Frequency of irritable bowel syndrome in spondyloarthritis: a multicentric cross-sectional study and meta-analysis

OBJECTIVE

To evaluate the prevalence of symptoms and factors associated with irritable bowel syndrome (IBS) in axial spondyloarthritis (ax-SpA).

METHODS

In a cross-sectional multicentric study, consecutive patients with ax-SpA treated with biologics in five rheumatology departments were asked for IBS Rome IV criteria. Demographic data, lifestyle behaviours and disease characteristics were recorded. Second, a systematic literature review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Of the 500 patients with ax-SpA included, 124 reported IBS symptoms (25%). Female gender, unemployment, higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and worse Bath Ankylosing Spondylitis Functional Index scores, multiple lines of biologics, fibromyalgia, anxiety, depression and lower physical activity were associated with IBS symptoms. In multivariate model, the risk of IBS was associated with anxiety and physical inactivity. From the literature review, the prevalence of IBS in patients with SpA was 15.4% (8.8% to 23.3%). Meta-analysis of the five studies comparing the presence of IBS in patients with SpA (323/7292) and healthy controls (484/35587) showed a significant increase of IBS in patients with SpA (OR=1.59 (1.05 to 2.40)).

CONCLUSION

The prevalence of IBS symptoms was high in the ax-SpA population and should therefore be considered in the presence of gastrointestinal disorders. The presence of IBS symptoms was associated with anxiety and low physical activity in multivariate analysis. Patients with IBS symptoms tended to have more difficult to manage disease characterised by higher activity, worse functional score and multiple lines of treatment in univariate analysis.

AB0366 A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS THE REAL-WORLD EFFECTIVENESS OF GOLIMUMAB IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS AND PREVIOUSLY TREATED WITH INITIAL TNFα INHIBITORY THERAPY

Background

TNF inhibitor (TNFi) treatment is standard for RA patients even though many reasons may lead to TNFi therapy failures such as lack of effectiveness, patient dissatisfaction or limited therapy adherence, or even safety. As a consequence, patients may switch to a different TNFi. The efficacy of golimumab (GLM) in RA patients with inadequate response to TNFi was demonstrated in the Go-AFTER phase III clinical trial.

Objectives

The objectives of the present Go-BEYOND study were to provide real-world data to evaluate disease activity and treatment persistence with GLM as a second line TNFi therapy in RA patients over a one-year follow-up.

Methods

Go-BEYOND is an observational French multicenter prospective cohort study. All consecutive patients over 18 years of age with a diagnosis of active RA were eligible at the time of initial GLM prescription. To be included, patients had to be previously treated with only 1 TNFi (discontinued for any reason) other than GLM. Patients were ineligible if they had been previously treated with other “non-TNFi” biologics or more than one TNFi.

The study’s primary outcome was the percentage of RA patients with a Disease Activity Score (DAS28-CRP score) ≤ 3.2 at the 6-month visit (M6 visit). Patients who permanently discontinued their treatment over the 1-year follow-up were considered as non-responders. The secondary outcomes were analyzed descriptively and included (but not limited to) DAS28-CRP score at 12-month visit (M12 visit), EULAR criteria assessment, treatment persistence analysis, HAQ score, RAPID3 score, and patient acceptable symptom state and satisfaction with the injection. The study was approved by a French Ethics Committee in July 2017.

Results

A total of 128 patients (72.7% female, median age 58.2 years, and duration of RA 13.2 ± 11.4 years) met the inclusion criteria. Anti-CPP antibodies and rheumatoid factors were present in 80 (62.5%) and 81 (63.3%) patients, respectively. In the majority, the initial TNFi was etanercept (n=88, 68.8%), then adalimumab (n=25, 19.5%). The reasons for switching to GLM were secondary non-response (i.e., lack of effectiveness after an initial response to the treatment) for 75 (58.6%) patients, then safety (n=22, 17.2%), primary non-response (n=21, 16.4%), and other personal or medical reasons (n=10, 7.8%).

At the M6 and M12 visits, a small number of patients, 27 (21.1%) and 48 (37.5%) had respectively permanently discontinued their GLM treatment and were considered as non-responders. At the M6 visit, 48 patients over the 128 included (37.5%) had a DAS28-CRP ≤ 3.2 and 32 (25%) < 2.6. At M12 visit, 41 (32%) patients had a DAS28-CRP ≤ 3.2 and 31 (24.2%) < 2.6. According to EULAR response criteria thresholds, 49 (38.3%) and 45 (35.2%) patients had a good or moderate response to GLM at the M6 and M12 visits.

Conclusion

The Go-BEYOND study confirms that in RA, a non-response to a first TNFi does not exclude a response to GLM as a second-line biologic in a substantial proportion of patients in real-life settings.

References

None

Acknowledgements

We would like to thank the investigators and the entire Go-BEYOND team for their involvement in the study.

Disclosure of Interests

Cécile Gaujoux-Viala Consultant of: AbbVie; Amgen; Boehringer Ingelheim; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB, Jérémie SELLAM Consultant of: Abbvie; Biogen; BMS; Fresenius Kabi; Janssen; MSD; Novartis; Pfizer; Roche, Florence Tubach: None declared, Naoual HARID Employee of: MSD France - Medical advisor, Bernard Combe Consultant of: AbbVie; Bristol-Myers Squibb; Celltrion; Eli Lilly; Gilead/Galapagos; Janssen; Merck; Novartis; Pfizer; Roche/Chugai; Sanofi; UCB, René-Marc Flipo Consultant of: Abbvie; BMS; Janssen; MSD; Pfizer; Roche-Chugai

AB1449 ADHERENCE TO MTX AT INITIATION OF FIRST TARGETED THERAPY (PREVALENCE AND ASSOCIATED FACTORS): RESULTS OF THE STRATEGE2 STUDY

Background

Treatment adherence is a major challenge in chronic inflammatory rheumatic disease (CIRD). Mainly studied in rheumatoid arthritis (RA), this ranges from 30 to 80% [1]. Given the impact of non-adherence to disease-modifying therapy among RA patients, guidelines aiming to facilitate management of adherence were published in 2019 [2]. These guidelines highlight the multifactorial characteristics and importance of clarifying the factors determining non-adherence. In addition, treatment adherence was also listed as a point to consider for the management of difficult-to-treat RA by an EULAR task force [3].

Objectives

Based on inclusion results of STRATEGE 2 we explore the adherence to methotrexate (MTX) and its associated factors prior to initiation of a first targeted therapy.

Methods

The objective of STRATEGE2 is to describe the therapeutic strategy in RA patients treated with MTX for at least 3 months, naive of targeted biological (bDMARD) or synthetic (tsDMARD) therapy and who are candidates for initiation of first b/tsDMARD therapy due to RA activity. Patients were included prospectively in 2019-2020 and completed the Compliance Questionnaire for Rheumatology (CQR) [4], a self-administered questionnaire specific to rheumatology, measuring treatment adherence. They were then divided into 2 groups: adherence (Ad) (CQR19>80) vs. non-adherence (NAd) to investigate factors liable to be associated with adherence. Then, univariate and multivariate analysis was applied to identify potential predictors for adherence.

Results

Between Feb. 2019 and Dec. 2020, 230 patients were included, with 124 RA patients having an analysable CQR19: 73.4% females, mean age 56.6 years (±13.2), diagnosed 5.6 years (±7.4) previously, treatment with MTX for 4.4 years (±5.3) and a mean DAS of 4.3 (±1.2). The mean CQR score was 75.8. Patient distribution: 45.2% in the Ad group and 54.8% in the NAd group.

Table 1.At baseline (before b/tsDMARD initiation)Ad - N=56NAd - N=68pSex: female73.2%73.5%-Age (mean)59.3 (±13.6)54.4 (±12.4)p < 0.05BMI (mean)27.2 (±7.0)25.0 (±4.7)p < 0.15Still in work39.3%55.9%p < 0.15At least 1 comorbidity60.7%47.1%p < 0.15Positive anti-CCP67.9%80.6%p < 0.15Positive rheumatoid factor69.8%84.8%p < 0.05Radiological signs57.1%41.8%p < 0.15RA duration (years)4.9 ±6.76.3 ±8.0-Average MTX initiation (years)4.0 ±4.74.8 ±5.7-Per os MTX28.6%29.4%-→ mean dosage (mg/week)16.4 ±4.515.6 ±4.6Subcutaneous MTX69.6%70.6%-→ mean dosage (mg/week)20.1 ±4.619.4 ±3.3-Intramuscular MTX1.8%0%-Patients self-administration30.0%12.5%P < 0.05Corticosteroid therapy53%50.6%-→ mean dosage (mg/day)8.1 ±4.19.5 ±5.8Mean DAS284.5 ± 1.34.2 ±1.2-Mean HAQ1.1 ± 0.70.9 ±0.7p < 0.15

In the multivariate analysis, no formal predictive factors to MTX adherence was identified except BMI>30kg/m2 (odds ratio, OR (95% confidence interval, CI)=4.00, 1.08-14.86, p=0,038) and adherents who estimate having completely participate to the decision-making for the targeted therapy (OR (95% CI)=6.41, 2.32-17.65, p<0.001).

Conclusion

In this cohort, beyond the recently published guidelines, nearly half of patients do not show adherence to MTX (CQR19-based evaluation) before initiation of b/tsDMARD. As physicians tend to overestimate adherence to medication, clarification of the factors associated with non-adherence would help improve patient assessment and, therefore, management. Supplementary data on patients’ adherence evolution and adherence predictors, might be observed on the follow-up data at 12 and 24 months of this cohort.

References

[1]Beauvais C, et al. Joint Bone Spine 2020;87(6):668-669.

[2]Gossec C, et al. Joint Bone Spine 2019;86(1):13-19.

