Translational insights and overall survival in the U31402-A-U102 study of patritumab deruxtecan (HER3-DXd) in EGFR-mutated NSCLC

BACKGROUND

Human epidermal growth factor receptor 3 (HER3) is broadly expressed in non-small-cell lung cancer (NSCLC) and is the target of patritumab deruxtecan (HER3-DXd), an antibody-drug conjugate consisting of a HER3 antibody attached to a topoisomerase I inhibitor payload via a tetrapeptide-based cleavable linker. U31402-A-U102 is an ongoing phase I study of HER3-DXd in patients with advanced NSCLC. Patients with epidermal growth factor receptor (EGFR)-mutated NSCLC that progressed after EGFR tyrosine kinase inhibitor (TKI) and platinum-based chemotherapy (PBC) who received HER3-DXd 5.6 mg/kg intravenously once every 3 weeks had a confirmed objective response rate (cORR) of 39%. We present median overall survival (OS) with extended follow-up in a larger population of patients with EGFR-mutated NSCLC and an exploratory analysis in those with acquired genomic alterations potentially associated with resistance to HER3-DXd.

PATIENTS AND METHODS

Safety was assessed in patients with EGFR-mutated NSCLC previously treated with EGFR TKI who received HER3-DXd 5.6 mg/kg; efficacy was assessed in those who also had prior PBC.

RESULTS

In the safety population (N = 102), median treatment duration was 5.5 (range 0.7-27.5) months. Grade ≥3 adverse events occurred in 76.5% of patients; the overall safety profile was consistent with previous reports. In 78/102 patients who had prior third-generation EGFR TKI and PBC, cORR by blinded independent central review (as per RECIST v1.1) was 41.0% [95% confidence interval (CI) 30.0% to 52.7%], median progression-free survival was 6.4 (95% CI 4.4-10.8) months, and median OS was 16.2 (95% CI 11.2-21.9) months. Patients had diverse mechanisms of EGFR TKI resistance at baseline. At tumor progression, acquired mutations in ERBB3 and TOP1 that might confer resistance to HER3-DXd were identified.

CONCLUSIONS

In patients with EGFR-mutated NSCLC after EGFR TKI and PBC, HER3-DXd treatment was associated with a clinically meaningful OS. The tumor biomarker characterization comprised the first description of potential mechanisms of resistance to HER3-DXd therapy.

Augmenting external control arms using Bayesian borrowing: a case study in first-line non-small cell lung cancer

Aim: This study aimed to improve comparative effectiveness estimates and discuss challenges encountered through the application of Bayesian borrowing (BB) methods to augment an external control arm (ECA) constructed from real-world data (RWD) using historical clinical trial data in first-line non-small-cell lung cancer (NSCLC). Materials & methods: An ECA for a randomized controlled trial (RCT) in first-line NSCLC was constructed using ConcertAI Patient360™ to assess chemotherapy with or without cetuximab, in the bevacizumab-inappropriate subpopulation. Cardinality matching was used to match patient characteristics between the treatment arm (cetuximab + chemotherapy) and ECA. Overall survival (OS) was assessed as the primary outcome using Cox proportional hazards (PH). BB was conducted using a static power prior under a Weibull PH parameterization with borrowing weights from 0.0 to 1.0 and augmentation of the ECA from a historical control trial. Results: The constructed ECA yielded a higher overall survival (OS) hazard ratio (HR) (HR = 1.53; 95% CI: 1.21-1.93) than observed in the matched population of the RCT (HR = 0.91; 95% CI: 0.73-1.13). The OS HR decreased through the incorporation of BB (HR = 1.30; 95% CI: 1.08-1.54, borrowing weight = 1.0). BB was applied to augment the RCT control arm via a historical control which improved the precision of the observed HR estimate (1.03; 95% CI: 0.86-1.22, borrowing weight = 1.0), in comparison to the matched population of the RCT alone. Conclusion: In this study, the RWD ECA was unable to successfully replicate the OS estimates from the matched population of the selected RCT. The inability to replicate could be due to unmeasured confounding and variations in time-periods, follow-up and subsequent therapy. Despite these findings, we demonstrate how BB can improve precision of comparative effectiveness estimates, potentially aid as a bias assessment tool and mitigate challenges of traditional methods when appropriate external data sources are available.

<sc>A</sc> multi-hierarchical approach reveals <sc>d</sc>-serine as a hidden substrate of sodium-coupled monocarboxylate transporters

Transporter research primarily relies on the canonical substrates of well-established transporters. This approach has limitations when studying transporters for the low-abundant micromolecules, such as micronutrients, and may not reveal physiological functions of the transporters. While d-serine, a trace enantiomer of serine in the circulation, was discovered as an emerging biomarker of kidney function, its transport mechanisms in the periphery remain unknown. Here, using a multi-hierarchical approach from body fluids to molecules, combining multi-omics, cell-free synthetic biochemistry, and ex vivo transport analyses, we have identified two types of renal d-serine transport systems. We revealed that the small amino acid transporter ASCT2 serves as a d-serine transporter previously uncharacterized in the kidney and discovered d-serine as a non-canonical substrate of the sodium-coupled monocarboxylate transporters (SMCTs). These two systems are physiologically complementary, but ASCT2 dominates the role in the pathological condition. Our findings not only shed light on renal d-serine transport, but also clarify the importance of non-canonical substrate transport. This study provides a framework for investigating multiple transport systems of various trace micromolecules under physiological conditions and in multifactorial diseases.

Network of extracellular vesicles surrounding senescent cells

Extracellular vesicles (EVs) are small lipid bilayers released from cells that contain cellular components such as proteins, nucleic acids, lipids, and metabolites. Biological information is transmitted between cells via the EV content. Cancer and senescent cells secrete more EVs than normal cells, delivering more information to the surrounding recipient cells. Cellular senescence is a state of irreversible cell cycle arrest caused by the accumulation of DNA damage. Senescent cells secrete various inflammatory proteins known as the senescence-associated secretory phenotype (SASP). Inflammatory SASP factors, including small EVs, induce chronic inflammation and lead to various age-related pathologies. Recently, senolytic drugs that selectively induce cell death in senescent cells have been developed to suppress the pathogenesis of age-related diseases. This review describes the characteristics of senescent cells, the functions of EVs released from senescent cells, and the therapeutic effects of EVs on age-related diseases. Understanding the biology of EVs secreted from senescent cells will provide valuable insights for achieving healthy longevity in an aging society.

Nanoparticles Based on Natural Lipids Reveal Extent of Impacts of Designed Physical Characteristics on Biological Functions

Nanoparticles based on lipids (LNPs) are essential in pharmaceuticals and intercellular communication, and their design parameters span a diverse range of molecules and assemblies. In bridging the gap in insight between extracellular vesicles (EVs) and synthetic LNPs, one challenge is understanding their in-cell/in-body behavior when simultaneously assessing more than one physical characteristic. Herein, we demonstrate comprehensive evaluation of LNP behavior by using LNPs based on natural lipids (N-LNPs) with designed physical characteristics: size tuned using microfluidic methods, surface fluidity designed based on EV components, and stiffness tuned using biomolecules. We produce 12 types of N-LNPs having different physical characteristics─two sizes, three membrane fluidities, and two stiffnesses for in vitro evaluation─and evaluate cellular uptake vitality and endocytic pathways of N-LNPs based on the physical characteristics of N-LNPs. To reveal the extent of the impact of the predesigned physical characteristics of N-LNPs on cellular uptakes in vivo, we also carried out animal experiments with four types of N-LNPs having different sizes and fluidities. The use of N-LNPs has helped to clarify the extent of the impact of inextricably related, designed physical characteristics on transportation and provided a bidirectional guidepost for the streamlined design and understanding of the biological functions of LNPs.

Effect of baseline urinary glucose levels on the relationship between sodium-glucose cotransporter 2 inhibitors and serum uric acid in Japanese patients with type 2 diabetes mellitus

In patients with type 2 diabetes mellitus (T2DM), controlling serum uric acid (SUA) and blood glucose levels is important. Moreover, sodium-glucose cotransporter 2 (SGLT2) inhibitors decrease SUA levels by accelerating urinary uric acid excretion. We investigated the effect of baseline urinary glucose levels on the relationship between SGLT2 inhibitors and SUA levels. We conducted a retrospective observational study using the electronic medical records of patients with T2DM of Kindai University Nara Hospital (April 2013 to March 2022). We divided the patients into two groups according to their baseline urinary glucose levels: the N-UG group, which included patients with negative urinary glucose strip test results (-), and the P-UG group, which included patients with positive urinary glucose strip test results (± or more). The changes in SUA levels before and after SGLT2 inhibitor administration were investigated. For comparison, the changes in SUA levels before and after the prescription of antidiabetic agents, excluding SGLT2 inhibitors, were also investigated. Our results revealed that SGLT2 inhibitors significantly decreased the SUA levels in patients in the N-UG group but tended to decrease its levels in those in the P-UG group. Regardless of the urinary glucose status at baseline, the administration of SGLT2 inhibitors may be useful for patients with T2DM to prevent the complications of hyperuricemia.

Oral teicoplanin administration suppresses recurrence of Clostridioides difficile infection: Proof of concept

OBJECTIVES

Teicoplanin is a potential antimicrobial candidate for Clostridioides difficile infection (CDI) treatment. However, the therapeutic potential of teicoplanin against severe CDI has not been clinically proven. In the present study, we investigated the efficacy of oral teicoplanin administration against severe CDI and the recurrence of severe CDI after teicoplanin treatment in a mouse model.

METHODS

A lethal CDI mouse model was established by colonizing the mice with C. difficile ATCC® 43255; they were orally administered teicoplanin (128 mg/kg/d) or vancomycin (160 mg/kg/d) for 10 d, 24 h after C. difficile spore challenge, and physiological and biological responses were monitored for 20 d after the initial antibiotic treatment. We also performed the in vitro time-kill assay and determined minimum inhibitory concentration (MIC), post-antibiotic effect, and toxin production with antibiotic exposure.

RESULTS

The therapeutic response (survival rates, body weight change, clinical sickness score grading, C. difficile load, and toxin titer in feces) of oral teicoplanin administration was comparable to that of oral vancomycin administration in the lethal CDI mouse model. Moreover, teicoplanin treatment suppressed the re-onset of diarrhea and re-increase in toxin titer 10 d after treatment compared with that by vancomycin treatment. In in vitro experiments, teicoplanin exhibited time-dependent antibacterial activity and possessed lower MIC and longer post-antibiotic effect than vancomycin against C. difficile. C. difficile toxin production was numerically lower with teicoplanin exposure than with vancomycin exposure.

CONCLUSIONS

The results obtained from the present basic experiments could suggest that teicoplanin is a potential antibiotic for the treatment of severe CDI with recurrence-prevention activity.

YBX1 Regulates Satellite II RNA Loading into Small Extracellular Vesicles and Promotes the Senescent Phenotype

Senescent cells secrete inflammatory proteins and small extracellular vesicles (sEVs), collectively termed senescence-associated secretory phenotype (SASP), and promote age-related diseases. Epigenetic alteration in senescent cells induces the expression of satellite II (SATII) RNA, non-coding RNA transcribed from pericentromeric repetitive sequences in the genome, leading to the expression of inflammatory SASP genes. SATII RNA is contained in sEVs and functions as an SASP factor in recipient cells. However, the molecular mechanism of SATII RNA loading into sEVs is unclear. In this study, we identified Y-box binding protein 1 (YBX1) as a carrier of SATII RNA via mass spectrometry analysis after RNA pull-down. sEVs containing SATII RNA induced cellular senescence and promoted the expression of inflammatory SASP genes in recipient cells. YBX1 knockdown significantly reduced SATII RNA levels in sEVs and inhibited the propagation of SASP in recipient cells. The analysis of the clinical dataset revealed that YBX1 expression is higher in cancer stroma than in normal stroma of breast and ovarian cancer tissues. Furthermore, high YBX1 expression was correlated with poor prognosis in breast and ovarian cancers. This study demonstrated that SATII RNA loading into sEVs is regulated via YBX1 and that YBX1 is a promising target in novel cancer therapy.

Blood levels of d-amino acids reflect the clinical course of COVID-19

d-Amino acids, rare enantiomers of amino acids, have been identified as biomarkers and therapeutic options for COVID-19. Methods for monitoring recovery are necessary for managing COVID-19. On the other hand, the presence of SARS-CoV2 virus in the blood is associated with worse outcomes. We investigated the potential of d-amino acids for assessing recovery from severe COVID-19. In patients with severe COVID-19 requiring artificial ventilation, the blood levels of d-amino acids, including d-alanine, d-proline, d-serine, and d-asparagine, which were lower than the normal range before treatment, quickly and transiently increased and surpassed the upper limit of the normal range. This increase preceded the recovery of respiratory function, as indicated by ventilation weaning. The increase in blood d-amino acid levels was associated with the disappearance of the virus in the blood, but not with inflammatory manifestations or blood cytokine levels. d-Amino acids are sensitive biomarkers that reflect the recovery of the clinical course and blood viral load. Dynamic changes in blood d-amino acid levels are key indicators of clinical course.

Imaging phonon eigenstates and elucidating the energy storage characteristics of a honeycomb-lattice phononic crystal cavity

We extend gigahertz time-domain imaging to a wideband investigation of the eigenstates of a phononic crystal cavity. Using omnidirectionally excited phonon wave vectors, we implement an ultrafast technique to experimentally probe the two-dimensional acoustic field inside and outside a hexagonal cavity in a honeycomb-lattice phononic crystal formed in a microscopic crystalline silicon slab, thereby revealing the confinement and mode volumes of phonon eigenstates-some of which are clearly hexapole in character-lying both inside and outside the phononic-crystal band gap. This allows us to obtain a quantitative measure of the spatial acoustic energy storage characteristics of a phononic crystal cavity. We also introduce a numerical approach involving toneburst excitation and the monitoring of the acoustic energy decay together with the integral of the Poynting vector to calculate the Q factor of the principal in-gap eigenmode, showing it to be limited by ultrasonic attenuation rather than by phonon leakage to the surrounding region.

Optimal therapeutic recommendation for Clostridioides difficile infection in pediatric and adolescent populations: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis to examine the efficacy profiles of metronidazole (MNZ) and vancomycin (VCM) in pediatric and adolescent patients with Clostridioides difficile infection (CDI). A systematic review and meta-analysis was conducted using four electronic databases (PubMed, Cochrane Library, Web of Science, and Clinicaltrials.gov) through July 6, 2022. We analyzed the clinical cure and recurrence rates to determine the efficacy of MNZ and VCM. The clinical cure rates in all included studies were not significantly different between MNZ and VCM (OR = 0.63; 95% CI = 0.36-1.10; I² = 0%; P = 0.10). Subgroup analyses were performed separately for each region to account for regional differences in the CDI. MNZ treatment achieved significantly lower clinical cure rates than did VCM in the United States of America (USA) and Europe (OR = 0.42, 95% CI = 0.19-0.93, I² = 0%, P = 0.03). Recurrence rates were not significantly different between MNZ and VCM (OR = 1.48, 95% CI = 0.62-3.53, I² = 28%, P = 0.38).    Conclusion: MNZ exhibited significantly lower clinical cure rates than did VCM in the US and Europe; therefore, it is not recommended for the management of CDI in pediatric and adolescent populations. What is Known: • The unavailability of robust data on recommendations of therapeutic agents for the management of Clostridioides difficile infections in children precludes effective antibiotic choice. What is New: • Metronidazole exhibited significantly lower clinical cure rates than did vancomycin in the United States of America and Europe and recurrence rate was not significantly different between metronidazole and vancomycin; therefore, it is not recommended for the management of Clostridioides difficile infection in children.

Clinical outcomes of medical treatments for progressive desmoid tumors following active surveillance: a systematic review

Approximately 80% of desmoid tumors (DTs) show spontaneous regression or disease stabilization during first-line active surveillance. Medical treatment can be considered in cases of disease progression. This systematic review aimed to evaluate the effectiveness and toxicity of each medical treatment by reviewing only the studies that included progressive disease as the inclusion criterion. We searched the EMBASE, PubMed, and CENTRAL databases to identify published studies for progressive DTs. The disease control rates of the medical treatments, such as low-dose chemotherapy with methotrexate plus vinblastine or vinorelbine, imatinib, sorafenib, pazopanib, nilotinib, anlotinib, doxorubicin-based agents, liposomal doxorubicin, hydroxyurea, and oral vinorelbine for progressive DTs were 71-100%, 78-92%, 67-96%, 84%, 88%, 86%, 89-100%, 90-100%, 75%, and 64%, respectively. Low-dose chemotherapy, sorafenib, pazopanib, nilotinib, anlotinib, and liposomal doxorubicin had similar toxicities. Sorafenib and pazopanib were less toxic than imatinib. Doxorubicin-based chemotherapy was associated with the highest toxicity. Hydroxyurea and oral vinorelbine exhibited the lowest toxicity. Stepwise therapy escalation from an initial, less toxic treatment to more toxic agents is recommended for progressive DTs. Sorafenib and pazopanib had limited on-treatment side effects but had the possibility to induce long-term treatment-related side effects. In contrast, low-dose chemotherapy has some on-treatment side effects and is known to have very low long-term toxicity. Thus, for progressive DTs following active surveillance, low-dose chemotherapy is recommended in young patients as long-term side effects are minor, whereas therapies such as sorafenib and pazopanib is recommended for older patients as early side effects are minor.

Identification of Novel Senescent Markers in Small Extracellular Vesicles

Senescent cells exhibit several typical features, including the senescence-associated secretory phenotype (SASP), promoting the secretion of various inflammatory proteins and small extracellular vesicles (EVs). SASP factors cause chronic inflammation, leading to age-related diseases. Recently, therapeutic strategies targeting senescent cells, known as senolytics, have gained attention; however, noninvasive methods to detect senescent cells in living organisms have not been established. Therefore, the goal of this study was to identify novel senescent markers using small EVs (sEVs). sEVs were isolated from young and senescent fibroblasts using three different methods, including size-exclusion chromatography, affinity column for phosphatidylserine, and immunoprecipitation using antibodies against tetraspanin proteins, followed by mass spectrometry. Principal component analysis revealed that the protein composition of sEVs released from senescent cells was significantly different from that of young cells. Importantly, we identified ATP6V0D1 and RTN4 as novel markers that are frequently upregulated in sEVs from senescent and progeria cells derived from patients with Werner syndrome. Furthermore, these two proteins were significantly enriched in sEVs from the serum of aged mice. This study supports the potential use of senescent markers from sEVs to detect the presence of senescent cells in vivo.

