Anyonic Statistics Revealed by the Hong-Ou-Mandel Dip for Fractional Excitations

The fractional quantum Hall effect (FQHE) is known to host anyons, quasiparticles whose statistics is intermediate between bosonic and fermionic. We show here that Hong-Ou-Mandel (HOM) interferences between excitations created by narrow voltage pulses on the edge states of a FQHE system at low temperature show a direct signature of anyonic statistics. The width of the HOM dip is universally fixed by the thermal time scale, independently of the intrinsic width of the excited fractional wave packets. This universal width can be related to the anyonic braiding of the incoming excitations with thermal fluctuations created at the quantum point contact. We show that this effect could be realistically observed with periodic trains of narrow voltage pulses using current experimental techniques.

POS1365 THE FMF&AID SURVEY - A PATIENT ORGANIZATION DRIVEN SURVEY FOR AUTOINFLAMMATORY DISEASES

Background

Autoinflammatory diseases (also referred to as hereditary periodic fever syndromes) are caused by defects in the innate immune system. Many autoinflammatory syndromes arise from inherited genetic mutations which begin in childhood and persist throughout adult life. These diseases are often present in several members and generations within a family. Newer research also reflects that, cases can often present at any age through-out childhood, teenage years, and even into older adulthood. These cases appear to be acquired, perhaps due to the interplay of genetic, immune, and environmental factors (somaticism). It is not uncommon that a patient is diagnosed with rheumatoid arthritis, multiple sclerosis or another autoimmune issue, as many physicians are not aware of monogenic inborn errors, nor how to conduct a thorough work up due to a lack of medical knowledge.

Objectives

Unfortunately, the knowledge base that many doctors have with regards to autoinflammatory genetic diseases is minimal to non-existent, when compared to the well-established expertise of autoimmune disease management. Concerns about the increasing patient accounts detailing lack of medical diagnosis, treatment, and pain management, lead to the important decision to collect further data from the autoinflammatory patient community. The aim of the survey responses collected, and post data aggregation will help identity patient trends and use this information to educate and increase awareness amongst the medical community as to the unmet diagnostic and treatment requirements for the autoinflammatory population.

Methods

A questionnaire comprised of thirty questions was developed by members of the patient organization FMF & AID Global Association (Executive Director, Malena Vetterli with Research Director, H. Ellen Cohen) under the guidance of Dr. med. Juergen Rech focused on collecting basic information (e.g. age, country, onset and duration of symptoms, pain and fatigue). The survey was published at the end of 2020 on social media (Facebook) and on the FMF&AID website (www.fmfandaid.org). Participation was voluntary and the patients agreed that the anonymised response information of the survey may be evaluated and published. This international survey was approved by the ETHICS Committee FAU in Erlangen-Nuremberg, Germany.

Results

Worldwide, over a thousand patients or parents/caregivers of patients (younger than 18 years) in fifty-two countries took part in this survey and answered the questionnaire. Eighty percent (80%) of the participants had already been diagnosed with an autoinflammatory disease. However, despite classic periodic symptom presentation, twenty percent (20%) of the participants were still without a concise diagnosis. FMF - forty-three percent (43%) was cited as the most common diagnosis and M. Behçet thirty percent (30%) as the second, with a variety of others (e.g. PFAPA, CAPS, HIDS, TRAPS, DADA, Yao syndrome, and uSAID). The minimum age at diagnosis ranged from 1 to 70+ years old with an average age of 33 years when properly diagnosed. Three-hundred and nine (309) patients reported that their pain had not been taken seriously and adequately treated in the past. Pain and fatigue, as measured by the standard visual analogue scale (VAS 0-10), was high in the past 30 and 7 days, respectively. VAS pain 30 days was 4.8 (SD +/-2.7) or 7 days with 4.2 (SD +/- 3), as well as fatigue VAS 30 days 5.7 (SD +/- 2.8) or fatigue VAS 7 days with 5.5 (SD +/- 3).

Conclusion

One-fifth of patients with classic symptoms of autoinflammatory diseases remain undiagnosed and therefore not specifically treated. Although, the rest of the participants eighty percent (80%) have a diagnosis of an autoinflammatory disease, therapy does not appear to be sufficient to manage their wide-ranging and debilitating symptoms, in particular pain and fatigue. Patients continue to carry the burden of receiving mental diagnosis vs actual medical diagnosis and are still forced to seek additional medical support, often incurring travel or relocation costs to obtain proper care.

Disclosure of Interests

Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Biogen, BMS, Chugai, GSK, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Koray Tascilar: None declared, Abdurrahman Tufan: None declared, Marco Gattorno: None declared, J. B. Kuemmerle-Deschner: None declared, Seza Ozen: None declared, Tobias Krickau: None declared, Ellen Cohen: None declared, Leonardo Oliveira Mendonca: None declared, Apostolos Kontzias: None declared, Malena Vetterli: None declared

POS0220 LONG-TERM SAFETY AND EFFECTIVENESS OF CANAKINUMAB IN CRYOPYRIN-ASSOCIATED PERIODIC SYNDROMES – 36-MONTH DATA FROM THE RELIANCE REGISTRY

Background

The cryopyrin-associated periodic fever syndromes (CAPS) are hereditary monogenic autoinflammatory diseases with severe systemic and organ inflammation due to increased production of Interleukin-1β (IL-1β). The subcutaneously administered monoclonal antibody canakinumab (CAN) effectively inhibits IL-1β and results in rapid remission of CAPS symptoms in clinical trials as well as in real-life.

Objectives

The RELIANCE registry is designed to explore long-term safety and effectiveness of CAN under routine clinical practice conditions in pediatric (≥2 years) and adult patients with CAPS, including Muckle-Wells syndrome (MWS), familial cold autoinflammatory syndrome (FCAS), and neonatal onset multisystem inflammatory disease (NOMID)/chronic infantile neurological cutaneous and articular syndrome (CINCA).

Methods

This prospective, non-interventional, observational study with a 3-year follow-up enrolls patients in Germany with clinically confirmed diagnoses of CAPS routinely receiving CAN. In 6-monthly visits, clinical data, physician assessments and patient-reported outcomes are evaluated starting at baseline.

Results

98 CAPS patients (52% female; 15 [15%] NOMID/CINCA subtypes) were enrolled by December 2021 (Table 1). At baseline, median age was 20 years and median duration of prior CAN treatment was 6 years. At the 36 months visit, 74% of patients reached disease remission by physicians´ assessment along with increasing rates of absent disease activity (patient’s assessment, median 2.0 at baseline and 0.0 month 36). In addition, patients reported low levels of fatigue (absent to mild/moderate: 87% at baseline and 95% at month 36). At baseline, CAPS impaired social life in 47% of patients (37% at month 36) and 33% (23% at month 36) reported days off from school/work. Lab parameters were within normal limits. Remission and disease control were sustained as evaluated parameters remained stable or even decreased over time.

Table 1.

Patient and physician assessment of clinical CAPS disease activity and laboratory markers over time.

Baseline12 months36 monthsNumber of patients, N987240Number (%) of patients in disease remission (physician assessment)64 (68)48 (70)28 (74)Patient’s assessment of current disease activity; 0–10, median (min; max)2.0 (0; 7)2.0 (0; 7)0.0 (0; 6)Patient’s assessment of current fatigue; 0–10, median (min; max)3.0 (0; 9)2.0 (0; 8)1.0 (0; 8)Number (%) of patients without impairment of social life by the disease34 (53)35 (65.0)17 (63)CRP (mg/dl) | SAA (mg/dl); median0.1 | 0.30.1 | 0.50.1 | 0.3Number (%) of patients with disease-related symptomsprior to inclusion into the study | at baseline12 months36 monthsFever75 (80) | 14 (15)19 (28)4 (11)Fatigue84 (89) | 49 (52)36 (52)17 (46)Conjunctivitis/Uveitis63 (67) | 27 (29)21 (30)7 (19)Headache68 (72) | 30 (32)30 (43)9 (24)Arthralgia/arthritis80 (85) | 32 (34)30 (43)14 (38)Impairment of hearing35 (37) | 23 (25)18 (26)11 (30)Trigger (cold, stress, infections, vaccinations, hormones)71 (76) | 32 (34)21 (30)3 (8)SAENumber of eventsIncidence rate* per 100 patient yearsAll types of SAE | SADR63 | 28#25.98 | 11.55

CRP, c-reactive protein; ESR, erythrocyte sedimentation rate; n. a., not annotated; SAA, serum amyloid A; SADR, serious adverse drug reaction; SAE, serious adverse event

*Incidence rate = number of events * 36,525 / sum of observation days (=88,558)

#Abdominal pain, Alport’s syndrome, appendicitis, arthralgia, blister, cardiovascular disorder, chest pain, circulatory collapse, dehydration, diplopia, dyspnoea, erythema, febrile convulsion, gastroenteritis, glomerulonephritis, haemophilus test positive, myalgia, oedema, pneumonia, premature delivery, skin discoloration, tonsillectomy, tonsillitis bacterial, tonsillitis streptococcal, vision blurred (all N=1 event), pyrexia (3 events)

Conclusion

The 36-month interim analysis of the RELIANCE study demonstrates that long-term CAN treatment is safe and effective in patients with CAPS, independent of subtype severity.

Disclosure of Interests

J. B. Kuemmerle-Deschner Consultant of: Novartis, AbbVie, Sobi, Grant/research support from: Novartis, AbbVie, Sobi, Birgit Kortus-Goetze Paid instructor for: Novartis, Prasad Oommen Grant/research support from: Novartis, Ales Janda: None declared, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Catharina Schuetz: None declared, Tilmann Kallinich Consultant of: Sobi, Novartis, Roche, Grant/research support from: Novartis, Frank Weller-Heinemann: None declared, Gerd Horneff Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Ivan Foeldvari Consultant of: Novartis, Hexal, Medac, Pfizer, Florian Meier Speakers bureau: Novartis, Michael Borte Grant/research support from: Pfizer, Shire, Tobias Krickau Speakers bureau: Novartis, Consultant of: Novartis, Grant/research support from: Novartis, Julia Weber-Arden Employee of: Novartis, Norbert Blank Consultant of: Novartis, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Actelion, UCB, Boehringer-Ingelheim, Roche, Grant/research support from: Novartis, Sobi

POS0314 IDENTIFICATION OF CIRCULATING microRNA SIGNATURES IN PATIENTS WITH PSORIASIS WITH SUBCLINICAL JOINT DISEASE AND PATIENTS WITH PSORIATIC ARTHRITIS

Background

MicroRNAs (miRNAs) are small non-coding RNAs that control gene expression. Specific miRNA signatures have been identified in numerous diseases and may serve as potential biomarkers or new drug targets. Whether certain miRNA signatures are associated with psoriatic joint disease is currently unknown.

Objectives

To search for circulating miRNA signatures in psoriasis patients with subclinical joint disease and in patients with psoriatic arthritis (PsA).

Methods

Analyses of serum miRNA were done in three groups: (1) PsA patients fulfilling CASPAR criteria (PsA), (2) healthy controls without past or present signs of musculoskeletal disease (HC) and (3) psoriasis patients with musculoskeletal pain but no signs of clinical PsA (PsO). PsO and PsA patients received a hand MRI, which was scored according to PsAMRIS method. miRNA analysis of serum samples was performed stepwise using RT-qPCR (TAmiRNA Vienna). In the discovery phase 192 miRNA assays were analyzed in 48 samples (N=16 each group). In the validation phase 17 miRNAs (Table 1) were selected and analyzed in 94 samples (N=35 PsA, N=24 PsO, N=35 HC) based on results of discovery phase and previous reports in literature. Results presented as mean±SD/median (IQR), p-values are adjusted for multiple testing.

Table 1.miRNAsPsA vs HCPsO vs HCPsA vs PsODiscovery PhaseValidation PhaseDiscovery PhaseValidation PhaseDiscovery PhaseValidation Phasep-adj.p-adj.p-adj.p-adj.p-adj.p-adj.miR-93-5p0.0001<0.0010.0080.0050.0390.947miR-29b-3p0.0001<0.00010.0040.00020.1910.522miR-19b-3p0.0070.7080.00020.0200.1380.147miR-320d0.0010.619<0.00010.1350.9410.247miR-144-5p0.0030.0060.00010.1690.3500.444miR-188-5p0.0140.9900.9750.6470.0530.839let-7b-5p0.0250.00030.8890.0260.00030.472miR-92a-3p0.0430.0010.0050.773<0.00010.0005miR-324-3p0.1381.0000.2570.3920.8140.518miR-126-3p0.0140.1690.0130.5980.9220.654miR-223-3p0.1690.8720.6170.7460.5191.000miR-130a-3p0.0390.0350.5560.0090.0060.724miR-140-3p0.3500.0530.0020.0060.1180.683miR-155-5p0.1590.9950.1690.5490.9220.604miR-21-5p0.2970.9900.0030.1160.080.014miR-146a-5p0.7060.0040.8360.0380.9050.941miR-122-5p0.9600.7340.6950.7990.9050.444

Results

51 PsA patients (age: 51.3±11.4 years; 56.9% females), 40 PsO patients (51.4±11.0; 37.5%) and 50 HC (51.0±10.5; 52.9%) were assessed. Duration of psoriasis was 12(25) years in PsA and 15(22.8) years in PsO. Duration of joint disease in PsA was 1.0(4.8) year. 51% of PsA and 5% of PsO patients were on biological disease modifying drugs (bDMARDs), 49% vs. 10% on conventional DMARDs. The most frequent findings in the MRI were erosions (PsA 59.6%; PsO 40%) and synovitis (PsA 48.9%; PsO 42.5%). PsA patients had higher number of tenosynovitis compared to PsO (p=0.04). In discovery phase 51 miRNAs in PsO and 64 miRNAs in PsA were down- or upregulated compared to HC, with an overlap of 33 miRNAs changed in PsA and PsO (p<0.05). Results of the selected 17 miRNAs are presented in Table 1. The top candidates to differentiate PsA and HC were miR-29b-3p (AUC=0.87), miR-93-5p (AUC=0.83) and let-7b-5p (AUC=0.79). For differentiating PsO and HC, they were miR-29b-3p (AUC=0.82), miR-140-3p (AUC=0.81) and miR-19b-3p (AUC=0.80) and for PsO vs. PsA miR-92a-3p (AUC=0.87), let-7b-5p (AUC=0.72) and miR-21-5p (AUC=0.70). miR-93-5p was lower in patients with erosions (p=0.01). miR-92a-3p, let-7b-5p and miR-21-5p were lower in patients with tenosynovitis, bone proliferations or erosions.

Conclusion

PsA and PsO patients show miRNA signatures different from HC. Top candidate miRNAs differentially regulated in PsA and PsO have been previously reported in alteration of bone metabolism and osteoarthritis indicating the intimate association of psoriatic inflammation with bone and cartilage changes.

References

[1]Faustini F et al. Ann Rheum Dis 2016 Dec;75(12):2068-2074

[2]Hackl, M et al. Molecular and Cellular Endocrinology Elsevier Ireland Ltd 432, pp 83–95

[3]Feichtinger X et al. Sci Rep 2018 Mar 20;8(1):4867

Disclosure of Interests

None declared

POS1374 LONG-TERM SAFETY OF CANAKINUMAB IN PATIENTS WITH AUTOINFLAMMATORY DISEASES - INTERIM ANALYSIS OF THE RELIANCE REGISTRY

Background

Autoinflammatory diseases (AID) are characterized by severe systemic and organ inflammation as well as high burden of disease for patients and their families. Treatment with the monoclonal antibody canakinumab (CAN), an interleukin-1β inhibitor, has been proven to be safe and effective in clinical trials and real-life.