[3]Nagy G, et al. Ann Rheum Dis 2021;0:1–14.

[4]De Klerk E, et al. J Rheumatol 2003;30(11):2469-2475

Acknowledgements

The authors wish to acknowledge RCTs for their contribution to the statistical analysis, the investigators, centres and patients.

Disclosure of Interests

Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Consultant of: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Emmanuelle Dernis Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Eric Senbel Speakers bureau: AbbVie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Consultant of: AbbVie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Hélène Herman-Demars Employee of: Nordic Pharma France, Jennifer Becker Employee of: Nordic Pharma France, René-Marc Flipo Speakers bureau: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi., Consultant of: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi.

POS0700 IMPACT OF DELAYING INITIATION OF METHOTREXATE BY 1 MONTH ON THE OUTCOME OF RHEUMATOID ARTHRITIS AT 1 YEAR

Background

It is recommended that vaccinations should be performed prior to start methotrexate (MTX) knowing that delaying initiation of background therapy may have an impact on the progression of RA.

Objectives

To access the impact of delaying initiation of MTX by 1 month on the outcome of RA at 1 year.

Methods

The VACIMRA study is a prospective, randomized, parallel-group, multicenter trial comparing the vaccine protection obtained in patients with rheumatoid arthritis according to the 1-month delay between anti-pneumococcal vaccine PCV13 and methotrexate initiation in one arm, versus immediate introduction of MTX following vaccination in the other arm. We analyzed disease activity based on DAS28-ESR at baseline (M0), 1, 2, 3, 6 and 12 months between the 2 groups. For structural progression, we performed a radiographic analysis of 79 RA patients included in the Montpellier center at baseline, 6 and 12 months. This analysis was performed by the same physician two times, blinded to the patient’s group. Structural damage progression at 6 months and 1 year was assessed according to van-der-Heijde-modified Sharp score (vSHS) on radiographs performed at inclusion, at 6 and 12 months of follow-up. Comparisons of the means of activity scores and radiographic scores were made with the non-parametric Wilcoxon-Mann-Whitney test.

Results

Of the 276 patients randomized, 261 could be analyzed (131 in the IMMEDIATE group and 130 in the DELAY group). At inclusion, there were no significant differences in demographic, disease activity (DAS28-ESR), biological and radiographic characteristics between the 2 groups (Table 1).

Table 1.

Baseline characteristics

VariableModalityTotal populationGROUP IMMEDIATEGROUPE DELAYpGender, n(%)N=261n=131n=1300.97Man74 (28.35)37 (28.24)37 (28.46)Woman187 (71.65)94 (71.76)93 (71.54)Age (years)Mean (± SD)55.74 (± 14.68)55.31 (± 15.27)56.16 (± 14.11)0.76MTX true naive (n(% col))No13 (4.98)8 (6.11)5 (3.85)0.40yes248 (95.02)123 (93.89)125 (96.15)Age at diagnosis (years)Mean (± SD)N=205 55.86 (± 15.16)n=98 55.31 (± 16.07)n=107 56.37 (± 14.34)0.80Positive rheumatoid factorn(% col)166 (64.59)84 (65.12)82 (64.06)0.86Positive ACPAn(% col)174 (68.24)89 (68.99)85 (67.46)0.79CRP (mg/L)Mean (± SD)N=260 17.62 (± 24.87)n=131 15.36 (± 17.95)n=129 19.91 (± 30.23)0.65DAS28-ESRMean (± SD)N=249 5.01 (± 1.11)n=125 5.03 (± 1.13)n=12 4.98 (± 1.10)0.54Sharp modified VdH total radiographic scoreMean (± SD)N=93 1.53 (± 3.62)n=47 1.57 (± 3.68)n=46 1.48 (± 3.60)0.88

DAS 28-ESR evolution during 1 year of follow-up

There was a significant difference in the means of DAS28-ESR at 1 month between the DELAY and IMMEDIAT groups (3.96 ± 1.46 vs 3.41 ± 1.33; p<0.001, respectively). There was no significant difference in the means of DAS28-ESR between the 2 groups at 3 months (3.19± 1.46 in the 2 groups p<0.91), at 6 months (3.11 ± 1.42 vs 3.24 ± 1.43; p=0.46, respectively) and at 12 months (2.96 ± 1.34 vs 2.98 ± 1.26p=0.89) (Graphic). Similarly, there was no significant difference in mean radiographic scores at 6 months (2.00 ± 4.41 vs. 1.80 ± 4.03 p=0.81) or at 12 months (2.23 ± 4.86 vs. 2.00 ± 4.07 p=0.93).

There was no significant variation between radiographic scores at 6 months compared to baseline in either group (mean difference 0.21 ± 0.52 vs. 0.36 ± 1.01, p=0.90) nor at 12 months compared to baseline (mean difference 0.40 ± 1.06 vs. 0.62 ± 1.58, p=0.85).

Conclusion

In patients with rheumatoid arthritis, initiation of methotrexate 1 month after PCV13 vaccination has no significant impact on RA activity and structural outcome at 1 year. Performing vaccinations 1 month before starting MTX can be proposed without significant impact on RA outcome at 1 year.

Figure 1.

Disclosure of Interests

None declared

AB0409 FRENCH REAL LIFE EFFECTIVENESS DATA FOR TOFACITINIB AT 1 YEAR IN PATIENTS WITH RHEUMATOID ARTHRITIS: INTERIM RESULTS OF THE OBSERVATIONAL STUDY, DeFacTo

Background

Tofacitinib, an oral Janus Kinase inhibitor, is indicated in the treatment of adult patients (pts) with active, moderate to severe rheumatoid arthritis (RA). At the present time we have no data concerning its efficacy in a French RA population in a real-life setting.

Objectives

DeFacTo, is an on-going observational study the principal goal of which is to identify factors predictive of Tofacitinib drug survival in RA patients in real life.

Methods

These are the results of interim descriptive analyses of effectiveness data after 1 year of follow up.

Results

Of the 313 pts enrolled in the study, 276 pts were included in the effectiveness analysis (POP1), 219 of whom were patients with a ≥1-year follow-up (POP2) including 122 patients who, as of 15 March 2021, were continuing to take Tofacitinib therapy. At inclusion, POP1 (n=276) was composed of 77.9% females of mean (± SD) age 59.7 ± 11.7 years, having a median disease duration of 9.1 years [Q1;Q3: 4.1; 19.2], TJC 7.5 ± 5.9 and SJC 5.3 ± 5.1; 115 patients presented with erosions, 206 had RF+ and 202 had ACPA+. The median CRP value was 7.4 [: 3.0; 20.0] mg/l, DAS28-4-CRP was 4.6 ±1.1, and the FACIT-Fatigue score was 28.3 ± 11.3. In all, 96.7% of the pts had received prior treatment with ≥1 csDMARDs, 65.2% with b/tsDMARDs (median = 2 [1; 4]). Tofacitinib was prescribed in combination with a csDMARD in 58.3% of cases. The baseline characteristics of the 122 patients still taking tofacitinib at 12 months were comparable to those of POP1. Results showed continued treatment with tofacitinib in 85.3% of pts with mean duration of treatment of 368 ± 197.1 days and reductions from baseline in the parameters of inflammatory markers, pain and the DAS28 activity scores; 20% of 122 pts were in DAS28-CRP remission (Table 1). Safety findings were similar to those reported previously in clinical studies1 2.

Table 1.

Baseline characteristics and effectiveness at 12 months Patient characteristics

Variables: mean ± SD or % ptsInclusion, n=219At 12 months, n=122*PtGA (VAS, mm)60.6 ± 20.829.8 ± 22.8Pain (VAS, mm)57.3 ± 24.830.1 ± 25.7CRP (mg/l)15.5 ± 21.97.9 ± 13.3DAS28-4-CRP4.6 ± 1.02.8 ± 1.1DAS28-4-ESR4.9 ± 1.13.3 ± 1.2EffectivenessInclusion. n=219At 12 months. n=219 ⱡLDA, % pts- DAS28-CRP ≤3.26.828.8- DAS28-ESR ≤3.24.621.5Remission, % pts- DAS28-CRP <2.63.720.1- DAS28-ESR <2.62.79.6

Conclusion

These real-life interim results for Tofacitinib in RA patients provide information on its use in France: with prescriptions for single drug therapy in 41.7% of cases, the effectiveness of Tofacitinib is confirmed as comparable to that found in clinical studies1-3.

References

[1]Burmester G et al. Lancet. 2013;381:451-460

[2]Fleischman R et al. Lancet 2017;390:457-68

[3]Wollenhaupt et al. Arthritis Research & Therapy (2019) 21:89 https://doi.org/10.1186/s13075-019-1866-2

Acknowledgements

To all investigators involved in this study, and all patients included in this study

Disclosure of Interests

Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Consultant of: AbbVie; Amgen; Boeringhe; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Andre BASCH Speakers bureau: Janssen, Novartis, Amgen, BMS, Abbvie, Lilly, Pfizer, MSD, UCB, Consultant of: Janssen, Novartis, Amgen, BMS, Abbvie, Lilly, Pfizer, MSD, UCB,, Slim Lassoued: None declared, Fabienne COURY-LUCAS Consultant of: AbbVie, Bristol-Myers Squibb, Janssen, Lilly, MSD, Novartis and Pfizer, Grant/research support from: AbbVie, Biogen, Roche Chugai, Pfizer, and UCB,, Meriem Kessouri Shareholder of: Pfizer, Employee of: Pfizer, Nadir Mammar Shareholder of: Pfizer, Employee of: Pfizer, Yves Brault Employee of: Pfizer, Thierry Lequerre Consultant of: Abbvie, BMS, Boeringher, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Roche – Chugai, Sanofi, UCB,, Carine Salliot Consultant of: Biogen, Lilly, Novartis, Roche Chugai, Pfizer

AB0388 FRENCH REAL LIFE SAFETY DATA ON THE USE OF TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS: OBSERVATIONAL STUDY, DeFacTo

Background

Tofacitinib, an oral Janus Kinase inhibitor, is indicated in the treatment of adult patients (pts) with active, moderate to severe rheumatoid arthritis (RA).

