Advancing ocular safety research: A comprehensive examination of benzocaine acute exposure without animal testing

Benzocaine is a widely employed local anaesthetic; however, there is a notable dearth of preclinical and clinical evidence regarding its safety in ophthalmological products. To address this, a comprehensive strategy incorporating in silico and in vitro methodologies was proposed for assessing benzocaine's ocular toxicity without animal testing. To collect the in silico evidence, the QSAR Toolbox (v4.5) was used. A single exposure to two benzocaine concentrations (2% and 20%) was evaluated by in vitro methods. Hen's Egg Chorioallantoic Membrane Test (HET-CAM) was performed to evaluate the effects on the conjunctiva. To study corneal integrity, Short Time Exposure test (STE) and Bovine Corneal Opacity and Permeability (BCOP) assay, followed by histopathological analysis, were carried out. Results from both in silico and in vitro methodologies categorize benzocaine as non-irritating. The histopathological analysis further affirms the safety of using benzocaine in eye drops, as no alterations were observed in evaluated corneal strata. This research proposes a useful combined strategy to provide evidence on the safety of local anaesthetics and particularly show that 2% and 20% benzocaine solutions do not induce eye irritation or corneal damage, supporting the potential use of benzocaine in the development of ophthalmic anesthetic products.

Immunoglobulins in systemic sclerosis management. A large multicenter experience

OBJECTIVE

To analyze the effectiveness and safety of intravenous immunoglobulin (IVIG) given in routine care to patients with systemic sclerosis (SSc).

METHODS

A retrospective multicenter observational study was conducted in SSc patients treated with IVIG. We collected data on epidemiological parameters and clinical outcomes. Firstly, we assessed changes in organ manifestations during IVIG treatment. Secondly, we analyzed the frequency of adverse effects. The following parameters were collected from baseline to the last follow-up: the patient's weight, modified Rodnan Skin Score (mRSS), modified manual muscle strength scale (MRC), laboratory test(creatine kinase(CK), hemoglobin and protein levels), The University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA GIT 2.0) questionnaire, pulmonary function tests, and echocardiography.

RESULTS

Data were collected on 78 patients (82% females; 59% with diffuse SSc). Inflammatory idiopathic myopathy was the most frequent concomitant overlap disease (41%). The time since Raynaud's phenomenon and SSc onset were 8.8 ± 18 and 6.2 ± 6.7 years respectively. The most frequent IVIG indication was myositis (38/78), followed by gastrointestinal (27/78) and cutaneous (17/78) involvement. The median number of cycles given were 5. 54, 53 and 9 patients have been treated previously with glucocorticoids, synthetic disease-modifying antirheumatic drugs and biologic therapies respectively. After IVIG use we found significant improvements in muscular involvement (MRC ≥ 3/5 92% IVIG, p = 0.001 and CK levels from 1149 ± 2026 UI to 217 ± 224 UI, p = 0.02), mRSS (15 ± 12.4 to 13 ± 12.5, p = 0.015) and improvement in total score of UCLA GIT 2.0 (p = 0.05). None Anti-RNA polymerase III patients showed an adequate response in gastrointestinal involvement (0/7) in comparison with other antibodies (0 vs. 25, p = 0,039). Cardiorespiratory involvement remained stable. A total of 12 adverse events were reported with only one withdrawn due to serious adverse effect.

CONCLUSIONS

this study suggest that IVIG may improve myositis, gastrointestinal and skin involvement in SSc patients treated in routine care and seems to have a good safety profile.

Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study

PURPOSE

The aim of this study is to compare the postoperative results, in terms of complications and recurrence, between the anterior and open preperitoneal approaches in emergency femoral hernia.

METHODS

This bi-centric retrospective cohort study included patients who underwent emergency femoral hernia repair between January 2010 and December 2018. Postoperative complications and recurrence were analyzed comparing anterior and open preperitoneal approaches. The predictors of complications, mortality and recurrence were investigated using multivariate logistic regression.

RESULTS

A total of 204 patients met the inclusion criteria. Open anterior approach was performed in 128 (62.7%) patients and open preperitoneal was performed in 76 (37.3%). Open preperitoneal approach was associated with lower rates of recurrence (P = 0.033) and associated midline laparotomies (P = 0.006). Multivariable analysis identified patients with chronic nephropathy (OR, 3.801; 95%CI, 1.034-13.974; P = 0.044), preoperative bowel obstruction (OR, 2.376; 95%CI, 1.118-5.047; P = 0.024) and required midline laparotomy (OR, 12.467; 95%CI, 11.392-102.372; P = 0.030) as risk factors for complications and ASA ≥ III (OR, 7.820; 95%CI, 1.279-47.804; P = 0.026), COPD (OR, 5.064; 95%CI, 1.188-21.585; P = 0.028), necrotic contents (OR, 36.968; 95%CI, 4.640-294.543; P = 0.001), and required midline laparotomy (OR, 11.047; 95%CI, 1.943-62.809; P = 0.007). as risk factors for 90-day mortality. Male gender (OR, 4.718; 95%CI, 1.668-13.347; P = 0.003) and anterior approach (OR, 5.292; 95%CI, 1.114-25.149; P = 0.036) were risk factors for recurrence.

CONCLUSION

Open preperitoneal approach may be superior to anterior approach in the emergency setting because it can avoid the morbidity of associated midline laparotomies, with a lower long-term recurrence rate.

One-Year Surveillance of SARS-CoV-2 and Rotavirus in Water Matrices from a Hot Spring Area

The pandemic of Coronavirus Disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is still impacting not only on human health but also all economic activities, especially in those related to tourism. In this study, in order to characterize the presence of SARS-CoV-2 in a hot spring park in Uruguay, swimming pools water, wastewater, and surface water from this area were analyzed by quantitative PCR. Wastewater from Salto city located next to the hydrothermal spring area was also evaluated as well as the presence of Rotavirus (RV). Overall, SARS-CoV-2 was detected in 13% (13/102) of the analyzed samples. Moreover, this virus was not detected in any of the samples from the swimming pools water and was present in 18% (3/17) of wastewater samples from the hotels area showing the same trend between the titer of SARS-CoV-2 and the number of infected people in Salto city. SARS-CoV-2 was also detected in wastewater samples (32% (11/34)) from Salto city, detecting the first positive sample when 105 persons were positive for SARS-CoV-2. Rotavirus was detected only in 10% (2/24) of the wastewater samples analyzed in months when partial lockdown measures were taken, however, this virus was detected in nearly all wastewater samples analyzed when social distancing measures and partial lockdown were relaxed. Wastewater results confirmed the advantages of using the detection and quantification of viruses in this matrix in order to evaluate the presence of these viruses in the population, highlighting the usefulness of this approach to define and apply social distancing. This study suggests that waters from swimming pools are not a source of infection for SARS-CoV-2, although more studies are needed including infectivity assays in order to confirm this statement.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Open Emergent Groin Hernia Repair: Anterior or Posterior Approach?

Introduction: The current literature has not yet provided a definitive conclusion on the best emergency groin hernia repair. The aim of this study was first to compare the short and long-term outcomes between open preperitoneal and anterior approach in emergency groin hernia repair and second to identify risk factors for postoperative complications, mortality, and recurrence. Materials and Methods: This retrospective cohort study included patients who underwent emergency groin hernia repair between January 2010 and December 2018. Short and long-term outcomes were analyzed comparing approach and repair techniques. The predictors of complications and mortality were investigated using multivariate logistic regression. Cox regression multivariate analysis were used to explore risk factors of recurrence. Results: A total of 316 patients met the inclusion criteria. The most widely used surgical techniques were open preperitoneal mesh repair (34%) and mesh plug (34%), followed by Lichtenstein (19%), plug and patch (7%) and tissue repair (6%). Open preperitoneal mesh repair was associated with lower rates of recurrence (p = 0.02) and associated laparotomies (p < 0.001). Complication and 90-day mortality rate was similar between the techniques. Multivariable analysis identified patients aged 75 years or older (OR, 2.08; 95% CI, 1.14-3.80; p = 0.016) and preoperative bowel obstruction (OR, 2.11; 95% CI, 1.20-3.70; p = 0.010) as risk factors for complications and Comprehensive Complication Index ≥26.2 as risk factor for 90-day mortality (OR, 44.76; 95% CI, 4.51-444.59; p = 0.01). Female gender was the only risk factor for recurrence. Conclusion: Open preperitoneal mesh repair may be superior to other techniques in the emergency setting, because it can avoid the morbidity of associated laparotomies, with a lower long-term recurrence rate.

AB0907 TREATMENT WITH UPADACINITIB IN REFRACTORY PSORIATIC ARTHRITIS. MULTICENTER STUDY OF FIRST PATIENTS OF CLINICAL PRACTICE

Background

Upadacitinib (UPA) is an inhibitor of JAK kinases recently approved by EMA for the treatment of psoriatic arthritis (PsA) in Europe (January 2021) 1. UPA has shown efficacy in refractory patients to anti-TNF 2.

Objectives

A) to assess efficacy and safety of UPA in the first cases in Spain in clinical practice. B) to compare the profile of clinical practice patients with clinical trial of UPA in PsA refractory to biologics 2.

Methods

Study of 39 patients of clinical practice with PsA treated with UPA in Spain. The diagnosis of PsA was made using CASPAR criteria. Patients who received at least one dose of UPA were included. Results are expressed as percentage, mean±SD or median [IRQ].

Results

39 patients (29♀/10♂), mean age of 51.5 ± 11.4 years (Table 1). Pattern joint involvement was as follows: peripheral (n=19), axial (3) and mixed (17) During the PsA evolution, patients also presented enthesitis (59%) nail involvement (28.2%) and dactylitis (35.9%).

Table 1.CLINICAL PRACTICE N=39CLINICAL TRIAL N=211pBaseline demographic parametersAge, years (mean±SD)51.5±11.453.0 ± 12.00.4706Sex, n (%) female29 (74.4)113 (53.6)0.016Disease CharacteristicsDuration of psoriatic arthritis, year (mean±SD)12.41±8.689.5 ± 8.40.0499HAQ-DI1.10± 0.421.10 ± 0.61.000Swollen joint count, mean±SD6±7.2911.3 ± 8.2< 0.001Painful joint count, mean±SD7.48±7.5824.9 ± 17.3< 0.001Enthesitis, n (%)23 (59.0) MASES172 (81.5) SPARCCDactylitis, n (%)14 (35.9)55(26.1)0.217PASI score, mean±SD2.72±2.3210.1 ± 9.2< 0.001CRP (mg/L)11.1±18.8611.2 ± 18.51.000Oral glucocorticoid use, n (%)17 (43.6)22 (10.4)< 0.001Concomitant synthetic DMARDs, n (%)16(41)98 (46,4)0.532Previous use of biological DMARDs, n (%)39(100)195 (92.4)0.075Number of prior failed biologic DMARDs, n(%)13(7.7)135 (63.7)<0.00124(10.3)35 (16.5)0.383≥332(82)24 (11.3)<0.001UPA in monotherapy, n (%)23(59)113 (53.6)0.531

HAQ-DI Health Assessment Questionnaire-Disability Index, PASI Psoriasis Area Severity Index, CRP C-reactive protein, DMARD disease-modifying antirheumatic drug

Prior to UPA, most patients (59%) had received oral prednisone or equivalent (max 9.03±12.12mg/d), synthetic immunosuppressants (mean1.8±0.9) and biological therapy (TB) (4.5±2.1). TB were as follows: etanercept (25), adalimumab (28), infliximab (12), golimumab (16), certolizumab (15), secukinumab (29), ustekinumab (21) Abatacept (2), brodalumab (1) and ixekizumab (17). Apremilast was used in 13, Tofacitinib in 11 and filgotinib in 1.

After a mean follow-up of 12.41± 8.68.3 years after the PsA diagnosis, UPA was started (15 mg/24 h), 43.6% associated prednisone (7.35±3.36 mg/d). In 16 (41%) UPA was started in combined therapy: methotrexate (9), salazopyrin (3) and leflunomide (4); in the remaining 23 (59%), monotherapy was prescribed. At UPA onset patients presented peripheral arthritis (76.9%), axial involvement (35.8%), skin involvement (25.6%), enthesitis (41%), and dactylitis (10.3%).

Patients of clinical practice compared with clinical trial there were more women, have a longer duration of PsA, and received a higher proportion of previous TB (Table 1).

After a median follow-up of 4.28 ± 2.6 months, patients showed prompt improvement in activity indexes (DAS28, DAPSA) (Figure 1) and laboratory test (CRP mg/L decreased from 4.00 [1.5;10.0] to 0.40 [0.30;4.00] (p 0.024) at the sixth month. Extra-articular manifestations also improved: dactylitis in 25% patients, enthesitis (43.8%), skin involvement (40%) and onychopathy (50%).

Figure 1.

No serious events were reported. Minor side effects were reported in 7 patients (17.9%), and UPA was discontinued in 9 due to inefficiency.

Conclusion

In this preliminary study, first patients of clinical practice in Spain with UPA in PsA had a longer evolution and received a greater number of TB than those of clinical trial. As in the UPA clinical trial, it seems effective, rapid and relatively safe in daily clinical practice for refractory PsA.

References

[1]https://www.ema.europa.eu/en

[2]Mease PJ, et al. Ann Rheum Dis 2021;80:312–320

Disclosure of Interests

None declared

POS0937 MEASURE 2: SECUKINUMAB PROVIDES RAPID AND SUSTAINED RELIEF FROM KEY CLINICAL SYMPTOMS OF ACTIVE ANKYLOSING SPONDYLITIS IN TNFi-NAÏVE PATIENTS THROUGH 5 YEARS

Background

Ankylosing spondylitis (AS) is a chronic, inflammatory disease resulting in debilitating clinical symptoms such as pain (70–83%), stiffness (54–90%) and fatigue (53–62%).1-3 Secukinumab (SEC 150 mg) has demonstrated long-term efficacy across multiple indications and is approved for the treatment of active AS in adults who have had an inadequate response to NSAIDs.4,5

Objectives

The Phase 3 MEASURE 2 trial (NCT01649375) assessed long-term efficacy, safety and tolerability of SEC in patients (pts) with active AS. This post-hoc analysis was conducted specifically to evaluate long-term efficacy of SEC 150 mg on key clinical symptoms of pain, morning stiffness, physical function and fatigue in TNFi-naïve pts over 5 years.

Methods

The MEASURE 2 study design has been reported previously.5 This post-hoc analysis evaluated key clinical symptoms at baseline through Wk 260. Assessments included total and nocturnal back pain (visual analogue scale [0–100 mm]), overall spinal pain (neck, back, or hip) from BASDAI, and morning stiffness (average BASDAI). Physical function (SF-36 PCS, BASFI), fatigue (BASDAI, FACIT) and disease activity (ASDAS-CRP) are also reported. Data are presented as LS mean change (± SE) using mixed model repeated measures from Wks 4–16 and observed data (mean ± SD) from Wks 24–260.

Results

Of TNFi-naïve pts randomised to SEC 150 mg, 89 were included (SEC, n=44, placebo [PBO], n=45) in this analysis. Of these pts randomised to SEC 150 mg, 84% completed 5 years of treatment. Significantly greater improvements were observed in pts treated with SEC 150 mg vs PBO at Wk 16 and were sustained through 5 years (Figure 1; Table 1).

Table 1.

Pain, physical function and fatigue scores

EndpointTreatmentBL mean ± SD*Wk 16 LS mean, SE (p-value)Wk 52 ± SDWk 104 ± SDWk 156 ± SDWk 208 ± SDWk 260 ± SDBACK PAINTotal back painSEC66.86 ± 15.42-33.99, 3.42 (p=0.0000)-40.56 ± 24.35-37.74 ± 26.09-39.03 ± 26.65-37.77 ± 28.40-36.78 ± 29.76PBO67.69 ± 17.71-12.75, 3.46NANANANANANocturnal back painSEC66.84 ± 14.17-36.25, 3.50 (p=0.0000)-45.13 ± 23.92-40.54 ± 25.23-43.92 ± 25.10-41.13 ± 24.87-38.95 ± 28.91PBO63.87 ± 18.78-14.41, 3.54NANANANANAPHYSICAL FUNCTIONSF-36 PCSSEC34.87 ± 6.587.90, 0.98 (p=0.0012)8.44 ± 7.488.95 ± 7.878.98 ± 8.179.39 ± 8.398.55 ± 9.32PBO35.45 ± 6.513.23, 0.98NANANANANABASFISEC6.42 ± 1.95-2.89, 0.31 (p=0.0002)-3.38 ± 2.38-3.23 ± 2.39-3.10 ± 2.49-3.10 ± 2.47-2.86 ± 2.61PBO6.34 ± 1.99-1.18, 0.32NANANANANAFATIGUEOverall level (BASDAI)SEC7.00 ± 1.26-2.39, 0.34 (p=0.0095)-3.44 ± 2.32-3.30 ± 2.45-3.16 ± 2.61-3.12 ± 2.34-2.92 ± 2.71PBO7.18 ± 1.49-1.12, 0.34NANANANANAFACITSEC22.27 ± 8.0210.62, 1.26 (p=0.0052)12.14 ± 9.7611.00 ± 9.3710.79 ± 8.9112.39 ± 9.0910.64 ± 10.66PBO23.22 ± 7.945.48, 1.26NANANANANADISEASE ACTIVITYASDAS-CRPSEC3.73 ± 0.82-1.47, 0.14 (p=0.0000)-1.80 ± 1.16-1.66 ± 1.21-1.63 ± 1.35-1.69 ± 1.24-1.58 ± 1.36PBO3.89 ± 0.76-0.51, 0.14NANANANANA

*Baseline refers to mean ± SD of observed values. LS mean change using MMRM for Wk 16 and observed data (mean ± SD) from Wks 24–260. SEC 150 mg, N=44 and PBO, N=45. ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score - C-reactive protein; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BL, baseline; FACIT, Functional Assessment of Chronic Illness Therapy; LS, least square; MMRM, mixed-effects model repeated measures; NA, not available; PBO, placebo; SD, standard deviation; SEC, secukinumab; SF-36 PCS, Short Form-36 Physical Component Summary; Wk, week.

Conclusion

TNFi-naïve pts with active AS treated with SEC 150 mg experienced rapid improvements across a range of key clinical symptoms including pain, physical function and fatigue measures, that were sustained through 5 years.

References

[1]Deodhar A et al. 2020 BMC Rheumatol 2020;4:19

[2]Ward M et al. Arth Care Res 1999;12:247–55

[3]van Tubergen A et al. Arth Rheum 2002;47:8–16

[4]Cosentyx SmPC (2020) [Accessed: 24 Jan 22]

[5]Baeten D et al. N Eng J Med 2015;373:2534–48

Acknowledgements

This study was sponsored by Novartis Pharma. Medical writing support for the development of this abstract, under the direction of the authors, was provided by Laura Crocker (BMedSci, Hons) of Ashfield MedComms, an Ashfield Health company, and funded by Novartis Pharma

Disclosure of Interests

Karel Pavelka Speakers bureau: AbbVie, Pfizer, Roche, Eli Lilly, BMS, MSD, USB, Alan Kivitz Shareholder of: Amgen, Novartis, Gilead, Pfizer, Glaxosmithkline, Sanofi, Speakers bureau: AbbVie, Merck, Celgene, Novartis, Flexion, Pfizer, Gilead, Sanofi, UCB, Horizon, Consultant of: AbbVie, Celgene, Janssen, Boehringer Ingelheim, Pfizer, Flexion, Regeneron, Gilead, Sanofi, Sun Pharma Advanced Research, UCB, Merck, Novartis, Horizon, Renato Calheiros Employee of: I am currently an employee for Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Erhard Quebe-Fehling Shareholder of: Novartis, Employee of: Novartis, Patricia Pertel Shareholder of: Novartis, Employee of: Novartis, Ricardo Blanco Speakers bureau: AbbVie, Amgen, Bristol-Myers, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and Sanofi, Consultant of: Astra-Zeneca, Galapagos, Janssen, Novartis, Pfizer, Grant/research support from: AbbVie, and Roche

POS0272 INTRAVENOUS VERSUS SUBCUTANEOUS TOCILIZUMAB IN A SERIES OF 471 PATIENTS WITH GIANT CELL ARTERITIS

Background

Tocilizumab (TCZ) has shown efficacy in large-vessel vasculitis, including Giant Cell Arteritis (GCA) (1-3). Clinical trials with TCZ in GCA was performed with intravenous (iv) TCZ in a phase 2 trial (3), and with subcutaneous (sc) TCZ in the phase 3 GiACTA (4). However, in GCA there are no studies comparing IV vs SC TCZ.

Objectives

To compare the efficacy of TCZ in GCA patients according to the route of administration IV-TCZ vs SC-TCZ.

Methods

Multicentre study of 471 patients diagnosed with GCA and treated with TCZ. They were divided into 2 groups according to the route of administration: a) IV, and b) SC. GCA was diagnosed by: a) ACR criteria, and/or b) temporal artery biopsy, and/or c) imaging techniques. Sustained remission was established according to EULAR definitions (5).

Results

We studied 471 patients (mean age, 74±9 years) treated with TCZ, 238 with IV-TCZ and 233 with SC-TCZ (Table 1). The time between diagnosis of GCA and TCZ onset was shorter in the SC TCZ group. Regarding acute phase reactants at the beginning of TCZ, no differences were found between both groups. There were no significant differences in sustained remission or in glucocorticoid-sparing effect of TCZ (Figure 1). Patients on IV TCZ treatment suffered more relevant adverse effects during follow-up.

Table 1.

Main characteristics of GCA patients treated with intravenous and subcutaneous tocilizumab

IV TCZ (n= 238)SC TCZ (n=233)PBaseline characteristics at TCZ onsetAge(years), mean±SD73.3±8.773.7±9.30.63Sex, female/male (% female)175/63 (73)167/66 (72)0.65Time from GCA diagnosis to TCZ onset (months), median [IQR]8 [3-23.5]5 [2-15]0.016ESR, mm 1st hour, median [IQR]30.5 [12.5-53]28 [10-56.5]0.66CRP, mg/dL, median [IQR]1.4 [0.5-2.8]1.4 [0.4-4]0.92Prednisone dose, mg/day, median [IQR]20 [10-40]20 [10-36.2]0.69Safety after TCZ onsetFollow-up, (months), median [IQR]27 [16-44]14 [6-26.7]<0.001Relevant adverse events, n (%)80 (34)46 (19)<0.001Relevant adverse events per 100 patients-year12.715.2NSSerious infections, n (%)44 (18)21 (9)0.44Serious infections per 100 patients-year6.77.2NSMACEs, n (%)/1 (0.4)0 (0)-MACEs per 100 patients-year0.10NSMalignancies, n (%)4 (1.7)1 (0.4)0.20Malignancies per 100 patients-year0.60.3NS

Abbreviations: CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GCA: giant cell arteritis; IQR: interquartile range; IV: intravenous; MACEs: major adverse cardiovascular events; NS: non significant; SC: subcutaneous; SD: standard deviation

Conclusion

In GCA, TCZ seems equally effective and safe regardless of the route of administration IV or SC.

References

[1]Calderón-Goercke M, et al. Semin Arthritis Rheum. 2019; 49: 126-135. PMID: 30655091

[2]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589

[3]Villiger PM, et al. Lancet. 2016; 387:1921-1927. PMID: 26952547

[4]Stone JH, et al. N Engl J Med. 2017; 377:317-328. PMID: 28745999

Hellmich B, et al. Ann Rheum Dis. 2020; 79: 19-30. PMID: 31270110

Disclosure of Interests

None declared

POS0806 OPTIMIZATION OF TOCILIZUMAB THERAPY IN GIANT CELL ARTERITIS. A MULTICENTER REAL-LIFE STUDY OF 471 PATIENTS

Background

Tocilizumab (TCZ) has shown to be useful in the treatment of large-vessel vasculitis, including giant cell arteritis (GCA) (1-4). There is general agreement on the initial and the standard maintenance dose of TCZ. However, information on duration and optimization of TCZ in GCA is really scarce.

Objectives

Our aim was to assess the effectiveness and safety of TCZ therapy optimization in an unselected wide series of GCA in real-world clinical practice.

Methods

Multicenter study on 471 patients with GCA who received TCZ therapy. Once complete remission was reached (n=231) TCZ was optimized in 125 patients. We compared patients in whom TCZ was optimized (TCZOPT group) or not (TCZNON-OPT group). Complete remission was defined as normalization of clinical and analytical (CRP and ESR) data. Optimization was done by decreasing the dose and/or prolonging the TCZ dosing interval progressively. We performed a comparison in effectiveness and safety parameters between optimized and non-optimized patients.

Results

We evaluated 231 GCA patients treated with TCZ with complete remission. No demographic or laboratory data differences was observed at TCZ onset between both groups (Table 1). The mean prednisone dose was higher in the TCZNON-OPT group at TCZ onset. The first TCZ optimization was performed after a median [25-75th] follow-up of 12 [6-17] months.

Table 1.

Main general features at TCZ onset of 231 GCA patients with prolonged remission.

OPTIMIZED-TCZ GROUP (n=125)NON-OPTIMIZED TCZ GROUP (n=106)pGENERAL FEATURES Age, years, mean± SD72.7±8.674±8.70.197 Sex, female/male n (% female)91/34 (72.8)74/32 (69.8)0.616 Time from GCA diagnosis to TCZ onset (months), median [IQR]8 [2-21.5]5 [2-21]0.384SYSTEMIC MANIFESTATIONS Fever, n (%)14 (11.2)15 (14.2)0.500 Constitutional syndrome, n (%)54 (43.2)39 (36.8)0.322 PMR, n (%)75 (60)69 (65.1)0.426ISCHEMIC MANIFESTATIONS Visual involvement, n (%)14 (11.2)16 (15.1)0.380 Headache, n (%)66 (52.8)62 (58.5)0.386 Jaw claudication, n (%)24 (19.2)25 (23.6)0.417AORTITIS (large-vessel involvement), n (%)65 (52)42 (39.6)0.060ANALYTICAL FINDINGS ESR, mm/1st hour, mean (SD)39.1±29.337.5±33.50.334 CRP, mg/dL mean (SD)2.6± 3.42.7± 40.305 Hemoglobin, g/dL, mean (SD)13.5±9.612.9±1.50.153GLUCOCORTICOIDS Prednisone dose, mg/d mean (SD)20.3±16.427±17.80.001

Abbreviations: CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GCA: giant cell arteritis; IQR: interquartile range; IV: intravenous; PMR: polymyalgia rheumatica; SC: subcutaneous; SD: standard deviation; TCZ: tocilizumab.

