitization. Scientists are growing interested in the role of the phenomenon of central sensitization. Central sensitization is present in almost half of patients with chronic pain (45% SpA, 41% RA, 62% OA and 94% of FM patients) [1]. Brain neurotrophic factor (BDNF) is involved in pain regulation mechanisms and the occurrence of central sensitization, but its role in patients with AS is poorly understood.

Objectives:

Our study aimed to determine levels of plasma BDNF in patients with AS and evaluate their role as central sensitization predictors in patients with ankylosing spondylitis.

Methods:

We examined 143 patients with AS according to modified New York criteria (26 women and 117 men) with mean age 42.1±11.3 years (M±σ) and 35 persons of the control group, representative by age, sex. The content of plasma BDNF was determined at 8:00 and 20:00 by ELISA and calculated the daily average and morning/evening ratio - 8:00/20:00 BDNF index. All patients completed self-administered questionnaire Fibromyalgia Rapid Screening Tool (FiRST) to detect FM. FM was defined by a score = > 5/6 by the FiRST. The study was conducted in compliance with bioethical standards. All data were analyzed using IBM Statistics SPSS 22.

Results:

Among 143 patients with AS, there were 51 persons with FiRST ≥ 5, indicating central sensitization and probable FM. In the group with AS mean scores (M±σ) of plasma BDNF levels were 962.5±357.2 pg/ml at 8:00 and 834.7±510.0 pg/ml at 20:00 compared to control group (785.2±109.7 pg/ml and 450.6±358.9 pg/ml; p< 0.001). 36% AS patients were with + FiRST and had higher daily average and evening BDNF levels and a decreased 8:00/20:00 BDNF index. According to 8:00/20:00 BDNF index, we divide AS patients into 4 groups: 1st quartile (Q1) included people with BDNF index <0.83; 2nd quartile (Q2) - 0.83 - 1.15; 3rd quartile (Q3) - 1.16 - 2.49; 4th quartile (Q4) - > 2.49. Table 1 shows detailed information about FM’s quantitative characteristics in patients with AS (n = 143) depending on the 8:00/20:00 BDNF index.

Table 1.

Quantitative characteristics of FM in patients with AS (n = 143) depending on the 8:00/20:00 BDNF index.

ParametersBDNF «8:00 / 20:00»< 0.830,83 – 1.151,16 – 2.49> 2.49Q1 (n=37)Q2 (n=35)Q3 (n=35)Q4 (n=36)FiRST (M±σ)4.49±1,464.23±1.423.03±1.442.81±1.04***#***#FiRST≥ 5, n (%)24 (64,9 %)17 (48.6 %)9 (25.7 %)1 (2.78 %)***#***#

Notes: 1. * - statistically significant differences relative to Q1 (* - p <0.05;** - p <0.01; *** - p <0.001); 2. # - statistically significant differences relative to Q2 (# - p <0.05).

In patients with AS and + FiRST was registered an inadequate decrease in plasma BDNF levels in the evening, as evidenced by a decrease in the 8:00/20:00 BDNF index, which was combined with increased disease activity and poorer of the functional status.

The ROC analysis results showed that the 8:00/20:00 BDNF index at the cut-off point of 0.95 confirms the presence of central sensitization in patients with AS with a sensitivity of 86.2% and a specificity of 79.6%. The AUC is 0.878, which indicates a good quality of the model. Patients with the 8:00/20:00 BDNF index <0.95 are many times more likely to detect features of central sensitization (OR = 20.9; 95% CI: 8.66-50.39, p < 0.001).

Conclusion:

Our results showed high diagnostic value to determine plasma levels of BDNF and to calculate 8:00/20:00 BDNF index as central sensitization marker in patients with AS with a sensitivity of 86.2% and a specificity of 79.6%.

References:

[1]Guler, M. A., Celik, O. F., & Ayhan, F. F. (2020). The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases. Clinical rheumatology, 39(1), 269-274.

Disclosure of Interests:

None declared

Safety and Efficacy of Filgotinib: Up to 4-year Results From an Open-label Extension Study of Phase II Rheumatoid Arthritis Programs

OBJECTIVE

The long-term safety and efficacy of filgotinib (from phase II studies), with or without methotrexate (MTX), for the treatment of patients with rheumatoid arthritis was assessed in DARWIN 3, a long-term, open-label extension study (ClinicalTrials.gov: NCT02065700).

