AB0266 PREGNANCY PLANNING AND FOLLOW-UP IN MULTIDISCIPLINARY UNITS IMPROVES THE OUTCOMES IN WOMEN WITH INFLAMMATORY ARTHROPATHIES

Background

Women with inflammatory arthropaties (IA) have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control.

Objectives

To evaluate pregnancy in women with IA in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment.

Methods

Retrospective and descriptive study of the evolution of pregnancy in patients with IA [Rheumatoid Arthritis (RA), Spondyloarthritis (SpA), Psoriatic arthritis (PsA) and Juvenile Idiopathic Arthritis (JIA)] and follow-up in a multidisciplinary unit for more than 15 years (until December 2021). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, cesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected.

Results

We registered 49 pregnancies (39 women): 27 RA (55.1%), 9 SpA (18.4%), 9 PsA (18.4%) and 4 JIA (8.1%). Maternal average age at diagnosis was 26.8±6.7 years and average age at childbirth/abortion was 34.5±5.3 years.

It took an average time of 9±7.7 months to conceive. 8.2% received fertility treatment with in vitro fertilization techniques.

AntiRo antibodies were registered in 6.3% of patients and 28.6% had at least 1 antiphospholipid antibody.

At the time of gestational desire/gestation 24 women (13 RA, 5 SpA, 3 PsA, 3 JIA) were receiving BT: 14 certolizumab (CZP), 5 adalimumab (ADA), 4 etanercept (ETN). 1 patient was being treated with baricitinib (BARI). Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as BARI. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 15 cases.

9 abortions were registered prior to follow-up in the unit (0.23 abortions/mother) and 3 (2 RA, 1 PsA) during follow-up (0.07 abortions/mother): 2 (1 RA, 1 PsA) of them in women with CZP. RA patient had positive antiphospholipid antibodies and was a smoker and the other one had moderate disease activity by the time of the abortion. C-section was performed in 26.1% of cases. Preterm birth (<37 weeks) happened in 8.2% (n: 4) of the pregnancies: 2 in women with CZP.

A total of 19 different fetal/maternal complications were registered during follow-up: 8 in the BT group (42.1%) compared to 11 (57.9%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Table 1.

Table 1.COMPLICATIONSWITH BT (n, %) n: 17WITHOUT BT (n, %) n: 32IUGR3 (17.6)1 (3.1)LBW2 (11.8)2 (6.2)INFECTION1 (5.9)4 (12.5)CHOLESTASIS0 (0)2 (6.2)PREECLAMPSIA0 (0)1 (3.1)DM2 (11.8)1 (3.1)HIGH BLOOD PRESSURE0 (0)0 (0)NEPHROPATY0 (0)0 (0)NEONATAL LUPUS0 (0)0 (0)HEART BLOCK0 (0)0 (0)MALFORMATION0 (0)0 (0)HELLP SYNDROME0 (0)0 (0)TOTAL811

Regarding concomitant treatment, low dose prednisone was used in 32.7% of pregnancies, hydroxychloroquine in 44.9%, sulfasalazine in 8.2% and acetylsalicylic acid in 51%. We didn´t find differences in the use of these treatments between the two groups.

Median DAS28 among RA patients with available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously.

Conclusion

In our series, as described in the literature, women with IA are older and more likely to have preterm births compared to general population. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR, low birth weight (LBW) and diabetes mellitus (DM) among women with BT but lower rate of infections. Given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary.

Disclosure of Interests

None declared

AB0676 One year progression of interstitial lung disease in connective tissue diseases. A descriptive study in a single tertiary center

Background

Interstitial lung disease (ILD) in connective tissue diseases (CTD) is an important cause of morbidity and mortalitiy.

Objectives

To evaluate ILD in CTD (systemic sclerosis, myositis, Sjögren syndrome, rheumatoid arthritis, mixed connective tissue disease), sarcoidosis and interstitial pneumonia with autoimmune features and its progression in 12 months evaluated through high resolution computed tomography (HRCT) and pulmonary function test (PFT).

Methods

A retrospective single tertiary center cohort study in CTD-ILD outpatients seen between 2012 and 2021. Clinical, serological data, PFT and HRCT results were collected. ILD patterns were classified into: usual interstitial pneumonia (UIP), inconsistent UIP, nonspecific interstitial pneumonia (NSIP), fibrosing NSIP, organizing pneumonia, interstitial lymphoid pneumonia and associated to sarcoidosis. Progression of ILD was defined as:

->10% decline in FVC in PFT.

->15% decline in DLCO in PFT.

-Progression of fibrosis in HRCT.

IBM SPSS v23 was used for statistical analysis.

Results

51 patients were collected. Baseline characteristics are shown in Table 1. Figure 1 shows ILD progression in 1 year.

Table 1.

Baseline characteristics.

Sociodemographic characteristicsClinical features/affection– n (%)Total51Raynaud23 (45,1%)Female-n (%)42 (82,4%)Skin23 (45,1%)Age- years (mean) IQR)56 (27-82)Ocular13 (25,5%)Arthritis16 (31,4%)Myositis7 (13,7%)Renal1 (2%)Esophagus7 (13,7%)Hemathological3 (5,9%)PHT7 (13,7%)Smoking status- n (%)Symptoms at ILD diagnosis- N (41) %Current9 (17,6%)Cough31,4%Former13 (25,5%)Toracic pain11,8%Never29 (56,9%)Dyspnea47,1%Comorbidities- n (%)Pattern HRCT- n (%)Diabetes mellitus5 (9,8%)UIP11 (21,6%)Ischaemic cardiopathy3 (5,9%)Fib-NSIP5 (9,8%)Hypertension15 (29,4%)UIPincons13 (25,5%)POCD3 (5,9%)NSIP15 (29,4%)OP2 (3,9%)LIP2 (3,9%)Sarcoidosis3 (5,9%)Type of disease associated to ILD - n (%)Immunosupression- n (%)Systemic Sclerosis14(27,5%)Methotrexate20(39,2%)Sjögren’s Syndrome7 (13,7%)Mycophenolate mofetil16 (31,4%)Sarcoidosis3 (5,9%)Hydroxychloroquine19(37,3%Myositis8 (15,7%)Cyclophosphamide4 (7,8%)SLE1 (2%)Etanercept6 (11,8%)MCTD3 (5,9%)TNF inhibitors4 (7,8%)RA12(23,5%)Tocilizumab2 (3,9%)IPAF4 (7,8%)Azathioprine10 (19,6%)Leflunomide3 (5,9%)MP pulses15 (29,4%)Rituximab12 (23,5%)Abatacept5 (9,8%)Tacrolimus5 (9,8%)Antibodies- n (%)Anti-myositis6 (11,8%)Anti-sclerosis15(29,4%)Anti- Ro25 (49%)Anti- RNP3 (5,9%)ANA35(68,6%)RF21(41,2%)Anti- Synt6 (11,8%)Note. POCD = Pulmonary Obstructive Chronic Disease SLE = Systemic Lupus Erythematosus MCTD = Mixed Connective Tissue Disease RA = Rheumatoid Arthritis IPAF = Insterstitial Pneumonia with Autoimmune Features Anti RNP = Anti RiboNucleoProtein ANA = Antinuclear Antibodies RF = Rheumatoid Factor Anti Synt =Anti-synthetasePHT= Pulmonary Hypertension UIP = Usual Interstitial Pneumonia Incons-UIP = Inconsistent Usual Interstitial PneumoniaNSIP = Nonspecific Interstitial PneumoniaFib-NSIP = Fibrosing Nonspecific Interstitial PneumoniaOP = Organizing PneumoniaLIP = Lymphoid Interstitial PneumoniaTNF inhibitor = Tumor Necrosis Factor inhibitorMP = MetyhprednisoloneFigure 1.

During follow up, 1 patient with sarcoidosis died of COVID19 bilateral pneumonia.

Conclusion

In our series most patients were middle aged women. Anti-Ro antibodies and smoking status (former or current) were common among patients. Common clinical features were Raynaud (45%), skin affection (45%) and arthritis (40%). 47% of the patients expressed dyspnea at ILD diagnosis. 29,4% were treated with MP pulses, 23,5% with rituximab, 31,4% with mycofenolate mophetil. Fibrosing pattern in HRCT (UIP and fib-NSIP) was the most prevalent. 20% of the patients had progressive fibrosis under PFT criteria and 18% under HCRT.

More studies of ILD-CTD are necessary to identify factors for progression and response to treatment and throw out more conclusions of prediction and prognosis of disease.

Disclosure of Interests

None declared

POS1439 CANCER IN PATIENTS WITH RHEUMATIC DISEASES EXPOSED TO DIFFERENT BIOLOGIC AND TARGETED SYNTHETIC DMARDS IN REAL-WORLD CLINICAL PRACTICE: DATA FROM A MULTICENTER REGISTER

Background

Extensive evidence has confirmed no increased risk of cancer associated to either conventional synthetic DMARDs or anti-TNF in patients with rheumatic diseases. The risk of cancer in biologic (bDMARDs) different to anti-TNF and targeted synthetic (tsDMARDs) is considerably less investigated. As new therapies are emerging, more data in real-world registries are needed to confirm safety in other treatment groups.

Objectives

To compare the risk of cancer of tsDMARDs and other bDMARDs versus anti-TNF in patients with rheumatic diseases.

Methods

Data of patients enrolled in BIOBADASER 3.0 up to October 2021 with the start of any bDMARD or tsDMARD were analyzed. For each group, demographic and clinical variables were estimated. Changes to therapy and occurrence of serious adverse events collected annually. Incident cancer was defined as any cancer during the exposure classified according to Meddra dictionary leading to therapy discontinuation. Incidence rate ratios of cancer per 1000 patients-year (PYs) and 95% confidence interval were estimated. Incidence rate ratio was calculated for each group versus anti-TNF.