The median prednisone dose at first TCZ optimization was 2.5 [0-5] mg/day. At the end of follow-up prolonged remission was observed in 78.2% of TCZOPT group compared with 66.7% in the TCZNON-OPT group (p= 0.001) (Figure 1). Seven (5.6%) of the 125 optimized cases relapsed. Serious adverse events were similar in both groups, while serious infections were more frequent in the TCZNON-OPT group (p=0.009).

Conclusion

Once complete remission is reached in GCA patients under TCZ treatment, optimization of biologic may be performed. Based on our experience it could be performed by reducing the dose or by prolonging dosing interval of TCZ. It seems to be an effective and safe practice.

References

[1]Calderón-Goercke M, et al. Semin Arthritis Rheum. 2019; 49: 126-135. PMID: 30655091

[2]Loricera J, et al. Clin Exp Rheumatol. 2016; 34: S44-53. PMID: 27050507

[3]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589

[4]Loricera J, et al. Int Immunopharmacol. 2015; 27: 213-9. PMID: 25828585

Disclosure of Interests

Carmen Álvarez-Reguera: None declared, Monica Calderón-Goercke: None declared, J. Loricera: None declared, Clara Moriano: None declared, Santos Castañeda: None declared, J. Narváez: None declared, Vicente Aldasoro: None declared, Olga Maiz: None declared, Rafael Melero: None declared, Ignacio Villa-Blanco: None declared, Paloma Vela-Casasempere: None declared, Susana Romero-Yuste: None declared, Jose Luis Callejas-Rubio: None declared, Eugenio de Miguel: None declared, E. Galíndez-Agirregoikoa: None declared, Francisca Sivera: None declared, Carlos Fernández-López: None declared, Carles Galisteo: None declared, Iván Ferraz-Amaro: None declared, Julio Sanchez-Martin: None declared, Lara Sanchez-Bilbao: None declared, Jose Luis Hernández Hernández: None declared, Miguel Á. González-Gay Consultant of: Abbvie, Pfizer, Roche, Sanofi and MSD., Grant/research support from: Abbvie, MSD, Jansen and Roche., Ricardo Blanco Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Grant/research support from: Abbvie, MSD and Roche.

POS0717 ASSOCIATION BETWEEN CUMULATED HYDROXYCHLOROQUINE IN SYSTEMIC LUPUS ERYTHEMATOSUS AND DEVELOPMENT OF CARDIAC CONDUCTION ALTERATIONS: A MULTIPLE LOGISTIC REGRESSION ANALYSIS

Background

Hydroxychloroquine (HCQ) is a widely used drug in Systemic Lupus Erythematosus (SLE). It may cause cardiac alterations which includes short term arrhythmic events (via QT interval prolongation) and medium-late term dose dependent cardiomyopathy1. The few research articles published on the medium-late term effects of HCQ in cardiac conduction disorder do not show relevant alterations2-3.

Objectives

To assess the effect of HCQ in cardiac conduction in a consecutive SLE population.

Methods

Observational, single University hospital study of all consecutive SLE patients with an electrocardiogram (EKG) at HCQ onset and at least one EKG in follow-up, with a period of at least 3 months on HCQ treatment was performed. We assessed conduction alteration (CA) by EKG, defined as atrio-ventricular block, bundle branch block or QT interval prolongation. The EKGs were gathered from the clinical history and interpreted at the beginning of the treatment and during the 15.2 years (CI95% 13.24-17.16) follow-up period. We defined cumulated HCQ (cHCQ) as the multiple of the mean annual dose of the sample. A Multiple logistic regression model, adjusted by different variables according to statistical significance and clinical relevance, was performed.

Results

We studied 109 (96 women/13 men) SLE patients with a mean (±SD) age of 61 ±. 2.78 years. A statistically significant association was observed between the cHCQ, and the development of CA [OR 1.1 CI95% 1.02-1.9; p = 0.011] (Table 1 & Figure 1). A total of 8 covariates were included. Among them, those that had the greatest influence on the development of the primary event were previous CA [OR 4.15 CI95% 6.39-624.54; p <0.01]; valvular heart disease [OR 7.15 CI95% 1.31-38.91; p = 0.023] and age [OR 1.07 95% CI 1.0-1.14; p = 0.04].

Table 1.

Results of univariable and multivariable logistic regressions evaluating the association between cumulated hydroxychloroquine and the development of cardiac conduction alterations.

VariableUnadjusted OR95%CIP-valueAdjusted OR95%CIP-valueCumulated hydroxychloroquine1.071.021.120.011.101.021.190.01CovariatesPrevious cardiac conduction alterations28.235.67140.540.0063.216.40624.540.00Cardiac valve disease4.711.6613.370.007.151.3138.910.02Age1.061.021.100.001.071.001.140.04Diabetes mellitus3.791.2611.410.023.440.5920.110.17Cerebrovascular disease2.951.028.500.050.100.011.030.05Chronic renal disease6.651.7724.980.054.880.6536.910.13Pulmonary Hypertension6.400.5673.580.143.840.13114.960.44Alcohol consumption6.400.5673.580.1410.590.58194.870.11Gender0.330.100.110.07Hypertension2.320.915.900.08Dyslipemia1.460.613.500.40Obesity1.850.418.320.42Smoking1.670.694.020.26Cardiac ischaemic disease2.080.3313.160.44Heart Failure5.911.3126.680.02Pericarditis2.080.3313.160.44

OR: Odds Ratio; CI: Confidence

Figure 1.

Cardiac conduction alterations development according to cumulated Hydroxychloroquine dose.

Conclusion

According to our study, it seems to be an association between the cHCQ and development of CA regardless of other variables evaluated. Wider longitudinal studies are required with a protocolized EKG performance in successive visits to further analyze this association.

References

[1]Chatre C, Roubille F, Vernhet H, et al. Cardiac complications attributed to chloroquine and hydroxychloroquine: a systematic review of the literature. Drug Saf. 2018;41(10):919–931.

[2]Costedoat-Chalumeau N, Hulot JS, Amoura Z, Leroux G, Lechat P, Funck-Brentano C, Piette JC. Heart conduction disorders related to antimalarials toxicity: an analysis of electrocardiograms in 85 patients treated with hydroxychloroquine for connective tissue diseases. Rheumatology (Oxford). 2007 May;46(5):808-10.

[3]Godeau P, Guillevin L, Fechner J et al (1981) Disorders of conduction in lupus erythematosus. Frequency and incidence in a group of 112 patients (author’s transl). AnnMed Interne (Paris) 132:234–240.

Disclosure of Interests

Alba Herrero-Morant: None declared, Jon Zubiaur-Zamacola: None declared, Adrián Margarida-de Castro: None declared, Raquel Pérez-Barquín: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Roche, Sanofi, Lilly, Celgene, Sobi, and MSD, Grant/research support from: Abbvie, MSD, Janssen, and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, BMS, Janssen, and MSD, Grant/research support from: Abbvie, MSD, and Roche

AB1367 PET ASSESSMENT OF THE EFFECTIVENESS OF TOCILIZUMAB IN GIANT CELL ARTERITIS. STUDY OF 101 PATIENTS FROM CLINICAL PRACTICE

Background

Positron emission tomography (PET) is one of the tools available for the diagnosis of extracranial large-vessel vasculitis (1-5). Tocilizumab (TCZ) has shown efficacy in large-vessel vasculitis (LVV) including GCA. However, the improvement objectified by imaging techniques after TCZ therapy in extracranial GCA patients is controversial.

Objectives

To assess the effectiveness of TCZ improving the wall vessel inflammation by PET in GCA patients with large-vessel involvement.

Methods

Observational, multicenter study of 101 GCA patients treated with TCZ. GCA was diagnosed according to: a) ACR criteria, and/or b) biopsy of temporal artery, and/or c) presence of signs of vessel wall inflammation by PET, defined by the presence of vascular wall uptake of Fluorodeoxyglucose (FDG). Patients were divided into two subgroups: a) with, and b) without signs of improvement (partial or total) in the follow-up PET.

Results

We studied 101 patients (74 women/27 men; mean age 69.7±9.3 years). Main clinical features of GCA with and without PET improvement are shown in Table 1. The group of patients which experienced PET improvement was older and was receiving higher doses of corticosteroids at TCZ onset.

Table 1.

Main features of 101 GCA patients treated with tocilizumab and with presence of signs of vessel wall inflammation by PET.

With PET improvement (n=88)Without PET improvement (n=13)pBaseline characteristics at TCZ onsetGeneral characteristicsAge(years), mean±SD70.6±9.163.8±9.20.014Sex, female/male (% female)67/21(76)7/6 (54)0.103Time from GCA diagnosis to TCZ onset (months), median [IQR]11 [4-24.2]4 [2-6]0.102Systemic manifestations, n (%)Fever, n (%)5 (6)2 (15)0.225Constitutional syndrome, n (%)36 (41)4 (31)0.466PmR, n (%)53 (60)9 (10)0.761Ischaemic manifestations, n (%)Visual involvement, n (%)2 (2)1 (1)0.342Headache, n (%)30 (34)3 (23)0.538Jaw claudication, n (%)8 (9)0 (0)0.592Laboratory dataESR, mm 1st hour, median [IQR]38.0 ± 26.213.54 ± 9.90.001CRP, mg/dL, median [IQR]1.5 [0.7-2.4]1 [0.5-1.7]0.179Prednisone dose, mg/day, median [IQR]40.3 ± 19.421.9 ± 12.70.001Time from TCZ onset and follow-up PET (months)13.1±8.010.1±5.30.446

Conclusion

TCZ seems to be effective controlling GCA including vascular involvement detected by PET. However, the improvement observed by PET is most often partial, and rarely complete.

Figure 1.

Improvement by PET according to the time of the test.

References

[1]Loricera J, et al. Rev Esp Med Nucl Imagen Mol. 2015; 34: 372-7. PMID: 26272121

[2]Loricera J, et al. Clin Exp Rheumatol. 2015; 33: S19-31. PMID: 25437450

[3]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589

[4]Martínez-Rodríguez I, et al. Semin Arthritis Rheum. 2018; 47: 530-537. PMID: 28967430

[5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019; 48: 720-727. PMID: 29903537

Acknowledgements

Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group: Juan C. González Nieto (H. Gregorio Marañón), Juan R. de Dios (H.U. Araba), Esther Fernández (H. Clínico Universitario Virgen de la Arrixaca), Isabel de la Morena (H. Clínico Universitario de Valencia), Patricia Moya (H. Sant Pau), Roser Solans i Laqué (H. Valle de Hebrón), Eva Pérez Pampín (H.U. de Santiago), José L. Andréu (H.U. Puerta de Hierro), Marcelino Revenga (H. Ramón y Cajal), Juan P. Baldivieso Achá (H. U. de La Princesa), Eztizen Labrador (H. San Pedro), Andrea García-Valle (Complejo Asistencial Universitario de Palencia), Adela Gallego (Complejo Hospitalario Universitario de Badajoz), Carlota Iñíguez (H.U. Lucus Augusti), Cristina Hidalgo (Complejo Asistencial Universitario de Salamanca), Noemí Garrido-Puñal (H. Virgen del Rocío), Ruth López-González (Complejo Hospitalario de Zamora), José A. Román-Ivorra (H.U. y Politécnico La Fe), Sara Manrique (H. Regional de Málaga), Paz Collado (H.U. Severo Ochoa), Enrique Raya (H. San Cecilio), Valvanera Pinillos (H. San Pedro), Francisco Navarro (H. General Universitario de Elche), Alejandro Olivé-Marqués (H. Trías i Pujol), Francisco J. Toyos (H.U. Virgen Macarena), María L. Marena Rojas (H. La Mancha Centro), Antoni Juan Más (H.U. Son Llàtzer), Beatriz Arca (H.U. San Agustín), Carmen Ordás-Calvo (H. Cabueñes), María D. Boquet (H. Arnau de Vilanova), Noelia Álvarez-Rivas (H.U. Lucus Augusti), María L. Velloso-Feijoo (H.U. de Valme), Cristina Campos (H. General Universitario de Valencia), Íñigo Rúa-Figueroa (H. Doctor Negrín), Antonio García (H. Virgen de las Nieves), Carlos Vázquez (H. Miguel Servet), Pau Lluch (H. Mateu Orfila), Carmen Torres (Complejo Asistencial de Ávila), Cristina Luna (H.U. Nuestra Señora de la Candelaria), Elena Becerra (H.U. de Torrevieja), Nagore Fernández-Llanio (H. Arnáu de Vilanova), Arantxa Conesa (H.U. de Castellón), Eva Salgado (Complejo Hospitalario Universitario de Ourense).

Disclosure of Interests

Julio Sanchez-Martin: None declared, Javier Loricera: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, J. Narváez: None declared, Vicente Aldasoro: None declared, Olga Maiz: None declared, Rafael Melero: None declared, Ignacio Villa-Blanco: None declared, Paloma Vela-Casasempere: None declared, Susana Romero-Yuste: None declared, Jose Luis Callejas-Rubio: None declared, Eugenio de Miguel: None declared, E. Galíndez-Agirregoikoa: None declared, Francisca Sivera: None declared, Carlos Fernández-López: None declared, Carles Galisteo: None declared, Iván Ferraz-Amaro: None declared, Lara Sanchez-Bilbao: None declared, Monica Calderón-Goercke: None declared, Jose Luis Hernández Hernández: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche

POS0796 TREATMENT, ADVERSE EVENTS AND FOLLOW UP IN PATIENTS WITH GIANT CELL ARTERITIS IN THE ARTESER MULTICENTER STUDY

Background

Glucocorticoids (GC) are the mainstay therapy in Giant Cell Arteritis (GCA), initially at high doses (40-60 mg/day) followed by gradual glucocorticoid tapering. This treatment, especially in older patients, is associated with numerous adverse effects (AE). In addition, there are frequent relapses. Therefore, conventional synthetic immunosuppressants such as methotrexate (MTX), leflunomide, azathioprine, cyclophosphamide or mycophenolate, have been used with controversial results. Studies with biological immunosuppressants, such as TNFi have been ineffective; in contrast, tocilizumab (TCZ) has obtained positive results and was approved for the treatment of GCA.

Objectives

In the ARTESER study we describe a) treatment with GC, synthetic or biological immunosuppressants; b) AE of CG; and c) evolution.

Methods

ARTESER is a retrospective observational study sponsored by the Spanish Society of Rheumatology. 26 Spanish centers participated and all new patients diagnosed with GCA from June 1, 2013 to March 29, 2019 were included. Data on GC and immunosuppressants were collected at the beginning and during the follow-up of GCA patients. For the calculation of the cumulative dose of GC, an application was developed that, by including the periods of time, dose and type of GC received during follow-up, performs the automatic calculation in mg of prednisone.

Results

Of the 1675 patients included, GC treatment was adequately recorded in 1650 patients (Table 1). All received oral treatment, being prednisone the most frequently drug used (N=1602, 97.09%). In addition, 426 (25.82%) patients received at least one iv pulse of methylprednisolone, being the 1000 mg regimen the most frequent (n=217; 50.9%). The total mean duration of GC treatment was 22.65 months. The mean cumulative dose per patient at the end of follow-up was 8514.98 mg of prednisone.

Table 1.

Corticosteroid treatment and immunosuppressive treatment

Patients taking oral corticosteroid1650 Prednisone, n (%)1602 (97.09) Methylprednisolone, n (%)164 (9.94) Deflazacort, n (%)64 (3.88)Patients receiving intravenous corticosteroid, n (%)426 (25.82)Mean duration of steroid treatment, mean (SD)22.65 (17.36)Mean cumulative dose at the end of follow-up per patient, mg of prednisone, mean (SD)8514.98 (6570.21)Methotrexate at diagnosis*, n (%)165 (9.9)Leflunomide at diagnosis*, n (%)2 (0.1)Azathioprine at diagnosis*, n (%)3 (0.2)Cyclophosphamide at diagnosis*, n (%)7 (0.4)Mycophenolate at diagnosis*, n (%)1 (0.1)Tocilizumab at diagnosis*, n (%)22 (1.3)Methotrexate during follow-up, n (%)532 (31.8)Leflunomide during follow-up, n (%)19 (1.2)Azathioprine during follow-up, n (%)26 (1.5)Cyclophosphamide during follow-up, n (%)10 (0.6)Mycophenolate during follow-up, n (%)10 (0.6)Tocilizumab during follow-up, n (%)153 (9.1)

The most widely used immunosuppressant was MTX both at diagnosis (n=165; 9.9%) and during follow-up (n=532; 31.8%), followed by TCZ, at diagnosis (22; 1.3%) and at follow-up (153; 9.1%).

AE with GC were described in 393 patients (23.8%), highlighting serious infections (n=67; 10.03%) followed by diabetes mellitus (n=63; 9.43%), steroid myopathy (n=53; 7.9%), vertebral fractures (n=47; 7.04%), non-vertebral fractures (n=36; 5.39%), heart failure (n=36; 5.39%), arterial hypertension (n=34; 5.09%) and neuropsychiatric alterations (n=27; 4.04%).

During the follow-up, 334 (19.9%) patients had relapses, 532 (31.8%) were hospitalized on some occasion, and 142 patients (8.48%) died. The main cause of death were infections (n=44; 30.99%), neoplasms (n=23; 16.2%), cardiovascular (n=15; 10.56%), and cerebrovascular (n=10; 7.04%).

Conclusion

The main treatment for GCA was oral GC, which were required for almost two years on average, in a quarter of patients associated with IV pulses. The cumulative steroid dose was high as well as the side effects. MTX was the most widely used immunosuppressant and TCZ was prescribed in 10%. Relapses and admissions at the hospital were relatively frequent.

Acknowledgements

This study has been funded by ROCHE Farma. The funder has not participated in the design, analysis, or interpretation of the results

Disclosure of Interests

None declared

AB0638 INTRAVENOUS IMMUNOGLOBULIN IN ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS. STUDY OF 28 CASES FROM A SINGLE UNIVERISTARY HOSPITAL AND LITERATURE REVIEW

Background

Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) includes granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) or microscopic polyarteritis (MPA). Standard treatment is often accompained by significant adverse events. Intravenous immunoglobulins (IVIG) may constitute a therapeutic alternative, however, the data are scarce.

Objectives

To assess the utility and safety of IVIG in AAV.

Methods

Observational study of patients with AAV from Spanish referral center treated with IVIG. AAV diagnosis was based on a compatible clinical presentation and/or positive ANCA serology and/or histology. Disease activity was assessed with the Birmingham Vasculitis Activity Score (BVAS).

Results

We included a total of 28 patients; GPA (n=15), MPA (10), and EGPA (3). The main features are summarized in Table 1. The reasons for using IVIG were: a) relapse/refractory disease (n=20), or presence/suspicion of infection (8). We observed a rapid and maintained Clinical improvement, since first month of IVIG onset, yielding a BVAS score of zero in 56.5% of patients at 24 months (Figure 1). Serious Adverse event was only observed in 1 patient who developed congestive cardiac failure and had to stop the IVIG therapy.

Table 1.

Main general features of 28 patients with antineutrophil cytoplasmic antibody-associated vasculitis treated with intravenous immunoglobulins.

GENERAL FEATURESRESULTSGENERAL FEATURES (Continuation)RESULTS (Continuation)DEMOGRAPHIC FEATURESANALITICAL FINDINGSAge of Diagnosis of AAV, mean±SD57.1±18CRP (mg/dL), median [IQR]13.02Men/ Women; n, (% men)15/13 (53.6%)ESR, mm/1st hour, median [IQR]70.4AAV Subtype, n (%)PR3-ANCA, n (%)11 (39.3)GPA15(53.6%)MPO-ANCA, n (%)12 (42.8)EGPA3(10.7%)ANCA negative, n(%)5 (17.8)MPA10(35.7%)FFS at AAV diagnosis, n (%)CLINICAL MANIFESTATIONS, n (%)010 (35.7)Fever15 (53.6%)111 (39.3)Constitutional symptoms26 (92.85%)27 (25)ORL involvement7 (25%)PREVIOUS TREATMENT, n (%)Pulmonary involvement19 (67.9%)Cyclophospamide13 (46.4%)Renal involvement25 (89.3%)Methotrexate6 (21.4%)Cutaneous involvement)6 (21.5%)Azathioprine3 (10.7%)Ocular involvement4 (14.3%)Cyclophosphamide13 (46.4%)Joint involvement4 (14.3%)Mycophenolate mofetil4 (14.3%)Neurologic involvement8 (28.57%)Rituximab5 (17.9%)

Abbreviations: ANCA:antineutrophil cytoplasmic antibody; EGPA: eosinophilic granulomatosis with polyangiitis; FFS: Five-Factors Score; GPA: granulomatosis with polyangiitis; MPA: microscopic polyangiitis

Figure 1.

BVAS Evolution with IVIG treatment of all our patients.

Conclusion

IVIG seems to be an effectiveness and relative safe therapeutic option in relapse/refractory AAV or in presence of a concomitant infection.

Disclosure of Interests

None declared

AB0913 EFFICACY AND SAFETY OF SWITCHING FROM FILGOTINIB TO TOFACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS AFTER 6 MONTHS OF FOLLOW-UP

Background

Phase 2 studies have shown that Filgotinib (FIL), a JAK-inhibitor (JAKi), significantly improves signs and symptoms of psoriatic arthritis (PsA) in patients with active disease. PENGUIN 1 and 2 were two phase III trials of FIL in PsA that were stopped. We considered Tofacitinib (TOFA) the best alternative drug for these patients because TOFA is the only JAKi approved so far in Spain for PsA. However, data in clinical practice about switching from FIL to TOFA have not been reported.

Objectives

To assess the efficacy and safety of switching FIL to TOFA in patients with PsA.

Methods

Prospective Single-University-hospital study of PsA patients diagnosed according to CASPAR criteria, and previously treated with FIL 100 mg and 200 mg/day in two clinical trials (PENGUIN 1 and 2). Based on a shared decision between the patient and the physician, once the trial was finished, patients receiving FIL were switched to TOFA (5 mg/12h) with a 7 days wash-up period. PsA activity, analytical and ultrasound outcomes were assessed at baseline and after 1, 3 and 6 months of treatment with TOFA.

A power doppler ultrasound score (PDUS) was obtained using a scoring system which assessed bilateral midline wrists, metacarpophalangeal joints 1-5, proximal and distal interphalangeal joints 2–5 in hands and feet, bilateral knees, ankles and metatarsophalangeal joints 2-5 (apart from any other painful joint). Each image was scored semi-quantitatively on a scale of 0-3.

We used MASEI index for the enthesis US evaluation (that includes entheses at 6 sites: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar tendon insertion, distal quadriceps tendon and distal brachial triceps tendon). We also evaluated in these enthesis the presence/absence (0/1) of PD signal as it is the main activity signal.

Results

We included 11 patients (6 women/5 men) with a mean age of 52.5±6.5 years who had received FIL during a mean time of 16.0±9.3 weeks. JAKi was used in monotherapy or combined with sulfasalazine (n=2), methotrexate (n=1) and apremilast (n=1).

Disease activity, US scores and laboratory values during the follow-up are shown in Table 1. No significant changes were observed in any case.

Table 1.

Psoriatic Arthritis activity, ultrasound and analytical outcomes at baseline, month 1, 3 and 6.

BaselineMonth 1Month 3Month 6pMusculoskeletal activity scores, median [IQR]TJC – no.2 [0-3]3 [1.5-16]1 [0-12]2 [0-5]0.22SJC – no.0 [0-0]0 [0-5]0 [0-6]0 [0-2]0.09Ultrasound exam, median [IQR]PDUS score (0-90)2 [1-9]3 [1-6]2 [0-4]2 [2-9]0.99Enthesitis according to PDUS (n)1 [0-2]1 [0-2]0 [0-2]1 [0-1]0.85MASEI index16.5 ±10.519.6 ± 14.515.5 ± 4.817.5 ± 11.80.82Laboratory valuesHemoglobin (g/dl) - mean±SD13.96 ± 1.4013.54 ± 1.3813.79 ±1.6014.40 ± 1.750.64Leucocytes (x103/µL) - mean±SD7.10 ± 3.407.27 ± 2.967.14 ± 2.898.20 ± 2.870.89Lymphocytes (x103/µL) - mean±SD2.03 ± 1.011.94 ± 0.952.16 ± 0.861.96 ± 0.450.94Neutrophils (x103/µL) - mean±SD4.24 ± 2.924.54 ± 1.974.18 ± 1.845.30 ± 2.370.85Platelet count (x103/µL) - mean±SD266.44 ± 57.35250.67 ± 53.29264.90 ± 56.78287.20 ± 25.580.69CRP (mg/dl) - median [IQR]0.00 [0.00-1.70]0.00 [0.00-0.00]0.00 [0.00-0.00]0.00 [0.00-0.00]0.12ESR (mm/h) - median [IQR]15 [6-19]9 [5-15]12 [4-15]13 [5-45]0.12

CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; MASEI: Madrid Sonographic Enthesis Index; TJC: Tender joint count; PDUS: Power doppler ultrasound; SJC: Swollen joint count.

No adverse events were reported during the 6 month of follow-up except for 1 patient with lymphopenia (500/µL).

TOFA was discontinued after 1 month in 1 patient because of lypmphopenia and inefficacy and after 3 months in 4 patients for worsening of the joint pain. It was remarkable that in some of the patients who reported a worsening of painful joints we did not observed a higher inflammatory activity in the SJC or US exam, and this incongruity could be due to the role that JAK/STAT inhibition plays in pain signaling pathways.

Conclusion

Switching from FIL to TOFA appears to be an effective and safe therapeutic option.