METHODS

Eligible patients completing the 24-week DARWIN 1 (filgotinib + MTX) and DARWIN 2 (filgotinib monotherapy) studies entered DARWIN 3, where they received filgotinib 200 mg/day, except for 15 men who received filgotinib 100 mg/day. Safety analyses were performed using the safety analysis set and the exposure-adjusted incidence rate (EAIR) of treatment-emergent adverse events (TEAEs) was calculated. Efficacy was assessed from baseline in the parent studies.

RESULTS

Of 790 patients completing the phase II parent studies, 739 enrolled in the study. Through April 2019, 59.5% of patients had received ≥ 4 years of the study drug. Mean (SD) exposure to filgotinib was 3.55 (1.57) years in the filgotinib + MTX group and 3.38 (1.59) years in the filgotinib monotherapy group. EAIR per 100 patient-years of exposure for TEAEs was 24.6 in the filgotinib + MTX group and 25.8 in the filgotinib monotherapy group, and for serious TEAEs, the EAIR was 3.1 and 4.3, respectively. American College of Rheumatology 20/50/70 responses among patients remaining in the study could be maintained through 4 years, with 89.3%/69.6%/49.1% of the filgotinib + MTX group and 91.8%/69.4%/44.4% of the monotherapy group maintaining ACR20/50/70 responses, respectively, based on observed data.

CONCLUSION

Filgotinib was well tolerated with a 4-year safety profile comparable to that of the parent trials, both in patients receiving combination therapy with MTX or as monotherapy.

AB0434 PREVALENCE OF ANTIPHOSPHOLIPID SYNDROME COMPONENTS IN MEN WITH STABLE СORONARY HEART DISEASE AND POSTINFARCTION CARDIOSCLEROSIS AND CONECTION WITH ECHOCARDIOGRAPHIC EVALUATION OF CARDIAC STRUCTURE AND FUNCTION 1.0.0.20

Background:

Antiphospholipid syndrome (APS) as an independent factor in different forms of coronary heart disease (CHD) has been attracting more attention in recent years [1]. The prevalence of AFS in the general population is low (1-5%) but among patients with acute coronary syndrome it ranges from 6.1% to 43.3%. The persistence of high titers of antiphospholipid (aPL) antibodies, especially antibodies to cardiolipin, accelerates the development of endothelial dysfunction and atherothrombotic lesions of the coronary arteries, worsens the course of acute myocardial infarction. It has been experimentally demonstrated that aPL antibodies can directly affect myocardial status through pro-apoptotic signaling pathways and increased cardiomyocyte apoptosis [2].The impact of aPL antibodies on the course of postinfarction myocardial remodeling in patients with CHD has not been established.

Objectives:

To study the prevalence of APS components in men with stable CHD with postinfarction cardiosclerosis and to evaluate the relationship with structural and functional state of left ventricular myocardium.

Methods:

164 patients with CHD with postinfarction cardiosclerosis were examined (100% males at the average age of 53,0±9,14 (M±σ)). The diagnosis of CAD was made according to the recommendations of the ANA / ACC (2014) and ESC (2013). The content of IgG and IgM of aPL antibodies - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate and levels of IgG and IgM to β2-glycoprotein I (β2-GP-I) in the blood serum were determined by ELISA. Echocardiography in M-, B- and D-modes was performed.

Results:

Among 164 patients with post-infarction cardiosclerosis: 75% had Q myocardial infarction (MI), 10.4% had recurrent MI, 7.9% had a stroke or transient ischemic attack and 4.2% had livedo reticularis. 93 (56.7%) patients had positive levels of total aPL antibodies and antibodies to β2-GP-I of IgG class (58 (35,4%) patients had low positive levels of antibodies, 35 (21.3%) patients had medium positive levels of one or both types of antibodies. Positive levels of aPL antibodies and antibodies to β2-GP-I of IgM were detected in 11.6% of patients. Positive levels of aPL antibodies and antibodies to β2-GP-I were more commonly found in men who had Q MI (OR 2.58 95% CI 1.26 - 5.28) and recurrent MI (OR 2.52 95% CI 0.83 - 7.67). Increases of levels of aPL antibodies and antibodies to β2-GP-I correlated with an increase of left ventricle (LV) mass index (r = 0.259 and 0.331, p <0.001). In patients with positive levels of antibodies of IgG to β2-GP-I in postinfarction LV remodeling was more likely to occur by concentric type of hypertrophy of LV than in patients with negative levels of antibodies to β2-GP-I (OR 6.50, 95% CI 2.49 - 16.9, p <0.001). Hypertension had no significant differences within these groups.