Objectives

The objective of this work is to describe the tofacitinib’s safety profile in the DeFacTo study (French prospective observational study).

Methods

The safety profile of tofacitinib was assessed on the basis of interim data from a descriptive analysis of pts having taken at least one dose of tofacitinib in the context of the DeFacTo study.

Results

Of the 313 pts enrolled in the study, 301 had received tofacitinib and were included in the safety analysis. Of these, 276 fulfilled the eligibility criteria and included 219 who had ≥ 1 year follow-up and a mean exposure period of 368 ± 197.1 days. As of 15 March 2021, 122 patients are continuing to take tofacitinib therapy (76 missing prescription data). On inclusion, 77.9% of the 276 pts were females of mean (± SD) age 59.7 ± 11.7 years and a median disease duration of 9.1 years [Q1;Q3: 4.1; 19.2]. A history of cardiovascular disease was found in 12.5% of cases, (4.4% myocardial infraction, 5.5% stroke/transient ischemic attack, 1.5% heart failure and 1.5% peripheral arterial occlusive disease); 5.5% had a history of cancer, 17.5% a prior infection and 46% were smokers/former smokers. Tofacitinib was prescribed in combination with a csDMARD in 58.3% of pts and with corticosteroids in 54.3% of cases. At the cut-off date of 15 March 2021, of the 301 patients, adverse effects (AE) had been reported in 44.9% of cases of which 10.6% were considered serious (SAE). Infections were detected in 18.6% of pts (Table 1).

Table 1.

Real life safety data for tofacitinib according to age

N, (%)< 65 years (n=190)≥ 65 years (n=110)Total (n=301*)Adverse effect80 (42.1)55 (50.0)135 (44.9)Serious adverse effect16 (8.4)16 (14.5)32 (10.6)Infection33 (17.4)23 (20.9)56 (18.6)Severe infection3 (1.6)4 (3.6)7 (2.3)AE of interest (number of events)  Infection  Herpes zoster5510  Severe infection  Herpes zoster101  Tuberculosis022 Cancer  Small-cell carcinoma011 MACE  Stroke101 Thromboembolic events  Venous thrombosis011Death000

*1 patient for whom age is unknown but is counted in the total.

Conclusion

These purely descriptive interim results reveal a safety profile for tofacitinib in patients with RA, similar to that previously reported in clinical and observational studies. (1-2)

References

[1]Wollenhaupt et al. Arthritis Research & Therapy (2019) 21:89 https://doi.org/10.1186/s13075-019-1866-2

[2]Kremer et al. ACR Open Rheumatology 2021. DOI 10.1002/acr2.11232

Acknowledgements

To all investigators involved in this study, and all patients included in this study

Disclosure of Interests

Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Consultant of: AbbVie; Amgen; Boeringhe; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Andre BASCH Speakers bureau: Janssen, Novartis, Amgen, BMS, Abbvie, Lilly, Pfizer, MSD, UCB, Consultant of: Janssen, Novartis, Amgen, BMS, Abbvie, Lilly, Pfizer, MSD, UCB,, Slim Lassoued: None declared, Fabienne COURY-LUCAS Consultant of: AbbVie, Bristol-Myers Squibb, Janssen, Lilly, MSD, Novartis and Pfizer, Grant/research support from: AbbVie, Biogen, Roche Chugai, Pfizer, and UCB,, Meriem Kessouri Shareholder of: Pfizer, Employee of: Pfizer, Nadir Mammar Shareholder of: Pfizer, Employee of: Pfizer, Yves Brault Shareholder of: Pfizer, Employee of: Pfizer, Thierry Lequerre Consultant of: Abbvie, BMS, Boeringher, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Roche – Chugai, Sanofi, UCB,, Carine Salliot Consultant of: Biogen, Lilly, Novartis, Roche Chugai, Pfizer

Diagnostic performance of 18 F-FDG-PET/CT in inflammation of unknown origin: A clinical series of 317 patients

BACKGROUND

Inflammation of unknown origin (IUO) is a challenging situation in internal medicine.

OBJECTIVES

To describe the final diagnoses in IUO and assess the helpfulness of ¹⁸ F-fluorodesoxyglucose positron emission tomography with computerized tomography (¹⁸ F-FDG-PET/CT) in the diagnosis strategy.

RESULTS

A total of 317 IUO patients with ¹⁸ F-FDG-PET/CT were enrolled. A diagnosis was reached in 228 patients: noninfectious inflammatory diseases (NIID) (37.5%), infectious diseases (18.6%), malignancies (7.9%), and non-systemic-inflammatory miscellaneous diseases (7.9%). The two leading causes of NIID were polymyalgia rheumatica and giant cell arteritis. ¹⁸ F-FDG-PET/CT results were classified as true positive in 49.8% of patients and contributory in 75.1% of overall IUO patients (after the complete investigation set and a prolonged follow-up). In multivariate analysis, only C-reactive protein minimum level (≥50 mg/L) was associated with the contributory status of ¹⁸ F-FDG-PET/CT.

CONCLUSION

Within the wide spectrum of IUO underlying diseases, ¹⁸ F-FDG-PET/CT is helpful to make a diagnosis and to eliminate inflammatory diseases. Obese patients constitute a specific group needing further studies.

POS0627 SUBOPTIMAL MANAGEMENT OF RHEUMATOID ARTHRITIS IN FRANCE: A REAL-WORLD STUDY BASED ON DATA FROM THE FRENCH NATIONAL HEALTH DATA SYSTEM

Background

Currently, real-world data on rheumatoid arthritis (RA) treatment patterns in France are limited.

Objectives

The aim of this study was therefore to describe, between 2013 and 2017, the sequence of therapies used in the treatment of patients with RA and to characterize RA treatment patterns using real-world data.

Methods

A non-interventional, longitudinal study was conducted using the Echantillon Généraliste des Bénéficiaires (EGB) between 1 January 2013 and 31 December 2017. EGB is a 1/97th representative random sample from the French National Healthcare Database (SNDS) which includes claims data covering 99% of the total French population.

Treatment patterns, adherence and persistence of RA treatments were described in a cohort of patients with RA, identified between 2013 and 2017.

Results

Between 2013 and 2017, 2,553 patients with RA were identified, including 2,314 in 2017. Of the 2,314 RA patients identified in 2017 (mean age 66.2 ± 15.4 years; 73.7% female; mean Charlson comorbidity score 4.2), 1,102 (47.6%) did not receive any disease-modifying anti-rheumatic drug (DMARD). Of these, 944 (85.7%) had received at least one symptomatic treatment, including 862 (91.3%) an analgesic, 509 (53.9%) an oral corticosteroid and 384 (40.7%) non-steroidal anti-inflammatory drugs.

Of the 2,553 RA patients monitored between 2013 and 2017, 1,512 (59.2%) patients received a DMARD, of which 721 (47.7%) patients received only one treatment sequence, mainly methotrexate (n=529, 35.0%), and did not discontinue or switch treatment. Switching treatment to a targeted DMARD was reported for 144 (9.5%) patients. During follow-up, 377 (25%) patients discontinued treatment. In total, 1,142 RA treatment initiations were recorded, 62.4% of which were conventional synthetic DMARDs (csDMARDs). Persistence rates (95% confidence interval) for csDMARDs, TNF inhibitors (TNFi) and other targeted DMARDs (tDMARDs) were 63.4% (59.6–67.0), 55.9% (49.2–62.0) and 59.4% (51.2–66.6) at 12 months, respectively; Medication Possession Ratio (MPR), an adherence indicator, was 80.5%, 90.8% and 71.9%, respectively.

Long-term oral corticosteroids (≥6 months) were also associated with csDMARD for 42.6% of cases (n=304/713), TNFi for 39.7% (n=100/252) and another tDMARD for 53.1% (n=94/177). The average doses of long-term oral corticosteroids were 7.5 mg, 6.5 mg and 7.8 mg of prednisone equivalent per day, respectively.

Conclusion

Using data obtained from the EGB, this study estimated the number of patients with RA in France to be 307,612 in 2017. Approximately half of the patients identified in the EGB cohort were not treated with a DMARD. For a substantial proportion of patients receiving DMARDs, therapeutic escalation, a switch in treatment, or long-term corticosteroid co-therapy with an average daily dose greater than 5 mg were needed. Furthermore, median persistence for most targeted DMARDs was less than 2 years, and the early discontinuation rates of up to 46.6% suggest poor DMARD tolerance in many patients.

This study highlights that the medical need for RA treatment is not covered by current therapeutic strategies.

Table 1.

Characteristics of DMARD treatments initiated between 2013–2017 in the EGB database (N=1,142)

csDMARDTNFiOther targeted DMARDTreatments initiated, n (%)713 (62.4)252 (22.1)177 (15.5)Median duration of treatment, months26.718.514.6Rate of early treatment discontinuation (≤2 dispensations within 2 months of initiation), %15.510.711.9Mean treatment adherence (MPR), %80.590.871.9

Acknowledgements

This study was funded by Galapagos NV (Mechelen, Belgium). Publications management support was provided by Aspire Scientific Ltd (Bollington, UK) and funded by Galapagos NV (Mechelen, Belgium).