Disclosure of Interests

None declared

POS0997 CLINICAL FEATURES OF UVEITIS ASSOCIATED TO SPONDYLOARTHRITIS. SINGLE CENTER UNIVERSITY STUDY

Background

Uveitis is a frequent extraarticular manifestation of spondyloarthritis (SpAs). It has been classically reported that whereas uveitis in axial spondyloarthritis (ax-SpA) is predominantly anterior, unilateral, acute, and non-recurrent; in psoriatic arthritis (PsA) and in inflammatory bowel disease (IBD) it has been described as posterior, bilateral, insidious, and continuous [1,2].

Objectives

In a large unselected series of SpAs, our aim was to assess the epidemiology and clinical features of SpAs-associated uveitis.

Methods

Study of consecutive patients from a single University Hospital with a) ax-SpA, b) PsA, and c) IBD (Crohn’s disease and Ulcerative colitis). We have selected patients with uveitis that were classified according to Standarization Uveitis Nomenclature (SUN) Working Group. Main general features, and uveitis pattern, location and onset were recorded.

Results

We studied 2156 (1038 women/118 men) patients with SpAs: IBD (n= 1449; 67.2%); PsA (n= 406; 18.8%); and ax-SpA (n= 301; 14%).

Uveitis was present in 87 (4%) (102 eyes) of 2156 patients with SpAs. However, uveitis occurs with varying frequency according to the SpAs subtype:14.6% of axSpA (n=44), 4.9% of PsA (n=20), and 1.6% of IBD (n=23) (Table 1).

In the global SpAs, the most common pattern of uveitis was typically anterior (n=78; 89.7%), unilateral (n=72; 82.8%), acute (n=19; 82.6%), and non-recurrent (n=83; 95.4%).

The comparative study between these three groups of SpAs showed a significant greater frequency of HLA-B27 positive, anterior location and acute onset in ax-SpA-related uveitis (Table 1).

Table 1.

Main clinical features and uveitis pattern.

Ax-SpA (n=44)PsA (n=20)IBD (n=23)pMain general featuresAge, years, mean ±SD45.6 ± 10.343.1 ± 14.549.1 ± 14.60.472Sex, w/m, n, (% of women)25/19 (56.8)12/8 (60)17/6 (73.9)0.382Disease Duration, years, mean±SD18.6 ± 10.59.9 ± 8.217.4 ± 10.20.067HLA-B27 positive, n (%)37 (84.1)9 (45)5 (2.8)0.001*Uveitis locationAnterior, n (%)44 (100)16 (80)18 (78.3)0.006*Posterior, n (%)0 (0)0 (0)4 (17.4)-Panuveitis, n (%)0 (0)0 (0)1 (4.5)-Uveitis patternUnilateral, n (%)37 (84.1)16 (80)19 (82.6)0.922Uveitis onsetAcute, n (%)44 (100)20 (100)19 (82.6)0.003*

Conclusion

Although SpAs associated uveitis have different frequencies depending on the underlying disease, they share the same clinical pattern: anterior, unilateral, acute, and non-recurrent, in contrast with published data from selected series.

References

[1]Paiva ES, et al. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis. 2000; 59:67-70.

[2]Lyons JL, Rosenbaum JT. Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch Ophthalmol. 1997;115:61-4.

Disclosure of Interests

None declared

POS0795 EPIDEMIOLOGY, DIAGNOSIS AND CLINICAL CHARACTERISTICS OF GIANT CELL ARTERITIS IN PATIENTS INCLUDED IN THE ARTESER MULTICENTER STUDY

Background

Epidemiological information on Giant Cell Arteritis (GCA) comes mainly from the Scandinavian countries of northern Europe, which show a higher incidence than the countries of southern Europe. GCA clinical manifestations can be divided into cranial, extracranial, and general syndrome.

Objectives

In a large series of GCA from Spain, we studied a) the incidence of GCA, b) clinical manifestations, and c) comorbidities at the time of disease diagnosis.

Methods

ARTESER is a retrospective epidemiological observational study of GCA promoted by the Spanish Society of Rheumatology in which 26 hospitals participate. The inclusion criteria were: all new patients diagnosed with GCA by a) ACR criteria, b) positive diagnostic test (temporal artery biopsy, temporal artery ultrasound or other relevant imaging techniques) and/or c) investigator’s clinical judgment. The patient recruitment period ranged from June 1, 2013 to March 29, 2019. The overall incidence of GCA per 100,000 people ≥50 years for the whole period and the mean annual incidence were evaluated. The clinical variables were collected by reviewing the patient’s medical history.

Results

1675 patients were included. The average annual incidence rate was 7.42 (95% CI: 6.57-8.27). All the cases were older than 50 years, and the age group with the highest annual incidence was that of 80 to 84 years, where it reached a value of 22.63 (95% CI: 22.04 -23.22). The mean annual incidence is higher in women than in men 10.07 (95% CI: 8.74-11.55) vs 4.81 (95% CI 3.84-5.93) (Table 1).

Table 1.

General characteristics, comorbidities and clinical manifestations

Epidemiologic, demographic and diagnosisMenWomenTotalGender, n (%)497 (29.7)1178 (70.3)1675Incidence annual rate (95% CI)4.81 (3.84-5.93)10.07 (8.74-11.55)7.42 (6.57-8.27)Age at diagnosis, years, mean (SD)76.9 (8.3)76.9 (8.0)76.9 (8.1)Diagnosis only by ACR Criteria89 (17.91)266 (22.58)355 (21.19)Diagnosis only with objective tests73 (14.69)140 (11.88)213 (12.72)Diagnosis ACR criteria + diagnosis objective tests311 (62.58)734 (62.31)1045 (62.39)Diagnosis by clinical judgment24 (4.8)38 (3.2)62 (3.7)Comorbidities at diagnosisArterial hypertension, n (%)330 (66.8)749 (63.7)1079 (64.6)Dyslipidemia, n (%)238 (48.3)563 (47.9)801 (48.0)Cranial clinical manifestationsNew-onset headache, n (%)382 (76.9)955 (81.1)1337 (79.9)Visual Clinic, n (%)194 (39.0)411 (34.9)605 (36.1)Extracranial manifestations and general syndromePolymyalgia rheumatica, n (%)178 (35.8)521 (44.3)699 (41.8)Asthenia, n (%)239 (48.1)634 (53.9)873 (52.2)Analysis at diagnosisErythrocyte sedimentation rate mm/h, mean (SD)72.3 (34.7)77.4 (33.0)75.9 (33.6)

The principal clinical characteristics of the population is shown in Table 1, the mean age at diagnosis was 76.9±8.1 years, 1178 (70.3%) were women. 1045 patients (62.39%) had ACR criteria and some positive objective test, 355 patients (21.9%) presented only ACR criteria and 213 (12.72%) only had a positive diagnostic test; 62 (3.7%) of the patients underwent diagnosis based on clinical judgment. The more frequent comorbidity was arterial hypertension (n=1079; 64.6%), followed by dyslipidemia (n=801, 48%). The predominant cranial manifestation was headache (n= 1337; 79.9%) and 605 patients experienced visual symptoms (36.1%). Polymyalgia rheumatica (n=699; 41.8%) and asthenia (n=837; 52.2%) were the most frequent extracranial and general syndrome manifestation, respectively. Regarding laboratory parameters, the most characteristic data was the increase of ESR (75.9±33.6 mm/1st h).

Conclusion

The mean annual incidence of GCA in Spain, 7.42 (95% CI: 6.57-8.27), is lower than that of the Scandinavian countries. It is higher in people older than 80 years. More than 60% of the patients met the ACR criteria and had a positive diagnostic test. Cranial manifestations constituted the most clinical features. The most frequent clinical manifestations are cranial. Up to a third of patients had visual manifestations.

Acknowledgements

This study has been funded by ROCHE Farma. The funder has not participated in the design, analysis, or interpretation of the results

Disclosure of Interests

None declared

POS1346 PREVALENCE, PHENOTYPICAL CLINICAL CLUSTERS AND TREATMENT OF NEUROBEHÇET’S DISEASE. STUDY IN NORTHERN SPAIN

Background

Behçet’s disease (BD) may present with different clinical phenotypes. Ocular and Neurobehçet’s Disease (NBD) are severe complications [1-4]. Data on NBD epidemiology, clinical phenotype and therapy are scarce and controversial.

Objectives

In a wide unselected single-center series of BD our aims were to assess a) NBD prevalence, b) associations with other clinical clusters and c) treatment.

Methods

Cross-sectional study of all 120 patients diagnosed with BD in Northern Spain, between January 1, 1999 to December 31, 2019. Finally, 96 patients were included in this study according to 2014 International Criteria for Behçet Disease (ICBD) [5]. NBD was diagnosed according to the International Consensus Recommendation (ICR) criteria [4].

Results

NBD was diagnosed in 23 of 96 (24%) patients (15 women/8 men) (mean age: 44±13.9 years). NBD was classified as parenchymatous (n=10, 43.5%), non-parenchymatous (n=10, 43.5%) and mixed (n=3, 13%). HLAB51 was positive in 5 out of 13 (38.4%) patients tested. The main cluster of clinical associations were oral aphthae (n=20, 87%); ocular (n=14, 60.9%), cutaneous (n=10, 43.5%), articular (n=9, 39.1%), vascular (n=4, 17.4%) and intestinal (n=1, 8.7%) involvement (Figure 1).

Figure 1.

Clusters of clinical associations of NBD

Treatments were oral corticosteroids (n=16; 69.6%; mean maximum dose 42±12.5 mg/ day, conventional immunosuppressants (n=13, 56.5%) and Biological Therapy (BT) (n= 7; 30.4%). BT was used in patients who were refractory to conventional immunosuppressants. Monoclonal anti-TNFα were used as the first option in all patients who received BT. In 3 out of 7 (42.7%) patients BT was switched due to inefficacy. Table 1 shows the main NBD clinical subtypes and treatment.

Table 1.

Main clinical features and treatment of 23 patients with NBD

n (%)Mean maximum oral prednisone dose, (SD) mg/dayConventional immunosuppressants, n (%)monoclonal anti-TNFα, n (%)Tocilizumab, n (%)Anakinra, n (%)Parenchymal phenotype10 (43.5)51.7±19.36 (46.2)4 (57.1)00-Hemiparesis5 (50)52.5±7.52 (50)3 (75)-Optic neuropathy-Encephalopathy3 (30)1 (10)52.3±26.3452 (66.7)1 (16.7)00-Ophtalmoparesis1 (10)01 (16.7)1(25)Non-parenchymal phenotype10 (43.5)42±12.55 (38.5)2 (28.6)00-Aseptic meningitis10 (43.5)42±12.55 (38.5)2 (28.6)Mixed3 (13)45±152 (15.4)1(14.3)1 (14.3)1 (14.3)-Aseptic meningitis and ophtalmoparesis1 (33.4)600000-Aseptic meningitis and other cranial nerve involvement1 (33.4)01 (50)000-Encephalopathy and intracranial hypertension1 (33.4)301(50)1(100)1(100)1(100)

Complete remission was achieved in 18 of 23 cases (78.2%), partial response in 2 out of 23 cases (8.7%). No severe adverse effects were observed.

Conclusion

NBD was observed in 24% of patients with BD. The most frequent clinical clusters of NBD were oral aphthae and ocular involvement. All patients treated with either conventional immunosuppressant or BT achieved clinical remission.

References

[1]Martín-Varillas JL, et al. Ophthalmology 2018 Sep;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020.

[2]Atienza-Mateo B, et al. Arthritis Rheumatol 2019 Dec;71(12):2081-2089. doi: 10.1002/art.41026.

[3]Santos-Gómez M, et al. Clin Exp Rheumatol 2016 Sep-Oct;34(6 Suppl 102): S34-S40.

[4]Kalra S, et al. Diagnosis and management of Neuro-Behçet’s disease: international consensus recommendations. J Neurol. 2014 Sep;261(9):1662–76.

[5]International Team for the Revision of the International Criteria for Behçet’s Disease (ITR-ICBD). J Eur Acad Dermatol Venereol. 2014 Mar;28(3):338-47.

Disclosure of Interests

Alba Herrero-Morant: None declared, Carmen Álvarez-Reguera: None declared, Lara Sanchez-Bilbao: None declared, David Martínez-López: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Lilly, Janssen, UCB, and Celgene, Guillermo Suárez-Amorín: None declared, Raúl Fernández Ramón: None declared, M. Cristina Mata Arnaiz: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Roche, Sanofi, Lilly, Celgene, Sobi, and MSD, Grant/research support from: Abbvie, MSD, Janssen, and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, BMS, Janssen, and MSD, Grant/research support from: Abbvie, MSD, and Roche

AB1431 EPIDEMIOLOGICAL AND GENETIC FEATURES OF ANTI-3-HYDROXY-3-METHYLGLUTARYL-COA REDUCTASE NECROTIZING MYOPATHY IN NORTHERN SPAIN: SINGLE-CENTER EXPERIENCE

Background

Anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) immune-mediated necrotizing myopathy (IMNM) is an entity of growing interest. However, data on epidemiology and clinical spectrum are still scarce and there is a need for the identification of its potential risk factors.

Objectives

To characterize the demographic, genetic, clinical, and serological features of patients with anti-HMGCR IMNM in a region of northern Spain.

Methods

Study of all patients diagnosed with anti-HMGCR IMNM during a 5-year period at a reference hospital in Northern Spain. Besides clinical and laboratory data, we analyzed the genetic influence of HLA genes and the rs4149056 (c.521T>C) single nucleotide polymorphism (SNP) in the SLCO1B1 gene.

Results

8 patients (5 women, 3 men) with a mean ± SD age of 64.9±7.3 years, fulfilled the criteria for anti-HMGCR IMNM. The incidence rate was 0.6 per 100.000 person-years and the prevalence 3 per 100.000 population. All patients had dyslipidemia and had been exposed to statins. Seven of the 8 of cases complained of myalgia. All of them had predominant lower limb proximal and symmetric muscle weakness that was severe in 2 of them. None of the patients had extra-muscular involvement. No evidence of malignancy was found. All patients had elevated serum CK levels with a median [IQR] of 4488 [2538-9194] IU/L. Serum 25-hydroxy vitamin D levels were decreased in all patients in whom it was determined. The 3 patients with a previous diagnosis of hypothyroidism had abnormal levels of TSH at the time of diagnosis. All patients experienced improvement with different schemes of immunosuppressive therapy. Noteworthy, 7 of 8 patients carried the HLA-DRB1*11 allele. The frequency of the rs4149056 C allele in the SLCO1B1 gene (12.5%) was similar to that of the general population.

Conclusion

In northern Spain, the IMNM anti-HMGCR preferentially affects people over 50 years of age who are carriers of the HLA-DRB1*11 allele and take statins. Both low vitamin D levels and hypothyroidism may play a potential predisposing role in the development of this disease

Table 1.PatientAge/SexHLA DRB1*11rs4149056 genotypeMRC at the weakest muscle group*DysphagiaCK (IU/L) at diagnosisAnti-HMGCR titer (CU)Induction therapy*Maintenance therapyClinical improvement**CK (IU/L) at last follow-up visit156/MYesTT2No8963277.8GC. IVIG.MTXGC. IVIG. MTX. RTXMarked134269/FYesTT0Yes9271235.9GC iv bolus. IVIG.GC. MTX. RTX.Marked890364/FYesTT3No4000242.6IVIG.IVIG.RTXMarked1284479/MYesTT4No4977145.6GC. IVIG.GC. IVIG.Complete92562/FNoTT3No2116210.0GCGC.MTX.Marked236657/FYesTC4No2294259.3IGIVIGIVComplete235768/FYesTT3No3273236.0GC. IGIV. AZA.GC. AZAComplete249864/MYesTC4Yes11000179.0GC iv bolus. AZA.GC. AZAComplete161

AZA: azathioprine; CK: creatinine kinase; CU: chemiluminescence units; F: female; GC: glucocorticoids; IVIG: intravenous immunoglobulins; M: male; MRC: medical research council scale; MTX: methotrexate; RTX: rituximab; ** Induction therapy initiated within 3 months of diagnosis. **Clinical improvement: no improvement (no improvement in MRC grade), mild improvement (improvement of MRC grade but still requiring assistance for activities of daily living), marked improvement (persistence of mild weakness without functional limitation), and complete improvement (return to baseline with no symptoms or signs of weakness).

Disclosure of Interests

None declared

AB1366 ULTRASOUND ASSESSMENT OF THE EFFECTIVENESS OF TOCILIZUMAB IN GIANT CELL ARTERITIS. STUDY OF 26 PATIENTS FROM CLINICAL PRACTICE

Background

Large-vessel vasculitis are characterized by the wall inflammation of the involved vessels, which can be detected by imaging tools (1-3). Ultrasound (US) is one of the most commonly used tools for the diagnosis of giant cell arteritis (GCA), especially in patients with a cranial phenotype. Tocilizumab (TCZ) has shown efficacy in large-vessel vasculitis (LVV) including GCA (4,5). However, the improvement objectified by imaging techniques such as US after TCZ therapy is poorly documented.

Objectives

To assess the effectiveness of TCZ improving the wall vessel inflammation by US.

Methods

Observational, multicenter study of 26 GCA patients treated with TCZ. GCA was diagnosed according to: a) ACR criteria, and/or b) biopsy of temporal artery, and/or c) presence of signs of vessel wall inflammation by US, defined by the presence of halo sign. In all the cases a baseline US and in the follow-up was mandatory.

Patients were divided into two subgroups: a) with, and b) without signs of improvement (partial or total) in the follow-up US.

Results

We studied 26 patients (19 women/7 men; mean age, 76.3±9.7 years). Main clinical features of GCA with and without US improvement are shown in Table 1. We found no significant differences in any of the variables studied between the two groups.

Table 1.

Main features of 27 GCA patients treated with tocilizumab followed by Ultrasound (US).

With US improvement (n=21)Without US improvement (n=5)pBaseline characteristics at TCZ onsetGeneral characteristicsAge(years), mean±SD77.3±8.972.2±12.90.270Sex, female/male (% female)17/4 (80,95)2/3 (40)0.101Time from GCA diagnosis to TCZ onset (months), median [IQR]6 [3-9]3 [1-6]0.452Systemic manifestations, n (%)Fever, n (%)1/21 (4.76)1/5 (20)0.354Constitutional syndrome, n (%)10/21 (47.62)2/5 (40)0.999PmR, n (%)11/21 (52.38)1/5 (20)0.330Ischaemic manifestations, n (%)Visual involvement, n (%)1/21 (4.76)1/5 (20)0.354Headache, n (%)15/21 (71.43)5/5 (100)0.298Jaw claudication, n (%)4/15 (26.67)¼ (25)0.999Laboratory dataESR, mm 1st hour, median [IQR]33 [22-49]55 [54-80]0.216CRP, mg/dL, median [IQR]1.5 [0.7-6.7]3.8 [1-4.2]0.948Prednisone dose, mg/day, median [IQR]13.7 [10-30]30 [12.5-30]0.505Time from TCZ onset and follow-up US (months)3.9±3.63.1±2.10.456

After TCZ onset, 21 of 26 patients (80.7%) showed US signs of improvement (12 complete, 9 partial). In 4 out of 5 patients in whom there was no improvement in US findings, clinical improvement was observed at first month after starting TCZ.

Conclusion

TCZ seems to be effective controlling GCA including vascular involvement detected by US. This improvement can be seen by follow-up US, especially when performed at least 3 months after TCZ onset.

References

[1]Loricera J, et al. Rev Esp Med Nucl Imagen Mol. 2015; 34: 372-7. PMID: 26272121

[2]Loricera J, et al. Clin Exp Rheumatol. 2015; 33: S19-31. PMID: 25437450

[3]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589

[4]Martínez-Rodríguez I, et al. Semin Arthritis Rheum. 2018; 47: 530-537. PMID: 28967430

[5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019; 48: 720-727. PMID: 29903537

Acknowledgements

Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group: Juan C. González Nieto (H. Gregorio Marañón), Juan R. de Dios (H.U. Araba), Esther Fernández (H. Clínico Universitario Virgen de la Arrixaca), Isabel de la Morena (H. Clínico Universitario de Valencia), Patricia Moya (H. Sant Pau), Roser Solans i Laqué (H. Valle de Hebrón), Eva Pérez Pampín (H.U. de Santiago), José L. Andréu (H.U. Puerta de Hierro), Marcelino Revenga (H. Ramón y Cajal), Juan P. Baldivieso Achá (H. U. de La Princesa), Eztizen Labrador (H. San Pedro), Andrea García-Valle (Complejo Asistencial Universitario de Palencia), Adela Gallego (Complejo Hospitalario Universitario de Badajoz), Carlota Iñíguez (H.U. Lucus Augusti), Cristina Hidalgo (Complejo Asistencial Universitario de Salamanca), Noemí Garrido-Puñal (H. Virgen del Rocío), Ruth López-González (Complejo Hospitalario de Zamora), José A. Román-Ivorra (H.U. y Politécnico La Fe), Sara Manrique (H. Regional de Málaga), Paz Collado (H.U. Severo Ochoa), Enrique Raya (H. San Cecilio), Valvanera Pinillos (H. San Pedro), Francisco Navarro (H. General Universitario de Elche), Alejandro Olivé-Marqués (H. Trías i Pujol), Francisco J. Toyos (H.U. Virgen Macarena), María L. Marena Rojas (H. La Mancha Centro), Antoni Juan Más (H.U. Son Llàtzer), Beatriz Arca (H.U. San Agustín), Carmen Ordás-Calvo (H. Cabueñes), María D. Boquet (H. Arnau de Vilanova), Noelia Álvarez-Rivas (H.U. Lucus Augusti), María L. Velloso-Feijoo (H.U. de Valme), Cristina Campos (H. General Universitario de Valencia), Íñigo Rúa-Figueroa (H. Doctor Negrín), Antonio García (H. Virgen de las Nieves), Carlos Vázquez (H. Miguel Servet), Pau Lluch (H. Mateu Orfila), Carmen Torres (Complejo Asistencial de Ávila), Cristina Luna (H.U. Nuestra Señora de la Candelaria), Elena Becerra (H.U. de Torrevieja), Nagore Fernández-Llanio (H. Arnáu de Vilanova), Arantxa Conesa (H.U. de Castellón), Eva Salgado (Complejo Hospitalario Universitario de Ourense).

Disclosure of Interests

Julio Sanchez-Martin: None declared, Javier Loricera: None declared, Lara Sanchez-Bilbao: None declared, Eugenio de Miguel: None declared, Rafael Melero: None declared, E. Galíndez-Agirregoikoa: None declared, J. Narváez: None declared, Carles Galisteo: None declared, Juan Carlos Nieto González: None declared, Patricia Moya: None declared, Eztizen Labrador-Sánchez: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche

POS0299 EFFECT OF SECUKINUMAB ON RADIOGRAPHIC PROGRESSION AND INFLAMMATION IN SACROILIAC JOINTS AND SPINE IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 2-YEAR IMAGING OUTCOMES FROM A PHASE III RANDOMISED TRIAL

Background

Axial spondyloarthritis (axSpA) is characterised by inflammation of the sacroiliac joints (SIJ) and the spine. Secukinumab (SEC) treatment was clinically efficacious and reduced SIJ bone marrow oedema as detected by magnetic resonance imaging (MRI) in patients (pts) with non-radiographic (nr)-axSpA through 52 weeks in the PREVENT (NCT02696031) study.1

Objectives

To report radiographic progression and the course of inflammation as assessed by X-ray and MRI of SIJ and spine over 2 years in the PREVENT study.

Methods

Study design and key endpoints have been reported earlier.1 In total, 555 pts were randomised (1:1:1) to receive SEC 150 mg, with (LD) or without loading (NL) doses, or placebo (PBO). Switch to open-label (OL) SEC or standard of care (SoC) was permitted after Week (Wk) 20. All pts (except those who switched to SoC) received OL SEC from Wk 52. Radiographs of the spine and SIJ were collected at baseline (BL) and Wk 104; MR images of the spine and SIJ were collected at BL, Wk 16, 52, and 104. Spinal radiographs were scored using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and SIJ radiographs according to modified New York criteria (mNYC). Pts whose screening SI joint radiographs fulfilled mNY criteria during the eligibility reading session were excluded from the study. Spinal MR images were assessed for signs of inflammation with the Berlin score. SIJ bone marrow oedema was assessed according to the Berlin Active Inflammatory Lesions Scoring. All images were evaluated in blinded fashion independently by 2 central readers. All data are reported from the Wk 104 reading session and are presented as observed.

Results

The vast majority (98%) of pts treated with SEC 150 mg (pooled LD and NL) showed no structural progression, defined as change in total mSASSS score ≤ smallest detectable change (SDC) of 0.76 (80% agreement level) over 2 years. At BL, 62 pts (43 in SEC, 19 in PBO) presented with ≥1 syndesmophyte (≥1 vertebral unit scored by ≥1 reader). Among these pts, 9 in SEC (20.9%) and 7 in PBO (36.8%) groups had developed ≥1 new syndesmophyte by Wk 104. Among 237 SEC and 117 PBO pts without syndesmophytes at BL, only 4 pts on SEC (1.7%) and 4 pts on PBO (3.4%) developed ≥1 new syndesmophyte by Wk 104. SIJ radiographs showed that 88% of pts on SEC and 86% on PBO had no progression in SIJ (defined as change ≤ SDC (0.46) in total mNYC score) by Wk 104. No patient had an increase in total mNYC score of 2 or more. When screening radiographs of eligible pts were scored alongside post-BL images in the final reading campaign, approximately 25% of pts (68/277 and 34/139 pts in the SEC and PBO groups, respectively) were evaluated as mNY-positive at screening (pts were considered mNY-positive if ≥1 reader evaluated them as mNY-positive). Of these, 11/68 pts in the SEC (16.2%) and 5/34 in the PBO (14.7%) groups were evaluated as mNY-negative at Wk 104. In the SEC and PBO groups, 202 (96.7%) and 102 (97.1%) pts who were mNY-negative at screening stayed negative through Wk 104, respectively. Only 7 pts in the SEC (3.3%) and 3 in the PBO (2.9%) groups who were mNY-negative at BL were scored as mNY-positive at Wk 104. In both groups, fewer pts progressed from mNY-negative to mNY-positive than had a change in the opposite direction (from positive to negative), resulting in an overall negative net progression. Spinal inflammation on MRI (Berlin score) was low at BL with a mean of 0.82 in SEC and 1.07 in PBO groups with no meaningful change up to Wk 104 (mean of 0.56, SEC). SEC reduced SIJ bone marrow oedema score versus PBO at Wk 16 and Wk 52 with sustained reduction through Wk 104 in the overall patient population, with greater reduction in pts with BL score >2 (Figure 1).