Objectives

The present study explores the long-term efficacy and safety of CAN in routine clinical practice conditions in pediatric (age ≥2 years) and adult patients with CAPS (cryopyrin-associated periodic syndromes), FMF (familial Mediterranean fever), TRAPS (tumor necrosis factor receptor-associated periodic syndrome) and HIDS/MKD (hyperimmunoglobulinemia D syndrome/mevalonate kinase deficiency).

Methods

RELIANCE is a prospective, non-interventional, observational study based in Germany. Patients with clinically confirmed diagnoses of AID routinely receiving CAN are enrolled. Besides efficacy parameters regarding disease activity and remission, safety parameters were recorded at baseline and assessed at 6-monthly intervals.

Results

Here, we present the interim analysis of patients with AID (N=199) enrolled in the RELIANCE Registry between October 2017 and December 2021. Mean age in this cohort was 24.4 years (2–79 years) and the proportion of female patients was 53% (N=104). At baseline, median duration of prior CAN treatment was 2 years (0–12 years).

A total of 123 patients (62%) experienced any AE (N=653) among which nasopharyngitis, increase of inflammatory markers and pyrexia were the most frequent AE with incidence rates per 100 patient years (IR) of 8.3, 6.2, and 6.2, respectively.

29 patients (15%) were affected by severe AE (SAE, total number N=90) including 11 patients (6%) with SAE suspected to be drug-related (SADR; total number N=30) with IR from 0.2 to 0.7 (Table 1). Overall, 16 AE comprised upper respiratory tract infections (URI). One death (COVID-19, not related) and one malignancy (skin papilloma, not related) were reported. No vertigo and no hypersensitivity reactions were observed. N=10 (IR 2.36) vaccination reactions were reported (no SAE).

Table 1.

Overview of the CAN safety data of the RELIANCE study across all study indications (N=199 patients).

Type of eventNumber of eventsIR‡AE total653154.43AE non-serious563133.15AE, non-serious, not related31774.97AE, URI163.78AE, non-serious adverse drug reaction24658.18SAE, total9021.28SAE, not related6014.19SADR#, total307.09

#Abdominal pain; Alport’s syndrome, appendicitis, arthralgia, blister, cardiovascular disorder, chest pain, circulatory collapse, dehydration, diplopia, dyspnoea, erythema, febrile convulsion, gastroenteritis, glomerulonephritis, Haemophilus test positive, myalgia, oedema, pneumonia, premature delivery, skin discoloration, tachycardia, tonsillitis bacterial, tonsillitis streptococcal, vision blurred (each n=1 event, IR 0.24‡), tonsillectomy (2 events, IR 0.47‡), pyrexia (3 events, IR 0.71‡), not yet coded (hospital admission due to exsiccosis upon gastroenteritis, 1 event, IR 0.35‡)

‡IR, incidence rate per 100 patient years; AE, adverse event; URI, upper respiratory tract infection; SAE, severe adverse event, SADR, severe adverse drug reaction

Incidence rate = number of events * 36,525 / sum of observation days (=154,442)

Conclusion

The interim data from the RELIANCE study, the longest running real-life canakinumab registry, confirm safety of long-term canakinumab treatment across the entire study population. A trend for dose-related increase of SAE/SADR requires continuous close monitoring and awareness in patient groups (children, severe phenotypes, certain genotypes) requiring greater than standard dose treatment regimens.

Disclosure of Interests

J. B. Kuemmerle-Deschner Consultant of: Novartis, AbbVie, Sobi, Grant/research support from: Novartis, AbbVie, Sobi, Jörg Henes Consultant of: Novartis, AbbVie, Sobi, Roche, Janssen, Boehringer-Ingelheim, Grant/research support from: Novartis, Roche, Birgit Kortus-Goetze Consultant of: Novartis, Tilmann Kallinich Consultant of: Sobi, Novartis, Roche, Grant/research support from: Novartis, Prasad Oommen Grant/research support from: Novartis, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Tobias Krickau Speakers bureau: Novartis, Consultant of: Novartis, Grant/research support from: Novartis, Frank Weller-Heinemann: None declared, Gerd Horneff Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Ales Janda: None declared, Ivan Foeldvari Consultant of: Novartis, Hexal, Medac, Pfizer, Catharina Schuetz: None declared, Frank Dressler Consultant of: Abbvie, Mylan, Novartis, Pfizer, Grant/research support from: Novartis, Michael Borte Grant/research support from: Pfizer, Shire, Markus Hufnagel Consultant of: Novartis and SOBI, Florian Meier Speakers bureau: Novartis, Michael Fiene: None declared, Julia Weber-Arden Employee of: Novartis, Norbert Blank Consultant of: Novartis, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Actelion, UCB, Boehringer-Ingelheim, Roche, Grant/research support from: Novartis, Sobi

POS1340 BASELINE CLINICAL DISEASE ACTIVITY IS NOT CRITICAL FOR PREDICTING REMISSION OF ADULTS ONSET STILL´S DISEASE

Background

The clinical course of adult-onset Still’s disease (AoSD) is highly variable, ranging from subtle constitutional symptoms to life-threatening complications such as macrophage activation syndrome. Therefore, it is of interest whether baseline disease activity in AoSD predicts the clinical course, i.e. clinical and serological remission.

Objectives

The aim of this study was to compare whether two instruments to measure AoSD disease activity, Pouchot-Score and Still-Activity-Score (SAS), at baseline predict later remission of disease. We also assessed whether serum levels of calprotectin (S100A8/A9) are associated with clinical disease activity as measured by SAS at follow up.

Methods

AoSD was diagnosed according to the Yamaguchi criteria. In all patients Pouchot-Score and Still-Activity Score (SAS) were assessed at baseline and SAS score also at follow-up. Clinical remission was defined as absence of all AoSD symptoms (i.e. fever and arthralgia), while serological remission was defined as normalization of Ferritin, IL-18 and S100A8/A9 (calprotectin) levels. To investigate the prediction accuracy of the baseline Pouchot-Score and SAS for clinical and serological remission, a calculation of the areas under the receiver operating characteristic (ROC) curves was performed.

Results

42 AoSD patients (19 males/23 females; mean+/-SD age:41+/-17 years) were assessed. Baseline Pouchot-Score was 5.3 +/- 1.6, baseline SAS was 5.7 +/- 1.0. With treatment of AoSD, clinical disease activity decreased reaching a mean SAS of 2.2 +/- 1.8 after a mean follow up time of 48 +/- 90 months. Glucocorticoids were used by 33%, methotrexate by 21%, IL-1 inhibitors by 33% and IL-6 inhibitors by 29% of the patients. 62% (N=26) of the 42 patients obtained clinical remission and 36% (N=15) serological remission. Neither Pouchot-Score (0.57) nor SAS (0.51) at baseline predicted clinical remission of AoSD. Furthermore, also serological remission was not predicted by baseline SAS (0.62) or Pouchot-Score (0.56) (Figure 1). With respect to activity of AoSD during treatment serum calprotectin levels were closely associated with SAS disease activity (r = 0.54, p < 0.0003) (Figure 2).

Conclusion

Baseline AoSD disease activity as measured by Pouchot-Score and SAS does not predict clinical or serological remission. Serum calprotectin level is closely related to AoSD disease activity during the treatment phase.

Figure 1.

ROC for baseline SAS and Pouchot-Score and clinical remission

Figure 2.

Association between S100A8/A9 protein measured by the ELISA method and disease activity by the SAS at follow-up

Acknowledgements

The research project was supported by SOBI and Novartis.

Disclosure of Interests

Jennifer Groetsch: None declared, Koray Tascilar: None declared, Georg Schett: None declared, Dirk Foell: None declared, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Sobi, Novartis

POS1376 LONG-TERM EFFICACY AND SAFETY OF CANAKINUMAB IN PATIENTS WITH HIDS (HYPER-IgD SYNDROME) - INTERIM ANALYSIS OF THE RELIANCE REGISTRY

Background

Hyper-IgD syndrome/mevalonate kinase deficiency (HIDS/MKD) is a rare autoinflammatory condition caused by a defect in the gene coding for mevalonate kinase. This periodic fever syndrome is characterized by severe systemic and organ inflammation. Treatment with interleukin-1β inhibitor canakinumab (CAN), approved and applied for treatment of HIDS/MKD patients since 2017 [1], resulted in rapid remission of symptoms and normalization of laboratory parameters in most patients in clinical trials [2] as well as in real-life.

Objectives

To explore the long-term efficacy and safety of CAN under routine clinical practice conditions in pediatric (age ≥2 years) and adult HIDS/MKD patients.

Methods

RELIANCE is a prospective, non-interventional, multi-center, observational study based in Germany with a 3-year follow-up period. Patients with clinically confirmed diagnoses of TRAPS, CAPS, FMF or HIDS/MKD who routinely receive CAN are enrolled in order to evaluate efficacy and safety of CAN under standard clinical practice conditions at baseline and at 6-monthly intervals.

Results

The present interim analysis shows baseline data of 8 HIDS/MKD patients enrolled by December 2021 as well as preliminary 18-month data. Of these patients, 5 (63%) were females and median age at baseline was 8 years (2–39 years). The median duration of prior CAN treatment at baseline was 1.5 years (0–5 years). Standard, low, and high dose CAN treatment was evenly distributed at every interval.

Preliminary results indicate stable remission and disease control by physicians´ and patients´ assessment as well as laboratory parameters (Table 1). In total, 4 patients were affected by adverse drug reactions, however, none of these events was classified as serious.

Table 1.

Baseline characteristics and interim analysis data of patients with HIDS.

Baseline (N=8)6 months (N=7)12 months (N=6)18 months (N=4)Number (%) of patients in disease remission (physician assessment)4 (50)6 (86)4 (67)3 (75.0)Physician assessment of disease activity, percentage of absent/mild-moderate/severe rating37 / 50 / 1371 / 29 / 050 / 33 / 1750 / 50 / 0Patient´s assessment of current disease activity; 0–10, median (min; max)0 (0; 7)2.0 (0; 7)0.0 (0; 8)0.0 (0; 0)Patient´s assessment of current fatigue; 0–10, median (min; max)2.5 (0; 7)3.0 (0; 7)1.0 (0; 4)1.0 (0; 2)Number (%) of patients without impairment of social life by the disease3 (50)4 (67)4 (80)1 (33)Number (%) of patients with days absent from work/school during last 6 months2 (25)3 (43)0 (0)1 (25)CRP, median (mg/dl)0.20.50.32.1SAA, median (mg/dl)0.60.70.80.5ESR, median (mm/h)10.06.08.013.0

CRP, c-reactive protein; SAA, serum amyloid A; ESR, erythrocyte sedimentation rate

Conclusion

Baseline characteristics and preliminary data of HIDS/MKD patients from the RELIANCE study indicate good clinical and laboratory disease control and no unexpected safety concerns at the 18 months interim analysis.

References

[1]Ilaris, INN-canakinumab (europa.eu)

[2]De Benedetti F, et al. Canakinumab for the treatment of autoinflammatory recurrent fever syndromes. N Engl J Med 2018;378:1908–19

Disclosure of Interests

Prasad Oommen Grant/research support from: Novartis, Tilmann Kallinich Consultant of: Sobi, Novartis, Roche, Grant/research support from: Novartis, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Norbert Blank Consultant of: Novartis, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Actelion, UCB, Boehringer-Ingelheim, Roche, Grant/research support from: Novartis, Sobi, Julia Weber-Arden Employee of: Novartis, J. B. Kuemmerle-Deschner Consultant of: Novartis, AbbVie, Sobi, Grant/research support from: Novartis, AbbVie, Sobi

POS1059 EFFICACY OF UST IN ACTIVE PsA IS INDEPENDENT FROM CONCOMITANT MTX USE, EVEN IN PATIENTS WITH MORE SEVERE SKIN PSORIASIS: SUBGROUP ANALYSIS FROM A RANDOMIZED PLACEBO-CONTROLLED INVESTIGATOR INITIATED CLINICAL TRIAL

Background

The use of bDMARDs treatments in patients with psoriatic arthritis (PsA) usually requires treatment failure or intolerance of csDMARD/MTX before initiation. The value of MTX in combination with bDMARDs is still unclear. We designed an investigator-initiated, randomized, placebo-controlled trial (IIT) in active PsA to examine if outcomes of treatment with ustekinumab (UST) in combination with MTX (either newly initiated or ongoing) were different from UST only (+Placebo; PBO). With known efficacy of MTX on skin psoriasis outcomes may differ in patients with or without significant skin involvement of their psoriatic disease.

Objectives

To compare efficacy outcomes in UST+PBO vs UST+MTX in dependency of skin involvement (Body Surface Area [BSA]) at baseline.

Methods

A total of 186 patients with active PsA (defined as TJC≥4, SJC≥4 [68/66 joint count] and DAS28≥3.2) were screened for eligibility. 173 patients were randomized to UST+MTX (new or ongoing) or UST+PBO.

With this post hoc subgroup analysis outcome parameters were compared between patients with or without skin psoriasis > 3 % BSA. Demographic data and disease activity status of arthritis (joint count [TJC/SJC], DAPSA, DAS28), skin (PASI, BSA), HR-QoL (EQ5D, DLQI) and physical function (HAQ) were compared between groups.

Results

BL data were well-balanced between main treatment groups (UST+MTX, n=86; UST+PBO, n=74) including gender (42.5% vs 40.5% female) and mean values for age (49.2 vs 47.2 years), BMI (29.4 vs 28.9 kg/m2), SJC (8 vs 8), TJC (12 vs 12), DAS28-CRP (4.6 vs 4.4), DAPSA (36.7 vs 34.9) and PASI (2.8 vs 2.4. Disease activity remained well-balanced even after dividing groups according to skin involvement ((a) BSA ≤3% and (b) BSA >3%) with a trend of more severe joint involvement (SJC, TJC) in BSA >3% for UST+MTX compared to UST+PBO. At week 24, relative changes in TJC (-62% vs -62%), change in DAS28 and DAPSA were equal in all treatment groups independent from skin involvement (Table 1). Differences between the groups according to skin involvement were seen for relative changes in SJC (BSA >3%: -74.8% UST+MTX vs -84.3% UST+PBO), subject global assessment (SGA), physician global assessment (PGA), DLQI and EQ5D. Highest levels for changes were detected in the UST+PBO group with high skin involvement (BSA >3%).

Table 1.

Outcomes at Week 24 (LOCF)

UST+MTXUST+PBOBSA ≤3%BSA >3%BSA ≤3%BSA >3%n=46n=40n=51n=23TJC68 change from BL-7.83 (SD 10.3)-9.5 (SD 10.3)-8.9 (SD 9.5)-7.3 (SD 7.4)SJC66 change from BL-6.0 (SD 5.4)-7.1 (SD 3.5)-6.5 (SD 6.2)-6.4 (SD 3.8)PASI change from BL+-1.3 (SD 1.9)-8.5 (SD 9.6)-1.5 (SD 2.4)-9.0 (SD 10.7)DAS-28 ESR [mm/hr] change from BL-1.6 (SD 1.1)-1.8 (SD 1.2)-1.7 (SD 1.4)-1.8 (SD 1.1)DAS-28 CRP [mg/l] change to BL-1.5 (SD 1.2)-1.5 (SD 1.3)-1.6 (SD 1.2)- 1.7 (SD 1.1)DAPSA change from BL-17.4 (SD 16.8)-20.8 (SD 13.2)-20.5 (SD 16.6)-20.4 (SD 15.3)HAQ change from BL-0.1 (SD 0.4)-0.2 (SD 0.5)-0.3 (SD 0.3)-0.3 (SD 0.5)DLQI change from BL-3.1 (SD 5.5)-5.5 (SD 8.2)-2.3 (SD 3.3)-6.4 (SD 7.9)EQ5D VAS Health State change from BL6.7 (SD 24.7)11.7 (SD 23.6)8.0 (SD 24.2)21.3 (SD 25.3)

Conclusion

IL12/23 inhibition with UST is an effective treatment for active PsA independent of MTX use. Data from this IIT indicate that additional MTX has no positive impact on UST efficacy for arthritis, skin, HR-QoL and physical function. This independency of UST effect from MTX can also be demonstrated in patients with active skin involvement despite known efficacy of MTX for skin psoriasis.