Disclosure of Interests

Cécile Gaujoux-Viala Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Inc., Janssen, Medac, Merck-Serono, Mylan, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Inc., Janssen, Medac, Merck-Serono, Mylan, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi, and UCB, Jean-François Bergmann Consultant of: AbbVie, Amgen, AstraZeneca, Bayer, BMS, Galapagos, Gilead, GSK, Lilly, Novartis, Roche, Sanofi, and Takeda, Mélanie Goguillot Employee of: Stève Consultants, who carried out the study on behalf of Galapagos, Asma Melaine Employee of: Stève Consultants, who carried out the study on behalf of Galapagos, Marie Guérin Employee of: Galapagos, Alban Edouard Employee of: Galapagos, Stève Benard Employee of: Stève Consultants, who carried out the study on behalf of Galapagos, Bruno Fautrel Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medac, MSD, Mylan, NORDIC Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, SOBI, and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medac, MSD, Mylan, NORDIC Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, SOBI, and UCB, Grant/research support from: AbbVie, Lilly, MSD, and Pfizer

POS0698 CHANGES IN RA PATIENT PROFILE AT INITIATION OF FIRST TARGETED THERAPY OVER A FIVE-YEAR PERIOD: ANALYSIS OF THE STRATEGE 1 AND STRATEGE 2 STUDIES

Background

The objective of the STRATEGE2 study (inclusion period: Feb. 2019-Dec. 2020) is to describe the therapeutic strategy in rheumatoid arthritis (RA) patients treated with methotrexate (MTX) for at least 3 months, not having received targeted biological (bDMARD) or synthetic (tsDMARD) therapy and who are candidates for initiation of first b/tsDMARD therapy due to RA activity.

The STRATEGE1 study [1] (conducted between 2014 and 2015) described the therapeutic strategies introduced for RA patients with an inadequate response to MTX monotherapy.

Objectives

We aim to compare the profiles of patients included in these two studies at first prescription of b/tsDMARD therapy, in order to evaluate changes in rheumatologist practices over this five-year period.

Methods

STRATEGE1 and 2 are two French multicentre, prospective, longitudinal, observational studies including patients with confirmed RA (ACR 1987 or ACR/EULAR 2010). Our aim is to compare baseline data. Only data from the sub-group of patients initiating b/tsDMARD therapy are presented for STRATEGE1. Qualitative variables are compared by Fisher’s exact test and quantitative variables by t-test.

Results

In STRATEGE1 (2014-2015), 117 out of 854 patients initiated a b/tsDMARD therapy. In STRATEGE2 (2019-2020), 230 patients were included, with 180 in the analysis population.

Table 1.At baseline (before b/tsDMARD initiation)STRATEGE1 (N=117)STRATEGE2 (N=180)pMean age (years)52.6 ±12.556.4 ±13.60.0158RA duration (years)6.5 ±7.15.6 ±7.2NSRadiological signs50.0%48.0%NSAverage MTX initiation (years)4.6 ±4.34.3 ±5.3NSMTX per os44.0%28.9%0.0088→ mean dosage (mg/week)16.2 ±3.616.0 ±4.1NSMTX subcutaneous52.6%70.6%0.003→ mean dosage (mg/week)18.5 ±3.219.9 ±3.9NS→ Patients self-administration53.8%75.8%0.0001Corticosteroid therapy53%50.6%NS→ mean dosage (mg/day)8.1 ±4.19.5 ±5.8NSMean DAS284.6 ± .14.3 ±1.20.0074Mean HAQ1.4 ±0.91.0 ±0.7<0.0001

The baseline visits involved initiation of b/tsDMARD therapy with 100% vs. 88.9% bDMARD (anti-TNF: 78.8% vs. 58.3%; anti-IL6: 6.7% vs. 12.8%; CTLA4 Ig: 11.5% vs. 16.7%; anti-CD20: 2.9% vs. 1.1%) and 0% vs. 11.1% tsDMARD. Therapeutic decisions concerning MTX were (STRATEGE 1 vs STRATEGE 2): identical regimen maintained (pharmaceutical form + dosage): 69.2% vs. 76.1%; discontinuation: 4.3% vs. 2.2%; adjustment: 26.7% vs. 21.7% [with dose reduction: 18.2% vs. 93.5% and/or change in pharmaceutical form (p.o. to SC): 54.5% vs. 0%].

Main reasons for adjusting treatment were (STRATEGE 1 vs STRATEGE 2): active RA: 86.1% vs. 77.8%; RA not in remission: 3.5% vs. 21.1%; exacerbation based on clinical/laboratory parameters: 42.6% vs. 10%.

Conclusion

Over the five-year period, these results suggest a change in practices for RA patients with an inadequate response to MTX and initiating their first targeted therapy: now with earlier recourse to first targeted therapy, for less active RA, and more pronounced investigation of remission.

References

[1]C. Gaujoux-Viala et al. MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE. Rheumatology 2021;0:1-11. doi:10.1093/rheumatologykeab274.

Acknowledgements

The authors wish to acknowledge RCTs for their contribution to the statistical analysis, the investigators, centres and patients.

Disclosure of Interests

Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB., Consultant of: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB., Emmanuelle Dernis Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Eric Senbel Speakers bureau: Abbvie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Consultant of: Abbvie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Hélène Herman-Demars Employee of: Nordic Pharma France, Agnès Courbeyrette Employee of: Nordic Pharma France, René-Marc Flipo Speakers bureau: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi., Consultant of: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi.

Efficacy and safety of filgotinib in methotrexate-naive patients with rheumatoid arthritis with poor prognostic factors: post hoc analysis of FINCH 3

OBJECTIVE

This analysis evaluated efficacy and safety of filgotinib, a Janus-associated kinase 1-preferential inhibitor, in methotrexate (MTX)-naive patients with rheumatoid arthritis (RA) with multiple poor prognostic factors (PPFs).

METHODS

This was a post hoc analysis of the phase III, randomised, double-blind, active-controlled, FINCH 3 study (clinicaltrials.gov NCT02886728). Patients received once-daily oral filgotinib 200 or 100 mg plus once-weekly oral MTX ≤20 mg (FIL200 + MTX and FIL100 + MTX), filgotinib 200 mg monotherapy (FIL200), or oral MTX monotherapy (MTX-mono) for up to 52 weeks. PPFs investigated were seropositivity for rheumatoid factor or anticyclic citrullinated peptide antibodies, high-sensitivity C reactive protein (CRP) ≥4 mg/L, Disease Activity Score in 28 joints with CRP (DAS28(CRP)) >5.1, and presence of erosions. Filgotinib efficacy and safety in patients with all four PPFs at baseline were explored versus MTX-mono within this subgroup and compared informally with the overall population.

RESULTS

Of 1249 patients in FINCH 3, 510 (40.8%) had all PPFs. Efficacy of FIL200 + MTX among these patients was comparable to the overall population, with higher rates of 20%/50%/70% improvement from baseline by American College of Rheumatology criteria, DAS28(CRP) <2.6, and remission; greater improvement in physical function and pain; and better inhibition of structural damage relative to MTX-mono. FIL100 + MTX and FIL200 were not consistently more efficacious versus MTX-mono. Safety of filgotinib in patients with PPFs was comparable to the overall population; no new safety signals were observed.

CONCLUSION

FIL200 + MTX efficacy and safety in patients with multiple PPFs were similar to the overall population.

POS1082 CATASTROPHIZING IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Catastrophizing is a negative cognitivo-affective response to an anxiety-provoking stimulus, especially anticipated or actual pain. It can be quickly assessed using a validated questionnaire: the Pain Catastrophizing Scale (PCS)1. Catastrophizing plays a role in maintaining chronic pain and is associated with several pain-related outcomes in osteoarthritis and low back pain. To our knowledge, there are no data on catastrophizing in patients with psoriatic arthritis (PsA).

Objectives:

To assess the prevalence of catastrophizing and associated factors in PsA.

Methods:

We performed a bi-centric observational, prospective study. All patients aged 18 or over with PsA fulfilling the 2006 CASPAR criteria were consecutively included. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires for disease activity (BASDAI), function (HAQ, BASFI), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), fibromyalgia (FiRST), insomnia (ISI) and catastrophizing scores (PCS). Statistical analysis included samples T-test, one-way variance analysis, Spearman’s correlation coefficient, Chi2 test, Fisher’s exact test, Wilcoxon test, multivariate linear regression (considering catastrophizing as a continuous variable) and multivariate logistics regression (considering catastrophizing as a categorical variable: PCS ≥ 20 = high level catastrophizing).

Results:

From September 2019 to March 2020, 85 PsA patients were included: 54.1% were women, the median age was 54.0 years and 33 patients (39.8%) were professionally active. The majority of patients (88.2%) had a disease lasting for more than 2 years. Axial involvement was found for 39 patients (45.9%), almost all patients (98.8%) had peripheral involvement, 32 patients (37.7%) had enthesitic involvement and 14 patients (16.7%) had erosions. Median DAS28 CRP was 3.12 [2.13-4.46] and the median BASDAI score was 5.50 [4.30-6.70]. The prevalence of a PCS score ≥20 was 45.9% [35.3;56.5]. The median PCS score was 16 [6-29]. In multivariate logistics regression, high-level catastrophizing was significantly associated with the HADS anxiety score (OR=1.35 [1.15-1.61]) and pain VAS (OR=1.04 [1.02-1.06]). In multivariate linear regression, catastrophizing was significantly associated with the HADS anxiety score (p= 0.004), pain VAS (p=0.001), HADS depression score (p=0.018) and insomnia score (p=0.034).

Conclusion:

Almost half the patients with PsA were high catastrophizers. Catastrophizing is related to anxiety, pain, depression and insomnia. It may be interesting to detect catastrophizing in order to improve the care of our patients.