Conclusion

Most pts initially randomised to SEC or PBO showed no radiographic progression through 2 years. There was some discrepancy between SIJ eligibility and efficacy reads. SEC reduced SIJ inflammation (bone marrow oedema) on MRI in pts with active nr-axSpA.

References

[1]Deodhar A, et al. Arthritis Rheumatol. 2021;73:110–20.

Disclosure of Interests

Juergen Braun Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Medac, MSD (Schering-Plough), Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, UCB pharma, Eli Lilly, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, UCB, Eli Lilly, Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, UCB, Eli Lilly, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD, Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD, Grant/research support from: AbbVie, MSD, Roche, Helena Marzo-Ortega Speakers bureau: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, Pfizer, Takeda, UCB, Consultant of: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, Pfizer, Takeda, UCB, Grant/research support from: Janssen, Novartis, UCB, Lianne S. Gensler Consultant of: Gilead, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Grant/research support from: UCB, Pfizer, Filip van den Bosch Speakers bureau: AbbVie, BMS, Celgene, Galapagos, Janssen, Eli Lilly, Merck, Novartis, Pfizer, UCB, Consultant of: AbbVie, BMS, Celgene, Galapagos, Janssen, Eli Lilly, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, BMS, Celgene, Galapagos, Janssen, Eli Lilly, Merck, Novartis, Pfizer, UCB, Stephen Hall Speakers bureau: Novartis, Merck, Janssen, Pfizer, Eli Lilly, UCB, Consultant of: Novartis, Merck, Janssen, Pfizer, Eli Lilly, UCB, Grant/research support from: AbbVie, UCB, Janssen, Merck, Hideto Kameda Speakers bureau: Abbvie, Asahi-Kasei, Astellas, BMS, Chugai, Eisai, Eli Lilly, Gilead Sciences, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Consultant of: Abbvie, Astellas, Boehringer, Eli Lilly, Gilead Sciences, Janssen, Novartis, Sanofi, UCB, Grant/research support from: Abbvie, Asahi-Kasei, Boehringer, Chugai, Eisai, Mitsubishi-Tanabe, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Biocad, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Samsung Bioepis, UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Marleen G.H. van de Sande Speakers bureau: Novartis, MSD, Consultant of: Abbvie, Novartis, Eli Lily, Grant/research support from: Novartis, Eli Lilly, Janssen, UCB, Désirée van der Heijde Paid instructor for: Novartis, AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Pfizer, UCB Pharma, and Director of Imaging Rheumatology BV, Tingting Zhuang Shareholder of: Novartis, Employee of: Novartis, Anna Stefanska Shareholder of: Novartis, Employee of: Novartis, Aimee Readie Shareholder of: Novartis, Employee of: Novartis, Hanno Richards Shareholder of: Novartis, Employee of: Novartis, Atul Deodhar Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB

POS0203 PREDICTIVE SEVERITY FACTORS OF COVID-19 IN PATIENTS WITH RHEUMATIC IMMUNE MEDIATED DISEASES

Background

COVID-19 has become a common disease in patients with rheumatic immune-mediated diseases (R-IMID). A risk stratification of the patients at COVID-19 onset is important to predict possible unfavorable results.

Objectives

To identify predictive severity factors in patients with COVID-19 with R-IMID.

Methods

Cross-sectional study in a single University Hospital. We included all consecutive patients with a R-IMID and COVID-19 up to November 6th, 2020. Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2.

COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1).

We performed a multivariable analysis and calculated de odds ratio of critical COVID in patients with R-IMID, adjusting by age, sex and comorbidities.

Results

We included 274 patients with R-IMID complicated with COVID-19. At COVID-19 onset, the main comorbidities, analytical values, underlying R-IMID and treatments received are shown in Table 1.

Table 1.

General features patients with R-IMID and COVID-19

General featuresOverall patients (n=274)Critical COVID (n=21)General features (continuation)Patients (n=274)Critical COVID (n=21)Age, years59 ±1876.32 ± 13.4Analytical values, mean ± SDFemale, n (%)185 (67)11 (52.4)-CRP (mg/dl)4.7 ± 5.2511.7 ± 8.6CV risk factors, n (%)-Creatinine (mg/dl)0.91 ± 0.41.4 ± 0.7-Current smoker27 (10)2 (9.5)-Platelets (x103/ul)179 ± 78163 ± 72-Obesity49 (18)5 (23.8)-Hemoglobina (g/l)13.0 ± 1.812.5 ± 2.1-Hypertension119 (43)18 (85.7)-Neutrophils (x103/ul)4.5 ± 2.54.9 ± 3.2-Diabetes Mellitus36 (13)5 (23.8)-Lymphocytes (x103/ul)1.1 ± 10.7 ± 0.5-Dyslipidemia119 (43)15 (71.4)-Ferritin (ug/L)426 ± 417664 ± 469Comorbidities, n (%)-LDH (U/L)257 ± 92314 ± 143-Chronic pulmonary disease12 (4.4)3 (14.3)-D-Dimer (ng/ml)999±12561890 ± 1893-Established cardiovascular disease45 (16.4)10 (47.6)Underlying R-IMID, n (%)-Cancer21 (8)6 (28.6)-RA79 (28.8)9 (42.9)-Chronic kidney disease27 (10)6 (28.6)-PsA55 (20.1)3 (14.3)-Chronic liver disease11 (4)3 (14.3)-SpA34 (12.4)0Treatments received, n (%)-PMR22 (8)6 (28.6)-Methotrexate // Hydroxychloroquine62 (23) // 50 (18)3 (14.3) // 2 (9.5)-SLE22 (8)0-TNFi31 (11.3)0-Vasculitis8 (2.9)1 (4.8)-Anti-CD208 (2.9)3 (14.3)-Sjogren’s syndrome8 (2.9)2 (9.5)-Other biologic DMARDs // JAKINIBs16 (5.8) // 6 (2.2)1 (4.8) // (4.8)-Others46 (16.8)0

CRP: C-reactive protein; ILD: Interstitial lung disease; LDH: Lactate dehydrogenase; PMR: Polymyalgia rheumatica¸PsA: Psoriatic arthritis, RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus; SpA: Axial spondyloarthritis

*Adjusted by age, cardiovascular risk factors and comorbidities

According to COVID-19 severity, patients were mild (n=209; 76.3%), moderate (n=35; 12.8%), severe (n=9; 3.3%) and critical (n=21; 7.7%).

The predictive variables at COVID-19 onset related statistically to critical COVID were older patients, hypertension, dyslipidemia, previous cardiovascular disease, cancer, chronic kidney disease, and chronic liver disease. The only underlying R-IMID and treatment was polymyalgia rheumatica and Rituximab, respectively. Regarding analytical values were higher values of C-reactive protein, LDH, platelets and lymphopenia (Figure 1).

Figure 1.

Predictive factors for critical COVID-19 in R-IMID (Multivariable analysis)

COPD: Chronic obstructive pulmonary disease; CRP: C-reactive protein; CV: Cardiovascular; HCQ: Hydroxychloroquine; ILD: Interstitial lung disease; LDH: Lactate dehydrogenase; MTX: Methotrexate; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus; TNFi: TNF inhibitors.

*p< 0.005

Data in graphic are presented in a logarithmic scale.

Conclusion

We identified various factors associated with a worse prognosis of COVID-19 in patients with R-IMID. This can help to identify which patients can present a worse course of the disease at the moment of the diagnosis.

Disclosure of Interests

David Martínez-López: None declared, Iván Ferraz-Amaro: None declared, Diana Prieto-Peña: None declared, Fabricio Benavides-Villanueva: None declared, Cristina Corrales-Selaya: None declared, Lara Sanchez-Bilbao: None declared, Alba Herrero-Morant: None declared, Carmen Álvarez-Reguera: None declared, Martin Trigueros-Vazquez: None declared, Miguel A González-Gay Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Pfizer, Roche, and MSD, Grant/research support from: Dr. Miguel A. Gonzalez-Gay received grants/research supports from Abbvie, MSD, and Roche, Ricardo Blanco Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, and MSD., Grant/research support from: Dr. Ricardo Blanco received grants/research supports from Abbvie, MSD, and Roche

POS0802 INVOLVEMENT OF THE AORTA AND/OR ITS MAIN BRANCHES IN GIANT CELL ARTERITIS. TREATMENT WITH TOCILIZUMAB

Background

Large vessel involvement in Giant Cell Arteritis (GCA), especially the aorta and/or its main branches, is frequent. Tocilizumab (TCZ) has shown efficacy and safety in GCA and other large-vessel vasculitis (1-4).

Objectives

To assess the efficacy and safety of TCZ in GCA patients with involvement of the aorta and/or its main branches.

Methods

Multicenter observational study of 196 patients with GCA and involvement of the aorta and/or its major branches treated with TCZ. GCA was diagnosed by: a) ACR criteria, and/or b) temporal artery biopsy, and/or c) imaging techniques. The presence of aortitis was performed by imaging techniques, mainly PET, and A-MRI.

Maintained remission was considered according to EULAR definitions (5).

Results

The main features of the 196 patients are showed in Table 1. Polymyalgia rheumatica, constitutional syndrome and headache were the most frequent clinical manifestations at TCZ onset. At 6 months after starting TCZ, 20% of the patients reached a sustained remission, that was progressively increasing. (Figure 1). A corticosteroid-sparing effect was observed from month 1 of TCZ onset (Figure 1). Relevant adverse events were observed in 12 per 100 patients-year, documenting serious infections in 4.8 per 100 patients-year (Table 1).

Table 1.

Main features of 196 GCA patients with involvement of the aorta and/or its main branches treated with TCZ.

GCA (n=196)Features at TCZ onsetAge(years), mean±SD71.3±9.5Sex, female/male (% female)148/48 (75)Time from GCA diagnosis to TCZ onset (months), median [IQR]7 [2-18.25]Systemic manifestations, n (%)Fever, n (%)24 (12)Constitutional syndrome, n (%)87 (44)PmR, n (%)131 (67)Ischaemic manifestations, n (%)Visual involvement, n (%)16 (8)Headache, n (%)74 (38)Jaw claudication, n (%)27 (14)Laboratory dataESR, mm 1st hour, median [IQR]32 [14-54]CRP, mg/dL, median [IQR]1.5 [0.6-3.2]Prednisone dose, mg/day, median [IQR]15 [10-30]Safety after TCZ onsetRelevant adverse events, per 100 patients-year12Serious infections, per 100 patients-year4.8Figure 1.

A) Sustained remission, and B) median prednisone dose required in GCA patients with aortitis treated with tocilizumab

Conclusion

TCZ seems to be effective and relatively safe in GCA patients with involvement of the aorta and/or its main branches.

References

[1]Calderón-Goercke M, et al. Semin Arthritis Rheum. 2019; 49: 126-135. PMID: 30655091

[2]Loricera J, et al. Clin Exp Rheumatol. 2016; 34: S44-53. PMID: 27050507

[3]Loricera J, et al. Clin Exp Rheumatol. 2015; 33: S19-31. PMID: 25437450

[4]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589

[5]Hellmich B, et al. Ann Rheum Dis. 2020; 79: 19-30. PMID: 31270110

Disclosure of Interests

Lara Sanchez-Bilbao: None declared, Javier Loricera Speakers bureau: from Roche, Novartis, UCB Pharma, Celgene, and Grünenthal., Rafael Melero: None declared, Santos Castañeda Speakers bureau: UAM-Roche, EPID- Future chair, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain., Clara Moriano: None declared, Iván Ferraz-Amaro: None declared, J. Narváez: None declared, Vicente Aldasoro: None declared, Olga Maiz: None declared, Ignacio Villa-Blanco: None declared, Paloma Vela-Casasempere: None declared, Susana Romero-Yuste: None declared, Jose Luis Callejas-Rubio: None declared, Eugenio de Miguel: None declared, E. Galíndez-Agirregoikoa: None declared, Francisca Sivera: None declared, Carlos Fernández-López: None declared, Carles Galisteo: None declared, Julio Sanchez-Martin: None declared, Monica Calderón-Goercke: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, and MSD., Grant/research support from: AbbVie, MSD, Jansen, and Roche,, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Lilly, Janssen, and MSD., Grant/research support from: Abbvie, MSD, and Roche

AB0279 HERPES ZOSTER IN RHEUMATOID ARTHRITIS. PROSPECTIVE SINGLE UNIVERSITY CENTER STUDY

Background

Patients with Rheumatoid arthritis (RA) have an increased risk of infections due to the disease itself, and/or immunosuppressive therapy. The risk of herpes zoster (HZ) including disseminated HZ is also increased(1)

Objectives

In an unselected series of RA patientswe assessa)prevalence, b)general features and c) predictive factors of HZ.

Methods

Study of 393 RA patients included in the prospective vaccination program of the Preventive Medicine and Rheumatology department of a University hospital, from October 2011 to October 2016. The minimum follow-up was of 12 months; therefore, it was made until December 2020. HZ vaccination is not included in our vaccination program.

RA was diagnosed according to the ACR/EULAR 2010 criteria. HZ was diagnosed if presented: characteristic skin rash and blisters, paresthesia and local pain, in one (localized) or more dermatomes (generalized).

Information on patients and HZ characteristics was retrieved from the hospital and general physician records.

Results

We studied 393 patients (310 women), mean age 61.5±11.9 years. They were followed-up during a mean period of 82.6±15.2 months(range; 50 months-9 years).

HZ infection was observed in 31 of 393 patients (7.9%) (26 women); mean age 67.5±11.6ys. Prevalence of HZ in this period (122months) was 7.88% with an annual incidence rate of 0.73/100 patients/year. A comparison between patients with and without HZ was performed (Table 1).

Table 1.

Main features of different groups

VariablesRA patientsN= 393RA with HZN=31RA without HZN=362PHZ vs noHZVariables (continued)RA patientsN= 393RA with HZN=31RA without HZN=362PHZ vs noHZAge (years) (men±SD)59.4±12.964.7±11.859.1±12.90.02MTX365 (92.87)29 (93.54)336 (92.81)0.87Sex (women)(%)309(78.62)25 (80.6)284 (78.5)0.95LFN127 (32.31)12 (38.70)115 (31.76)0.42RA Evolution(months) (mean±SD)136.9±109.8155.3±117.0135.30±109.20.33SSZ94 (23.91)7 (22.58)87 (24.03)0.78Hypertension, n(%)165 (42.0)19 (61.3)146 (40.3)0.04Anti-TNFa, n (%)Diabetes Mellitus, n(%)55 (14.0)7 (22.6)48 (13.3)0.24ADA144 (36.6)15 (48.4)129 (35.6)0.22Dislypidemia, n(%)149 (37.9)15 (48.4)134 (37.0)0.29ETN139(35.4)16 (51.6)123 (33.9)0.05RAfeatures, n(%)IFX40 (10.1)5 (16.1)35 (9.7)0.25PositiveRF224 (57.0)17 (54.8)207 (57.2)0.95GLM33 (8.4)3 (9.7)30 (8.3)0.74PositiveACPA207 (52.7)13 (41.9)194 (53.6)0.29CZP13 (3.3)1 (3.2)12 (3.3)0.97Erosions145 (36.9)10 (32.3)135 (37.3)0.71Non anti-TNFa n (%)Subcutaneousnodules22 (5.6)1 (4.6)21 (5.8)0.85TCZ134 (34.1)16 (51.6)118 (32.6)0.05Pulmonary fibrosis20 (5.1)3 (9.7)17 (4.7)0.20RTX69 (17.5)9 (29.0)60 (16.7)0.13Associated Sjögren Syndrome20 (5.1)1 (3.2)19 (5.3)0.95ABA55 (13.9)6 (19.3)49 (13.5)0.41Vasculitis23 (5.9)2 (6.5)21 (5.8)0.7SARI2 (5.1)1 (3.2)1 (0.3)0.03RATreatment, n (%)JAK inhibitors n (%)Prednisone139 (35.4)19 (61.3)120 (33.1)0.04BARI32 (8.14)3 (9.67)29 (8.01)0.73Prednisona>5mg/d13 (3.30)5 (16.1)8 (2.20)0.001TOFA17 (4.32)3 (9.67)14 (3.87)0.14ConventionalDMARDsUPA4 (1.01)1 (3.22)3 (0.83)0.20

HZ locations were intercostal (n=6), dorsal (5), abdominal (3), lumbar (3), facial (3), cervical (1), gluteus (1), submmamary fold (1), intermmamary fold (1) and upper extremity (1). Main HZ complications were post-herpetic neuralgia (n=7), visual alteration in facial HZ (n=1) and disseminated HZ(n=1).

HZ treatment was anitiviral agents (n=23) (brivudine=7; acyclovir 6; famciclovir6; valaciclovir4), topic (n=2) and none (n=6).

Predictive factors for HZ(Figure 1) were older age (>65 years), hypertension and treatment with high prednisone dose and antiTNF.

Figure 1.

Predictive factors for Herpes zoster

Conclusion

HZ is a relative frequent complication of RA. In our series, although are usually localized, post-herpetic neuralgia is relatively frequent. Probably to include HZ vaccine in our vaccination program of RA may be useful.

References

[1]Robert Harrington et al., J Inflamm Res, 2020 14;13:519-531

Disclosure of Interests

None declared

POS0405 INCREASED LEVELS OF CELLULAR ADHESION MOLECULES ARE LINKED TO THE PRESENCE OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH AUTOIMMUNE DISEASES

Background

Intercellular adhesion molecule-1 (ICAM-1) and E-Selectin are adhesion molecules considered as markers of underlying endothelial activity and damage. These molecules are known to play an important role in autoimmune disease (AD) [1]. Accordingly, they may contribute to the development of interstitial lung disease (ILD), one of the main causes of death in patients with AD [2]. In fact, they have been proposed as prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) [3]. However, studies on the role of ICAM-1 and E-Selectin in AD-ILD+ are scarce.

Objectives

To study the role of ICAM-1 and E-Selectin in the pathogenesis of AD-ILD+.

Methods

Peripheral venous blood was collected from 57 patients with AD-ILD+ and three comparative groups: 45 AD-ILD- patients, 21 IPF patients and 21 healthy controls (HC). All the subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. ICAM-1 and E-Selectin levels were measured in serum samples by enzyme-linked immunosorbent assay.

Results

Higher levels of ICAM-1 and E-Selectin were found in patients with AD-ILD+ compared to AD-ILD- patients (p<0.001 and p=0.001, respectively) and HC (p<0.001 in both cases). Likewise, IPF patients showed increased levels of ICAM-1 and E-Selectin in relation to AD-ILD- patients (p<0.001 and p=0.002, respectively) and HC (p<0.001 in both cases). However, no statistically significant difference in ICAM-1 and E-Selectin concentrations was observed between AD-ILD+ and IPF patients.

Conclusion

Our study suggests that increased levels of ICAM-1 and E-Selectin are associated with the presence of ILD in AD patients.

References

[1]Int J Mol Sci 2014;15(7):11324-49;

[2]Expert Rev Clin Immunol 2018;14(1):69-82;

[3]Eur Respir J 2019;54(3):1900295

Acknowledgements

VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01); SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from `Instituto de Salud Carlos III´ (ISCIII), co-funded by the European Regional Development Fund; RL-M is a recipient of a Miguel Servet type I programme fellowship from ISCIII, co-funded by the European Social Fund, `Investing in your future’ (grant CP16/00033).

Disclosure of Interests

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Leticia Lera-Gómez: None declared, Diana Prieto-Peña: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Alfonso Corrales: None declared, Oreste Gualillo: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche.

AB0759 Efficacy of secukinumab in patients with non-radiographic axial spondyloarthritis: analysis by symptom duration and age

Background

Patients (pts) with axial spondyloarthritis (axSpA) often experience delayed diagnosis, which can lead to treatment delay1. However, earlier diagnosis and treatment of axSpA pts can lead to a greater clinical response2. Secukinumab (SEC) 150 mg has demonstrated sustained improvement in signs and symptoms over 2 years in non-radiographic (nr)-axSpA pts3.

Objectives

To assess the efficacy of SEC in pts with nr-axSpA [tumour necrosis factor (TNF) naïve] by subgroups of younger versus (vs) older pts and early vs late symptom duration of back pain.

Methods

PREVENT (NCT02696031) is a phase 3, randomised study in pts with nr-axSpA and detailed study design is reported previously4. In this post hoc analysis, efficacy outcomes including Assessment of SpondyloArthritis international Society 40 (ASAS40), ASAS partial remission (ASAS PR), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) inactive disease (ID) and low disease activity (LDA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the proportion of pts meeting the minimal clinically important difference criteria for total back pain (improvement of ≥50%) were assessed in the TNF naïve population. Age categories included 4 approximately equally distributed age groups (18 to 33, 34 to 42, 43 to 51 and ≥52 years). The categories for time since onset of back pain as a surrogate of disease symptoms and sign, was based on patients’ distribution and the hypothesis that patients with shorter disease duration will present better results (≤2, >2 to 5, >5 to 10 and >10 years). Missing responses were imputed as non-response up to Week (Wk) 16 and reported as observed at Wks 52 and 104. Data is presented here for categories 18-33 vs ≥52 years and patients with symptom duration ≤2 vs >10 years.

Results

At Wk 104, greater improvements in ASAS40 scores were reported in younger (18-33 years) vs older age categories (>52 years) treated with SEC and also in patients with shorter disease duration (≤2 years) when compared to long term disease (Figure 1 and Table 1).

Table 1.

Efficacy responses with SEC up to Week 104 based on age and symptom duration

Age 18-33 yearsAge >52 years≤2 years of back pain>10 years of back painSEC 150 mg LD (N=61)SEC 150 mg NL (N=59)PBO (N=61)SEC 150 mg LD (N=25)SEC 150 mg NL (N=33)PBO (N=28)SEC 150mg LD (N=51)SEC 150 mg NL (N=33)PBO (N=47)SEC 150 mg LD (N=50)SEC 150 mg NL (N=46)PBO (N=49)ASDAS-CRP ID and LDA50.8*55.9*34.4*36.0*39.4*21.4*51.0*48.5*40.4*44.0*30.4*26.5*77.4#81.1#72.2#45.8#46.7#33.3#77.3#60.0#77.3#53.3#48.7#37.2#71.7†70.2†77.6†50.0†57.1†60.9†74.4†69.2†82.1†55.3†53.3†53.8†BASDAI 5045.9*47.5*27.9*28.0*36.4*17.9*45.1*51.5*29.8*34.0*23.9*20.4*77.8#71.7#72.2#37.5#53.3#37.0#75.6#60.0#75.0#46.7#46.2#43.2#73.5†72.3†77.6†47.6†60.9†52.2†78.0†65.4†76.9†53.8†53.1†51.3†ASAS PR29.5*32.2*8.2*12.0*12.1*7.1*27.5*24.2*8.5*18.0*10.9*12.2*41.5#50.9#38.9#12.5#20.0#22.2#45.5#40.0#38.6#22.2#23.1#20.5#46.9†44.7†59.2†23.8†31.8†21.7†56.1†34.6†46.2†25.6†25.8†23.1†Total back pain50.8*50.8*27.9*24.0*30.3*32.1*51.0*48.5*36.2*32.0*23.9*32.7*74.1#75.5#72.2#58.3#46.7#44.4#73.3#63.3#72.7#53.3#48.7#47.7#71.4†68.1†79.6†61.9†52.2†52.2†75.6†69.2†74.4†61.5†50.0†59.0†

Data is presented as % of responders. Symbols are used to denote the Weeks. *Week 16; #Week 52; †Week 104

. All patients received open-label SEC 150 mg treatment after Week 52 up to Week 104

. ASDAS-CRP ID and LDA (ASDAS-CRP <2.1); Total back pain improvement ≥50%

. LD, loading dose; NL, without loading; PBO, placebo

Conclusion

Efficacy responses were numerically higher with SEC in patients with nr-axSpA with shorter symptom duration and in younger age. These data suggest that earlier treatment improves patient outcomes in nr-axSpA.

References

[1]Lapane KL, et al. BMC Fam Pract. 2021;22(1):251

[2]Poddubnyy D, Sieper J. Curr Rheumatol Rep. 2020;22(9):47

[3]Poddubnyy D, et al. Ann Rheum Dis. 2021;80 (suppl1):707

[4]Deodhar A et al. Arthritis Rheumatol. 2021;73(1):110-120

Disclosure of Interests

Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Roche, Consultant of: AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, UCB, Roche, Grant/research support from: AbbVie, MSD, Novartis, Pfizer, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD and Lilly, Consultant of: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma and MSD, Grant/research support from: AbbVie, MSD, and Roche, Stephen Hall Speakers bureau: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Consultant of: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Grant/research support from: AbbVie, UCB, Janssen, and Merck, Marina Magrey Consultant of: Eli Lily, Novartis, Grant/research support from: AbbVie, UCB and Amgen, Erhard Quebe-Fehling Shareholder of: Shareholder of Novartis, Employee of: Novartis, Renato Calheiros Shareholder of: Shareholder of Novartis, Employee of: Novartis, Patricia Pertel Shareholder of: Shareholder of Novartis, Employee of: Novartis, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Moonlake, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen, Novartis and UCB

POS1351 CERTOLIZUMAB PEGOL VS ADALIMUMAB IN THE TREATMENT OF REFRACTORY CYSTOID MACULAR EDEMA DUE TO BEHÇET’S DISEASE. MULTICENTER STUDY

Background

Cystoid Macular Edema (CME) is the leading cause of blindness in non-infectious uveitis. Behçet’s disease (BD) is one of the diseases most frequently associated with CME [1-4].