Cryopreservation of two species of the multicellular volvocine green algal genus Astrephomene

BACKGROUND

Astrephomene is an interesting green algal genus that, together with Volvox, shows convergent evolution of spheroidal multicellular bodies with somatic cells of the colonial or multicellular volvocine lineage. A recent whole-genome analysis of A. gubernaculifera resolved the molecular-genetic basis of such convergent evolution, and two species of Astrephomene were described. However, maintenance of culture strains of Astrephomene requires rapid inoculation of living cultures, and cryopreserved culture strains have not been established in public culture collections.

RESULTS

To establish cryopreserved culture strains of two species of Astrephomene, conditions for cryopreservation of the two species were investigated using immature and mature vegetative colonies and two cryoprotectants: N,N-dimethylformamide (DMF) and hydroxyacetone (HA). Rates of cell survival of the A. gubernaculifera or A. perforata strain after two-step cooling and freezing in liquid nitrogen were compared between different concentrations (3 and 6%) of DMF and HA and two types of colonies: immature colonies (small colonies newly released from the parent) and mature colonies (large colonies just before daughter colony formation). The highest rate of survival [11 ± 13% (0.36-33%) by the most probable number (MPN) method] of A. gubernaculifera strain NIES-4017 (established in 2014) was obtained when culture samples of immature colonies were subjected to cryogenic treatment with 6% DMF. In contrast, culture samples of mature colonies subjected to 3% HA cryogenic treatment showed the highest "MPN survival" [5.5 ± 5.9% (0.12-12%)] in A. perforata. Using the optimized cryopreservation conditions for each species, survival after freezing in liquid nitrogen was examined for six other strains of A. gubernaculifera (established from 1962 to 1981) and another A. perforata strain maintained in the Microbial Culture Collection at the National Institute for Environmental Studies (MCC-NIES). We obtained ≥0.1% MPN survival of the A. perforata strain. However, only two of the six strains of A. gubernaculifera showed ≥0.1% MPN survival. By using the optimal cryopreserved conditions obtained for each species, five cryopreserved strains of two species of Astrephomene were established and deposited in the MCC-NIES.

CONCLUSIONS

The optimal cryopreservation conditions differed between the two species of Astrephomene. Cryopreservation of long-term-maintained strains of A. gubernaculifera may be difficult; further studies of cryopreservation of these strains are needed.

Less demand on stem cell marker-positive cancer cells may characterize metastasis of colon cancer

BACKGROUND

CD44 and CD133 are stem cell markers in colorectal cancer (CRC). CD44 has distinctive isoforms with different oncological properties like total CD44 (CD44T) and variant CD44 (CD44V). Clinical significance of such markers remains elusive.

METHODS

Sixty colon cancer were examined for CD44T/CD44V and CD133 at mRNA level in a quantitative PCR, and clarified for their association with clinicopathological factors.

RESULTS

(1) Both CD44T and CD44V showed higher expression in primary colon tumors than in non-cancerous mucosas (p<0.0001), while CD133 was expressed even in non-cancerous mucosa and rather decreased in the tumors (p = 0.048). (2) CD44V expression was significantly associated with CD44T expression (R = 0.62, p<0.0001), while they were not correlated to CD133 at all in the primary tumors. (3) CD44V/CD44T expressions were significantly higher in right colon cancer than in left colon cancer (p = 0.035/p = 0.012, respectively), while CD133 expression were not (p = 0.20). (4) In primary tumors, unexpectedly, CD44V/CD44T/CD133 mRNA expressions were not correlated with aggressive phenotypes, but CD44V/CD44T rather significantly with less aggressive lymph node metastasis/distant metastasis (p = 0.040/p = 0.039, respectively). Moreover, both CD44V and CD133 expressions were significantly decreased in liver metastasis as compared to primary tumors (p = 0.0005 and p = 0.0006, respectively).

CONCLUSION

Our transcript expression analysis of cancer stem cell markers did not conclude that their expression could represent aggressive phenotypes of primary and metastatic tumors, and rather represented less demand on stem cell marker-positive cancer cells.

Preoperative state anxiety predicts postoperative health-related quality of life: A prospective observational study on patients undergoing lung cancer surgery

Objective

Improving quality of life (QOL) after surgery is very important. Recently, preoperative anxiety has been suggested to predict postoperative health-related (HR) QOL, however the accuracy of anxiety measurement remains problematic. We examined the relationship between preoperative anxiety level and postoperative HRQOL using qualitative and quantitative assessment of anxiety.

Method

We used a detailed anxiety assessment to quantitatively investigate preoperative anxiety as a predictor of postoperative HRQOL in lung cancer patients. Fifty one patients who underwent surgery for lung cancer were included. They were assessed four times: on admission, on discharge, 1 month after surgery, and 3 months after surgery. Anxiety was measured separately as "state anxiety" and "trait anxiety" using the State-Trait Anxiety Inventory, and HRQOL was measured using the EuroQol 5 dimension 5-level.

Results

The HRQOL decreased at discharge and gradually recovered over time, reaching the same level at 3 months after surgery as at admission. HRQOL score was lower at discharge than at pre-surgery and 3 months after the surgery (p < 0.0001 each), and the score at 1 month after the surgery was lower than at pre-surgery (p = 0.007). In addition, multiple regression analysis showed that HRQOL at discharge was associated with "state anxiety" rather than "trait anxiety" at admission (p = 0.004).

Conclusion

This study identifies the types of anxiety that affect postoperative HRQOL. We suggest that postoperative HRQOL on discharge may be improved by interventions such as psychological or medication treatment for preoperative state anxiety if identified preoperative state anxiety can be managed appropriately.

Clinical characteristics and outcomes of pheochromocytoma crisis: a literature review of 200 cases

PURPOSE

Pheochromocytoma crisis is a life-threatening endocrine emergency that requires prompt diagnosis and treatment. Because of its rarity, sudden onset, and lack of internationally uniform and validated diagnostic criteria, pheochromocytoma crisis remains to be fully clarified. Therefore, we aimed to describe the clinical characteristics and outcomes of pheochromocytoma crisis through a literature review.

METHODS

We performed a systematic literature search of PubMed/MEDLINE database, Igaku-Chuo-Zasshi (Japanese database), and Google Scholar to identify case reports of pheochromocytoma crisis published until February 5, 2021. Information was extracted and analyzed from the literature that reported adequate individual patient data of pheochromocytoma crisis in English or Japanese. Cases were also termed as pheochromocytoma multisystem crisis (PMC) if patients had signs of hyperthermia, multiple organ failure, encephalopathy, and labile blood pressure.

RESULTS

In the 200 cases of pheochromocytoma crisis identified from 187 articles, the mean patient age was 43.8 ± 15.5 years. The most common symptom was headache (39.5%). The heart was the most commonly damaged organ resulting from a complication of a pheochromocytoma crisis (99.0%), followed by the lungs (44.0%) and the kidney (21.5%). PMC accounted for 19.0% of all pheochromocytoma crisis cases. After excluding 12 cases with unknown survival statuses, the mortality rate was 13.8% (26/188 cases). Multivariable logistic regression analysis revealed that nausea and vomiting were significantly associated with a higher mortality rate.

CONCLUSION

Pheochromocytoma can present with different symptomatology, affecting different organ systems. Clinicians should be aware that patients with nausea or vomiting are at a higher risk of death because of pheochromocytoma crisis.

Safety and effectiveness of dulaglutide 0.75 mg in Japanese patients with type 2 diabetes in real-world clinical practice: 36 month post-marketing observational study

AIMS/INTRODUCTION

This study evaluated the safety and effectiveness of dulaglutide in patients with type 2 diabetes in the real-world setting in Japan.

MATERIALS AND METHODS

This prospective, observational post-marketing surveillance study was conducted for 36 months (July 2016 to July 2021) in Japan. Investigators reported data via an electronic data capture system. Data were analyzed by overall population and age group (<65, ≥65 to <75, and ≥75 years).

RESULTS

The analysis population (N = 3,136) included 1,538 (49.04%), 869 (27.71%), and 729 (23.25%) patients aged <65 years, ≥65 to <75 years, and ≥75 years, respectively. Overall, 231 patients (7.37%) experienced ≥1 adverse drug reactions, with the highest frequency in the ≥75 years group. The most common adverse drug reactions were gastrointestinal disorders (n = 106; 3.38%). Severe hypoglycemia (n = 4; 0.13%), major adverse cardiovascular events (n = 4; 0.13%), and acute pancreatitis (n = 1; 0.03%) were uncommon. The mean glycated hemoglobin and bodyweight were reduced from baseline by -0.76% and -1.6 kg, respectively (last observation carried forward). The rate of dulaglutide continuation at 36 months was 58.03% overall and 59.43%, 63.13%, and 48.88% in the <65, ≥65 to <75, and ≥75 years groups, respectively. A factor analysis showed age ≥65 years was associated with a greater incidence of gastrointestinal adverse drug reactions as well as larger reductions in glycated hemoglobin and bodyweight.

CONCLUSIONS

The current real-world data are in accordance with clinical trial findings and further confirm the safety and effectiveness of dulaglutide for elderly patients, whose numbers were limited in the clinical trials.

Efficacy of surgical skin preparation with chlorhexidine in alcohol according to the concentration required to prevent surgical site infection: meta-analysis

Background

A combination of chlorhexidine gluconate and alcohol (CHG–alcohol) is recommended for surgical skin preparation to prevent surgical site infection (SSI). Although more than 1 per cent CHG–alcohol is recommended to prevent catheter-related bloodstream infections, there is no consensus regarding the concentration of the CHG compound for the prevention of SSI.

Methods

A systematic review and meta-analysis was performed. Four electronic databases were searched on 5 November 2020. SSI rates were compared between CHG–alcohol and povidone-iodine (PVP-I) according to the concentration of CHG (0.5 per cent, 2.0 per cent, 2.5 per cent, and 4.0 per cent).

Results

In total, 106 of 2716 screened articles were retrieved for full-text review. The risk ratios (RRs) of SSI for 0.5 per cent (6 studies) and 2.0 per cent (4 studies) CHG–alcohol were significantly lower than those for PVP-I (RR = 0.71, 95 per cent confidence interval (c.i.) 0.52 to 0.97; RR = 0.52, 95 per cent c.i 0.31 to 0.86 respectively); however, no significant difference was observed in the compounds with a CHG concentration of more than 2.0 per cent.

Conclusions

This meta-analysis is the first study that clarifies the usefulness of an alcohol-based CHG solution with a 0.5 per cent or higher CHG concentration for surgical skin preparation to prevent SSI.

Evaluation of age-related thymic changes using computed tomography images: A retrospective observational study

We aimed to investigate if Computed tomography (CT) attenuation values can help improve the identification of age-related changes in the thymus. We assessed CT images of 405 patients aged 0 to 80 years. We measured the area of the anterior mediastinum at the level of the carina and its average CT attenuation value. We evaluated the thymic area, the ratio of the thymus area to the total thoracic area, and the CT attenuation value. Additionally, we evaluated changes in the thymus area in the 0 to 13-year age group. The area of the thymus decreased from birth to the middle 20s. After the middle 20s, the area tended to increase and plateau till after 50 years of age. The ratio of the thymic area to the thoracic area decreased from age 0 to 20 years, but remained stable after 20 years of age. The CT attenuation values were stable from birth to puberty, decreased after puberty, and were stable again in the late 50s and beyond. The thymus of children showed mass formation, but the shape changed with age. No significant differences in the CT attenuation value were found across underlying conditions for the 0 to 13-year age group. The decrease in the CT attenuation values, observed with advancing age, reflects adipose degeneration of the thymus, indicating that by the late 50s, thymic tissue is replaced completely by adipose tissue. Our data suggest that adipose degeneration of the thymus begins after puberty and advances with age.

Optimization of a Stacked-design Core-body-temperature Sensor for Long-period Human Trials

We fabricated a wearable sensor that can be attached to the skin surface and continuously measure core body temperature (CBT) wirelessly over a long period. CBT is calculated from skin-surface temperature and heat flux passing through the sensor. Since heat flux is lost to the surroundings of the probe, the slightest change in convection in daily life will degrade the measurement accuracy of the sensor. Accordingly, we previously proposed a heat-flux-path control structure to reduce the absolute amount of heat-flux loss. To make wearable sensors for long-term human trials, we proposed an integrated design in which a sensor probe, a circuit board, and a battery are stacked. We optimized the proposed design by computer simulation and evaluated the fabricated sensor by a phantom experiment in which the convectional state was changed. The evaluation results demonstrate that the sensor has limits of agreement (LOA) of [-0.13; 0.03]°C under 1-m/s-wind convection. Moreover, a preliminary human trial conducted under daily-life conditions (including convectional changes) demonstrated that the sensor has LOA of [-0.18; 0.22]°C. These results demonstrate that the fabricated sensor is suitable for CBT measurement.

P-603 Presence of an asymmetrical response to ovarian stimulation in patients with low ovarian reserve

Study question

Does ovarian reserve decline with a symmetrical manner between right and left ovaries in poor responders (POR) with diminished ovarian reserve (DOR)?

Summary answer

Asymmetrical ovarian response to ovarian stimulation with the left-side dominance was found in POR with DOR.

What is known already

Ovarian follicles are produced during fetal stage and not regenerated after birth. Thus, the number of ovarian follicles declines with age, resulting in infertile POR with DOR. In the morphometric study of human neonatal ovaries, no significant difference was found in the number of follicles between the right and left ovaries in the same individual. A previous study demonstrated that there is a difference in the number of follicles between right and left ovaries in patients with normal ovarian reserve with the right-side dominance, suggesting the asymmetrical activation and growth of follicles.

Study design, size, duration

A retrospective analysis was conducted in patients with POR with DOR based on the Bologna Criteria. Inclusion criteria was patients who received more than five times of ovarian stimulations followed by oocyte retrievals. Data were obtained from a total of 265 participants who received IVF-ET treatments from April 2015 to March 2021 after receiving written informed consents under an approval from the institutional ethical committee. Patients with the history of previous ovarian surgery were excluded.

Participants/materials, setting, methods

The enrolled patients were received ovarian simulation under short or GnRH antagonist protocols for oocyte retrieval. We collected the data of retrieved oocyte number as well as the outcome of IVF from medical chart. We defined the right-left asymmetry of ovarian reserve (%) based on the number of retrieved oocytes from dominant side ovary per total number of retrieved oocytes. Statistical significance was determined using Dunnett or chi-square tests, with P &lt; 0.05 being statistically significant.

Main results and the role of chance

The average age of participants was 37.2±5.99 years of age exhibiting low serum AMH levels (average 0.09±0.20 ng/ml). We analyzed 2,181 cycles of ovarian stimulation (average 8.3±3.9 cycles/patient). The number of retrieved oocytes were 3, 882 in total cycles (average 12.8±7.1/patient). Among participants, 22 cases (8.4%) showed left and right equal in the number of retrieved oocytes, whereas &gt;70% asymmetry was observed in 107 cases (40.7%) and &gt;80% asymmetry was detected in 60 cases (22.8%). In 18 cases (6.9%), oocytes were collected from one side ovary only showing 100% asymmetry. In the cases with &gt;70 and 100% asymmetry, the left-side dominance was 1.3-fold and 5.0-fold higher than right-side dominance, respectively. In cases with 100% asymmetry, there was no difference in the number of cryopreserved high-quality embryos between left and right sides of ovary.

Limitations, reasons for caution

Although we enrolled POR with DOR patients who received ovarian stimulations more than five times, the duration of ovarian stimulation was different among patients. It affects the numbers of ovarian stimulation cycles and retrieved oocytes in each patient.

Wider implications of the findings

Considering the finding of right-side dominance in the number of follicles with normal ovarian reserve, the activation and development of follicles might be accelerated in the right side due to asymmetric blood supply to the ovaries, and thus follicles are likely remained in the left-side ovary with low ovarian reserve.

Trial registration number

not applicable

LB0001 BIMEKIZUMAB IN BDMARD-NAIVE PATIENTS WITH PSORIATIC ARTHRITIS: 24-WEEK EFFICACY & SAFETY FROM BE OPTIMAL, A PHASE 3, MULTICENTRE, RANDOMISED, PLACEBO-CONTROLLED, ACTIVE REFERENCE STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A.

Objectives

Assess BKZ efficacy and safety vs PBO in bDMARD-naïve pts with active PsA to Wk 24 of BE OPTIMAL.

Methods

BE OPTIMAL (NCT03895203) comprises 16 wks double-blind PBO-controlled and 36 wks treatment-blind. Pts were ≥18 yrs, bDMARD-naïve, with adult-onset, active PsA, ≥3 tender and ≥3 swollen joints. Pts randomised 3:2:1, subcutaneous BKZ 160 mg Q4W:PBO:adalimumab (ADA; reference arm) 40 mg Q2W. From Wk 16, PBO pts received BKZ 160 mg Q4W. Primary endpoint: ACR50 at Wk 16.

Results

821/852 (96.4%) pts completed Wk 16 and 806 (94.6%) Wk 24. Mean age 48.7 yrs, BMI 29.2 kg/m2; since diagnosis: 5.9 yrs; 46.8% male. BL characteristics comparable across arms. Primary endpoint met (Wk 16 ACR50: 43.9% BKZ vs 10.0% PBO, p<0.001; ADA: 45.7%; Figure 1). All ranked secondary endpoints met at Wk 16 (Table 1). As early as Wk 2, ACR20 was higher in BKZ vs PBO (27.1% vs 7.8%, nominal p<0.001; ADA: 33.6%). Outcomes continued to improve at Wk 24 (Table 1). To Wk 16, pts with ≥1 TEAE, BKZ: 59.9%; PBO: 49.5%; ADA: 59.3%. SAE rate low (1.6%; 1.1%; 1.4%). Most frequent (≥5%) AEs for all arms: nasopharyngitis (9.3%; 4.6%; 5.0%), URTI (4.9%; 6.4%; 2.1%), increased ALT (0.7%; 0.7%; 5.0%). Candida infections: 2.6%, 0.7%, 0%; no systemic candidiasis. 2 malignancies (BKZ: basal cell carcinoma; PBO: breast cancer stage 1); no MACE, uveitis, IBD or deaths.