Results

We identified 271 cancers in BIOBADASER 3.0, corresponding to a cancer incident rate of 7.4 (6.5-8.3) per 1000 PY of exposure. Patients exposed to anti-TNF and anti-IL17 were younger, with lower disease duration and comorbidity versus other groups. Proportionally more malignancies were identified in the anti-CTLA-4 group (3.4%) versus the anti-TNF group (2.9%). The rates of incident cancer ranged between 2.6 events/1000 PY in the anti-IL17 group and 15.3 events/1000 PY in the anti-CTLA-4 group. The rate of cancer did not differ significantly in patients exposed to JAKi [0.8 (95% CI 0.4-1.5)], anti CD20 [1.1 (95% CI 0.6-1.8)], or anti-IL6 [1.3 (95% CI 0.9-1.9)] versus anti-TNF; it was significantly lower in patients exposed to anti-Il17 [0.4 (95% CI 0.2-0.9)], and significantly higher in patients exposed to anti-CTLA-4 [2.2 (95% CI 1.4-3.2)]. The most frequent malignancy was non-melanoma skin cancer, followed by solid cancer (mainly breast cancer with 24 events and lung cancer with 14 events) and melanoma (13 events).

Table 1.

New Cancer Diagnosis Among Patients with anti-TNF versus other therapies

Anti-TNF (N=6356)JAKi (N=1079)Anti-CD20 (N=667)Anti-IL6 (N=1178)Anti-CTLA-4 (N=783)Anti-IL17 (N=1051)Female, n (%)3738 (58.8)868 (80.4)523 (78.4)947 (80.4)598 (76.4)492 (46.81)Mean age, (SD)54.8 (14.7)58.5 (12.4)60.9 (13.6)59.8 (15.1)64.0 (12.8)52.2 (11.6)Mean start age, (SD)49.1 (14.0)56.6 (12.3)57.9 (13.5)55.7 (15.2)59.7 (13.0)49.8 (22.2)Disease duration, median (IQR)6.2[2.2-13.0]10.4[4.7 -17.2]11.0[5.1-18.5]8.3[3.2-15.1]10.3[5.2-17.0]3.1[0.3-10.7]Charlton Index1.9 (1.3)2.4 (1.6)2.4 (1.7)2.4 (1.7)2.8 (1.9)1.8 (1.3)First line biologic, n (%)99 (53.2)2 (22.2)1 (7.1)6 (20.0)5 (18.5)2 (66.7)New cancer diagnosis, n (%)186 (2.9%)9 (0.8%)14 (2.1%)30 (2.5%)27 (3.4%)5 (0.5%)Median years of follow-up months4.2 [2.3-7.3]2.4 [1.4-3.2]1.0 [1.0-1.0]2.6 [1.3-6.6]4.4 [1.5-5.7]1.8 [1-5-2.2]Time of exposure, yrs26233.51652.71871.53196.71762.11921Cancer Incidence Rate (per 1000 PY) ancer Incide7.1 (6.1-8.2)5.4 (2.8-10.5)7.5 (4.4-12.6)9.4 (6.6-13.4)15.3 (10.5-22.3)2.6 (1.1-6.3) .6 (1.1-6.3).5.2 (4.4-6.1)6.3 (1.6-8.1)5.9 (3.3-10.6)7.5 (5-11.2)10.8 (6.9-16.9)1.6 (0.5-4.8) .6 (0.5-40.3 (0.2-0.6)0 (0-0)1.1 (0.3-4.3)0.3 (0-2.2)0.6 (0.1-4)0 (0-0) (0-0)1-4)3)9)) Rate (per1.6 (1.2-2.2)1.8 (0.6-5.6)0.5 (0.1-3.8)1.6 (0.7-3.8)4 (1.9-8.3)1 (0.3-4.2)Rate ratio (vs anti-TNF)NA0.8 (0.4-1.5)1.1 (0.6-1.8)1.3 (0.9-1.9)2.2 (1.4-3.2)0.4 (0.2-0.9)

Conclusion

In this register-based study, rates of incident cancer did not differ between patients treated with anti-TNF and other bDMARDs or tsDMARDs, with the possible exception of a potential increased risk in patients treated with anti-CTLA-4.

Acknowledgements

Thank you to all patients, rheumatologists, and to the research personnel from the Spanish Foundation of Rheumatology who made this study possible.

Disclosure of Interests

Isabel Castrejon: None declared, Juan Molina Collada: None declared, Carolina Perez-Garcia: None declared, Paloma Vela-Casasempere Speakers bureau: ROCHE, UCB, GSK, LILLY, Consultant of: PFIZER, BMS, LILLY, UCB, GSK, Abbvie, Fresenius Kabi, Grant/research support from: ROCHE, ABBVIE, PFIZER, BMS, LILLY, SANDOZ, AMGEN, Cesar Diaz-Torne: None declared, Cristina Bohórquez: None declared, J M Blanco: None declared, Fernando Sánchez-Alonso: None declared

OP0138 RISK OF CANCER AFTER BIOLOGIC AND TARGETED SYNTHETIC DMARDS INITIATION IN PATIENTS WITH RHEUMATIC DISEASES AND A HISTORY OF PRIOR MALIGNANCY: DATA FROM THE BIOBADASER REGISTRY

Background

Patients with a history of cancer are routinely excluded from randomized controlled trials. As consequence, data on the safety of biologic disease modifying antirheumatic drugs (bDMARDS) and targeted synthetic (ts) DMARDs are limited. Although real world data from various national registries have not provided evidence of increased cancer recurrence, additional data from real-world registries may help to confirm safety of non-TNFi bDMARDs and tsDMARDs regarding cancer recurrence to guide treatment decisions.

Objectives

To compare the risk of incident malignancy with exposure to different bDMARDs and tsDMARDs in patients with rheumatic diseases and a prior malignancy.

Methods

The study population comprised patients with a prior malignancy from the BIOBADASER 3.0 up to 2021. BIOBADASER is a large national drug safety registry of patients with rheumatic diseases starting treatment with any bDMARD or tsDMARD and followed thereafter at the time an adverse event or a change in biological therapy occurs. Incident cancer was defined as any cancer (new primaries, local recurrence or metastases) during the exposure classified according to Meddra dictionary. Incidence rate ratios of cancer per 1000 patients-year (PY) and 95% CI were estimated. Rates of incident cancer in tsDMARDs and other bDMARDs versus anti-TNF treated patients were compared.

Results

A total of 9,129 patients treated with bDMARDs and tsDMARDs are included in BIOBADASER 3.0 at the time of the study. Of them, 352 with a prior history of malignancy at time of enrollment were selected for analysis (Figure 1). Overall, there were 32 incident malignancies (17 solid cancer, 14 non-melanoma skin cancer and 1 melanoma). The overall rate of incident malignancy was 27.1 (95% CI 18.6-38.3) events/1,000 PY, ranging between none events/1000 PY in the anti-IL17 group to 51.7 events/1000 PY in the anti-CTLA-4 group (Table 1). The overall rate of incident cancer did not differ significantly in patients exposed to JAKi [0.6 (95% CI 0.1-2.5)], anti-CD20 [0.3 (95% CI 0.1-1.4)], anti-IL6 [1.2 (95% CI 0.5-3.4)] or anti-CTLA-4 [1.3 (95% CI 0.5-3.6) versus anti-TNF therapy. The rate of different types of cancer (melanoma, non-melanoma skin cancer or solid tumors) did not differ between the different treatment groups when compared to anti-TNF therapy (Table 1).

Table 1.

Baseline characteristics and rate of incident cancer.

Anti-TNF(n = 185)JAKi(n = 61)Anti-CD20(n= 61)Anti-IL6(n= 68)Anti-CTLA-4(n= 47)Anti-IL17(n= 39)Total(n=352)Female, n (%)129 (69.7)49 (80.3)43 (70.5)54 (79.4)34 (72.3)21 (53.9)247 (70.2)Age, mean (SD)64.4 (13.1)66.7 (13.1)67.8 (10.0)70.5 (11.6)71.8 (10.4)59.5 (14.6)65.3 (13.0)Start treatment age, mean (SD)60.0 (12.9)64.8 (12.8)65.7 (9.6)67.3 (11.3)62.8 (12.7)56.9 (14.5)61.6 (12.8)Disease duration, median (IQR)6.7 (3.0-13.1)12.3 (7.4-19.6)10.8 (6.3-19.4)8.5 (4.0-16.8)8.2 (4.1-16.6)8.4 (4.7-16.1)7.0 (2.9-15.5)Time of follow-up months, mean (SD)23.1 (25.3)15.9 (13.3)11.5 (2.5)16.8 (17.6)23.7 (22.6)18.4 (15.5)17.5 (18.2)Charlson comorbidity index4.9 (2.0)5.2 (2.2)5.1 (2.0)5.5 (2.1)6.1 (2.6)6.9 (2.6)5.2 (2.1)Prior malignancyNon-lymphoproliferative (solid or melanoma), n (%)174 (94.5)58 (95.1)54 (88.5)65 (95.6)46 (97.9)36 (92.3)331 (94.0)Lymphoproliferative, n (%)9 (4.9)3 (4.9)13 (21.3)4 (5.9)4 (8.5)5 (12.8)29 (8.2)Metastatic cancer, n (%)2 (1.1)2 (3.3)2 (3.3)1 (1.5)3 (6.4)0 (0.0)7 (2.0)Incident cancerNew cancer diagnosis, n (%)182255032Time of exposure, sum (years)470,191,6163104,996,863,81178,6Rate of incident cancer (per 1,000 PY)38.3 (24.1-60.8)21.8 (5.5-87.3)12.3 (3.1-49.1)47.7 (19.8-114.5)51.7 (21.5-124.1)0 (0-0)27.1 (18.6-38.3)Rate ratio of incident cancer (vs anti-TNF)-0.6 (0.1-2.5)0.3 (0.1-1.4)1.2 (0.5-3.4)1.3 (0.5-3.6)--Figure 1.