Acknowledgements

We thank Janssen for support of the study with a research grant.

Disclosure of Interests

Michaela Köhm Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Tanja Rossmanith Grant/research support from: Janssen, Ann Christina Foldenauer Grant/research support from: Janssen, Herbert Kellner Speakers bureau: Janssen, Consultant of: Janssen, Uta Kiltz Speakers bureau: Abbvie, Fresenius, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, Pfizer, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Biogen, BMS, Chugai, GSK, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Gerd Rüdiger Burmester Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, David M Kofler Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Jan Brandt-Juergens Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Christin Jonetzko Grant/research support from: Janssen, Harald Burkhardt Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Frank Behrens Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen

AB0113 A MINIMAL-INVASIVE METHOD TO RETRIEVE AND IDENTIFY ENTHESEAL TISSUE FROM PSORIATIC ARTHRITIS PATIENTS

Background

Enthesitis represents a hallmark feature of spondyloarthritis, including psoriatic arthritis (PsA).1 So far, most of the data on enthesitis in PsA are based on clinical assessment of tenderness as well as MRI or ultrasound examinations.2 These approaches, however, do not allow molecular analysis of entheses, which will require acquisition of entheseal tissue. Up today, it is unknown, which entheseal structure in humans would qualify for a feasible biopsy and how correct sampling of entheseal structures could be ascertained within such biopsy material. These technical challenges have led to substantial lack of knowledge on human entheseal tissues.

Objectives

To establish a minimally invasive biopsy technique of human entheses for the analysis of entheseal tissue in patients with PsA.

Methods

Human cadavers were used for establishing the technique to retrieve tissue from the lateral humeral epicondyle enthesis (cadaveric biopsies). After biopsy, the entire entheses was surgically resected (cadaveric resections). Biopsies and resections were assessed by label-free second-harmonic-generation (SHG) microscopy. The same biopsy technique was then applied in PsA patients with subsequent definition of entheseal tissue by SHG.

Results

Entheseal biopsies were performed in five cadavers and allowed the retrieval of entheseal tissue, validated by analysis of the resection material. Thus, microscopy of biopsy and resection sections allowed differentiation of entheseal, tendon and muscle tissue by SHG and definition of specific intensity thresholds for entheseal tissue. The same method was then successfully applied to 10 PsA patients. Hence, the fraction of entheseal tissue within the PsA biopsy specimens was high (65%) and comparable to the fraction retrieved in cadaveric biospies (68%) as assessed by SHG microscopy.

Conclusion

Entheseal biopsy of the tendon plate of the lateral epicondyle is feasible in PsA patients allowing reliable retrieval of entheseal tissue and its identification by SHG microscopy.

References

[1]Schett, G, Lories D, D´Agostino MA, Elewaut E, Kirkham B, Soriano ER, McGonagle D. Enthesitis: from pathophysiology to treatment Nat Rev Rheumatol 2017 Nov 21;13(12):731-741.

[2]Groves C, Chandramohan M, Chew NS, et al. Clinical Examination, Ultrasound and MRI Imaging of The Painful Elbow in Psoriatic Arthritis and Rheumatoid Arthritis: Which is Better, Ultrasound or MR, for Imaging Enthesitis? Rheumatol Ther 2017;4:71-84.

Disclosure of Interests

None declared

POS0809 CHARACTERIZATION OF RELAPSES IN PATIENTS WITH GIANT CELL ARTERITIS (GCA) PATIENTS- DATA FROM THE REAL-LIFE TREATMENT AND SAFETY (REATS)-GCA COHORT

Background

Giant cell arteritis (GCA) has the tendency to relapse once treatment is tapered or stopped. Such relapses represent a potential threat to GCA patients as they can lead to severe symptoms and organ damage.

Objectives

To assess the frequency and type of relapses in patients with GCA

Methods

The Real-Life Treatment and Safety (REATS)-GCA cohort has been established by extracting the data on clinical presentation, inflammatory markers, imaging, comorbidities, treatments and serious adverse events of GCA patients from 6 specialized centres in Germany. We undertook descriptive and survival analyses (Kaplan-Meier), and compared baseline characteristics of participants with vs. without relapse. Ethical approval for the cohort was obtained.

Results

We included 395 patients with a mean age of 71 years, including 264 (66.8 %) females and 129 (32.7%) males. Diagnosis of GCA was supported by temporal artery ultrasound in 37%, 18F-FDG-PET/CT in 29%, temporal artery biopsy in 14% of patients and by MRI or clinically in the remaining patients. 31% of patients presented with an isolated cranial manifestation and 18% with isolated extracranial manifestations. Most common presenting symptoms were headache (57%), fatigue (55%), weight loss (42%) and polymyalgia (38%) (Table 1). The most common comorbidities at the time of study inclusion were arterial hypertension (68%), followed by osteoporosis (26%). Within a median total follow-up duration of 22.2 (11.7-40.6) months, 97 of the 395 patients relapsed including 15 patients who relapsed more than once. The median (IQR) time to first relapse was 12.5 (7.1-21.8) months. Median relapse-free survival was 7.8 years with a relapse risk of 12% (CI, 9 to 15%) at 1 year and 38% (CI, 30 to 45%) at 5 years (Figure 1). Most common symptoms at relapse were headache (35%), polymyalgia (23%), fatigue (19%) and night sweats (12%) (Table 1). Three patients relapsed with sudden loss of vision. Among the 114 relapses observed, 94 (83%) occurred under prednisolone treatment with a median dose of 7.0 mg/day (IQR 4.0-12.5). 26 (23%) occurred under methotrexate and 14 (12%) under tocilizumab treatment. Comparing the baseline characteristics that were documented in this study, we did not find a statistically significant difference in relapsing versus non-relapsing GCA patients.

Table 1.Symptom at disease onsetN=395 (%)Symptom at relapseN=97 (%)Headache216 (54.7)Headache35 (30.7)Fatigue208 (52.7)Polymyalgia (PMR)23 (20.2)Weight loss159 (40.3)Fatigue19 (16.7)Polymyalgia (PMR)144 (36.5)Vision impairment13 (11.4)Night sweats140 (35.4)Night sweats12 (10.5)Headache in the temple area125 (31.6)Headache in the temple area12 (10.5)Jaw pain121 (30.6)Jaw pain11 (9.6)Vision impairment118 (29.9)Morning stiffness7 (6.1)Morning stiffness89 (22.5)Weight loss7 (6.1)Fever80 (20.3)Claudication upper limb6 (5.3)Swelling temporal arteries77 (19.5)Arthralgia6 (5.3)Vision loss57 (14.4)Claudication lower limb5 (4.4)Scalp tenderness38 (9.6)Vision loss3 (2.6)Claudication upper limb38 (9.6)Arthritis3 (2.6)Claudication lower limb34 (8.6)Scalp tenderness2 (1.8)Arthralgia28 (7.1)Fever2 (1.8)Arthritis3 (0.8)Swelling temporal arteries2 (1.8)Figure 1.

Conclusion

About one fourth of GCA patients relapsed and the overwhelming majority of relapses occurred before patients were able to stop glucocorticoids. The leading symptoms at relapse are headache and fatigue, while loss of vision is rare (0.76%). Baseline characteristics seem to be poorly informative about the risk of relapse, therefore regular monitoring of GCA patients is necessary.

Acknowledgements

This research was financially supported by Roche Pharma Ag and Chugai Pharma Europe Ltd.

Disclosure of Interests

Verena Schönau Speakers bureau: Novartis, Janssen, Grant/research support from: Roche, Chugai, Giulia Corte: None declared, Sebastian Ott: None declared, Koray Tascilar: None declared, Fabian Hartmann: None declared, Bernhard Manger: None declared, Bernhard Hellmich: None declared, Alexander Pfeil: None declared, Peter Oelzner: None declared, Wolfgang A. Schmidt: None declared, Andreas Krause: None declared, Marc Schmalzing: None declared, Matthias Fröhlich: None declared, Michael Gernert: None declared, Nils Venhoff: None declared, Jörg Henes: None declared, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB,, Consultant of: Biogen, BMS, Chugai, GSK, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Sobi, Novartis, Georg Schett: None declared

POS0009 SUBJECTIVE ASSESSMENT OF PHYSICAL FUNCTION DOES NOT SUFFICIENTLY EXPLAIN VARIANCE OF MEASURED HAND FUNCTION AND GRIP STRENGTH IN ARTHRITIS PATIENTS AND NON-ARTHRITIS CONTROLS

Background

Monitoring disease activity in patients with inflammatory arthritis is essential for effective treatment. While the health assessment questionnaire (HAQ) is commonly used to assess physical function, additional functional tests, such as isometric grip strength and the Moberg Pick-Up-Test (MPUT), provide objective measures for hand function and allow assessing hand function across different diseases (1). It remains unclear to date, if measured hand function is already reflected by the HAQ, as the most widely used patient reported outcome measure of physical function in arthritis.

Objectives

To estimate the proportion of hand function and grip strength variability explained by HAQ, patient-reported hand function, and between-person variation in patients with inflammatory arthritis and non-arthritic controls.

Methods

Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis without PsA (PsO) and healthy controls (HC) were investigated. Subject characteristics (age, sex, disease) and HAQ were recorded. Hand function was assessed by vigorimetric grip strength, MPUT, and a patient-reported tool (Michigan Hand Questionnaire, MHQ). Mixed pure-random-effect linear regression models were used to estimate the proportion of variance in measured hand function or grip strength explained by subject characteristics (age, hand dominance, sex, reported hand function, disease group).

Results

299 subjects were tested, 101 with RA (Age: 59.1±13.3 years, BMI: 27.2±5 kg/m2, HAQ-DI score: 0.9±06), 92 with PsA (Age: 58.8±11.6 years, BMI: 29±6.1kg/m2, HAQ-DI score: 0.6±0.7) and 106 non-arthritic controls (51 with Pso (Age: 47.3±14.1 years, BMI: 29.8±7.3 kg/m2, HAQ-DI score: 0.4±06) and 55 HC (Age: 54.6±16.5 years, BMI: 25.2±3.3 kg/m2, HAQ-DI score: 0.1±0.2). Overall variation of MPUT is mostly accounted for by between-person variation (43.1%), followed by HAQ (20.3%) and MHQ (20.2%) (Figure 1A). Overall variation in grip strength is mostly accounted for by sex (59.8%), between-person variation (21.1%) and HAQ (11.3%) (Figure 1B). Overall variation in MHQ is mostly accounted for by HAQ (59.2%) and residual variation (28.3%). Study group specific result are summarized in Table 1.

Table 1.

Variance proportions for each of the four study groups.

Variance proportions (%)Hand function (MPUT)Grip strengthGroupControlPsAPsORAControlPsAPsORAMHQ3.439.00.00.00.02.10.00.0ID34.836.251.652.816.112.921.327.9Age0.013.80.00.78.48.40.00.0HAQ35.810.834.316.43.83.110.312.0Dominant hand0.60.20.00.03.50.61.30.2Sex12.10.00.04.364.268.963.755.0Residual13.30.014.125.83.94.03.45.0

Conclusion

While the variance variation in grip strength is mainly explained by sex and between-person variation for all subject groups, the proportions of explained variance for measured hand function is not similar between diseases. In all groups > 50% of the variation in measured hand function remains unexplained by the variables used. Especially in arthritis patients, HAQ explained less than 25% of the variance in measured hand function. Grip-strength can be considered a poor surrogate for hand function in this context due to its large gender dependence. The explainability of MHQ variation largely by HAQ indicates that it has limited potential to provide further information beyond overall functional impairment. In contrast, the large between-person variation in MPUT likely indicates unexplored movement patterns of hand motion that may be further dissected using sensor-based analyses (2) and can help identify movement components a potential for an in-depth assessment of subtle hand-function alterations in inflammatory arthritis.

References

[1]Liphardt AM et al. ACR Open Rheumatol 2020, 2, 734-740. 2. Phutane U et al. Sensors (Basel) 2021, 21.

Acknowledgements

This study was supported by the German Research Council (SFB 1483 – Project-ID 442419336, INST 90 / 985-1 FUGG, FOR2438/2886; SFB1181), the German Ministry of Science and Education (project MASCARA), the European Union (H2020 GA 810316 - 4D-Nanoscope European Research Council Synergy Project) and Novartis Germany GmbH.

Disclosure of Interests

None declared

OP0042 LONG-TERM EFFICACY AND SAFETY OF CANAKINUMAB IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER (FMF) - INTERIM ANALYSIS OF THE RELIANCE REGISTRY

Background

Familial Mediterranean Fever (FMF) is a chronic disease characterized by recurrent attacks of fever as well as serositis and bears the risk of serious complications (e. g. amyloidosis). Treatment of FMF according to EULAR aims to control acute attacks and subclinical inflammation as well as to improve patient´s quality of life1. Clinical data indicate that the inhibition of interleukin-1β with canakinumab (CAN) is effective in controlling and preventing flares in FMF patients2.

Objectives

The present study explores the long-term efficacy and safety of canakinumab in routine clinical practice conditions in pediatric (age ≥2 years) and adult FMF patients.

Methods

RELIANCE is a prospective, non-interventional, multi-center, observational study based in Germany with a 3-year follow-up period. Patients with clinically confirmed FMF diagnosis who routinely receive canakinumab are enrolled in order to evaluate effectiveness and safety of canakinumab. Disease activity and remission by physicians´ assessment, disease activity, fatigue and impact on social life by patients’ assessment, inflammatory markers and AIDAI (Auto-Inflammatory Diseases Activity Index) score were recorded at baseline and assessed at 6-monthly intervals within the 3-year observation period of the study.

Results

This interim analysis of FMF patients (N=74) enrolled by December 2021 includes baseline as well as 6- to 24-month data. Mean age in this cohort was 25 years (2−61 years) and the proportion of female patients was 51 % (N=38). At baseline, median duration of prior CAN treatment was 1.0 years (0−6 years).

At month 24, physician ratings report around 63% of patients in disease remission and patient-reported disease activity (mean PPA) decreased from moderate (3.0) to low (2.6) during the observation period. Other disease activity parameters also decreased (Table 1). A total of 18 serious adverse events were reported, of which 2 (1 case of tonsillectomy and 1 case of tachycardia) were classified as drug - related.

Table 1.

Baseline characteristics and 4th interim analysis data of patients with FMF

Baseline12 months24 monthsNumber of patients, N744624Number (%) of patients with days absent from work/school during last 6 months6 (8)11 (24)9 (38)Number (%) of patients in disease remission (physician assessment)22 (45)23 (72)12 (63)Patient’s assessment of current disease activity; 0–10, median (min; max)2.0 (0; 10)2.0 (0; 7)2.0 (0; 10)Patient’s assessment of current fatigue; 0–10, median (min; max)5.0 (0; 10)2.0 (0; 10)4.0 (0; 10)Number (%) of patients without impairment of social life by the disease27 (50)28 (80)8 (67)CRP (mg/dl) | SAA (mg/dl) | ESR (mm/h); median0.2 | 0.7 | 8.00.2 | 0.5 | 4.00.2 | 0.7 | 6.0Number (%) of patients with disease-related symptomsprior to inclusion into the study | at baseline12 months24 monthsFever68 (93) | 14 (29)8 (25)3 (16)Abdominal pain67 (92) | 20 (41)10 (31)4 (21)Thoracic pain45 (62) | 5 (10)3 (9)1 (5)Headache34 (47) | 11 (22)7 (22)5 (26)Myalgia23 (32) | 6 (12)4 (13)2 (11)Arthralgia/arthritis39 (54) | 16 (33)9 (28)5 (26)Dermal symptoms (urticarial, maculopapulose)15 (21) | 5 (10)3 (9)0 (0)SAENumber of eventsIncidence rate# per 100 patient yearsAll types of SAE1814.03SADR21.56

Incidence rate = number of events * 36,525 / sum of observation days (=46,848).