Table 1.

Wk 16 and 24 efficacy

BLWk 16Wk 24PBO N=281BKZ 160 mg Q4W N=431ADA 40 mg Q2W N=140†PBO N=281BKZ 160 mg Q4W N=431ADA 40 mg Q2W N=140†p value (BKZ vs PBO)PBO→ BKZ 160 mg Q4WaN=281BKZ 160 mg Q4W N=431ADA 40 mg Q2W N=140†Ranked endpointsbACR50 [NRI],–––28189 (43.9)64<0.00110119666n (%)-10-45.7(35.9)(45.5)-47.1HAQ-DI CfB [MI],0.890.820.86−0.09 (0.03)−0.26 (0.02)−0.33<0.001c−0.28−0.30−0.34mean (SE)-0.04-0.03-0.05(0.04)(0.03)(0.02)(0.05)PASI90d [NRI],–––4133 (61.3)f28<0.00186 (61.4)e158 (72.8)f32n (%)(2.9)e(41.2)g(47.1)gSF-36 PCS CfB [MI],36.938.137.62.36.36.8<0.001c6.27.37.3mean (SE)-0.6-0.5-0.7-0.5-0.4-0.8-0.5-0.4-0.8MDA [NRI],51413719463<0.00110620967n (%)-1.8-3.2-0.7-13.2(45.0)-45(37.7)(48.5)-47.9vdHmTSS CfB (subgroup)h [MI], mean (SE)15.67 (1.80)i15.56 (1.69)j17.39 (2.89)k0.36 (0.10)i−0.01 (0.04)j−0.06 (0.08)k<0.001c–––vdHmTSS CfB [MI],mean (SE)13.31 (1.56)l13.44 (1.47)m14.55 (2.44)n0.31 (0.09)l0(0.04)m−0.03 (0.07)n0.001c–––Other endpointsACR20 [NRI],–––6726896<0.001o17528299n (%)-23.8(62.2)-68.6(62.3)(65.4)-70.7ACR70 [NRI],–––1210539<0.001o5312642n (%)-4.3(24.4)-27.9-18.9(29.2)-30PASI100d [NRI],–––3103f14<0.001o6012226n (%)(2.1)e(47.5)(20.6)g(42.9)e (56.2)f(38.2)gTJC CfB [MI],17.116.817.5−3.2−10.0−10.9<0.001o−9.4−11.5−11.8mean (SE)-0.7-0.6-1.1(0.7) (0.5)-1(0.7)(0.5)-0.9SJC CfB [MI],9.599.6−3.0 (0.5)−6.6 (0.3)−7.5<0.001o−6.8 (0.4)−7.2 (0.3)−7.9mean (SE)-0.4-0.3-0.6-0.6-0.6

Randomised set. Interim results.

†Reference arm; study not powered for statistical comparisons of ADA to BKZ or PBO.

aPBO→BKZ pts received PBO to Wk 16, switched to BKZ 160 mg Q4W through Wk 24 (8 wks BKZ);

bResolution of enthesitis/dactylitis in pts with LEI>0/LDI>0 at BL pooled with BE COMPLETE (Wk 16 LEI=0 BKZ: 124/249 [49.8%], PBO: 37/106 [34.9%], p=0.008; LDI=0 BKZ: 68/90 [75.6%], PBO: 24/47 [51.1%], p=0.002);

cContinuous outcome p values calculated with RBMI data;

dPts with PSO and ≥3% BSA at BL;

en=140;

fn=217;

gn=68;

hPts with hs-CRP ≥6 mg/L and/or bone erosion at BL;

in=221;

jn=357;

kn=108;

ln=261;

mn=416;

nn=131;

oNominal, not powered for multiplicity.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in bDMARD-naïve pts with active PsA resulted in rapid, clinically relevant improvements in musculoskeletal and skin outcomes vs PBO. No new safety signals observed.1,2

References

[1]Ritchlin CT Lancet 2020;395(10222):427–40; 2. Coates LC Ann Rheum Dis 2021;80:779–80(POS1022).

Disclosure of Interests

Iain McInnes Consultant of: AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, Novartis, and UCB Pharma, Grant/research support from: BMS, Boehringer Ingelheim, Celgene, Janssen, UCB Pharma, Laura Coates Consultant of: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Domain, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB Pharma, Robert B.M. Landewé Consultant of: Abbott, Ablynx, Amgen, AstraZeneca, BMS, Centocor, GSK, Novartis, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Speakers bureau: Abbott, Amgen, BMS, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Grant/research support from: Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Philip J Mease Consultant of: AbbVie, Amgen, BMS, Boehringer Ingelheim, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Amgen, BMS, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Eli Lilly, Gilead, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Amgen and UCB Pharma, Yoshiya Tanaka Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Sanofi, and Taisho, Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer-Ingelheim, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi-Tanabe, and YL Biologics, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer-Ingelheim, Chugai, Corrona, Daiichi-Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda, Akihiko Asahina Grant/research support from: AbbVie, Amgen, Eisai, Eli Lilly, Janssen, Kyowa Kirin, LEO Pharma, Maruho, Mitsubishi Tanabe Pharma, Pfizer, Sun Pharma, Taiho Pharma, Torii Pharmaceutical, and UCB Pharma, Laure Gossec Consultant of: AbbVie, Amgen, BMS, Celltrion, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, Sandoz and UCB Pharma, Alice B Gottlieb Consultant of: Amgen, AnaptsysBio, Avotres Therapeutics, Boehringer Ingelheim, BMS, Dermavant, Eli Lilly, Incyte, Janssen, Novartis, Pfizer, Sanofi, Sun Pharma, UCB Pharma, and XBiotech, Grant/research support from: Boehringer Ingelheim, Janssen, Novartis, Sun Pharma, UCB Pharma, and XBiotech: all funds go to Mount Sinai Medical School, Richard B. Warren Consultant of: AbbVie, Almirall, Amgen, Arena, Astellas, Avillion, Biogen, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, GSK, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, and UCB Pharma, Paid instructor for: Astellas, DiCE, GSK, and Union, Grant/research support from: AbbVie, Almirall, Janssen, LEO Pharma, Novartis, and UCB Pharma, Barbara Ink Shareholder of: GSK, UCB Pharma, Employee of: UCB Pharma, Deepak Assudani Shareholder of: UCB Pharma, Employee of: UCB Pharma, Jason Coarse Shareholder of: UCB Pharma, Employee of: UCB Pharma, Rajan Bajracharya Shareholder of: UCB Pharma, Employee of: UCB Pharma, Joseph F. Merola Consultant of: AbbVie, Amgen, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB Pharma, Paid instructor for: Amgen, Abbvie, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB Pharma

POS0734 THE CLINICAL JUDGMENT FOR THE ACCEPTABILITY OF PREGNANCY IN PATIENTS WITH SEROLOGICALLY ACTIVE SLE IN JAPAN: A NATIONWIDE ONLINE SURVEY FROM THE VIGNETTE STUDY

Background

The risk of pregnancy complications, such as gestational hypertension is high in pregnancies with SLE. In addition, the risk of flare is elevated if pregnancy occurs during the high disease activity. The EULAR recommendation provides a checklist for preconception counseling, in which patients with SLE desiring pregnancy were required the condition that the disease activity prior to pregnancy should be stable for 6-12 months in terms of serological activity (1). However, it does not provide specific criteria for serological activity so that physicians should evaluate the risk of pregnancy in each case by their clinical intuitions.

Objectives

In order to uncover the present clinical situation for the acceptability of pregnancy in patients with SLE, we performed questionnaire survey to physicians regarding to the degree of serological activity.

Methods

This cross-sectional study was performed to physicians registered with the Japanese College of Rheumatology from December 2020 to January 2021 using the online survey. The questionnaire asked about the characteristics of physicians, facilities and the permission of pregnancies with SLE using vignette scenarios. In this study, data from vignettes of women visiting a regular outpatient clinic were used. The vignettes varied in age (28 or 35 years), duration of stable disease and serological activity. Analysis methods were descriptive statistics, chi-square test. generalized estimating equations (GEE) was performed to investigate the relationship between the determining permission for pregnancy and the scenario patient’s characteristics (age, period of stable disease, titer of anti ds-DNA antibody)

Results

The questionnaire was distributed to 4946 physicians, and 463 responded. Completion rate (ratio agreed to participate/finished survey) of survey was 91.1%. The median age of physicians was 46 (interquartile range (IQR) 2-10). The specialty was rheumatology (84.9%), other internal medicine (8%), and pediatrics (5.6%). There were no significant differences in patient’s age about the acceptability of pregnancy (coeffficianet -0.02, 95% CI -0.17 -0.01, p=0.42). Case who had been stable for 6 months were more tolerant of pregnancy than case who had been stable for 3 months (coeffficianet 0.12, 95% CI 0.09-0.15, P<0.001) Pregnancy was not allowed in case with mild or high serological activity (mild: coefficient -0.49, 95% CI -0.29- -0.22, p <0.001, high: -0.64, 95% CI -0.65 - -0.61, p <0.001). In contrast, as many as 92 (19.2%) physicians tolerated pregnancy even in the presence of residual high anti ds-DNA antibody titers. Female physicians are significantly more cautious about pregnancy than male when patients have a serologically high activity (12% vs 37.5%, p<0.001). There were no significant differences in specialty status or clinical experience.

Conclusion

We found that even mild serological activity alone had a significant negative effect on the physician’s decision to allow pregnancy. We conclude that current physicians make cautious decisions about pregnancies of patients with SLE following the recommendation. On the other hand, an additional investigation should be performed about the results of pregnancies in patients with serological abnormalities, since there are some physicians who thought that pregnancy may be acceptable for patients with only serological abnormalities if the clinical symptoms are stable.

References

[1]Ann Rheum Dis．2017 Mar;76(3):476-485

Acknowledgements

I would like to express my gratitude to the members of Japan College of Rheumatology who cooperated in filling out the questionnaire.

Disclosure of Interests

Sakiko Isojima: None declared, Nobuyuki Yajima: None declared, Ryo Yanai: None declared, Yoko Miura: None declared, Shingo Fukuma: None declared, Kayoko Kaneko: None declared, Keishi Fujio: None declared, Kenji Oku: None declared, Masakazu Matsushita: None declared, Takako Miyamae: None declared, Takashi Wada: None declared, Yuko Kaneko: None declared, Yoshiya Tanaka Speakers bureau: Y. Tanaka has received speaking fees and/or honoraria from Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Grant/research support from: Y. Tanaka has received research grants from Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, and consultant fee from Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie., Ayako Nakajima: None declared, ATSUKO MURASHIMA: None declared

POS0676 EFFICACY AND SAFETY OF FILGOTINIB IN PATIENTS AGED ≥75 YEARS: A POST HOC SUBGROUP ANALYSIS OF THE FINCH 4 LONG-TERM EXTENSION (LTE) STUDY

Background

Filgotinib (FIL) is a Janus kinase 1 preferential inhibitor for the treatment of moderate to severe rheumatoid arthritis (RA)1. The recommended dose for adults with RA is 200 mg (FIL200); however, a starting dose of 100 mg (FIL100) is recommended for those aged ≥75 years (y) in view of limited clinical experience1. An important consideration is the generally higher incidence of adverse events (AEs) in the elderly due to comorbidities.

Objectives

To evaluate the efficacy and safety of FIL100 and FIL200 in patients with RA aged ≥75 y.

Methods

FINCH 4 (NCT03025308) is an ongoing phase 3 open-label LTE study of FIL100 and FIL200 for RA. Eligible patients completed a prior phase 3 randomized double-blind study of FIL lasting 52 weeks (FINCH 1 or 3) or 24 weeks (FINCH 2). In this post hoc analysis, safety and efficacy were assessed in patients aged <75 and ≥75 y in FINCH 4. Efficacy measures were American College of Rheumatology (ACR)20/50/70 responses, clinical disease activity index (CDAI) ≤10/≤2.8, disease activity score (DAS)28 <2.6/≤3.2 and health assessment questionnaire-disability index (HAQ-DI).

Results

At LTE Week 48, 52% and 44% of patients aged <75 and ≥75 y, respectively, were on methotrexate. In both age groups, response rates for key efficacy measures at LTE Week 48 were generally maintained from LTE baseline (Figure 1) in patients with and without prior FIL exposure in FINCH 1–3, and were numerically higher with FIL200 vs FIL100. Mean change from baseline in HAQ-DI with FIL200 and FIL100 was 0.61 and 0.74 in those aged <75 y and 1.04 and 0.98 in those aged ≥75 y, respectively.

Figure 1.

The exposure-adjusted incidence rate (EAIR) of serious AEs and AEs of special interest (AESI) was generally higher in patients aged ≥75 y than <75 y. In those aged ≥75 y, the EAIR of AEs leading to premature study discontinuation, treatment-emergent AEs (TEAEs), and serious TEAEs was higher with FIL200 vs FIL100; the incidence of major adverse cardiovascular events, venous thrombotic and embolic events, serious infections, herpes zoster and malignancies was low in both dose groups (Table 1). Three patients died, all from the FIL200 group; each had a medical history relevant to the cause of death.

Table 1.

Exposure-adjusted incidence rate (95% CI) of AEs at Week 48 as events per 100 years of exposure

FIL200FIL100Age, years<75≥75<75≥75n=1469n=61n=1136n=63(PYE 2253.9)(PYE 92.2)(PYE 1753.7)(PYE 98.4)With prior FIL exposure, n (%)1142 (77.7)53 (86.9)830 (73.1)33 (52.4)TEAE48.3 (45.5, 51.3)55.3 (42.1, 72.8)48.7 (45.5, 52.1)42.7 (31.6, 57.8)Serious TEAE6.8 (5.8, 8.0)17.4 (10.6, 28.3)7.4 (6.2, 8.7)14.2 (8.4, 24.0)AE leading to premature study discontinuation2.9 (2.3, 3.7)9.8 (5.1, 18.8)3.9 (3.1, 5.0)4.1 (1.5, 10.8)AE leading to death0.5 (0.3, 0.9)3.3 (0.7, 9.5)*0.3 (0.2, 0.8)0.0 (0.0, 3.8)Infections28.8 (26.6, 31.1)29.3 (20.1, 42.7)27.4 (25.0, 29.9)26.4 (18.0, 38.8)Serious infections1.6 (1.2, 2.2)2.2 (0.5, 8.7)1.7 (1.1, 2.4)3.1 (1.0, 9.5)Herpes zoster1.6 (1.2, 2.3)2.2 (0.5, 8.7)1.0 (0.6, 1.6)3.1 (1.0, 9.5)Adjudicated major adverse cardiovascular event0.4 (0.2, 0.7)2.2 (0.5, 8.7)0.5 (0.2, 0.9)1.0 (0.1, 7.2)Venous thrombotic and embolic events0.3 (0.1, 0.6)2.2 (0.5, 8.7)0.2 (0.1, 0.5)1.0 (0.1, 7.2)Malignancy excluding NMSC0.7 (0.4, 1.2)4.3 (1.6, 11.6)0.7 (0.4, 1.2)3.1 (1.0, 9.5)NMSC0.4 (0.2, 0.8)1.1 (0.0, 6.0)0.2 (0.1, 0.6)0.0 (0.0, 3.8)

*Cause of death: esophageal carcinoma; cardiovascular; unknown. FIL(100/200), filgotinib (100/200 mg); NMSC, nonmelanoma skin cancer; PYE, patient years of exposure; (TE)AE, (treatment-emergent) adverse event

Conclusion

In the ≥75 y group, response rates for key efficacy measures remained stable to Week 48 and were generally higher with FIL200 vs FIL100. The incidence of serious AEs and AESI was higher in those aged ≥75 than <75 y. Patient numbers/exposure time may have been insufficient to show potential between-group differences in safety/efficacy outcomes.

References

[1]Filgotinib SmPC

Acknowledgements

The FINCH studies were funded by Gilead Sciences (Foster City, CA, United States). We thank the physicians and patients who participated in the studies. Medical writing support was provided by Debbie Sherwood, BSc (Aspire Scientific Ltd, Bollington, UK) and funded by Galapagos NV (Mechelen, Belgium).

Disclosure of Interests

Daniel Aletaha Speakers bureau: AbbVie, Amgen, Lilly, Janssen, Merck, Novartis, Pfizer, Roche, and Sandoz, Consultant of: AbbVie, Amgen, Lilly, Janssen, Merck, Novartis, Pfizer, Roche, and Sandoz, Grant/research support from: AbbVie, Amgen, Lilly, Novartis, Roche, SoBi, and Sanofi, Rene Westhovens Speakers bureau: Celltrion, Galapagos, and Gilead, Consultant of: Celltrion, Galapagos, and Gilead, Bernard Combe Speakers bureau: AbbVie, BMS, Celltrion, Eli Lilly, Gilead-Galapagos, Janssen, MSD, Novartis, Pfizer, and Roche-Chugai, Consultant of: AbbVie, Celltrion, Eli Lilly, Gilead-Galapagos, Janssen, and Roche-Chugai, Jacques-Eric Gottenberg Consultant of: AbbVie, BMS, Galapagos, Gilead, Lilly, and Pfizer, Grant/research support from: BMS and Pfizer, Maya H Buch Speakers bureau: AbbVie, Consultant of: AbbVie, Galapagos, Gilead, and Pfizer, Grant/research support from: Gilead and Pfizer, Roberto Caporali Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, and UCB, Consultant of: AbbVie, Amgen, BMS, Celltrion, Fresenius-Kabi, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, José A Gómez-Puerta Speakers bureau: AbbVie, BMS, Galapagos, GSK, Lilly, MSD, Novartis, Pfizer, Roche, and Sanofi, Consultant of: GSK, Roche, and Sanofi, Paul Van Hoek Employee of: Galapagos, Vijay Rajendran Employee of: Galapagos, Pieter-Jan Stiers Shareholder of: Galapagos, Employee of: Galapagos, Thijs Hendrikx Employee of: Galapagos, Gerd Rüdiger Burmester Consultant of: AbbVie, Amgen, BMS, Galapagos, Lilly, MSD, Pfizer, Roche, and Sanofi, Yoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, Astra-Zeneca, Boehringer-Ingelheim, BMS, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi-Tanabe, and YL Biologics, Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Sanofi, and Taisho, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer-Ingelheim, Chugai, Corrona, Daiichi-Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda

POS1014 IMPACT OF SERUM INTERLEUKIN 22 AS A BIOMARKER FOR THE DIFFERENTIAL USE OF MOLECULAR TARGETED DRUGS FOR PSORIATIC ARTHRITIS

Background

Although each bDMARD target different molecules, no optimal drug selection method has been established. Because studies directly comparing TNF-i and IL-17-i have shown that these drugs are equally effective, the establishment of an optimal selection method for these drugs can contribute to better patient outcomes. We reported the possibility of stratification of patients by peripheral blood lymphocytes phenotyping and precision medicine based on the selective use of bDMARDs in psoriatic arthritis (PsA). However, since peripheral blood lymphocytes phenotyping is complex, the development of simple methods using biomarkers to stratify patients and simple treatment strategies based on such methods is needed to promote precision medicine in a real-world clinical setting.