Flowchart of patients included.

Conclusion

The risk of incident cancer in patients with rheumatic diseases and a prior malignancy does not differ according to the type of bDMARD and tsDMARD exposure.

Disclosure of Interests

None declared

AB0151 FOLLOW-UP IN A MULTIDISCIPLINARY UNIT IMPROVES PREGNANCY OUTCOME IN INFLAMMATORY ARTHROPATIES ON BIOLOGICAL THERAPY

Background:

Women with inflammatory arthropaties have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control.

Objectives:

To evaluate pregnancy in women with inflammatory arthropaties in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment used (including BT).

Methods:

Retrospective and descriptive study of the evolution of pregnancy in patients with

inflammatory diseases (Rheumatoid Arthritis (RA), Spondyloarthritis (SpA) and Juvenile Idiopathic Arthritis (JIA)) and follow-up in a multidisciplinary unit for more than 15 years (until December 2020). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, Caesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected.

Results:

We registered 41 pregnancies (32 women): 20 RA (62.5%), 9 SpA (28.1%) and 3 JIA (9.4%). Maternal average age at diagnosis was 27.1±6.6 years and average age at childbirth/abortion was 34.9±5.1 years.

It took an average time of 9.6±8.5 months to conceive. 9.8% received fertility treatment with in vitro fertilization techniques.

AntiRo antibodies were registered in 7.3% of patients and 34.1% had at least 1 antiphospholipid antibody.

At the time of gestational desire/gestation 17 women (12 RA, 4 SpA, 2 JIA) were receiving BT: 7 certolizumab (CZP), 7 adalimumab (ADA), 3 etanercept (ETN). 1 patient was being treated with baricitinib. Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as baricitinib. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 9 cases.

9 abortions were registered prior to follow-up in the unit (0.28 abortions/mother) and 3 during follow-up (0.09 abortions/mother): 2 of them in women with CZP.

C-section was performed in 26.8% of cases.

Preterm birth (<37 weeks) happened in 9.7% (n: 4) of the pregnancies: 1 case in a woman with CZP.

A total of 17 different fetal/maternal complications were registered during follow-up: 6 in the BT group (35.3%) compared to 11 (64.7%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Complications are listed in Table 1.

Table 1.COMPLICATIONSWITH BT (n, %) n: 11WITHOUT BT (n, %) n: 30IUGR3 (27.3%)1 (3.3%)LOW BIRTH WEIGHT2 (18.2%)2 (6.6%)INFECTION1 (9.1%)4 (13.3%)CHOLESTASIS0 (0%)2 (6.6%)PREECLAMPSIA0 (0%)1 (3.3%)DIABETES MELLITUS0 (0%)1 (3.3%)HIGH BLOOD PRESSURE0 (0%)0 (0%)NEPHROPATY0 (0%)0 (0%)NEONATAL LUPUS0 (0%)0 (0%)HEART BLOCK (0%)0 (0%)MALFORMATION0 (0%)0 (0%)HELLP SYNDROME0/0%)0 (0%)TOTAL6 (54.6%)11 (36.4%)

Regarding concomitant treatment, low dose prednisone was used in 48.8% of pregnancies, hydroxychloroquine in 51.2%, sulfasalazine in 9.8% and acetylsalicylic acid in 51.2%. We didn´t find differences in the use of these treatments between the two groups.

Median DAS28 among RA patients and available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously.

Conclusion:

In our series, as described in the literature, women with inflammatory arthropaties are older and are more likely to have preterm births compared to general population. Fewer abortions were registered during follow-up in the multidisciplinary unit. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR and low birth weight among women with BT but given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary.

Disclosure of Interests:

None declared

AB0170 RHEUMATOID ARTHRITIS ASSOCIATED LUNG DISEASE: EXPERIENCE IN A BIOLOGICAL THERAPY UNIT

Background:

Rheumatoid arthritis (RA) associated lung disease is a relatively frequent extra articular disease manifestation, with a prevalence between 5% and 30%. The rather wide range of estimated prevalence is a result of differences in study designs and studied populations, as well as lacking diagnostic and classification criteria for lung disease in patients with RA.

Objectives:

To evaluate the prevalence of RA associated lung disease in patients with biological therapy (BT), as well as its severity, treatment changes and possible associated factors.

Methods:

Review of clinical records of 257 patients with RA treated with BT (TNFi, non-TNFi) between January 2015 to December 2020 in a single center. Patients with preexisting lung disease for other causes (asthma, smoking) have been excluded. RA diagnosis was performed according to ACR 2010 classification criteria. Epidemiological variables, clinical characteristics, type of pulmonary involvement, evolution, type of BT, changes in treatment and concomitant treatment were collected. For the analysis frequencies and percentages are used in qualitative variables, and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.

Results:

We registered 21 patients (85.7% women) mean aged 70.3±11.9 years. 52.4% were never smokers. RF was positive in 100% and 20 patients were anti-CCP positive. Erosive disease was present in 13 (61.9%) patients.

At the time of lung disease diagnosis, 15 patients (66.7%) were receiving TNFi (Etanercept 7, Adalimumab 6, Infliximab 1, Golimumab 1), 2 were with non-TNFi (Rituximab) and 4 had never received BT previously. Symptoms (cough and/or dyspnea) were reported in 10 (47.6%) patients. The median time of treatment with BT until lung disease diagnosis was 33 [15.5-95.5] months. Conventional synthetic DMARDs (csDMARDs) were used in 85.7% of cases (methotrexate 72.2%, leflunomide 22.2%, other 5.6%). The inflammatory activity was mild (DAS28: 3.22±1.6). The median time until lung disease diagnosis was 104 [56.2-156] months.

After the lung disease diagnosis, BT was only modified in 1 patient. In the 4 patients who had not previously received BT, non-TNFi was started (Rituximab 2, Abatacept 1, Tocilizumab 1). csDMARD was discontinued in 1 patient.

Interstitial lung disease (ILD) was the most frequent pulmonary involvement (16 patients, 76.2%): 8 usual interstitial pneumonia (UIP), 6 non-specific interstitial pneumonia (NSIP), 1 organising pneumonia (OP) and 1 lymphocytic interstitial pneumonia (LIP). Other pulmonary manifestations observed in our patients were: nodular lung disease (2 patients) and small airways disease (bronchiectasis 2, obliterative bronchiolitis 1). Chest x-ray was normal in almost half of the patients (42.9%). Gold standard image diagnostic technique was high resolution CT.

In respiratory function tests (PFTs) at diagnosis, only 4 patients (19%) had a FVC<80% and 4 (19%) a DLCO<60%. In the following 2 years, in 2 patients the FVC worsened > 10% and in 5 there was a worsening of the DLCO > 15%. In 3 (14.3%) patients PFTs were never performed and in 7 (43.7%) were not repeated after the diagnosis.

We haven´t found association between different types of pulmonary involvement and the variables analysed.

Conclusion:

In our series, prevalence of RA associated lung disease is similar to that described in the literature. Lung involvement is asymptomatic and chest X-ray is normal in most RA patients. High resolution CT is the gold standard for diagnosis.

ILD was the most frequent pulmonary involvement. Although in most patients the diagnosis of lung disease did not imply a BT change, it had an influence on the type of BT chosen for those who started treatment. Maintenance of csDMARD was not associated with a worsening of lung disease.

Screening and treatment protocols for lung disease in patients with RA in clinical practice are needed.

Disclosure of Interests:

None declared

OP0123 SAFETY PROFILE OF JAK-INHIBITORS VERSUS TNF-INHIBITORS IN REAL-WORLD CLINICAL PRACTICE: DATA FROM A MULTICENTER REGISTER

Background:

JAK-inhibitors (JAKi) are small molecules emerging as a promising treatment for immune mediated diseases. Data from clinical trials are very promising. But long-term observational studies, with patients with diverse clinical backgrounds are required to confirm safety profile.

Objectives:

To compare the safety profile of JAKi versus TNF antagonists (anti-TNF) in a multicenter real world dataset.

Methods:

Data of patients enrolled in BIOBADASER 3.0 up to November 2020 with the start of anti-TNF or JAKi were analysed. Adverse events (AE) were classified according to Meddra dictionary (v19.0). For each group, demographic, clinical variables and ncidence rate ratios of AE per 1000 patients-year (PYs) and 95% confidence interval were estimated.

Results:

A total of 3,729 patients on anti-TNF (5,306) or JAKi (493) were analyzed. Patients on JAKi were older and with a mean disease duration of 10 years. JAKi were prescribed as first line treatment only in 24% of patients. The main reason of stopping treatment was ineffectiveness (53-59%) followed by adverse events (25-34%) in both groups. Survival during first year was similar between groups.

Table 1.

