AB0349 ANALYSIS EFFICACY OF ABATACEPT TREATMENT IN BIOLOGIC-NAÏVE AND BIOLOGIC-EXPERIENCED PATIENTS

Background

Despite the high efficacy of rheumatoid arthritis (RA) therapy, in routine clinical practice, clinicians face questions about the choice of a second biologics, as well as the possibility of biologics monotherapy. Therefore, the specialties of biologics use in these categories of patients are of great clinical interest. This work is devoted to the study of the effectiveness of abatacept (ABA) therapy in biologic-naïve and biologic-experienced patients and in the subgroup of ABA monotherapy.

Objectives

To evaluate the effectiveness of ABA therapy between biologic-naïve and patients who had experienced an inadequate response to biological agents and in the subgroup of ABA monotherapy.

Methods

We prospectively enrolled and followed 91 patients with high RA activity (SDAI=28±13.4, CDAI=25±12) and an inadequate response of conventional synthetic DMARDs (mainly methotrexate, 70.3%) and biologics (mainly TNF-α blockers, 93%) were included in the study. Most of the patients were middle-aged (49±13.5), positive for RF (72.5%) and ACCP (77%) with moderate functional impairment - 1.4 (0.9-2). Patients were divided into two groups: biologic-naïve (48.4%, n=44) and biologic-experienced patients (51.6%, n=47). 18% (n=17) of patients had a history of an inadequate response of 2 or more biologics. The ABA monotherapy group (13%, n=12) was assessed separately. ABA were administered IV, 10 mg/kg according to the standard scheme. The evaluation of the effectiveness of the therapy was carried out according to the EULAR/ACR 2011 criteria using the intention-to-treat approach and SDAI, CDAI and the functional state using the HAQ.

Results

ABA led to a significant (p<0.05) decrease in RA activity after 3 months of ABA therapy in all groups. After 6 months of treatment, there was a tendency towards an increase in the number of patients who achieved remission and low RA activity in the group of biologic-naïve patients, which continued to 12 months of therapy. So, after 6 months and 12 months in the group of biologic-naïve patients, the frequency of remission and low disease activity was 71% (n=25) and 76% (n=19) by SDAI, 75.6% (n=28) and 81.5% (n=24) by CDAI, respectively. Whereas, in the group of biologic-experienced patients - SDAI - 61.8% (n=21) and 69.2% (n=18), CDAI - 64.8% (n=22) and 77.8% (n=21), respectively. However, these differences didn’t reach significance. Similar results were obtained according to the EULAR criteria: after 12 months of treatment, the percentage of patients with a good response in both groups did not differ, 38% (n=14) in biologic-naïve and 38.4% (n=15) in biologic-experienced patients. ABA significantly improved functional status of patients, after 12 months the median HAQ of biologic-naïve and biologic-experienced patients were 0.7 (0.2–0.8) and 1.18 (0.7–1.6), respectively. More biologic-naïve patients achieved functional remission by HAQ after 6 and 12 months compared with biologic-experienced patients: 67% (n=23) vs. 33% (n=17), 62.5% (n=11) vs. 37.5% (n=9), respectively, but these differences didn’t reach significance. In the ABA monotherapy group after 6 months treatment, a good response by EULAR criteria was achieved in 10% (n=1) patients, while in the group of ABA+csDMARDs therapy in 43.5%, p=0.04. After 12 months the trend towards a more pronounced response in the combination therapy group persisted (11%, n=1 and 42%, n=28, respectively), but no significant differences were obtained.

Conclusion

Abatacept has shown significant improvement clinical and functional status in all studied groups. There were no significant differences in response to ABA therapy between biologic-naïve and biologic-experienced patients. ABA monotherapy were significantly worse compared with the combination therapy of ABA and csDMARDs after 6 months. After 12th month observation, this tendency continued, but no significant differences were achieved. This is probably due to the small number of patients on ABA monotherapy and, as a result, to the insufficient statistical representativeness of the sample.

Disclosure of Interests

None declared

AB0170 AMCV POSITIVITY AND HIGHER SERUM IP-10 (CXCL-10) LEVEL ARE ASSOCIATED WITH A MORE PRONOUNCED EFFECT OF ABATACEPT THERAPY

Background

With the advent of medications with different mechanisms of action in the treatment of rheumatoid arthritis (RA), clinicians face the challenge of personalizing the approach to the treatment of RA patients. One of the steps in this direction is to identify predictors of the effectiveness of the therapy. This work is devoted to the identification of predictors of the therapy effectiveness with the blocker of T cells co-stimulation - abatacept (ABA).

Objectives

Search for clinical and immunological predictors of the effectiveness of ABA therapy.

Methods

91 patients were included in the study, most of them women, with high disease activity of RA (DAS28=5.1±1.0, SDAI=28±13.4, CDAI=25±12) and failure of previous biologics (51, 6%) and DMARDs (100%). Moreover, in 20% (n=18) of patients the inefficiency more than 2 biologics were recorded. The average duration of the disease was 3.0 (1.4–12) years, most patients were positive for RF 72.5%, ACCP 77%, AMCV 86%. In 44 patients the levels of RF, ACCP, AMCV and MMP-3 were assessed after 24 weeks of ABA therapy. In 36 patients enzyme-linked immunoassay was used to measure serum concentrations of biomarkers IL-1β, IL-6, IL-17AF, TNF-α, VEGF-A, IP-10, YKL-40 at baseline and after 24 weeks of ABA therapy. The effectiveness of therapy was assessed according to the EULAR criteria. ABA IV infusions were performed according to the standard schedule. Methods of parametric and non-parametric statistics were used in statistical analysis.

Results

ABA treatment led to a significant decrease of disease activity assessed by DAS28, SDAI, CDAI starting from 3 months of therapy (p<0.05). More than half of the patients were in remission and had low disease activity according to the DAS28 (65.7%, n=35) after 48 weeks of treatment. After 48 weeks, the highest percentage of patients with RA remission was registered by the DAS28 (37.4%, n=20), the lowest — SDAI (21.6%, n=11). After 24 weeks of therapy, ABA led to a significant decrease in the serum levels of IL-6 from 2.4 [1.1 - 6,4] to 1.29 [0.9-2.2] pg/ml, (p=0.0006), IP-10 from 21 [12,9-49,8] to 14 [7.5-28] pg/ml, (p=0.007) and matrix metalloproteinase 3 (MMP3) from 30.1 [13-82] pg/ml to 10 [7.4-55] pg/ml, (p = 0.0003). A decrease in the serum level of IL-6 significantly correlated with a decrease in the DAS28 and SDAI (r=0.5 and r=0.479, p<0.05), IP-10 with DAS28 (r=0.326, p<0.05). Initially, the serum level of TNF-α was significantly lower in patients who achieved low disease activity by the SDAI (72.6%, n=37) after 48 weeks of therapy, compared with the rest. On the contrary, a significantly higher level of IP-10 before treatment was recorded in patients with a good response according to the EULAR criteria (39%, n=29) after 48 weeks of ABA treatment (Figure 1). The ROC-analysis revealed that an initially high concentration of TNF-α may indicate with 71% sensitivity and 77% specificity about the possible ineffectiveness of ABA therapy after 48 weeks of treatment, the area under the curve was 0.7, 95% CI (0.5– 0.9). In patients initially positive for AMCV, low RA activity by SDAI was significantly more often registered after 24 (p=0.04) and 48 weeks. (p=0.01). 89% (n=34) of AMCV-positive patients achieved low disease activity after 48 weeks therapy by the SDAI and CDAI. It is noteworthy that a cohort of patients with insufficient effect after 48 weeks consisted entirely of AMCV-negative patients.

Conclusion

ABA therapy led to a significant decrease in disease activity according to the main indices (DAS28, SDAI, CDAI). During ABA treatment, there was a decrease of important immunoinflammatory markers - IL-6, IP-10, MMP-3. AMCV positivity is significantly associated with higher efficacy of ABA therapy. Also, a high basal concentration of TNF-α could use as a predictor of possible failure of ABA therapy, and a high initial level of IP-10, on the contrary, indicates the possible efficacy of ABA therapy.

References

None

Disclosure of Interests

None declared

The Effect of Blood Contained in the Samples on the Metabolomic Profile of Mouse Brain Tissue: A Study by NMR Spectroscopy

(1) Recently, metabolic profiling of the tissue in the native state or extracts of its metabolites has become increasingly important in the field of metabolomics. An important factor, in this case, is the presence of blood in a tissue sample, which can potentially lead to a change in the concentration of tissue metabolites and, as a result, distortion of experimental data and their interpretation. (2) In this paper, the metabolomic profiling based on NMR spectroscopy was performed to determine the effect of blood contained in the studied samples of brain tissue on their metabolomic profile. We used 13 male laboratory CD-1^® IGS mice for this study. The animals were divided into two groups. The first group of animals (n = 7) was subjected to the perfusion procedure, and the second group of animals (n = 6) was not perfused. The brain tissues of the animals were homogenized, and the metabolite fraction was extracted with a water/methanol/chloroform solution. Samples were studied by high-frequency ¹H-NMR spectroscopy with subsequent statistical data analysis. The group comparison was performed with the use of the Student's test. We identified 36 metabolites in the brain tissue with the use of NMR spectroscopy. (3) For the major set of studied metabolites, no significant differences were found in the brain tissue metabolite concentrations in the native state and after the blood removal procedure. (4) Thus, it was shown that the presence of blood does not have a significant effect on the metabolomic profile of the brain in animals without pathologies.

Partition of Poly(Oxyethylene)s with 5-Chloro-8-Quinolinoxyl End-Groups between 1-Octanol and Water

Apparent partition coefficients for a series of poly(oxyethylene)s with 5-chloro-8-quinolinoxyl end-groups and different polyether chain lengths; POE*400, POE*1000, POE*1000 and POE*3000 (the subscripts show the molecular weight of the polyether chain) were determined for the system 1-octanol/water at different pHs at 37°. The partition coefficient was found to decrease with increasing polyether chain length. The substituent constants were calculated and the effect of the substituents on the partition behavior of the compounds was estimated. The antibacterial effect of POE* on gram-positive and gram-negative bacteria was found to be lower than that of CHQ. The activity of POE* slightly increased in the presence of Fe3+ ions.

[The surgical treatment of perforated gastric and duodenal ulcers in middle-aged and elderly patients--an analysis of the 1985-1996 period]

The problem relating to perforated gastric and duodenal ulcers (PGDU) treatment is still pressing nowadays not only on account of the constant mortality rate (6.7-14.55 per cent according to personal data), but also on account of the lack of universally accepted tenets for their management, irrespective of the fact that the first operative interventions were done more than 100 years earlier, and so far, more than 50 palliative and radical procedures have been suggested. Between 20 and 40 per cent of all ulcer patients are individuals in advanced and senile age. In this contingent a characteristic feature is the elevated incidence of complications, one of them being perforation, necessitating operative treatment and exposing elderly patients to serious surgical and anesthesiological hazards.