CRP, c-reactive protein; ESR, erythrocyte sedimentation rate; n. a., not annotated; SAA, serum amyloid A; SADR, serious adverse drug reaction; SAE, serious adverse events.

Conclusion

Interim data of FMF patients from the RELIANCE study, the longest running real-life canakinumab registry confirm efficacy and safety of long-term canakinumab treatment.

References

[1]Ozen S, et al. EULAR recommendations for the management of familial Mediterranean fever. Ann Rheum Dis 2016;75:644–651. doi:10.1136/annrheumdis-2015-208690

[2]De Benedetti F, et al. Canakinumab for the treatment of autoinflammatory recurrent fever syndromes. N Engl J Med 2018;378:1908–19.

Disclosure of Interests

Jörg Henes Consultant of: Novartis, AbbVie, Sobi, Roche, Janssen, Boehringer-Ingelheim, Grant/research support from: Novartis, Roche, J. B. Kuemmerle-Deschner Consultant of: Novartis, AbbVie, Sobi, Grant/research support from: Novartis, AbbVie, Sobi, Tobias Krickau Speakers bureau: Novartis, Consultant of: Novartis, Grant/research support from: Novartis, Tilmann Kallinich Consultant of: Sobi, Novartis, Roche, Grant/research support from: Novartis, Frank Dressler Consultant of: Abbvie, Mylan, Novartis, Pfizer, Grant/research support from: Novartis, Gerd Horneff Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Florian Meier Speakers bureau: Novartis, Ivan Foeldvari Consultant of: Novartis, Hexal, Medac, Pfizer, Frank Weller-Heinemann: None declared, Birgit Kortus-Goetze Consultant of: Novartis, Markus Hufnagel Grant/research support from: Novartis, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Prasad Oommen Grant/research support from: Novartis, Julia Weber-Arden Employee of: Novartis, Norbert Blank Consultant of: Novartis, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Actelion, UCB, Boehringer-Ingelheim, Roche, Grant/research support from: Novartis, Sobi.

OP0182 SECUKINUMAB IN GIANT CELL ARTERITIS: THE RANDOMISED, PARALLEL-GROUP, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTRE PHASE 2 TitAIN TRIAL

Background

Little is known about glucocorticoid-sparing agents in giant cell arteritis (GCA) except for IL-6 inhibition. Secukinumab (SEC) has shown significant improvements in the signs and symptoms of IL-17A driven medical conditions such as plaque psoriasis, psoriatic arthritis, and axial spondyloarthritis.1,2 It has a favourable long-term safety profile.1,2

Objectives

TitAIN is the first randomised controlled trial investigating the potential efficacy, safety, and tolerability of SEC in GCA patients (pts).

Methods

This phase 2, randomised, double-blind, placebo (PBO) controlled, multicentre, proof-of-concept trial enrolled pts (aged ≥50 years) with new onset (diagnosed within 6 weeks (wks) of baseline) or relapsing (diagnosed >6 wks from baseline) GCA, naïve to biological therapy. Pts were randomised (1:1) to SEC 300 mg or PBO initially administered wkly (5 doses) and every 4 wks thereafter through Wk 48 (last dose), in combination with a 26-wk prednisolone taper regimen starting from baseline. Proportion of GCA pts in sustained remission until Wk 28 was the primary endpoint assessed by a Bayesian analysis of the posterior distribution with non-responder imputation. Other key endpoints included proportion of GCA pts in sustained remission until Wk 52 (based on study data with non-responder imputation) and time to first GCA flare after baseline.

Results

Out of 52 randomised pts (SEC, n=27; PBO, n=25), 71.2% (n=37) completed study treatment (SEC, 81.5%; PBO, 60.0%). Overall, 42 (80.8%) pts had new onset GCA and 10 (19.2%) pts had relapsing GCA at baseline. Proportion (posterior median with 95% credibility interval) of GCA pts in sustained remission until Wk 28 was higher with SEC, 70.1% (51.6%-84.9%), than with PBO, 20.3% (12.4%-30.0%); odds ratio (posterior median with 95% credibility interval), 9.31 (3.54-26.29) (Table 1). Until Wk 52, proportion (95% confidence interval) of GCA pts in sustained remission were 59.3% (38.8%-77.6%) in SEC group and 8.0% (1.0%-26.0%) in PBO group (Table 1). Median (95% confidence interval) time to first GCA flare after baseline was not reached for GCA pts treated with SEC and was 197.0 (101.0-280.0) days for PBO (Figure 1). Overall, treatment-emergent adverse events (AEs) occurred in 98.1% (SEC vs PBO, 100.0% vs 96.0%) and serious AEs in 32.7% (SEC vs PBO, 22.2% vs 44.0%) pts. Two pts in each SEC and PBO groups had AEs that led to study drug discontinuation and 1 pt in each group had AEs that led to death (not treatment-related). There were no new or unexpected safety signals identified with SEC treatment.

Table 1.

Proportion of GCA patients with sustained remission (Full analysis set) until Week 28 and 52

Proportion of ptsSecukinumab (N=27)Placebo (N=25)Median percentage (95% credibility interval), Wk 2870.1% (51.6%, 84.9%)20.3% (12.4%, 30.0%)Percentage (95% confidence interval), Wk 5259.3% (38.8%, 77.6%)8.0% (1.0%, 26.0%)

The full analysis set comprises all pts to whom study treatment has been assigned by randomisation and who received at least one dose of randomised study treatment (secukinumab or placebo).

GCA, giant cell arteritis; N, number of pts in each treatment group in the full analysis set, pts, patients; Wk, Week

Figure 1.

Kaplan-Meier plot of time to first GCA flare from baseline up to Week 52 (Full analysis set)

Conclusion

SEC demonstrated a higher sustained remission rate and longer time to first GCA flare vs PBO through 52 wks in pts with GCA. This proof-of-concept phase 2 study supports further development of SEC as a potential treatment in combination with 26 wk glucocorticoid taper for pts with GCA.

References

[1]Mease PJ, et al. ACR Open Rheumatol. 2020;2(1):18-25

[2]Baraliakos X, et al. RMD Open. 2019;5:e001005

Disclosure of Interests

Nils Venhoff Speakers bureau: AbbVie, Novartis, Bristol-Myers-Squibb, Chugai, Roche, Vifor, Consultant of: AbbVie, Chugai, Novartis, Vifor, Grant/research support from: Bristol-Myers-Squibb, Novartis, Wolfgang A. Schmidt Speakers bureau: Abbvie, Chugai, Medac, Novartis, Roche, Sanofi, Consultant of: Advisory board member: Abbvie, Chugai, GlaxoSmithKline, Novartis, Roche, Sanofi, Grant/research support from: principle investigator in GCA trials: Abbvie, GlaxoSmithKline, Novartis, Sanofi, Raoul Bergner Speakers bureau: Abbvie, Bristol Myers Squibb, Chugai, Novartis, Roche, Consultant of: Advisory board member: Gilead, GlaxoSmithKline, Vifor, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Leonore Unger Paid instructor for: Novartis, Hans-Peter Tony Consultant of: Abbvie, BMS, Chugai, Gilead, Lilly, Novartis, Roche, Sanofi, Meryl Mendelson Shareholder of: Novartis Pharmaceuticals Corporation, Employee of: Novartis Pharmaceuticals Corporation, Christian Sieder Employee of: Novartis Pharma GmbH, Meron Maricos Employee of: Novartis Pharma GmbH, Jens Thiel Speakers bureau: Novartis, GSK, Bristol-Myers-Squibb, Roche, AstraZeneca, Vifor, Consultant of: Novartis, Janssen, GSK; research grants: Bristol-Myers-Squibb, Novartis

Scattering theory of non-equilibrium noise and deltaTcurrent fluctuations through a quantum dot

We consider the non-equilibrium zero frequency noise generated by a temperature gradient applied on a device composed of two normal leads separated by a quantum dot. We recall the derivation of the scattering theory for non-equilibrium noise for a general situation where both a bias voltage and a temperature gradient can coexist and put it in a historical perspective. We provide a microscopic derivation of zero frequency noise through a quantum dot based on a tight binding Hamiltonian, which constitutes a generalization of the seminal result obtained for the current in the context of the Keldysh formalism. For a single level quantum dot, the obtained transmission coefficient entering the scattering formula for the non-equilibrium noise corresponds to a Breit-Wigner resonance. We compute the delta-Tnoise as a function of the dot level position, and for a broad range of values of the dot level width, in the Breit-Wigner case, for two relevant situations which were considered recently in two separate experiments. In the regime where the two reservoir temperatures are comparable, our gradient expansion shows that the delta-Tnoise is dominated by its quadratic contribution, and is minimal close to resonance. In the opposite regime where one reservoir is much colder, the gradient expansion fails and we find the noise to be typically linear in temperature before saturating. In both situations, we conclude with a short discussion of the case where both a voltage bias and a temperature gradient are present, in order to address the potential competition with thermoelectric effects.

In-depth profiling of COVID-19 risk factors and preventive measures in healthcare workers

Purpose

To determine risk factors for coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs), characterize symptoms, and evaluate preventive measures against SARS-CoV-2 spread in hospitals.

Methods

In a cross-sectional study conducted between May 27 and August 12, 2020, after the first wave of the COVID-19 pandemic, we obtained serological, epidemiological, occupational as well as COVID-19-related data at a quaternary care, multicenter hospital in Munich, Germany.

Results

7554 HCWs participated, 2.2% of whom tested positive for anti-SARS-CoV-2 antibodies. Multivariate analysis revealed increased COVID-19 risk for nurses (3.1% seropositivity, 95% CI 2.5–3.9%, p = 0.012), staff working on COVID-19 units (4.6% seropositivity, 95% CI 3.2–6.5%, p = 0.032), males (2.4% seropositivity, 95% CI 1.8–3.2%, p = 0.019), and HCWs reporting high-risk exposures to infected patients (5.5% seropositivity, 95% CI 4.0–7.5%, p = 0.0022) or outside of work (12.0% seropositivity, 95% CI 8.0–17.4%, p < 0.0001). Smoking was a protective factor (1.1% seropositivity, 95% CI 0.7–1.8% p = 0.00018) and the symptom taste disorder was strongly associated with COVID-19 (29.8% seropositivity, 95% CI 24.3–35.8%, p < 0.0001). An unbiased decision tree identified subgroups with different risk profiles. Working from home as a preventive measure did not protect against SARS-CoV-2 infection. A PCR-testing strategy focused on symptoms and high-risk exposures detected all larger COVID-19 outbreaks.

Conclusion

Awareness of the identified COVID-19 risk factors and successful surveillance strategies are key to protecting HCWs against SARS-CoV-2, especially in settings with limited vaccination capacities or reduced vaccine efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s15010-021-01672-z.

POS0460 ASSOCIATION OF ANTI-CITRULLINATED PROTEIN ANTIBODIES OF IgA SUBCLASSES WITH SUSTAINED REMISSION AND FLARE IN RHEUMATOID ARTHRITIS

Background:

Understanding key mechanisms of flare development and sustained remission is one of the acute goals in modern rheumatology. Anti-citrullinated protein antibodies (ACPA) are the most abundant and specific autoantibodies in rheumatoid arthritis (RA) patients. However, the impact of ACPA of IgA isotype is poorly defined. IgA ACPA were previously shown to have a higher percentage of IgA2 in comparison to total IgA; and a correlation between IgA2% ACPA with the DAS28 score was observed in a previous study [1]. Of note, IgA1 and IgA2 were shown to exhibit different effector functions, with IgA2 being pro-inflammatory, which might be the background for its role in RA [1].

Objectives:

We aimed to investigate, whether IgA ACPA could be used as a predictive factor for flare development in RA; and to look further into the changes in IgA ACPA levels in patients remaining in stable remission versus patients developing flare.

Methods:

We analysed serum of 111 patients from a multicentre randomized controlled trial ‘RETRO’. The study observational period was 12 months. Patients in the trial had to be in stable remission (DAS28-ESR<2.6) for a minimum of 6 months and were randomized into 3 different treatment arms: continuation of treatment, tapering by 50% or a gradual tapering until discontinuation [2]. IgA ACPA concentrations were measured with an enzyme-linked immunosorbent assay on CCP2-pre-coated plates.

Results:

60% of patients had IgG-ACPA. IgA ACPA levels were higher among the IgG-ACPA-positive patients (median 4.7 versus 2.24 µg/ml, p<0.0001). Baseline IgA1 and 2 ACPA levels were not different between patients who had a flare later on in the study period and those remaining in remission, showing no predictive value for flare development. However, the percentage of IgA2 in ACPA was correlating with the first registered DAS28 after flare (r=0.36, p=0.046). After the 12 months study period, IgA2 ACPA as well as IgA2% ACPA decreased significantly in patients who remained in stable remission by 17.5% (median, p<0.0001) and 13.6% (p=0.0006), respectively. By contrast, there was no significant change in IgA2 ACPA levels over time in patients who developed a flare. IgA1 ACPA levels remained stable over time. Disease management strategies did not seem to influence IgA ACPA levels in a specific way, as baseline levels were similar between patients on biological and conventional DMARDs and changes in levels after 12 months did not depend on the assignment to either of the study arms.

Conclusion:

Neither IgA1 nor IgA2 ACPA levels were predictive of flare development or associated with treatment strategies (though rituximab, JAK-inhibitors and abatacept were not amongst treatment options). However, in patients remaining in sustained remission after 1 year a decrease in IgA2 and IgA2% ACPA was observed and IgA2% ACPA was associated with DAS28 score registered after flare. This could be an indication towards ACPA of IgA2 isotype contributing to the severity of flare, alongside other factors, and its reduction being associated with a prolonged state of remission.

References:

[1]Steffen U, Koeleman CA, Sokolova MV, et al. IgA subclasses have different effector functions associated with distinct glycosylation profiles. Nat Commun 11, 120 (2020).

[2]Haschka J, Englbrecht M, Hueber AJ, et al. Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis. 75:45-51 (2016).

Disclosure of Interests:

None declared

OP0148 SPATIOTEMPORAL DYNAMICS OF BONE LOSS BEFORE AND AFTER THE ONSET OF RHEUMATOID ARTHRITIS

Background:

Rheumatoid Arthritis (RA) is preceded by a clinically silent pre-phase characterized by autoimmunity against anti-modified protein antibodies including anti-citrullinated protein antibodies (ACPA). At this pre-stage patients already experience significant loss of volumetric peripheral bone mineral density (vBMD) compared to healthy controls measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) (1-2). However, the longitudinal course of vBMD changes during the preclinical phase, after diagnosis, and its association with time to disease onset have not been investigated.

Objectives:

To longitudinally characterize the changes of metacarpal and radial vBMD before and after the clinical onset of RA and its association with time to onset of arthritis.