Patient characteristics and adverse events by treatment group

Anti-TNFJAKiMean age start of treatment (SD), yrs50.8 (12.6)57.6 (11.9)Female, n (%)3122 (58.8)392 (79.5)Disease duration, median (IQR)7.0 (2.7-13.7)9.9 (4.9-16.8)First line biologic, n (%)2614 (49.3)117 (23.7)Rheumatoid Arthritis1385 (41.1)339 (95.2)Ankylsosing Spondylitis1031 (30.6)1 (0.3)Psoriatic Arthritis957 (28.4)16 (4.5)DAS28-ESR4.3 (1.4)4.7 (1.4)Survival first year (IC 95%)73.3 (71.9-74.6)69.7 (66.0-73.0)Charlson Index, mean (SD)1.9 (1.3)2.3 (1.6)Reason to stop therapy (n)*: Lack of efficacy1534 (53.2)57 (58.8) Adverse event723 (25.1)33 (34.0)Adverse events (AE)*Serious infections14.2 (12.4-16.2)33.2 (19.3-57.3)Herpes zoster5.7 (4.6-7.1)12.8 (5.3-30.7)Tuberculosis0.7 (0.4-1.3)0.0 (0.0-0.0)Malignancy/Neoplasia10.2 (8.7-11.9)15.3 (6.9-34.2)Cardiac events13.9 (12.2-16.0)30.7 (17.4-54.0)GI perforation1.2 (0.8-1.9)10.2 (3.8-27.3)Vascular events9.8 (8.3-11.5)25.6 (13.8-47.5)

*Data show the incidence rate ratio per 1000 patient-years (PYs; 95% CI)

Conclusion:

Serious infections and herpes zoster tend to be more frequent in patients on JAKi. However patients on JAKi were older, presented higher comorbidity and have a longer disease duration.

Disclosure of Interests:

None declared

AB0153 REAL LIFE SEVERE INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS ON TREATMENT WITH BIOLOGICAL THERAPY AND JAKI

Background:

Infections are one of the main complications among patients with rheumatoid arthritis (RA) with immunosuppressive treatment. The differences between treatments and the influence of other factors is unclear.

Objectives:

To evaluate the frequency and factors associated with serious infections in patients with RA treated with biological therapy (BT) and JAKi and the differences between treatments.

Methods:

Descriptive and retrospective study (January 2015-December 2020) of patients with RA treated with BT (TNFi, non-TNFi) and JAKi (tofacitinib, bariticinib, upadacitinib) in a single center. Severe infection was considered a life-threatening infection or one that required hospitalization and intravenous treatment. Epidemiological variables, clinical characteristics, Charlson comorbidity index, type of BT or JAKi and concomitant treatment were collected.

For the analysis frequencies and percentages are used in qualitative variables and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.

Results:

We registered 257 patients (84.4% women) mean aged 56.1±13.4 years. RF was positive in 86.8%, anti-CCP in 75.9% and 16.5 % presented extra-articular manifestations (nodulosis 9.7%, intersticial lung disease 4.3%, other 1.5%). At the start of the study, 157 (61.1%) patients were with TNFi, 80 (31.1%) with non-TNFi and 20 (7.8%) with JAKi. Conventional synthetic DMARDs (csDMARDs) were used in 86% of cases (methotrexate 71.1%, leflunomide 21.2%, other 7.7%).

During the study, 162 (63%) patients continued with the same treatment and in 95 (37%) it was changed at least once. 3 patients discontinued the treatment. At the end of the study, 126 (49%) patients were with TNFi, 81 (31.5%) with non-TNFi and 47 (18.3%) with JAKi.

Severe infection was developed in 28 (10.9%) patients (13 respiratory, 5 urinary, 5 cellulitis, 4 sepsis, 1 osteomyelitis) among them 2 patients had severe infection and herpes zoster at the same time and 3 developed a second infection. 14 (50%) patients were with TNFi, 8 (28.6%) with non-TNFi and 6 (21.4%) with JAKi. Table 1

The inflammatory activity of RA was mild at the time of infection (DAS28: 2.6±1.1). The median time until infection was: TNFi 45.25 [4.9-202.3] months, non- TNFi 19.14 [4.9-72.5] months and JAKi 17.63 [1.1-29.2] months.

The Charlson index, concomitant use of glucocorticoids (GCC) at lower doses than 10mg/d, chronic obstructive pulmonary disease (COPD), diabetes (DM), moderate-severe renal insufficiency, congestive heart failure (CHF) and peripheral vascular disease were statistically significantly associated with infection. Table 1.

TABLE 1.

CHARACTERISTICS OF PATIENTS WITH INFECTION VS. WITHOUT INFECTION

INFECTIONYES n:28NO n:229pFEMALE, n (%)22 (78.6)195 (85.2)0.406AGE years, (mean±SD)57.7 ± 13.955.9 ± 13.40.507AGE ≥ 65 n (%)10 (35.7)68 (29.7)0.513RF +, n (%)25 (89.3)198 (86.5)0.677ANTI-CCP +, n (%)21 (75)174 (75.1)1.00ILD, n (%)1 (3.5)10 (4.3)0.809ALCOHOL, n (%)3 (10.7)17 (7.4)0.465SMOKER, n (%)10 (35.7)60 (26.2)0.244COPD, n (%)7 (25)24 (10.5)0.026*DM, n (%)7 (25)19 (8.3)0.013*CHF, n (%)4 (14.3)1 (0.4)0.001*RENAL INSUFFICIENCY, n (%)3 (10.7)2 (0.9)0.010*PERIPHERAL VASCULAR DISEASE, n (%)9 (32.1)22 (9.6)0.002*CHARLSON INDEX (mean±SD)1.64 ± 2.10.63 ± 1.20.001*TNFi, n (%) NON-TNFi n (%) JAKi, n (%)14 (50)112 (48.9)8 (28.6)73 (31.9)6 (21.4)41 (17.9)csDMARDs, n (%)22 (78.6)159 (69.4)0.317GCC dose <10mg/d, n (%)17 (60.8)111 (48.5)0.007*

Conclusion:

In our study, 10.9% of patients with RA treated with BT or JAKi developed severe infection during 5 years of follow-up. Concomitant GCC therapy and comorbidity increased the risk of presenting this complication.

Disclosure of Interests:

None declared

SAT0075 ABATACEPT IN COMBINATION WITH METOTREXATE IN PATIENTS WITH RHEUMATOID ARTHRITIS ASSOCIATED TO INTERSTITIAL LUNG DISEASE: NATIONAL MULTICENTER STUDY OF 263 PATIENTS

Background:

Interstitial Lung Disease (ILD) is an extra-articular complication of rheumatoid arthritis (RA) that is associated with increased morbidity and mortality. Conventional disease-modifying drugs (DMARDs) such as methotrexate (MTX) have been implicated in the development and exacerbation of a pre-existing ILD.

Objectives:

The aim of our study was to check the influence of combined MTX treatment in patients with RA-ILD treated with abatacept (ABA).

Methods:

National multicentre retrospective registry of 263 patients with RA-ILD treated with ABA. RA was diagnosed according to the ACR classification criteria of 1987 or by the EULAR/ACR criteria of 2010. ILD was diagnosed by high resolution computed tomography (HRCT). In this study we have done a subanalysis of the 46 patients treated with ABA in combination with MTX (ABA+MTX) vs. 217 patients treated with ABA in monotherapy or in combination with other synthetic DMARDs. Efficacy was evaluated according to the following parameters: a) Dyspnoea (MMRC) considering variations ≥ 1; b) Lung function test (LFT) considering variations ≥ 10% in FVC and a variation of DLCO ≥ 10%; c) Imaging test (HRCT) d) DAS28 score e) prednisone dose. Variables were collected at the beginning of the study and at months 3, 6, 12 and then every 12 months until a maximum of 60 months.

Results:

263 patients with ILD associated with RA were included in the study with mean age 64.64±10 years. RF or CCPA were positive in 235 (89.4%) and 233 (88.6%) cases, respectively, with a mean follow-up of 22.7±19.7 months. Baseline characteristics of both groups are shown in table 1, while data obtained during evolution of this complication are presented in Figure 1.

Conclusion:

Despite the baseline differences of both groups, the good evolution in the ABA+MTX subgroup suggests that this therapeutic strategy can be a safe combination for patients with RA-ILD.

ABA with MTX (n=46)ABA w/t MTX (n=217)PSex (F/M)28/18122/950.625Age (years)65.11±10.216.2±9.80.202RF/CCPA + (%)91.3/91.389.8/90.10.810Smoking or past smoking (%)47.855.10.417Follow-up (months)22.73±18.0022.3±20.850.916DAS28 at baseline4.08±1.514.61±1.470.056DAS28 at last visit3.00±1.463.13±1.310.642Prednisone at baseline, median (IQR) (mg)5 (5-7.5)7.75 (5-15)0.008*Prednisone at the end of study, median (IQR) (mg)5 (1-5)5 (5-7.5)0.032*DLCO at baseline (%)66.85±19.0465.43±18.210.823DLCO at the end of study (%)66.05±20.9565.17±19.720.831FVC at baseline (%)90.06±17.7785.40±21.560.164FVC at the end of study (%)90.58±15,4584.21±21.490.038*

Disclosure of Interests:

Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, J. Loricera: None declared, Francisco Ortiz-Sanjuán: None declared, A. Juan-Mas: None declared, Carmen Carrasco-Cubero Speakers bureau: Janssen, MSD, AbbVie, Novartis, Bristol Myers Squibb, and Celgene, S, Rodriguéz-Muguruza: None declared, S. Rodrigez -Garcia: None declared, R. Castellanos-Moreira: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