Conclusion:

The risk of persisting positive levels of aPL antibodies and antibodies to β2-GP-I in the postinfarction period is significantly increased in men who had Q MI. Patients with CHD with positive antibodies to β2-GP-I of IgG are associated with an increased risk of postinfarction LV myocardial remodeling by concentric type of hypertrophy of LV.

References:

[1]Kolitz, T., Shiber, S., Sharabi, I., Winder, A., & Zandman-Goddard, G. (2019). Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Frontiers in immunology,10, 941.

[2]Bourke, L. T., McDonnell, T., McCormick, J., Pericleous, C., Ripoll, V. M., Giles, I., ... & Ioannou, Y. (2018). Antiphospholipid antibodies enhance rat neonatal cardiomyocyte apoptosis in an in vitro hypoxia/reoxygenation injury model via p38 MAPK.Cell death & disease,8(1), e2549-e2549.

Disclosure of Interests:

None declared

THU0480 EXPERIENCE USING DIFFERENT CRITERIA OF FIBROMYALGIA IN PATIENTS WITH ANKYLOSING SPONDYLITIS: 1990 AMERICAN COLLEGE OF RHEUMATOLOGY CLASSIFICATION CRITERIA VS. NEW

Background:

Fibromyalgia (FM) is a very frequent condition in patients with diseases associated with pain syndrome, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and other chronic rheumatic diseases. FM, RA and AS has different clinical characteristics, but can share symptoms such as pain, fatigue and sleep disturbance that leads to delay in appropriation correct diagnosis [1]. For today well known many different criteria for FM: 1990 American College of Rheumatology (ACR) classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and new AAPT Diagnostic Criteria for Fibromyalgia. According to the literature, prevalence FM in AS patients can reach from 12.6 to 28.5%, but prevalence estimates should be interpreted with care as no data that the criteria for FM have been validated for use in patients with AS and other chronic inflammatory arthritis [1, 2]. The lack of appropriate information needs further investigation for better identification FM.

Objectives:

The aim of our study was to compare the presence of FM by 1990 ACR classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and new criteria FM 2019 - AAPT Diagnostic Criteria for Fibromyalgia in AS patients.

Methods:

One hundred and thirteen AS patients (19 women and 94 men) with mean age (M ± SD) 42.3±10.94 years were enrolled in the study. Diagnosis AS was established according to modified New York criteria. For FM detection were used 1990 ACR classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and AAPT Diagnostic Criteria for Fibromyalgia. All patients were asked to complete self-reported disease-related questionnaires for patients with AS.

Results:

According 1990 ACR criteria, FM met in 26 patients (23%). 38.1% patients were positively screened for FM due to modified 2010 ACR diagnostic criteria, and in 31.9% patients according 2016 Fibromyalgia Diagnostic Criteria, and in 41.6% patients due to AAPT Diagnostic Criteria for Fibromyalgia. All new criteria correlated with 1990 ACR classification criteria with p<0,01: r=0.654, r=0.664, r=0.520, concordantly. Using the ROC analysis, we evaluated the sensitivity and specificity of different FM criteria in patients with AS. Our results showed high diagnostic value of all new criteria, but the most sensitive for detection FM in patients with AS were the modified 2010 ACR diagnostic criteria with sensitivity of 96% and specificity of 79%.

Conclusion:

Our study results confirmed very high prevalence FM in patients with AS.The most sensitive tool for detection FM in patients with AS were the modified 2010 ACR diagnostic criteria with sensitivity of 96% and specificity of 79%.The similar percentages of FM due to different classification criteria might be a good sign in context of the validity of these criteria for AS patient.

References:

[1]Zhao, S. S., Duffield, S. J., & Goodson, N. J. (2019). The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis.Best Practice & Research Clinical Rheumatology, 1014-23.

[2]Salaffi, F., De Angelis, R., Carotti, M., Gutierrez, M., Sarzi-Puttini, P., & Atzeni, F. (2014). Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity.Rheumatology international,34(8), 1103-1110.