Methods:

To explore the development of arthritis, we initiated a RA-at-risk cohort in 2011. (Ethics 334_16B). This prospective cohort includes adults positive for CCP-AB with or without musculoskeletal symptoms, excluding arthritis. Participants are regularly followed with clinical examination and HR-pQCT imaging of the MCP and radial bone to monitor early bone changes. HR-pQCT images with low motion grade artefacts were analyzed to obtain the total (D100), cortical (DComp) and trabecular (DTrab) vBMD (D100) in mg HA cm3.

We descriptively analyzed the vBMD time course in patients who developed RA by fitting regression curves separately for the pre-clinical and clinical periods and estimated time-conditional marginal mean VBMDs for the 5-year peri-RA period. We analyzed time to diagnosis of clinical RA defined by the 2010 ACR/EULAR classification criteria using Cox regression models. Hazard ratios indicate the relative risk of clinical disease onset associated with 1 standard deviation reduction in bone density.

Results:

130 subjects (mean [SD] age 47.0 [12.2], 89 female [68%]) between 2011 and 2020 were analyzed. Median (IQR) follow-up duration for the cohort was 18.6 (4.6-47.6) months. Participants underwent 233 HR-pQCT scans and 58 (45%) underwent 2 to 6 scans with a median interval of 16.2 (12.2-21.2) months. 49 (38%) patients who developed RA had a pre-diagnosis follow-up of 4.1 (2.5-13.4) months and post-diagnosis follow-up of 22.0 (8.8-38.9) months. The time course of scaled bone mineral densities depicted in Figure 1A suggest that bone density around the MCP joints deteriorate in the preclinical phase of RA, which is mostly prominent in the trabecular bone. Modelling (Figure 1B) suggests that trabecular bone loss around the MCP joints has a constant pace regardless of the clinical status. Whereas the radial bone densities are relatively stable in the preclinical phase and show a reduction after the clinical onset of RA. Age and sex adjusted hazard ratios (95%CI) for the risk of RA clinical onset were 1.52 (1.03 to 2.25) for radius D100 and 1.66 (1.07 to 2.55) for radius DComp (Table-1).

Table 1.

Relative risk of RA development in the total cohort; crude and age/sex adjusted hazard ratios for one standard-deviation reduction in vBMD.

CrudeAdjustedHR (95%CI)PHR (95%CI)PMCP.D-Comp1.16 (0.86 to 1.57)0.3361.20 (0.89 to 1.63)0.229MCP.D-Trab1.14 (0.83 to 1.57)0.4051.17 (0.85 to 1.62)0.341MCP.D1001.16 (0.83 to 1.61)0.3921.21 (0.86 to 1.71)0.265Rad.D-Comp1.42 (0.97 to 2.07)0.0711.66 (1.07 to 2.55)0.023Rad.D-Trab1.20 (0.87 to 1.66)0.2571.23 (0.88 to 1.71)0.223Rad.D1001.43 (0.99 to 2.06)0.0561.52 (1.03 to 2.25)0.033

Conclusion:

Metacarpal bone showed a constant decline that started already in the pre-phase of RA and continued after its clinical onset. In contrast, bone loss in the radius was not observed in the pre-phase but started at onset of RA. Low radial vBMD in the pre-clinical phase, however, was associated with a higher risk of RA onset. These findings suggest different spatiotemporal dynamics of bone loss before and after RA onset

References:

[1]Kleyer A. et. al. Ann Rheum Dis. 2014, 73:854-60

[2]Simon D. et. al. Ann Rheum Dis. 2020, doi:10.1002/art.41229

Disclosure of Interests:

None declared

POS0381 PATIENTS AT RISK FOR RA SHOW THE SAME AMOUNT OF ACUTE SOLUBLE CARTILAGE DEGRADATION MARKERS AFTER PHYSICAL ACTIVITY COMPARED TO PATIENTS WITH ESTABLISHED RA

Background:

Serum concentration of cartilage oligomeric matrix protein (COMP) is related to the degree of cartilage destruction in patients with rheumatoid arthritis (RA) and shows a mechanosensitive response to ambulatory loads. We showed previously, that individuals with positive for anti-citrullinated protein antibody (ACPA+) status already show bone loss. It is unclear if these individuals experience cartilage deterioration and how this is related to physical activity.

Objectives:

To test whether soluble COMP levels in ACPA+ display the same response as RA patients after a walking exercise and explore the association between overall serum COMP levels and physical activity.

Methods:

RA patients and ACPA+ individuals (IRACE cohort: Individuals at Risk for Arthritis Cohort Erlangen; Ethics approval 334_16B) were enrolled in the study after written informed consent. Inclusion criteria were age between 18 and 69 years, RA (by 2010 ACR/EULAR criteria) or ACPA+ (without clinical manifestation of RA and prior treatment with glucocorticoids, DMARDs and biologics). The study comprised three visits (baseline (Visit 1), 6 (Visit 2), and 12 months (Visit 3). During each visit, serum samples were collected after 30 minutes rest (pre) and at 0, 30, 60, and 120 minutes after a 30-minute walking exercise. Serum COMP concentration was analyzed by commercial ELISA. Physical activity duration (hours) was measured using an activity monitor for 7 consecutive days, and physical activity level (metabolic equivalent of the task (MET)) was quantified using the International Physical Activity Questionnaire (IPAQ). The reponse of COMP levels to the walking exercise was modelled using linear mixed-effects regression models. The association between physical activity and overall serum COMP concentrations was analyzed using a mixed-effects regression model (Random effects: individuals, visits and COMP measurement time points).

Results:

28 RA and 22 ACPA+ patients participated in this prospective study. Table 1 summarizes patient demographics and outcome measures. Serum COMP levels increased in response to the walking exercise in both groups but the acute response was not different in RA patients compared to ACPA+ individuals. Higher physical activity level by IPAQ was associated with higher overall COMP concentration. Doubling of total physical activity is associated with an increase in serum concentration of 0.32 U/L (95%CI 0.09 to 0.54, p=0.006). ACPA+ individuals but not RA patients show an association between serum COMP concentration and physical activity duration (Figure 1).

Table 1.

Summary of subject characteristics and outcome measures.

DescriptivesMeasureACPA+RAindividuals, number (%)22 (44.0)28 (56.0)Age, years (mean (SD))47.6 (12.8)57.0 (9.1)Female, number (%)14 (28.0)19 (38.0)BMI, kg/m2, mean (SD)25.1 (5.6)27.2 (5.8)Anti-CCP positive (N)1714DAS28-score, mean (SD)2.5 (1.2)2.7 (1.4)Cartilage Oligomeric Matrix Protein (U/l)Visit 1Visit 2Visit 3ACPA+RAACPA+RAACPA+RApre-walking exercise9.4 (2.8)9.7 (3.8)10.8 (2.2)11.3 (4.5)10.2 (2.5)10.5 (3.9)09.5 (2.6)10.4 (3.9)11.8 (1.8)12.2 (4.0)10.1 (2.0)11.1 (4.6)309.2 (2.2)9.9 (3.6)10.8 (1.9)11.4 (4.4)9.2 (2.2)10.6 (4.2)609.2 (2.0)9.4 (4.0)10.4 (2.1)10.9 (4.5)8.6 (2.9)10.0 (4.0)1209.2 (2.1)9.5 (4.0)9.6 (1.8)10.9 (4.4)8.0 (2.4)9.9 (3.9)Figure 1.

Estimated marginal mean COMP by physical activity duration for RA and ACPA+.

Conclusion:

Pre-exercise serum COMP concentration is similar in ACPA+ and RA and shows a similar increase in response to walking in both groups. Physical activity duration appears to influence serum COMP concentration in ACPA+. Given that acute COMP release was not different between ACPA+ and RA while overall COMP values are associated with physical activity level, the discrepancy between ACPA+ and RA for this association can be explained by reduced vigor or qualitative differences in physical activity.

Disclosure of Interests:

Lisa Bleckwedel-Rolack: None declared, Koray Tascilar: None declared, Veronika Nees: None declared, Julia Hühne: None declared, Axel Hueber: None declared, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Georg Schett Speakers bureau: Lilly, Novartis, Consultant of: Lilly, Novartis, Gilead, BMS, Abbvie, Grant/research support from: Lilly, Novartis, Arnd Kleyer Speakers bureau: Lilly, Novartis, Consultant of: Lilly, Novartis, Gilead, BMS, Abbvie, Grant/research support from: Lilly, Novartis, Anna-Maria Liphardt Speakers bureau: Mylan, Paid instructor for: Abbvie, Consultant of: MEDA Pharma, Grant/research support from: Novartis

OP0318 TREATMENT TAPERING AND WITHDRAWAL IN RHEUMATOID ARTHRITIS WITH STABLE REMISSION - FINAL ANALYSIS OF THE RETRO STUDY

Background:

Due to better treatment strategies and higher remission rates the management of rheumatoid arthritis (RA) patients in sustained remission is of increasing interest (1). The Rheumatoid Arthritis in Ongoing Remission (RETRO) study investigated the possibility to taper and stop disease modifying anti-rheumatic drugs (DMARDs).

Objectives:

To compare one-year remission and relapse rates in rheumatoid arthritis patients randomized to continued treatment, reduced treatment or gradual treatment withdrawal after stable remission under routine care.

Methods:

Primary data of the phase III, randomized, controlled RETRO trial in RA patients with stable conventional synthetic and/or biologic DMARD treatment in sustained (>6 months) DAS28-ESR remission (<2.6 units). Patients were randomized 1:1:1 into three strategy arms (continuation of 100% DMARD dose, CONT; tapering to 50% DMARD dose, TAP; 50% tapering followed by withdrawal of DMARDs, STOP). The primary endpoint was the proportion of patients in sustained DAS28-ESR remission after 1 year.

Results:

316 RA patients in sustained remission were included, 303 were randomized (CONT: N=100; TAP: N=102; STOP: N=101) and 282 (93%) had complete data sets after 1 year (CONT:N=93; TAP: N=93; STOP: N=96; Table 1). After 1 year, 81.2%, 58.6%, 43.3% of patients, maintained their remission state over 1 year in the CONT, TAP and STOP arms, respectively (p=0.0004 with log rank test for trend; Figure 1). Hazard ratios for flare were 3.02 (95%CI 1.69 to 5.40) and 4.34 (95%CI 2.48 to 7.60) for the TAP and STOP arms. RA patients who flared were more likely to be female, have longer disease duration, RF/ACPA positivity and higher baseline DAS-28 scores with standardized mean differences >0.2. Serious adverse events were reported in 10.8%, 7.5%, and 13.5% in the CONT, TAP and STOP arms, respectively.

Table 1.

Baseline Characteristics

GroupControlReduceReduce/StopOverallN939396282Age, mean(SD)55.9 (12.7)56.9 (13.0)56.5 (13.3)56.5 (13.0)Female, n (%)53 (57.0)57 (62.0)57 (59.4)167 (59.4)RF, n (%)52 (55.9)58 (62.4)52 (54.2)162 (57.4)ACPA, n (%)53 (57.0)50 (54.9)55 (57.3)158 (56.4)Disease duration, years, mean(SD)7.6 (6.9)7.8 (6.9)6.8 (8.1)7.4 (7.3)Remission duration, months, mean(SD)20.6 (18.0)16.5 (15.9)22.7 (30.4)20.0 (22.6)Biologics, n (%)39 (41.9)44 (47.3)39 (40.6)122 (43.3)Methotrexate, n (%)71 (76.3)67 (72.0)75 (78.1)213 (75.5)Other DMARDs, n (%)24 (25.8)20 (21.5)16 (16.7)60 (21.3)Glucocorticoids, n (%)27 (29.0)23 (24.7)17 (17.7)67 (23.8)CRP, mg/L, mean(SD)0.3 (0.3)0.5 (0.5)0.5 (0.6)0.4 (0.5)ESR, mm/h, mean(SD)11.3 (8.4)12.2 (8.8)13.0 (10.0)12.2 (9.1)Tender joint count, mean(SD)0.2 (0.6)0.0 (0.2)0.1 (0.3)0.1 (0.4)Swollen joint count, mean(SD)0.1 (0.3)0.1 (0.3)0.1 (0.4)0.1 (0.3)Physician VAS,mm, mean(SD)1.8 (4.2)2.6 (4.4)2.0 (3.9)2.1 (4.2)Patient VAS,mm, mean(SD)6.4 (9.0)5.5 (8.3)4.5 (8.4)5.5 (8.6)HAQ, standard, mean(SD)0.2 (0.4)0.2 (0.3)0.2 (0.4)0.2 (0.4)HAQ, alternative, mean(SD)0.2 (0.4)0.1 (0.3)0.2 (0.3)0.2 (0.3)DAS-28, mean(SD)1.7 (0.7)1.7 (0.6)1.7 (0.6)1.7 (0.6)SDAI, mean(SD)1.4 (1.5)1.4 (1.5)1.3 (1.3)1.3 (1.4)DAS-28 remission, n (%)91 (97.8)93 (100.0)95 (99.0)279 (98.9)SDAI remission, n (%)79 (87.8)79 (84.9)88 (92.6)246 (88.5)Boolean remission, n (%)69 (75.8)71 (76.3)76 (79.2)216 (77.1)

Conclusion:

This randomized controlled study shows that half of RA patients in sustained remission relapse when tapering/stopping their DMARDs. Presence of autoantibodies, higher baseline DAS28-ESR and female sex are predictors for flares.

References:

[1]Schett G et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis. 2016 Aug;75(8):1428-37.

Disclosure of Interests:

Melanie Hagen Speakers bureau: advisory boards, Koray Tascilar Speakers bureau: advisory board, Michaela Reiser: None declared, Larissa Valor: None declared, Judith Haschka Speakers bureau: advisory board, Arnd Kleyer Speakers bureau: advisory board, Axel Hueber Speakers bureau: advisory boards, Bernhard Manger Speakers bureau: advisory boards, Jayme Cobra Speakers bureau: advisory boards, Camille Figuereido Speakers bureau: advisory boards, Stephanie Finzel Speakers bureau: advisory boards, Hans-Peter Tony Speakers bureau: advisory boards, Joerg Wendler Speakers bureau: advisory boards, Stefan Kleinert Speakers bureau: advisory boards, Florian Schuch Speakers bureau: advisory boards, Monika Ronneberger: None declared, Martin Feuchtenberger Speakers bureau: advisory boards, Martin Fleck Speakers bureau: advisory boards, Karin Manger: None declared, Wolfgang Ochs: None declared, Matthias Schmitt-Haendle: None declared, Hanns-Martin Lorenz Speakers bureau: advisory boards, Rieke Alten Speakers bureau: advisory boards, Jörg Henes Speakers bureau: advisory boards, Klaus Krueger Speakers bureau: advisory boards, Jürgen Rech Speakers bureau: advisory boards, Georg Schett Speakers bureau: advisory boards.

Andreev reflection of fractional quantum Hall quasiparticles

Electron correlation in a quantum many-body state appears as peculiar scattering behaviour at its boundary, symbolic of which is Andreev reflection at a metal-superconductor interface. Despite being fundamental in nature, dictated by the charge conservation law, however, the process has had no analogues outside the realm of superconductivity so far. Here, we report the observation of an Andreev-like process originating from a topological quantum many-body effect instead of superconductivity. A narrow junction between fractional and integer quantum Hall states shows a two-terminal conductance exceeding that of the constituent fractional state. This remarkable behaviour, while theoretically predicted more than two decades ago but not detected to date, can be interpreted as Andreev reflection of fractionally charged quasiparticles. The observed fractional quantum Hall Andreev reflection provides a fundamental picture that captures microscopic charge dynamics at the boundaries of topological quantum many-body states.