, CLARA AGUILERA CROS: None declared, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Sergi Ordoñez: None declared, Susana Romero-Yuste: None declared, C. Ojeda-Garcia: None declared, Manuel Moreno: None declared, Gemma Bonilla: None declared, I. Hernández-Rodriguez: None declared, Mireia Lopez Corbeto: None declared, José Luis Andréu Sánchez: None declared, Trinidad Pérez Sandoval: None declared, Alejandra López Robles: None declared, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, Natalia Mena-Vázquez: None declared, C. Peralta-Ginés: None declared, ANA URRUTICOECHEA-ARANA: None declared, Luis Marcelino Arboleya Rodríguez: None declared, J. Narváez: None declared, DESEADA PALMA SANCHEZ: None declared, Olga Maiz-Alonso: None declared, J. Fernández-Leroy: None declared, I. Cabezas-Rodriguez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, A. Ruibal-Escribano: None declared, JR De Dios-Jiménez Aberásturi: None declared, Paloma Vela-Casasempere: None declared, C. González-Montagut Gómez: None declared, J M Blanco: None declared, Noelia Alvarez-Rivas: None declared, N. Del-Val: None declared, M. Rodíguez-Gómez: None declared, Eva Salgado-Pérez: None declared, Carlos Fernández-López: None declared, E.C. Cervantes Pérez: None declared, A. Devicente-DelMas: None declared, Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, Cristina Hidalgo: None declared, Sabela Fernández: None declared, Edilia García-Fernández: None declared, R. López-Sánchez: None declared, S. Castro: None declared, P. Morales-Garrido: None declared, Andrea García-Valle: None declared, Rosa Expósito: None declared, L. Exposito-Perez: None declared, Lorena Pérez Albaladejo: None declared, Ángel García-Aparicio: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

AB1167 PREGNANCY AND INFLAMMATORY ARTHROPATIES: EXPERIENCE IN A MULTIDISCIPLINARY UNIT

Background:

Systemic inflammatory diseases are common in women at the reproductive age. These women may have fertility problems and complications during pregnancy.

Objectives:

To describe the experience in a multidisciplinary unit (composed of Rheumatologists and Obstetricians) and asses the complications and treatments used in patients with inflammatory diseases in a tertiary hospital compared to those registered in healthy women from the same center (preterm births 6.59%, Caesarean section (C-section) 14.4%, maternal average age 33.33 years).

Methods:

Retrospective and descriptive study of the evolution of pregnancy in patients with inflammatory diseases and follow-up in a multidisciplinary unit for more than 15 years (until December 2019). Demographics, maternal disease, time until conception, births, abortions, C-sections, treatments and complications were collected. Data was analyzed using IBM SPSS v23.

Results:

We registered 29 pregnancies (25 patients): 20 Rheumatoid Arthritis (RA), 5 Psoriatic Arthritis (PsA), and 4 Spondylarthritis (SpA). Maternal average age at diagnosis was 27.6±6.36 years and average age at childbirth/abortion 35±5.6 years.

It took an average time of 8 months to conceive. 11.5% received fertility treatment using in vitro fertilization techniques.

5 abortions were registered prior to follow-up in this unit (0.2 abortions/mother). During follow-up 1 abortion (0.04 abortions/mother) was recorded in a RA patient. C-section was performed in 11 cases (39.2%): 6 RA (31.6%), 3 SpA (75%) and 2 PsA (40%).

17.2% of pregnancies were preterm (<37 weeks).

Intrauterine growth restriction (IUGR) was observed in a woman (3.4%) with RA and preeclampsia was observed in 2 cases (6.9%) (RA 1, SpA 1).

Disease activity (DAS28 and BASDAI) is shown in Table 1.

Table 1.DAS28 (median)PreviousFirstTrimesterSecondTrimesterThirdTrimesterPosteriorRheumatoid Arthritis2.692.593.093.333.11Psoriatic Arthritis2.582.53.323.082.89RA with biological agents (n: 6)2.372.942.712.42.52BASDAI (median)Spondylarthritis2.82.41.7511.9

Treatments used prior to and during pregnancy are listed in Table 2.

Table 2.TREATMENT BEFORE PREGNANCYn (%)TREATMENT DURINGPREGNANCYn (%)Hydroxychloroquine13 (44.8%)Prednisone17 (58.6%)Prednisone12 (41.4%)Acetylsalicylic acid16 (55.2%)Methotrexate9 (31%)Hydroxychloroquine15 (51.7%)TNF inhibitors7 (24.1%)Sulfasalazine2 (6.9%)Sulfasalazine2 (6.9%)TNF inhibitors2 (6.9%)

8 patients had received biological treatment prior to pregnancy (2 SpA, 6 RA)(3 Etanercept, 3 Adalimumab, 2 Certolizumab). 2 of them (RA) continued treatment during pregnancy. 1 of them discontinued it at week 17 on her own (Adalimumab) while the other continued with Certolizumab throughout pregnancy and presented IUGR. No other complications, such as infections or malformation, were observed in newborns. DAS28 data of these women can be found in Table 1.

Conclusion:

In our series, as described in the literature, women with inflammatory arthropaties are older, need longer time to achieve pregnancy and have increased use of fertility techniques and increased likelihood of preterm and instrumental delivery compared to general population. Given the low number of patients receiving biological treatment no conclusions about complications and evolution of the disease can be drawn, so further investigation are needed in this group of patients.

Monitoring inflammatory arthropathies in a multidisciplinary unit increases the chances of successful pregnancies.

Disclosure of Interests:

None declared

SAT0095 REAL LIFE SEVERE INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS ON TREATMENT WITH BIOLOGICAL THERAPY AND JAKI

Background:

Infections are one of the main complications among patients with rheumatoid arthritis (RA) with immunosuppressive treatment. The differences between treatments and the influence of other factors is unclear.

Objectives:

To evaluate the frequency and factors associated with serious infections in patients with RA treated with biological therapy (BT) and JAKi and the differences between treatments.

Methods:

Descriptive and retrospective study (January 2015-December 2019) of patients with RA treated with BT (TNFi, non-TNFi) and JAKi (tofacitinib, bariticinib) in a single center. Severe infection was considered a life-threatening infection or one that required hospitalization and intravenous treatment. Epidemiological variables, clinical characteristics, Charlson comorbidity index, type of BT or JAKi and concomitant treatment were collected.

For the analysis frequencies and percentages are used in qualitative variables, and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.

Results:

We registered 246 patients (85% women) mean aged 55.8±13.5 years. RF was positive in 87%, anti-CCP in 75.6% and 15.4 % presented extra-articular manifestations (nodulosis 8.9%, intersticial lung disease 5.3%, other 1.2%). At the start of the study 149 patients (60.6%) were with TNFi, 79 (32.1%) non-TNFi and 18 (7.3%) with JAKi and non-biologic DMARD (nbDMARDs) were used in 84.1% of cases (methotrexate 71.2%, leflunomide 21.4%, other 7.4%).

During the study 176 patients (71.5%) continued with the same treatment and in 70 (28.5%) it was changed at least once. 5 patients discontinued the treatment. At the end of the study, 124 patients (50.4%) were with TNFi, 83 (33.7%) non-TNFi and 34 (13.8%) with JAKi.

Severe infection was developed in 17 (6.9%) patients (respiratory 7, se sis 4, urinary 3, cellulitis 2, osteomyelitis 1) among them 2 patients had severe infection and herpes zoster and 3 developed a second infection. 9 patients were with TNFi (52.9%), 6 non- TNFi BT (35.3%) and 2 JAKi (11.8%). Table 1

TABLE 1.

CHARACTERISTICS OF PATIENTS WITH INFECTION VS. WITHOUT INFECTION

INFECTIONYESn:17NOn:229pFEMALE,n (%)13 (76.5)196 (85.6)0.297AGE years,(mean±SD)60.8 ± 1355.4 ± 13.50.112AGE ≥ 65n (%)9 (52.9)63 (27.5)0.070RF +,n (%)17 (100)197 (86)0.139ANTI-CCP +,n (%)14 (82.4)172 (75.1)0.770ILD,n (%)1 (25)12 (35.3)0.708ALCOHOL, n (%)1 (5.9)19 (8.3)1.00SMOKER, n (%)5 (29.4)60 (26.2)0.772COPD, n (%)5 (29.4)24 (10.5)0.036*DM, n (%)7 (41.2)19 (8.3)0.001*SEVERE LIVER DISEASE, n (%)2 (11.8)1 (0.4)0.013*RENAL INSUFFICIENCY,n (%)2 (11.8)3 (1.3)0.040*PERIPHERAL VASCULAR DISEASE, n (%)7 (41.2)25 (10.9)0.003*CHARLSON INDEX(mean±SD)2.35 ± 2.10.66 ± 1.20.014*TNFi, n (%)9 (52.9)115 (50.2)NON-TNFi n (%)6 (35.3)77 (33.6)JAKi, n (%)2 (11.8)32 (14)nbDMARDs,n (%)12 (70.6)156 (68.1)0.833GCC, n (%)13 (76.5)115 (50.2)0.037*

The inflammatory activity of RA was mild at the time of infection (DAS28: 2.7±1.2). The median time until infection was: TNFi 28.05 months, non- TNFi BT 25.03 and Jakinibs 16.97.

The Charlson index, concomitant treatment with glucocorticoids (GCC) (not treatment with nbDMARDs), chronic obstructive pulmonary disease (COPD), diabetes (DM), severe liver disease and moderate-severe renal insufficiency were statistically significantly associated with infection. Table 1

Conclusion:

In our study, 6.9% of patients with RA treated with BT or JAKi developed severe infection during 4 years of follow-up. Concomitant GCC therapy and comorbidity increased the risk of presenting this complication.