Objectives

We explored whether serum cytokines could be used as biomarkers for optimal use TNF-i and IL-17-i in patients with PsA.

Methods

In cohort 1 (IL-17-i [n=23] or TNF-i [n=24] for ≥1 year), we identified serum cytokines that predicted the achievement of DAPSA remission (REM), PASI 90 and Minimal Disease Activity after 1 year of TNF-i or IL-17-i therapy. Subsequently, we developed treatment strategies based on the identified cytokines. In cohort 2, treatment responses were compared between the strategic treatment group (n=17), which was treated based on the treatment strategies, and the mismatched treatment group (n=17) to verify the validity of the treatment strategies developed using serum cytokines as biomarkers.

Results

In cohort 1, serum IL-22 concentrations were statistically identified as a predictor of DAPSA remission after 1 year of IL-17-i therapy. However, no baseline serum cytokines were identified as factors contributing to achievement of DAPSA-REM in the TNF-i-treated group or achievement of PASI90 and Minimal Disease Activity in either group. Using a cut-off value of 0.61376 (sensitivity, 81.8%; specificity, 91.7%; area under the curve, 0.848) determined by a ROC analysis, we stratified 47 patients into the IL-22 high group (n=25) (0.61376<) and the IL-22 low group (n=22) (< 0.61376). Serum IL-17 concentrations were significantly higher in both the IL-22 high and IL-22 low groups than in the healthy control (HC), whereas no significant difference was observed between the IL-22 high and IL-22 low groups. The serum TNF-α concentrations did not significantly differ between the IL-22 low and HC; however, they were significantly higher in the IL-22 high group than in the HC and IL-22 low groups. Based on these results, we created treatment strategies using TNF-i and IL-17-i based on serum IL-22 concentrations, that is, initiation of IL-17-i therapy in patients with low IL-22 concentrations and TNF-i therapy in patients with high IL-22 concentrations. To validate the efficacy of the treatment strategies, we retrospectively compared the efficacy of the bDMARDs at 1 year between the following groups in cohort 2. The strategic treatment group (n=17) included patients with low IL-22 concentrations who were treated with IL-17-i and those with high IL-22 concentrations who were treated with TNF-i. The mismatched treatment group (n=17) included patients with low IL-22 concentrations who were treated with TNF-i and those with high IL-22 concentrations who were treated with IL-17-i. No statistically significant differences were observed between the two groups in baseline characteristics at the initiation of bDMARD. After initiation of bDMARD, tender joint counts, swollen joint counts, CRP, DAPSA, and PASI were significantly improved in both groups. When the treatment responses over 1 year were compared between the two groups, the rate of achieving DAPSA-REM (58.8% vs. 25.3%, P=0.0399) and Minimal Disease Activity (82.3% vs. 41.2%, P=0.0162) at M12 was significantly higher in the strategic treatment group. There were no statistically significant differences in the rates of achieving PASI75 or PASI90 at M 6 or 12.

Conclusion

We verified that serum IL-22 can be used as a simple biomarker for the proper selection of TNF-i and IL-17-i.

Acknowledgements

The authors thank the study participants, without whom this study could not have been

accomplished, and all medical staff at all participating institutions for providing the data,

especially Ms. Hiroko Yoshida, Ms. Youko Saitou, Ms. Machiko Mitsuiki and Ms. Ayumi

Maruyama for the excellent data management. The authors thank Ms. M.

Hirahara for providing excellent technical assistance. We also thank Dr Kazuyoshi Saito at

Tobata General Hospital; Dr Kentaro Hanami and Dr Shunsuke Fukuyo at Wakamatsu Hospital

of the University of Occupational and Environmental Health; Dr Keisuke Nakatsuka at Fukuoka

Yutaka Hospital, and all staff members at Kitakyushu General Hospital and Shimonoseki

Saiseikai Hospital. Nakama Municipal Hospital, and Steel Memorial Yawata Hospital for their

engagement in data collection.

Disclosure of Interests

Ippei Miyagawa: None declared, Shingo Nakayamada Speakers bureau: consulting fees, speaking fees, and/or honoraria from Bristol-Myers, Pfizer, GlaxoSmithKline, Sanofi, Astellas, Asahi-kasei, and Boehringer Ingelheim and research grants from Mitsubishi-Tanabe and Novartis., Masanobu Ueno: None declared, Yusuke Miyazaki: None declared, Yoshiya Tanaka Speakers bureau: speaking fees and/or honoraria from Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, and Janssen, Consultant of: consultant fees from Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, and Abbvie., Grant/research support from: research grants from Abbvie, Mitsubishi-Tanabe, Chugai, Asahi-Kasei, Eisai, Takeda, and Daiichi-Sankyo

POS0579 ABSENCE OF ASSOCIATION BETWEEN ABATACEPT EXPOSURE LEVELS AND INITIAL INFECTION IN PATIENTS WITH RA: A POST HOC ANALYSIS OF THE RANDOMIZED, PLACEBO-CONTROLLED AVERT-2 STUDY

Background

Infections are the most commonly reported AE observed in patients with RA treated with immunosuppressive therapies and can be clinically significant. A recent review reported differences in the risk of infection for some biologics such as tocilizumab and TNF inhibitors.1 Abatacept selectively modulates T-cell co-stimulation and is approved for the treatment of RA. In patients with polyarticular-course juvenile idiopathic arthritis, no association was found between higher serum abatacept exposure and the incidence of infection.2 This has not been evaluated for adult patients with RA.

Objectives

To determine if higher serum abatacept exposure during treatment with SC abatacept was associated with increased risk of infection in adult patients with RA.

Methods

AVERT-2 (Assessing Very Early Rheumatoid arthritis Treatment-2) was a randomized, placebo-controlled study of SC abatacept + MTX vs abatacept placebo + MTX in MTX-naive, anti-citrullinated protein antibody–positive patients with early, active RA.3 A post hoc population pharmacokinetic (PK) analysis was performed using PK-evaluable patient data from the induction period (year 1) of AVERT-2. Association between steady-state abatacept exposure (min plasma concentration [Cmin], max plasma concentration [Cmax], and average plasma concentration [Cavg]) and first infection was evaluated using Kaplan–Meier plots of probability vs time on treatment by abatacept exposure quartiles and Cox proportional-hazards models.

Results

PK of SC abatacept was defined as a linear 2-compartment model with first-order absorption and first-order elimination. The findings of the updated PK analysis were consistent with those reported in prior population analyses of abatacept PK in adults with RA. The final model included effects of baseline body weight, estimated glomerular filtration rate, sex, age, albumin, MTX use, NSAID use, SJC, and race on abatacept clearance. The only covariate with a clinically relevant effect was higher body weight, which caused an increase in clearance and volume. Infections occurred in a total of 330/693 (47.6%; serious, 1.6%) patients treated with abatacept, and 134/301 (44.5%; serious, 1.3%) with placebo during the first year of AVERT-2. In patients taking abatacept, the mean (SD) study exposure to abatacept was 376 (60) days, while mean (SD) prednisone equivalent dose was 6.7 (3.8) mg/day and mean (SD) MTX dose was 9.6 (3.0) mg/week. No exposure–response relationship was observed between the probability of first infection and steady-state abatacept exposure quartiles (Cavg, Cmin, and Cmax), or compared with placebo (Figure 1A–C). Kaplan–Meier assessment also showed no increase in risk of infection with concomitant use of MTX and glucocorticoids.

Conclusion

No association was found between initial infection and steady-state abatacept exposure (Cavg, Cmin, Cmax) or MTX and glucocorticoid use in patients with RA treated with SC abatacept.

References

[1]Jani M, et al. Curr Opin Rheumatol 2019;31:285–92.

[2]Ruperto N, et al. J Rheumatol 2021;48:1073–81.

[3]Emery P, et al. Arthritis Rheumatol 2019;71(suppl 10):L11.

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Writing and editorial assistance were provided by Fiona Boswell, PhD, of Caudex, and was funded by Bristol Myers Squibb. Support was provided by Sandra Overfield as Protocol Manager, and Prema Sukumar and Renfang Hwang as Data Science Leads.

Disclosure of Interests

Paul Emery Consultant of: AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Grant/research support from: AbbVie, Bristol Myers Squibb, Eli Lilly, Novartis, Pfizer, Roche, Samsung, Roy Fleischmann Consultant of: Amgen, AbbVie, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Novartis, Pfizer, Grant/research support from: Amgen, AbbVie, Arthrosi, Biosplice, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Horizon, Novartis, Pfizer, Regeneron, TEVA, UCB, Robert Wong Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Karissa Lozenski Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Yoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi Tanabe, YL Biologics, Consultant of: AbbVie, Ayumi, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Taisho, Sanofi, Grant/research support from: AbbVie, Asahi Kasei, Boehringer Ingelheim, Chugai, Corrona, Daiichi Sankyo, Eisai, Kowa, Mitsubishi Tanabe, Takeda, Vivian Bykerk Consultant of: Amgen, Bristol Myers Squibb, Genzyme Corporation, Gilead, Regeneron, UCB, Grant/research support from: Amgen, Bristol Myers Squibb, Genzyme Corporation, Pfizer, Regeneron, Sanofi Aventis, UCB, Clifton Bingham Consultant of: AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Sanofi, Grant/research support from: Bristol Myers Squibb, Thomas Huizinga Speakers bureau: Abblynx, Abbott, Biotest AG, Bristol Myers Squibb, Crescendo Bioscience, Eli Lilly, Epirus, Galapagos, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi- Aventis, UCB, Consultant of: Abblynx, Abbott, Biotest AG, Bristol Myers Squibb, Crescendo Bioscience, Eli Lilly, Epirus, Galapagos, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi- Aventis, UCB, Grant/research support from: Abblynx, Abbott, Biotest AG, Bristol Myers Squibb, Crescendo Bioscience, Eli Lilly, Epirus, Galapagos, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi- Aventis, UCB, Gustavo Citera Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Yedid Elbez Consultant of: Bristol Myers Squibb, Employee of: Signifience, Vidya Perera Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Bindu Murthy Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Kelly Maxwell Consultant of: Bristol Myers Squibb, Employee of: Cognigen Corporation, Julie Passarell Consultant of: Bristol Myers Squibb, Employee of: Cognigen Corporation, William Hedrich: None declared, Daphne Williams Consultant of: Black Diamond Network, Joule, Syneos, Employee of: Bristol Myers Squibb.

POS0714 POOLED SAFETY ANALYSIS OF BARICITINIB IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM THREE RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED, CLINICAL TRIALS

Background

Baricitinib (BARI), an oral selective inhibitor of Janus kinase 1 and 2 approved for the treatment of rheumatoid arthritis and atopic dermatitis, has been evaluated in clinical studies in patients with systemic lupus erythematosus (SLE).

Objectives

To assess the safety profile of BARI in patients with SLE.

Methods

Patients with SLE receiving stable background therapy were randomised 1:1:1 to BARI 2-mg, 4-mg, or placebo (PBO) once daily in one 24-week, phase 2 (NCT02708095) and two 52-week, phase 3, PBO controlled studies (NCT03616912 and NCT03616964).

Results

A total of 1,849 patients were included in this pooled analysis, representing 1,463.5 patient years of exposure (PYE). The incidence rates per 100 PYR at risk (IR/100 PYR) for serious adverse events (SAEs) were 9.5, 14.7, and 14.1 respectively for PBO, BARI 2-mg, and BARI 4-mg. There were no clinically meaningful differences between treatment groups for discontinuations due to AEs or death (Table 1).

Table 1.

Overview of safety measures of baricitinib in patients with SLE

Safety measurePBOBARI 2-mgBARI 4-mgPooled-BARIN=614N=621N=614N=1235PYE=488.1PYE=494.0PYE=481.4PYE=975.4n(%)n(%)n(%)n(%)PYRPYRPYRPYR[IR; 95%CI][IR; 95%CI][IR; 95%CI][IR; 95%CI]SAEs45 (7.3)70 (11.3)*65 (10.6)*135 (10.9)*473.2476.6461.9938.5[9.5; 6.9, 12.7][14.7; 11.5, 18.6][14.1; 10.9, 17.9][14.4; 12.1, 17.0]Discontinuation of study drug due to AE48 (7.8)58 (9.3)57 (9.3)115 (9.3)485.3492.3480.6973.0[9.9; 7.3, 13.1][11.8; 8.9, 15.2][11.9; 9.0, 15.4][11.8; 9.8, 14.2]Death4 (0.7)1 (0.2)4 (0.7)5 (0.4)488.2494.0481.5975.5[0.8; 0.2, 2.1][0.2; 0.0, 1.1][0.8; 0.2, 2.1][0.5; 0.2, 1.2]Serious infections12 (2.0)22 (3.5)28 (4.6)*50 (4.0)*484.3487.2472.5959.7[2.5; 1.3, 4.3][4.5; 2.8, 6.8][5.9; 3.9, 8.6][5.2; 3.9, 6.9]Herpes Zoster18 (2.9)17 (2.7)29 (4.7)46 (3.7)481.1486.5468.6955.1[3.7; 2.2, 5.9][3.5; 2.0, 5.6][6.2; 4.1, 8.9][4.8; 3.5, 6.4]VTEs#6 (1.2)3 (0.6)1 (0.2)4 (0.4)444.0450.2438.1888.3[1.4; 0.5, 2.9][0.7; 0.1, 1.9][0.2; 0.0, 1.3][0.5; 0.1, 1.2]MACE#01 (0.2)3 (0.6)4 (0.4)443.9450.1438.1888.3[0.0; NA, 0.8][0.2; 0.0, 1.2][0.7; 0.1, 2.0][0.5; 0.1, 1.2]Malignancy excluding NMSC2 (0.3)3 (0.5)2 (0.3)5 (0.4)488.0494.1481.4975.5[0.4; 0.0, 1.5][0.6; 0.1, 1.8][0.4; 0.1, 1.5][0.5; 0.2, 1.2]NMSC2 (0.3)000*486.7494.0481.4975.4[0.4; 0.0, 1.5][0.0; NA, 0.7][0.0; NA, 0.8][0.0; NA, 0.4]

Data are n (%) patients PYR [IR; 95% CI]. #Phase 2 study data not included. AE=adverse event; CI=confidence interval; MACE=major adverse cardiac event; NMSC=non-melanoma skin cancers; VTE=venous thrombotic event (includes deep vein thrombosis and pulmonary embolism); IR=incidence rate (100 times the number of patients reporting an adverse event divided by the event-specific exposure to treatment); N=number of patients in the analysis population; n=number of patients in the specified category; PYE=patient-year of exposure; PYR=patient years at risk; SAE=serious adverse event. *p≤0.05 vs placebo.

The IR/100 PYR for serious infections were 2.5, 4.5, and 5.9 respectively for PBO, BARI 2-mg, and BARI 4-mg. The risk of Herpes Zoster was higher in BARI 4-mg (4.7%) vs PBO (2.9%) (Table 1).

The IR/100 PYR for positively adjudicated venous thrombotic events (VTEs) were 1.4, 0.7, and 0.2 respectively for PBO, BARI 2-mg, and BARI 4-mg. The IR/100 PYR for positively adjudicated major adverse cardiac event (MACE) was numerically higher in BARI 2-mg (0.2) and BARI 4-mg (0.7) vs PBO (0.0), however the pooled-BARI IR/PYR (0.5) was within the range of background disease (1). No increased risk for malignancies was observed.

Conclusion

The safety profile of BARI in SLE patients was consistent with the known BARI safety profile. There was no increased risk of VTE in BARI treatment groups.

References

[1]Barbhaiya M, Feldman CH, et al. Arthritis Rheumatol. 2017;69(9):1823-31.