Renormalization flow of a weak extended backscattering Hamiltonian in a non-chiral Tomonaga-Luttinger liquid

We consider a non-chiral Luttinger liquid in the presence of a backscattering Hamiltonian which has an extended range. Right/left moving fermions at a given location can thus be converted as left/right moving fermions at a different location, within a specific range. We perform a momentum shell renormalization group treatment which gives the evolution of the relative degrees of freedom of this Hamiltonian contribution under the renormalization flow, and we study a few realistic examples of this extended backscattering Hamiltonian. We find that, for repulsive Coulomb interaction in the Luttinger liquid, any such Hamiltonian contribution evolves into a delta-like scalar potential upon renormalization to a zero temperature cutoff. On the opposite, for attractive couplings, the amplitude of this kinetic Hamiltonian is suppressed, rendering the junction fully transparent. As the renormalization procedure may have to be stopped because of experimental constraints such as finite temperature, we predict the actual spatial shape of the kinetic Hamiltonian at different stages of the renormalization procedure, as a function of the position and the Luttinger interaction parameter, and show that it undergoes structural changes. This renormalized kinetic Hamiltonian has thus to be used as an input for the perturbative calculation of the current, for which we provide analytic expressions in imaginary time. We discuss the experimental relevance of this work by looking at one-dimensional systems consisting of carbon nanotubes or semiconductor nanowires.

Negative Delta-T Noise in the Fractional Quantum Hall Effect

We study the current correlations of fractional quantum Hall edges at the output of a quantum point contact subjected to a temperature gradient. This out-of-equilibrium situation gives rise to a form of temperature-activated shot noise, dubbed delta-T noise. We show that the tunneling of Laughlin quasiparticles leads to a negative delta-T noise, in stark contrast with electron tunneling. Moreover, varying the transmission of the quantum point contact or applying a voltage bias across the Hall bar may flip the sign of this noise contribution, yielding signatures that can be accessed experimentally.

OP0051 STRUCTURAL ENTHESEAL LESIONS IN PSORIASIS PATIENTS ARE ASSOCIATED WITH AN INCREASED RISK OF PROGRESSION TO PSORIATIC ARTHRITIS - A PROSPECTIVE COHORT STUDY

Background:

We have previously reported that the presence of musculoskeletal pain in psoriasis patients is associated with a higher risk of developing psoriatic arthritis (PsA) (1). Furthermore, a subset of psoriasis patients shows evidence for structural entheseal lesions (SEL) in their hand joints (2), sometimes also referred as “Deep Koebner Phenomenon”, which are highly specific for psoriatic disease and virtually absent in healthy controls, rheumatoid arthritis and hand osteoarthritis patients (2-4). However, it remains unclear whether SEL alone or in combination with musculoskeletal pain are associated with the development of PsA.

Objectives:

To test whether the presence of SEL in psoriasis patients increases the risk for progression to PsA and how this is related to the presence of musculoskeletal pain.

Methods:

Psoriasis patients without evidence of PsA were enrolled in a prospective cohort study between 2011 and 2018. All patients underwent baseline assessment of SEL in their 2ndand 3rdMCP joints by high-resolution peripheral quantitative computed tomography (HR-pQCT). The risk of PsA development associated with SEL and arthralgia was explored using survival analyses and multivariable Cox regression models.

Results:

114 psoriasis patients (72 men/42 women) with a mean (SD) follow-up duration of 28.2 (17.7) months were included, 24 of whom developed PsA (9.7 /100 patient-years, 95%CI 6.2 to 14.5) during the observation period. Patients with SEL (N=41) were at higher risk of developing PsA compared to patients without such lesions (21.4/100 patient-years, 95%CI 12.5 to 34.3, HR 5.10, 95%CI 1.53 to 16.99, p=0.008) (Kaplan Meier plot A). Furthermore, while patients without arthralgia and without SEL had a very low progression rate to PsA (1/29; 3.4%), patients with arthralgia but no SEL showed higher progression (5/33; 15.2%), which was in line with previous observations (1) (Kaplan Meier plot B). Presence of SEL further enhanced the risk for progression to PsA both in the absence (6/16; 37.5%) and presence (6/14; 42.8%) of arthralgia with the highest progression rate in those subjects with both arthralgia and SEL (p<0.001 by log rank test for trend) (Kaplan Meier plot B).

Conclusion:

Presence of SEL is associated with an increased risk of developing PsA in patients with psoriasis. If used together with pain, SEL allow defining subsets of psoriasis patients with very low and very high risk to develop PsA.

References:

[1]Faustini F et al. Ann Rheum Dis. 2016;75:2068-2074

[2]Simon D et al. Ann Rheum Dis. 2016;75:660-6

[3]Finzel S et al. Ann Rheum Dis. 2011;70:122-7

[4]Finzel S et al. Arthritis Rheum. 2011;63:1231-6

Disclosure of Interests:

David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Koray Tascilar: None declared, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Sara Bayat Speakers bureau: Novartis, Eleni Kampylafka Speakers bureau: Novartis, BMS, Janssen, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Louis Schuster: None declared, Klaus Engel: None declared, Michael Sticherling Grant/research support from: Novartis, Consultant of: Advisory boards Abbvie, Celgene, Janssen Cilag, Lilly, Pfizer, MSD, Novartis, Amgen, Leo, Sanofi, UCB, Speakers bureau: Abbvie, Celgene, Janssen Cilag, Leo, MSD, Novartis, Pfizer, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

FRI0360 IMPACT OF METHOTREXATE ON DISEASE PATTERN IN ACTIVE PSORIATIC ARTHRITIS PATIENTS ELIGIBLE FOR A RANDOMIZED CLINICAL TRIAL WITH USTEKINUMAB: COMPARATIVE BASELINE DATA FROM MULTICENTRE INVESTIGATOR-INITIATED MUST TRIAL

Background:

Methotrexate (MTX) is a csDMARD treatment that is initiated as first-line therapy (after NSAID) in active psoriatic arthritis (PsA). Randomized clinical trials mostly require treatment failure or intolerance of csDMARD/MTX therapy before initiation of a biological treatment. We designed an investigator-initiated (IIT) randomised blinded study comparing PsA patients starting open label Ustekinumab (UST) combined with blinded MTX or placebo (PLC). Patients are stratified regarding their previous MTX therapy (continuation or discontinuation of MTX (MTX-pre-treated patients –group A) or newly initiate MTX or continue without MTX (MTX-naïve patients – group B).

Objectives:

To determine disease characteristics of patients with active psoriatic arthritis regarding their skin and musculoskeletal manifestations in dependence of their MTX treatment status.

Methods:

A total of 186 patients with active PsA (defined as TJC ≥4, SJC ≥4 (68/66 joint count) and DAS28 ≥ 3,2) were screened for eligibility. At baseline (BL) 173 patients starting open label UST were randomised to receive either MTX or PLC. At Screening (SCR) and BL, demographic data, PsA and PsO disease activity (joint count (TJC/SJC), enthesitis (LEI), dactylitis (number of digits), PASI, BSA, mtNAPSI), previous medication as well as quality of life (QoL) and function (documented as PRO using DLQI, HAQ and subjects assessment of pain as visual analogue scale (VAS) was documented.

Results:

Our preliminary blinded data export comprised all documented and released data for SCR and BL until Mid-January 2020 - in total 154 randomized patients. Thereof, 78 patients were randomized in group A and 76 in group B. BL characteristics were well balanced between groups (mean age A: 50,7 years vs. 46,4 in B, BMI 29 vs. 29,6 in B). More male were included in B (72% vs. 50 %). In median, patients in A had a disease duration of 2,9 y whereas duration in B was in median 0,3 y. More patients in A had failed previous biological therapy (17 to 6 in B), discontinued due to intolerability or ineffectiveness as allowed for study inclusion. Mean DAS28 was 4,5 (moderate disease activity) for both groups and mean values for SGA, PGA were comparable (SGA: 59,1 vs 54,9 PGA: 61,4 vs. 55.6) reflecting comparable disease activity in peripheral arthritis. Mean LEI was comparable in both groups (A: 1,3 vs B: 1,1). Mean number of digits with dactylitis were slightly higher in B (0,8) than in A (0,2). Overall HAQ showed no differences (1.0 in B vs. 0.8 in A – missing data 45 and 29 resp.) and pain VAS did not differ between groups (A: 54,9 mm vs. 56,6 mm in B). PASI and NAPSI were higher in B at BL than in group A (PASI: 7,2 vs. 3,3, mtNAPSI 5,0 vs. 3,0) and PRO showed a higher skin disease burden experienced by MTX-naïve patients prior randomization: in DLQI more patients on MTX experience “no effect” of their skin disease on QoL (22% vs. 7%) whereas more MTX naïve patients see a “moderate” “large” to “extreme large effect” of their disease on QoL (16%, 11%, 5% in B vs. 10%, 8%, 3% in A).

Conclusion:

Our results give important information about comparability of patient population on MTX or without MTX therapy eligible for biological trials. Despite a comparable disease activity in peripheral arthritis scores, skin disease activity was increased in patients without MTX compared to MTX treated patients. Number of affected digits in dactylitis was lower with MTX, whereas its impact on enthesitis seems to be neglectable.

Disclosure of Interests:

Tanja Rossmanith Grant/research support from: Janssen, BMS, LEO, Pfizer, Michaela Köhm Grant/research support from: Pfizer, Janssen, BMS, LEO, Consultant of: BMS, Pfizer, Speakers bureau: Pfizer, BMS, Janssen, Novartis, Uta Kiltz Grant/research support from: AbbVie, Amgen, Biogen, Novartis, Pfizer, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer, Roche, UCB, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Herbert Kellner: None declared, Anita Bulczak-Schadendorf Grant/research support from: Janssen, Ann Christina Foldenauer: None declared, Harald Burkhardt Grant/research support from: Pfizer, Roche, Abbvie, Consultant of: Sanofi, Pfizer, Roche, Abbvie, Boehringer Ingelheim, UCB, Eli Lilly, Chugai, Bristol Myer Scripps, Janssen, and Novartis, Speakers bureau: Sanofi, Pfizer, Roche, Abbvie, Boehringer Ingelheim, UCB, Eli Lilly, Chugai, Bristol Myer Scripps, Janssen, and Novartis, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai

SAT0275 MAINTAINED BENEFIT IN HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH GIANT CELL ARTERITIS TREATED WITH TOCILIZUMAB PLUS PREDNISONE TAPERING: RESULTS FROM THE OPEN-LABEL, LONG-TERM EXTENSION OF A PHASE 3 RANDOMIZED CONTROLLED TRIAL

Background:

In part 1 of the 52-week, double-blind GiACTA trial, patients with giant cell arteritis (GCA) who received weekly tocilizumab (TCZ) plus prednisone tapering reported improvement in the 36-item Short-Form Health Survey (SF-36) Mental Component Summary (MCS) and Physical Component Summary scores and FACIT-Fatigue scores that were statistically significant and clinically meaningful compared with patients who received prednisone alone.1

Objectives:

To analyze whether benefit in SF-36 MCS was maintained in patients originally assigned to TCZ compared with those originally assigned to placebo (PBO) plus a 26- or 52-week prednisone taper among patients who achieved clinical remission at week 52 and maintained treatment-free clinical remission in the 2-year, long-term extension of GiACTA.

Methods:

At the end of part 1, patients entered open-label part 2, in which GCA therapy (including initiation/termination of open-label TCZ and/or GCs) was given at the investigator’s discretion according to disease status. Change from baseline in SF-36 MCS score was compared for combined original TCZ (n = 33) and PBO (n = 17) patients who achieved clinical remission at week 52 and maintained treatment-free (no TCZ or GCs) clinical remission in part 2 using a repeated-measures model. The minimal clinically important difference (MCID) for SF-36 MCS is >2.5.2

Results:

During treatment, SF-36 MCS scores in all 50 patients who maintained treatment-free clinical remission in part 2 had diverged between the TCZ and PBO groups as early as 36 weeks after baseline, with greater improvements evident in the TCZ group (Figure). The difference in least square means (LSM) change between TCZ and PBO was statistically significant at week 52 (p= 0.016) and maintained at weeks 100 (p= 0.023) and 156 (p= 0.002). The LSM difference (95% CI) between TCZ and PBO at weeks 52, 100, and 156 was 5.6 (1.1-10.2), 6.5 (0.9-12.1), and 7.4 (2.9-11.9), respectively, exceeding the MCID.

Conclusion:

Among patients who maintained treatment-free clinical remission during part 2 of GiACTA, those originally assigned to receive TCZ plus a prednisone taper during part 1 maintained statistically significant and clinically meaningful improvements in SF-36 MCS up to week 156 compared with those originally assigned to receive PBO plus a prednisone taper in part 1. This was true even though neither of the patient groups received TCZ or GC treatment after they achieved clinical remission at week 52.

References:

[1]Strand V et al.Arthritis Res Ther2019;21:64.

[2]Lubeck DP.Pharmacoeconomics2004;22:27-38.

Disclosure of Interests:

John H. Stone Grant/research support from: Roche, Consultant of: Roche, Jian Han Shareholder of: Genentech, Inc., Employee of: Genentech, Inc., Sebastian Unizony Grant/research support from: Genentech, Inc., Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche, Daniel Blockmans Consultant of: yes, Speakers bureau: yes, Elisabeth Brouwer Consultant of: Roche (consultancy fee 2017 and 2018 paid to the UMCG), Speakers bureau: Roche (2017 and 2018 paid to the UMCG), Maria C. Cid Speakers bureau: Roche, Bhaskar Dasgupta Grant/research support from: Roche, Consultant of: Roche, Sanofi, GSK, BMS, AbbVie, Speakers bureau: Roche, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Carlo Salvarani: None declared, Robert Spiera Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Forbius, Sanofi, Inflarx, Consultant of: Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Forbius, Mistubishi Tanabe, Min Bao Shareholder of: Roche, Employee of: Genentech

SAT0354 TYPE 3 INNATE LYMPHOID CELLS ARE KEY DRIVERS OF PSORIATIC ARTHRITIS

Background:

Psoriasis (PsO) and psoriatic arthritis (PsA) are two types of chronic inflammatory diseases that share a similar cytokines profile. About 30% of PsO patients also develop a joint involvement, but the underlying mechanism is still unclear. Innate lymphoid cells (ILC) and specifically the type 3 ILCs (ILC3s) have raised increasing interest as possible player in the pathogenesis of both diseases, as they produce the pathological key cytokine IL-17A.

Objectives:

We addressed the contribution of ILC3s to the pathogenesis of PsO and PsA in patients as well as murinein vivomodels.

Methods:

130 patients satisfying the Classification Criteria for Psoriatic Arthritis (CASPAR), 40 patients with PsO and 35 healthy volunteers were enrolled in the study. Information regarding clinical features, laboratory parameters were collected and psoriasis area severity index (PASI), disease activity score 28 (DAS28), disease activity in psoriatic arthritis (DAPSA), minimal disease activity score (MDA) were calculated. Magnetic resonance imaging (MRI) and high-resolution peripheral CT (HR-pQCT) were taken and PsA MRI score (PsAMRIS) was assessed. Flow cytometric analysis was performed and IFNγ-producing ILC1s, IL-4/IL-5-producing ILC2s and IL-17/IL-22-producing ILC3s were identified among ILCs. Multivariate linear regression and Receiver-Operating Characteristic (ROC) Curve analysis was performed using the IBM SPSS Statistics software. Different in vivo models were used to assess functional implications of ILCs at different time points of the disease. Joint inflammation was assessed through MRI and H&E staining of ankle areas. Peripheral blood was obtained from mice of each group and flow cytometry analysis was performed. High dimensional analyses including RNA-seq was performed to identify phenotypic characteristics of ILCs implemented into the pathogenesis of the disease.