Disclosure of Interests:

None declared

SAT0035 RESPONSE TO ABATACEPT OF DIFFERENT PATTERNS OF INTERSTITIAL LUNG DISEASE IN RHEUMATOID ARTHRITIS: NATIONAL MULTICENTER STUDY OF 263 PATIENTS

Background:

Interstitial Lung Disease (ILD) is a severe extraarticular manifestation of rheumatoid arthritis (RA). In this line, several radiological patterns of RA-ILD have been described: i) usual interstitial pneumonia (UIP), ii) nonspecific interstitial pneumonia (NSIP), iii) obliterating bronchiolitis, iv) organized pneumonia and mixed patterns. Abatacept (ABA) could be an effective and safe option for patients with RA-ILD, although the response in the different radiological patterns is not well defined.

Objectives:

Our aim was to assess the response to ABA in different radiological patterns of ILD.

Methods:

Observational retrospective multicenter study of RA-ILD treated with ABA. ILD was diagnosed by HRCT and classified by radiological patterns in 3 different subgroups of RA-ILD: a) UIP, b) NSIP and c) “other”. ABA was used sc. or iv. at standard dose. We assessed: a) Dyspnoea (MMRC scale; significant variation ≥1); b) Respiratory function tests (significant changes ≥10% in FVC and DLCO); c) HRCT imaging; d) DAS28 e)prednisone dose.

Variables were collected at months 0, 3, 6, 12 months and subsequently every 12 months until a maximum of 60 months.

Results:

We included 263 patients: 106 UIP, 84 NSIP and 73 others (150 women / 113 men), mean age 64.64±10 years. Total patients positive for RF or CCPA were 235 (89.4%) and 233 (88.6%), respectively. In 26 out of 263 patients, the development of ILD was closely related to the administration of sDMARDs (MTX n = 11 and LFN n = 1) or bDMARDs (ETN n = 5, ADA n = 4, CZP n = 2 and IFX n = 3). Patient characteristics are shown in table 1. Figure 1 shows the evolution of the cases with available data after a mean follow-up of 22.7±19.7 months. Mean DLCO and FVC remained stable in the 3 groups without statistically significant changes, and all the groups showed a statistically significant reduction in DAS28 and prednisone dose.

Conclusion:

ABA could be a good choice of treatment in patients with RA-ILD independently of the radiological pattern of ILD.

Disclosure of Interests:

Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, J. Loricera: None declared, Francisco Ortiz-Sanjuán: None declared, A. Juan-Mas: None declared, Carmen Carrasco-Cubero Speakers bureau: Janssen, MSD, AbbVie, Novartis, Bristol Myers Squibb, and Celgene, S, Rodriguéz-Muguruza: None declared, S. Rodrigez -Garcia: None declared, R. Castellanos-Moreira: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

, CLARA AGUILERA CROS: None declared, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Sergi Ordoñez: None declared, Susana Romero-Yuste: None declared, C. Ojeda-Garcia: None declared, Manuel Moreno: None declared, Gemma Bonilla: None declared, I. Hernández-Rodriguez: None declared, Mireia Lopez Corbeto: None declared, José Luis Andréu Sánchez: None declared, Trinidad Pérez Sandoval: None declared, Alejandra López Robles: None declared, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, Natalia Mena-Vázquez: None declared, C. Peralta-Ginés: None declared, ANA URRUTICOECHEA-ARANA: None declared, Luis Marcelino Arboleya Rodríguez: None declared, J. Narváez: None declared, DESEADA PALMA SANCHEZ: None declared, Olga Maiz-Alonso: None declared, J. Fernández-Leroy: None declared, I. Cabezas-Rodriguez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, A. Ruibal-Escribano: None declared, JR De Dios-Jiménez Aberásturi: None declared, Paloma Vela-Casasempere: None declared, C. González-Montagut Gómez: None declared, J M Blanco: None declared, Noelia Alvarez-Rivas: None declared, N. Del-Val: None declared, M. Rodíguez-Gómez: None declared, Eva Salgado-Pérez: None declared, Carlos Fernández-López: None declared, E.C. Cervantes Pérez: None declared, A. Devicente-DelMas: None declared, Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, Cristina Hidalgo: None declared, Sabela Fernández: None declared, R. López-Sánchez: None declared, Edilia García-Fernández: None declared, S. Castro: None declared, P. Morales-Garrido: None declared, Andrea García-Valle: None declared, Rosa Expósito: None declared, L. Exposito-Perez: None declared, Lorena Pérez Albaladejo: None declared, Ángel García-Aparicio: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0906 PREVALENCE OF HYPOVITAMINOSIS D IN DIAGNOSTIC PATIENTS OF BREAST NEOPLASIA IS GREATER THAN EXPECTED FOR THE GENERAL POPULATION? SERIES OF 200 DIAGNOSTIC PATIENTS OF BREAST NEOPLASIA IN A TERTIARY HOSPITAL INITIATING TREATMENT WITH AROMATASE INHIBITORS

Background:

In our population the prevalence of hypovitaminosis D is high. A recent cross-sectional observational study conducted in Spain shows that 63% of postmenopausal women who receive osteoporosis (OP) therapy and 76% who do not receive treatment had 25 (OH) D levels below 30 ng / mL1.

The latest studies show a relationship between hypovitaminosis D and the development of systemic inflammatory and tumor diseases, determined by the presence of receptors in various tissues, including breast.

Objectives:

To determine which levels of serum 25 (OH) D, and secondarily calcium, phosphorus, PTH and CTX, present 200 patients diagnosed with breast cancer and taking hormonal treatment, referred to a monographic OP consultation of a tertiary hospital for the assessment of their bone metabolism, and if these values differ from what is expected for the general population.

Methods:

Retrospective cross-sectional study of 200 women diagnosed with breast cancer receiving treatment with aromatase inhibitors (AI), performed in a tertiary hospital. Blood levels of vitamin D, calcium, phosphorus, PTH and CTX have been collected, as well as other variables and risk factors.

Results:

200 patients with a mean age of 64.8 years and an ED of 9.5 were collected. The median is 64.5 (Q1 58 and Q3 72).

The vitamin D levels presented by the study patients were <10 ng/mL in 13 patients (6.67%), 11-20 ng/mL in 50 (25.64%), 21-30 ng/mL in 68 (34.87%), 31-70 ng/mL in 62 (31.79%), and> 70 ng/mL in 2 (1.03%). This implies that in 67.18% of the patients they had values below the optimal range.

92.31% of patients (180) presented PTH values within the normal range and only 7.69% presented values above normal.

The serum calcium and phosphorus levels of the patients selected for the study had ranges within normal (99.49%) except 1 case that presented high values (0.51%) for both.

The values of CTX (carboxyterminal telopeptide used as a marker of bone resorption) were in the normal range in 81.96% of patients (159), low values in 0.52% (1) and values above the normal range by 17.53% (34).

Conclusion:

The prevalence of insufficient levels of vitamin D in our study (Breast cancer + AI) is not greater than that estimated for the general population according to various studies.

Our study found that 67.18% of patients (2/3 of the selected population) had values below those considered optimal (<30 ng / mL) and 32% had values <20.

Only 7.69% of the patients presented PTH values above the normal range.

In 82% of patients, CTX used as a marker of bone resorption had normal values.

References:

[1]Quesada Gomez JM, Díaz Curiel M, Sosa Henríquez M, Malouf-Sierra J, Nogués-Solan X, Gómez-Alonso C, et al. Low calcium intake and insufficient serum vitamin D status in treated and non-treated postmenopausal osteoporotic women in Spain. J Steroid Biochem Mol Biol. 2013;136:175-7.

[2]Jian Sun et al., Vitamin D receptor expression in peripheral blood mononuclear cells is inversely associated with disease activity and inflammation in lupus patients; Clinical Rheumatology (2019) 38:2509–2518

Disclosure of Interests:

None declared

OP0212 ABATACEPT IN INTERSTITIAL LUNG DISEASE ASSOCIATED WITH RHEUMATOID ARTHRITIS. NATIONAL MULTICENTER STUDY OF 263 PATIENTS

Background:

Interstitial Lung Disease (ILD) is a severe complication of Rheumatoid Arthritis (RA). Several conventional disease-modifying anti-rheumatic drugs (cDMARDs) and biologic (b) DMARDs may induce or impaired ILD-RA. Abatacept (ABA) may be useful in ILD-RA (1).

Objectives:

To assess the efficacy and safety of ABA in a large series of ILD-RA for a long-term follow-up.

Methods:

Multicenter open-level study of ILD-RA treated with at least 1 dose of ABA. ILD was diagnosed by high-resolution computed tomography (HRTC). We study these outcomes: a) 1-point change Modied Medical Research Council (MMRC); b) forced vital capacity (FVC) and/or DLCO improvement or decline ≥10%; c) change in HRCT, d) change in DAS28. e) Prednisone dose. Values were collected at 0, 3, 6, 12 and then every 12 months.

Results:

We studied 263 patients (150 women/113 men) (mean age;64.6±10 years), with ILD-RA. At ABA-onset they were smokers or exsmoker (53.8%), positive APCC (88.6%), median [IQR] duration of ILD of 12 [3-41.25] months, mean DLCO (65.7±18.3) and FVC (85.9±21.8).

The ILD-pattern were usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%).

ABA was prescribed at standard subcutaneous (125 mg/w) in 196 (74.5%) or intravenously (10 mg/kg/4 w) in 67 (25.5%); in monotherapy (n=111) or combined with cDMARDs (n=152); especially leflunomide (n=55), MTX (n=46), or antimarials (n=21).