Disclosure of Interests: :

None declared

FRI0025 CIRCADIAN RHYTHMS OF ENDOTHELIAL NITRIC OXIDE SYNTHASE PRODUCTION IN FEMALES WITH RHEUMATOID ARTHRITIS AND ARTERIAL HYPERTENSION DEPENDING ON NOS3 Т786С GENE POLYMORPHISM

Background:

One of the most common comorbidity in patients with rheumatoid arthritis (RA) is arterial hypertension (AH), with incidence ranging from 20 to 60%. Mechanisms of this comorbidity arises a lot of interest. In our previous study was established the association ofT786C NOS3(rs2070744) gene polymorphism with AH in females with RA in the Ukrainian population [1].

Objectives:

So next, we were aiming to investigate daily fluctuation of endothelial nitric oxide synthase (NOS3) in RA patients with AH depending onNOS3 T786Cgene polymorphism.

Methods:

In the study were enrolled 173 females with RA aged 43.7 ± 7.35 years (Mean ± SD) and 34 age-matched healthy women without joint diseases and autoimmune diseases (control). Serum NOS3 level was determined at 08:00 and 20:00 using Cloud-Clone Corp kits (USA).NOS3 T-786Сpolymorphism was determined by Real-Time PCR (Bio-Rad iCycler IQ5) using SNP-express kit. Study was carried out in compliance with bioethical standards and provisions of the WHO, Helsinki Declaration of the General Assembly of the World Medical Association (1989).

Results:

Among enrolled patients prevailed individuals with more than 5 years disease history, ІІ-ІІІ radiographic stage (80.9 %), and were seropositive for anti-cyclic citrullinated peptide (80.6%). There were 114 (66%) normotensive patients and 59 (34%) patients with AH (13% - I stage, 20.8% - II stage). The daily fluctuation of NOS3 serum level was established in the control group. The evening NOS3 level was higher in 1.3 times, than the morning level (р<0.001). In RA patients the similar fluctuations of NOS3 level was registered, but the daily NOS3 production was lower, than in control. Diurnal variation of NOS3 level depended on comorbid AH andNOS3 T-786Сgenotype. InCCgenotype NOS3 levels at 08:00 and at 20:00 were lower in 1.2-1.3 times (p<0.05) than inTTandTCgenotypes. In patients with RA and AH the lowest diurnal variation of NOS3 level was inCCgenotype. The decrease of evening NOS3 production was strong associated with comorbid AH (OR 3.78; 95% CI 1.96-7.28).

Conclusion:

Circadian rhythms of NOS3 production in females with RA and AH depend onNOS3 Т786Сgene polymorphism. The depression of NOS3 production in the evening can be predictor of comorbid AH in females with RA.

References:

[1]Zaichko, K., & Stanislavchuk, M. (2017, April). T-786C gene promoter polymorphism of endothelial nitric oxide synthase: its association to the disease activity and arterial hypertension in patients with rheumatoid arthritis in the ukraine population. In rheumatology (vol. 56, pp. 129-129). GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND: OXFORD UNIV PRESS.

Acknowledgments:

NA

Disclosure of Interests:

None declared

Circadian fluctuations of endothelial nitric oxide synthase activity in females with rheumatoid arthritis: a pilot study

Rheumatoid arthritis (RA) is a disease associated with circadian disorders of steroid hormones or cytokine secretion which induce inflammatory, destructive and proliferative processes in the synovial joints. Angiogenesis plays an important role in RA, but circadian rhythms of the angiogenic mediator production, especially endothelial nitric oxide synthase (NOS3), are still unclear. NOS3 takes part in regulation of endothelial functions, inflammation, and bone remodeling process. Studying circadian rhythms of NOS3 production in RA patients will make an improvement in understanding the angiogenic-inflammatory pathways relevant to rheumatic diseases. The aim of the study was to test the hypothesis of a diurnal variation in circulating levels of NOS3 in RA patients. A cross-sectional monocentric pilot study of circadian variability of endothelial nitric oxide synthase in a Ukrainian population was conducted between March and July 2017. We examined 36 RA patients (100% women) and 34 age-matched healthy women without joint diseases and autoimmune diseases (control). Blood samples were collected four times per day (at 08:00; 14:00; 20:00 and 02:00) for two consecutive days. Serum NOS3 concentration was measured by ELISA (Cloud-Clone Corp kit). The study was conducted in compliance with bioethical standards. The SPSS22 software package was used for statistical processing of the results. A diurnal variation in circulating levels of NOS3 in healthy women was established, with peak values appearing in the evening and acrophase at 20:00, and low values in the morning, with batiphase at 08:00. In patients with RA serum, NOS3 levels were substantially decreased throughout the day compared to the control. In RA patients, a diurnal variation in circulating levels of NOS3 was also established. However, the variability of NOS3 production was higher in RA patients than in the control group. For example, in RA patients the difference between morning/evening values of NOS3 was 1.3 times higher (p < 0.05) than in the control. Negative correlations were found between the morning NOS3 levels and RA activity markers such as DAS28 and the number of tender and swollen joints. The diurnal variation in circulating levels of NOS3 in women with RA as well as in healthy women was found. However, in RA patients, a decrease in NOS3 production was observed, especially in the morning, which was associated with an increase in the disease activity. Thus, the circadian rhythm of circulating NOS3 can be opposite to the circadian rhythm of secretion of main inflammatory regulators in RA.