Objectives

to compare the efficacy and safety of Certolizumab (CZP) and Adalimumab (ADA) in CME due to BD refractory to conventional therapy.

Methods

multicenter study of patients with CME secondary to BD refractory to glucocorticoids (GC) and at least 1 conventional immunosuppressant. All patients had CME (OCT>300µ) at baseline. Efficacy was assessed with the following ocular parameters: macular thickness (µm), visual acuity (BCVA) and GC-sparing effect. The efficacy of CZP vs. ADA was compared between the baseline visit, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with IBM SPSS Statistics v.23.

Results

We studied 21 patients/38 affected eyes were studied. 10 patients were treated with CZP (200 mg c/2 weeks) and 11 with ADA (loading dose of 80 mg and subsequently 40 mg c/2 weeks).

No statistically significant baseline differences were observed in both groups (CZP vs. ADA) in sex (♂/♀; 3/7 vs 5/6; p=0.65) and mean age (36.1±8.0 vs 42.2±8.6; p=0.10). However, CZP group was more severe with a longer time between EB diagnosis and biologic initiation (91.6±71.4 vs 34.4±21.3 months, p=0.02), and a greater median [IQR] number of previous biologic drugs (2 [0.75-3] vs 0 [0-0]). In CZP group, 8 patients were previously treated with ADA.

Combined therapy with conventional DMARDs was used with ADA in 81.8% vs. 18.2% of CZP patients.

Regarding the efficacy outcomes analyzed, a rapid and maintained improvement in macular thickness, measured by OCT, was observed after 2 years of follow-up in both groups with no statistically significant differences between them (Table 1). Improvement in visual acuity and a GC-sparing effect was also observed (Table 1).

Table 1.

main ocular parameters compared in the CZP-treated group and in the ADA-treated group.

CZP(n=10)ADA(n=11)PBaseline  OCT (µm, mean±SD)380.7±96.4416.9±171.10.56 BCVA (mean±SD)0.72±0.300.57±0.200.21 Prednisone (mg/dl, mean±SD)13.1±11.434.1±18.90.071st month  OCT (µm, mean±SD)333.7±60.4302±44.20.19 BCVA (mean±SD)0.80±0.270.72±0.180.45 Prednisone (mg/dl, mean±SD)8.1±5.5112.1±6.40.316th month  OCT (µm, mean±SD)284.4±45.5272.8±38.90.53 BCVA (mean±SD)0.82±0.230.86±0.160.65 Prednisone (mg/dl, mean±SD)6.8±6.66.1±2.80.921st year  OCT (µm, mean±SD)269.0±46.8260.9±39.50.67 BCVA (mean±SD)0.82±0.230.89±0.170.48 Prednisone (mg/dl, mean±SD)6.2±3.05.8±2.10.872nd year  OCT (µm, mean±SD)289.4±49.3248.0±42.00.16 BCVA (mean±SD)0.87±0.200.87±0.171.0 Prednisone (mg/dl, mean±SD)3.7±1.23.1±2.30.90

No serious adverse events were observed in either group.

Conclusion

Our study suggests that both CZP and ADA are effective in the treatment of CME due to BD refractory to conventional treatment. CZP was equally effective despite most patients were refractory to ADA.

References

[1]Schaap-Fogler M, et al. Graefes Arch Clin Exp Ophthalmol. 2014 Apr;252(4):633-40. doi: 10.1007/s00417-013-2552-8.

[2]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451 doi: 10.1016/j.ophtha.2018.02.020

[3]Martín-Varillas JL, et al. J Rheumatol. 2021;48:741-750. doi: 10.3899/jrheum.200300

[4]Vegas-Revenga N et al Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019

Disclosure of Interests

None declared

AB0146 BAFF, APRIL y BAFFR: DIFFERENTIAL BIOMARKERS BETWEEN IgA VASCULITIS AND IgA NEPHROPATHY?

Background

IgA vasculitis (IgAV) and IgA nephropathy (IgAN) are inflammatory conditions [1, 2], that share pathogenic mechanisms [1], in which B-lymphocytes are described as key cells implicated in these processes. BAFF, APRIL and BAFF-R are cytokines implicated in the development of B-lymphocytes [3, 4] and in autoimmune processes [5, 6]. In this regard, an influence of BAFF, APRIL and BAFFR polymorphisms was observed on several immune-mediated conditions, being BAFF GCTGT>A a shared insertion-deletion variant for inflammatory conditions [7, 8].

Objectives

To determine whether BAFF, APRIL and BAFFR could be used as differential biomarkers between IgAV and IgAN.

Methods

BAFF rs374039502 (which colocalizes with BAFF GCTGT>A), two tag variants within APRIL (rs11552708 and rs6608) and two tag variants within BAFFR (rs7290134 and rs77874543) were genotyped in 394 Caucasian IgAV patients, 95 patients with IgAN and 832 matched healthy controls.

Results

Similar genotype and allele frequencies were observed in the whole cohort of patients with IgAV when compared to those with IgAN when BAFF, APRIL and BAFFR variants were analyzed independently (Table 1). In accordance with that, no BAFF, APRIL and BAFFR genotype or allele differences were detected between IgAV patients who developed nephritis and patients with IgAN (Table 1). Additionally, no statistically significant differences were observed between the whole cohort of patients with IgAV and healthy controls as well as between patients with IgAN and healthy controls when each when BAFF, APRIL and BAFFR genetic variant was also analyzed independently (Table 1). Similar results were disclosed when haplotype frequencies of APRIL and BAFFR were compared between the different comparative groups above mentioned (data not shown).

Table 1.

Genotype and allele frequencies of BAFF, APRIL and BAFFR in the whole cohort of patients with IgAV, patients with IgAV who developed nephritis, patients with IgAN and healthy controls.

PolymorphismChangeData setGenotypes, % (n)Alleles, % (n)1/21/11/22/212BAFF rs374039502T/AIgAV92.1 (363)7.9 (31)0.096.1 (757)3.9 (31)IgAV with nephritis90.1 (128)9.9 (14)0.095.1 (270)4.9 (14)IgAN91.6 (87)8.4 (8)0.095.8 (182)4.2 (8)Controls91.8 (764)7.8 (65)0.4 (3)95.7 (1593)4.3 (71)APRIL rs11552708G/AIgAV78.7 (310)20.1 (79)1.3 (5)88.7 (699)11.3 (89)IgAV with nephritis81.1 (116)18.9 (27)0.090.6 (259)9.4 (27)IgAN75.8 (72)23.2 (22)1.1 (1)87.4 (166)12.6 (24)Controls78.7 (655)19.7 (164)1.6 (13)88.6 (1474)11.4 (190)APRIL rs6608C/TIgAV72.6 (286)25.4 (100)2.0 (8)85.3 (672)14.7 (116)IgAV with nephritis75.5 (108)23.1 (33)1.4 (2)87.1 (249)12.9 (37)IgAN65.3 (62)30.5 (29)4.2 (4)80.5 (153)19.5 (37)Controls71.0 (591)26.6 (221)2.4 (20)84.3 (1403)15.7 (261)BAFFR rs7290134A/GIgAV58.9 (232)35.5 (140)5.6 (22)76.6 (604)23.4 (184)IgAV with nephritis60.1 (86)32.2 (46)7.7 (11)76.2 (218)23.8 (68)IgAN57.9 (55)38.9 (37)3.2 (3)77.4 (147)22.6 (43)Controls58.7 (488)35.1 (292)6.3 (52)76.2 (1268)23.8 (396)BAFFR rs77874543G/CIgAV83.2 (328)15.5 (61)1.3 (5)91.0 (717)9.0 (71)IgAV with nephritis83.1 (118)16.9 (24)0.091.5 (260)8.5 (24)IgAN86.3 (82)13.7 (13)0.093.2 (167)6.8 (13)Controls83.7 (696)16.0 (133)0.4 (3)91.6 (1525)8.4 (139)

IgAV: IgA vasculitis; IgAN: IgA nephropathy.

Conclusion

Our results reveal a similar BAFF, APRIL and BAFFR genetic distribution in IgAV and IgAN, suggesting that these genes could not be used as differential biomarkers between these pathologies.

References

[1]N Engl J Med 2013;368:2402-14;

[2]Am J Kidney Dis 1988;12:373-7;

[3]J Exp Med 1999;189:1747-56;

[4]Nat Genet 2005;37:793-4;

[5]Arthritis Res Ther 2018;20:158;

[6]Arthritis Res Ther 2020;22:157;

[7]Engl J Med 2017;376:1615-26;

[8]Sci Rep 2018;8:8195.

Acknowledgements

This study was supported by the European Regional Development Fund (ERDF) and “Fondo de Investigaciones Sanitarias” (grant PI18/00042 and PI21/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). DP-P is a recipient of a Río Hortega programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) [grant number CM20/00006]; SR-M is supported by funds of the RETICS Program co-funded by ERDF [grant number RD16/0012/0009]; VP-C is supported by a pre-doctoral grant from IDIVAL [grant number PREVAL 18/01]; RL-M is a recipient of a Miguel Servet type II programme fellowship from the ISCIII, co-funded by ESF `Investing in your future´ [grant number CPII21/00004].

Disclosure of Interests

Diana Prieto-Peña: None declared, Fernanda Genre: None declared, Sara Remuzgo Martinez: None declared, Verónica Pulito-Cueto: None declared, Belén Atienza-Mateo: None declared, Belén Sevilla: None declared, Javier Llorca: None declared, Norberto Ortego: None declared, Maite Leonardo: None declared, Ana Peñalba: None declared, Luis Martín-Penagos: None declared, Jose Alberto Miranda Fillloy: None declared, J. Narváez: None declared, LUIS CAMINAL MONTERO: None declared, PAZ COLLADO: None declared, Antonio Fernandez-Nebro: None declared, Gisela Díaz-Cordoves: None declared, Secundino Cigarrán: None declared, Jesús Calviño: None declared, Carmen Cobelo: None declared, Diego de Argila: None declared, Esther F. Vicente-Rabaneda: None declared, Esteban Rubio-Romero: None declared, MANUEL LEON LUQUE: None declared, Juan María Blanco-Madrigal: None declared, E. Galíndez-Agirregoikoa: None declared, Oreste Gualillo: None declared, Javier Martin Ibanez: None declared, Santos Castañeda: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Miguel A González-Gay Speakers bureau: Abbvie, MSD, Jansen, and Roche, Grant/research support from: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD and GSK, Raquel López-Mejías: None declared

AB0069 ASSOCIATION OF NUCLEAR FACTOR OF ACTIVATED T CELLS CYTOPLASMIC 1 (NFATc1) EXPRESSION WITH CARDIOVASCULAR RISK IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS

Background

Nuclear factor of activated T cells (NFAT) is a transcription factor family that plays a crucial role in physiological and immune processes, modulating intracellular and extracellular signaling pathways related with several diseases1,2. In this regard, it has been involved in the pathogenesis of rheumatoid arthritis (RA) and in the development of cardiovascular (CV) disease3-5. Given that CV disease is one of the main causes of morbidity and mortality in patients with RA6, functional studies focused on the implication of NFAT in CV disease in RA are of potential interest.

Objectives

To study the role of the gene expression of two members of the NFAT family, NFATc1 and NFATc2, in the risk of developing CV disease in patients with RA.

Methods

A total of 79 disease-modifying antirheumatic drug-naïve patients with early RA7 from Hospital Universitario Marqués de Valdecilla (Santander, Spain) were included in this study. The relative mRNA expression of NFATc1 and NFATc2 in peripheral blood was determined by qPCR. Carotid ultrasound data were used as surrogate markers of subclinical atherosclerosis. The association between NFATc1 and NFATc2 expression in RA patients and their clinical characteristics was evaluated. Results were adjusted by sex, age at the time of the study and traditional CV risk factors.

Results

A statistically significant increase of NFATc1 mRNA expression was found in women compared to men (fold change=+1.18, p=0.035). In addition, a higher NFATc1 mRNA expression was observed in patients with dyslipidemia compared to those with normal lipid profile (fold change=+1.18, p=0.006). With respect to this, we also disclosed a positive correlation between NFATc1 mRNA expression and low-density lipoprotein cholesterol levels (r=0.27, p=0.039). No significant associations were detected between NFATc2 mRNA expression and clinical characteristics of our RA patients. Carotid ultrasound findings were not related to NFATc1 and NFATc2 expression.

Conclusion

Our study suggests that a higher expression of NFATc1 in peripheral blood is associated with abnormalities in the lipid profile and, consequently, with an increased risk of CV disease in patients with early RA.

References

[1]Annu Rev Immunol.1997;15:707-747;

[2]Nat Rev Immunol.2005;5:472-484;

[3]Autoimmun Rev.2006;5:106-110;

[4]Immunol Rev. 2010;233:286-300;

[5]Front Cardiovasc Med. 2021;8:635172;

[6]Arthritis Rheumatol. 2019;71:351-360;

[7]Arthritis Rheum.2010;62:2569-2581.

Acknowledgements

Study supported by NVAL 19/18 awarded to SR-M (IDIVAL) and partially supported by PI18/00043 (ISCIII). Personal funds, SR-M: RD16/0012/0009 (ISCIII-ERDF); VP-C: PREVAL18/01 (IDIVAL); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests

Fernanda Genre: None declared, Verónica Pulito-Cueto: None declared, Alfonso Corrales: None declared, Virginia Portilla: None declared, Leticia Lera-Gómez: None declared, Belén Atienza-Mateo: None declared, Oreste Gualillo: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Iván Ferraz-Amaro: None declared, Santos Castañeda: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD and GSK, Grant/research support from: Abbvie, MSD, Janssen, and Roche, Sara Remuzgo-Martínez: None declared

POS1347 BIOLOGICAL THERAPY IN NEUROSARCOIDOSIS. STUDY OF 30 PATIENTS FROM A SERIES OF 234 SYSTEMIC SARCOIDOSIS FROM A UNIVERSITY HOSPITAL

Background

Neurosarcoidosis (NS) is a severe complication of sarcoidosis [1,2]. NS may be classified according to several subtypes [1]. Data on therapy, including biological therapy (BT) is scarce.

Objectives

To assess efficacy and safety of BT in refractory NS subtypes.

Methods

Study of NS from a large cohort (n=234) of all consecutive patients diagnosed with sarcoidosis in a single university hospital from January 1, 1999 to December 31, 2019. Diagnosis of sarcoidosis was established according to ATS/ERS/WASOG criteria [3].

Efficacy was considered as complete or partial response and no-response according to the resolution of the neurological syndrome (signs and/or symptoms) after the BT onset.

Results

NS was observed in 30 (19 women/11 men) of 234 (12.8%) patients; mean age, 55.0±15.8 years. NS subtypes were chronic headache (n=13, 43.4%), peripheral neuropathy (n=6, 20%), cranial neuropathy (n=5, 16.7%), spinal cord abnormalities (n=3, 10%) and aseptic meningitis (n=3, 10%). A total of 26 (86.7%) patients received oral corticosteroids (CT) (mean maximum dose: 50±19.2 mg/dL) and 7 (23.3%) IV CT. In addition, conventional immunosuppressants were administered to 18 (60%) patients and BT to 12 (40%) patients. No treatment was administered to 4 (13.3%) patients. Table 1 shows treatment according to NS subtypes.

Table 1.

Treatment of 30 patients with neurosarcoidosis

Neurosarcoidosis subtypen (%)Other clinical manifestationsn (%)Conventional immunosuppressant,N=23n (%)monoclonal anti-TNFα, N=22 n (%)Etarnecept, N=1n (%)Tocilizumab, N=1n (%)Secukinumab, N=1 n (%)Rituximab, N=1 n (%)Chronic headache*13 (43.4)P (n=9, 69.2%)A (n=9, 69.2%)C (n=6, 46.2%) O (n=4, 30.8%)D (n=4, 30.8%)MTX (n=6, 26.1%) AZA (n=1, 4.3%)IFX (n=1, 4.5%)ADA (n=1, 4.5%)GLM (n=1, 4.5%)0 (0)01 (4.5)1 (4.5)Peripheral neuropathy6 (20.0)P (n=5, 83.3%)A (n=3, 50%)O (n=3, 50%) C (n=2, 33.3%)MTX (n=4, 17.4%) AZA (n=2, 8.7%)IFX (n=3, 13.6%)ADA (n=2, 9.1%)GLM (n=1, 4.5%)1 (4.5)000Cranial neuropathy5 (16.7)P (n=4, 80%) O (n=3, 60%)C (n=1, 20%)A (n=1, 20%)D (n=1, 20%)AZA (n=4, 17.4%)MTX (n=3, 13.1%)IFX (n=3, 13.6%)ADA (n=1, 4.5%)0000Spinal cord abnormalities3 (10.0)P (n=3, 100%)O (n=1, 33.3%)C (n=1, 33.3%)A (n=1, 33.3%)MTX (n=1, 4.3%)IFX (n=1, 4.5%)GLM (n=1, 4.8%)0000Aseptic meningitis3 (10.0)P (n=2, 66.7%)O (n=1, 33.3%)C (n=1, 33.3%)A (n=1, 33.3%)MTX (n=2, 8.7%)IFX (n=2, 9.1%)ADA (n=1, 4.5%)01 (4.5)00TOTAL(n= 30)30 (100)P (n=23, 76.7%)A (n=15, 50%)O (n=12, 40%)C (n=11,36.7%)D (n=5, 16.7%)MTX (n=16, 69.6%) AZA (n=7, 30.4%)IFX (n=10, 45.5%)ADA (n=5, 22.7%)GLM (n=3, 13.6%)1 (4.5)1 (4.5)1 (4.5)1 (4.5)

Abbreviations: A: Articular, ADA: Adalimumab, AZA: Azathioprine, C: Cutaneous, D: Digestive, GLM: Golimumab, IFX: Infliximab, MTX: Methotrexate, O: Ocular, P: Pulmonar

*With MRI, CSF, and/or EMG/NCS findings typical of granulomatous inflammation of the nervous system after rigorous exclusion of other causes and not meeting criteria for other neurosarcoidosis subtypes.

A total of 12 patients received treatment with 22 BT. Most used BT were monoclonal anti-TNFα (n=18, 81.8%), infliximab (IFX) (n= 10, 45.5%) and adalimumab (ADA) (n=5, 22.7%). After 12 months since the initiation of BT, complete, partial or no response was observed in 14 of 17 (82.4%), 2 (11.8%) and 1 patient (5.9%), respectively (Figure 1). Severe allergic reaction was observed in one patient on both IFX and ADA. No more severe adverse events were observed.

Figure 1.

Neurological clinical response to biological therapy

Conclusion

BT, especially monoclonal anti-TNFα, seems to be effective and safe in NS, regardless of subtype.

References

[1]J. Bradshaw M, et al. Neurol Neuroimmunol Neuroinflamm 2021;8:e1084. doi:10.1212/NXI.0000000000001084

[2]Riancho-Zarrabeitia L, et al. Clin Exp Rheumatol. 2014 Mar-Apr;32(2):275-84. PMID: 24321604.

[3]Statement on Sarcoidosis. Am J Respir Crit Care Med [Internet] 1999;160(2): 736–55. https://doi.org/10.1164/ajrccm.160.2.ats4-99

Disclosure of Interests

Alba Herrero-Morant: None declared, David Martínez-López: None declared, Lara Sanchez-Bilbao: None declared, Iñigo Gonzalez-Mazon: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Lilly, Janssen, UCB, and Celgene, Raúl Fernández Ramón: None declared, Carmen Álvarez-Reguera: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Roche, Sanofi, Lilly, Celgene, Sobi, and MSD, Grant/research support from: Abbvie, MSD, Janssen, and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, BMS, Janssen, and MSD, Grant/research support from: Abbvie, MSD, and Roche

POS1350 UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES TREATED WITH CERTOLIZUMAB PEGOL. MULTICENTER STUDY OF 80 PATIENTS

Background

Adalimumab remains the only biologic approved by the EMA and FDA for the treatment of non-infectious uveitis [1-6]. The reports on efficacy of other anti-TNF drugs such as Certolizumab Pegol (CZP) are scarce.

Objectives

to determine the efficacy and safety of CZP in refractory uveitis secondary to Immune-mediated Inflammatory Diseases (IMIDs).

Methods

national multicenter study of 80 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants treated with CZP. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, vitritis, macular thickness and presence of retinal vasculitis. The efficacy of CZP was compared between the baseline visit, 1st week, 1st and 6th month, and 1st year. Statistical analysis was performed with IBM SPSS Statistics v.23.

Results

we studied 80 patients/111 affected eyes (33 men/47 women) with a mean age of 41.6±11.7 years. The IMIDs included were: spondyloarthritis (n=43), Behçet’s disease (10), psoriatic arthritis (8), Crohn’s disease (4), sarcoidosis (2), JIA (1), reactive arthritis (1), rheumatoid arthritis (1), relapsing polychondritis (1), TINU (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (6). Anterior was the most frequent uveitis pattern (n=61).

In 20 patients, besides the presence of refractory uveitis, desire of pregnancy was the reason for CZP initiation.

Prior to CZP, patients had received: methotrexate (n=38), sulfasalazine (28), azathioprine (14), cyclosporine (10), leflunomide (3), mycophenolate mofetil (4), and cyclophosphamide (1). Previous biologic therapy was administered in 52 patients (63%), with a median [IQR] of 2 [1-3] drugs per patient. The most used biologic was adalimumab (n=48), followed by infliximab (32), golimumab (15), tocilizumab (5), etanercept (7), rituximab (1), anakinra (1) and secukinumab (1). CZP was administered as monotherapy in 39 patients.

After 24 [12-36] months of follow-up, all parameters analyzed showed a rapid and maintained improvement (Table 1). A decrease in the mean number of uveitis flares was observed before and after CZP, (2.6±2.3 vs. 0.6±0.4, p<0.001). CZP was discontinued in 16 patients due to: ocular remission (n=3), insufficient ocular response (4) and incomplete response of extraocular manifestations (9). No serious adverse effects were found.

Table 1.

main ocular parameters analyzed in 80 patients with uveitis due to IMID and treated with CZP.

Baseline1st week1st month3rd month6th month1st yearBCVA (mean±SD)0.68±0.270.73±0.26*0.79±0.26*0.82±0.25*0.85±0.24*0.86±0.23*Tyndall improvement, n (%)Patients with Tyndall + at baseline (n=57)-23 (40.3)45 (78.9)47 (82.4)57 (100)57 (100)Vitritis improvement, n (%)Patients with Vitritis at baseline (n=14)-5 (35.7)8 (57.1)13 (92.8)14 (100)14 (100)OCT (µm) (mean±SD)297.5±48.1297.1±45.5286.5±39.8*277.6±43.3*271.5±38.6*269.0±38.8*Choroiditis, affected eyes, n (%)3 (2.4)3 (2.4)2 (1.6)2 (1.6)1 (0.8)1 (0.8)Retinal vasculitis, affected eyes, n (%)3 (2.4)2 (1.6)1 (0.8)0 (0)0 (0)0 (0)

*p<0.01

Conclusion

CZP seems to be effective and safe in the control of uveitis associated to different IMIDs.

References

[1]Jaffe GJ, et al. N Engl J Med 2016;375:932-43. doi: 10.1056/NEJMoa1509852.

[2]Nguyen QD, et al. Lancet 2016;388:1183-92. doi: 10.1016/S0140-6736(16)31339-3.

[3]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451 doi: 10.1016/j.ophtha.2018.02.020

[4]Martín-Varillas JL, et al. J Rheumatol. 2021;48:741-750. doi: 10.3899/jrheum.200300

[5]Atienza-Mateo B. Arthritis Rheumatol. 2019;71:2081-2089. doi: 10.1002/art.41026.

[6]Vegas-Revenga N et al Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019

Disclosure of Interests

None declared

AB1320 JAK2 (V617F) MUTATION AND ASSOCIATION TO RHEUMATOLOGICAL DISEASES TREATMENT. STUDY OF 130 PATIENTS FROM A SINGLE UNIVERSITY HOSPITAL

Background

Janus Kinases (JAK) can promote cytokine production in immune and hematopoietic cells. The JAK-2 (V617F) mutation is the most frequently detected mutation in myeloproliferative neoplasms (MPN) which include essential thrombocythemia (ET), polycythemia vera (PV), primary myelofibrosis (PMF) and undifferenciated MPN. JAK-2 (V617F) mutation displays a pro-inflammatory phenotype that may be associated to a higher risk of immune mediated diseases (IMID).

Objectives

In a wide series of JAK2 (V617F) mutation, we assess the presence of a) IMID (rheumatic and non-rheumatic), b) treatment of rheumatic IMID.

Methods

We studied all the patients diagnosed with a positive JAK-2 (V16F) mutation in a single University Hospital from January 2004 to December 2019. JAK-2 (V16F) mutation was detected by using both peripheral blood and bone marrow samples. Associated IMID and treatment of rheumatic IMID were evaluated.

Results

We included 130 patients (73 men/57 women; mean age, 70.1±14.5 years). All of them were diagnosed of MPN; ET (n=64, 49.2%), PV 46 (35.4%), undifferentiated MPN (n=12, 9.2%) and PMF (n=8, 6.1%). In 10 of these 130 patients (7.7%) a rheumatic IMID was diagnosed: rheumatoid arthritis (RA) (n=4; 40%), polymyalgia rheumatica (PMR) (n=3; 30%), Sjögren syndrome (SS) (n=1; 10%), antiphospholipid syndrome (APS) (n=1; 10%) and autoinflammatory syndrome (WDR1 mutation) (n=1; 10%). Patients with RA, SS, PmR, and APS were clinically mild. RA patients were seronegative, non-erosive and without extraarticular involvement. Treatment and response are summarized in Table 1. All patients diagnosed with PMR were treated with glucocorticoids (prednisone 5 mg/12 hours), SS with hydroxychloroquine (HCQ) (200 mg/day), APS was anticoagulated with acenocumarol and one autoinflammatory syndrome was finally treated with baritinib (4 mg/day) after failure to anakinra (100 mg/day).

Conclusion

Except in autoinflammatory syndrome, most rheumatic IMID associated to JAK-2 (V16F) mutation are clinically mild, and treatment and response of patients seems similar or even better than those without this mutation.