After a mean follow-up of 22.7±19.7 months most outcomes remain stable (Figure). Moreover, DAS28 improved from 4.5±1.5 to 3.1±1.3; prednisone dose reduced from a median 7.5 [5-10] to 5 mg [5-7.5] and retention rate was 76.4%. The main adverse effects were serious infections (n=28), neoplasia (n=3), serious infusion reaction (n=1) and myocardial infarction (n=1).

Conclusion:

ABA seems effective and relatively safe in ILD-RA.

References:

[1]Fernández-Díaz C et al. Semin Arthritis Rheum. 2018; 48:22-27

Disclosure of Interests:

Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, J. Loricera: None declared, Francisco Ortiz-Sanjuán: None declared, A. Juan-Mas: None declared, Carmen Carrasco-Cubero Speakers bureau: Janssen, MSD, AbbVie, Novartis, Bristol Myers Squibb, and Celgene, S, Rodriguéz-Muguruza: None declared, S. Rodrigez -Garcia: None declared, R. Castellanos-Moreira: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

CLARA AGUILERA CROS: None declared, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Sergi Ordoñez: None declared, Susana Romero-Yuste: None declared, C. Ojeda-Garcia: None declared, Manuel Moreno: None declared, Gemma Bonilla: None declared, I. Hernández-Rodriguez: None declared, Mireia Lopez Corbeto: None declared, José Luis Andréu Sánchez: None declared, Trinidad Pérez Sandoval: None declared, Alejandra López Robles: None declared, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, Natalia Mena-Vázquez: None declared, C. Peralta-Ginés: None declared, ANA URRUTICOECHEA-ARANA: None declared, Luis Marcelino Arboleya Rodríguez: None declared, J. Narváez: None declared, DESEADA PALMA SANCHEZ: None declared, Olga Maiz-Alonso: None declared, J. Fernández-Leroy: None declared, I. Cabezas-Rodriguez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, A. Ruibal-Escribano: None declared, JR De Dios-Jiménez Aberásturi: None declared, Paloma Vela-Casasempere: None declared, C. González-Montagut Gómez: None declared, J M Blanco: None declared, Noelia Alvarez-Rivas: None declared, N. Del-Val: None declared, M. Rodíguez-Gómez: None declared, Eva Salgado-Pérez: None declared, Carlos Fernández-López: None declared, E.C. Cervantes Pérez: None declared, A. Devicente-DelMas: None declared, Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, Cristina Hidalgo: None declared, Sabela Fernández: None declared, Edilia García-Fernández: None declared, R. López-Sánchez: None declared, S. Castro: None declared, P. Morales-Garrido: None declared, Andrea García-Valle: None declared, Rosa Expósito: None declared, L. Exposito-Perez: None declared, Lorena Pérez Albaladejo: None declared, Ángel García-Aparicio: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

Engineering of Magnetic Softness and Domain Wall Dynamics of Fe-rich Amorphous Microwires by Stress- induced Magnetic Anisotropy

We observed a remarkable improvement of domain wall (DW) mobility, DW velocity, giant magnetoimpedance (GMI) effect and magnetic softening at appropriate stress-annealing conditions. Beneficial effect of stress-annealing on GMI effect and DW dynamics is associated with the induced transverse magnetic anisotropy. An improvement of the circumferential permeability in the nearly surface area of metallic nucleus is evidenced from observed magnetic softening and remarkable GMI effect rising. We assumed that the outer domain shell with transverse magnetic anisotropy associated to stress-annealing induced transverse magnetic anisotropy affects the travelling DW in a similar way as application of transversal bias magnetic field allowing enhancement the DW velocity. Observed decreasing of the half-width of the EMF peak in stress-annealed microwires can be associated to the decreasing of the characteristic DW width. Consequently, stress annealing enabled us to design the magnetic anisotropy distribution beneficial for optimization of either GMI effect or DW dynamics.

Tailoring of magnetoimpedance effect and magnetic softness of Fe-rich glass-coated microwires by stress- annealing

There is a pressing need for improving of the high-frequency magneto-impedance effect of cost-effective soft magnetic materials for use in high-performance sensing devices. The impact of the stress-annealing on magnetic properties and high frequency impedance of Fe-rich glass-coated microwires was studied. Hysteresis loops of Fe-rich microwires have been considerably affected by stress- annealing. In stress-annealed Fe- rich microwire we obtained drastic decreasing of coercivity and change of character of hysteresis loop from rectangular to linear. By controlling stress-annealing conditions (temperature and time) we achieved drastic increasing (by order of magnitude) of giant magnetoimpedance ratio. Coercivity, remanent magnetization, diagonal and of-diagonal magnetoimpedance effect of Fe-rich microwires can be tuned by stress-annealing conditions: annealing temperature and time. Observed experimental results are discussed considering relaxation of internal stresses, compressive "back-stresses" arising after stress annealing and topological short range ordering.

Study of Jet Quenching with Z+jet Correlations in Pb-Pb and pp Collisions at sqrt[s]_{NN}=5.02 TeV

The production of jets in association with Z bosons, reconstructed via the μ^{+}μ^{-} and e^{+}e^{-} decay channels, is studied in pp and, for the first time, in Pb-Pb collisions. Both data samples were collected by the CMS experiment at the LHC, at a nucleon-nucleon center-of-mass energy of 5.02 TeV. The Pb-Pb collisions were analyzed in the 0%-30% centrality range. The back-to-back azimuthal alignment was studied in both pp and Pb-Pb collisions for Z bosons with transverse momentum p_{T}^{Z}>60  GeV/c and a recoiling jet with p_{T}^{jet}>30  GeV/c. The p_{T} imbalance x_{jZ}=p_{T}^{jet}/p_{T}^{Z}, as well as the average number of jet partners per Z, R_{jZ}, was studied in intervals of p_{T}^{Z}. The R_{jZ} is found to be smaller in Pb-Pb than in pp collisions, which suggests that in Pb-Pb collisions a larger fraction of partons associated with the Z bosons fall below the 30  GeV/c p_{T}^{jet} threshold because they lose energy.

Marine protected area design patterns in the Mediterranean Sea: Implications for conservation

Mediterranean marine protected area (MPA) design patterns regarding geographic distribution, size, spacing and shape were analysed as a proxy of the region's MPA's ecological effectiveness and a first step towards an ecologically coherent MPA network. Results for legally designated MPAs and ecologically functional MPAs accounting for overlaps are presented. Geographically, Mediterranean MPA area is very unevenly distributed, with four-fifths concentrated in just three countries of the north-western part of the basin. Average distance between functional MPAs lies within recommended ecological thresholds, which suggests adequate potential connectivity of the Mediterranean MPA system. Mediterranean designated MPAs are larger than MPAs worldwide on average, although they are generally smaller than international guidance suggests at different levels: ecoregion, country and designation category. On average, Mediterranean designated and functional MPAs have relatively high compactness, which makes them prone to spillover and adequate viability, and less vulnerable to edge effects.

Biological characterization of the skin of shortfin mako shark Isurus oxyrinchus and preliminary study of the hydrodynamic behaviour through computational fluid dynamics

This study characterized the morphology, density and orientation of the dermal denticles along the body of a shortfin mako shark Isurus oxyrinchus and identified the hydrodynamic parameters of its body through a computational fluid-dynamics model. The study showed a great variability in the morphology, size, shape, orientation and density of dermal denticles along the body of I. oxyrinchus. There was a significant higher density in dorsal and ventral areas of the body and their highest angular deviations were found in the lower part of the mouth and in the areas between the pre-caudal pit and the second dorsal and pelvic fins. A detailed three-dimensional geometry from a scanned body of a shark was carried out to evaluate the hydrodynamic properties such as drag coefficient, lift coefficient and superficial (skin) friction coefficient of the skin together with flow velocity field, according to different roughness coefficients simulating the effect of the dermal denticles. This preliminary approach contributed to detailed information of the denticle interactions. As the height of the denticles was increased, flow velocity and the effect of lift decreased whereas drag increased. The highest peaks of skin friction coefficient were observed around the pectoral fins.

Magnetoelastic contribution in domain wall propagation of micrometric wires

We report on studies of domain wall propagation of magnetically-bistable Fe-Co-rich microwires paying attention on the effect of applied and internal stresses. We measured magnetic domain propagation in various magnetic Fe-Co-rich amorphous microwires with metallic nucleus diameters (from 2.8 microm to 18 microm) using Sixtus Tonks-like experiments. We found that application of applied stresses and increasing of internal stresses result in decreasing of domain wall (DW) velocity. We assume that in order to achieve higher DW propagation velocity at the same magnetic field and enhanced DW mobility, special attention should be paid to the decrease of magnetoelastic energy.

Role of d electrons in Auger neutralization at metal surfaces

A generalized theory of Auger electron transfer processes in the interaction of ions with metal surfaces, including the previously ignored role of d electrons is presented. It is shown that a correct and accurate description of Auger neutralization has to account for the contribution of d electrons, as this is illustrated on the case of He+ ion neutralization on Ag, where the neglect of these leads to a strong overestimation of ion survival probabilities. Crystal lattice site specific rates are calculated and allow for a correct description of crystal azimuthal effects in neutralization.