ASSOCIATIONS BETWEEN EFFICACY OF THE THERAPY AND CIRCADIAN FLUCTUATIONS OF ENDOTHELIAL NITRIC OXIDE SYNTHASE WITH TOLL-LIKE RECEPTORS 2 EXPRESSION, AND NOS3 POLYMORPHISM IN FEMALES WITH RHEUMATOID ARTHRITIS

Despite significant progress in treatment of rheumatoid arthritis (RA), a considerable part of patients remains resistant to the current therapy, apparently for the reasons of undefined mechanisms of its pathogenesis. Recently, the disturbances of circadian regulation of inflammatory processes in RA have been highlighted as important ones. Endothelial nitric oxide synthase (NOS3) and soluble toll-like receptors 2 (sTLR2) take part in the regulation of angiogenesis, osteoclastogenesis, immune responses but their circadian rhythms and predictive significance in RA patients are still unknown. Aim - to estimate the associations between efficacy of treatment and the circadian rhythms of NOS3 and sTLR2, and NOS3 polymorphism in females with rheumatoid arthritis, Ukraine. 97 RA patients (100% female) aged 46.3±8.89 years with disease duration 8.44±6.52 years were examined. All patients as a disease-modifying therapy received methotrexate (MTX) orally in a dose ≤15 mg/week, folic acid 5 mg/week, NSAIDs and corticosteroids (CS) ≤10 mg/day by prednisone. Doses of MTX, NSAIDs and CS were stable 4 weeks prior to the enrolment and during the whole period of study. The efficacy end points included DAS28, RAID and American College of Rheumatology response criteria (ACR20/50/70). Serum levels of NOS3 and sTLR2 were determined at 08:00 and 20:00 using Cloud-Clone Corp kits (USA). NOS3 T-786С polymorphism was determined by Real-Time PCR. The SPSS22 software package was used for statistical processing of the results. The study was performed in accordance to the bioethical standards. After 12-week treatment among RA patients were revealed 52.6% ACR 20 responders and 47.4% non-responders. Opposite diurnal variation of NOS3 and sTLR2 serum levels were found in RA patients. There were significant differences in NOS3/sTLR2 ratio at 08:00 accordingly to NOS3 T786C genotype. The disturbances in daily variability of NOS3 or sTLR2 serum levels were more significant in non-responders compare to responders. Decrease of NOS3/sTLR2 ratio was a predictor of non-response to treatment in RA patients (β=0.366, р=0.000). In RA patients the disturbances of circadian rhythms of endothelial nitric oxide synthase or toll-like receptors 2 expression are associated with an increase of resistance to disease-modifying therapy with methotrexate.

Circadian Rhythms of Endothelial Nitric Oxide Synthase and Toll-like Receptors 2 Production in Females with Rheumatoid Arthritis Depending on NOS3 Gene Polymorphism

BACKGROUND

Rheumatoid Arthritis (RA) is an autoimmune polygenic disease characterized by rapid disability progression and high prevalence. Progression of RA is closely associated with chronobiological changes in the production of some hormones and inflammatory mediators, influencing the disease course and therapy efficacy. The main pathogenetic mechanism of RA is angiogenesis, which is controlled by biological clock-genes. Further investigation of circadian rhythms of angiogenic mediators production in RA patients may be considered as important and relevant. The aim of this study was to establish daily variability of serum endothelial Nitric Oxide Synthase (NOS3) and toll-like receptors 2 (sTLR2) levels in female RA patients depending on the NOS3 gene polymorphism.