Disclosure of Interests

Thomas Dörner Speakers bureau: Eli Lilly and Company and Roche, Consultant of: AbbVie, Celgene, Eli Lilly and Company, Janssen, Novartis, Roche, Samsung and UCB, Grant/research support from: Chugai, Janssen, Novartis and Sanofi, Yoshiya Tanaka Speakers bureau: Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Consultant of: Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie, Grant/research support from: Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, Marta Mosca Speakers bureau: Eli Lilly, GSK, Astra Zeneca, Consultant of: Eli Lilly, GSK, Astra Zeneca, Ian N. Bruce Speakers bureau: GSK, Astra Zeneca, UCB, Consultant of: Eli Lilly, GSK, UCB, BMS, Merck Serono, Astra Zeneca, IL-TOO, Aurinia, Grant/research support from: GSK, Janssen, Mario Cardiel Speakers bureau: Eli Lilly, Pfizer, Abbvie, Consultant of: Eli Lilly, Pfizer, Grant/research support from: Pfizer, Gilead, Roche, Janssen, Eric F. Morand Speakers bureau: AstraZeneca, Eli Lilly, Novartis, Consultant of: Amgen, AstraZeneca, Asahi Kasei, Biogen, BristolMyersSquibb, Capella, Eli Lilly, EMD Serono, Genentech, GlaxoSmithKline, Janssen, Neovacs, Sanofi, Servier, UCB, Wolf, Grant/research support from: Janssen, AstraZeneca, BristolMyersSquibb, Eli Lilly, EMD Serono, GlaxoSmithKline, Michelle A Petri Consultant of: Eli Lilly, Grant/research support from: Eli Lilly, Maria Silk Shareholder of: Eli Lilly, Employee of: Eli Lilly, christina dickson Shareholder of: Eli Lilly, Employee of: Eli Lilly, Gabriella Meszaros Shareholder of: Eli Lilly, Employee of: Eli Lilly, Maher Issa Shareholder of: Eli Lilly, Employee of: Eli Lilly, Lu Zhang Shareholder of: Eli Lilly, Employee of: Eli Lilly, Daniel J. Wallace Consultant of: Amgen, Eli Lilly and Company, EMD Merck Serono and Pfizer

POS0704 EFFICACY AND SAFETY OF FILGOTINIB IN PATIENTS WITH INADEQUATE RESPONSE TO METHOTREXATE, WITH 4 OR <4 POOR PROGNOSTIC FACTORS: A POST HOC ANALYSIS OF THE FINCH 1 STUDY

Background

Patients (pts) with rheumatoid arthritis (RA) and poor prognostic factors1 (PPF) are at risk for progression without adequate treatment. Filgotinib (FIL) is a once daily Janus kinase 1 preferential inhibitor. In FINCH 1 (NCT02889796), FIL 200 mg (FIL200) was effective vs placebo (PBO) and noninferior to adalimumab (ADA) in pts with RA and inadequate response to methotrexate (MTX-IR); FIL200 and FIL 100 mg (FIL100) were well tolerated.2

Objectives

This post hoc, exploratory analysis examined efficacy and safety of FIL in MTX-IR pts with 4 or <4 PPF.

Methods

The FINCH 1 52-week (W), double-blind trial randomised MTX-IR pts with moderate–severe RA to FIL200 or FIL100, ADA, or PBO; all received background MTX. PBO pts were rerandomised, blinded, at W24 to FIL200 or FIL100. We examined pts with 4 PPF at baseline (BL): erosions on X-ray, seropositivity for rheumatoid factor or anticyclic citrullinated peptide, high-sensitivity C-reactive protein (hsCRP) ≥6 mg/L, and disease activity score in 28 joints with CRP (DAS28[CRP]) >5.1, along with those with <4 PPF. Efficacy included DAS28(CRP) <2.6 and modified Total Sharp Score (mTSS) change from baseline (CFB). Fisher’s exact test was used for DAS28(CRP); the mixed-effects model was used to generate least squares mean mTSS CFB. P values were nominal, not adjusted for multiplicity.

Results

At BL, of 1755 randomized, treated pts, 687 had 4 PPF, and 1068 had <4 PPF. Among pts with <4PPF, 804 [75%] had erosions, 810 [76%] were seropositive, 377 [35%] had hsCRP ≥6 mg/L, 638 [60%] had DAS28[CRP] >5.1). Pts with 4 vs <4 PPF were aged 53 vs 52 years, had RA duration 8.3 vs 7.4 years, DAS28(CRP) 6.3 vs 5.4, and SDAI 45.6 vs 37.7. In pts with 4 or <4 PPF, higher proportions receiving FIL200 or FIL100 achieved DAS28(CRP) <2.6 at W12 vs PBO (nominal P <.001); proportions with DAS28(CRP) <2.6 increased with FIL200, FIL100, or ADA at W52 (Figure 1). DAS28(CRP) responses for FIL200 at W52 were similar in 4 vs <4 PPF pts; FIL100 and ADA responses were numerically higher in <4 vs 4 PPF pts. At W24, mTSS CFB in pts with 4 PPF was 0.21, 0.23, 0.30, and 0.66 for FIL200, FIL100, ADA, and PBO (P <.05 for FIL200 and FIL100 vs PBO); corresponding changes in <4 PPF pts were 0.08, 0.10, 0.11, and 0.24 (P >.05). At W52, mTSS CFB in 4 PPF pts was 0.29, 0.84, and 0.80 for FIL200, FIL100, and ADA, respectively, and 0.14, 0.25, and 0.53 in <4 PPF pts. Rates of adverse events (AEs), including AEs of interest, were comparable for pts with 4 PPF and <4 PPF for all treatment arms (Table 1).

Table 1.

AEs and AEs of interest in BL 4 PPF and <4 PPF subgroups

4 PPF<4 PPFFIL200FIL100ADAPBO beforeFIL200FIL100ADAPBO(n = 191)(n = 189)(n = 126)W24 switch (n = 181)(n = 284)(n = 291)(n = 199)before W24 switch (n = 294)All AEs146 (76.4)136 (72.0)85 (67.5)90 (49.7)206 (72.5)214 (73.5)154 (77.4)164 (55.8)AEs of interestSerious infectious AE5 (2.6)4 (2.1)6 (4.8)2 (1.1)8 (2.8)9 (3.1)4 (2.0)2 (0.7)Opportunistic infections001 (0.8)0001 (0.5)0Active tuberculosis0000001 (0.5)0Herpes zoster1 (0.5)1 (0.5)1 (0.8)05 (1.8)3 (1.0)1 (0.5)2 (0.7)Hepatitis B or C01 (0.5)001 (0.5)01 (0.5)0MACE01 (0.5)01 (0.6)01 (0.3)1 (0.5)1 (0.3)VTE001 (0.8)1 (0.6)1 (0.4)001 (0.3)DVT001 (0.8)1 (0.6)0001 (0.3)PE00001 (0.4)000Malignancy0003 (1.7)2 (0.7)2 (0.7)2 (1.0)0(non-NMSC)GI perforation00001 (0.4)000

Values are n (%). ADA, adalimumab; AE, adverse event; BL, baseline; DVT, deep vein thrombosis; FIL100, filgotinib 100 mg; FIL200; filgotinib 200 mg; GI, gastrointestinal; MACE, major adverse cardiac event; NMSC, nonmelanoma skin cancer; PBO, placebo; PE, pulmonary embolism; PPF, poor prognostic factor; VTE, venous thromboembolism; W, week.

Conclusion

In high-risk (4 PPF) pts with MTX-IR RA, FIL200 and FIL100 showed similar reductions in disease activity vs PBO at W12 as in pts with <4 PPF; mTSS in FIL200 pts changed little from W24 to W52. Tolerability was comparable across treatment arms, regardless of presence of 4 or <4 PPF.

References

[1]Smolen JS et al. Ann Rheum Dis. 2020;79:685–99.

[2]Combe B et al. Ann Rheum Dis. 2021;80:848–58.

Acknowledgements

This study was funded by Gilead Sciences, Inc., Foster City, CA. Medical writing support was provided by Rob Coover, MPH, of AlphaScientia, LLC, San Francisco, CA, and was funded by Gilead Sciences, Inc., Foster City, CA. Funding for this analysis was provided by Gilead Sciences, Inc. The sponsors participated in the planning, execution, and interpretation of the research.

Disclosure of Interests

Bernard Combe Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Eli Lilly, Gilead-Galapagos, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and Roche-Chugai, Consultant of: AbbVie, Bristol-Myers Squibb, Celltrion, Eli Lilly, Gilead-Galapagos, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and Roche-Chugai, Grant/research support from: Pfizer and Roche-Chugai, Yoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, Behringer-Ingelheim, Bristol-Myers, Chugai, Eisai, Eli Lilly, Gilead Sciences, Inc., Mitsubishi-Tanabe, and YL Biologics, Paid instructor for: AbbVie, Amgen, Astellas, AstraZeneca, Behringer-Ingelheim, Bristol-Myers, Chugai, Eisai, Eli Lilly, Gilead Sciences, Inc., Mitsubishi-Tanabe, and YL Biologics, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer-Ingelheim, Chugai, Corrona, Daiichi-Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda, Maya H Buch Speakers bureau: AbbVie, Eli Lilly, Gilead Sciences, Inc., Merck-Serono, Pfizer, Roche, Sanofi, and UCB, Paid instructor for: AbbVie, Eli Lilly, Gilead Sciences, Inc., Merck-Serono, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Eli Lilly, Gilead Sciences, Inc., Merck-Serono, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Eli Lilly, Gilead Sciences, Inc., Merck-Serono, Pfizer, Roche, Sanofi, and UCB, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly, Pfizer, and Gilead Sciences, Inc., Consultant of: AbbVie, Eli Lilly, Pfizer, and Gilead Sciences, Inc., Beatrix Bartok Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Ling Han Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Kahaku Emoto Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences K.K., Shungo Kano Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences K.K., Thijs Hendrikx Employee of: Galapagos BV, Daniel Aletaha Speakers bureau: Bristol-Myers Squibb, Merck Sharp & Dohme, and UCB; AbbVie, Amgen, Celgene, Eli Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, and Sanofi/Genzyme., Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, and Sanofi/Genzyme; Janssen, Grant/research support from: from AbbVie, Merck Sharp & Dohme, Novartis, and Roche

POS0708 EVALUATING THE HYPERSENSITIVITY PROFILE OF ANIFROLUMAB AND THE NEED FOR PREINFUSION PROPHYLACTIC TREATMENT IN PATIENTS WITH SLE

Background

Anifrolumab, a human monoclonal antibody (mAb), is approved in Canada, Japan, and the United States for the treatment of patients with systemic lupus erythematosus (SLE) based on results from the phase 2b MUSE and the phase 3 TULIP-1/-2 trials.1–3 Anaphylactic reactions (ARs), hypersensitivity reactions (HSRs), and infusion-related reactions (IRRs) are risks of mAb infusions, so physicians prescribing anifrolumab may wish to understand the hypersensitivity profile and whether prophylactic pretreatments are required to mitigate HSR/IRRs.

Objectives

To evaluate the hypersensitivity profile of anifrolumab and the need for pretreatment.

Methods

Pooled data were analyzed from patients with moderate to severe SLE despite standard therapy who received intravenous infusions (every 4 weeks, 48 weeks) of anifrolumab or placebo in the randomized, 52-week MUSE (NCT01438489),1 TULIP-1 (NCT02446912),2 and TULIP-2 (NCT02446899)3 trials. An AR (analyzed in the anifrolumab 150/300/1000 mg and placebo groups) was defined as acute illness onset within minutes to several hours of infusion with involvement of skin and/or mucosal tissue, and/or respiratory compromise, and/or reduced blood pressure, and/or persistent gastrointestinal symptoms. HSRs and IRRs were analyzed in the anifrolumab 300 mg group (as this is the approved dose) and the placebo group. An HSR was defined as acute illness onset with involvement of skin and/or mucosal tissue during infusion (not meeting the AR definition); IRR was defined as any other reaction occurring during/within 24 hours of infusion. Patients did not receive pretreatment unless they had experienced a previous IRR/HSR in the program. Pretreatment was assumed if a patient received prophylactic antihistamine, corticosteroid, non-steroidal anti-inflammatory drug, and/or dopamine antagonist 1 day before/on the day of infusion.

Results

Of patients who received anifrolumab 300 mg (n=459), anifrolumab 1000 mg (n=105), or placebo (n=466), none experienced ARs; 1 patient who received anifrolumab 150 mg (n=93) experienced an AR. HSRs occurred in 3% (n=12) of anifrolumab 300 mg-treated patients (of whom 4 had a history of HSRs) vs 1% (n=3) in the placebo group. IRRs occurred in 9% (n=43) of anifrolumab-treated patients vs 7% (n=33) in the placebo group. All HSRs and IRRs were mild/moderate in intensity. There were no discontinuations due to HSRs or IRRs in the anifrolumab group, while there were 2 in the placebo group (HSR: n=1; IRR: n=1). In the anifrolumab 300 mg and placebo groups, more patients experienced HSR/IRRs with the initial (1–6) vs later infusions (Figure 1). In the anifrolumab group, the median (median absolute deviation) time to first HSR or IRR was 30.5 (29.5) days or 27.0 (26.0) days, respectively. Of the 12 anifrolumab-treated patients with ≥1 HSR, 3 received subsequent pretreatment, and none had any HSR after the use of pretreatment. Of the 43 anifrolumab-treated patients with ≥1 IRR, 2 received pretreatment, of whom 1 had an IRR after pretreatment and anifrolumab dosage remained unchanged.

Conclusion

Following anifrolumab infusion, ARs were uncommon, and few (3%) patients experienced HSRs. HSRs and IRRs with the approved anifrolumab 300 mg dose were mild to moderate, occurred early in treatment, did not lead to discontinuation, and only rarely required pretreatment. Our data support a safe and manageable hypersensitivity profile for anifrolumab.

References

[1]Furie R, et al. Arthritis Rheumatol. 2017;69:376–86.

[2]Furie R, et al. Lancet Rheumatol. 2019;1:e208–19.

[3]Morand E, et al. N Engl J Med. 2020;382:211–21.

Acknowledgements

Writing assistance was provided by Rosie Butler, PhD, of JK Associates Inc., part of Fishawack Health. This study was sponsored by AstraZeneca.

Disclosure of Interests

Kenneth C Kalunian Consultant of: Aurinia, Equillium, Kezar, BMS, Chemocentryx, Eli Lilly, Biogen, Roche/Genentech, Grant/research support from: Horizon, UCB, Yoshiya Tanaka Speakers bureau: Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Consultant of: Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie, Grant/research support from: Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, Ihor Hupka Employee of: AstraZeneca, Lijin (Jinny) Zhang Shareholder of: AstraZeneca, Employee of: AstraZeneca, Manish Shroff Employee of: AstraZeneca, Shanti Werther Shareholder of: AstraZeneca, Employee of: AstraZeneca, Gabriel Abreu Employee of: AstraZeneca AB, Catharina Lindholm Employee of: AstraZeneca, Raj Tummala Shareholder of: AstraZeneca, Employee of: AstraZeneca

POS0190 EFFICACY AND SAFETY OF BARICITINIB IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM TWO RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PARALLEL-GROUP, PHASE 3 STUDIES

Background

In a 24-week, phase 2 clinical study (NCT02708095) in patients with systemic lupus erythematosus (SLE), baricitinib (BARI), an oral selective inhibitor of Janus kinase 1 and 2 approved for the treatment of rheumatoid arthritis and atopic dermatitis, inhibited the type l interferon gene signature, multiple other cytokine pathways, and improved disease activity (1) (2).

Objectives

To further evaluate the efficacy and safety of BARI in patients with SLE.

Methods

Patients with active SLE receiving stable background therapy were randomised 1:1:1 to BARI 2-mg, 4-mg, or placebo (PBO) once daily in two identically designed, 52-week, phase 3 randomised, PBO-controlled studies. In SLE-BRAVE-I (NCT03616912) and -II (NCT03616964), 760 and 775 patients, respectively were enrolled in a balanced manner across regions, although different countries per region participated in each study. The primary endpoint for both studies was the proportion of patients achieving an SLE Responder Index-4 (SRI-4) response at week 52. Glucocorticoid tapering was encouraged but not required per protocol.

Results

The mean Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) at baseline was 10.1 for both SLE-BRAVE-I and -II participants; musculoskeletal and mucocutaneous domains were the most common domains involved at baseline. In SLE-BRAVE-I, the proportion of SRI-4 responders at week 52 among patients treated with BARI 4-mg (56.7%), but not BARI 2-mg (49.8%), was significantly greater than in patients treated with PBO (45.9%, p = 0.016) (Table 1). No difference was seen in SLE-BRAVE-II (47.1%, 46.3%, and 45.6%, BARI 4-mg, 2-mg, and PBO, respectively). None of the key secondary endpoints, including glucocorticoid tapering or time to first severe flare (SFI), were met in either study. The proportions of patients with serious adverse events (SAEs) were 7.1% and 8.6% for PBO, 9.4% and 13.4% for BARI 2-mg and 10.3% and 11.2% for BARI 4-mg in SLE-BRAVE-I and II, respectively.

Table 1.

Efficacy and safety of baricitinib in patients with SLE-BRAVE-I and -II

SLE-BRAVE-ISLE-BRAVE-IIEfficacy measurePBO (N=253)BARI 2-mg (N=255)BARI 4-mg (N=252)PBO (N=256)BARI 2-mg (N=261)BARI 4-mg (N=258)SRI-4 (W52)116 (45.9)126 (49.8)142 (56.7)*116 (45.6)120 (46.3)121 (47.1)SRI-4 (W24)99 (39.1)114 (44.8)117 (46.5)98 (38.6)104 (40.0)108 (42.1)Severe Flares (n, events)38 (15.0)34 (13.3)26 (10.3)26 (10.2)29 (11.1)29 (11.2)HR for time to first severe flare (SFI) HR [CI]NA0.8 [0.52, 1.32]0.65 [0.40, 1.08]NA1.1 [0.65, 1.89]1.1 [0.67, 1.94]Glucocorticoid sparing36 (30.8)31 (29.2)36 (34.0)33 (31.7)34 (29.8)36 (34.3)LLDAS (W52)66 (26.2)65 (25.7)74 (29.7)59 (23.2)62 (24.0)65 (25.4)Safety measureTEAE210 (83.0)210 (82.4)208 (82.5)198 (77.3)199 (76.2)200 (77.5)SAE18 (7.1)24 (9.4)26 (10.3)22 (8.6)35 (13.4)29 (11.2)

Data are n (%) patients, unless otherwise indicated. BARI=baricitinib; CI=confidence interval; HR=hazard ratio compared with PBO; LLDAS=lupus low disease activity state; N=number of patients in the analysis population; n=number of patients in the specified category; PBO=placebo; TEAE=treatment-emergent adverse event; SAE=serious adverse event; W=week. *p≤0.05 vs PBO.

Conclusion

Although phase 2 data suggested BARI as a potential treatment for patients with SLE (2), the SLE-BRAVE-I and -II phase 3 study results were discordant for the primary outcome measure, with only SLE-BRAVE-I positive, making it difficult to elucidate benefit. Additional analyses are being performed to understand this discordance. No new safety signals were observed.

References

[1]Dörner T, Tanaka Y, et al. Lupus Sci Med. 2020;7(1).

[2]Wallace DJ, Furie RA, et al. Lancet. 2018;392(10143):222-31.