Chaunocephalus ferox in free-living white storks in central Spain

Ten out of 42 (23.8%) white storks (Ciconia ciconia) admitted to two rehabilitation centers in central Spain had lesions caused by the trematode Chaunocephalus ferox in the small intestinal wall. Fourteen of the examined birds were adults, five were subadults, and 23 were chicks of various ages. Parasitation was 32% (n = 8) in chicks and 13% (n = 2) in adult birds, whereas no juvenile bird was affected. Among dead birds, stork chicks affected by C. ferox lesions had a lower body weight (2196.1 g, SD = 814.2) than storks without lesions (2965.8 g, SD = 742.9, P < 0.05). Two chicks were additionally infected with Salmonella subspecies I serotype enteritidis 1,9,12: g, m:1, 7. Prevalence of the parasite in the examined birds was lower than in a population of Asian open-billed storks (Anastomus oscitans), in which it was pathogenic due to the destruction of the tunica muscularis and formation of large granulomatous lesions in the wall of the postduodenal portion of the small intestine. Pathogenic alterations caused by C. ferox are presumed to be related to numbers of adults present. Because storks admitted to rehabilitation centers suffer stress due to various reasons that may lower their immune response and exacerbate existing infections, the analysis of fecal sediments of white storks admitted for rehabilitation is recommended.

Seroprevalence of avian paramyxovirus 1, 2, and 3 in captive and free-living birds of prey in Spain (preliminary results): implications for management of wild and captive populations

Since December 1997, 700 blood plasma samples from 31 different species of captive and free-living birds of prey from Spain were analyzed by hemagglutination inhibition (HI) test for the presence of antibodies to avian paramyxovirus (aPMV) 1,2, and 3. Out of 700 birds, 120 tested positive for aPMV-1, 10 birds had antibodies to aPMV-2, and 4 birds tested positive against aPMV-3. Prevalence of antibodies against aPMV-1 was significantly higher in captive than in free-living birds of prey and in Falconiformes than in Strigidae and Accipitridae. Infection or exposure in captive birds may be due to the use of avian-derived food in rehabilitation and captive-breeding centers. This may be of concern at the time of reintroduction of these birds into free-living populations.

Outcomes of a health education intervention in a sample of patients infected by HIV, most of them injection drug users: possibilities and limitations

We studied the receptivity of a population of HIV-infected patients to the development of a group educational intervention in order to enhance the adherence to therapy. We designed a group educational activity conducted by family physicians and directed to patients with HIV infection treated with antiretrovirals for at least six months. We conducted a randomized trial that compared two interventions: an educational intervention plus individual counsel or the last option alone. We studied their clinical situation, adherence to therapy and familial support. We offered 115 patients (66.9% injection drug users (IDUs), 69.6% males) the opportunity to be included in our trial, but 73.9% of them refused. No group with four or more participants was formed. Fifty-nine per cent refused to be included claiming personal reasons and 32.9% cited trouble in their jobs. There was a non-significant trend to accept in the case of women (p = 0.19), patients with AIDS (p = 0.11) and non-adherent patients (p = 0.08). This trend was significant in the group of women with AIDS (p = 0.01) and non-adherent women (p = 0.05). We concluded that HIV-infected patients, mainly IDUs, are not receptive to group educational programmes. The design of future interventions must take into account the patients' characteristics.

A cyclobutane carbonucleoside with marked selectivity against TK+ and TK- varicella zoster virus

Several cyclobutyladenine and analogous carbonucleosides were synthesized from 1R-alpha-pinene and their anti-viral activity was tested. One of them (3e) showed interesting selectivity against both TK+ and TK- VZV.

Mesoscale vertical motion and the size structure of phytoplankton in the ocean

Phytoplankton size structure is acknowledged as a fundamental property determining energy flow through 'microbial' or 'herbivore' pathways. The balance between these two pathways determines the ability of the ecosystem to recycle carbon within the upper layer or to export it to the ocean interior. Small cells are usually characteristic of oligotrophic, stratified ocean waters, in which regenerated ammonium is the only available form of inorganic nitrogen and recycling dominates. Large cells seem to characterize phytoplankton in which inputs of nitrate enter the euphotic layer and exported production is higher. But the size structure of phytoplankton may depend more directly on hydrodynamical forces than on the source of available nitrogen. Here we present an empirical model that relates the magnitude of mesoscale vertical motion to the slope of the size-abundance spectrum of phytoplankton in a frontal ecosystem. Our model indicates that the relative proportion of large cells increases with the magnitude of the upward velocity. This suggests that mesoscale vertical motion-a ubiquitous feature of eddies and unstable fronts-controls directly the size structure of phytoplankton in the ocean.

Species variation in osmotic, cryoprotectant, and cooling rate tolerance in poultry, eagle, and peregrine falcon spermatozoa

Potential factors influencing spermatozoa survival to cryopreservation and thawing were analyzed across a range of the following avian species: domestic chicken (Gallus domesticus), domestic turkey (Meleagris gallopavo), golden eagle (Aquila chrysaetos), Bonelli's eagle (Hieraaetus fasciatus), imperial eagle (Aquila adalberti), and peregrine falcon (Falco peregrinus). Studies focused on spermatozoa tolerance to the following: 1) osmotic stress, 2) different extracellular concentrations of the cryoprotectant dimethylacetamide (DMA), 3) equilibration times of 1 versus 4 h, 4) equilibration temperature of 4 versus 21 degrees C, and 5) rapid versus slow cooling before cryopreservation and standard thawing. Sperm viability was assessed with the live/dead stain (SYBR-14/propidium iodine). Sperm viability at osmolalities >/=800 mOsm was higher (P: < 0.05) in raptor than poultry semen. Return to isotonicity after exposure to hypertonicity (3000 mOsm) decreased (P: < 0.05) number of viable spermatozoa in chicken, turkey, and golden and Bonelli's eagle spermatozoa but not in imperial eagle or peregrine falcon spermatozoa. Differences were found in spermatozoa resistance to hypotonic conditions, with eagle species demonstrating the most tolerance. Semen, equilibrated for 1 h (4 degrees C) in diluent containing DMA (> or =2.06 M), experienced decreased (P: < 0. 05) spermatozoa survival in all species, except the golden eagle and peregrine falcon. Number of surviving spermatozoa diminished progressively with increasing DMA concentrations in all species. Increased equilibration temperature (from 4 to 21 degrees C) markedly reduced (P: < 0.05) spermatozoa survival in all species except the Bonelli's eagle and turkey. Rapid cooling was detrimental (P: < 0.05) to spermatozoa from all species except the imperial eagle and the chicken. These results demonstrate that avian spermatozoa differ remarkably in response to osmotic changes, DMA concentrations, equilibration time, temperature, and survival after fast or slow freezing. These differences emphasize the need for species-specific studies in the development and enhancement of assisted breeding for poultry and endangered species.

Synthesis and antiviral and cytostatic activities of carbocyclic nucleosides incorporating a modified cyclobutane ring. Part 1: Guanosine analogues

Five new carbocyclic nucleosides were prepared by constructing a guanine (compounds 3, 5) or 8-azaguanine (compounds 4, 6, and 7) base on the amino group of (1'S,3'R)-3-(3'-amino-2',2'-dimethylcyclobutyl)propan-1-ol (8), and their activities against a variety of viruses and tumor cell lines were determined. Only compounds 3 and 7 showed a detectable activity at subtoxic concentrations against some viruses tested.

Synthesis and antiviral and antineoplastic activities of some novel carbocyclic guanosine analogues with a cyclobutane ring

Cyclobutyl nucleoside analogues containing guanine and 8-azaguanine (compounds 5-10) were prepared from (1R,cis)-3-aminomethyl-2,2-dimethylcyclobutylmethanol (1). All were evaluated as antiviral and antitumoral agents in a variety of assay systems. Compounds 6 and 7 showed a noteworthy activity against a respiratory syncytial virus and compound 10 was moderately active against vaccinia virus. Only compound 5 showed some cytostatic activity.

Synthesis of novel carbocyclic nucleosides with a modified cyclopentane ring and evaluation of their antiviral activity

New carbocyclic nucleosides with purine (compounds 2a-2c), 8-azapurine (compounds 2d and 2e) or pyrimidine (compound 3) as base were prepared and assayed for in vitro activity.

Synthesis, antiviral and cytostatic activities of carbocyclic nucleosides incorporating a modified cyclopentane ring. Part 2: Adenosine and uridine analogues

Six new carbocyclic nucleosides were prepared by mounting a purine (compounds 5-7), 8-azapurine (compounds 9 and 10) or pyrimidine (compound 13) base on the amino group of (1R,cis)-3-(aminomethyl)-1,2,2-trimethylcyclopentylmethanol (2). The antiviral activity of compounds 5-7, 10 and 13, and their cytostatic activity, were evaluated. At subtoxic concentrations, the compounds showed no or marginal antiviral activity. Compound 5 showed moderate inhibition on tumor cell proliferation.

Fractionation and amino acid composition of an aspartic acid-containing thermal proteinoid population

The heterogeneity of an aspartic acid-containing thermal polymer population has been studied by anion exchange chromatography, amino acid analysis of the resulting fractions and data processing by the principal components method. By using stepwise or continuous gradients of ionic strength both saw-toothed or bell-shaped elution profiles were obtained. This behaviour and the amino acid composition of analyzed fractions suggest a relatively high degree of heterogeneity in the polymer population although less than theoretically expected. This conclusion is compared with the findings reported in proteinoids made by similar procedures.

Treatment of splenic artery aneurysm after distal splenorenal shunt. A case report

A patient with splenic artery aneurysm which developed after creation of selective distal spleno-renal shunt for hepatic cirrhosis and portal hypertension was presented. Three months after operation, an aneurysm of the splenic artery with a diameter of about 20 mm was detected. This aneurysm reached 4 cm three months later, and a resection was carried out. An arterial continuity was established by means of end-to-end anastomosis of the sectioned arterial ends. Because the flow through the splenic artery was about 60% of the total flow of the selective distal spleno-renal shunt, it is important to maintain continuity in order to avoid thrombosis of the shunt.