References:

[1]Sullivan MJL. et al. Psychological Assessment. 1995;7(4):524–32

Disclosure of Interests:

None declared.

POS1239 POSITIVE IMPACT OF THE FIRST LOCKDOWN IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATISM

Background:

Since the beginning of 2020, the COVID-19 pandemic has caused a considerable amount of fear, worry and concern in the general population and among certain groups such as the elderly, healthcare providers and people with pre-existing conditions in particular. Our patients suffering from chronic inflammatory rheumatism (CIR), a group of autoimmune pathologies treated by immunosuppressant medication, are particularly concerned. Actions taken – particularly quarantine and its effects on the normal activities, habits or livelihoods of many people – also have a significant impact. There is little information on the impact of the lockdown in patients with CIR with data measured prospectively, in a standardized way, before and during the first lockdown period.

Objectives:

The objective of this ancillary study was to evaluate the psychological impact of the first lockdown period (anxiety, depression, sleep disorders, catastrophizing...) as well as the evolution of disease activity in patients suffering from CIR.

Methods:

At two French university hospitals, adult patients with rheumatoid arthritis (RA) according to the ACR-EULAR 2010 criteria, spondyloarthritis (SpA) fulfilling the ASAS 2009 criteria and psoriatic arthritis (PsA) according to the Caspar 2006 criteria were consecutively included in the Catastrophism in Chronic Inflammatory Rheumatism (CRIC) study from September 2019. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires on disease activity (DAS28, CDAI, BASDAI), function (HAQ), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), insomnia (ISI) and catastrophizing scores (PCS). These data were collected prospectively at baseline, 3, 6 and 12 months.

In this ancillary study, data from patients with an assessment before and during lockdown were analyzed. Statistical analyses were descriptive with a paired Student’s T-test.

Results:

In all, 140 patients (49 RA, 69 SpA and 22 PsA) were evaluated before and during lockdown. The median age was 53.5 [44-63] years and 60.7% were women; 74 patients (53.2%) were professionally active and 102 (72.9%) were living as couples. The majority of patients (92.9 %) had a disease lasting more than 2 years. Concerning treatments, 63 (45%) were treated by bDMARD monotherapy, 40 (28.5%) by bDMARD+ csDMARD, 17 (12.1%) by csDMARD monotherapy and 2 patients by tsDMARD; 90.7% were not taking any corticosteroids and 8.6% were taking ≤5 mg/d; 30% were on NSAIDs.

When comparing before and during lockdown, pain, tender joint count, swollen joint count, disease activity (CDAI, BASDAI) and function (HAQ, SF12 physical component) were similar. However, there was a significant improvement in psychological status, anxiety (HADS, GAD7), the mental component of SF12, catastrophizing and overall quality of life (EQ5D) (see Table 1 below).

Conclusion:

There are very few prospective, standardized data on the impact of lockdown in patients with CIR with an assessment before and during the first lockdown period. In patients with CIR, the first lockdown period had no impact on the activity of the disease and was well experienced psychologically with less anxiety and an improvement in quality of life.

Table 1.Outcome (N)140 CIR: 49 RA, 69 SpA, 22 PsABefore lockdownMean (SD)During lockdownMean (SD)Mean change(SD)PPain VAS (138)39.4 (25.3)39.4 (25.0)-0.28 (27.1)NSTJC (57)4.0 (6.8)4.7 (4.4)0.7 (5.9)NSSJC (56)1.0 (2.6)1.6 (1.7)0.5 (2.4)NSCDAI (36)11.7 (1.4)12.3 (7.5)1.2 (8.7)NSBASDAI (84)4.7 (1.9)4.9 (2.0)0.14 (1.4)NSHAQ (135)0.72 (0.57)0.72 (0.53)0.03 (0.33)NSSF12 mental(136)32.7 (8.7)36.2 (8.4)3.46 (8.01)<0.0001GAD-7 (anxiety) (135)7.7 (5.5)5.0 (5.3)-1.73 (0.40)<0.0001HADS anxiety(137)8.5 (3.9)7.8 (3.9)-0.64 (2.91)0.0113EQ5D(139)0.55 (0.31)0.61 (0.29)0.06 (0.24)0.0078PCS (catastrophizing) (137)18.9 (13.3)15.9 (11.1)-3.10 (9.60)0.0003

Disclosure of Interests:

None declared

POS0659 REAL WORD EXPERIENCE WITH TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS: AN INTERIM ANALYSIS FROM A FRENCH PROSPECTIVE OBSERVATIONAL STUDY DeFacTo

Background:

Tofacitinib is an oral JAK inhibitor indicated for moderate to severe active rheumatoid arthritis (RA).

Objectives:

To present baseline patients characteristics and effectiveness data at 6 months of DeFacTo real life study (“IDentification of Factors predictive of Tofacitinib’s survival”).

Methods:

DeFacTo is an observational, open-label, prospective, multi-center, national study designed to evaluate the predictive factors of tofacitinib’s survival in patients with moderate-to-severe active rheumatoid arthritis according to the SmPC[1]. Here we present the 1st interim results involving a descriptive analysis of the 221 patients included between January 2019 and March 2020 (POP1). Effectiveness results at 6 months of 145 patients having ≥ 6 months follow-up (POP2) are also described.

Results:

The baseline characteristics of the POP1 patients (n = 221) were: 78.3% women with a mean age (± SD) of 60.4 ± 11.1 years, disease duration of 12.0 ± 9.8 years, TJC: 7.3 ± 5.7 and SJC: 5.1 ± 4.7; 44.0% of patients had erosions, 79.5% were RF+ and 75.9% were ACPA+. The mean CRP was 15.3 ± 21.8 mg/l, the ESR at one hour was 28.7 ± 23.6 mm, DAS28-4 CRP was 4.6 ± 1.0, DAS28-4 ESR was 4.9 ± 1.1 and the FACIT-Fatigue score was 27.6 ± 11.3. A total of 97.3% of patients had been previously treated by ≥1 csDMARD (mean number 1.9 ± 1.0) and 66.1% by b/tsDMARDs (mean number 2.9 ± 2.5), tofacitinib was prescribed as monotherapy (without csDMARD) in 49.3% of patients. The characteristics of the POP2 patients were similar to those of POP1. At 6 months in POP2, 29 patients have discontinued their treatment with tofacitinib. The results showed a decrease from baseline in inflammatory markers (CRP from 14.2±17.1 to 4.7±4.2 mg/l), pain (Pain VAS from 58.3±23.4 to 27.6±22.1) and DAS28 activity scores with 23% of patients in DAS28-CRP remission and 36% of patients in DAS28-CRP LDA (figure 1). This interim analysis didn’t identifyany new safety findings (Table 1).

Conclusion:

Preliminary results from this prospective observational study on the use of tofacitinib in patients suffering with RA in France indicate that its effectiveness and safety are similar to those found in the clinical studies[1-3]. In this study, tofacitinib was prescribed as monotherapy (without csDMARD) in more than 49% of cases.

References:

[1]European Medicines Agency, Tofacitnibi SmPc (summary of product characteristics).

[2]Burmester G et al. Lancet. 2013; 381: 451-460.

[3]Fleischman R et al. Lancet 2017; 390: 457-6.

[4]Wollenhaupt et al. Arthritis Research & Therapy (2019) 21:89

Figure 1.

Patients with LDA or remission at baseline and 6 months

Table 1.

Safety data

Tolerability, n patients (%)<65 years, n = 132≥ 65 years, n = 86Total n = 218AE56 (42.4)33 (38.4)89 (40.8)Serious AE8 (6.1)5 (5.8)13 (6.0)Herpes Zoster4 (3.0)2 (2.3)6 (2.8)Infection27 (20.5)15 (17.4)42 (19.3)Severe infection2 (1.5)2 (2.3)4 (1.8)

Acknowledgements:

To all investigators involved in this study.

Disclosure of Interests:

Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Consultant of: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Andre BASCH Speakers bureau: Janssen, Novartis, Amgen, BMS, Abbvie, Lilly, Pfizer, MSD, UCB, Consultant of: Janssen, Novartis, Amgen, BMS, Abbvie, Lilly, Pfizer, MSD, UCB, Slim Lassoued: None declared, Fabienne COURY-LUCAS Consultant of: AbbVie, Bristol-Myers Squibb, Janssen, Lilly, MSD, Novartis and Pfizer, Grant/research support from: AbbVie, Biogen, Roche Chugai, Pfizer, and UCB, Meriem Kessouri Shareholder of: Pfizer, Employee of: Pfizer, Nadir Mammar Shareholder of: Pfizer, Employee of: Pfizer, Thierry Lequerre Consultant of: Abbvie, BMS, Boeringher, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Roche – Chugai, Sanofi, UCB, Carine Salliot Consultant of: Biogen, Lilly, Novartis, Roche Chugai, Pfizer

POS0306 IMPACT OF MULTIMORBIDITY ON DISEASE MODIFYING ANTI-RHEUMATIC DRUG THERAPY IN EARLY RHEUMATOID ARTHRITIS: DATA FROM THE ESPOIR COHORT

Background:

Multimorbidity is frequent in rheumatoid arthritis (RA) and could interfere with the therapeutic response.

Objectives:

The aim of this study was to evaluate multimorbidity in the French cohort of early arthritis (ESPOIR cohort) and its possible impact on the therapeutic response.

Methods:

We included patients fulfilling 2010 ACR/EULAR criteria for RA. An adapted MultiMorbidity Index (aMMI) was developed [1]. Each patient was assigned scores of binary aMMI (0= no comorbidity, 1= at least 1 comorbidity) and counted and weighted aMMI. The primary endpoint was achievement of Clinical Disease Activity Index (CDAI) low disease activity after initiation of a first disease-modifying anti-rheumatic drug (DMARD) according to the aMMI. Secondary endpoints were other disease activity scores and response criteria. We collected data from the visit preceding the first DMARD initiation (baseline visit) and the visit after at least 3 months of treatment (follow-up visit). The impact of aMMI on therapeutic maintenance at 1, 3, 5 and 10 years was evaluated.