Results:

Total number of circulating ILCs were increased in PsA patients compared to PsO and healthy controls (p<0,001). Linear regression analyses of the relationship between disease activity and circulating ILCs counts showed strongest correlation between ILC3s counts and DAPSA score. ILC3s counts also correlated with imaging signs of inflammation such as enthesitis, synovitis, erosions and/or ostoeproliferation as assessed by MRI and HR-pQCT. Musculoskeletal inflammation in mice was predominantly associated with p19 expression and IL-23R-signaling as assessed by RNA-seq. These effects were also accompanied by a strong upregulation of IL-17-producing lymphocytes within the inflamed joint niche with a dominant presence of ILC3s. Multi-channel immunofluorescence and confocal laser scanning microscopy revealed not only upregulation of ILC3 induced IL-17 production within the synovial membrane but also in peri-articular areas of the inflamed joints.

Conclusion:

ILC3s not only correlate with various facets of PsA manifestations but also functionally contribute to synovitis and enthesitis suggesting them as interesting target for upcoming treatment strategies in the near future.

Disclosure of Interests:

Maria Gabriella Raimondo Grant/research support from: Celgene, Partner Fellowship, Simon Rauber: None declared, Markus Luber: None declared, Aleix Rius Rigau: None declared, Stefanie Weber: None declared, Charles Gwellem Anchang: None declared, Rahul Agarwal: None declared, Alina Soare: None declared, Michael Sticherling Grant/research support from: Novartis, Consultant of: Advisory boards Abbvie, Celgene, Janssen Cilag, Lilly, Pfizer, MSD, Novartis, Amgen, Leo, Sanofi, UCB, Speakers bureau: Abbvie, Celgene, Janssen Cilag, Leo, MSD, Novartis, Pfizer, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Jörg Distler Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Andreas Ramming Grant/research support from: Pfizer, Novartis, Consultant of: Boehringer Ingelheim, Novartis, Gilead, Pfizer, Speakers bureau: Boehringer Ingelheim, Roche, Janssen

SAT0556 FINE STRUCTURE ANALYSIS OF THE INTER-RELATION BETWEEN TOPHUS DEPOSITION AND BONE LESIONS IN GOUT USING A COMBINATION OF DUAL ENERGY AND HIGH-RESOLUTION CT

Background:

Deposition of uric acid crystals cause an inflammatory reaction, which can lead to structural bone changes, if such deposits form adjacent to cortical bone [1, 2]. Both erosions and bony spurs can form in conjunction with tophus deposition. The exact spatial inter-relation between tophi and structural bone lesions in humans in vivo is not fully characterized.

Objectives:

To spatially relate structural bone changes (erosions, osteophytes) to the deposition of monosodium urate crystals in the first metatarsophalangeal (MTP1) joint in patients with tophaceous gout.

Methods:

Tophaceous gout patients with clinically detected tophi at the MTP1 joint underwent simultaneous dual energy computed tomography (DECT) and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the feet. Tophi detected by DECT and erosions and osteophytes detected by HR-pQCT were overlayed to define their exact anatomical relation. Furthermore, feet of sex- and age-matched healthy controls (HC) were scanned to define the normal architecture of the MTP1 joint.

Results:

Gout patients (N=20) had significantly higher numbers (5 (0–17 vs. 1 (1– 2)) and volumes (45.32 mm3(7.26–550.32) vs. 0.82 mm3(0.15–21.8)) of bone erosions as well as significantly higher numbers (10.5 (0-26) vs. 1 (0-10)) and sizes of osteophytes (4.93 mm (0.77-7.19 mm vs. 0.93 mm (0.05-7.61 mm))than healthy controls (N=20). Erosions were in direct spatial relation to bone erosions, while osteophytic responses were more widespread and affected bone regions on the MTP1, which were not directly adjacent to tophi. Median tophus volume detected by DECT (0.12 mm3(0.01–2.53)) was associated with the total volume of erosions (r=0.597, p=0.005).

Conclusion:

This study demonstrates that bone changes in gout are substantial and not only include erosions but also widespread architectural bone remodeling associated osteophyte formation. While there is a direct spatial relation between tophi and bone erosions the anabolic bone responses in gout are more widespread.

References:

[1]Dalbeth, N. et al. Ann Rheum Dis. 2015 Jun;74(6):1030-6.

[2]Dalbeth, N. et al. Arthritis Res Ther. 2012; 14(4): R165.

Data are based on high-resolution peripheral quantitative computed tomography (HR-pQCT) of metatarsophalangeal joints I in gout patients (grey boxplots) and healthy controls (white boxplots). (A) number of bone erosions, (B) volume of bone erosions, (C) number of osteophytes and (D) size of osteophytes. Data are shown as medians and inter-quartile ranges (boxes).

Distribution of (A) tophi based on dual-energy computed tomography (DECT) as well as (B) bone erosions and (C) osteophytes based on high-resolution peripheral quantitative computed tomography (HR-pQCT) of metatarsophalangeal (MTP) I head in gout patients. Data are shown for the different regions of the MTPI head including the plantar, medial, dorsal and lateral region of the metatarsal head, as well as the medial and lateral sesamoid bones. Data indicate percentage of patients with tophi, erosions and osteophytes in respective region.

Disclosure of Interests:

Sara Bayat Speakers bureau: Novartis, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Caroline Pecherstorfer: None declared, Hanna Ellmann: None declared, Camille Figueiredo: None declared, Matthias Englbrecht: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

OP0117 LONGITUDINAL CHANGE IN THE CENTRAL NERVOUS SYSTEM PAIN RESPONSE AFTER TREATMENT WITH CERTOLIZUMAB OR PLACEBO. A POST-HOC ANALYSIS FROM THE PRECEPRA TRIAL

Background:

Tumor necrosis factor inhibitors have revolutionized the treatment of rheumatoid arthritis (RA). However, only about 50% of the patients respond well to TNF inhibitors. Therefore, markers that predict response to TNF inhibitors are valuable. Previously we demonstrated that central nervous system (CNS) response to nociceptive stimuli, measured by fMRI of the brain as blood oxygen level dependent (BOLD) signals, decreases already after 24 hours of anti-TNF administration a higher pre-treatment BOLD signal volume seems to predict clinical response to treatment with certolizumabpegol (CZP)1,2. We therefore hypothesized that the baseline volume of BOLD signal in the CNS could predict anti-TNF treatment response.

Objectives:

To perform a randomized placebo controlled trial in active RA patients to test the effect of TNF inhibition on arthritis induced pain activity in the brain and to test whether patients with high-level RA-related brain activation react differently to TNF-inhibitors than patients with low-level brain activation.

Methods:

Adult RA patients fulfilling the 2010 ACR/EULAR classification criteria with a DAS28>3.2 receiving stable DMARD treatment for at least 3 months were eligible. Patients underwent the first fMRI at screening measuring BOLD signal upon MCP joint compression and were stratified into low (< 700 units) and high (>700 units) voxel counts. Then patients were randomized to CZP or placebo with a 2:1 ratio. The second and third fMRI were performed after 12 and 24 weeks, respectively. Control stimulation was done by measuring brain activation after non-painful finger tapping.

Results:

156 RA patients with moderate-to-high disease activity participated in the study. In the finger tapping control, fMRI showed no significant changes in BOLD signal in the CZP-L and CZP-H arms, but a slight but significant decrease (p=0.043) was observed. After joint compression, the CZP-L group showed significant increase in the BOLD signal volume (p=0.043) in fMRI-2 as compared to fMRI-1 with no further significant changes. In contrast, in the CZP-H group, the BOLD signal volume significantly decreased (p=0.037) in fMRI-2 and continued to decrease further, p=0.007. No significant changes were observed in the placebo arm over time.

Conclusion:

TNF inhibition improves arthritis-related brain activity in the subgroup of RA patients with high baseline BOLD activity in the fMRI.

References:

[1]Hess, A.et al.PNAS (2011).

[2]Rech, J. et al. Arthritis & Rheumatism (2013).

Fig 1.

BOLD fMRI responses to painful stimulation

Acknowledgments:

The study was supported by an unrestricted grant of UCB Biopharma SPRL Brussels, Belgium

Disclosure of Interests:

Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Koray Tascilar: None declared, Hannah Schenker: None declared, Melanie Hagen: None declared, Marina Sergeeva: None declared, Mageshwar Selvakumar: None declared, Laura Konerth: None declared, Jutta Prade: None declared, Sandra Strobelt: None declared, Verena Schönau: None declared, Larissa Valor: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis, Abbvie, Speakers bureau: Novartis, Lilly, Frank Behrens Grant/research support from: Abbvie, Pfizer, Roche, Chugai, Janssen, Consultant of: Abbvie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly; Boehringer; Sandoz, Speakers bureau: Abbvie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly; Boehringer; Sandoz, Christoph Baerwald Consultant of: CGB received speaker or consulting fees from AbbVie, Paid instructor for: CGB received speaker or consulting fees from AbbVie, Speakers bureau: CGB received speaker or consulting fees from AbbVie, Stephanie Finzel: None declared, Reinhard Voll: None declared, Eugen Feist Consultant of: Novartis, Roche, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Sanofi, Speakers bureau: Novartis, Roche, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Sanofi, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis, Arnd Doerfler: None declared, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Andreas Hess: None declared, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

OP0027 TIME TO FLARE AND GLUCOCORTICOID EXPOSURE IN PATIENTS WITH NEW-ONSET VERSUS RELAPSING GIANT CELL ARTERITIS TREATED WITH TOCILIZUMAB OR PLACEBO PLUS PREDNISONE TAPERING: 3-YEAR RESULTS FROM A RANDOMIZED CONTROLLED PHASE 3 TRIAL

Background:

In part 1 of the 52-week, double-blind GiACTA trial, tocilizumab (TCZ) every week (QW) or every other week (Q2W) + prednisone tapering reduced the risk for flare versus placebo (PBO) + 26-week prednisone tapering among patients with new-onset giant cell arteritis (GCA) at baseline. Among patients with relapsing GCA, TCZ QW but not Q2W + prednisone reduced the risk for flare versus both PBO groups, and there was separation in the time to flare between the TCZ QW and Q2W groups.1

Objectives:

To report time to first flare and potential cumulative glucocorticoid (GC) sparing over 3 years of the GiACTA trial (part 1 + 2-year open-label part 2) among patients with new-onset or relapsing GCA.

Methods:

At the end of part 1, patients entered open-label part 2, in which GCA therapy (including initiation/termination of open-label TCZ and/or GCs) was given at the investigator’s discretion according to disease status. Time to first GCA flare during the 3-year study period was assessed using Kaplan-Meier analysis for patients in the intention-to-treat population according to disease onset status at baseline (new-onset/relapsing) based on their originally assigned treatment groups: TCZ QW, TCZ Q2W, or pooled PBO (PBO+26-week and PBO+52-week prednisone taper).

Results:

Among patients randomly assigned in part 1, 47 of 100 (47%) in the TCZ QW group, 26 of 49 (53%) in the TCZ Q2W group, and 46 of 101 (46%) in the pooled PBO group had new-onset GCA at baseline; the rest had relapsing GCA. Median time to first flare over 3 years was longer for patients assigned to TCZ treatment in part 1 than for patients assigned to PBO; Kaplan-Meier analysis showed a clear separation between the TCZ QW and the pooled PBO groups over 3 years for patients with new-onset and relapsing GCA (Figure 1A). Separation between the TCZ QW and TCZ Q2W groups was also observed over 3 years in patients with new-onset and relapsing GCA, although this was more evident in patients with relapsing GCA (Figure 1B). Higher proportions of patients in the TCZ QW group (new-onset, 49%; relapsing, 47%) than the pooled PBO group (new-onset, 28%; relapsing, 31%) and the TCZ Q2W group (new-onset, 27%; relapsing, 35%) remained flare-free during their entire treatment period. Cumulative prednisone dose over 3 years was lower for patients originally assigned to TCZ QW versus those originally assigned to PBO for patients with new-onset GCA and those with relapsing GCA at baseline (Figure 2).

Conclusion:

In this 3-year analysis of GiACTA parts 1 and 2, time to first flare favored TCZ QW over TCZ Q2W in patients with new-onset and relapsing GCA. TCZ QW delayed time to first flare and resulted in lower cumulative GC exposure compared with PBO in patients with new-onset and relapsing GCA, supporting TCZ QW dosing in patients with GCA regardless of disease onset.

References:

[1]Stone JH et al. N Engl J Med 2017;377:317-28.

Disclosure of Interests:

John H. Stone Grant/research support from: Roche, Consultant of: Roche, Helen Spotswood Shareholder of: Roche Products Ltd, Employee of: Roche Products Ltd, Sebastian Unizony Grant/research support from: Genentech, Inc., Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche, Daniel Blockmans Consultant of: yes, Speakers bureau: yes, Elisabeth Brouwer Consultant of: Roche (consultancy fee 2017 and 2018 paid to the UMCG), Speakers bureau: Roche (2017 and 2018 paid to the UMCG), Maria C. Cid Speakers bureau: Roche, Bhaskar Dasgupta Grant/research support from: Roche, Consultant of: Roche, Sanofi, GSK, BMS, AbbVie, Speakers bureau: Roche, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Carlo Salvarani: None declared, Robert Spiera Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Forbius, Sanofi, Inflarx, Consultant of: Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Forbius, Mistubishi Tanabe, Min Bao Shareholder of: Roche, Employee of: Genentech

SAT0050 PREDICTION OF RESPONSE TO CERTOLIZUMAB PEGOL TREATMENT BY FUNCTIONAL MRI OF THE BRAIN: AN INTERNATIONAL, MULTI-CENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL (PRECEPRA)

Background:

Personalization of RA treatment is not optimal due to lack of predictors. We previously demonstrated in RA patients that central nervous system (CNS) pain response to tender joint compression, measured by using functional MRI (fMRI) of the brain rapidly wanes after 24 hours of anti-TNF administration and that a higher pre-treatment BOLD signal volume seems to predict clinical response to treatment with certolizumab-pegol (CZP)1,2. We therefore hypothesized that the CNS pain response upon compression of a painful joint could predict subsequent anti-TNF treatment response.

Objectives:

To compare disease activity after 12-weeks of CZP treatment to that of placebo in DMARD-refractory RA patients based on pre-treatment baseline CNS pain response measured using BOLD fMRI.

Methods:

Adult RA patients fulfilling the 2010 ACR/EULAR classification criteria with a DAS28>3.2 under stable DMARD treatment for at least 3 months were eligible. Patients underwent fMRI scanning of the brain at screening for stratification by CNS pain response. Whole brain BOLD-signal-voxel-count of 700 units classifying between low and high, and were randomized to CZP or placebo (2:1) The primary outcome was low disease activity (LDA, DAS28 ≤3.2) after 12 weeks of treatment.

Results:

156 RA patients, inadequate responders to csDMARD, signed the informed consent. 139 patients (46/47, 46/49 and 42/43) (99 females, 71%) with moderate-high disease activity (mean (SD) DAS-28: 4.83 (1.03)) could be included respectively and completed the 12-week study treatment. Geometric mean (SD) numbers of baseline BOLD signal positive voxels were 559 (10), 81 (12) and 2498 (3) in the 3 arms respectively. The mean DAS28 (SD) scores after 12 weeks of study treatment were Placebo: 3.89 (1.29), CZP-L: 3.42 (1.06) and CZP-H: 3.06 (1.04). LDA was achieved in 12/47 patients (25.5 %) in placebo, 22/49 (44.9%) in the CZP-L, and 25/43, (58.1%) in the CZP-H arm. The linear effect term for the ordinal study group variable supported a linear trend of increasing CZP treatment effect with increasing baseline CNS pain response. RR (95% CI) for achieving LDA with each unit increase in treatment category over placebo was 1.79 (1.24 to 2.74, p=0.003).