METHODS

We examined 173 RA patients (100% female) aged 43.7 ± 7.35 years and 34 age-matched healthy women without joint diseases and autoimmune diseases (control). RA was diagnosed by ACR/EULAR 2010 criteria. Blood serum NOS3 and sTLR2 levels were determined at 08:00 and 20:00 using Cloud-Clone Corp kits (USA). NOS3 T-786С (rs2070744) polymorphism was determined by Real-Time PCR (Bio-Rad iCycler IQ5) using SNP-express kits. The SPSS22 software package was used for statistical processing of the results.

RESULTS

Females with RA demonstrated oppositely directed serum NOS3 and sTLR2 daily changes: NOS3 level in the morning (08:00) was lower than in the evening (+ 45.5 ± 30.7%), and sTLR2 level in the evening (at 20:00) was lower than in the morning (-21.6 ± 13.1%). RA patients had differences in NOS3 and sTLR2 production depending on NOS3 T786C genotype. CC subjects had NOS3 level at 08:00, 20:00 and day average levels lower (16-25%), and sTLR2 level higher (24-27%) than those of TT subjects. RA patients, carriers of CC genotype, had higher chances of NOS3 and sTLR2 aberrant production compared to TT and TC genotype carriers (OR = 2.99 and 4.79, respectively).

CONCLUSION

RA patients demonstrated oppositely directed circadian changes of serum NOS3 and sTLR2. CC genotype carriers had lower NOS3 and higher sTLR2 production rates than TT and TC genotype carriers.

FKB327, an adalimumab biosimilar, versus the reference product: results of a randomized, Phase III, double-blind study, and its open-label extension

Objective

To compare the efficacy, serum drug concentrations, immunogenicity, and safety of FKB327 with the adalimumab reference product (RP) in combination with methotrexate in patients with moderate-to-severe, active rheumatoid arthritis (RA).

Methods

Patients were randomized 1:1 in a double-blind study (NCT02260791), received 40 mg of FKB327 or RP by subcutaneous injection every other week for 24 weeks (Period I), then re-randomized 2:1, remaining on the same study drug or switching to the other up to week 54 in an open-label extension (Period II, NCT02405780). Efficacy was evaluated using American College of Rheumatology (ACR20) response rate difference at week 24 with equivalence margins of ± 13% and − 12% to + 15% using 95% and 90% confidence intervals (CIs), respectively. Efficacy, serum drug concentrations, immunogenicity, and safety were compared at week 54.

Results

A total of 730 patients were randomized in Period I (n = 367 FKB327, n = 363 RP), and 645 transitioned to Period II (n = 216 FKB327–FKB327, n = 108 FKB327–RP, n = 108 RP–FKB327, n = 213 RP–RP). At week 24, ACR20 response rates were 74.1% with FKB327 versus 75.7% with RP. 95% and 90% CI of the response rate difference were − 7.9 to 4.7% and − 7.3 to 3.6%, respectively, meeting predefined equivalence margins. The ACR20 response rate remained over 70% of patients to week 54 with all treatment sequences. In Period I, mean trough serum drug concentrations were slightly higher for patients receiving FKB327 than those receiving RP. Mean concentrations were stable over time and reflected steady state in Period II. The proportions of patients with samples positive for neutralizing antidrug antibodies (ADAs) were comparable (57.7% with FKB327 vs. 55.5% with RP) at week 24, and no consistent difference in ADA were seen between continuous and switched treatments in Period II. Efficacy was slightly reduced in the small proportion of patients with high ADA titers in all treatment groups. No clinically significant differences were observed in the incidence of commonly reported treatment-emergent adverse events between the treatments across Periods I and II.

Conclusion

FKB327 was equivalent to RP in clinical efficacy and demonstrated comparable safety and immunogenicity in patients with moderate-to-severe RA. No effect of switching between FKB327 and RP was observed.

Trial registration

ClinicalTrials.gov, NCT02260791, Registered 29 July 2014.

ClinicalTrials.gov, NCT02405780, Registered 17 July 2015.

Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active psoriatic arthritis (EQUATOR): results from a randomised, placebo-controlled, phase 2 trial

BACKGROUND

The Janus kinase 1 (JAK1) pathway has been implicated in the pathogenesis of psoriatic arthritis. We aimed to investigate the efficacy and safety of filgotinib, a selective JAK1 inhibitor, for the treatment of psoriatic arthritis.