Results:

Analyses involved 472 patients: 302 (64%) had at least 1 comorbidity. Overall, 45.3% and 44.7% with binary aMMI= 0 or 1, respectively (p= 0.9), achieved CDAI low disease activity (Table 1). Similar results were found with counted and weighted aMMI. Use of other disease activity scores or response criteria did not show a significant impact of multimorbidity on the therapeutic response. Therapeutic maintenance was significantly better with binary aMMI = 1 than binary aMMI = 0. Increased counted aMMI was associated with increased probability of still being on the first initiated DMARD at each time point (Table 2).

Table 1.

Impact of aMMIs on CDAI, DAS28 and SDAI low disease activity (LDA) achievement at follow-up visit (univariate analyses)

LDA achievementCDAIpDAS28pSDAIpYesNoYesNoYesNoBinary aMMI, n (%)077 (45.3)93 (54.7)0.9*85 (50.0)85 (50.0)0.2*80 (47.1)90 (52.9)0.9*1135 (44.7)167 (55.3)131 (43.4)171 (56.6)141 (46.7)161 (53.3)Counted aMMI, mean (SD)1.0 (1.1)1.1 (1.1)0.71.0 (1.1)1.1 (1.1)0.21.1 (1.1)1.1 (1.1)1.0Weighted aMMI, mean (SD)4.1 (5.2)4.0 (4.7)0.94.0 (5.2)4.1 (4.7)0.34.0 (5.0)4.0 (4.9)1.0

aMMI= adapted MultiMorbidity Index; CDAI= Clinical Disease Activity Index; SDAI= Simplified Disease Activity Index

* Proportion of patients achieving LDA between patients with binary aMMI= 0 and binary aMMI= 1. Because of no statistically significant results, no multivariate analysis was performed.

Table 2.

Probability of first DMARD maintenance at 1, 3, 5 and 10 years (multivariate analysis)

Time pointFirst DMARD maintained or stoppedBinary aMMI#Counted aMMI§011 year(n= 530)Maintenance (n= 300)22981.71 (0.93)OR [95% CI]*> 999 [286.2->999]221.3 [84.0-583.0]Withdrawal (n= 230)205250.12 (0.37)3 years(n= 493)Maintenance (n= 285)102751.66 (0.94)OR [95% CI]*153.9 [73.0-324.5]26.1 [15.1-45.3]Withdrawal (n= 208)175330.22 (0.64)5 years(n= 459)Maintenance (n= 116)91071.72 (1.05)OR [95% CI]*10.9 [5.1-23.3]2.2 [1.8-2.7]Withdrawal (n= 343)1631800.82 (1.0)10 years(n= 415)Maintenance (n= 40)2381.58 (0.84)OR [95% CI]*14.0 [3.3-59.1]1.6 [1.2-2.0]Withdrawal (n= 375)1582170.99 (1.12)

#data are number of patients

§ data are mean (standard error)

* data are odds ratios (ORs) and 95% confidence intervals (95% CI) of still being on the first initiated DMARD at 1, 3, 5 and 10 years between patients with binary aMMI = 1 and binary aMMI = 0 and according to counted aMMI, per additional point.

Conclusion:

In the ESPOIR cohort, therapeutic response to a first DMARD was not affected by multimorbidity but therapeutic maintenance was better in multimorbid patients.

References:

[1]Radner H, Yoshida K, Mjaavatten MD, et al. Development of a multimorbidity index: Impact on quality of life using a rheumatoid arthritis cohort. Semin Arthritis Rheum 2015;45:167–73.

The variables included in multivariate analyses were sex, rheumatoid factor and/or anti-citrunillated peptide antibody positivity, age, CDAI at baseline visit, number of treatments at baseline visit.

Acknowledgements:

We are grateful to Nathalie Rincheval (Montpellier) for expert monitoring and data management and all the investigators who recruited and followed the patients (F. Berenbaum, Paris-Saint Antoine; MC. Boissier, Paris-Bobigny; A. Cantagrel, Toulouse; B. Combe, Montpellier; M. Dougados, Paris-Cochin; P. Fardellone and P. Boumier, Amiens; B. Fautrel, Paris-La Pitié; RM. Flipo, Lille; Ph. Goupille, Tours; F. Liote, Paris- Lariboisière; O. Vittecoq, Rouen; X. Mariette, Paris-Bicêtre; P. Dieude, Paris Bichat; A. Saraux, Brest; T. Schaeverbeke, Bordeaux; and J. Sibilia, Strasbourg).

Disclosure of Interests:

Aurélie BELTAI: None declared, Bernard Combe Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche, Amandine Coffy: None declared, Cécile Gaujoux-Viala: None declared, Cédric Lukas Speakers bureau: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai and UCB, Consultant of: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai and UCB, Grant/research support from: Pfizer, Novartis and Roche-Chugai, Alain Saraux Speakers bureau: AbbVie; Bristol-Myers Squibb; Lilly; Nordic; Novartis; Pfizer; Roche-Chugai; Sanofi and UCB, Consultant of: AbbVie; Bristol-Myers Squibb; Lilly; Nordic; Novartis; Pfizer; Roche-Chugai; Sanofi and UCB, Grant/research support from: AbbVie; Bristol-Myers Squibb; Lilly; Nordic; Novartis; Pfizer; Roche-Chugai; Sanofi and UCB, Maxime Dougados Speakers bureau: Pfizer, Abbvie, Lilly, UCB, Merck, BMS, Roche, Biogen, Sanofi, Novartis, Sandoz, Consultant of: Pfizer, Abbvie, Lilly, UCB, Merck, BMS, Roche, Biogen, Sanofi, Novartis, Sandoz, Grant/research support from: Pfizer, Abbvie, Lilly, UCB, Merck, BMS, Roche, Biogen, Sanofi, Novartis, Sandoz, Jean-Pierre DAURES: None declared, Charlotte Hua: None declared

POS1003 CATASTROPHIZING IN PATIENTS WITH SPONDYLOARTHRITIS

Background:

Catastrophizing is a negative cognitivo-affective response to an anxiety-provoking stimulus, especially anticipated or actual pain. It can be assessed quickly using a validated questionnaire: the Pain Catastrophizing Scale (PCS)1. Catastrophizing plays a role in maintaining chronic pain and is associated with several pain-related outcomes in osteoarthritis and low back pain. There is a lack of knowledge about catastrophizing in axial spondyloarthritis (AS) with only one study2 so far.

Objectives:

To assess the prevalence of catastrophizing and associated factors in spondyloarthritis.

Methods:

We performed an observational, prospective, bi-centric study. All patients aged 18 or over with AS fulfilling the 2009 Assessment in Spondyloarthritis International Society (ASAS) criteria were consecutively included. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires regarding disease activity (BASDAI), function (HAQ, BASFI), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), fibromyalgia (FiRST), insomnia (ISI) and catastrophizing scores (PCS). Statistical analysis included a samples t-test, one-way variance analysis, Spearman’s correlation coefficient, the Chi2 test, Fisher’s exact test, the Wilcoxon test, multivariate linear regression (considering catastrophizing as a continuous variable) and multivariate logistics regression (considering catastrophizing as a categorical variable: PCS ≥ 20 = high level catastrophizing).

Results:

From September 2019 to March 2020, 168 AS patients were included: 48.5% were women, the median age was 48.5 years and 100 patients (60.2%) were professionally active. Almost all patients (95.8%) had a disease lasting for more than 2 years; 110 (72%) were HLA-B27+; 84 (50%) had MRI sacroiliitis and 62 (37.6%) radiographic sacroiliitis. In all, 166 (98.8%) had axial involvement, 99 (58.9%) had peripheral involvement and 44 (26.2%) had enthesitic involvement. The median BASDAI score was 6.30 [Q1-Q3 4.65-6.30].

The prevalence of a PCS score ≥20 was 45.5% [38.0;53.0]. The median PCS score was 18 [7-27]. In multivariate logistics regression, high-level catastrophizing was significantly associated with the HADS anxiety score (OR=1.54 [1.22-2.0]), HADS depression score (OR=1.25 [1.10-1.43]) and disease activity (BASDAI OR=1.14 [1.01-1.26]). In multivariate linear regression, catastrophizing was also significantly associated with anxiety (p<0.0001), depression (p<0.0001) and disease activity (p=0.0008).

Conclusion:

Almost half the patients with AS were high catastrophizers. Catastrophizing is linked to anxiety, depression, and disease activity. It may be interesting to detect catastrophizing in order to improve the management of our patients.

References:

[1]Sullivan MJL. et al. Psychological Assessment. 1995;7(4):524–32

[2]Penhoat M. et al. Joint Bone Spine. 2014;81(3):235–9

Disclosure of Interests:

None declared.

POS0566 CATASTROPHIZING IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Catastrophizing is conceptualized as a negative cognitive–affective response to an anxiety-provoking stimulus, especially anticipated or actual pain. Catastrophizing can be assessed quickly using a validated questionnaire: the Pain Catastrophizing Scale (PCS)1. Catastrophizing plays a role in maintaining chronic pain and is associated with several pain-related outcomes in osteoarthritis and low back pain.

Objectives:

To assess the prevalence of catastrophizing and associated factors in rheumatoid arthritis (RA).