Table 1.

Treatment of 10 patients with rheumatic IMIDs and JAK-2 (V16F) mutation.

Abbreviation:

ANA: anakinra, BARI: baricitinib, NSAIDs: Non-Steroidal Anti-inflammatory Drugs, PDN: prdnisone, RA: Rheumatoid arthritis, SS: Sjögren syndrome, PMR: polymyalgia rheumatica.

Disclosure of Interests

Carmen Álvarez-Reguera: None declared, Lara Sanchez-Bilbao: None declared, Sara Fernández López: None declared, Ana Batlle-López: None declared, Alba Herrero-Morant: None declared, David Martínez-López: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Grant/research support from: Abbvie, Pfizer, Roche, Sanofi and MSD., Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD., Grant/research support from: Abbvie, MSD and Roche.

POS0052 ANGIOGENIC T CELLS AS RELEVANT PLAYERS IN THE LUNG VASCULOPATHY OF RHEUMATOID ARTHRITIS, SYSTEMIC SCLEROSIS AND OTHER AUTOIMMUNE DISEASES

Background

Interstitial lung disease (ILD) is a common and life-threatening complication in patients with autoimmune diseases (AD), mainly in those with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Growing evidence indicate that vascular abnormalities constitute the early phase in the pathogenesis of these inflammatory diseases [1]. We recently reported a decrease of angiogenic T cells (TAng), that promote endothelial repair and revascularization cooperating with endothelial progenitor cells (EPC) [2], in patients with AD-ILD+ [3]. Nevertheless, no studies have been conducted on the role of TAng in the presence of ILD in RA, SSc or other AD.

Objectives

To determine the contribution of TAng in the pathogenic processes of vasculopathy and lung fibrosis in RA-ILD+, SSc-ILD+ and other AD-ILD+, as well as their relationship with EPC in all the AD-ILD+ patients.

Methods

Peripheral venous blood was collected from 21 RA-ILD+ patients, 21 SSc-ILD+ patients and 15 patients with other AD-ILD+. Furthermore, we included 4 comparative groups: 25 RA-ILD- patients, 20 SSc-ILD- patients, 21 idiopathic pulmonary fibrosis (IPF) patients and 21 healthy controls (HC). TAng were considered as CD3+CD184+CD31+ cells by flow cytometry. Additionally, EPC data were previously published by Pulito-Cueto et al. [4-5].

Results

Regarding the role of TAng in vasculopathy, the frequencies of these cells were significantly lower in patients with RA-ILD+, SSc-ILD+ and other AD-ILD+, as well as with IPF in relation to HC (p=0.007, p=0.016, p=0.005 and p<0,001, respectively, Figure 1). No differences between RA-ILD- patients, SSc-ILD- patients and HC were found (Figure 1). With respect to TAng involvement in fibrosis, TAng frequencies were similar in patients with RA-ILD+, SSc-ILD+, other AD-ILD+ and those with IPF (Figure 1). Nevertheless, patients with RA-ILD+ and SSc-ILD+ showed significantly lower TAng frequencies than those with RA-ILD- and SSc-ILD-, respectively (p=0.006 and p=0.044, respectively, Figure 1). In this line, a higher frequency of TAng was found in SSc-ILD- and RA-ILD- patients in relation with those with IPF (p<0.001 and p=0.003, respectively, Figure 1). Moreover, TAng frequency did not show significant correlation with EPC frequency in the whole cohort of AD-ILD+ patients.

Figure 1.

Quantification of TAng population by flow cytometry in all individuals included in the study.

Conclusion

TAng play a relevant role in the lung vasculopathy of RA-ILD+, SSc-ILD+ and other AD-ILD+. Interestingly, circulating TAng may be considered as a useful biomarker of the presence of ILD in patients with RA and SSc.

References

[1]Expert Rev Clin Immunol 2018;14(1):69-82.

[2]Rheum Dis 2015;74(5):921–927.

[3]Ann Rheum Dis 2021;80(1):1047-1048.

[4]J Clin Med 2020;9(12):4098.

[5]Biomedicines 2021;9(7):847.

Acknowledgements

VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01); SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from `Instituto de Salud Carlos III´ (ISCIII), co-funded by the European Regional Development Fund; RL-M is a recipient of a Miguel Servet type I programme fellowship from ISCIII, co-funded by the European Social Fund, `Investing in your future’(grant CP16/00033).

Disclosure of Interests

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Leticia Lera-Gómez: None declared, Javier Rodriguez Carrio: None declared, Diana Prieto-Peña: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Alfonso Corrales: None declared, Oreste Gualillo: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche

POS0817 TOCILIZUMAB IN NEWLY DIAGNOSED GIANT CELL ARTERITIS VERSUS REFRACTORY/RECURRENT GIANT CELL ARTERITIS; MULTICENTER STUDY OF 471 PATIENTS OF CLINICAL PRACTICE

Background

Tocilizumab (TCZ) is the only biologic drug approved in giant cell arteritis (GCA), based in two clinical trials (CT) (1,2). CT included selected patients who may differ from those of clinical practice (CP). A high proportion of GCA patients treated with TCZ in CT had a newly diagnosed GCA, whereas in CP, most of them are refractory/recurrent GCA (3,4). Although in CT the efficacy of TCZ seems to be similar in patients with newly diagnosed GCA and in patients with refractory/recurrent GCA, in CP it is not documented.

Objectives

To compare in CP, the effectiveness and safety of TCZ in newly diagnosed vs refractory/recurrent GCA.

Methods

Multicentre observational study on 471 GCA patients treated with TCZ. GCA was diagnosed by: a) ACR criteria, and/or b) temporal artery biopsy, and/or c) imaging techniques. A comparative study between patients with newly diagnosed GCA (<6 weeks) and those with refractory/recurrent GCA (>6 weeks) (according to GiACTA study definitions) (2). Sustained remission was based on EULAR definitions (5).

Results

The 471 GCA patients were divided into 2 subgroups: a) newly diagnosed GCA (n=91) and b) refractory/recurrent GCA (n=380) (Table 1).

Table 1.

Main features of patients with newly diagnosed GCA and refractory/recurrent GCA treated with tocilizumab.

Newly diagnosed GCA (n=91)Refractory/recurrent GCA (n=380)pBaseline characteristics at TCZ onset Age(years), mean±SD74.3±8.573.3±9.10.35 Sex, female/male (% female)60/31 (66)282/98 (74)0.11 Time from GCA diagnosis to TCZ onset (months), median [IQR]1 [0.5-1]10 [4-24]0.0001 ESR, mm 1st hour, median [IQR]46 [17.5-80.5]27 [10-50]0.02 CRP, mg/dL, median [IQR]2.1 [0.7-8.5]1.3 [0.4-2.8]0.13 Haemoglobin, g/dL, mean±SD12.3±1.512.7±1.50.03 Prednisone dose, mg/day, median [IQR]40 [21.2-50]15 [10-30]<0.001Effectiveness and Safety after TCZ onsetFollow-up, (months), median [IQR]15 [6-27.5]22 [11-37]0.004Relevant adverse events, n (%)23 (25)102 (27)0.54Relevant adverse events per 100 patients-year2015NSSerious infections, n (%)13 (14)53 (14)0.49Serious infections per 100 patients-year11.28NSMACES, n (%)0 (0)1 (0.3)-MACES per 100 patients-year00.2-Malignancies n (%)2 (2)3 (0.8)0.99Malignancies per 100 patients-year1.60.5NS

Abbreviations: CRP: C-reactive protein;ESR: erythrocyte sedimentation rate;GCA: giant cell arteritis; IQR: interquartile range; IV: intravenous; MACEs: major adverse cardiovascular events; NS: non significant; SC: subcutaneous; SD: standard deviation

No significant differences were observed between both groups in sustained remission, although a greater tendency towards sustained remission is observed in newly diagnosed than in refractory/recurrent GCA patients (Figure 1). The decrease in glucocorticoids dose was faster in the first three months in the newly diagnosed GCA group, but thereafter, was similar in both groups, as well as the appearance of relevant adverse events and serious infections.

Figure 1.

A) Sustained remission, and B) median prednisone dose required in patients with newly diagnosed GCA and in patients with refractory/recurrent GCA treated with tocilizumab.

Conclusion

The effectiveness and safety of TCZ seems to be similar in patients with newly diagnosed GCA and in patients with refractory/recurrent GCA.

References

[1]Villiger PM, et al. Lancet. 2016; 387:1921-1927. PMID: 26952547

[2]Stone JH, et al. N Engl J Med. 2017; 377:317-328. PMID: 28745999

[3]Calderón-Goercke M, et al. Semin Arthritis Rheum. 2019; 49: 126-135. PMID: 30655091

[4]Calderón-Goercke M, et al. Clin Exp Rheumatol. 2020; 124: S112-119. PMID: 32441643

[5]Hellmich B, et al. Ann Rheum Dis. 2020; 79: 19-30. PMID: 31270110

Acknowledgements

Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group: Juan C. González Nieto (H. Gregorio Marañón), Juan R. de Dios (H.U. Araba), Esther Fernández (H. Clínico Universitario Virgen de la Arrixaca), Isabel de la Morena (H. Clínico Universitario de Valencia), Patricia Moya (H. Sant Pau), Roser Solans i Laqué (H. Valle de Hebrón), Eva Pérez Pampín (H.U. de Santiago), José L. Andréu (H.U. Puerta de Hierro), Marcelino Revenga (H. Ramón y Cajal), Juan P. Baldivieso Achá (H. U. de La Princesa), Eztizen Labrador (H. San Pedro), Andrea García-Valle (Complejo Asistencial Universitario de Palencia), Adela Gallego (Complejo Hospitalario Universitario de Badajoz), Carlota Iñíguez (H.U. Lucus Augusti), Cristina Hidalgo (Complejo Asistencial Universitario de Salamanca), Noemí Garrido-Puñal (H. Virgen del Rocío), Ruth López-González (Complejo Hospitalario de Zamora), José A. Román-Ivorra (H.U. y Politécnico La Fe), Sara Manrique (H. Regional de Málaga), Paz Collado (H.U. Severo Ochoa), Enrique Raya (H. San Cecilio), Valvanera Pinillos (H. San Pedro), Francisco Navarro (H. General Universitario de Elche), Alejandro Olivé-Marqués (H. Trías i Pujol), Francisco J. Toyos (H.U. Virgen Macarena), María L. Marena Rojas (H. La Mancha Centro), Antoni Juan Más (H.U. Son Llàtzer), Beatriz Arca (H.U. San Agustín), Carmen Ordás-Calvo (H. Cabueñes), María D. Boquet (H. Arnau de Vilanova), Noelia Álvarez-Rivas (H.U. Lucus Augusti), María L. Velloso-Feijoo (H.U. de Valme), Cristina Campos (H. General Universitario de Valencia), Íñigo Rúa-Figueroa (H. Doctor Negrín), Antonio García (H. Virgen de las Nieves), Carlos Vázquez (H. Miguel Servet), Pau Lluch (H. Mateu Orfila), Carmen Torres (Complejo Asistencial de Ávila), Cristina Luna (H.U. Nuestra Señora de la Candelaria), Elena Becerra (H.U. de Torrevieja), Nagore Fernández-Llanio (H. Arnáu de Vilanova), Arantxa Conesa (H.U. de Castellón), Eva Salgado (Complejo Hospitalario Universitario de Ourense).

Disclosure of Interests

Julio Sanchez-Martin: None declared, Javier Loricera: None declared, Clara Moriano: None declared, Santos Castañeda: None declared, J. Narváez: None declared, Vicente Aldasoro: None declared, Olga Maiz: None declared, Rafael Melero: None declared, Ignacio Villa-Blanco: None declared, Paloma Vela-Casasempere: None declared, Susana Romero-Yuste: None declared, Jose Luis Callejas-Rubio: None declared, Eugenio de Miguel: None declared, E. Galíndez-Agirregoikoa: None declared, Francisca Sivera: None declared, Carlos Fernández-López: None declared, Carles Galisteo: None declared, Iván Ferraz-Amaro: None declared, Lara Sanchez-Bilbao: None declared, Monica Calderón-Goercke: None declared, Jose Luis Hernández Hernández: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche

AB0280 SERIOUS INFECTIONS-RELATED HOSPITALIZATION IN RHEUMATOID ARTHRITIS. OBSERVATIONAL STUDY OF 392 PATIENTS FROM A SINGLE UNIVERSITY CENTER

Background

Patients with Rheumatoid Arthritis (RA) have an increased risk of infections. This may belinked to disease-related, the immunosuppressive therapy and the co-morbidities.

Objectives

in an unselected group of RA patients, our aim was to assess the a)incidence b)features of disease and c)predictive factors of serious infections-related hospitalization.

Methods

Observational study of all patients diagnosed with RA that were included in the vaccination program of our university hospital between October2011 and October 2016.The minimum follow-up was of 12 months; therefore, it was made until December 2020.

Patients with serious infections-related hospitalization were a) compared with those not requiring hospital admission and, b)identified predictive factors (multivariate analysis adjusted by age and sex).

Vaccination program in our hospital includes vaccination for Influenza, Streptococcus pneumoniae and Haemophilus influenzae.

Information on patients, infections and hospitalizations was retrieved from the hospital and general physician records.

Results

We studied 392RApatients (309women/83men); mean age 63.1±13.7 years.

After a mean follow-up of 71.8±20.6 months, in 88 of 392patients (22.4%) (60 women) 187serious infections-related hospitalizations were required. The median [IQR] number of hospitalizations were 1.5 [1-2]. The main serious infections were respiratory (44 patients; 78 hospitalizations), urinary (33 patients; 48 hospitalization), cutaneous (19 patients; 28 hospitalizations), abdominal (17 patients, 20 hospitalizations), septic arthritis (7 patients; 8 hospitalizations), maxillofacial(2 patients, 2 hospitalizations), bacterial endocarditis (2 patients, 2 hospitalizations) and genital (1 patient, 1 hospitalization).

Patients with serious infections-related hospitalization were older, with a longer RA, with more co-morbidities (hypertension, hypercholesterolemia diabetes mellitus, and Interstitial lung disease) and with more conventional and biological DMARDS (Table 1).

Table 1.

Comparative study of different groups

Patientswithserious infections-related hospitalization N=88Patients without serious infections-related hospitalization N=304pDemographic features and comorbiditiesAge (years),mean±SD69.7±11.259.2±12.60.005Women, n (%)60 (68.2)249 (81.9)0.33Active smokers, n (%)41 (46.6)114 (7.5)0.32Hypertension, n (%)56 (63.6)109 (35.8)0.004Hypercholesterolemia, n(%)47 (53.4)101 (33.2)0.02Diebetes Mellitus, n(%)25 (28.4)30 (9.9)0.0002RA featuresDuration of RA (months) mean±SD165.8±130.1128.6±102.60.005Positive RF, n (%)52(59.1)171(56.2)0.80Positive ACPA, n (%)48 (54.5)158 (52.6)0.81Erosive disease, n (%)32 (36.4)113 (51.9)0.89Associated Sjögren Syndrome, n (%)4 (4.5)16 (5.3)0.79Interstitial lung disease n (%)11 (12.5)9 (2.9)0.0008Subcutaneousnodules n (%)6 (6.8)16 (5.3)0.57Prednisone (or equivalent) dose mg/day, mean±SD5.3±4.53.3±3.80.001Number of convencional DMARDs, mean±SD1.9±1.41.5±1.30.05Number of biologic DMARDs, mean±SD0.1±0.20.1±0.40.03Number of JAK inhibitors, mean±SD69.7±11.259.2±12.60.1

The predictive factors for hospitalization were hypertension and Diabetes Mellitus, RA related interstitial lung disease and treatment with biologic DMARDs. (Figure 1)

Figure 1.

Predictive factors for serious infections-related hospitalization

Conclusion

Despite to be included in a vaccination program up to 22% of patients required hospitalization due to serious infection. The main predictive factors were co-morbidities, interstitial lung disease and treatment with biologic DMARDs. Serious infections in RA remain to be an unmet need.

Disclosure of Interests

None declared

POS0801 VISUAL INVOLVEMENT AND PERMANENT VISUAL LOSS IN GIANT CELL ARTERITIS: PREDICTIVE FACTORS

Background

Visual involvement is the most feared complication of Giant Cell Arteritis (GCA) (1-5). Permanent visual loss (PVL) may be preceded by transient visual loss. Once blindness is established, the prognosis is poor. Most of the series of predictive factors of visual involvement in GCA are old and with a small number of patients.

Objectives

To assess the predictive factors of visual involvement and PVL in GCA.

Methods

Multicenter observational study of 471 patients with GCA. The diagnosis of GCA was performed between 2016 and 2021 according to: a) ACR criteria, and/or b) temporal artery biopsy, and/or c) imaging techniques.

From the 471 patients, we selected patients who developed a) visual involvement at any time during GCA and b) PVL. PVL was defined as partial or complete visual loss of >24 hours. Predictive factors were identified by multivariate analysis.

Results

Visual involvement was observed in 122 cases and PVL in 60 (Table 1). The ischemic and systemic manifestations set of variables associated with visual involvement were headache, and jaw claudication, whereas large-vessel involvement was a protective variable (Figure 1). The area under the curve (AUC) for the model was 0.72 (95%CI 0.67-0.77; p<0.0001).

Figure 1.

Forest plot of multivariate analysis.

Table 1.

Main features of the patients

Overall (n= 471)GCA without visual involvement (n=349)GCA with visual involvement (n= 122)GCA with PVL (n=60)P visual vs non visual involvementP PVL vs non visual involvementAge at diagnosis of GCA (mean±SD)72±971±975±875±90.0010.001Female/Male (% of female)342/129 (73)265/84 (76)77/45 (63)41/19 (68)0.0060.21Positive TAB, n (%)201 (43)146 (42)55 (45)33 (55)0.530.34Cardiovascular risk factorsHigh blood pressure, n (%)272 (58)189 (54)83 (68)40 (67)0.0130.058Dyslipidemia, n (%)241 (51)175 (50)66 (54)32 (53)0.610.63Diabetes, n (%)81 (17)50 (14)31 (25)16 (27)0.0070.016Previous or current smoking history, n (%)47 (10)31 (9)16 (13)8 (13)0.210.27CHADS2 score, median [IQR]1 [1-2]1 [0-2]2 [1-2]2 [1-2]0.0010.004Ischemic manifestationsHeadache, n (%)259 (55)167 (48)92 (75)42 (70)0.0000.002Jaw claudication, n (%)112 (24)63 (18)49 (40)26 (43)0.0000.000Systemic manifestationsFever, n (%)57 (12)47 (13)10 (8)4 (7)0.120.20Constitutional syndrome, n (%)175 (37)132 (38)43 (35)20 (33)0.550.47PmR, n (%)284 (60)218 (62)66 (54)29 (48)0.0940.022Large-vessel involvement, n (%)254 (54)211 (60)43 (35)20 (33)0.0000.000ESR, mm/1st hour, median [IQR]32 [12-57]30 [11-54]34 [15-67]42 [12-67]0.220.28CRP (mg/dL), median [IQR]1.5 [0.5-3.4]1.4 [0.5-3.0]1.5 [0.4-4.7]1.5 [0.4-3.6]0.0420.30

In the same line, the set of variables associated with PVL were headache, and jaw claudication. By contrast, polymyalgia rheumatica (PmR), and large-vessel involvement were protective factors (Figure 1). The AUC for this model was 0.77 (95%CI 0.71-0.83; p<0.0001).

Conclusion

Headache, and jaw claudication seem to be associated with visual involvement in GCA, while large vessel involvement seems to be a protective factor. PmR also appears to be a protective factor for the development of PVL.

References

[1]Calderón-Goercke M, et al. Semin Arthritis Rheum. 2019; 49: 126-135. PMID: 30655091

[2]Baalbaki H, et al. Clin Rheumatol. 2021; 40: 3207-3217. PMID: 33580374

[3]González-Gay MA, et al. Arthritis Rheum. 1998; 41: 1497-1504. PMID: 9704651

[4]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019; 48: 720-727. PMID: 29903537

[5]Martínez-Rodríguez I, et al. Semin Arthritis Rheum. 2018; 47: 530-537. PMID: 28967430

Acknowledgements

Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group.

Disclosure of Interests

Lara Sanchez-Bilbao: None declared, Javier Loricera Speakers bureau: Roche, Novartis, UCB Pharma, Celgene, and Grünenthal, Clara Moriano: None declared, Santos Castañeda Speakers bureau: UAM-Roche, EPID- Future chair, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain., Iván Ferraz-Amaro: None declared, J. Narváez: None declared, Vicente Aldasoro: None declared, Olga Maiz: None declared, Rafael Melero: None declared, Ignacio Villa-Blanco: None declared, Paloma Vela-Casasempere: None declared, Susana Romero-Yuste: None declared, Jose Luis Callejas-Rubio: None declared, Eugenio de Miguel: None declared, E. Galíndez-Agirregoikoa: None declared, Francisca Sivera: None declared, Carlos Fernández-López: None declared, Carles Galisteo: None declared, Julio Sanchez-Martin: None declared, Monica Calderón-Goercke: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, and MSD., Grant/research support from: AbbVie, MSD, Jansen, and Roche,, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Lilly, Janssen, and MSD., Grant/research support from: Abbvie, MSD, and Roche

POS0663 THE USE OF EXPOSURE-ADJUSTED EVENT RATES VERSUS EXPOSURE-ADJUSTED INCIDENCE RATES IN ADVERSE EVENT REPORTING: INSIGHTS FROM FILGOTINIB INTEGRATED SAFETY DATA IN RHEUMATOID ARTHRITIS

Background

Reporting of treatment-emergent adverse events (TEAEs) in rheumatoid arthritis (RA) clinical trials can be summarized as exposure-adjusted incidence rates (EAIRs) or exposure-adjusted event rates (EAERs). Censored EAIR (EAIR), weighing exposure up to a patient’s first event, is commonly reported; uncensored EAIR (EAIRu), using total exposure time for all patients, can also be used. For EAIR, exposure time can vary by event. In contrast to EAIR(u), the total number of events are used to calculate EAER. The three methods account for different exposures and/or multiple events, which can impact the outcome evaluation. Studies of filgotinib (FIL) in RA1 report safety data as EAIR/100 patient-years of exposure (PYE) for TEAEs, which is uncensored.

Objectives

To describe the outcome of long-term FIL integrated safety data in RA by applying different statistical methodologies: EAER, EAIRu and EAIR.

Methods

Integrated FIL safety data from seven clinical trials were assessed1. Predefined adverse events of special interest (AESI) included serious infections (any), herpes zoster (HZ), major adverse cardiac events (MACE), malignancies (excluding nonmelanoma skin cancer [NMSC]), NMSC and venous thromboembolism (VTE). The number of patients with an event, number of events, EAER, EAIRu and EAIR were summarized. The data extraction date was January 2021 for the DARWIN 3 (NCT02065700) long-term extension (LTE) and November 2020 for the FINCH 4 (NCT03025308) LTE.

Results

In total, 3691 patients received ≥1 FIL dose for 8085 PYE. In this population, 176 serious infections were reported in 137 patients, 125 HZ events were reported in 112 patients, 39 MACE were reported in 33 patients, 20 cases of VTE were reported in 15 patients, 60 malignancies excluding NMSC were reported in 49 patients and 21 cases of NMSC were reported in 20 patients. Within each treatment arm (FIL 200 mg [FIL200], FIL 100 mg [FIL100] or combined FIL), rates for most AESI were similar when reported as EAER, EAIRu or EAIR (Table 1). For serious infections, EAER was higher than EAIRu or EAIR. The total exposure time to first event (censored PYE) was high and comparable to total exposure (PYE) (>2700 years and >5100 years for the total populations in the FIL100 and FIL200 groups, respectively).

Table 1.

Exposure-adjusted event and incidence rates for AESI

FIL200FIL100FIL combinedNumber of patients/PYE2267/5302.51647/2782.63691/8085.1Serious infectionsEAER1.9 (1.5, 2.4)3.2 (2.2, 4.5)2.0 (1.7, 2.4)EAIRu1.5 (1.1, 1.9)2.7 (1.9, 3.9)1.6 (1.3, 2.0)EAIR1.5 (1.2, 1.9)2.8 (1.9, 4.0)1.7 (1.4, 2.0)HZEAER1.6 (1.3, 2.1)1.3 (0.9, 1.8)1.5 (1.2, 1.8)EAIRu1.5 (1.2, 2.0)1.1 (0.8, 1.5)1.4 (1.1, 1.7)EAIR1.6 (1.2, 2.0)1.1 (0.8, 1.6)1.4 (1.1, 1.7)MACEEAER0.3 (0.2, 0.5)0.6 (0.4, 1.0)0.4 (0.3, 0.6)EAIRu0.3 (0.2, 0.5)0.5 (0.3, 0.8)0.4 (0.2, 0.6)EAIR0.3 (0.2, 0.5)0.5 (0.3, 0.9)0.4 (0.2, 0.6)VTEEAER0.3 (0.2, 0.5)0.1 (0.1, 0.4)0.2 (0.2, 0.4)EAIRu0.2 (0.1, 0.4)0.1 (0.1, 0.4)0.2 (0.1, 0.3)EAIR0.2 (0.1, 0.4)0.1 (0.1, 0.4)0.2 (0.1, 0.3)Malignancies excluding NMSCEAER0.8 (0.5, 1.1)0.8 (0.5, 1.2)0.7 (0.2, 2.8)EAIRu0.6 (0.4, 0.9)0.6 (0.4, 1.0)0.6 (0.4, 0.8)EAIR0.6 (0.4, 0.9)0.6 (0.4, 1.0)0.6 (0.4, 0.8)NMSCEAER0.3 (0.2, 0.5)0.2 (0.1, 0.5)0.3 (0.2, 0.4)EAIRu0.3 (0.2, 0.5)0.2 (0.1, 0.4)0.2 (0.2, 0.4)EAIR0.3 (0.2, 0.5)0.2 (0.1, 0.4)0.2 (0.2, 0.4)

Data are rate (95% CI) unless otherwise stated.