METHODS

The EQUATOR trial was a randomised, double-blind, placebo-controlled phase 2 trial that enrolled adults from 25 sites in seven countries (Belgium, Bulgaria, Czech Republic, Estonia, Poland, Spain, and Ukraine). Patients (aged ≥18 years) had active moderate-to-severe psoriatic arthritis (defined as at least five swollen joints and at least five tender joints) fulfilling Classification for psoriatic arthritis (CASPAR) criteria, active or a documented history of plaque psoriasis, and an insufficient response or intolerance to at least one conventional synthetic disease-modifying anti-rheumatic drug (csDMARD). Patients continued to take csDMARDs during the study if they had received this treatment for at least 12 weeks before screening and were on a stable dose for at least 4 weeks before baseline. Using an interactive web-based system, we randomly allocated patients (1:1) to filgotinib 200 mg or placebo orally once daily for 16 weeks (stratified by current use of csDMARDs and previous use of anti-tumour necrosis factor). Patients, study team, and sponsor were masked to treatment assignment. The primary endpoint was proportion of patients achieving 20% improvement in American College of Rheumatology response criteria (ACR20) at week 16 in the full analysis set (patients who received at least one dose of study drug), which was compared between groups with the Cochran-Mantel-Haenszel test and non-responder imputation method. This trial is registered with ClincalTrials.gov, number NCT03101670.

FINDINGS

Between March 9, and Sept 27, 2017, 191 patients were screened and 131 were randomly allocated to treatment (65 to filgotinib and 66 to placebo). 60 (92%) patients in the filgotinib group and 64 (97%) patients in the placebo group completed the study; five patients (8%) in the filgotinib group and two patients (3%) in the placebo group discontinued treatment. 52 (80%) of 65 patients in the filgotinib group and 22 (33%) of 66 in the placebo group achieved ACR20 at week 16 (treatment difference 47% [95% CI 30·2-59·6], p<0·0001). 37 (57%) patients who received filgotinib and 39 (59%) patients who received placebo had at least one treatment-emergent adverse event. Six participants had an event that was grade 3 or worse. The most common events were nasopharyngitis and headache, occurring at similar proportions in each group. One serious treatment-emergent adverse event was reported in each group (pneumonia and hip fracture after a fall), one of which (pneumonia) was fatal in the filgotinib group.

INTERPRETATION

Filgotinib is efficacious for the treatment of active psoriatic arthritis, and no new safety signals were identified.

FUNDING

Galapagos and Gilead Sciences.

ASSOCIATION OF DYSADIPOKINEMIA WITH TLR4 SERUM CONCENTRATION IN GOUT PATIENTS

Study objective was to estimate the levels of TLR4 in gout patients and evaluate their association with the dysadipokinemia. The study involved 65 gout patients and 24 healthy individuals. All study subjects proceeded clinical and laboratory examination. Levels of adipokines and TLR4 concentration were estimated by commercial ELISA kits. The statistical information was processed using MS Excel and Statistica SPSS22 utility programs for Windows. Our study revealed that gout patients had elevated leptin and TLR4 levels, decreased adiponectin concentration and lg A/L dysadipokinemia indicator compared to apparently healthy individuals. More prominend disturbance of adipokines status was estimated in patients with high level of TLR4. The adipokine status disturbances were associated with elevated TLR4 serum concentrations.

Special peculiarities of clinical course of osteoarthrosis of knee joints depending on 6-hydroxymelatonin-sulfate urinary excretion profile

The study objective was to define the special features of the clinical course of knee joint osteoarthrosis depending on 6-sulfatoxymelatonin urinaryexcretion profile.Materials and methods.We surveyed 141 patients with radiological Stage II-III osteoarthrosis (OA) of the knee joints (18 female subjects). Diagnosis of OA was established on the basis of ACR criteria (1991) and EULAR (2010) recommendations. We determined the AO clinical indexes (Lequesne, WOMAC, KOOS), HAQ functional index, sleep quality and psycho-emotional state indicators. ELISA was used to assess 6-sulfatoxymelatonin urinary excretion profile.Results. It was established that 66% of patients with OA of knee joints had a reduced 6-sulfatoxymelatonin urinary excretion compared to this of practically healthy individuals. AO patients with low 6-SMT urinary excretion profiles had higher incidence of severe insomnia and depressive disorders. Reduction in 6-SMT excretion was associated with a moderate increase in pain syndrome and deterioration of physical functions by Lequesne, WOMAC, KOOS, and HAQ indexes.Conclusion.The reducedmelatonin production in ОА patients is a factor of more severe clinical course of the disease due to deterioration of the psycho-emotional state, the development of pain syndrome, and functional disorders.