Methods:

We performed an observational, prospective, bi-centric study. All patients aged 18 or over with RA and fulfilling the ACR-EULAR 2010 criteria were consecutively included. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires for disease activity (DAS28), function (HAQ), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), fibromyalgia (FiRST), insomnia (ISI) and catastrophizing scores (PCS). Statistical analysis included the samples t-test, one-way variance analysis, the Spearman’s correlation test, the Chi2 test, Fisher’s exact test, the Wilcoxon test, multivariate linear regression (considering catastrophizing as a continuous variable) and multivariate logistics regression (considering catastrophizing as a categorical variable: PCS ≥ 20 = high level catastrophizing).

Results:

From September 2019 to March 2020, 201 patients with RA were included: 78.1% were women and the median age was 63.0 years. In all, 64.1% of patients were RF+, 65.7% ACPA+, and 46% had erosive disease. Median DAS28 CRP was 2.9 [2.1-4.0]. with 45% of patients in remission, 14.8% with low, 31.2% moderate and 9 % high activity. The majority of patients (92 %) had a disease lasting for more than 2 years.

The prevalence of a PCS score ≥20 was 48.0% [41.0;54.9]. The median PCS score was 18 [7-28]. In multivariate logistics regression, high-level catastrophizing was significantly associated with DAS28-CRP (OR= 1.61 [1.18-2.20]), HADS anxiety score (OR=1.25 [1.11-1.40]) and the HADS depression score (OR=1.19 [1.07-1.33]). In multivariate linear regression, catastrophizing was significantly associated with the HADS anxiety score (p< 0.0001), HADS depression score (p=0.0055), HAQ (p=0.0015) and the ISI insomnia score (p=0.005).

Conclusion:

Almost half the patients with RA were high catastrophizers. Catastrophizing is linked to anxiety, depression, disease activity, function impairment and insomnia. It may be interesting to detect catastrophizing in order to improve the management of our patients.

References:

[1]Sullivan MJL. et al. Psychological Assessment. 1995;7(4):524–32

Disclosure of Interests:

None declared

THU0188 EFFICACY OF FILGOTINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS WITH POOR PROGNOSTIC FACTORS: POST HOC ANALYSIS OF FINCH 3

Background:

Patients (pts) with rheumatoid arthritis (RA) with poor prognostic factors (PPF) are at risk for RA progression if disease activity is not rapidly controlled. In FINCH 3 (NCT02886728), filgotinib (FIL)—an oral, potent, selective JAK1 inhibitor—was effective relative to methotrexate monotherapy (MTX mono) in MTX-naïve patients with ≥1 PPF—erosions, seropositivity for rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP), or hsCRP ≥4 mg/L.1

Objectives:

This post hoc analysis examined FIL efficacy in FINCH 3 pts with multiple PPF.

Methods:

The global, phase 3, double-blind, active-controlled FINCH 3 study randomised MTX-naïve pts with moderately to severely active RA 2:1:1:2 to oral FIL 200 mg once daily + MTX ≤20 mg weekly, FIL 100 mg + MTX, FIL 200 mg mono, or PBO + MTX up to week (W)52. This subgroup analysis included pts with all 4 of the following PPF at baseline (PPF pts): erosions, seropositivity for RF or anti-CCP, hsCRP ≥4 mg/L, and DAS(28)CRP >5.1. Comparisons were not adjusted for multiplicity.

Results:

Of 1249 pts randomised and treated in FINCH 3, 510 had all 4 PPF. At baseline, relative to the overall FINCH 3 population, PPF pts had longer mean disease duration (2.4 vs 2.2 years); higher mean hsCRP (27.9 vs 17.5 mg/L), mTSS (17.9 vs 13.3), DAS28(CRP) (6.3 vs 5.7), HAQ-DI (1.76 vs 1.56), CDAI (44.3 vs 39.8), and SDAI (47.1 vs 41.5); and greater frequency of seropositivity for RF (90.6% vs 67.9%), anti-CCP (92.4% vs 68.5%), or both (82.9% vs 59.6%). Efficacy in PPF pts was comparable to data from all FINCH 3 pts (Table, Figures 1–2). PPF pts receiving FIL 200 mg with or without MTX vs MTX mono had higher frequencies of ACR20/50/70 response and greater improvement in HAQ-DI at W24; responses were numerically greater for FIL 200 mg + MTX vs FIL 100 mg + MTX or FIL 200 mg mono (Table) and were evident by W12 (data not shown). Radiographic progression at W24 was lower in PPF pts receiving FIL 200 mg + MTX or FIL 200 mg mono vs MTX mono (Figure 1). Proportions of PPF pts receiving FIL 200 mg with or without MTX who achieved DAS28(CRP) <2.6, CDAI ≤2.8, SDAI ≤3.3, and Boolean remission at W24 (Figure 2) were larger vs pts receiving MTX mono and numerically greater vs pts receiving FIL 100 mg + MTX.

Table.

Efficacy outcomes in patients with 4 PPF and all FINCH 3 patients at W24

FIL 200 mg+ MTXFIL 100 mg+ MTXFIL 200 mg monoMTXmonoPPFAllPPFAllPPFAllPPFAlln1724168520787210166416ACR20, %85.5*81.0***83.580.2*81.678.174.771.4ACR50, %70.3***61.5***58.857.0**59.858.1**48.245.7ACR70, %54.1***43.8***37.640.1***43.7*40.0***28.326.0HAQ-DIa−1.2***−0.94***−1.0*−0.90**−1.0*−0.89*−0.9−0.79

aMean change from baseline.

*, p <0.05;**, p <0.01;***, p <0.001 vs MTX mono, not adjusted for multiplicity.

FIL, filgotinib; mono, monotherapy; MTX, methotrexate; PPF, poor prognostic factors.

Conclusion:

FIL treatment provided rapid and deep disease control including higher rates of remission and other clinical outcomes, improved physical function, and less radiographic progression compared with MTX alone in MTX-naïve pts with RA with 4 PPF, a population at risk for severe progressive disease. In pts with 4 PPF, W24 remission rates following FIL 200 mg with or without MTX were higher vs MTX mono and numerically higher vs FIL 100 mg + MTX.

References:

[1]Westhovens et al.Ann Rheum Dis2019;78(Suppl2):259–60.

Disclosure of Interests:

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, Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, Cecile Gaujoux-Viala Consultant of: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Gilead Sciences, Inc.; Janssen; Lilly; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB, Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Gilead Sciences, Inc.; Janssen; Lilly; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB, Giovanni Adami: None declared, Alan Matsumoto Grant/research support from: AbbVie; BMS; Eli Lilly; Galapagos; Gilead Sciences, Inc.; GSK; Janssen; Novartis; Pfizer; Sanofi; UCB; Regeneron

, Consultant of: AbbVie; Gilead Sciences, Inc.; GSK; Novartis, Paul Bird Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer – advisor, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, Osvaldo Messina Speakers bureau: Amgen; Americas Health Foundation; Pfizer, 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, Beatrix Bartok Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Zhaoyu Yin Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Ying Guo Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Thijs Hendrikx Shareholder of: Galapagos (share/warrant holder), Employee of: Galapagos, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma

OP0077 DETERMINANTS OF THE PHYSICIAN’S GLOBAL ASSESSMENT AND INFLUENCE OF CONTEXTUAL FACTORS IN EARLY AXIAL SPONDYLOARTHRITIS

Background:

In RMDs, the physician’s global assessment (PhGA) is a major factor of treatment decision. It is not well-known which disease manifestations contribute to PhGA in early axSpA and if contextual factors have an impact.

Objectives:

To investigate determinants of PhGA and the influence of contextual factors on this relationship in patients with early axSpA.

Methods:

Five-year data from DESIR, a cohort of early axSpA, were analysed. Clinical data were collected every 6 months up to 2 years and annually thereafter. The primary analysis included all patients, and the subgroup analysis patients with follow-up MRI at 2 and/or 5 years. PhGA over 5 years was the outcome of interest. Univariable generalized estimating equation (GEE) models were used to investigate relationships between potential determinants and PhGA. Longitudinal relationships were investigated in autoregressive models. Effect modification by contextual factors (educational level, gender and age) was tested and, if significant, models were stratified. Univariable analyses were chosen to better assess the contributory explanatory effects of each of the determinants in each of the strata.

Results:

A total of 708 patients were included, mean age 33.7 (SD 8.6) years, 46% male, 41% lower educated. The subgroup consisted of 220 patients with similar characteristics. Higher BASDAI questions 1-6, SJC28, TJC53, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), CRP and BASMI were associated with a higher PhGA (Table 1). Gender and age were effect modifiers of SJC28; the effect was largest in the younger male stratum (β [95% CI]; 1.07 [0.71, 1.43]), and smallest in the older female stratum (0.13 [0.04, 0.22]) (Figure 1). Autoregressive GEE models revealed the same determinants of PhGA and the same pattern of effect modification by gender and age.

Table 1.