Disclosure of Interests

Eric F. Morand Speakers bureau: Astra Zeneca, Eli Lilly, Novartis, Sanofi, Consultant of: Amgen, AstraZeneca, Asahi Kasei, Biogen, BristolMyersSquibb, Capella, Eli Lilly, EMD Serono, Genentech, Glaxosmithkline, Janssen, Neovacs, Sanofi, Servier, UCB, Wolf, Grant/research support from: Janssen, AstraZeneca, BristolMyersSquibb, Eli Lilly, EMD Serono, GlaxoSmithKline, Yoshiya Tanaka Speakers bureau: Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Consultant of: Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie, Grant/research support from: Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, Richard Furie Consultant of: Eli Lilly, Edward Vital Consultant of: Eli Lilly (consultant and honoraria), Ronald van Vollenhoven Consultant of: Abbvie, Biotest, BMS, Celgene, Crescendo, Eli Lilly and Company, GSK, Janssen, Merck, Novartis, Pfizer, Roche, UCB, Vertex, Grant/research support from: Abbvie, Amgen, BMS, GSK, Pfizer, Roche, UCB, Kenneth Kalunian Consultant of: Eli Lilly, Marta Mosca Consultant of: Eli Lilly, GSK, Astra Zeneca, Thomas Dörner Speakers bureau: AbbVie, Eli Lilly, BMS, Novartis, BMS/Celgene, Janssen, Consultant of: AbbVie, Eli Lilly, BMS, Novartis, BMS/Celgene, Janssen, Daniel J. Wallace Consultant of: Amgen, Eli Lilly and Company, EMD Merck Serono, and Pfizer, Maria Silk Shareholder of: Eli Lilly, Employee of: Eli Lilly, christina dickson Shareholder of: Eli Lilly, Employee of: Eli Lilly, Inmaculada De La Torre Shareholder of: Eli Lilly, Employee of: Eli Lilly, Gabriella Meszaros Shareholder of: Eli Lilly, Employee of: Eli Lilly, Bochao Jia Shareholder of: Eli Lilly, Employee of: Eli Lilly, Brenda Crowe Shareholder of: Eli Lilly, Employee of: Eli Lilly, Michelle A Petri Consultant of: Eli Lilly

POS0235 INTEGRATED SAFETY ANALYSIS UPDATE FOR FILGOTINIB (FIL) IN PATIENTS (PTS) WITH MODERATELY TO SEVERELY ACTIVE RHEUMATOID ARTHRITIS (RA) RECEIVING TREATMENT OVER A MEDIAN OF 2.2 YEARS (Y)

Background

The preferential Janus kinase-1 inhibitor FIL significantly improved signs and symptoms of RA in Phase 2 and 3 trials.1–5 FIL is approved for treatment of moderate to severe active RA in Europe and Japan. Integrated safety analysis of FIL with patient data through 2019 was presented at the 2020 ACR virtual meeting.6

Objectives

To report updated, as-treated data from the FIL integrated safety analysis with increased study drug exposure.

Methods

Data were integrated from 2 Phase 2 (NCT01668641, NCT01894516), 3 Phase 3 (NCT02889796, NCT02873936, NCT02886728), and 2 long-term extension (LTE) (NCT02065700, NCT03025308) trials. Phase 2 and 3 LTE data were through Nov 2020 and Jan 2021, respectively. The as-treated analysis set included all available data for pts receiving ≥1 dose FIL 200 (FIL200) or 100 mg (FIL100), including those rerandomized to FIL for LTE. Exposure-adjusted incidence rates (EAIR)/100 patient-y exposure (PYE) of treatment-emergent adverse events (TEAEs; onset after first dose and no later than 30 days after last dose or new drug first dose date −1 day) and TEAEs of special interest (AESIs) are presented.

Results

3691 pts received FIL200 or FIL100 for 8085.1 PYE (median 2.2, maximum 6.8 y). In the as-treated set, 61% of FIL200 and 45% of FIL100 pts received FIL for ≥2 y, 19% and 5% for ≥3 y, and 11% and 0.5% for ≥4.5 y, respectively. EAIR for TEAEs was higher with FIL100 than FIL200; EAIRs for deaths were 0.5 and 0.3 for FIL200 and FIL100 (Figure 1). Incidences of infections and serious infections were numerically greater for FIL100 vs FIL200, while EAIRs for other AESIs were comparable between doses (Table 1). EAIRs for AESIs tended to decrease since the previous update, except for venous thromboembolism (total FIL 0.1 to 0.2) and malignancies excluding NMSC (total FIL 0.5 to 0.6).

Table 1.

TEAEs of special interest, as-treated set

TEAE, n (%) and EAIR per 100 PYE (95% CI)FIL 200 mgn=2267PYE=5302.5FIL 100 mgn=1647PYE=2782.6Total FILN=3691PYE=8085.1Infectious AEs1206 (53.2)747 (45.4)1927 (52.2)EAIR21.1 (19.7, 22.5)30.2 (26.8, 34.0)21.0 (19.9, 22.3)Serious infectious AEs80 (3.5)57 (3.5)137 (3.7)EAIR1.5 (1.1, 1.9)2.7 (1.9, 3.9)1.6 (1.3, 2.0)Opportunistic infections5 (0.2)4 (0.2)9 (0.2)EAIR0.1 (0, 0.2)*0.1 (0.1, 0.4)*0.1 (0.1, 0.2)*Active tuberculosis03 (0.2)3 (<0.1)EAIR00.1 (0, 0.3)*0 (0, 0.1)*Herpes zoster84 (3.7)30 (1.8)114 (3.1)EAIR1.6 (1.2, 2.0)1.1 (0.8, 1.5)*1.4 (1.1, 1.7)Major adverse cardiovascular eventsa19 (0.8)14 (0.9)33 (0.9)EAIR0.3 (0.2, 0.5)0.5 (0.3, 0.8)*0.4 (0.2, 0.6)Venous thromboembolismb11 (0.5)4 (0.2)15 (0.4)EAIR0.2 (0.1, 0.4)*0.1 (0.1, 0.4)*0.2 (0.1, 0.3)*Atrial systemic thrombotic eventsa1 (<0.1)1 (<0.1)2 (<0.1)EAIR0 (0, 0.1)0 (0, 0.3)0 (0, 0.1)Malignancy excluding NMSC32 (1.4)17 (1.0)49 (1.3)EAIR0.6 (0.4, 0.9)0.6 (0.4, 1.0)*0.6 (0.4, 0.8)NMSC15 (0.7)5 (0.3)20 (0.5)EAIR0.3 (0.2, 0.5)*0.2 (0.1, 0.4)*0.2 (0.2, 0.4)*Gastrointestinal perforations3 (0.1)1 (<0.1)4 (0.1)EAIR0.1 (0, 0.2)*0 (0, 0.3)*0 (0, 0.1)*

*Except when any study had 0 event within the treatment, the Poisson model was not adjusted by study. PYE was defined as (last dose date − first dose date + 1)/365.25.

a

Positively adjudicated.

b

Adjudicated as deep vein thrombosis or pulmonary embolism.

NMSC, nonmelanoma skin cancer

Conclusion

With 1 additional year of exposure since the 2020 report, FIL continues to be well tolerated with no new safety concerns emerging. EAIRs of TEAEs, including deaths, and AESIs remained stable or decreased since the 2020 report, except for slight increases in rates of NMSC and malignancies excluding NMSC. In the context of demonstrated efficacy, both FIL doses had an acceptable risk/benefit profile.

References

[1]Westhovens R et al. Ann Rheum Dis 2017;76:998–1008.

[2]Kavanaugh A et al. Ann Rheum Dis 2017;76:1009–19.

[3]Combe B et al. Ann Rheum Dis 2021;80:848–58.

[4]Genovese MC et al. JAMA 2019;322:315–25.

[5]Westhovens R et al. Ann Rheum Dis 2021;80:727–38.

[6]Winthrop K et al. Arthritis Rheumatol 2020;72(suppl 10); abstract 0229.

Acknowledgements

Funding for DARWIN 1 and 2 was provided by Galapagos NV, and funding for DARWIN 3, FINCH 1, 2, 3, and 4 was provided by Gilead Sciences, Inc., Foster City, CA. Funding for this analysis was provided by Gilead Sciences, Inc. The sponsors participated in the planning, execution, and interpretation of the research. Medical writing support was provided by Gregory Bezkorovainy, MA, of AlphaScientia, LLC, San Francisco, CA; and funded by Gilead Sciences, Inc., Foster City, CA.

Disclosure of Interests

Kevin Winthrop Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly and Co., Galapagos NV, Gilead Sciences, Inc., GlaxoSmithKline, Pfizer, Roche, Regeneron, Sanofi, and UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, and Pfizer, Yoshiya Tanaka Speakers bureau: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol Myers Squibb, Eisai, Chugai, AbbVie, Astellas, Pfizer, Sanofi, Asahi-Kasei, GSK, Mitsubishi-Tanabe, Gilead Sciences, Inc., and Janssen, Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Taisho, and Sanofi, Grant/research support from: AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda, Tsutomu Takeuchi Speakers bureau: AbbVie, AYUMI, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Dainippon Sumitomo, Eisai, Eli Lilly Japan, Gilead Sciences, Inc., Mitsubishi-Tanabe, Novartis, Pfizer Japan, and Sanofi, Consultant of: Astellas, Chugai, and Eli Lilly Japan, Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Mitsubishi-Tanabe, Shionogi, Takeda, and UCB Japan, Alan Kivitz Shareholder of: Amgen, Gilead Sciences, Inc., GlaxoSmithKline, Pfizer, and Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, and Sanofi, Paid instructor for: Celgene, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, and Sanofi, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Genzyme, Gilead Sciences, Inc., Janssen, Novartis, Pfizer, Regeneron, Sanofi, and SUN Pharma Advanced Research, Mark C. Genovese Shareholder of: Gilead Sciences, Inc., Consultant of: AbbVie, Amgen, Beigene, Eli Lilly and Co., Genentech, Inc., Gilead Sciences, Inc., Sanofi Genzyme, RPharm, and SetPoint, Employee of: Gilead Sciences, Inc., Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Franziska Matzkies Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Beatrix Bartok Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Kun Chen Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Deyuan Jiang Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Iyabode Tiamiyu Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Robin Besuyen Shareholder of: Galapagos BV, Employee of: Galapagos BV, Sander Strengholt Shareholder of: Galapagos BV, Employee of: Galapagos BV, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly and Co., Galapagos, Gilead Sciences, Inc., and Pfizer, Consultant of: AbbVie, Eli Lilly and Co., Galapagos, Gilead Sciences, Inc., and Pfizer, Jacques-Eric Gottenberg Speakers bureau: AbbVie, Eli Lilly and Co., Galapagos BV, Gilead Sciences, Inc., Roche, Sanofi Genzyme, and UCB, Consultant of: Bristol Myers Squibb, Sanofi Genzyme, and UCB, Grant/research support from: Bristol Myers Squibb and Pfizer

OP0142 COMPARISON OF ATTAINMENT AND PROTECTIVE EFFECTS OF THE LUPUS LOW DISEASE ACTIVITY STATE IN PATIENTS WITH NEWLY DIAGNOSED VERSUS ESTABLISHED SLE - A MULTICENTRE PROSPECTIVE STUDY

Background

Lupus low disease activity state (LLDAS) attainment has been reported to be associated with reduced damage accrual, flare, and mortality, as well as improved quality of life, in cohorts of SLE patients with established disease. Whether these associations are present in recent-onset disease is less well known.

Objectives

To evaluate the associations of LLDAS attainment with outcomes in patients with recent onset SLE.

Methods

Data from a 13-country longitudinal SLE cohort (ACR/SLICC criteria) were collected prospectively between 2013 and 2020 using standard templates. Organ damage and flare were captured using SLICC Damage Index and SELENA-SLEDAI Flare Index, respectively. LLDAS was defined as Golder et al., 2019 [1]. An inception cohort was defined based on duration since SLE diagnosis<1 year at enrolment. Patient characteristics between inception and non-inception cohorts were compared using Wilcoxon rank-sum (continuous variables) or Pearson’s Chi-squared tests (categorical variables). Survival analyses were performed to examine the association between LLDAS attainment and damage accrual and flare.

Results

The study cohort included 4,106 patients of whom 680 (16%) were recruited within 1 year of SLE diagnosis (inception cohort). Compared to the non-inception cohort, inception cohort patients were significantly younger, had higher disease activity (SLEDAI-2K and physician global assessment), used more glucocorticoids and immunosuppressants but had less organ damage at enrolment and only 88 (13.6%) patients accrued damage during a median 2.2 years follow-up (Table 1).

Table 1.Non-inception cohortInception cohortp-valuen=3426n=680Age at enrolment (years), median [IQR]40 [31, 51]33 [25, 44]<0.001Age at diagnosis (years), median [IQR]28 [21, 38]33 [25, 43]<0.001SLE duration at enrolment (years), median [IQR]10 [5, 16]1 [0, 1]<0.001Study duration (years), median [IQR]2.5 [1.0, 5.4]2.2 [0.9, 3.7]<0.001Females, n (%)3155 (92.1%)623 (91.6%)0.68Asian ethnicity, n (%)3037 (89.1%)595 (88.1%)0.49Prednisolone (PNL) use - ever, n (%)2865 (83.6%)620 (91.2%)<0.001Time adjusted mean (TAM)-PNL, median [IQR]5.0 [2.2, 8.6]6.2 [3.2, 10.3]<0.001Cumulative PNL (g), median [IQR]3.4 [0.5, 9.7]3.8 [1.1, 8.5]0.26Anti-Malarial use - ever, n (%)2669 (77.9%)569 (83.7%)<0.001Immunosupressant use -ever, n (%)2367 (69.1%)521 (76.6%)<0.001AMS (TAM-SLEDAI-2K), median [IQR]2.8 [1.2, 4.6]3.1 [1.6, 5.0]0.002TAM-PGA, median [IQR]0.4 [0.2, 0.7]0.4 [0.3, 0.8]<0.001Mild/moderate/severe flare ever, n (%)1789 (52.2%)391 (57.5%)0.012Organ damage accrual, n (%)629 (20.8%)88 (13.6%)<0.001LLDAS at baseline, n (%)1730 (50.5%)195 (28.7%)<0.001LLDAS-ever (at least once), n (%)2637 (78.2%)492 (73.9%)0.014≥50% time in LLDAS (LLDAS-5), n (%)1612 (50.6%)256 (41.1%)<0.001

Significantly fewer inception cohort patients were in LLDAS at enrolment than the non-inception cohort (29% vs. 51%, p<0.001). However, 74% of inception and 78% of non-inception cohort patients achieved LLDAS at least once during follow-up. Limiting analysis only to patients not in LLDAS at enrolment, time to first LLDAS attainment was assessed: inception cohort patients were 60% more likely to attain their first LLDAS (HR = 1.60 (95%CI: 1.40, 1.82), p<0.001) than non-inception cohort patients. LLDAS attainment was significantly protective against flare in the inception (HR, 95% CI) and non-inception (HR, 95% CI) cohorts. Trends towards protection against damage accrual in association with LLDAS in the inception cohort were not significant.

Conclusion

LLDAS attainment is protective from flare in recent onset SLE. Significant protection from damage accrual was not observed, due to low rates of damage accrual in the first years after SLE diagnosis.

References

[1]Golder, V., et al., Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. The Lancet Rheumatology, 2019. 1(2): p. e95-e102.

Acknowledgements

We thank all patients participating in the Asia Pacific Lupus Collaboration (APLC) cohort, and all data collectors for their ongoing support for APLC research activities.

The APLC has received unrestricted project grants from AstraZeneca, BMS, Eli Lily, Janssen, Merck Serono, and UCB to support data collection contributing to this work.