Conclusion

These data confirm that using different methods to analyze FIL safety data (EAER, EAIRu, EAIR) does not result in different safety outcomes, reinforcing the previously reported FIL safety profile in patients with RA. As the AESI reported in the long-term safety database with FIL are rare, patients commonly have long exposure times before experiencing an event, which are often associated with end of treatment. As such, EAIRu, EAIR and EAER are similar.

References

[1]Winthrop KL et al. Ann Rheum Dis 2021, doi: 10.1136/annrheumdis-2021-221051.

Acknowledgements

This study was co-funded by Galapagos NV (Mechelen, Belgium) and Gilead Sciences, Inc. (Foster City, CA, USA). Medical writing support was provided by Iain Haslam, PhD (Aspire Scientific Ltd, Bollington, UK), and funded by Galapagos NV.

Disclosure of Interests

Patrick Durez Speakers bureau: AbbVie, Galapagos, and Lilly, Eugen Feist Speakers bureau: AbbVie, Galapagos, Lilly, Novartis, Pfizer, Roche, and Sobi, Consultant of: AbbVie, Galapagos, Lilly, Novartis, Pfizer, Roche, and Sobi, Grant/research support from: Lilly, Pfizer, and Roche, Ricardo Blanco Speakers bureau: AbbVie, Amgen, Bristol-Myers, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and Sanofi, Consultant of: Astra-Zeneca, Galapagos, Janssen, Novartis, and Pfizer, Grant/research support from: AbbVie and Roche, Vijay Rajendran Employee of: Galapagos, Nadia Verbruggen Employee of: Galapagos, Katrien Van Beneden Shareholder of: Galapagos, Employee of: Galapagos, James Galloway Speakers bureau: AbbVie, Biogen, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Galapagos, Gilead, Janssen, Lilly, Novartis, and Pfizer, Grant/research support from: Astra-Zeneca, Celgene, Gilead, Janssen, Medicago, Novavax, and Pfizer

AB0679 INTRAVENOUS INMUNOGLOBULIN IN INFLAMMATORY MYOPATHIES: EXPERIENCE OF A SINGLE REFERRAL CENTER

Background

Treatment of inflammatory idiopathic myopathies (IIM) is not well-stablished. Although the mechanism of action of intravenous immunoglobulins (IVIG) is not completely understood, they may be useful in rheumatic diseases, including IIM.

Objectives

To assess the efficacy and safety of IVIG in IIM.

Methods

Observational Single University study of IIM requiring therapy with at least one cycle of IVIG from January 2000 to December 2021. IIM, was diagnosed according to EULAR/ACR classification criteria (1).

Efficacy outcomes were a) clinical features (muscular strength and cutaneous involvement), b) analytical parameters (Creatine Kinase) and, c) glucocorticoid-sparing effect. All of them were measured at 2-4 weeks, 3 months, 6 months, 1 year and 2 years after IVIG onset.

Muscular Strength was measured in three muscle areas (upper limbs, lower limbs and neck flexor muscles) by using Medical Research Council Grading System.

We classified clinical outcomes (muscular strength and dermatological) improvement in 3 categories: Complete improvement, Partial improvement and No improvement.

IVIG schedule was a total of 2 g/kg administered in 1-5 days.

Results

We included 28 patients (22 females, mean age; 47.07±26.71 years) with IIM. The main clinical features are summarized in Table 1. Muscular weakness was present in 18 patients and cutaneous manifestations in 18 patients at baseline.

Table 1.

General features of 28 patients with inflammatory idiopathic myopathies with IVIG treatment

GENERAL FEATURESGENERAL FEATURES (continuation)Gender female / male, n (%)22(78.6) / 6 (21.4)Clinical manifestations at IVIG onset; n (%)Age (mean±SD)47.07±26.71Upper limbs involvement17 (60.71)Underlying IIM; n (%)Lower limbs involvement17 (60.71)Dermatomyositis12 (46.42)Neck flexors muscular involvement14 (50.00)Amyopathic Dermatomyositis1 (3.57)Cutaneous involvement18 (64.28)Juvenile Dermatomyositis6 (21.42)Dysphagia8 (28.57)Polymiositis2 (7.14)Constitutional symptoms9 (3.14)Inmune-mediated necrotizing miopathy5 (17.85)Malignancy2 (7.14)Systemic sclerosis/myositis overlap syndrome1 (3.57)Respiratory disease3 (10.71)Toxic myopathy1 (3.57)Articular involvement4 (14.28)IIM duration, months (mean±SD)28.74±38.75Cutaneous vasculitis2 (7.14)Previous immunosupressants before IVIG; n (%)Methotrexate9 (32.14)Concomitant Therapy with IVIG; n (%)Azathioprine4 (14.28)Oral Corticosteroids at IVIG onset18 (64.28)Cyclophosphamide1 (3.57)Methotrexate10 (35.71)Mycophenolate mofetil2 (7.14)Azathioprine4 (14.28)Hydroxychloroquine5 (17.85)Mycophenolate mofetil1 (3.57)Rituximab1 (3.57)Hydroxychloroquine5 (17.85)Plasmapheresis1 (3.57)

An early and maintained improvement was observed in all outcomes: clinical (muscular strength (a) and cutaneous manifestations (b)), Creatine Kinase (c) and glucocorticoid-sparing effect (d) (Figure 1).

Figure 1.

Efficacy Outcome.

Figure 1. *p< 0.05 (Wilcoxon test).

After two years of follow-up, we observed the following adverse effects: headache (n=6), pruritus (n=3), allergic reaction (n=2) and arterial hypertension (n=1). No heart failure, renal insufficiency or thrombotic events were found.

Conclusion

IVIG seems effective and safety in IIM treatment.

References

[1]Lundberg, et al. Ann Rheum Dis 2017:76; 1955-1964.

Disclosure of Interests

None declared

AB1310 JANUS KINASE INHIBITORS IN SEVERE AND REFRACTORY INFLAMMATORY OCULAR PATHOLOGY. CASES REPORTS AND LITERATURE REVIEW

Background

Inflammatory ocular pathology (IOP) includes internal and external involvement. IOP may be severe ocular conditions refractory to conventional immunosuppressants and even biological therapy. Janus Kinase inhibitors (JAKINIB) had shown efficacy in refractory cases of different immune-mediated inflammatory diseases (IMID).

Objectives

In patients with refractory IOP treated with JAKINIB our aims were a) to assess the patients of Spanish referral centers, b) Literature review.

Methods

Multicenter study of 6 patients with refractory IOP treated with JAKINIB. For Literature review a search was conducted in PubMed, Embase and the Cochrane library from their inception to 1st January 2022, and conference proceedings from four major rheumatology conferences. In addition, a therapeutical approach of refractory IOP is proposed.

Results

We have identified 6 cases in five University Hospitals and 11 cases in the literature review. These 17 patients (14 women/ 3 men) (24 affected eyes), mean age 35.5±23.4 years had different refractory IOP (uveitis=11; scleritis= 3, PUK= 3).

Most of IOP were associated with IMID (n=13, 76.5%). The main underlying IMID were juvenile idiopathic arthritis (n=5, 29.4%), rheumatoid arthritis (n=2, 11.8%) and spondyloarthritis (n=2; 11.8%) (Table 1).

Table 1.

Cases reports and Literature review

Study, yearCasesAge/ SexUnderlying IMIDJAKINIBOcular involvementPrevious immunosuppressive treatmentOcular Improvement(Ref)Meadow et al. 2014159, FRATOFAPUKMTX, ABA, ivMPPartial (PI)(1)Bauermann et al. 2018122, FJIATOFAA. uveitis, CMEMTX, ADA, RTX, GOLI, IFX, CsA, TCZ, MMFComplete (CI)(2)Paley et al. 201921.40, F1.Idiopathic1.TOFA1.Scleritis1.MTX, MMF, AZA, CYP1.CI(3)2.45, F2.Idiopathic2.TOFA2.A. uveitis, CME2.MTX, LFN, AZA, MMF, ADA, IFX, CZP, intravitreal fluocinolone ac.2.CILiu J et al. 2020130, MBehçet disTOFAScleritisSSZ, MTX, AZA, LFN, THD, COL, GLMPI(4)Majumder et al. 2020126, FVogt-Koyanagi- Harada disTOFAP. uveitisivMPCI(5)Miserocchi et al. 202041. 9, FJIA1. TOFA1. Panuv1. IFX, ADA, LFN, ABA, RTX, TCZ.1. CI2. 1, F2. BARI2. Panuv2. MTX, ADA, IFX, RTX, ABA.2. CI(6)3. 2, F3. BARI3. Panuv3. MTX, AZA, IFX, ADA, TCZ.3. CI4. 10, M4. BARI4. Panuv4. ETN, MTX, CsA, IFX, ADA, ABA, TCZ, RTX.4. CIPyare et al. 2020145, FIdiopathicTOFANecrotizing scleritisMMFCI(7)Present study, 202261. 25, F1. Blau Syndrome1. TOFA/BARI1. Panuv1.MTX, ETN, ANA, ABA1. CI2. 85, F2. RA2. BARI2. PUK2.MTX, LFN, CZP, ADA, iv MP.2. CI3. 41, F3. Relapsing polychondritis3. BARI3. PUK3. MTX, CsA, SSZ, MMF, AZA, IFX, TCZ, CZP, ABA, ADA.3. CI4. 65, F4. Idiopathic4. BARI4. Panuv4. MTX, AZA4. CI5. 59, M5. AS5. UPA5. A. uveitis5. MTX, ADA5. CI6. 40, F6. SpA and ulcerative colitis6. TOFA6. A. uveitis6. MTX, AZA, ADA6. CI

Uveitis (n=11) followed by ocular surface pathology (n=6) were the most frequent subtypes of IOP. Patterns of uveitis were panuveitis (n=6), anterior uveitis (n=4; 2 of them with Cystoid macular edema) and posterior (n=1). Ocular surface pathology was due to scleritis (n=3) and PUK (n=3).

Besides systemic corticosteroids, before JAKINIB, conventional (n= 16; 94.1%) and biological immunosuppressive drugs (n=13; 76.5%) were required. The JAKINIB most widely used was tofacitinib (n= 10; 58.8%) followed by baricitinib (n=7; 41.2%). In only one patient with Blau Syndrome and uveitis, tofacitinib was switched to baricitinib due to severe lymphopenia.

After starting JAKINIB treatment, all patients presented clinical improvement, complete (n=15, 88.2%) or partial (n= 2; 11.8%).

Based on these data a therapeutical approach of refractory IOP was proposed (Figure 1).

Figure 1.

Therapeutical approach

Conclusion

JAKINIB may be an effective and safe therapy in IOP refractory to conventional or even biological immunosuppressive therapy.

References

[1]Meadow PB. Case Rep Rheumatol. 2014.

[2]Bauermann P. Ocul Immunol Inflamm. 2019.

[3]Paley MA. Am J Ophthalmol Case Reports. 2019.

[4]Liu J. Ann Rheum Dis. 2020.

[5]D Majumder. Indian J Ophthalmol. 2020.

[6]Miserocchi E. Clin Rheumatol. 2020.

[7]Pyare E. Indian J Ophtalmol, 2020.

Disclosure of Interests

None declared

AB1341 ASSESSMENT OF COMMON FEMORAL VEIN INTIMA-MEDIA THICKNESS BY ULTRASOUND IN BEHÇET’S DISEASE: COMPARATIVE STUDY OF PATIENTS WITH OR WITHOUT VASCULAR INVOLVEMENT IN A NATIONAL REFERRAL CENTER

Background

Vascular manifestations are frequent in Behçet’s disease (BD). However, they have been less studied than other manifestations, such as uveitis [1]. Increased venous wall thickness assessed with ultrasound (US) has been reported in BD [2]. However, it remains unclear if US findings correlate with vascular involvement in BD.

Objectives

To assess vascular Doppler US findings in patients with BD with and without clinical vascular manifestations.

Methods

Observational study of unselected consecutive patients with BD assessed in a national referral center, from March 2021 to May 2021. All patients fulfilled the 2014 ICBD criteria [3]. They were evaluated sequentially with a scheduled clinic visit after signing an informed consent. Demographic and clinical variables were collected. Patients were considered to have vascular involvement if they had history of deep vein thrombosis, pulmonary thromboembolism, superficial thrombophlebitis, arterial thrombosis (peripheral arterial thrombosis, stroke, transient ischemic attack), aneurysms, acute myocardial infarction or Raynaud’s disease. Wall thickness of bilateral common femoral vein was measured by assessing the intima-media thickness (IMT) with a high-resolution Doppler US [2]. Statistical analysis was performed with SPSS. Student´s t test or Mann-Whitney U test was used to compare continuous variables, and Chi-squared test or Fisher´s exact test for categorical variables, as appropriate.

Results

We evaluated 17 BD patients with vascular manifestations and 25 BD patients without vascular manifestations. Main clinical and demographic characteristic are described in Table 1. The vascular manifestations were deep vein thrombosis (n=4), superficial thrombophlebitis (n=1), arterial aneurysms (n=2), acute myocardial infarction (n=3), arterial thrombosis (n=1) and Raynaud’s disease (n=10). The median [IQR] value of the common femoral vein IMT was significantly higher in patients with vascular manifestations (0.65 [0.45-0.82] vs 0.49 [0.39-0.55]; p= 0.028). A significant increase in vascular manifestations was observed in patients with arterial hypertension (p=0.003). HLA B51 presence was more frequent in patients with no vascular manifestations.

Table 1.Vascular manifestations (n=17)Without vascular manifestations (n=25)P valueSex (men), n (%)10 (41.2)13 (48)0.663Age (years), mean ± SD51.24±12.845.56±12.880.133HLA B51 positive, n/tested cases4/1714/25-Evolution time (years) from diagnosis, mean ± SD13.35 ± 10.4513.04 ± 8.520.891Cardiovascular risk factorsHypertension, n (%)7 (41.2)1 (4)0.003Diabetes mellitus, n (%)1 (5.9)2 (8)0.794Dyslipidemia, n (%)6 (35.3)5 (20)0.268Smoking habit (current or former smokers), n (%)10 (58.8)12 (48)0.067Clinical manifestationsOral ulcers, n (%)16 (94.1)25 (100)0.220Genital ulcers, n (%)12 (70.6)16 (64)0.657Erythema nodosum like, n (%)9 (52.9)6 (24)0.055Pseudofolliculitis, n (%)9 (52.9)19 (76)0.120Uveitis, n (%)7 (41.2)9 (36)0.735Arthralgia, n (%)14 (82.4)17 (68)0.299Neurological manifestations, n (%)2 (11.8)2 (8)0.683Ultrasound findingsFemoral vein IMT (mm), median [IQR]0.65 [0.45-0.82]0.49 [0.39-0.55]0.028

IMT: intima-media thickness. IQR: interquartile range.

Conclusion

Patients with BD and vascular involvement present higher values of common femoral vein IMT. The assessment of venous wall thickness with Doppler US constitutes a useful technique to evaluate clinical vascular involvement in BD patients.

References

[1]Atienza-Mateo B, et al. Arthritis Rheumatol. 2019 Dec;71(12):2081-2089. doi: 10.1002/art.41026.

[2]Alibaz-Oner F, Ergelen R, Yildiz Y, Aldag M, Yazici A, Cefle A, et al. Femoral vein wall thickness measurement: A new diagnostic tool for Behçet’s disease. Rheumatology (Oxford). 2021 01 5;60(1):288-96.

[3]International Team for the Revision of the International Criteria for Behçet’s Disease (ITR-ICBD). J Eur Acad Dermatol Venereol. 2014 Mar;28(3):338-47.

Disclosure of Interests

None declared

POS1036 EFFICACY AND SAFETY OF RISANKIZUMAB (RZB) FOR ACTIVE PSORIATIC ARTHRITIS (PsA): 52-WEEK RESULTS FROM KEEPsAKE 2

Background

RZB, a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits the p19 subunit of the human cytokine interleukin-23, is being investigated as a treatment for PsA.

Objectives

Evaluate longer-term safety and efficacy of RZB in patients with active PsA who experienced inadequate response or intolerance to 1 or 2 biologic therapies and/or to at least 1 csDMARD therapy.

Methods

KEEPsAKE 2 (NCT03671148) is an ongoing, phase 3, multicenter study that includes a screening period; a 24-week double-blinded, randomized, placebo-controlled, parallel-group period (period 1); and an open-label extension period (period 2). Eligible patients were ≥18 years of age with active PsA (symptom onset ≥6 months before screening, meeting Classification Criteria for PsA [CASPAR], and ≥5 tender and ≥5 swollen joints) and had inadequate response or intolerance to 1 or 2 biologic therapies (Bio-IR) and/or ≥1 conventional synthetic disease modifying antirheumatic drug (csDMARD-IR). Patients received RZB 150 mg or placebo (PBO) at weeks 0, 4, and 16 (1:1). The primary endpoint was the proportion of patients achieving ACR20 response at week 24. Period 2 started at week 24, and patients were switched to receive open-label RZB 150 mg every 12 weeks through week 208. Efficacy and safety were analyzed in patients who received ≥1 dose of study drug through week 52. Mixed-effect model with repeated measures and nonresponder imputation methods were used to assess continuous and binary variables, respectively. Treatment-emergent adverse events (TEAEs) were summarized using exposure-adjusted event rates (EAERs, events/100 patient-years [PY]).

Results

At week 24, 51,3% of RZB-treated (N=224) and 26.5% of PBO-treated (N=219) patients achieved ACR20. At week 52, 58.5% of patients who were randomized to RZB and 55.7% of patients who were randomized to PBO and then switched to RZB at week 24 achieved ACR20. In patients with ≥3% of body surface area affected at baseline, 55.0% of RZB-treated patients (N=123) and 10.2% of PBO-treated patients (N=119) achieved PASI 90 at week 24. At week 52, 64.2% of patients randomized to RZB and 59.7% of patients who were randomized to PBO and then switched to RZB at week 24 achieved PASI 90. For other efficacy measures, similar trends were observed. RZB was well tolerated through 52 weeks of treatment, and EAERs of adverse events were stable between weeks 24 and 52. At the week 52 data cutoff (19 April 2021), the total EAER of any TEAE in patients receiving RZB was 184.2/100 PY.

Conclusion

Continuous RZB treatment resulted in maintained efficacy responses with a consistent safety profile through 52 weeks of treatment in patients with active PsA who were Bio-IR and/or csDMARD-IR.

Acknowledgements

AbbVie, Inc. participated in the study design; study research; collection, analysis, and interpretation of data. AbbVie funded the research for this study and provided writing support for this abstract. Medical writing assistance, funded by AbbVie, was provided by Jay Parekh, PharmD, of JB Ashtin.

Disclosure of Interests

Andrew Ostor Speakers bureau: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Filip van den Bosch Speakers bureau: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Kim Papp Speakers bureau: AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, Lilly, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, Consultant of: AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, Lilly, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, Grant/research support from: AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, Lilly, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, CECILIA ASNAL Speakers bureau: AbbVie, Amgen, Genentech, Janssen, Lilly, Pfizer, Roche, and R-Pharm., Consultant of: AbbVie, Amgen, Genentech, Janssen, Lilly, Pfizer, Roche, and R-Pharm., Grant/research support from: AbbVie, Amgen, Genentech, Janssen, Lilly, Pfizer, Roche, and R-Pharm., Ricardo Blanco Speakers bureau: AbbVie, Bristol Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Roche., Consultant of: AbbVie, Bristol Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Roche., Grant/research support from: AbbVie, Merck, and Roche, Jacob Aelion Grant/research support from: AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Galapagos/Gilead, Genentech, GlaxoSmithKline, Lilly, Mallinckrodt, Nektar Therapeutics, Nichi-Iko, Novartis, Pfizer, Regeneron, Roche, Sanofi, Selecta Biosciences, and UCB., Wenjing Lu Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Byron Padilla Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Alan Kivitz Shareholder of: AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB., Speakers bureau: AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB., Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Flexion, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB.

POS0537 MORTALITY IN RHEUMATOID ARTHRITIS: CHANGING CAUSES AND PREDICTIVE FACTORS. STUDY OF A COHORT FOLLOWED PROSPECTIVELY

Background

Patients with Rheumatoid Arthritis (RA) present an increased risk of mortality. In the last decades, mortality rates tended to decrease but cardiovascular (CV) events remained as the leading cause of death in most series (1).

Objectives

To assess mortality rates and leading causes of death, as well as predictors of mortality related to disease activity in a prospectively followed-up cohort of RA patients.

Methods

We conducted a prospective longitudinal study that included 673 RA patients from a single tertiary center. Univariate and multivariate Cox proportional hazards regression were used to identify predictors of mortality.

Results

We studied 673 patients with RA (75% women), mean age 61±13 years. The main general characteristics, CV risk factors, RA disease activity data and current treatment are summarized in the Table 1.

Table 1.

Baseline characteristics of 673 RA patients

Age, years, (mean±sd)61 ± 13Female/Male, n (%)505 (75) /168 (25)Past or Current smoker, n (%)338 (50)Obesity, n (%)226 (34)Hypertension, n (%)310 (46)Diabetes Mellitus, n (%)85 (13)Dyslipidemia, n (%)310 (46)BMI, kg/m2 (mean±sd)28 ± 6Abdominal circumference, cm (mean±sd)97 ± 15Total/HDL/LDL cholesterol, mg/dl (mean±sd)204±38/62±18/120 ± 31Disease duration, years (median, [IQR])13 [10-20]CRP, mg/l (median, [IQR])3.0 [0.8-7.0]ESR, mm/ 1º hour (median, [IQR])12 [5-21]Rheumatoid factor/ ACPA, n (%)376 (56) / 314 (48)DAS28-ESR/ DAS28-PCR (mean±sd)3.18 ± 1.41/3.00 ± 1.23NSAIDs / Prednisone, n (%)265 (39) /341 (51)Prednisone dose, mg/day (median, [IQR])5 (2.5-5)c-DMARDS: Metotrexate/ Leflunomide/ Hydroxychloroquine/ Salazopyrin, n (%)406 (60) /52 (8) / 178 (26) / 10 (1)b-DMARDS: TNFi/ Tocilizumab/ Rituximab/ Abatacept, n (%)88 (13) / 43 (6) / 13 (2) / 8 (1)JAK inhibitors, n (%)12 (2)

After a follow-up of 4,367 person-years (mean 6.4±1.4), 67 deaths were recorded. Considering all causes of mortality, the cumulative incidence was 14% (95% CI 11-18) with a mortality incidence rate of 0.015 (95% CI 0.012-0.020) patient/year. The main causes of mortality in decreasing order of frequency were infections (N=23) (34%), incidence rate-IR: 0.005 [95% CI 0.003-0.008]), cancer (N=18) (27%), IR: 0.004 [95% CI 0.002-0.007]), CV events (N= 12) (18%), IR: 0.003 [95% CI 0.001-0.005]), respiratory diseases (N=2) (3%), IR: 0.0005 [95% CI 0.00007-0.002] and other causes (N=12) (18%), IR: 0.003 [95% CI 0.001-0.005I].

The statistically significant predictive factors of mortality in the univariate analysis were male gender (HR 1.97[95%CI 1.20-3.21, p=0.007), abdominal circumference (HR 1.03 [95% CI 1.01-1.05], p=0,0006), diabetes (HR 2.85 [95%CI 1.68-4.86], p<0.001) and hypertension (HR 2.92 [95%CI 1.73-4.94], p<0.001). Also, baseline data of variables associated with disease activity such as increased CRP, ESR, DAS28-CRP, DAS28-ESR were predictors of mortality (Figure 1). Disease related parameters were adjusted by CV risk factors in a multivariate analysis. Following this procedure, the predictive factors that reached statistical significance; (Hazard Ratio [95%CI]), were an increased in DAS28-VSG (1.40 [1.07-1.83], p=0.016), DAS- 28-PCR (1.40 [1.07-1.83], p=0.016), CRP (1.02 [1.01-1.05] p=0.002), and ESR (1.03 [1.01- 1.05], p=<0.001) (Figure 1).

Figure 1.

Forest Plot of mortality (Univariate and multivariate analysis).

Results expressed in logarithmic scale. Multivariate analysis: Disease activity related parameters adjusted by age, gender, disease duration, smoker, diabetes, hypertension and abdominal circumference. CDAI, ESR and CPR expressed value/10. (*) p<0.05.

Conclusion

In a cohort of patients with RA followed prospectively in a tertiary hospital, infections and malignancies are the main cause of mortality rather than CV events. Disease activity parameters are associated with an increased risk of mortality in these patients with RA.

References

[1]Avina-Zubieta JA et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008,59:1690–97.

Disclosure of Interests

None declared.

POS0804 TOCILIZUMAB IN LARGE-VESSEL GIANT CELL ARTERITIS AND TAKAYASU ARTERITIS: MULTICENTRIC OBSERVATIONAL COMPARATIVE STUDY

Background

Tocilizumab (TCZ) has shown to be effective for large vessel vasculitis including giant cell arteritis (GCA) and Takayasu arteritis (TAK) (1-5). However, LVV-GCA and TAK show different demographic and clinical features that may influence on TCZ therapeutic response.

Objectives

To compare the effectiveness of TCZ in patients with LVV-GCA and patients with TAK.

Methods

Observational multicenter study of patients with LVV-GCA and TAK who received TCZ. Outcome variables were: a) proportion of patients who achieved complete clinical improvement along with normalization of laboratory markers (CRP ≤0.5mg/dL and/or ESR ≤ 20 mm/1st hour) at 12 months b) complete improvement in imaging techniques. A comparative study between patients with LVV-GCA and TAK was performed.

Results

We evaluated 70 LVV-GCA and 57 TAK patients who received TCZ. Main clinical and demographic characteristic are described in Table 1. Patients with TAK were younger, had longer disease duration, had received more commonly previous biologic therapy and were receiving higher doses of prednisone at baseline. TCZ intravenous administration was more common in TAK patients (80.7% vs 48.6%; p<0.01). Follow-up time after TCZ onset was similar in both groups. At 12 months, about 75% of patients achieved complete clinical improvement and ESR/CRP normalization in both groups. A follow-up imaging technique was performed in 37 LVV-GCA patients after a mean time of 12.9±6.0 months and 38 TAK patients after 9.5±5.0 months. Complete improvement in imaging techniques was only observed in 18.9% and 21.1% of patients with LVV-GCA and TAK, respectively (Figure 1).