Efficacy, Safety, Pharmacokinetics, and Pharmacodynamics of Filgotinib, a Selective JAK-1 Inhibitor, After Short-Term Treatment of Rheumatoid Arthritis: Results of Two Randomized Phase IIa Trials

OBJECTIVE

JAK inhibitors have shown efficacy in rheumatoid arthritis (RA). We undertook this study to test our hypothesis that selective inhibition of JAK-1 would combine good efficacy with a better safety profile compared with less selective JAK inhibitors.

METHODS

In two 4-week exploratory, double-blind, placebo-controlled phase IIa trials, 127 RA patients with an insufficient response to methotrexate (MTX) received filgotinib (GLPG0634, GS-6034) oral capsules (100 mg twice daily or 30, 75, 150, 200, or 300 mg once daily) or placebo, added onto a stable regimen of MTX, to evaluate safety, efficacy, pharmacokinetics (PK), and pharmacodynamics (PD) of filgotinib. The primary efficacy end point was the number and percentage of patients in each treatment group meeting the American College of Rheumatology 20% improvement criteria (achieving an ACR20 response) at week 4.

RESULTS

Treatment with filgotinib at 75-300 mg met the primary end point and showed early onset of efficacy. ACR20 response rates progressively increased to week 4, and the Disease Activity Score in 28 joints using the C-reactive protein (CRP) level decreased. Marked and sustained improvements were observed in serum CRP level and other PD markers. The PK of filgotinib and its major metabolite was dose proportional over the 30-300 mg range. Early side effects seen with other less selective JAK inhibitors were not observed (e.g., there was no worsening of anemia [JAK-2 inhibition related], no effects on liver transaminases, and no increase in low-density lipoprotein or total cholesterol). A limited decrease in neutrophils without neutropenia was consistent with immunomodulatory effects through JAK-1 inhibition. There were no infections. Overall, filgotinib was well tolerated. Events related to study drug were mild or moderate and transient during therapy, and the most common such event was nausea.

CONCLUSION

Selective inhibition of JAK-1 with filgotinib shows initial efficacy in RA with an encouraging safety profile in these exploratory studies.

Filgotinib (GLPG0634/GS-6034), an oral selective JAK1 inhibitor, is effective as monotherapy in patients with active rheumatoid arthritis: results from a randomised, dose-finding study (DARWIN 2)

Objectives

To evaluate the efficacy and safety of different doses of filgotinib, an oral Janus kinase 1 inhibitor, as monotherapy in patients with active rheumatoid arthritis (RA) and previous inadequate response to methotrexate (MTX).

Methods

In this 24-week phase IIb study, patients with moderately to severely active RA were randomised (1:1:1:1) to receive 50, 100 or 200 mg filgotinib once daily, or placebo, after a ≥4-week washout from MTX. The primary end point was the percentage of patients achieving an American College of Rheumatology (ACR)20 response at week 12.

Results

Overall, 283 patients were randomised and treated. At week 12, significantly more patients receiving filgotinib at any dose achieved ACR20 responses versus placebo (≥65% vs 29%, p<0.001). For other key end points at week 12 (ACR50, ACR70, ACR-N, Disease Activity Score based on 28 joints and C reactive protein, Clinical Disease Activity Index, Simplified Disease Activity Index and Health Assessment Questionnaire-Disability Index) significant differences from baseline in favour of filgotinib 100 and 200 mg versus placebo were seen; responses were maintained or improved through week 24. Rapid onset of action was observed for most efficacy end points. Dose-dependent increases in haemoglobin were observed. The percentage of patients with treatment-emergent adverse events (TEAE) was similar in the placebo and filgotinib groups (∼40%). Eight patients on filgotinib and one on placebo had a serious TEAE, and four patients, all of whom received filgotinib, experienced a serious infection. No tuberculosis or opportunistic infections were reported.

Conclusions

Over 24 weeks, filgotinib as monotherapy was efficacious in treating the signs and symptoms of active RA, with a rapid onset of action. Filgotinib was generally well tolerated.

Trial registration number

NCT01894516.