Disclosure of Interests

Vera Golder: None declared, Rangi Kandane-Rathnayake: None declared, Worawit Louthrenoo: None declared, Yi-Hsing Chen Speakers bureau: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Lilly, GSK, Astra& Zeneca, Sanofi, MSD, Guigai, Astellas, Inova Diagnostics, UCB, Agnitio Science Technology, United Biopharma, Thermo Fisher, Consultant of: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Lilly, GSK, Astra and Zeneca, Sanofi, Guigai, Astellas, Inova Diagnostics, UCB, Agnitio Science Technology, United Biopharma, Thermo Fisher, Gilead, Grant/research support from: Yes. Clinical trials and/or research grants from Pfizer, Norvatis, BMS, Abbevie, Johnson & Johnson, Roche,Sanofi, Guigai, Roche, Boehringer Ingelheim, UCB, MSD, Astra-Zeneca,Astellas, Gilead, Jiacai Cho: None declared, Aisha Lateef: None declared, Laniyati Hamijoyo Speakers bureau: Pfizer, Novartis, Abbot, Shue Fen Luo: None declared, Yeong-Jian Jan Wu Speakers bureau: Pfizer, Lilly, Novartis, Abbvie, Sandra Navarra Speakers bureau: Pfizer, Johnson & Johnson, Novartis, Astellas, Grant/research support from: Astellas, Johnson & Johnson, Leonid Zamora: None declared, Zhanguo Li Speakers bureau: Eli, Lilly, Novartis, GSK, AbbVie, Paid instructor for: Pfizer, Roche, Johnson, Consultant of: Lilly, Pfizer, Grant/research support from: Pfizer, Yuan An: None declared, Sargunan Sockalingam Speakers bureau: Yes. Pfizer, Roche, Novartis, Grant/research support from: Roche and Novartis, Yasuhiro Katsumata Speakers bureau: Chugai Pharmaceutical Co., Ltd., Glaxo-Smithkline K.K., and Sanofi K.K., Masayoshi Harigai Speakers bureau: MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc.,Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd, Consultant of: MH is a consultant for AbbVie, Boehringer-ingelheim, Bristol Myers Squibb Co., Kissei Pharmaceutical Co.,Ltd. and Teijin Pharma., Grant/research support from: MH has received research grants from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc.,Eisai Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., Sekiui Medical, Shionogi & Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Yanjie Hao: None declared, Zhuoli Zhang Speakers bureau: Norvatis, GSK, Pfizer, BMDB Basnayake: None declared, Madelynn Chan Speakers bureau: AbbVie, Novartis, Consultant of: Advisory Board member for Pfizer, Eli-Lilly, Jun Kikuchi: None declared, Tsutomu Takeuchi Speakers bureau: AbbVie AYUMI Pharmaceutical Corp. Bristol-Myers Squibb Chugai Pharmaceutical Co, Ltd. Daiichi Sankyo Co., Ltd. Eisai Co., Ltd. Eli Lilly Japan, Gilead Sciences, Inc. Mitsubishi-Tanabe Pharma Corp. Pfizer Japan Inc. Sanofi K.K., Consultant of: Astellas Pharma, Inc. Chugai Pharmaceutical Co, Ltd. Eli Lilly Japan, Mitsubishi-Tanabe Pharma Corp., Grant/research support from: AbbVie Asahikasei Pharma Corp. Chugai Pharmaceutical Co, Ltd. Mitsubishi-Tanabe Pharma Corp. Sanofi K.K, Sang-Cheol Bae: None declared, Sean O’Neill Paid instructor for: Advisory board member for GSK, Fiona Goldblatt: None declared, Shereen Oon: None declared, Kathryn Gibson Speakers bureau: UCB, Consultant of: Novartis – co-chair for NSW and steering committee member for ARISE meeting Feb 2021

Janssen Pharmaceuticals – advisory board, Grant/research support from: Novartis, Employee of: Eli Lilly, Kristine Ng Speakers bureau: speaker fees and advisory board (Abbvie, Novartis, Janssen), Annie Law: None declared, Nicola Tugnet: None declared, Sunil Kumar: None declared, Cherica Tee: None declared, Michael Tee: None declared, Yoshiya Tanaka Speakers bureau: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen, Grant/research support from: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen, C.S. Lau Shareholder of: Pfizer, Sanofi and Janssen, Mandana Nikpour Speakers bureau: Actelion, GSK, Janssen, Pfizer, UCB, Paid instructor for: UCB, Consultant of: Actelion, Boehringer Ingelheim, Certa Therapeutics, Eli Lilly, GSK, Janssen, Pfizer, UCB, Grant/research support from: Actelion, Astra Zeneca, BMS, GSK, Janssen, UCB, Alberta Hoi Consultant of: AH is on the advisory board for Abbvie and GSK, Grant/research support from: AH has received research support from AstraZeneca, GSK, BMS, Janssen, and Merck Serono, Eric F. Morand Speakers bureau: AstraZeneca, Paid instructor for: Eli Lilly, Consultant of: AstraZeneca, Amgen, Biogen, BristolMyersSquibb, Eli Lilly, EMD Serono, Genentech, Janssen, Grant/research support from: AstraZeneca, BristolMyersSquibb, Eli Lilly, EMD Serono, Janssen

POS0387 RISK STRATIFICATION APPROACHES PERFORM DIFFERENTLY IN SSc-ASSOCIATED PAH IN EUSTAR

Background

Pulmonary arterial hypertension (PAH) is a major clinical challenge in systemic sclerosis (SSc), and is associated with high mortality. Risk stratification provides an estimate for individual patient risk of 1-year mortality. The aim is to detect patients with the worst prognosis to optimize management strategies. Nine risk stratification approaches have been proposed in PAH, but have not been validated in SSc-PAH.

Objectives

To assess four risk stratification models and their performance to predict 1- and 3- year mortality and to identify the best risk assessment approach for SSc-PAH.

Methods

We included all patients with SSc diagnosed with PAH by right heart catheterization (RHC) from the European scleroderma trial and research (EUSTAR) database from 2001 to February 2021. PAH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg, pulmonary artery wedge pressure (PAWP) ≤15mmHg, and pulmonary vascular resistance (PVR) >3 Wood units (WU) in the absence of significant interstitial lung disease. We applied four different approaches for risk stratification at time of PAH diagnosis. Risk parameters included New York Heart Association (NYHA) class, 6-minute walk distance (6MWD), NT-proBNP or BNP, and echocardiographic and hemodynamic parameters with cut-off values based on the 2015 ESC/ERS Guidelines. Model 1 and 2 stratified patients into low, intermediate and high-risk categories; while Model 3 and 4 stratified the patients into four categories (low, intermediate-low, intermediate-high and high).

Model 1: Patients with ≥ 1 high-risk parameter were considered at high risk; with ≥ 1 intermediate-risk parameter at intermediate risk, otherwise at low risk1

Model 2: Each variable was graded from 1 to 3 representing low to high risk. The mean of available risk parameters was rounded to the nearest integer to define the risk category2

Model 3: Equals Model 2, but the intermediate risk group was divided into intermediate-low and intermediate-high based on the mean score3

Model 4: Stratifies patients into four risk categories based on the proportion of low-risk parameters3

We performed analysis of 1- and 3- year mortality in patients with a minimum follow-up of 1 and 3 years, respectively.

Results

Of 911 patients who conducted RHC, 273 (30%) were diagnosed with SSc-PAH according to the inclusion criteria (Table 1). Median follow-up time was 2.8 years (IQR 1.3-5.3). The models varied in their ability to predict mortality (Figure 1). Model 1 and 4 either over- or underestimated mortality. Model 2 stratified patients according to the expected 1-year mortality of <5%, 5-10% and >10% suggested by the ESC/ERS Guidelines. Model 3, which divided the intermediate risk group in two different risk groups, segregated the risk of mortality further within this group.

Table 1.

Demographic and clinical characteristics of patients segregated by risk stratification (Model 3)

NAll patients (n=273)Low-risk (n=78)Intermediate-low (n=118)Intermediate-high (n=56)High-risk (n=21)Age, years (SD)27365 (10.7)65 (10.3)65 (10.7)65 (10.8)67 (12.8)Female sex, n (%)273230 (84)64 (82)98 (83)48 (86)20 (95)lcSSc, n (%)263221 (84)60 (80)99 (86)47 (90)15 (71)NYHA 3 or 4, n (%)261155 (59)12 (16)75 (68)49 (89)19 (95)NT-proBNP, pg/ml (IQR)1111941 (230-1485)215 (103-377)763 (325-1418)1926 (1051-5681)3314 (1129-6553)6MWD, m (SD)196321 (124.1)404 (119.7)314 (99.9)262 (128.6)215 (96.0)RHC:- mPAP, mmHg (SD)27340 (11.0)35 (8.8)41 (11.5)41 (10.8)45 (11.6)- PAWP, mmHg (SD)2739 (3.2)9 (3.0)9 (3.4)9 (3.2)8 (3.1)- Cardiac index, l/min/m2(SD)2602.8 (0.8)3.2 (0.7)2.7 (0.8)2.6 (1.0)2.0 (0.5)- PVR, WU (SD)2737.4 (4.1)5.3 (2.8)7.9 (4.0)7.9 (4.2)11.3 (4.7)Figure 1.

1- and 3-year mortality according to risk category in the four different models

Conclusion

Model 3 provides signals for a better risk stratification of patients with newly diagnosed SSc-PAH, with progressively increasing mortality across the categories. This may provide guidance for optimized management in clinical practice.

References

[1]Hoffmann-Vold, Rheum 2018

[2]Kylhammar, Eur Heart J 2018

[3]Kylhammar, ERJ open 2021

Acknowledgements

The authors thank all EUSTAR collaborators.

Disclosure of Interests

Hilde Jenssen Bjørkekjær: None declared, Cosimo Bruni Speakers bureau: Actelion, Consultant of: Boehringer-Ingelheim, Patricia Carreira: None declared, Paolo Airò Speakers bureau: Boehringer Ingelheim, Bristol-Myers-Squibb, Consultant of: Bristol-Myers-Squibb, Grant/research support from: Bristol-Myers-Squibb, Roche, Janssen, CSL Behring, Carmen Pilar Simeón-Aznar Speakers bureau: Janssen, Boehringer Ingelheim and MSD, Consultant of: Janssen, Boehringer Ingelheim, Marie-Elise Truchetet: None declared, Alessandro Giollo: None declared, Alexandra Balbir-Gurman: None declared, Mickael Martin: None declared, Christopher P Denton Speakers bureau: Boehringer Ingelheim; Janssen, Consultant of: Boehringer Ingelheim; GSK; Corbus; Sanofi; Roche; Horizon; CSL Behring; Acceleron, Grant/research support from: CSL Behring; Horizon; GSK; Servier, Armando Gabrielli: None declared, Håvard Fretheim Consultant of: Bayer, GSK, Actelion, Imon Barua: None declared, Helle Bitter Speakers bureau: Boehringer Ingelheim, Øyvind Midtvedt: None declared, Kaspar Broch: None declared, Arne Andreassen: None declared, Yoshiya Tanaka Speakers bureau: Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Consultant of: Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie, Grant/research support from: Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, Gabriela Riemekasten: None declared, Ulf Müller-Ladner: None declared, Marco Matucci-Cerinic: None declared, Ivan Castellví: None declared, Elise Siegert: None declared, Eric Hachulla Speakers bureau: Johnson & Johnson, GlaxoSmithKline, Roche-Chugai, Consultant of: Bayer, Boehringer Ingelheim, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, Grant/research support from: CSL Behring, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, Oliver Distler Speakers bureau: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Grant/research support from: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim, Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim

OP0112 THE EVER-LARGEST ASIAN GWAS FOR SYSTEMIC SCLEROSIS AND TRANS-POPULATION META-ANALYSIS IDENTIFIED SEVEN NOVEL LOCI AND A CANDIDATE CAUSAL SNP IN A CIS-REGULATORY ELEMENT OF THE FCGR REGION

Background

Genome-wide association studies (GWASs) have identified 29 disease-associated single nucleotide polymorphisms (SNPs) for systemic sclerosis (SSc) in non-human leukocyte antigen (HLA) regions (1-7). While these GWASs have clarified genetic architectures of SSc, study subjects were mainly Caucasians limiting application of the findings to Asians.

Objectives

The study was conducted to identify novel causal variants for SSc specific to Japanese subjects as well as those shared with European population. We also aimed to clarify mechanistic effects of the variants on pathogenesis of SSc.

Methods

A total of 114,108 subjects comprising 1,499 cases and 112,609 controls were enrolled in the two-staged study leading to the ever-largest Asian GWAS for SSc. After applying a strict quality control both for genotype and samples, imputation was conducted using the reference panel of the phase 3v5 1,000 genome project data combined with a high-depth whole-genome sequence data of 3,256 Japanese subjects. We conducted logistic regression analyses and also combined the Japanese GWAS results with those of Europeans (6) by an inverse-variance fixed-effect model. Polygenicity and enrichment of functional annotations were evaluated by linkage disequilibrium score regression (LDSC), Haploreg and IMPACT programs. We also constructed polygenic risk score (PRS) to predict SSc development.

Results

We identified three (FCRLA-FCGR, TNFAIP3, PLD4) and four (EOMES, ESR1, SLC12A5, TPI1P2) novel loci in Japanese GWAS and a trans-population meta-analysis, respectively. One of Japanese novel risk SNPs, rs6697139, located within FCGR gene clusters had a strong effect size (OR 2.05, P=4.9×10-11). We also found the complete LD variant, rs10917688, was positioned in cis-regulatory element and binding motif for an immunomodulatory transcription factor IRF8 in B cells, another genome-wide significant locus in our trans-ethnic meta-analysis and the previous European GWAS. Notably, the association of risk allele of rs10917688 was significant only in the presence of the risk allele of the IRF8. Intriguingly, rs10917688 was annotated as one enhancer-related histone marks, H3K4me1, in B cells, implying that FCGR gene(s) in B cells may play an important role in the pathogenesis of SSc. Furhtermore, significant heritability enrichment of active histone marks and a transcription factor C-Myc were found in B cells both in European and Japanese populations by LDSC and IMPACT, highlighting a possibility of a shared disease mechanism where abnormal B-cell activation may be one of the key drivers for the disease development. Finally, PRS using effects sizes of European GWAS moderately fit in the development of Japanese SSc (AUC 0.593), paving a path to personalized medicine for SSc.

Conclusion

Our study identified seven novel susceptibility loci in SSc. Downstream analyses highlighted a novel disease mechanism of SSc where an interactive role of FCGR gene(s) and IRF8 may accelerate the disease development and B cells may play a key role on the pathogenesis of SSc.

References

[1]F. C. Arnett et al. Ann Rheum Dis, 2010.

[2]T. R. Radstake et al. Nat Genet, 2010.

[3]Y. Allanore et al. PLoS Genet, 2011.

[4]O. Gorlova et al. PLoS Genet, 2011.

[5]C. Terao et al. Ann Rheum Dis, 2017.

[6]E. López-Isac et al. Nat Commun, 2019.

[7]W. Pu et al. J Invest Dermatol, 2021.

Disclosure of Interests

None declared

POS0679 CLINICAL OUTCOMES UP TO WEEK (W) 48 IN THE ONGOING FILGOTINIB (FIL) LONG-TERM EXTENSION (LTE) TRIAL OF RHEUMATOID ARTHRITIS (RA) PATIENTS (pts) WITH INADEQUATE RESPONSE (IR) TO METHOTREXATE (MTX) INITIALLY TREATED WITH FIL OR ADALIMUMAB (ADA) DURING THE PHASE 3 PARENT STUDY (PS)

Background

The preferential Janus kinase-1 inhibitor FIL is approved for treatment of moderate to severe active RA in Europe and Japan.

Objectives

Efficacy and safety of FIL were assessed in pts with IR to MTX who completed a Phase 3 trial (NCT02889796)1 and enrolled in an LTE (NCT03025308).

Methods

Pts completing the PS1 on study drug were eligible to enter the LTE (data cutoff: June 1, 2020). Median exposure: 2.2 years (y). Efficacy data to W48 are reported for 4 treatment groups (all with background MTX): pts receiving FIL 200 mg (FIL200) or FIL 100 mg (FIL100) in the PS and continuing their dose in LTE (FIL200/FIL200, FIL100/FIL100) and ADA pts rerandomized, double blind, to FIL200 or FIL100 for LTE (ADA/FIL200, ADA/FIL100); safety data are reported.

Results

As of June 1, 2020, 522/571 (91%) FIL200/FIL200, 502/570 (88%) FIL100/FIL100, 118/128 (92%) ADA/FIL200, and 115/130 (89%) ADA/FIL100 pts remained on study drug. LTE baseline disease characteristics were similar between groups: mean duration of RA approximately 8.7 y; DAS28(CRP) 2.55, and mean concurrent MTX dosage was 15.0 mg/week. Proportions of pts achieving ACR20/50/70, DAS28(CRP) ≤3.2, <2.6, and CDAI ≤10, ≤2.8 were generally maintained in all LTE groups through W48 (Figure 1). Numerically greater proportions of pts met response criteria at W48 in the FIL200 groups vs FIL100, regardless of PS treatment. Treatment-emergent AEs (TEAE), serious AEs, and AEs Grade ≥3 were largely comparable between groups and lowest in ADA/FIL100. There were 10 deaths (Table 1). Exposure-adjusted incidence rates (EAIRs)/100 pt-y of exposure for deaths were lower for FIL/FIL vs ADA/FIL.

Table 1.

EAIRs of TEAEs in LTE, as of June 1, 2020

1TEAE, n (%)3FIL200+MTX → FIL200+MTX6ADA+MTX → FIL200+MTX9FIL100+MTX → FIL100+MTX12ADA+MTX → FIL100+MTX2EAIR (95% CI)4n=5717n=12810n=57013n=1305PYE=859.48PYE=197.811PYE=852.314PYE=192.6TEAE429 (75.1)91 (71.1)443 (77.7)88 (67.7)49.9 (45.4, 54.9)46.0 (37.5, 56.5)52.0 (47.4, 57.0)45.7 (37.1, 56.3)TEAE Grade ≥364 (11.2)15 (11.7)72 (12.6)7 (5.4)7.4 (5.8, 9.5)7.6 (4.6, 12.6)8.4 (6.7, 10.6)3.6 (1.7, 7.6)TE serious AE52 (9.1)13 (10.2)60 (10.5)9 (6.9)6.1 (4.6, 7.9)6.6 (3.8, 11.3)7.0 (5.5, 9.1)4.7 (2.4, 9.0)Death3 (0.5)2 (1.6)3 (0.5)2 (1.5)0.3 (0.1, 1.1)1.0 (0.3, 4.0)0.4 (0.1, 1.1)1.0 (0.3, 4.2)TE infections243 (42.6)52 (40.6)249 (43.7)43 (33.1)28.3 (24.9, 32.1)26.3 (20.0, 34.5)29.2 (25.8, 33.1)22.3 (16.6, 30.1)TE serious infections7 (1.2)2 (1.6)13 (2.3)1 (0.8)0.8 (0.4, 1.7)1.0 (0.3, 4.0)1.5 (0.9, 2.6)0.5 (0.1, 3.7)Opportunistic infections2 (0.4)02 (0.4)00.2 (0, 0.8)0 (0, 1.9)0.2 (0, 0.8)0 (0, 1.9)TE herpes zoster16 (2.8)5 (3.9)13 (2.3)1 (0.8)1.9 (1.1, 3.0)2.5 (1.1,6.1)1.5 (0.9, 2.6)0.5 (0.1, 3.7)TE MACE (adjudicated)1 (0.2)03 (0.5)3 (2.3)01 (0, 0.6)0 (0, 1.9)0.4 (0.1, 1.1)1.6 (0.5, 4.8)TE DVT/PE (adjudicated)3 (0.5)03 (0.5)00.3 (0.1, 1.0)0 (0, 1.9)0.4 (0.1, 1.0)0 (0, 1.9)Malignancies (excluding NMSC)5 (0.9)3 (2.3)4 (0.7)00.6 (0.2, 1.4)1.5 (0.5, 4.7)0.5 (0.1, 1.2)0 (0, 1.9)NMSC3 (0.5)02 (0.4)00.3 (0.1, 1.0)0 (0, 1.9)0.2 (0, 0.8)0 (0, 1.9)

DVT, deep vein thrombosis; MACE, major adverse cardiovascular event; NMSC, nonmelanoma skin cancer; PE, pulmonary embolism; TE, treatment-emergent

Figure 1.

Conclusion

During the LTE through W48, response rates generally were maintained for FIL/FIL and ADA/FIL pts. Though there were differences between LTE groups, safety was largely comparable and consistent with PS observations1 and previously reported results from 7 trials2: rates of AEs of special interest were low; all confidence intervals were overlapping. Limitation: the LTE was not formally randomized for comparison between FIL/FIL and ADA/FIL treatment groups, the groups were of unequal size, and the switch from ADA to FIL for LTE was by design, rather than based on disease activity.