Table 1.LVV-GCA (n=70)TAK (n=57)pGeneral featuresAge (years), mean ± SD67.2 ± 10.540.5 ± 16.3< 0.01Sex (female), n (%)51 (72.9)49 (86)0.07Disease evolution before TCZ onset (months), median [IQR]5 [2-15]12 [3-37]<0.01Baseline laboratory parametersESR (mm/1st hour), median [IQR]32 [12.5-54.7]31 [10-52]0.82CRP (mg/dL), median [IQR]1.4 [0.5-2.4]1.4 [0.5-3.5]0.41Baseline prednisone dose (mg/day), median [IQR]15 [10-20]30 [15-50]< 0.01Previous therapyConventional DMARDs, n(%)45 (64.3)44(77.2)0.51Biologic therapy, n (%)0(0)12 (21.1)<0.01TCZ therapyIntravenous, n (%)34 (48.6)46 (80.7)< 0.01Combined with MTX, n(%)24 (34.3)24 (42.1)0.37Follow-up time after TCZ onset, median [IQR]20 [10-36]18 [7-41]0.73Complete clinical improvement and ESR/CRP normalization at 12 months, n/N (%)35/47 (74.4)30/39 (76.9)0.79Complete improvement in imaging techniques, n/N(%)7/37 (18.9)8/38 (21.1)0.85

CRP: C-reactive protein; DMARDs: Disease-modifying anti-rheumatic drugs ESR: erythrocyte sedimentation rate; GCA: giant cell arteritis; IQR: interquartile range; LVV: large vessel; MTX: methotrexate; n: Number of patients; N: total number of patients: TCZ: tocilizumab; TAK:takayasu

Figure 1.

Conclusion

The effectiveness of TCZ was similar in patients with LVV-GCA and TAK, despite a more refractory disease in TAK patients. A discordance between clinical and imaging activity improvement was observed in both LVV-GCA and TAK, as reported in previous studies (3).

References

[1]Calderón-Goercke M, et al. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003

[2]Prieto-Peña D et al. Ther Adv Musculoskelet Dis. 2021;13:175. PMID: 34211589.

[3]Prieto Peña D et al. Clin Exp Rheumatol. 2021;39 Suppl 129:69-75. PMID: 33253103.

[4]González-Gay MA, et al. Expert Opin Biol Ther. 2019;19:65-72. doi: 10.1080/14712598.2019.1556256.

[5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019;48(4):720-727. doi: 10.1016/j.semarthrit.2018.05.007

Disclosure of Interests

None declared

AB1311 INCREASED RISK OF HEPATOTOXICITY WITH DMARDS IN PATIENTS WITH PREVIOUS LIVER TOXICITY WITH ISONIAZID. STUDY IN A SINGLE UNIVERSITY HOSPITAL

Background

Isoniazid (INH) is used to treat latent tuberculosis infection (LTBI), and hepatotoxicity is one of the most frequent adverse effect. Several Disease-modifying drugs (DMARDs) can also cause hepatotoxicity. Many patients with rheumatic immune mediated diseases (R-IMID) receive INH prior to DMARDs for prophylaxis of LTBI. This risk of hepatotoxicity with DMARDs after hepatotoxicity with INH is unknown.

Objectives

To assess the risk of hepatotoxicity with DMARDs in patients who have presented hepatotoxicity with INH.

Methods

Study of all consecutive R-IMID patients evaluated in the last five years (2016-2020) in a University Hospital, who presented hepatotoxicity after INH and later received DMARDs. We study if they also presented hepatotoxicity with DMARDs.

Hepatotoxicity was defined as an elevation of liver enzymes (ALT and/or AST) upper the high limit after the introduction of the treatment.

Results

INH was used in 232 of 7218 patients with R-IMID. We finally included 64 patients (45 women; 70.3%; mean age 53.4±10.5 years), who had hepatotoxicity due to INH (Table 1).

Table 1.

Main characteristics of 64 patients with rheumatic immune-mediated diseases (R-IMID) that presented hepatotoxicity after receiving isoniazid (INH).

VariablesPatients (n=64)Age (years), mean ±SD53.4±10.5Sex (women), n (%)45 (70.3)R-IMID- SpA / PsA36 (56.3%)- RA21 (32.8%)- SSc3 (4.7%)- Conectivopathies3 (4.7%)- Other2 (3.2%)Liver enzyme elevation over baseline (INH)*- x264 (100)- x322 (34.4)- x4 or higher13 (20.3)csDMARDs- MTX34 (53.1%)- HCQ15 (23.4)- LFN13 (20.3)- SSZ10 (15.6)bDMARDs47 (73.4%)Targeted synthetic DMARDs (Jakinib)8 (12.5)

ABA: Abatacept; AZA: Azathioprine, HCQ: Hydroxychloroquine; INH: Isoniazid; LFN: Leflunomide; MMF: Mycophenolate mofetil, MTX: Methotrexate; PsA: Psoriatic arthritis, RA: Rheumatoid arthritis, RTX: Rituximab; SpA: Axial spondyloarthritis; SSc: Systemic sclerosis; TCZ: Tocilizumab; TNFi: TNF inhibitors

* Patients with higher liver enzyme elevation are included in the previous groups.

The most frequent R-IMIDs were rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis. Methotrexate (MTX) (n=34, 53.1%) and TNF inhibitors (n=27, 42.2%) were the conventional and biologic-DMARD more frequently used, respectively.

Hepatotoxicity was higher with MTX (14 of 34, 41.2%), and lower with the other DMARDs (Figure 1). Hepatotoxicity was not observed with hydroxychloroquine, azathioprine, mycophenolate mofetil, secukinumab, abatacept or rituximab.

Figure 1.

Hepatotoxicity with different DMARDs in 64 patients with previous hepatotoxicity with INH

* Patients with higher liver enzyme elevation are included in the previous groups.

Conclusion

In patients with previous hepatotoxicity with INH, we observed an increased risk with different DMARDs, especially with MTX.

Disclosure of Interests

David Martínez-López: None declared, Joy Osorio-Chavez: None declared, Virginia Portilla: None declared, Carmen Álvarez-Reguera: None declared, Alba Herrero-Morant: None declared, Lara Sanchez-Bilbao: None declared, Iñigo Gonzalez-Mazon: None declared, Miguel A González-Gay Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Pfizer, Roche, and MSD, Grant/research support from: Dr. Miguel A. Gonzalez-Gay received grants/research supports from Abbvie, MSD, and Roche, Ricardo Blanco Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, and MSD., Grant/research support from: Dr. Ricardo Blanco received grants/research supports from Abbvie, MSD, and Roche

POS0623 SUBCLINICAL ATHEROSCLEROSIS IS NOT RELATED WITH ACID URIC IN RHEUMATOID ARTHRITIS. STUDY OF 1005 PATIENTS OF A SINGLE UNIVERSITY HOSPITAL

Background

Rheumatoid Arthritis (RA) and Gout are associated with an increase of cardiovascular (CV) disease (1,2). Carotid plaques and increased carotid intima-media thickness (cIMT) are surrogate markers of CV mortality (3). The association of serum uric acid (SUA) levels as an independent factor of subclinical Atherosclerosis and mortality in RA remains not fully clarified (4,5).

Objectives

In a wide cohort of patients with RA our aims were to assess the relationship of SUA with a) CV risk factors and b) presence of atherosclerosis.

Methods

Cross-sectional study including 1005 patients with RA from a Single University Center. The presence of Atherosclerosis (c-IMT and carotid plaque) was explored by Carotid Ultrasonography. The relationship between SUA and markers of subclinical atherosclerosis was studied through linear regression and logistic multivariate analysis.

Results

We studied 1005 RA patients (741 women, 74%), mean age 61±13. The main general features, CV risks factors, RA activity data and current therapy are summarized in Table 1.

Table 1.

Main features of 1005 RA patients

GENERAL FEATURESRESULTSGENERAL FEATURES (CONTINUATION)RESULTS (CONTINUATION) Age, years, mean±SD60±13RA features Female/ Male, n (%)741 (74) / 264 (26)RA duration, years; mean±SD17±12CRP, mg/L, median, [IQR]3.0 [0.9-7.5]CV risk factorsESR, mm/ 1st hour; median, [IQR]14 [6-24] Past or Current smoker, n (%)539 (54)Rheumatoid factor, n (%)528 (53) Obesity/ Dyslipidemia, n (%)307 (31)/ 560 (56)ACPA, n (%)492 (50) Hypertension, n (%)453 (45)DAS28-ESR; mean±SD3.3 ± 1.5 Diabetes Mellitus, n (%)127 (13)DAS28-CRP; mean±SD3.1 ± 1.3 BMI, kg/m2, mean±SD28±5/93±15Uric acid Abdominal circumference cm;  mean±SDUric acid level (mg/dl); mean±SD4.8 ± 1.4 Previous CV Events, n (%)125 (12) Chronic Kidney Disease,  n (%)58 (6)Carotid Ultrasonography Gout / using drugs for  hyperuricemia; n (%)20 (2)cIMT microns; mean±SD708 ± 157 Total cholesterol, mg/dl;  mean±SD201±39Carotid plaque¸ n (%)617 (62) HDL cholesterol, mg/dl;  mean±SD61±17 LDL cholesterol, mg/dl;  mean±SD119 ± 32

Abbreviations: ACPA: Anti–citrullinated protein antibody; BMI: Body mass index; CV: Cardiovascular; cIMT: carotid intima-media thickness; cm: centimeter; CRP: C Reactive protein; DAS28-ESR: Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate; DAS28-PCR: Disease Activity Score-28 for Rheumatoid Arthritis with C reactive protein; dl: deciliter; ESR: Erythrocyte Sedimentation Rate; HDL: high-density lipoprotein; IQR: Interquartile range; Kg: kilogram; LDL: Low-density lipoprotein; mg: milligram; m2: square meter; n: number; RA: Rheumatoid Arthritis; SD: Standard Deviation.

SUA as a dependent variable was significantly correlated with age, male gender and most of CV risk factors (body mass index, abdominal circumference and obesity) (single-variable analysis). Similarly, a significative beta coef. [95%CI] positive relationship with SUA was observed with hypertension (0.7 [0.5-0.8], p<0.001), diabetes (0.5 [0.2-0.7], p<0.001), dyslipidemia (0.2 [0.04-0.4], p=0.016), renal chronic insufficiency (1.5 [95CI 1.1-0.8], p<0.001) and previous CV events (0.8 [0.4-1.2], p<0.001).

Subclinical Atherosclerosis, as dependent variable, was significantly correlated with SUA (single-variable analysis). In addition, SUA showed a positive significative beta coef. [95%CI] relationship with cIMT (18 [12-25], p<0.001) and the presence of carotid plaques (1.29 [17-1.42], p<0.001). However, statistical significance was not observed in the multivariable analysis adjusted by Classic CV Risk Factors.

Conclusion

In RA, SUA is related with most of CV risk factors. However, SUA is not associated with Subclinical Atherosclerosis.

References

[1]Aviña-Zubieta JA, et al. Arthritis Rheum. 2008,15;59:1690-7.

[2]Klein R, et al. Arch Intern Med 1973, 132:401–410.

[3]de Groot E, et al. Circulation, 2004,109:33–38.

[4]Lauren Shahin, et al Cureus 2021. 5; 13.:e14855.

[5]Chiou A, et al. Arthritis Care Res (Hoboken). 2020, 72:950-958.

Disclosure of Interests

None declared

POS0327 IRISIN: A NEW MARKER OF SUBCLINICAL ATHEROSCLEROSIS, CARDIOVASCULAR RISK AND DISEASE ACTIVITY IN AXIAL SPONDYLOARTHRITIS?

Background

Axial spondyloarthritis (axSpA) is an inflammatory disease with detrimental effects on the health status of the individuals affected by this condition [1]. axSpA patients also exhibit high cardiovascular (CV) risk, mainly due to accelerated atherosclerosis [2]. Interestingly, the adipomyokine irisin was described to play a beneficial role in several physiological and pathophysiological processes such as inflammation, angiogenesis, oxidative stress, as well as lipid and bone metabolism [3]. However, studies on the role of irisin in CV risk in the setting of axSpA or in the pathogenesis of axSpA are limited [4].

Objectives

In this study we evaluated the role of irisin as a genetic and serological biomarker of subclinical atherosclerosis and CV risk in a large cohort of patients with axSpA. We also assessed its role as a marker of axSpA susceptibility and severity.

Methods

725 patients who fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axSpA were included in this study [5]. In these patients, the presence of subclinical atherosclerosis (plaques and/or abnormal carotid intima-media thickness values) was assessed by carotid ultrasound. Four irisin polymorphisms (rs16835198 G/T, rs3480 A/G, rs726344 G/A and rs1570569 G/T) were genotyped by TaqMan probes in all the patients and in 656 age, sex and ethnically-matched healthy controls. Additionally, serum irisin levels were determined by ELISA in all the patients. All analyses were performed using STATA v.11.1 statistical software, adjusting for potential confounding factors. The strength of associations is indicated as odds ratios (OR) [95% confidence intervals].

Results

Low levels of serum irisin were linked to the presence of plaques (p=0.002) and with atherogenic index values indicative of an adverse lipid profile (p=0.01). Serum irisin levels also negatively correlated with visual analogue scale (VAS) patient, VAS physician and Bath Ankylosing Spondylitis Metrology Index (BASMI) values (p<0.05). Moreover, the presence of sacroiliitis was related to lower serum irisin levels (p<0.001). Furthermore, the minor alleles of rs3480 (G) and rs1570569 (T) were associated with higher values of Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA patients (p≤0.01 in both cases). In this line, the frequency of the minor allele of rs1570569 (T) was higher in patients with ASDAS values >2.1 (indicative of high disease activity) (OR: 1.46 [1.08-1.97], p=0.01), while the minor allele of rs16835198 (T) was less frequent in this group of patients (OR: 0.73 [0.57-0.92], p=0.01).

Conclusion

Low serum irisin levels could be indicators of the presence of subclinical atherosclerosis, high CV risk and more severe disease in axSpA patients. In addition, irisin may also constitute a genetic biomarker of disease activity in axSpA.

References

[1]Packham J. Rheumatology (Oxford). 2018;57(6):vi29-vi34.

[2]Szabo SM, et al. Arthritis Rheum. 2011;63(11):3294–304.

[3]Korta P, et al. Medicina (Kaunas). 2019;55(8):485.

[4]Nam B, et al. Ann Rheum Dis. 2020;79:1358.

[5]Sieper J, et al. Ann Rheum Dis. 2009;68(2):ii1–44.

Acknowledgements

This work was partially supported by grants from Instituto de Investigación Sanitaria IDIVAL (NVAL17/10), from the `Asociación Cántabra de Reumatología’ awarded to FG. FG and JR-G are beneficiaries of a grant funded by `Instituto de Salud Carlos III´ (ISCIII) (PI20/00059). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from ISCIII, co-funded by the European Regional Development Fund. VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01). RL-M is a recipient of a Miguel Servet type I programme fellowship from ISCIII, co-funded by the European Social Fund, `Investing in your future´ (grant CP16/00033).

Disclosure of Interests

Sara Remuzgo-Martínez: None declared, Javier Rueda-Gotor: None declared, Verónica Pulito-Cueto: None declared, Raquel López-Mejías: None declared, Alfonso Corrales: None declared, Leticia Lera-Gómez: None declared, Raquel Pérez-Fernández: None declared, Virginia Portilla: None declared, Iñigo Gonzalez-Mazon: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Rosa Expósito: None declared, Cristina Mata: None declared, Javier Llorca: None declared, Vanessa Hernández-Hernández: None declared, Carlos Rodríguez-Lozano: None declared, Nuria Barbarroja Puerto: None declared, Rafaela Ortega Castro: None declared, Esther F. Vicente-Rabaneda: None declared, Cristina Fernández-Carballido: None declared, Maria Paz Martínez-Vidal: None declared, David Castro-Corredor: None declared, Joaquín Anino-Fernández: None declared, Diana Peiteado: None declared, Chamaida Plasencia: None declared, E Galindez: None declared, María L. García Vivar: None declared, Nuria Vegas-Revenga: None declared, Irati Urionaguena: None declared, Oreste Gualillo: None declared, Juan Carlos Quevedo-Abeledo: None declared, Santos Castañeda: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche, Fernanda Genre: None declared

AB1314 JANUS KINASE INHIBITORS IN REFRACTORY AUTOINFLAMMATORY SYNDROMES. TWO CASE REPORTS AND LITERATURE REVIEW

Background

Autoinflammatory syndromes are characterized by dysregulation of innate immunity and recurrent episodes of fever, cutaneous and other. Janus Kinase inhibitors (JAKINIB) may inhibit innate and acquired immunity. They have been approved in several immune mediated diseases, but not in autoinflammatory syndromes.

Objectives

To assess the efficacy and safety of JAKINIB in refractory autoinflammatory syndromes.

Methods

Study of patients from a single University Hospital and Literature review of refractory autoinflammatory syndromes treated with JAKINIB.

Results

We have identified 2 cases in our hospital. One of them was a 25-year-old girl diagnosed with Blau syndrome refractory to different conventional and biological therapies. Tofacitinib (TOFA) had a good clinical response but was switched to Bariticitinib (BARI) due to severe lymphopenia. The 2nd patient was a 65-year-old man, diagnosed with an autoinflammatory syndrome (WDR1 mutation) and policytemia vera (positive JAK-2; V617F mutation). Based on the JAK2 mutation, BARI was started with complete improvement. In literature review, we found 59 patients (41 women/ 18 men), mean age 38.1±13 years. TOFA (n=23) was the most used JAKINIB, followed by BARI (n=20) and Ruxolitinib (RUXO) (n=16). After starting JAKINIB treatment, most patients presented clinical complete (n=45, 76.3%) or partial (n=11; 18.6%) improvement, only 3 (5.1%) did not respond. (Table 1)

Table 1.

Case reports and literature review of patients with refractory autoinflammatory syndromes treated with Janus Kinase Inhibitors.

Study, yearCases, nAge/SexUnderlying DiseaseJAKINIBPrevious immunosuppressive treatmentClinical Evolution(Ref)García-Robledo et al, 2022 (1)116, FFMFTOFAMTX, TCZ, CANAC.I.Gök K et al, 2017 (2)127, FFMFTOFAMTXC.I.Forbes et al, 2018 (3)1712.4±7.5*, F=9STAT1 and TAT3 GOFRUXO (n=16)TOFA (n=1)AZA(n=1), iv immunoglobulins (n=3), CsA (n=2), RTX (n=2) ECU (n=1), ANA (n=1), MTX (n=2), CYC (n=2), MMF (n=1)C.I. (n=14)N.R. (n=3)Landhari et al, 2020 (4)143, FAOSDBARIMTX, SSZ, ANA, IFX, TCZ, ABAC.I.Sánchez et al, 2018 (5)1812.5 (1.2-24.1) ** (F=12)CANDLE n=10BARIImmunomodulators (n=17)C.I. (n=16)CANDLE-related n=4SAVI n=4Biologics (n=13)P.I. (n=2)Karadeniz et al, 2020 (6)41. 28, MFMFTOFA1. AZA, MTX, ANA, CANA, IFX, TCZ1. C.I.2. 58, F2. SSZ, MTX, LEF, ANA, ADA, TCZ2. C.I.3. 64, F3. SSZ, MTX, LEF, HCQ, CsA, ADA, ABA, ANA3. P.I.4. 43, F4. SSZ, ADA, ETA, ANA4. C.I.Hu et al, 2020 (7)1434,8±14*AOSDTOFAMTX (n= 8), HCQ (n=5), CsA (n=5), TCZ (n=2), ANA (n=1)C.I. (n=7)F=12P.I. (n=7)Honda et al, 2020 (8)168, FAOSDTOFATCZ, Tacrolimus, CYCP.I.Present study, 202221.25, F1. Blau Syndrome1.TOFA/BARI1. MTX, ETN, ANA, ABA1. C.I.2. 64, M2. Autoinflammatory syndrome (WDR1 mutation)2.BARI2. ANA2. C.I.

*Mean±Standard deviation, **Median (range)

Abbreviations: ABA: abatacept, ADA: adalimumab, ANA: anakinra, AOSD: adult onset Still disease, AZA: azathioprine, BARI: baricitinib, CANA: canakinumab, CANDLE: Cronichle atypical neutrophilic dermatosis with lypodistrophy and elevated temperature, C.I.: Complete improvement, CsA: cyclosporine A, ECU: eculizumamb, ETN: etanercept, FMF: familial mediterranean fever, HCQ: hydroxychloroquine, IFX: infliximab, LEF: leflunomide, MMF: mycophenolate mofetil, MTX: methotrexate, N.R: no response, P.I.: partial improvement, RUXO: ruxolitinib, SAVI: STING-associated vasculopathy with onset in infancy, SSZ: sulfasalazine, STAT1 and STAT3 GOF: STAT1 and STAT 3 gain of function, TCZ: tocilizumab, TOFA: tofacitinib.

Conclusion

JAKINIB may be an effective therapy in autoinflammatory syndromes refractory to conventional and/or biologic therapy.

References

[1]García-Robledo. Rheumatology. 2019; 58:553-554.

[2]Gök. Acta Reumatol Port. 2017; 42:88-90.

[3]Forbes. J Allergy Clin Immunol. 2018; 142:1665-1669.

[4]Landhari. Rheumatology. 2019; 58:736–737.

[5]Sánchez. J Clin Invest. 2018; 128:3041-3052.

[6]Karadeniz. Rheumatology. 2020; 40: 169-173.

[7]Hu. Ann Rheum Dis. 2020; 79: 842-844.

[8]Honda. Scand J Rheumatol. 2020; 49:336-338

Disclosure of Interests

Carmen Álvarez-Reguera: None declared, Diana Prieto-Peña: None declared, Lara Sanchez-Bilbao: None declared, Alba Herrero-Morant: None declared, David Martínez-López: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi and MSD., Grant/research support from: Abbvie, MSD, Janssen and Roche., Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen Lilly and MSD., Grant/research support from: Abbvie, MSD and Roche.

AB1147 COVID 19 INFECTION IN PATIENTS WITH RHEUMATIC IMMUNE-MEDIATED DISEASES IN A SINGLE UNIVERSITY HOSPITAL. MATCHED CASE-CONTROL STUDY

Background

COVID19 may present different degrees of severity. It is generally thought that viral infections in patients with rheumatic inflammatory diseases (R-IMID) or receiving immunosuppressive treatment tend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce.

Objectives

To assess the predisposing factors, clinical-analytical features and severity of COVID-19 infection in R-IMID compare to patients without R-IMID.

Methods

Case-control study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to March 31st, 2021.

A total of 274 controls were selected for each case, and matched by sex, age (± 5 years), and without previous diagnosis of R-IMID or use of immunosuppresive therapy.

Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2.

COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical.

Results

We included 274 patients (185 women/89 men), mean age 59.1 18 years.

More frequent R-IMID were: Rheumatoid arthritis (RA) (n=87, 31.8%), Axial spondyloarthritis/ Psoriatic arthritis (SpA/PsA) (n=90, 32.8%), Polymyalgia Rheumatica (PMR) (n=22, 8%) and Systemic Lupus Erythematosus (SLE) (n=22, 8%)

We also included 274 age and matched controls. Main characteristics of patients with R-IMID and controls are shown in Table 1.

Table 1.

Main clinical and analytical features of patients with R-IMID and matched controls

R-IMID patients (n=274)Controls (n=274)PAge59.1±1858.8±17.30.842Sex F/M, n, (%)185/89 (67.5/32.5)185/89 (67.5/32.5)1Comorbidities (n,%)Hypertension119 (43.4)84 (30.7)0.0026*Dyslipidemia119 (43.4)79 (28.8)0.0005*Diabetes mellitus36 (13.1)37 (13.5)1Pulmonary disease29 (10.6)32 (11.7)0.79Cardiovascular disease45 (16.4)33 (12)0.18Severity of the disease (n, %)Mild209 (76.3)204 (74.5)0.69Moderate35 (12.8)47 (17.2)0.19Severe9 (3.3)14 (5.1)0.39Critical21 (7.7)9 (3.3)0.04*Deaths17 (6.2)7 (2.6)0.0076*Analytical values, median [25-75th IQR]CRP4.7 [2-9.3]3.9 [1-7.3]0.176Lymphocytes (x103 /µL)1 [0.6-1.5]1.1 [0.8-2.5]0.711Platelets (x103 /µL)179 [141-237]174 [155-211]0.722D-Dimer (ng/mL)999 [342-1417]548 [336-997]0.032*

CRP: C-reactive protein.

Concerning comorbidities, hypertension and dyslipidemia were more frequent in patients with R-IMID (p< 0.05).

COVID-19 symptoms’ distribution is shown in Figure 1.

Figure 1.

Symptoms in R-IMID patients and matched controls

*: p < 0.05

Cough and dyspnoea were more frequent and headache, odynophagia and diarrhea were less frequent in the R-IMID group.

The only analytical difference was D-Dimer that was significantly higher in patients with R-IMID.

Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID (p <0.05).

Conclusion

Most of the patients present a mild COVID-19. However, a more severe syndrome was observed in R-IMID

References

[1]COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed [insert date].

Disclosure of Interests

David Martínez-López: None declared, Diana Prieto-Peña: None declared, Fabricio Benavides-Villanueva: None declared, Lara Sanchez-Bilbao: None declared, Cristina Corrales-Selaya: None declared, Alba Herrero-Morant: None declared, Carmen Álvarez-Reguera: None declared, Martin Trigueros-Vazquez: None declared, Reinhard Wallman: None declared, Miguel A González-Gay Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Pfizer, Roche, and MSD., Grant/research support from: Dr. Miguel A. Gonzalez-Gay received grants/research supports from Abbvie, MSD, and Roche., Ricardo Blanco Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, and MSD., Grant/research support from: Dr. Ricardo Blanco received grants/research supports from Abbvie, MSD, and Roche