Conclusion:

A higher pre-treatment brain activity in response to pain measured with fMRI predicts the chance of achieving low disease activity with CZP treatment.

References:

[1] Hess, A.et al.PNAS (2011)

[2] Rech, J.et al. Arthritis & Rheumatism(2013).

Acknowledgments :

The study was supported by an unrestricted grant from UCB Biopharma SPRL, Brussels, Belgium

Disclosure of Interests:

Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Koray Tascilar: None declared, Hannah Schenker: None declared, Marina Sergeeva: None declared, Mageshwar Selvakumar: None declared, Laura Konerth: None declared, Jutta Prade: None declared, Sandra Strobelt: None declared, Melanie Hagen: None declared, Verena Schönau: None declared, Larissa Valor: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Frank Behrens Grant/research support from: Abbvie, Pfizer, Roche, Chugai, Janssen, Consultant of: Abbvie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly; Boehringer; Sandoz, Speakers bureau: Abbvie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly; Boehringer; Sandoz, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis, Christoph Baerwald Consultant of: CGB received speaker or consulting fees from AbbVie, Paid instructor for: CGB received speaker or consulting fees from AbbVie, Speakers bureau: CGB received speaker or consulting fees from AbbVie, Stephanie Finzel: None declared, Reinhard Voll: None declared, Eugen Feist Consultant of: Novartis, Roche, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Sanofi, Speakers bureau: Novartis, Roche, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Sanofi, Arnd Doerfler: None declared, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Andreas Hess: None declared, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

OP0218 CENTRAL NERVOUS SYSTEM PAIN RESPONSE AND COMPONENTS OF DISEASE ACTIVITY IN RA PATIENTS AFTER TREATMENT WITH CERTOLIZUMAB OR PLACEBO: A POST-HOC ANALYSIS FROM THE PRECEPRA TRIAL

Background:

We have previously observed in RA patients that central nervous system (CNS) response to compression of a painful joint, measured using functional MRI (fMRI) of the brain as the number of blood oxygen level dependent (BOLD) signal positive voxels, is rapidly ameliorated, much earlier than any clinical response with anti-TNF treatment and a high baseline CNS pain response could predict better response to certolizumab pegol (CZP) treatment. Pre-CePRA was designed and conducted to test this effect in a randomized, placebo controlled trial of CZP and showed an incremental linear trend of DAS28 low disease activity (LDA) across study groups treated with placebo, and two CZP arms stratified as low or high pre-treatment CNS pain response.

Objectives:

To explore and describe pre-treatment CNS pain response associations with post treatment course of RA disease activity components and patient-physician discrepancy in global disease assessment.

Methods:

Patients fulfilling the 2010 ACR/EULAR classification criteria with moderate-severe disease activity (DAS-28>3.2) under stable DMARD treatment were recruited. Patients underwent an fMRI scan, stratified by a whole-brain BOLD positive voxel count threshold of 700 units and randomized to treatment with CZP or placebo in a 2:1 ratio. We descriptively assessed components of RA disease activity (Table 1 + 2). We summarized the mean results and 95% confidence intervals of these measurements at study timepoints and compared the 3 study groups at week 12 using one-way ANOVA and post-hoc Tukey tests.

Results:

156 eligible patients were screened and 139 (99 females, 71%) patients with moderate-high disease activity were randomized. ANOVA and pairwise comparisons showed that PGA-VAS improvement was larger in the CZP-H group whereas more similar to that in placebo in the CZP-L group. PhysGA-VAS however was similarly reduced in both CZP groups. Patients in the CZP-L group constantly rated their pain numerically higher than physicians whereas in the CZP-H group an initially higher discrepancy numerically reduced over time.

Conclusion:

These results suggest that improved patient global disease activity assessment could be the main driver of improved DAS-28 LDA rates with CZP treatment in patients with a high CNS pain response. Our findings indicate a potential role of fMRI imaging of the brain to further understand disease activity perception in RA patients.

Figure 1.

Course of disease activity components through trial timepoints. *indicates log-transformed y axis. *#x002A; Discrepancy equals Patient global minus physician global assessment.

Disclosure of Interests:

Hannah Schenker: None declared, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Koray Tascilar: None declared, Melanie Hagen: None declared, Verena Schönau: None declared, Marina Sergeeva: None declared, Mageshwar Selvakumar: None declared, Laura Konerth: None declared, Jutta Prade: None declared, Sandra Strobelt: None declared, Larissa Valor: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Frank Behrens Grant/research support from: Abbvie, Pfizer, Roche, Chugai, Janssen, Consultant of: Abbvie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly; Boehringer; Sandoz, Speakers bureau: Abbvie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Lilly; Boehringer; Sandoz, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis, Christoph Baerwald Consultant of: CGB received speaker or consulting fees from AbbVie, Paid instructor for: CGB received speaker or consulting fees from AbbVie, Speakers bureau: CGB received speaker or consulting fees from AbbVie, Stephanie Finzel: None declared, Reinhard Voll: None declared, Eugen Feist Consultant of: Novartis, Roche, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Sanofi, Speakers bureau: Novartis, Roche, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Sanofi, Arnd Doerfler: None declared, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Andreas Hess: None declared, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

Bone microstructure and volumetric bone mineral density in patients with hyperuricemia with and without psoriasis

We analyzed volumetric bone mineral density (vBMD) and bone microstructure using HR-pQCT in subjects with normouricemia (NU) and subjects with hyperuricemia (HU) with and without psoriasis (PSO). HU was associated with higher cortical vBMD and thickness. Differences in average and trabecular vBMD were found between patients with PSO + HU and NU.

INTRODUCTION

Hyperuricemia (HU) and gout are co-conditions of psoriasis and psoriatic arthritis. Current data suggest a positive association between HU and areal bone mineral density (BMD) and a negative influence of psoriasis on local bone, even in the absence of arthritis. However, the influence of the combination of HU and psoriasis on bone is still unclear. The aim of this study was to assess the impact of HU with and without psoriasis on bone microstructure and volumetric BMD (vBMD).

METHODS

Healthy individuals with uric acid levels within the normal range (NU), with hyperuricemia (HU), patients with hyperuricemia and psoriasis (PSO + HU), and patients with uric acid within the normal range and psoriasis (PSO + NU) were included in our study. Psoriasis patients had no current or past symptoms of arthritis. Average, trabecular, and cortical vBMD (mgHA/cm³); trabecular number (Tb.N, 1/mm) and thickness (Tb.Th, mm); inhomogeneity of the network (1/N.SD, mm); and cortical thickness (Ct.Th., mm) were carried out at the ultradistal radius using high-resolution peripheral quantitative computed tomography. In addition, bone turnover markers such as DKK-1, sclerostin, and P1NP were analyzed.

RESULTS

In total, 130 individuals were included (44 NU participants (34% female), 50 HU (24%), 16 PSO + HU (6%), 20 PSO + NU (60%)). Subjects were aged: NU 54.5 (42.8, 62.1), HU 57.5 (18.6, 65.1), PSO + HU 52.0 (42.3, 57.8), and PSO + NU 42.5 (34.8, 56.8), respectively. After adjusting for age, sex, BMI, and diabetes, patients in the HU group revealed significantly higher values of cortical vBMD (p < 0.001) as well as cortical thickness (p = 0.04) compared to the NU group. PSO + NU showed no differences to NU, but PSO + HU demonstrated both lower average (p = 0.03) and trabecular vBMD (p = 0.02). P1NP was associated with average, cortical, and trabecular vBMD as well as cortical thickness while sclerostin levels were related to trabecular vBMD.

CONCLUSION

Hyperuricemia in otherwise healthy subjects was associated with a better cortical vBMD and higher cortical thickness. However, patients with both psoriasis and hyperuricemia revealed a lower vBMD.

The ageing joint-standard age- and sex-related values of bone erosions and osteophytes in the hand joints of healthy individuals

OBJECTIVE

To analyze the age-related changes of the physiological hand joint architecture.

METHOD

To address this concept, healthy individuals (each 10 women and 10 men in six different age decades spanning from 21 to 80 years) were recruited through a field campaign, investigated for the absence of rheumatic diseases and other comorbidities and received high-resolution quantitative computed tomography (HR-pQCT) examination of the hand joints. Number and extent of erosions and osteophytes were quantified across the ages and different sexes.

RESULTS

Bone erosions [median (Q1-Q3), 1 (0-2)] and osteophytes [2 (1-4)] were found in healthy women and men with no significant sex differences. Structural changes however accumulated with age: the overall incidence rate ratio (IRR) for the number of erosions and osteophytes per age were 1.04 (95% CI: erosions 1.03-1.06; osteophytes: 1.03-1.05). This means a 4% increase in the number of erosions and osteophytes per year. Using third decade as reference, healthy individuals in the age decades from 50 years had higher IRR for erosion numbers (sixth, seventh, eigth decade: 4.87 (2.20-11.75), 6.81 (3.08-16.46) and 6.92 (3.11-16.79)) compared to younger subjects (fourth, fifth decade: 1.80 (0.69-4.87), 1.53 (0.59-4.10)). The IRRs of osteophytes also indicate a gradual increase after the fifth decade, with IRRs of 2.32 (1.32-4.17), 4.17 (2.38-7.49) and 6.86 (3.97-12.20) for the sixth, seventh and eigth decades, respectively.

CONCLUSIONS

Structural changes in the hand joints of healthy individuals are age dependent. While being rare under 50 years of age, erosions and osteophytes accumulate above the age of 50, suggesting that the threshold between "normal" and "pathological" is shifted with the increase of age.

Giant Shot Noise from Majorana Zero Modes in Topological Trijunctions

The clear-cut experimental identification of Majorana bound states in transport measurements still poses experimental challenges. We here show that the zero-energy Majorana state formed at a junction of three topological superconductor wires is directly responsible for giant shot noise amplitudes, in particular at low voltages and for small contact transparency. The only intrinsic noise limitation comes from the current-induced dephasing rate due to multiple Andreev reflection processes.

Glycosylation of random IgG distinguishes seropositive and seronegative rheumatoid arthritis

The N-glycosylation of human immunoglobulins, especially IgGs, plays a critical role in determining affinity of IgGs towards their effector (pro- and anti-inflammatory) receptors. However, it is still not clear whether altered glycosylation is involved in only antibody-dependent disorders like seropositive rheumatoid arthritis (RA) or also in pathologies with similar clinical manifestations, but no specific autoantibodies like seronegative RA. The clarification of that uncertainty was the aim of the current study. Another study aim was the detection of specific glycan forms responsible for altered exposure of native glycoepitopes. We studied sera from seropositive RA (n = 15) and seronegative RA (n = 12) patients for exposure of glycans in native IgG molecules, followed by determination of specific glycans by capillary electrophoresis with laser-induced fluorescent detection (CE-LIF). Aged-matched groups of normal healthy donors (NHD) and samples of intravenous immunoglobulin IgG preparations (IVIG) served as controls. There was significantly stronger binding of Lens culinaris agglutinin (LCA) and Aleuria aurantia lectin (AAL) lectins towards IgG from seropositive RA compared to seronegative RA or NHD. CE-LIF analysis revealed statistically significant increases in bisecting glycans FA2BG2 (p = .006) and FABG2S1 (p = .005) seropositive RA, accompanied by decrease of bisecting monogalactosylated glycan FA2(6)G1 (p = .074) and non-bisecting monosialylated glycan FA2(3)G1S1 (p = .055). The results suggest that seropositive RA is distinct from seronegative RA in terms of IgG glycan moieties, attributable to specific immunoglobulin molecules present in seropositive disease. These glycans were determined to be bisecting GlcNAc-bearing forms FA2BG2 and FABG2S1, and their appearance increased the availability of LCA and AAL lectin-binding sites in native IgG glycoepitopes.

Evidence for genetic overlap between adult onset Still's disease and hereditary periodic fever syndromes

OBJECTIVE

Adult onset Still's disease (AOSD) is a severe, autoimmune disease that can be challenging to treat with conventional therapeutics and biologicals in a considerable number of cases. Therefore, there is a high need to understand its pathogenesis better. As major clinical symptoms overlap between AOSD and hereditary periodic fever syndromes (HPFS), we analysed four known HPFS genes in AOSD.

METHODS

We performed Sanger sequencing and quantitative analysis of all coding regions of MEFV, TNFRSF1A, MVK and NLRP3 in 40 AOSD patients. All rare coding variants (n = 6) were evaluated for several aspects to classify them as benign to pathogenic variants. Statistical analysis was performed to analyse whether variants classified as (likely) pathogenic were associated with AOSD.

RESULTS

We identified three rare variants in MEFV, one previously not described. Association to the three likely pathogenic MEFV variants was significant (p _c = 2.34E- 03), and two of the three carriers had a severe course of disease. We observed strong evidence for significant association to mutations in TNFRSF1A (p _c = 2.40E- 04), as 5% of patients (2/40) carried a (likely) pathogenic variant in this gene. Both of them received a biological for treatment.

CONCLUSION

Our results indicate TNFRSF1A as a relevant gene in AOSD, especially in patients with a more challenging course of disease, while causal variants remain to be identified in the majority of patients.

Surfing on Protein Waves: Proteophoresis as a Mechanism for Bacterial Genome Partitioning

Efficient bacterial chromosome segregation typically requires the coordinated action of a three-component machinery, fueled by adenosine triphosphate, called the partition complex. We present a phenomenological model accounting for the dynamic activity of this system that is also relevant for the physics of catalytic particles in active environments. The model is obtained by coupling simple linear reaction-diffusion equations with a proteophoresis, or "volumetric" chemophoresis, force field that arises from protein-protein interactions and provides a physically viable mechanism for complex translocation. This minimal description captures most known experimental observations: dynamic oscillations of complex components, complex separation, and subsequent symmetrical positioning. The predictions of our model are in phenomenological agreement with and provide substantial insight into recent experiments. From a nonlinear physics view point, this system explores the active separation of matter at micrometric scales with a dynamical instability between static positioning and traveling wave regimes triggered by the dynamical spontaneous breaking of rotational symmetry.

Estimation of π-π Electronic Couplings from Current Measurements

The π-π interactions between organic molecules are among the most important parameters for optimizing the transport and optical properties of organic transistors, light-emitting diodes, and (bio-) molecular devices. Despite substantial theoretical progress, direct experimental measurement of the π-π electronic coupling energy parameter t has remained an old challenge due to molecular structural variability and the large number of parameters that affect the charge transport. Here, we propose a study of π-π interactions from electrochemical and current measurements on a large array of ferrocene-thiolated gold nanocrystals. We confirm the theoretical prediction that t can be assessed from a statistical analysis of current histograms. The extracted value of t ≈35 meV is in the expected range based on our density functional theory analysis. Furthermore, the t distribution is not necessarily Gaussian and could be used as an ultrasensitive technique to assess intermolecular distance fluctuation at the subangström level. The present work establishes a direct bridge between quantum chemistry, electrochemistry, organic electronics, and mesoscopic physics, all of which were used to discuss results and perspectives in a quantitative manner.

Minimal Excitations in the Fractional Quantum Hall Regime

We study the minimal excitations of fractional quantum Hall edges, extending the notion of levitons to interacting systems. Using both perturbative and exact calculations, we show that they arise in response to a Lorentzian potential with quantized flux. They carry an integer charge, thus involving several Laughlin quasiparticles, and leave a Poissonian signature in a Hanbury Brown-Twiss partition noise measurement at low transparency. This makes them readily accessible experimentally, ultimately offering the opportunity to study real-time transport of Abelian and non-Abelian excitations.