References

[1]Combe B et al. Ann Rheum Dis 2021;80:848–58.

[2]Winthrop K et al. Arthritis Rheumatol 2020;72(suppl 10); abstract 0229.

Acknowledgements

This study was funded by Gilead Sciences, Inc., Foster City, CA. Medical writing support was provided by Claudine Bitel, PhD, of AlphaScientia, LLC, San Francisco, CA; and funded by Gilead Sciences, Inc., Foster City, CA.

Disclosure of Interests

Bernard Combe Speakers bureau: BMS, Eli Lilly & Co., Gilead Sciences, Inc., MSD, Pfizer, Roche-Chugai, and UCB, Consultant of: AbbVie, Eli Lilly & Co., Gilead Sciences, Inc., Janssen, Pfizer, Roche-Chugai, and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche-Chugai, Yoshiya Tanaka Speakers bureau: AbbVie, Asahi-Kasei, Astellas, Bristol-Myers, Chugai, Daiichi- Sankyo, Eli Lilly, Eisai, Gilead, GSK, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, and YL Biologics, Consultant of: AbbVie, Ayumi, Daiichi- Sankyo, Eli Lilly, GSK, Sanofi, and Taisho, Grant/research support from: AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda, Paul Emery Consultant of: AbbVie, BMS, Celltrion, Gilead, Lilly, Novartis, Roche, Samsung, and Sandoz, Grant/research support from: AbbVie, BMS, Lilly, and Samsung, Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Albert Kuo Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Qi Gong Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Katrien Van Beneden Shareholder of: Galapagos NV, Employee of: Galapagos NV, Vijay Rajendran Shareholder of: Galapagos NV, Employee of: Galapagos NV, Hendrik Schulze-Koops Speakers bureau: AbbVie, Amgen, BMS, Celgene, Celltrion, Chugai, Gilead, Janssen, Eli Lilly and Company, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, and Sanofi, Consultant of: AbbVie, Amgen, BMS, Celgene, Celltrion, Chugai, Gilead, Janssen, Eli Lilly and Company, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, and Sanofi, Grant/research support from: AbbVie and Novartis

POS0664 RADIOGRAPHIC CHANGE IN PATIENTS WITH RHEUMATOID ARTHRITIS AND ESTIMATED BASELINE YEARLY PROGRESSION ≥5 OR <5: POST HOC ANALYSIS OF TWO PHASE 3 TRIALS OF FILGOTINIB

Background

In some patients (pts) with rheumatoid arthritis (RA), especially those with joint damage early in the disease, first-line methotrexate (MTX) treatment may not suffice to prevent further rapid radiographic progression (RRP).1 In FINCH 1 (NCT02889796), filgotinib 200 mg (FIL200) and 100 mg (FIL100) reduced change in modified total Sharp score (mTSS) vs placebo (PBO) in pts with RA and inadequate response to MTX (MTX-IR).2 In FINCH 3 (NCT02886728), FIL200 and FIL100 reduced change in mTSS vs MTX monotherapy (MTX mono) in MTX-naïve pts.3

Objectives

To evaluate, via post hoc analysis of 2 trials, filgotinib’s effects on radiographic progression vs MTX mono in pts with estimated baseline (BL) yearly progression ≥5 or <5 mTSS units/year.

Methods

The double-blind 52-week (W) FINCH 1 study randomised MTX-IR pts with moderate–severe active RA to FIL200 or FIL100, subcutaneous adalimumab (ADA) 40 mg, or PBO; at W24, PBO pts were rerandomised blinded to FIL200 or FIL100; all took stable background MTX.2 In FINCH 3, MTX-naïve pts were randomised, blinded, to FIL200 + MTX, FIL100 + MTX, FIL200 alone, or MTX mono for up to W52.3 This analysis examined subgroups by estimated BL yearly progression (BL mTSS/duration in years of RA diagnosis), based on ≥5 or <5 mTSS units/year,4 a threshold commonly used to define RRP. We assessed effects of filgotinib vs ADA or PBO in mTSS change from BL (CFB) at W24/W52 (using a mixed model for repeated measures) and percentages with no W24 progression (mTSS change ≤0, ≤0.5, ≤smallest detectable change [SDC], using Fisher’s exact test).

Results

At BL, 558/1755 MTX-IR and 787/1249 MTX-naïve pts had BL estimated yearly progression ≥5. Median mTSS in pts with BL yearly progression ≥5 and <5 was 53.25 vs 5.00 respectively in the MTX-IR trial and 6.00 vs 2.50 in the MTX-naïve trial. At W24, the mTSS CFB in pts with BL yearly progression ≥5 and <5 was 0.84 and 0.22 in MTX-IR pts taking PBO + MTX, and 0.67 and 0.25 in MTX-naïve pts taking MTX mono. At W52, in pts with BL yearly progression ≥5, FIL200 + MTX reduced mTSS change vs PBO + MTX in the MTX-IR trial and vs MTX mono in the MTX-naïve trial (Figure 1). At W24, among pts with estimated BL yearly progression ≥5, FIL200 + MTX increased odds of no progression (≤0.5 or ≤0) vs PBO + MTX in MTX-IR pts and vs MTX mono in MTX-naïve pts (Table 1).

Table 1.

Ratio of no radiographic progression at W24

FINCH 1: MTX-IRFIL200 + MTXFIL100 + MTXADA + MTXPBO + MTXBL yearly progression≥5(n = 138)<5(n = 267)≥5(n = 139)<5(n = 265)≥5(n = 91)<5(n = 180)≥5(n = 101)<5(n = 250)% with no progression (≤0.5)87.797.088.592.587.993.976.291.6OR2.22*2.97*2.40*1.12††††% with no progression (≤0)80.491.881.388.380.289.467.386.4OR2.00*1.752.11*1.19††††% with no progression (≤SDC [1.36])91.398.192.196.692.395.681.294.0OR2.43*3.35*2.70*1.82††††FINCH 3: MTX-naïveFIL200 + MTXFIL100 + MTXFIL200 monoMTXBL yearly progression≥5<5≥5<5≥5<5≥5<5(n = 221)(n = 134)(n = 121)(n = 63)(n = 115)(n = 58)(n = 224)(n = 132)% with no progression (≤0.5)86.994.083.593.789.689.778.687.9OR1.81*2.171.382.032.34*1.20††% with no progression (≤0)78.783.672.784.180.087.967.980.3OR1.75*1.251.261.31.89*1.79††% with no progression (≤SDC [1.53])93.797.891.796.895.796.689.395.5OR1.772.081.331.452.641.33††

MTX-IR ORs are FIL vs PBO + MTX; MTX-naïve are FIL vs MTX. *Nominal P<.05. †Not applicable.

ADA, adalimumab; FIL, filgotinib; IR, inadequate response; mTSS, modified total Sharp score; MTX, methotrexate; OR, odds ratio; SDC, smallest detectable change; W, week.

Conclusion

These data suggest filgotinib’s inhibition of radiographic progression was numerically greater than MTX monotherapy in RA pts with high estimated BL yearly progression. In those with a more moderate estimated rate of progression, filgotinib suppressed progression comparably to ADA and/or MTX.

References

[1]Smolen J et al. Ann Rheum Dis 2018;77:1566–1572.

[2]Combe B et al. Ann Rheum Dis 2021;80:848–858.

[3]Westhovens R et al. Ann Rheum Dis 2021;80:727–738.

[4]Vastesaeger N et al. Rheumatology. 2009;48:1114–1121.

Acknowledgements

This study was funded by Gilead Sciences, Inc., Foster City, CA. Medical writing support was provided by Rob Coover, MPH, of AlphaScientia, LLC, San Francisco, CA; and funded by Gilead Sciences, Inc., Foster City, CA. Funding for this analysis was provided by Gilead Sciences, Inc. The sponsors participated in the planning, execution, and interpretation of the research.

Disclosure of Interests

Yoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, Behringer-Ingelheim, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi-Tanabe, and YL Biologics, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer-Ingelheim, Chugai, Corrona, Daiichi Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda, Tatsuya Atsumi Paid instructor for: Gilead Sciences, Inc.; Mitsubishi Tanabe; Chugai; Astellas Pharma; Takeda; Pfizer; AbbVie: Eisai; Daiichi Sankyo; Bristol-Myers Squibb; UCB Japan Co. Ltd.; Eli Lilly Japan K.K., Otsuka Pharmaceutical Co., Ltd.; and Alexion Inc., Grant/research support from: Gilead Sciences, Inc.; Mitsubishi Tanabe; Chugai; Astellas Pharma; Takeda; Pfizer; AbbVie: Eisai; Daiichi Sankyo; Bristol-Myers Squibb; UCB Japan Co. Ltd.; Eli Lilly Japan K.K., Otsuka Pharmaceutical Co., Ltd.; and Alexion Inc., Daniel Aletaha Speakers bureau: AbbVie; Amgen; Celgene; Eli Lilly; Medac; Merck; Novartis; Pfizer; Roche; Sandoz; and Sanofi/Genzyme; Bristol-Myers Squibb, Merck Sharp & Dohme, and UCB, Consultant of: Janssen; AbbVie; Amgen; Celgene; Eli Lilly; Medac; Merck; Novartis; Pfizer; Roche; Sandoz; and Sanofi/Genzyme, Grant/research support from: AbbVie, Merck Sharp & Dohme, Novartis, and Roche, Robert B.M. Landewé Paid instructor for: AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos NV, Novartis, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos NV, Novartis, Pfizer, and UCB, Beatrix Bartok Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc, Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Zhaoyu Yin Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Ling Han Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Kahaku Emoto Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences K.K., Shungo Kano Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences K.K., Vijay Rajendran Employee of: Galapagos BV, Tsutomu Takeuchi Speakers bureau: AbbVie, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Dainippon Sumitomo Eisai, Eli Lilly Japan, Mitsubishi-Tanabe, Novartis, Pfizer Japan, Sanofi, and Gilead Sciences, Inc., Consultant of: Astellas, Chugai, and Eli Lilly Japan, Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Mitsubishi-Tanabe, Shionogi, Takeda, and UCB Japan

OP0255 BIMEKIZUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AND AN INADEQUATE RESPONSE TO TUMOUR NECROSIS FACTOR INHIBITORS: 16-WEEK EFFICACY & SAFETY FROM BE COMPLETE, A PHASE 3, MULTICENTRE, RANDOMISED PLACEBO-CONTROLLED STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. BKZ has shown sustained efficacy and tolerability up to 152 wks in a phase 2b study in patients (pts) with active psoriatic arthritis (PsA).1,2

Objectives

To assess efficacy and safety of BKZ vs placebo (PBO) in pts with active PsA and prior inadequate tumour necrosis factor inhibitor (TNFi) response in the 16-wk pivotal phase 3 study, BE COMPLETE.

Methods

BE COMPLETE (NCT03896581) comprises a 16-wk double-blind, PBO-controlled period. Pts were aged ≥18 yrs, had a diagnosis of adult-onset, active PsA with ≥3 tender joints and ≥3 swollen joints, and inadequate response or intolerance to treatment with 1 or 2 TNFi. Pts were randomised 2:1 to BKZ 160 mg Q4W or PBO. From Wk 16, pts were eligible to enter an open-label extension, receiving BKZ 160 mg Q4W. The primary endpoint was a ≥50% improvement in American College of Rheumatology response criteria (ACR50) at Wk 16. Primary and ranked secondary efficacy endpoints were assessed at Wk 16.

Results

Of 400 randomised pts (BKZ: 267; PBO: 133), 388 (97.0%) completed Wk 16 (BKZ: 263 [98.5%]; PBO: 125 [94.0%]). Baseline characteristics were comparable between groups: mean age 50.5 yrs, weight 86.0 kg, BMI 29.8 kg/m2, time since diagnosis 9.5 yrs; 47.5% pts were male.

At Wk 16, the primary endpoint (ACR50: 43.4% BKZ vs 6.8% PBO; p<0.001; Figure 1) and all ranked secondary endpoints (HAQ-DI CfB, PASI90, SF-36 PCS CfB and MDA response) were met (all p<0.001; Table 1). The ACR50 response was rapid with separation from PBO observed from Wk 4 (nominal p<0.001). Additional outcomes, including ACR20/70, TJC and SJC CfB, and PASI75/100, demonstrated numerical improvement with BKZ compared to PBO at Wk 16 (all nominal p<0.001; Table 1).

Table 1.

Disease characteristics at baseline and efficacy at Wk 16

PBO N=133BKZ 160 mg Q4W N=267p valueBaseline characteristicsTJCmean (SD)19.3 (14.2)18.4 (13.5)-SJCmean (SD)10.3 (8.2)9.7 (7.5)-PtGA-PsAmean (SD)63.0 (22.0)60.5 (22.5)-PtAAPmean (SD)61.7 (24.6)58.3 (24.2)-Psoriasis BSAn (%)<3%45 (33.8)91 (34.1)-≥3 to ≤10%63 (47.4)109 (40.8)->10%25 (18.8)67 (25.1)-PASIamean (SD)8.5 (6.6)b10.1 (9.1)c-Prior TNFin (%)Inadequate response to 1 TNFi103 (77.4)204 (76.4)-Inadequate response to 2 TNFi15 (11.3)29 (10.9)-Intolerance to TNFi15 (11.3)34 (12.7)-Current cDMARDsn (%)63 (47.4)139 (52.1)-Ranked endpoints in hierarchical orderACR50* [NRI] n (%)9 (6.8)116 (43.4)<0.001HAQ-DI CfB† [RBMI] mean (SE)–0.1 (0.0)–0.4 (0.0)<0.001PASI90†a [NRI]n (%)6 (6.8)b121 (68.8)c<0.001SF-36 PCS CfB† [RBMI]mean (SE)1.4 (0.7)7.3 (0.5)<0.001MDA Response† [NRI]n (%)8 (6.0)118 (44.2)<0.001Other endpointsACR20† [NRI]n (%)21 (15.8)179 (67.0)<0.001‡ACR70† [NRI] n (%)1 (0.8)71 (26.6)<0.001‡TJC CfB [MI] mean (SE)–2.4 (0.9)–10.9 (0.8)<0.001‡SJC CfB [MI] mean (SE)–2.0 (0.5)–7.0 (0.4)<0.001‡PASI75a [NRI]n (%)9 (10.2)b145 (82.4)c<0.001‡PASI100a [NRI]n (%)4 (4.5)b103 (58.5)c<0.001‡

Randomised set (N=400). *Primary endpoint; †Secondary endpoint; ‡Nominal p value. aIn patients with ≥3% BSA with PSO at BL; bn=88; cn=176.

Over 16 wks, 107/267 (40.1%) pts on BKZ had ≥1 TEAE vs 44/132 (33.3%) pts on PBO; the three most frequent TEAEs on BKZ were nasopharyngitis (BKZ: 3.7%; PBO: 0.8%), oral candidiasis (BKZ: 2.6%; PBO: 0%) and upper respiratory tract infection (BKZ: 2.2%; PBO: 1.5%). Incidence of SAEs was low (BKZ: 1.9%; PBO: 0%); none led to discontinuation. 2 pts on BKZ discontinued due to a TEAE (BKZ: 0.7%; PBO: 0%). No systemic candidiasis, cases of IBD, MACE, uveitis, VTE or deaths were reported.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in pts with active PsA and prior inadequate TNFi response resulted in rapid, clinically relevant and statistically significant improvements in efficacy outcomes vs PBO. No new safety signals were observed.1,2

References

[1]Ritchlin C.T. Lancet 2020;395(10222):427–40; 2. Coates L.C. Ann Rheum Dis 2021;80:779–80(POS1022).

Acknowledgements

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

Disclosure of Interests

Joseph F. Merola Paid instructor for: Amgen, Abbvie, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma and UCB Pharma, Consultant of: Amgen, Abbvie, Biogen, BMS, Dermavant, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma and UCB Pharma, Iain McInnes Consultant of: AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, Novartis, and UCB Pharma, Grant/research support from: BMS, Boehringer Ingelheim, Celgene, Janssen, UCB Pharma, Christopher T. Ritchlin Consultant of: Amgen, AbbVie, Eli Lilly, Gilead, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Amgen and UCB Pharma, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Amgen, BMS, Boehringer Ingelheim, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Grant/research support from: AbbVie, Amgen, BMS, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma, Robert B.M. Landewé Speakers bureau: Abbott, Amgen, BMS, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Consultant of: Abbott, Ablynx, Amgen, AstraZeneca, BMS, Centocor, GSK, Novartis, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Grant/research support from: Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB Pharma, and Wyeth, Akihiko Asahina Grant/research support from: AbbVie, Amgen, Eisai, Eli Lilly, Janssen, Kyowa Kirin, LEO Pharma, Maruho, Mitsubishi Tanabe Pharma, Pfizer, Sun Pharma, Taiho Pharma, Torii Pharmaceutical, and UCB Pharma, Yoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer-Ingelheim, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi-Tanabe, and YL Biologics, Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Sanofi, and Taisho, Grant/research support from: Asahi-Kasei, AbbVie, Boehringer-Ingelheim, Chugai, Corrona, Daiichi-Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda, Richard B. Warren Paid instructor for: Astellas, DiCE, GSK, and Union, Consultant of: AbbVie, Almirall, Amgen, Arena, Astellas, Avillion, Biogen, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, GSK, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, and UCB Pharma, Grant/research support from: AbbVie, Almirall, Janssen, LEO Pharma, Novartis, and UCB Pharma, Laure Gossec Consultant of: AbbVie, Amgen, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB Pharma, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, and Sandoz, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma, Frank Behrens Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Genzyme, Janssen, MSD, Novartis, Pfizer, Roche, and Sanofi, Barbara Ink Shareholder of: GSK, UCB Pharma, Employee of: UCB Pharma, Deepak Assudani Shareholder of: UCB Pharma, Employee of: UCB Pharma, Rajan Bajracharya Shareholder of: UCB Pharma, Employee of: UCB Pharma, Jason Coarse Shareholder of: UCB Pharma, Employee of: UCB Pharma, Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma