FRI0575 BIOMARKER ANALYSIS FROM THE RISE-SSC STUDY OF RIOCIGUAT IN EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC)

Background:

RISE-SSc (NCT02283762) was a multicenter, double-blind, Phase IIb study of riociguat in early dcSSc. Primary endpoint was change in mRSS from baseline to Wk 52.

Objectives:

Exploratory, descriptive analyses of riociguat target engagement and effects on disease biomarkers in RISE-SSc and their relationship with effects on the primary endpoint. All biomarker p-values are for information only.

Methods:

Pts with dcSSc (duration ≤18 mo; modified Rodnan skin score [mRSS] 10–22 units) were randomized to riociguat 0.5−2.5 mg tid (n=60) or placebo (n=61). Biomarkers of target engagement (cGMP), inflammation and/or vascular/endothelial function (e.g. high-sensitivity C-reactive protein [hsCRP], soluble platelet endothelial cell adhesion molecule 1 [sPECAM-1], soluble E-selectin, chemokine ligand 4 [CXCL-4]), and fibrosis (e.g. alpha-smooth muscle cell actin [alphaSMA], pro-collagen mRNA expression) were measured in plasma, serum, and skin biopsies at baseline and Wk 14.

Results:

Mean±SD change from baseline in mRSS was –2.09±5.66 (n=57) with riociguat and –0.77±8.24 (n=52) with placebo (p=0.08). From baseline to Wk 14, plasma cGMP rose by mean (SD) 94% (78%) (n=52) with riociguat and 10% (39%) (n=52) with placebo (nominal p<0.001). Serum sPECAM-1 and CXCL-4 fell with riociguat vs placebo; changes in hsCRP or E-selectin differed little between groups (Fig 1). Pts with higher baseline sPECAM-1 showed larger mRSS reductions with riociguat vs placebo than pts with lower levels (nominal interaction p=0.004). In baseline skin biopsies, 34% and 31% of pts in the riociguat and placebo groups, respectively, had no alphaSMA-positive cells; other pts had +ve cells (alphaSMA counts 0.1–99.5, median 2.5), a potential indicator of higher disease activity. Pts with +ve baseline alphaSMA counts showed a reduction of mRSS with riociguat vs placebo (Fig 2). Skin collagen mRNA expression biomarkers in skin biopsies showed no differences between groups.

Conclusion:

Primary study endpoint (change in mRSS) was not met. Plasma cGMP rose with riociguat, confirming engagement with the NO-sGC-cGMP pathway. Serum sPECAM-1 (marker of endothelial activation) and CXCL-4 (marker of progressive SSc) fell with riociguat; hsCRP and E-selectin did not. Some serum and skin biomarkers of higher disease activity at baseline were associated with a greater effect of riociguat on skin fibrosis.

Acknowledgments:

RISE-SSc was jointly funded by Bayer AG and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Disclosure of Interests:

Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Frank Kramer Employee of: Bayer AG, Josef Höfler Employee of: Josef Höfler is an employee of Staburo GmbH, Munich, Germany, contracted by Bayer AG to perform the biomarker analyses, Mercedeh Ghadessi Employee of: Bayer AG, Peter Sandner Employee of: Bayer AG, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Masataka Kuwana Grant/research support from: Acetelion, Consultant of: Acetelion, Bayer, Chugai, Corbus Pharmaceuticals, CSL Behring and Reata Pharmaceuticals. He was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Tatsuya Atsumi Grant/research support from: Eli Lily Japan K.K., Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb Co., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., Consultant of: Gilead Sciences, Inc., Eli Lilly Japan K.K., UCB Japan Co. Ltd., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Speakers bureau: Eli Lilly Japan K.K., UCB Japan Co. Ltd., Bristol-Myers Squibb Co., AbbVie Inc., Eisai Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Radim Bečvář Consultant of: Actelion, Roche, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Ellen De Langhe Consultant of: member of advisory board for Boehringer, Eric Hachlla: None declared, Tomonori Ishii: None declared, Osamu Ishikawa: None declared, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Kaisa Laapas Employee of: Partly in-sourced to Bayer, Valeria Riccieri: None declared, Elena Schiopu: None declared, Richard Silver: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Chiara Stagnaro: None declared, Viginia Steen Grant/research support from: The associated affiliation has received grants/research from Boehringer Ingelheim, Corbus Pharmaceuticals, CSL Behring, Eicos, Galapagos, Immune Tolerance Network, Reata, Consultant of: Virginia Steen has acted as a consultant for Boehringer Ingelheim, Corbus, CSL Behring, Eicos, Forbius, Wendy Stevens: None declared, Gabriella Szücs: None declared, Marie-Elise Truchetet: None declared, Melanie Wosnitza Employee of: Bayer AG, Dinesh Khanna Shareholder of: Eicos Sciences, Inc./Civi Biopharma, Inc., Grant/research support from: Dr Khanna was supported by NIH/NIAMS K24AR063120, Consultant of: Acceleron, Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Corbus Pharmaceuticals, Horizon Therapeutic, Galapagos, Roche/Genentech, GlaxoSmithKline, Mitsubishi Tanabe, Sanofi-Aventis/Genzyme, UCB

FRI0245 PULMONARY ARTERIAL HYPERTENSION IN SYSTEMIC SCLEROSIS IS NEARLY ALWAYS ACCOMPANIED BY A LOW DIFFUSING CAPACITY

Background:

Scleroderma (systemic sclerosis; SSc) has high morbidity and mortality. Pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) is common with a high mortality (1). SSc patients are screened with pulmonary function tests (diffusing capacity of the lung for carbon monoxide; DLCO) (2).

Objectives:

The DLCO%predicted was analyzed comparing patients with and without PAH to determine if it is always low at time of PAH diagnosis.

Methods:

The Canadian Scleroderma Research Group (CSRG) database was used containing more than 1300 SSc patients with a mean disease duration of 8 years. All patients with at least one follow up visit and DLCO recorded at least twice were eligible for enrolment into this nested case control study. Diagnosis of PH was verified using several algorithms within the database including R heart catheterization, use of PH medications and physician response of ‘yes’ to question has this patient been diagnosed with pulmonary hypertension. Sensitivity, specificity and positive (PPV) and negative predictive values (NPV) were calculated for DLC0%predicted <50% and presence of PH/PAH.

Results:

At time of PH diagnosis, the mean DLCO% predicted was 47% (N=30) vs no PH 73% (N=960) P<0.0001, and proven documented PAH also showed the differences (PAH, N=22 DLCO% predicted 51% vs. PAH negative (N=968) DLCO% pred 72%, P<0.0001) (Table 1). The OR of a DLCO%predicted less than 60 was 4.7 for PAH and 7.6 for PH (both P<0.001) and even higher if DLCO<50% (OR 11.5 for PH and 7.6 for PAH). Table 2 shows the PPV of DLCO at varying levels.

Table 1.

DLCO comparison between PH+ and PH- SSc patients and between PAH+ and PAH- SSc patients, at the time of diagnosis.

PH+(n=30)PH-(n=960)P-valuePAH+(n=22)PAH- (n=968)P-valuemean±SD47.17±17.5372.74±20.79<0.000151.23±17.5572.44±20.99<0.0001Range18-8113-14725-8113-147Table 2.

Sensitivity, specificity and predictive values in SSc-PH and -PAH for DLCO at various cut points.

ORPPVSpecificityNPVSensitivityDLCO<50%11.5 (CI 95% 5.4-24.8),p<0.000113.2%87.0%98.7%63.3%PHDLCO<60%7.6 (CI 95% 3.3-17.2), p<0.00017.9%73.3%98.9%73.3%DLCO>80%0.06 (CI 95% 0.008-0.46), p=0.0070.3%64.5%95.5%3.3%DLCO<50%7.6 (CI 95% 3.2-17.9), p<0.00018.3%86.4%98.8%54.5%PAHDLCO<60%4.7 (1.9-11.3), p<0.0015.0%72.7%98.9%63.6%DLCO>80%0.1 (0.01-0.7), p=0.0180.3%64.8%96.8%4.5%

Conclusion:

A low DLCO is associated with a high odds of PH/PAH in SSc and the NPV is very high at both DLCO<50% predicted and <60% predicted. This may aid in determining who should recieve a right heart catheterization in SSc patients.

References:

[1]Mukerjee D et al (2003) Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 62(11):1088-93

[2]Khanna D et al (2013) Recommendations for screening and detection of connective tissue disease-associated pulmonary arterial hypertension. Arthritis Rheum 65(12):3194-201

Disclosure of Interests:

None declared

FRI0030 MORE THAN HALF OF NEWLY DIAGNOSED RA PATIENTS ARE NOT CONVINCED OF THE NECESSITY OF RA MEDICINES: ASSOCIATIONS WITH RA CHARACTERISTICS, SYMPTOMS, AND FUNCTION IN THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

Background:

Although DMARDs are essential for early aggressive control of RA to reduce symptoms and disability, medication adherence is variable. Beliefs about the necessity of medications and safety concerns predict adherence and are modifiable.

Objectives:

To examine associations among RA medication necessity beliefs and concerns, sociodemographics, RA characteristics, symptom level and function in newly diagnosed RA patients.

Methods:

Baseline data were analyzed from participants in the Canadian Early Arthritis Cohort (CATCH) who enrolled between 2017-2020 and completed the Beliefs about Medicine Questionnaire (BMQ) and PROMIS-29. All met ACR1987 or 2010 ACR/EULAR criteria and had active RA at enrollment. BMQ Necessity (N) and Concerns (C) scores were classified ashigh(≥20) orlow(<20) and categorized into: Accepting (↑N ↓C); Ambivalent (↑N↑C); Sceptical (↓N↑C); and 4) Indifferent (↓N↓C). Groups were compared using ANOVA and chi-square tests.

Results:

The 362 patients were mostly white (83%) women (66%) with a mean (SD) age of 56 (15), symptom duration of 6 (3) months, and 32% were obese (BMI≥30). More than half (56%) were DMARD-naive or minimally exposed. Mean N and C scores were similar between men and women; 54% were classified asIndifferent, 31%Accepting, 9%Ambivalent,and 6%Sceptical.

As compared to those classified asAccepting, moreIndifferent participantssmoked, had a healthy weight, lower TJCs, and trend for lower CDAI (Table). Groups were similar by sociodemographics, symptom duration, and DMARD/steroid use, except fewerIndifferentpatients received MTX.Indifferentpatients had statistically and meaningfully lower patient global, depression, anxiety, fatigue and pain interference, and higher function and participation scores (Table).

Conclusion:

Many new RA patients had low medication necessity beliefs and concerns, and only 31% had high necessity beliefs and low concerns around diagnosis. Lifestyle and lower CDAI, TJCs, symptoms and functional impacts were associated with RA medication indifference. Identifying medication indifference can prompt discussions about medication beliefs/concerns to facilitate shared decision-making and adherence.

Disclosure of Interests:

Viviane Ta: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie

AB0598 THE INCREASING USE OF IMMUNOSUPPRESSANTS IN EARLY SYSTEMIC SCLEROSIS

Background:

Immunosuppression (IS) remains the main treatment for progressing skin involvement, active interstitial lung disease (ILD) and underlying inflammatory joint (IJ) or muscle disease in systemic sclerosis (SSc).

Objectives:

This study investigated the pattern and trends in immunosuppressive agent use in patients with early SSc diagnosed before and after 2007 to determine whether the changes in the preferred type and combination of IS, timing and predictors of administration took place over the past decade.

Methods:

397 SSc patients from Canadian Scleroderma Research Group (CSRG) database (183dcSSc, 214 lcSSc) who had baseline and follow-up visits within 3 years (1.8±0.8) after disease onset were included: 82% females, age at diagnosis 53±13 years, disease duration 1.6±0.8 years. Organ involvement was assessed by modified Rodnan skin score, Medsger Disease Severity Score (DSS) and CSRG definitions using bivariate, chi-squared, ANOVA, and adjusted regression analyses.

Results:

115 dcSSc patients (63%) and 62 lcSSc (29%) received IS, most commonly methotrexate (MTX) (72% dcSSc and 52% lcSSc), followed by mycophenylate mofetil (MMF) and cyclophosphamide (CYC). Within the patients receiving IS, monotherapy prevailed (77% dcSSc and 68% lcSSc); CYC and azathioprine were the preferred choice of IS more frequently in lcSSc compared to dcSSc (p<0.006 and p<0.02, respectively). In dcSSc, IS were predominantly prescribed at years 2 and 3 after the onset of first non-Raynaud’s phenomenon (RP) manifestation, when about half of the patients received IS. The proportion of lcSSc patients receiving IS was significantly lower and distributed more equally through the first three years. After 2007, dcSSc patients received IS more often (74% vs 50%, p=0.001), especially MTX (p=0.02) and MMF (p<0.05), and earlier (peaked at 2 years after disease onset)(Table 1).

Table 1.

Proportion of patients receiving immunosuppressive treatment at each year after disease onset in SSc diagnosed before and after 2007.

Years after the first non-RP symptomlcSScBefore 2007After 2007Total N of pts seen at each year% receiving immune suppressivesTotal N of pts seen at each year% receiving immune suppressivesP-value113154717>0.92242182180.7723491410714>0.9dcSSc1242940430.2862512665650.00013624563540.325

IS administration was associated with male gender, ILD, a-Scl-70 positivity, ACA-negativity and IJ disease in lcSSc, and with ACA-negativity and a higher mRSS in dcSSc. Multivariate logistic regression analysis showed that IS treatment could be predicted by ACA-negativity in lcSSc patients (Exp(B) 0.317, p=0.012) and younger age in dcSSc patients (Exp(B) 0.974, p=0.002).

Conclusion:

Over the past decade, there has been a trend to prescribe IS more often, especially MTX, and earlier in dcSSc patients. MMF has gained favour over CYC. Autoantibody status was the most consistent predictor whether a patient is likely to take IS over the course of the disease.

Disclosure of Interests:

Ryan Park: None declared, Tatiana Nevskaya: None declared, Murray Baron: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

OP0333 RISK FACTORS OF ANTIMALARIAL-INDUCED RETINOPATHY IN SYSTEMIC LUPUS ERYTHEMATOSUS AND OTHER AUTOIMMUNE CONDITIONS

Background:

Hydroxychloroquine (HCQ) and chloroquine (CQ) are effective antimalarial (AM) medications for systemic lupus erythematosus (SLE) and other autoimmune conditions such as rheumatoid arthritis (RA). AM-induced retinopathy is a well-recognized irreversible complication with variable incidences [1]. Few studies have compared the AM-induced retinopathy between rheumatologic conditions.

Objectives:

To describe the pattern of AM-associated retinopathy, including diagnosis of SLE as a risk factor.

Methods:

A chart review was conducted at an urban Canadian center. Each patient was classified as SLE, based on ACR criteria, or non-SLE. Minimum duration of AM use was 3 months. AM-induced retinopathy was classified as possible or definite, and was determined based on characteristic visual field loss, abnormal retinal imaging, and eye specialists’ opinion. Univariate and multivariate logistic regressions were performed to determine factors associated with definite AM-induced retinopathy. Sensitivity analyses included inclusion of possible AM-induced retinopathy and stratification of analysis by diagnosis and by CQ versus HCQ.

Results:

Of the 680 patients, 282 patients had SLE and the remaining had RA (N=224), cutaneous lupus (N=41), or other connective tissue diseases (N=131). Patients with SLE tended to be younger, female, and had relatively more CQ and total AM exposure (Table 1). Definite AM-induced retinopathy was observed in 12 patients, 11 of whom had SLE and 7 had chloroquine exposure (Figure 1). The earliest toxicity occured after 5.4 years of AM use, and prevalence beyond 5 years was 2.7%.

Table 1.

Patient characteristics. Data represented as N (%) or means (SD)

SLE (N=282)Non-SLE (N=398)*Total (N=680)PAge40.1 ± 1551 ± 13.846.5 ± 15.35.72×10-21Female258 (91%)333 (84%)591 (87%)4.19×10-3AM duration (years)11.5 ± 8.17.3 ± 6.29.1 ± 7.33.52×10-11CQ ever35 (12%)21 (5%)56 (8%)1.41×10-3

*other connective tissue diseases and RA

In univariate logistic regression (Table 2), a diagnosis of SLE (P=7.95×10-3; OR= 16.1; 95% confidence interval (CI)= [2.1, 125]), and cumulative CQ dose (P=1.13×10-2; OR= 1.002; 95% CI=[1.000, 1.003]) were significantly associated with definite AM-induced retinopathy. When possible retinopathy was included in the analysis, both SLE (P=7.27×10-3; OR=3.12, 95% CI=[1.39, 7.00]) and CQ cumulative dose (P= 6.16×10-7; OR= 1.002; 95% CI=[1.001, 1.003]) remained significant. Total AM duration and hypertension also had significant associations. In multivariate analysis, diagnosis of SLE was significantly associated with ocular toxicity (P=1.49×10-2; OR=14.2; 95%CI: [1.83-127]) after adjusting for CQ/HCQ dosages, age, sex, weight, hypertension and renal impairment.

Table 2.

Univariate logistic regression for risk of AM-induced retinopathy. Data represented as N (%) or mean ± SD

Definite retinopathyPossible or definite retinopathyNo retinopathy N=668RetinopathyN=12PNo retinopathy N=652RetinopathyN=28PAge46.5 ± 15.343.2 ± 14.30.45246.4 ± 15.447.1 ± 12.40.832Female580 (87%)11 (92%)0.626567 (87%)24 (86%)0.848Weight (kg)76.5 ± 19.567.3 ± 12.80.09876.5 ± 19.573.5 ± 17.80.424SLE Diagnosis271 (41%)11 (92%)0.008263 (40%)19 (68%)0.006AM duration (years)9 ± 7.411.7 ± 5.80.2158.9 ± 7.312.8 ± 6.80.007AM> 5 years417 (63%)0-250 (40%)1 (3%)0.006HCQ dose (mg/kg/day)5.2 ± 15.55.9 ± 1.50.8915.2 ± 15.65.3 ± 1.40.971HCQ total dose (g)1042 ± 913.81235 ± 10320.4711340 ± 9141187 ± 9550.404CQ total dose (g)46 ± 205.1225± 2910.01137.6 ± 174)318 ± 5296.16×10-7Renal Impairment100 (15%)2 (17%)0.88399 (15%)3 (11%)0.506Hypertension298 (45%)5 (42%)0.832285 (44%)18 (64%)0.038Diabetes61 (9%)1 (8%)0.92459 (9%)3 (11%)0.765

Conclusion:

The risk of AM-induced retinal toxicity increases after 5 years of use. SLE patients may be at increased risk due to longer treatment duration, AM choice, and underlying disease processes.

References:

[1]Petri M, Elkhalifa M, Li J. 15 Frequency of hydroxychloroquine retinopathy in the hopkins lupus cohort. Lupus Science & Medicine 2019;6:doi: 10.1136/lupus-2019-lsm.15

Disclosure of Interests:

Hsin Yen Liu: None declared, Gemma Cramarossa: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

OP0263-HPR MAJOR STRESSORS IN THE YEAR PRIOR TO RA DIAGNOSIS: IMPACT ON PATIENT-REPORTED OUTCOMES ONE YEAR LATER

Background:

Stress is implicated in RA onset and poorer prognoses through changes in neuro-endocrine and autoimmune function. Although many people with RA link disease onset to recent stressful life events, results from retrospective studies are unclear.

Objectives:

To describe the incidence of major stressors(+STRESS) in year prior to diagnosis and compare characteristics and patient-reported outcomes (PROs) of newly diagnosed RA patients with and without+STRESSat 0 and 12 months.

Methods:

Data were from early RA patients (symptoms <1 yr) enrolled in the Canadian Early Arthritis Cohort (CATCH) from 2007-17 who met 1987/2010 ACR/EULAR criteria and had ≥12 months of follow-up. Patients reported major psychological (death, divorce/separation, family, financial, other) and physical (motor vehicle accident, surgery, major illness/infection, other) stressors in previous year. We used independent t-tests and chi square to compare characteristics by stressors at baseline, and multivariable regression to examine the impact of+STRESSon disease activity and PROs at 1 year, adjusting for age, sex, education, fibromyalgia, and SJC.

Results:

The 1933 adults were mostly female (72%), with a mean (SD) age of 55 (15) years. 52% reported 1+ stressors in previous year; family (48%), financial stress (36%), death (35%), surgery (28%), and major illness (26%) were the most common stressors. Patients with +STRESS were more likely to be women, younger, have more comorbidities including fibromyalgia, and higher mean DAS28. Patients with +STRESS also had significantly higher mean pain, fatigue, depression, sleep disturbance, patient global, and HAQ scores at baseline.

At 1 year, SJC and the proportion in DAS28 REM was similar between groups. However, PROs (pain, HAQ, Fatigue, Pt Global, Depression, Poor Sleep) remained higher in+STRESS, with evidence of an additive effect for number of stressors and having both physical and psychological stressors (Table). The greatest impacts were on mood, sleep disturbance, and fatigue.

Conclusion:

In this pan-Canadian early RA cohort, more than half reported 1+ stressful life events in the year prior to diagnosis. Individuals reporting major stressors had significantly worse pain, patient global, disability, depression, fatigue, and sleep disturbance at diagnosis; 1 year later, though disease activity was similar between groups, the effects of +STRESS on PROs persisted. Early RA patients with recent major stressors may benefit from emotional support and stress reduction to optimize how they feel and function.

Mean (SD) or N (%)No Stress(N=928; 48%)Physical(N=131; 7%)Psychological(N=658; 34%)Both(N=216; 11%)Age56 (15)56 (15)53 (14)52 (15)Women622 (67%)82 (63%)512 (78%)174 (81%)College Education464 (50%)76 (58%)345 (52%)126 (58%)Rheum Dis Comorbid Index1.1 (1.2)1.4 (1.4)1.1 (1.3)1.4 (1.3)OA or Spinal pain168 (18%)35 (27%)117 (18%)55 (25%)Fibromyalgia diagnosis15 (2%)2 (2%)13 (2%)11 (5%)Symptom duration (months)5.6 (3.0)5.7 (3.0)5.9 (3.0)5.9 (3.0)DAS28 – mean5.0 (1.4)5.1 (1.5)5.0 (1.5)5.2 (1.4)MTX ±csDMARDs679 (73%)100 (76%)489 (74%)166 (77%)Oral Steroids295 (32%)40 (31%)215 (33%)55 (25%)Pain (0-10)5.3 (2.8)5.5 (2.9)5.7 (2.8)6.2 (2.8)HAQ-DI1.0 (0.7)1.2 (0.7)1.1 (0.7)1.3 (0.7)Fatigue (0-10)4.7 (3.1)5.0 (3.0)5.7 (2.9)5.9 (2.9)Patient Global (0-10)5.6 (2.9)6.0 (2.9)6.0 (2.9)6.4 (3.0)Depression (SF12 MCS < 45.6)329 (35%)54 (41%)356 (54%)123 (57%)Poor sleep (0-10)4.5 (3.4)4.8 (3.3)5.3 (3.2)6.0 (3.1)

Disclosure of Interests:

Nicole Andersen: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Glen Hazlewood: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer

Speakers bureau: Medexus/Medac, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie

FRI0024 HOW OFTEN DOES REACHING TARGET MISS THE MARK? LONGITUDINAL PATTERNS OF REMISSION IN REAL-WORLD EARLY RHEUMATOID ARTHRITIS PATIENTS

Background:

Early diagnosis and rapid initiation of DMARDs following a treat-to-target approach have made remission a realizable goal for many with RA. Yet, some patients are unable to sustain remission over time.

Objectives:

To describe longitudinal patterns of remission and identify predictors of sustained vs transient remission in real-world early RA patients.

Methods:

Data were from the Canadian Early Arthritis Cohort (CATCH), a prospective study of early RA patients (symptoms < 1 year) treated in rheumatology clinics across Canada from 2007- 2019. The sample was limited to patients with active disease at enrolment who later reached remission (SDAI<=3.3) and were followed for 12-24 months thereafter. Patients were classified as in sustained remission (Pattern 1) or transient remission with transient remission patients divided into those who transitioned from REM to LDA only (Pattern 2) and those who transitioned from REM to MDA or HDA (Pattern 3), over FU. Multi-adjusted multinomial regression was used to identify predictors of transient remission patterns.

Results:

The study included 1,419 (46%) CATCH participants that reached remission. At enrolment, most (70%) were female, mean(sd) SDAI was high (27(15)) and 92% were treated with csDMARDs. Only 47% remained in sustained remission by 12-months and, only 40% by 24 months (Pattern 1) (Figure). Among patients with transient remission patterns, transitions to LDA only (Pattern 2) were more common than to MDA/HDA over FU (Pattern 3) (Fig 1). Older age, female sex, smoking, higher comorbidity index and positive serology, were significantly associated with transient remission patterns (Table). There were also borderline significant associations between transient remission patterns and longer time to remission, lack of early MTX treatment and reducing treatment after remission (Table).

Table .

Adjusted Multinomial Regression Results of Predictors of Transient Remission Patterns over 24-Month Follow Up

Pattern 2 vs, Pattern 1OR (95% CI)Pattern 3 vs. Pattern 1OR (95% CI)Age1.01 (1.00, 1.02)1.01 (0.99, 1.02)Women vs Men1.78 (1.33, 2.39)1.63 (1.09, 2.44)Current smoker1.57 (1.09, 2.28)1.53 (0.95, 2.47)RDCI at baseline1.11 (0.99, 1.25)1.30 (1.13, 1.50)Seropositive1.38 (1.03, 1.85)1.21 (0.81, 1.80)MTX first 3 months1.18 (0.85, 1.63)0.76 (0.51, 1.12)Time to remission (months)1.01 (1.00, 1.01)1.01 (1.00, 1.02)Treatment reduction after REM vs. No Change1.33 (0.96, 1.86)1.01 (0.99, 1.02)

  Pattern 1: Sustained REM

  Pattern 2: Transient REM: Transitions to LDA only

  Pattern 3: Transient REM: Transitions to MDA/HDA

   RDCI: Rheumatic Disease Comorbidity Index (range 0-9)

  Treatment reduction: Change from biologic or JAK to csDMARD(s) OR reduction in number of csDMARDs OR change from MTX +/- csDMARDs to non-MTX csDMARD

Figure.

Distribution of Disease Activity States over 12-24 After First Achieving SDAI REM

Conclusion:

Results of this large longitudinal analysis of real-world data suggests that < 50% of patients that reach remission sustain remission for 12-24months. Closer monitoring of patients with prognostic indicators for transient remission and additional research focusing on why remission is lost may help improve the rates of sustained remission.

References:

[1]Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskelet Dis. 2017;9(10):249-62.

Disclosure of Interests:

Orit Schieir: None declared, Glen Hazlewood: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Tin: None declared, Vivian Bykerk: None declared

SAT0049 DIFFERENCES BETWEEN EARLY AND ESTABLISHED RHEUMATOID ARTHRITIS IN TIME TO ACHIEVING CDAI BUT NOT FATIGUE LOW DISEASE ACTIVITY AND REMISSION: DATA FROM THE OBRI REGISTRY

Background:

Previous studies have shown that early diagnosis and treatment of rheumatoid arthritis (RA) is important for achieving comprehensive disease control and have identified established disease as an independent predictor of worse clinical outcomes. However, it is not clear whether these differences are driven by patient-reported or objective outcome measures.

Objectives:

The aim of this analysis was to compare the time to achieving low disease activity (LDA) and remission based on both objective and patient-reported outcomes in people with early vs. established RA followed in routine clinical care.

Methods:

RA patients enrolled in the Ontario Best Practices Research Initiative (OBRI) registry that were not in a low disease state at baseline based on the CDAI, SJC28, PtGA, pain and fatigue criteria below, and had at least six months of follow-up, were included in the analysis. LDA was defined as CDAI≤10, SJC28≤2, TJC28≤2, PtGA≤2cm, pain≤2cm, fatigue≤2cm, and MDGA≤2cm; remission was defined as CDAI≤2.8, SJC28≤1, TJC28≤1, PtGA≤1cm, pain≤1cm, fatigue≤1cm, and MDGA≤1cm. Between group (early vs. established) differences in time to first LDA/remission were assessed with Kaplan-Meier survival analysis and the log-rank test.

Results:

A total of 986 patients were included, 347 (35%) with early RA and 639 (65%) with established RA. At baseline, patients with early RA were significantly younger (55.8 vs. 58.3 years) and were less likely to have a comorbidity (94.5% vs. 97.5%) or an erosion (26.7% vs. 62.6%), be RF-positive (65.6% vs. 74.2%), use bDMARDs (7.5% vs. 26.6%), and be non-smokers (38.9% vs. 47.3%).

Time to achieving LDA based on CDAI (HR [95%CI]: (1.23 [1.07,1.43]), SJC28 (1.32 [1.15,1.51]), TJC28 (1.18 [1.02,1.36]), MDGA (1.28 [1.10,1.49]), PtGA (1.23 [1.05,1.44]), and pain (1.29 [1.09,1.52]) were significantly shorter in early RA compared to established RA. Similarly, time to achieving remission based on CDAI (HR [95%CI]: (1.50 [1.22,1.84]), SJC28 (1.35 [1.17,1.55]), MDGA (1.25 [1.06,1.47]), PtGA (1.22 [1.02,1.47]), and pain (1.37 [1.14,1.65]) were significantly shorter in early RA. However, no differences were observed in time to remission based on TJC28 (1.12 [0.96,1.31]) and either LDA or remission based on fatigue (LDA (1.10 [0.94,1.30]); remission (1.09 [0.92,1.31]).

Adjustment for age, gender, presence of comorbidities, and baseline scores did not alter the results.

Conclusion:

Time to achieving low disease state or remission based on various objective and patient-reported measures is significantly shorter in early compared to established RA with the exception of fatigue.

Disclosure of Interests:

Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Mohammad Movahedi Consultant of: Allergan, Emmanouil Rampakakis: None declared, Angela Cesta: None declared, John Sampalis: None declared, Claire Bombardier Grant/research support from: Dr Bombardier reports sources of funding for Ontario Best Practice Research Initiative Research grants from Abbvie, Janssen, Amgen, Medexus, Merck, Pfizer, and Novartis outside of the submitted work. Consulting Agreements: Abbvie, Covance, Janssen, Merck, Pfizer, Sanofi and Novartis outside of the submitted work. Advisory Board Membership: Hospira, Sandoz, Merck, Pfizer and Novartis outside of the submitted work.

FRI0032 REGIONAL AND WIDESPREAD PATTERNS OF NON-ARTICULAR PAIN ARE COMMON AT RA DIAGNOSIS AND CONTRIBUTE TO POOR OUTCOMES AT 12 MONTHS: A PROSPECTIVE STUDY OF PAIN PATTERNS IN CANADIANS WITH RA

Background:

Persistent pain can occur in early RA patients, despite improvement in synovitis and may be due to coexisting non-articular pain (NAP). Though NAP is often attributed to fibromyalgia and widespread NAP, regional NAP syndromes may be more common and under-recognized.

Objectives:

To describe patterns of NAP, predictors of persistent NAP and impact on outcomes in the first year following early RA diagnosis.

Methods:

Data were from participants enrolled in the Canadian Early Arthritis Cohort (CATCH) between2017-2019who completed 0,6,12-month evaluations with patient-reported outcomes [PROs] and clinical data available. We used the McGill Body Pain Diagram (BPD) to classify patients as experiencing no NAP, regional (RP:1-2 regions) or widespread NAP (WP:3-5 regions). Multinomial regression was used to identify baseline predictors of persistent RP and WP at 12-months. Multi-adjusted GEE with linear and logit links were used to estimate time-varying associations of NAP patterns with outcomes updated at each time point.

Results:

Study included 421 participants: 66% were female, with a mean(sd) age 56 (14); 72% were seropositive and 90% were treated with MTX ± csDMARDs as initial therapy. NAP at baseline was common (55%), with majority (62%) reporting regional NAP. NAP prevalence was 33% at 12 months (Figure). Female sex and baseline depressive symptoms were independent predictors of widespread NAP at 12 months while poorer function and lack of early MTX treatment independently predicted regional NAP, at 12 mos. Regional and widespread NAP were associated with lower likelihood of remission in adjusted models that accounted for changes in NAP and remission over time (Table).

Figure.

Point prevalence of regional and widespread NAP at baseline, 6 and 12 months.

Table .

Results of Multi-Adjusted GEE Logistic Regression showing Regional and Widespread NAP is associated with a reduced likelihood of achieving Stringent Remission Targets

Conclusion:

NAP is commonly reported in early RA pts seen in real world settings. Regional NAP was more common than WSP at all time-points, but both NAP patterns were associated lower odds of achieving remission targets by 12 months. These data support considering the role of NAP when assessing RA treatment efficacy during clinical visits and warrant different treatment approaches to reduce symptoms in RA patients receiving target-based care.

Disclosure of Interests:

Vivian Bykerk: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie

SAT0252 INCREASED MORTALITY FOR INDIVIDUALS WITH GIANT CELL ARTERITIS: A POPULATION-BASED STUDY

Background:

Individuals with giant cell arteritis (GCA) are at increased risk of serious morbidity including cardiovascular disease and stroke. Yet the risk of mortality among individuals with GCA have produced conflicting reports1.

Objectives:

Our aim was to evaluate excess all-cause mortality among individuals with GCA relative to the general population over time.

Methods:

We performed a population-based study in Ontario, Canada, using health administrative data among all individuals 50 years and older. Individuals with GCA were identified using a validated case definition (81% PPV, 100% specificity). All Ontario residents aged 50 and above who do not have GCA served as the General Population comparators. Deaths occurring in each cohort each year were ascertained from vital statistics. Annual crude and age/sex standardized all-cause mortality rates were determined for individuals with and without GCA between 2000 and 2018. Standardized mortality ratios (SMRs) were calculated to measure relative excess mortality over time. Differences in mortality between sexes and ages were also evaluated.

Results:

Population denominators among individuals 50 years and older with GCA and the General Population increased over time with 12,792 GCA patients and 5,456,966 comparators by 2018. Annual standardized mortality rates among the comparators steadily declined over time and were significantly lower than GCA morality rates (Figure). Annual GCA mortality rates fluctuated between 42-61 deaths per 1000 population (with overlapping confidence intervals) during the same time period. SMRs for GCA ranged from 1.28 (95% CI 1.08,1.47) at the lowest in 2002 to 1.96 (95% CI 1.84, 2.07) at the highest in 2018. GCA mortality rates and SMRs were highest among males and younger age groups.

Conclusion:

Over a 19-year period, mortality has remained increased among GCA patients relative to the general population. GCA mortality rates were higher among males and more premature deaths were occurring at younger age groups. In our study, improvements to the relative excess mortality for GCA patients over time (mortality gap) did not occur. Understanding cause-specific mortality and other factors are necessary to inform contributors to premature mortality among GCA patients.

References:

[1]Hill CL, et al. Risk of mortality in patients with giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2017;46(4):513-9.

Figure.

Acknowledgments: :

This study was supported by a CIORA grant

Disclosure of Interests:

Lillian Barra: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Priscila Pequeno: None declared, Jodi Gatley: None declared, Jessica Widdifield: None declared

SAT0457 PREVALENCE OF OSTEOPOROSIS IN OSTEOARTHRITIC PATIENTS: A SYSTEMATIC REVIEW

Background:

There is controversy regarding the relationship between osteoarthritis (OA) and osteoporosis (OP). While OA may be associated with increased bone mineral density (BMD) due to increased weight, evidence exists that the incidence of OP may be increased in patients with OA.

Objectives:

To determine whether the prevalence of OP is increased in patients with OA, compared to age and sex-matched populations.

Methods:

We conducted a systematic literature review using the databases PubMed, Embase, Scopus, and Web of Science, including articles that that analysed the frequency, rate, prevalence, incidence, risk, or excess risk of OP in patients with OA compared to age and sex-matched comparison groups (controls). Articles with fewer than 200 participants, and those without controls were excluded. Two reviewers conducted title and abstract screening.

Results:

Of 2772 unique articles, 49 articles were chosen for full article screening, and 4 articles met the inclusion criteria of our present study. Data from 2 and 4 studies used OP in men and women, respectively. Other articles reported on BMD and not OP so they were excluded. In women, 998 participants with OA were compared with 1903 controls. The pooled estimate of the odds ratio for prevalence of OP vs general matched population was not statistically different (Figure 1). In men, 136 participants with OA were compared with 682 controls. The results did not show a statistically significant different in the frequency of OP in OA in men (Figure 2).

Figure 1.

Prevalence of OP in women with OA compared to controls

Figure 2.

Prevalence of OP in men with OA compared to controls

Conclusion:

The frequency of OP in participants with OA was the same in both men and women compared to the matched controls.

References:

[1]Chang, C. B., Kim, T. K., Kang, Y. G., Seong, S. C., & Kang, S. B. (2014). Prevalence of osteoporosis in female patients with advanced knee osteoarthritis undergoing total knee arthroplasty. Journal of Korean Medical Science, 29(10), 1425-1431.

[2]Liu, G., Peacock, M., Eilam, O., Dorulla, G., Braunstein, E., & Johnston, C. C. (1997). Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporosis International, 7(6), 564-569.

[3]Schneider, D. L., Barrett-Connor, E., Morton, D. J., & Weisman, M. (2002). Bone mineral density and clinical hand osteoarthritis in elderly men and women: the Rancho Bernardo study. The Journal of Rheumatology, 29(7), 1467-1472.

[4]Schneider, D. L., Bettencourt, R., & Barrett-Connor, E. (2006). Clinical utility of spine bone density in elderly women. Journal of Clinical Densitometry, 9(3), 255-260.

Disclosure of Interests:

Ali Ahmadi Pirshahid: None declared, Dongkeun Kim: None declared, Yueyang Li: None declared, Timothy Varghese: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

SAT0053 ESTIMATING REAL-WORLD UNMET NEEDS FOR REACHING REMISSION IN THE FIRST YEAR FOLLOWING EARLY RA DIAGNOSIS: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

Background:

Several composite RA disease activity indices are commonly used in clinical practice and research. Different disease activity indices however can be inconsistent in classifying remission (REM).

Objectives:

1) Compare remission prevalence across 4 common RA indices; 2) compare changes in remission across indices; and, 3) Identify predictors of persistent active disease across all indices, in real-world early RA patients over 1 year follow up.

Methods:

Data were from patients with early RA (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2018. Participants had active disease at enrolment, were treated with csDMARDs and completed standardized clinical assessments every 3-months. Remission status was assessed using 4 indices: 1) DAS28< 2.6 OR DAS28CRP < 2.5, 2) CDAI ≤ 2.8, 3) SDAI≤ 3.3, and 4) ACR/EULAR Boolean remission – SJC28, TJC28, CRP, PGA all ≦1. T-tests/ chi-squared tests were used to compare differences in remission prevalence by 1 year, and changes in remission before and after a QI program. Logistic regression was used to identify predictors of persistent active disease on all 4 indices.

Results:

1202 adults were eligible for this analysis. At enrolment, 877 (73%) were women, mean (sd) age was 55 (14), average disease activity was high (DAS28 5.1 (1.4); CDAI 27 (14); SDAI 29 (15)). Prevalence of remission by 12-months follow up was 14-21% higher when estimated with the DAS28 compared with CDAI, SDAI and Boolean criteria, and 378 (31%) did not achieve remission according to any of the 4 indices (Fig 1). Improvement in remission after a QI program however was similar across all 4 indices(~+15-17%). In adjusted logistic regression, Persistent active disease across all measures was most strongly associated with positive serostatus and smoking in men, and with obesity and more tender joints in women. Pain and lower education were predictors in BOTH men and women (Table 2)

Table 1.

Multivariable Logistic Regression Predicting Persistent Active Disease by 12-months across ALL RA indices

Conclusion:

In the absence of a single “best measure” that also takes in to account the patient’s perspective, we estimate unmet needs for achieving remission in the first year of follow up in 1 in 3 ERA patients who did not achieve remission by ANY of the 4 indices.

References:

[1] Kuriya B, Sun Y, Boire G, Haraoui B, etal. Remission in Early Rheumatoid Arthritis – A Comparison of New ACR/EULAR Remission Criteria to Established Criteria.J Rheumatol2012;39:1155-1158.

Disclosure of Interests:

Orit Schieir: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer

, Speakers bureau: Medexus/Medac, Diane Tin: None declared, Vivian Bykerk: None declared

FRI0037 ALL-CAUSE MORTALITY IN EARLY RHEUMATOID ARTHRITIS PREDICTED BY HEALTH ASSESSMENT QUESTIONNAIRE AT ONE YEAR

Background:

Patients with RA are at greater risk of mortality than the general population. Higher HAQ disability has been associated with hospitalizations and mortality in established RA; whether HAQ disability predicts mortality in early RA (ERA) is unknown.

Objectives:

The objective of this study is to analyze how well the HAQ can predict future mortality in patients with early RA.

Methods:

Data were from adult early RA patients (symptoms <1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2017; who initiated treatment with 1 or more DMARDs and had completed HAQ data at baseline and 1 year. Descriptive statistics, t-tests and chi-square tests were used to summarize and compare baseline patient characteristics including sociodemographic variables, RA characteristics and comorbidities amongst deceased and non-deceased patients. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations between HAQ at baseline and 1 year, respectively, with all-cause mortality in each year of follow up.

Results:

This study included 1724 patients with early RA; mean age was 55 years and 72% were female. In 10 years of follow up, 62 deaths (2.4%) occurred. Deceased patients had higher HAQ scores and DAS28 scores at baseline and at 1 year versus the non-deceased group. Age, male sex, lower education, smoking, more comorbidities, higher baseline disease activity and steroid use were associated with mortality in unadjusted survival models (Table 1). Contrary to HAQ at baseline, the association between all-cause mortality and HAQ at 1 year remained significant even after adjusting for age, gender, comorbidities, disease activity, smoking, education, seropositivity, symptom duration and steroid use in adjusted survival models (Table 2).

Table 1.

Unadjusted survival model: Association of each variable with all-cause mortality

Baseline VariableUnadjustedHazard OR95% CISocio-DemographicAge (years)1.101.07 – 1.13Female0.370.22 – 0.62Caucasian (white or European)1.010.46 – 2.24Aboriginal1.710.61 – 4.76Education > high school degree0.480.28 – 0.82Current Smoker1.811.01 – 3.24Rheumatic Disease Comorbidity Index (0-9)1.601.36 – 1.87RA CharacteristicsSymptom duration (months)0.990.91 – 1.08Seropositivity in first year1.110.55 – 2.23DAS28 ESR or CRP if ESR is missing1.261.06 – 1.51Oral Steroid use1.751.03 – 2.98Table 2.

Multivariable discrete-time survival models: HAQ baseline vs 1 year

ModelModel 1:Crude(Time + HAQ-DI)Model 2:Adjusted for age + sexModel 3:Adjusted for Model 2 + DAS28 + RDCIModel 4:Adjusted for Model 3 + education, smoking, seropositivity, symptom duration and oral steroids useModel 5:Adjusted for Model 3 + smoking, symptom duration onlyHAQ-DI (0-3) (at baseline)1.461.02 – 2.091.370.96 – 1.951.250.81 – 1.941.320.85 – 2.041.300.84 – 2.00HAQ-DI (0-3) (at 1 year)2.581.78 – 3.722.401.63 – 3.521.751.10 – 2.771.871.16 – 3.021.731.09 – 2.74

*Hazard OR, 95% CI

~HAQ-DI: (Health Assessment Questionnaire Disability Index); RDCI: Rheumatic Disease Comorbidity Index; DAS28: Disease Activity Score

Conclusion:

Higher HAQ at 1 year was significantly associated with all-cause mortality in a large early RA cohort suggesting that poorer disease control and function in the first year of RA contributes to higher mortality.

Disclosure of Interests:

Safoora Fatima: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Vivian Bykerk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

THU0189 EFFICACY AND SAFETY OF NINTEDANIB IN PATIENTS WITH AUTOIMMUNE DISEASE-RELATED INTERSTITIAL LUNG DISEASE TREATED WITH DMARDS AND/OR GLUCOCORTICOIDS AT BASELINE

Background:

In the INBUILD trial in patients with progressive fibrosing ILDs, nintedanib reduced the rate of decline in forced vital capacity (FVC) vs placebo over 52 weeks in the overall population and in the subgroup with autoimmune disease-related ILDs. Patients taking stable doses of medications to treat RA or CTD were eligible, but the protocol excluded enrolment of patients treated with azathioprine, cyclosporine, mycophenolate, tacrolimus, rituximab, cyclophosphamide, or oral glucocorticoids >20 mg/day.

Objectives:

Assess the influence of DMARDs and/or glucocorticoids at baseline on the efficacy and safety of nintedanib in patients with progressive autoimmune disease-related ILDs.

Methods:

In patients with progressive autoimmune disease-related ILDs in the INBUILD trial, the rate of decline in FVC (mL/year) and adverse events (AEs) over 52 weeks of treatment (or until 28 days after last trial drug intake for patients who discontinued drug before week 52) were assessed in subgroups by use of DMARDs and/or glucocorticoids (any dose) at baseline (yes/no).

Results:

170 patients in the INBUILD trial (82 nintedanib, 88 placebo) had autoimmune disease-related ILDs (89 RA-ILD, 39 SSc-ILD, 19 MCTD-ILD, 23 other). The baseline characteristics of patients taking (n=131) and not taking (n=39) DMARDs and/or glucocorticoids are shown in the Table. All but 1 patient taking glucocorticoids at baseline was taking <20 mg/day. The mean (SE) annual rate of decline in FVC in the placebo group was numerically greater in patients taking vs not taking DMARDs and/or glucocorticoids at baseline (Figure). The effect of nintedanib vs placebo on reducing the rate of decline in FVC was numerically more pronounced in patients taking vs not taking DMARDs and/or glucocorticoids at baseline, but the treatment-by-subgroup-by-time interaction p-values did not indicate heterogeneity in the effect of nintedanib between subgroups (Figure). In patients taking vs not taking DMARDs and/or corticosteroids at baseline, respectively, diarrhoea was reported in 59.4% and 77.8% of patients treated with nintedanib and 28.4% and 23.8% of patients treated with placebo. Serious AEs were more frequent in patients taking vs not taking DMARDs and/or glucocorticoids at baseline in both the nintedanib (39.1% vs 16.7%) and placebo (35.8% vs 19.0%) groups.

Conclusion:

In the INBUILD trial, the rate of FVC decline was numerically greater in placebo-treated patients who were taking DMARDs and/or glucocorticoids at baseline than in those who were not. The rate of FVC decline was slower in patients treated with nintedanib than placebo both in patients who were and were not taking DMARDs and/or glucocorticoids at baseline. Nintedanib had an acceptable safety profile both in patients who were and were not using DMARDs and/or glucocorticoids at baseline.

DMARDs and/or glucocorticoids at baselineYes (n=131)No (n=39)Male, %51.930.8FVC, mL, mean (SD)2372 (718)2188 (619)ILD diagnosis, %RA-ILD60.325.6SSc-ILD15.348.7MCTD-ILD10.712.8Other13.712.8Biologic DMARDs, %15.3–Non-biologic DMARDs, %46.6–Glucocorticoids, %87.8–

Disclosure of Interests:

Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Clive Kelly Consultant of: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, John Belperio: None declared, Alexandra James Employee of: Employee of Boehringer Ingelheim, Carl Coeck Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Eric Matteson Grant/research support from: Pfizer, Consultant of: Boehringer Ingelheim, Gilead, TympoBio, Arena Pharmaceuticals, Speakers bureau: Simply Speaking

FRI0545 A META-ANALYSIS OF GIANT CELL ARTERITIS TEMPORALLY AND ACROSS REGIONS

Background:

Giant cell arteritis (GCA) is an immune-mediated disease of the large vessels, and occurs in adults over 50 years old1. It is the most commonly seen form of chronic vasculitis and is associated with significant rates of morbidity2. This meta-analysis examines the geographical and temporal epidemiology of GCA, including incidence, prevalence and mortality.

Objectives:

To identify changes in incidence rate, prevalence, and mortality rate over time

To compare these rates between geographic regions around the world

Methods:

A systematic review of the English literature was conducted using the EMBase, Scopus and PubMed databases. Articles were included if they were cohort or cross-sectional studies with 50 or more patients with GCA and reported on population, location and time-frame parameters. Articles on mortality were included if they compared mortality to age and gender matched population. Review articles, case-control studies and case series were excluded. Two reviewers extracted data and a third verified inclusion of studies. Study quality was assessed by using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Mortality rate was standardized across cohorts to deaths per 1000 people per year.

Results:

Of the 3569 citations identified by the literature search, 107 were included in analysis. The pooled incidence of GCA internationally was 10.00 [9.22, 10.78] cases per 100 000 people over 50 years old (Figure). This incidence was highest in Scandinavia 21.57 [18.90, 24.23], followed by North and South America 10.89 [8.78, 13.00], Europe 7.26 [6.05, 8.47], and Oceania 7.85 [1.48,17.19]. Nine studies reported prevalence. Pooled prevalence from these 9 was 51.74 [42.04,61.43] cases per 100 000 people over 50 years old. Overall, pooled mortality was 20.44 [17.84,23.03] deaths/1000 per year. Mortality had a generally decreasing trend over the years of publication.

Conclusion:

The incidence of GCA varies regionally almost 3-fold. Likely genetic and environmental factors may explain this trend. Incidence and prevalence are important for tracking the efficacy and side effects of current therapies, as well as planning for the costs of biologic treatment.

References:

[1] Floris A, Piga M, Cauli A, Salvarani C, Mathieu A. Polymyalgia rheumatica: an autoinflammatory disorder?. RMD Open. 2018;4(1):e000694. Published 2018 Jun 4. doi:10.1136/rmdopen-2018-000694

[2] Crow RW, Katz BJ, Warner JE, et al. Giant cell arteritis and mortality. J Gerontol A Biol Sci Med Sci. 2009;64(3):365–369. doi:10.1093/gero na/gln030

Acknowledgments:

Both Daniel Semenov and Katherine Li equally contributed and sharing first authorship

Funding in part was from the Canadian Rheumatology Association summer studentship

Disclosure of Interests:

Daniel Semenov: None declared, Katherine Li: None declared, Matthew Turk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

SAT0145 EFFICACY AND SAFETY OF UPADACITINIB MONOTHERAPY IN MTX-NAÏVE PATIENTS WITH EARLY ACTIVE RA RECEIVING TREATMENT WITHIN 3 MONTHS OF DIAGNOSIS: A POST-HOC ANALYSIS OF THE SELECT-EARLY

Background:

Early treatment of RA within the therapeutic window(0-3 months from symptom onset), has been associated with improved clinical outcomes and physical function. However, ≤42% of RA patients(pts) visit a rheumatologist within 90 days of symptom onset1,2.

Objectives:

To assess safety and efficacy of Upadacitinib(UPA), an oral, reversible, potent JAK-1 selective inhibitor3, in pts with moderate to severely active RA who were MTX-naïve or had an inadequate response to csDMARDs/bDMARDs4-6.

Methods:

In SELECT–EARLY, MTX-naïve pts with active RA and poor prognosis were randomized 1:1:1 to once-daily UPA monotherapy at 15 or 30 mg or weekly MTX (titrated up to 20 mg/week through Week 8). Efficacy (including ACR, DAS28(CRP), CDAI responses and change in mTSS) and safety outcomes from a post-hoc analysis of patients who received treatment within 90 days from diagnosis are reported here. The statistical significance defined asp<0.05was exploratory in nature.

Results:

A total of 270 pts commenced treatment within 90 days from RA diagnosis (median: 44 days [11, 89]). Pts in each arm were mostly female (70%), had moderately to severely active RA with mean DAS28(CRP) =5.9±1.02, had structural joint damage (mean mTSS =7.7±21.5) and were seropositive for both ACPA and RF at baseline (72%)4. At Week 24, compared to MTX, significantly greater proportions of pts receiving UPA 15 or 30 mg monotherapy achieved efficacy outcomes including ACR20, 50 and 70 responses, DAS28CRP<2.6, CDAI≤2.8 or Boolean remission. Improvements in physical function (HAQ-DI) and decrease in pain were also significantly greater in pts receiving UPA 15 and 30 mg vs MTX at Week 24. Treatment with UPA was also associated with a greater inhibition of structural joint damage compared with MTX (Figure 1). Safety outcomes were consistent with the full study and the integrated safety analysis (all phase 3 studies of UPA). Compared to MTX, higher frequencies of serious infections and herpes zoster were reported in both UPA groups. There were 2 deaths in total (UPA 30 mg: 1 due to cardiovascular death and 1 due to pneumonia and sepsis) (Figure 2).

Conclusion:

In RA pts, early initiation of treatment with UPA 15 mg and 30 mg monotherapy within 3 months from diagnosis was associated with clinically meaningful improvements in efficacy, including remission and inhibition of progression of structural joint damage compared to MTX. The safety profile was consistent with the overall study and the integrated phase 3 safety analysis7. UPA seems to be a promising treatment option for more patients to reach their treatment targets of remission or low disease activity when treated within 3 months of diagnosis.

References:

[1]Raza K et al. Ann Rheum Dis. 2011;70(10):1822-5.

[2]Stack RJ et al. BMJ Open. 2019;9:e024361.

[3]Parmentier et al. BMC Rheumatol. 2018;2:23.

[4]van Vollenhoven R et al, Arth Rheumatol. 2018; 70 (s10) [Abs ACR2018].

[5]Burmester GR et al. Lancet 2018;391:2503-12.

[6]Genovese MC et al, Lancet 2018;391:2513-24.

[7]Cohen S et al, Ann Rheum Dis [Abs EULAR2019].

Disclosure of Interests:

Meliha C Kapetanovic: None declared, Maria Andersson Shareholder of: AbbVie, Employee of: AbbVie, Alan Friedman Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, Tim Shaw Shareholder of: AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Daniel Aletaha Grant/research support from: AbbVie, Novartis, Roche, Consultant of: AbbVie, Amgen, Celgene, Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, Speakers bureau: AbbVie, Celgene, Lilly, Merck, Novartis, Pfizer, Sanofi Genzyme, UCB, Maya H Buch Grant/research support from: Pfizer, Roche, and UCB, Consultant of: Pfizer; AbbVie; Eli Lilly; Gilead Sciences, Inc.; Merck-Serono; Sandoz; and Sanofi, Ulf Müller-Ladner Speakers bureau: Biogen, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

FRI0130 A SYSTEMATIC REVIEW OF NATURAL SUPPLEMENTS IN THE TREATMENT OF RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is a chronic autoimmune condition affecting almost 1% of the general population (1). Pharmacological management has been the mainstay of treatment for RA and includes DMARDs and biologics. Despite these therapies, anywhere from 28-90% of patients with RA use complementary and alternative medicine (2). These non-pharmacological therapies range from dietary interventions to supplements to nonprescription therapies.

Objectives:

To determine the efficacy of non-pharmacological, orally-ingested interventions on clinically-relevant endpoints in patients with rheumatoid arthritis.

Methods:

We systematically reviewed EMBASE and MEDLINE electronical databases from inception until Feb 23, 2019 for relevant articles. Only randomized controlled trials (RCTs) which assessed oral, non-pharmacological interventions (e.g. diets, vitamins, oils, herbal remedies, fatty acids, supplements, etc.) in adult patients with RA, that presented clinically-relevant outcomes (defined as pain, fatigue, disability, joint counts, and/or disease indices) were included.

Clinical outcome data was extracted by two independent authors as difference from baseline measurement. Therapies with at least 3 RCTs which presented data on the same clinical outcome were meta-analyzed using a pooled random effects model using RevMan 5.

Results:

A total of 4423 unique articles were independently assessed by two authors, of which 72 articles met our inclusion criteria. Thirteen different interventions were studied more than once, and six interventions had clinical outcomes reported in at least 3 trials. However, only vitamin D and fatty acids met criteria for meta-analysis.

Pooled random effects models suggested vitamin D supplementation improved HAQ scores from baseline (mean difference = -0.10, 95% confidence interval (CI) = -0.17 to -0.02; p=0.01) but had no effect on DAS28 scores (Table 1).

Table 1.

Mean differences from baseline of various clinical outcomes in RA patients taking vitamin D or fatty acid supplementation compared to control group.

Clinical OutcomeTotal PatientsMean Difference (95% CI)P-valueVitamin DHAQ573-0.10 (-0.17 to -0.02)0.01DAS28174-0.30 (-0.71 to 0.11)0.15Fatty AcidsTJC661-2.05 (-2.83 to -1.27)0.04SJC582-0.35 (-0.96 to 0.26)0.26RAI234-1.82 (-4.69 to 1.05)0.21Pain756-0.61 (-1.02 to -0.20)0.004Patient Global484-0.26 (-0.59 to 0.07)0.12Physician Global382-1.08 (-1.98 to -0.18)0.02HAQ277-0.13 (-0.18 to -0.09)<0.001DAS28543-0.19 (-0.36 to -0.01)0.03

Fatty acid supplementation improved total joint counts, pain, physician global assessment scores, HAQ, and DAS28 from baseline (Table 1). There were significantly more patients who achieved ACR20 criteria (Relative Risk Ratio = 2.73, 95% CI 1.62-4.58; p<0.001) (Figure 1).

Figure 1.

Forest plot of studies in which RA patients taking fatty acids achieved ACR20 criteria.https://account-congress.eular.org/Modules/Abstract/Submission/summary.aspx

Conclusion:

From our meta-analysis, vitamin D and fatty acids supplementation showed statistically significant improvement in some clinical outcomes in patients with RA; however, the degree of improvement is unlikely to be clinically significant.

Overall, many trials were of low quality and had high risks of bias including inadequate reporting of data. Further clinical trials that are well-designed and fully powered are still needed to confirm the efficacy of many supplements and diets in RA.

References:

[1]Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007.Arthritis Rheum. 2010;62(6):1576–1582. doi:10.1002/art.27425

[2]Efthimiou P, Kukar M, Mackenzie CR. Complementary and alternative medicine in rheumatoid arthritis: no longer the last resort!.HSS J.2010;6(1):108–111. doi:10.1007/s11420-009-9133-8

Disclosure of Interests:

Yideng Liu: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Matthew Turk: None declared

An evidence-based strategy to screen for pulmonary arterial hypertension in systemic sclerosis

BACKGROUND

Clinical practice guidelines recommend screening all systemic sclerosis (SSc) patients for pulmonary arterial hypertension (PAH) with yearly echocardiograms. There is a paucity of evidence to support these guidelines.

RESEARCH QUESTION

Can a prediction model identify SSc patients with a very low probability of PAH and therefore not requiring annual screening echocardiogram?

STUDY DESIGN AND METHODS

We performed a case-control study of 925 unselected SSc subjects nested in a multi-centered, longitudinal cohort. The probability of PAH for each subject was calculated using the results of multivariate logistic regression models. A cut-off was identified for the estimated probability of PAH below which no subject developed PAH (100% sensitivity).

RESULTS

Study subjects were predominantly female (87.5%), with mean (SD) age 58.6 (11.7) years and disease duration of 18.2 (12.2) years. Thirty-seven subjects developed PAH during 5407.97 person-years of observation (incidence rate 0.68 per 100 person-years). Shortness of breath (SOB), diffusing capacity for carbon monoxide (DLCO) and NT-proBNP were independent predictors of PAH. All SSc-PAH cases had a probability of PAH of >1.1%. Subjects below this cut-off, none of whom had PAH, accounted for 46.2% of the study population.

INTERPRETATION

A simple prediction model identified subjects at very low probability of PAH who could potentially forego annual screening echocardiogram. This represents almost half of SSc subjects in a general SSc population. This study, which is the first evidence-based study for the rational use of follow-up echocardiograms in an unselected SSc cohort, requires validation. The scoring system is freely available online at http://pahtool.ladydavis.ca.

Mammalian target of rapamycin is activated in the kidneys of patients with scleroderma renal crisis

Objectives:

Scleroderma renal crisis is a rare but serious complication affecting 2%–15% of patients with systemic sclerosis. Despite treatment with angiotensin-converting enzyme inhibitors, outcomes for scleroderma renal crisis patients are still poor. The cellular signaling mechanisms in scleroderma renal crisis are not yet known. Mammalian target of rapamycin, comprised of the subunits mTORC1 and mTORC2, has been shown to be activated in vascular lesions of renal transplant patients with anti-phospholipid antibody syndrome. Given the similarities between the pathophysiology of scleroderma renal crisis and anti-phospholipid antibody syndrome, we hypothesized that the mammalian target of rapamycin pathway would also be activated in the renal vasculature of patients with scleroderma renal crisis.

Methods:

We retrospectively analyzed renal biopsies of five patients with scleroderma renal crisis in the Canadian Scleroderma Research Group cohort. Immunostaining was performed using anti-P-S6RP antibodies to evaluate the phosphorylation of mTORC1, and anti-Rictor and anti-S473 to determine activation of mTORC2.

Results:

Four of the five patients showed mTORC1 activation in arteriolar endothelial cells, and three of the five patients showed mTORC1 activation in the arterial endothelial cells. Two of four samples showed Rictor expression in the arteriolar and arterial endothelial cells, showing mTORC2 activation. There was no expression of mTORC1 or mTORC2 in samples from two healthy controls.

Conclusion:

We demonstrate that both mTORC1 and mTORC2 are activated in renal biopsies with typical histologic features of scleroderma renal crisis. Dual mammalian target of rapamycin inhibitors are currently available and in development. These findings could inform further research into novel treatment targets for scleroderma renal crisis.

Prostate-specific antigen velocity in a prospective prostate cancer screening study of men with genetic predisposition

This corrects the article DOI: 10.1038/bjc.2017.429.

Prostate-specific antigen velocity in a prospective prostate cancer screening study of men with genetic predisposition

BACKGROUND

Prostate-specific antigen (PSA) and PSA-velocity (PSAV) have been used to identify men at risk of prostate cancer (PrCa). The IMPACT study is evaluating PSA screening in men with a known genetic predisposition to PrCa due to BRCA1/2 mutations. This analysis evaluates the utility of PSA and PSAV for identifying PrCa and high-grade disease in this cohort.

METHODS

PSAV was calculated using logistic regression to determine if PSA or PSAV predicted the result of prostate biopsy (PB) in men with elevated PSA values. Cox regression was used to determine whether PSA or PSAV predicted PSA elevation in men with low PSAs. Interaction terms were included in the models to determine whether BRCA status influenced the predictiveness of PSA or PSAV.

RESULTS

1634 participants had ⩾3 PSA readings of whom 174 underwent PB and 45 PrCas diagnosed. In men with PSA >3.0 ng ml-l, PSAV was not significantly associated with presence of cancer or high-grade disease. PSAV did not add to PSA for predicting time to an elevated PSA. When comparing BRCA1/2 carriers to non-carriers, we found a significant interaction between BRCA status and last PSA before biopsy (P=0.031) and BRCA2 status and PSAV (P=0.024). However, PSAV was not predictive of biopsy outcome in BRCA2 carriers.

CONCLUSIONS

PSA is more strongly predictive of PrCa in BRCA carriers than non-carriers. We did not find evidence that PSAV aids decision-making for BRCA carriers over absolute PSA value alone.