Factors associated with PhGA over time in gender/age-stratified groups in univariable analysis

Female/Older(n=200)Female/Younger(n=181)Male/Older(n=154)Male/Younger(n=173)Coefficient (95% CI)BASDAI Q1 (fatigue, 0-10)0.39 (0.34, 0.44)0.39 (0.34, 0.44)0.41 (0.35, 0.46)0.46 (0.41, 0.51)BASDAI Q2 (back pain, 0-10)0.49 (0.45, 0.54)0.53 (0.49, 0.57)0.48 (0.43, 0.53)0.58 (0.54, 0.63)BASDAI Q3 (peripheral joint pain, 0-10)0.31 (0.27, 0.36)0.36 (0.31, 0.41)0.32 (0.27, 0.37)0.43 (0.37, 0.48)BASDAI Q4 (enthesitis, 0-10)0.37 (0.33, 0.41)0.42 (0.37, 0.46)0.36 (0.31, 0.41)0.52 (0.47, 0.56)BASDAI Q5 (severity of morning stiffness, 0-10)0.42 (0.37, 0.46)0.45 (0.40, 0.49)0.44 (0.40, 0.49)0.58 (0.54, 0.63)BASDAI Q6 (duration of morning stiffness, 0-10)0.30 (0.25, 0.35)0.35 (0.30, 0.39)0.36 (0.31, 0.41)0.50 (0.45, 0.56)BASMI linear (0-10)0.61 (0.45, 0.78)0.67 (0.48, 0.86)0.49 (0.30, 0.68)0.95 (0.75, 1.15)SJC28 (0-28)0.13 (0.04, 0.22)0.52 (0.31, 0.73)0.58 (0.40, 0.76)1.07 (0.71, 1.43)TJC53 (0-159) ¶0.05 (0.04, 0.06)0.13 (0.11, 0.16)0.13 (0.11, 0.16)0.15 (0.13, 0.18)MASES (0-39)0.10 (0.08, 0.12)0.15 (0.12, 0.17)0.18 (0.14, 0.23)0.30 (0.25, 0.35)CRP (mg/L)0.02 (0.01, 0.04)0.03 (0.01, 0.05)0.06 (0.04, 0.07)0.04 (0.03, 0.05)Any EAM (presence vs absence)-0.13 (-0.49, 0.23)-0.20 (-0.58, 0.19)-0.26 (-0.68, 0.17)-0.28 (-0.69, 0.14)SPARCC-spine (0-414) §0.06 (-0.11, 0.22)0.05 (-0.11, 0.20)0.02 (-0.03, 0.06)0.05 (-0.04, 0.14)SPARCC-SIJ (0-72) §-0.02 (-0.13, 0.09)0.01 (-0.08, 0.10)0.05 (-0.01, 0.11)0.01 (-0.04, 0.06)

¶ Each joint graded 0-3

§ Coefficients were estimated in the subgroup

Conclusion:

Patient’s subjective symptoms, peripheral arthritis, enthesitis, higher CRP and impaired spinal mobility contribute to explain PhGA in patients with early axSpA irrespective of gender and age. But physicians consider the presence of swollen joints as more important in males than in females.

Disclosure of Interests:

Fumio Hirano Paid instructor for: Ono pharmaceuticals, Astellas Pharma Inc, Sumitomo Dainippon Pharma, Chugai Pharmaceutical Co., Ltd., Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Floris A. van Gaalen: None declared, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Cecile Gaujoux-Viala: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis

FRI0101 EFFECTS OF IL6 INHIBITORS ON THE INCIDENCE OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN RHEUMATOID ARTHRITIS PATIENTS: A SYSTEMATIC REVIEW WITH META ANALYSIS

Background:

Rheumatoid arthritis (RA) is associated with a 2 fold increased risk of cardiovascular events (CVE) and mortality when compared to the general population. The systemic inflammation in RA seems to play a pivotal role by creating endothelial dysfunction and thus accelerating atherosclerosis. This long lasting inflammatory process potentiates the effects of additional classical cardiovascular risk factors. Since the 2000s, numerous therapeutic advances, in particular biologics, allow better control of this inflammation. Among these, IL6 inhibitors (IL6i) are known to provide rapid and sustained improvements in clinical, biological and radiographic outcomes. However, an increase in circulating lipid concentrations in patients treated with IL6i is usual. This raises the question of the risk -to -benefit ratio of IL6i.

Objectives:

The purpose of this systematic literature review and meta-analysis was to evaluate the impact of IL6i on the incidence of major adverse cardiovascular events in RA patients in comparison with TNFalpha inhibitors (TNFi), non TNFi bDMARDs or csDMARDS.

Methods:

A systematic literature search of MEDLINE (via PubMed), EMBASE and the Cochrane Library databases until February 2019 was performed. Included studies were observational studies or randomized controlled trials having reported relevant confirmed CVEs (death from CVE, myocardial infarction, heart failure and stroke) in patients with RA treated with IL6i, and a suitable control group. A meta-analysis of the relative risk for each CVE in RA patients treated with IL6i compared to patients in the control groups was performed. A random effect model was applied in case of substantial heterogeneity.

Results:

Of 6869 studies, 23 randomized controlled trials and 6 controlled cohorts could be included. IL6i were significantly associated with a reduction in the risk of myocardial infarction in comparison with TNFi (OR, 0.73; 95% CI [0.56 to 0.96]). No other significant effects were observed with regard to the risks of stroke, heart failure (HF), and death from CVE in comparison with csDMARDs, TNFi, or non-TNFi bDMARDs (table 1).

Table 1.

Pooled relative risks of cardiovascular events in RA patients treated with IL-6 inhibitors and respective control groups

Cs DMARDSTNFiNon TNFi bDMARDSMyocardial infarction1.44 [0.50;4.17]0.73 [0.56; 0.96]0.81 [0.48; 1.36]Stroke1.08 [0.40; 2.91]1.20 [0.82; 1.77]0.73 [0.39; 1.37]Heart failure0.17 [0.01; 4.08]1.51 [0.61; 3.70]1.19 [0.71; 1.98]Cardiovascular death1.59 [0.62; 4.11]1.13 [0.72; 1.78]NA

Our findings of a potentially protective effect of IL6i use on the risk of MI are reassuring. Although several beneficial effects might be involved, like the effective control of systemic inflammation, the anti-arrhythmia effect or the improvement of endothelial and left ventricle dysfunction, a potential indication bias with a decreased likelihood to prescribe these drugs in patients with high cardiovascular risk cannot be excluded.

Conclusion:

This review of the literature with meta-analysis provides reassuring results about the association between use of IL6i and CVE in RA patients. Data from long-term observational studies is however needful to confirm and ascertain this result.

Disclosure of Interests:

None declared

SAT0375 DETERMINANTS OF PATIENT’S GLOBAL ASSESSMENT OF WELL-BEING IN EARLY AXIAL SPONDYLOARTHRITIS; 5-YEAR LONGITUDINAL DATA FROM THE DESIR COHORT

Background:

A framework has been proposed to explain which disease outcomes impact quality of life or well-being in patients with axSpA; this was based on cross-sectional data and patients with radiographic axSpA.1

Objectives:

To investigate the determinants of patient’s well-being over time, and the influence of contextual factors on these relationships in patients with early axSpA.

Methods:

Five-year data from DESIR, a cohort of early axSpA, were analysed. Clinical data were collected every 6 months up to 2 years and annually thereafter. X-rays and MRI of the spine and SIJ were performed at baseline, 2, and 5 years. The outcome was BAS-G, the patient’s global assessment of the disease impact on well-being. Generalized estimating equations (GEE) were used to test the relationship between potential explanatory variables from 5 domains (disease activity, physical function, spinal mobility, structural damage, spinal and SIJ inflammation) and BAS-G over 5 years. Longitudinal relationships were analysed using an autoregressive GEE model. Contextual factors (patient’s educational level, gender and age) were tested as potential effect modifiers or confounders.

Results:

A total of 708 patients were included, mean age 33.7 (SD 8.6) years, 46% male, 41% lower educated. Higher scores of the individual questions of BASDAI on fatigue (Q1) (β [95% CI]: 0.17 [0.13-0.22]), back pain (Q2) (0.51 [0.46-0.56]), peripheral joint pain (Q3) (0.08 [0.04-0.12]) and severity of morning stiffness (Q5) (0.08 [0.03-0.13]), and BASFI (0.14 [0.08-0.19]) were independently associated with a higher BAS-G over time (Table 1). In the autoregressive GEE model, all variables except for the BASDAI Q5 showed true longitudinal associations with BAS-G. Age, gender and educational level were neither effect modifiers nor confounders.

Table 1.

Factors associated with BAS-G over time.

Multivariable GEE modelMultivariable autoregressive GEE model §Coefficient (95% CI)Coefficient (95% CI)BASDAI Q1 (fatigue, 0-10)0.17 (0.13 to 0.22)*0.15 (0.10 to 0.20)*BASDAI Q2 (back pain, 0-10)0.51 (0.46 to 0.56)*0.54 (0.47 to 0.60)*BASDAI Q3 (peripheral joint pain, 0-10)0.08 (0.04 to 0.12)*0.13 (0.08 to 0.19)*BASDAI Q4 (enthesitis, 0-10)0.03 (-0.01 to 0.07)0.02 (-0.04 to 0.08)BASDAI Q5 (severity of morning stiffness, 0-10)0.08 (0.03 to 0.13)*0.06 (-0.01 to 0.13)BASDAI Q6 (duration of morning stiffness, 0-10)0.03 (-0.01 to 0.07)0.05 (-0.01 to 0.11)SJC28 (0-28)0.01 (-0.11 to 0.13)0.10 (-0.11 to 0.31)TJC53 (0-159) ¶-0.01 (-0.02 to 0.01)-0.01 (-0.03 to 0.01)MASES (0-39)0.00 (-0.02 to 0.02)-0.00 (-0.03 to 0.02)CRP (mg/L)0.01 (-0.00 to 0.01)0.00 (-0.01 to 0.01)Any EAM (presence vs absence)-0.05 (-0.21 to 0.11)-0.09 (-0.28 to 0.10)BASFI (0-10)0.14 (0.08 to 0.19)*0.08 (0.00 to 0.16)*BASMI linear (0-10)-0.07 (-0.16 to 0.02)-0.10 (-0.22 to 0.02)mNY grading (0-8)0.01 (-0.03 to 0.06)0.06 (0.01 to 0.12)*mSASSS (0-72)-0.01 (-0.04 to 0.02)0.00 (-0.03 to 0.04)

* p-value < 0.05

¶ Each joint graded 0-3

§Adjusted for the outcome (i.e. BAS-G) one year before, in order to disentangle the cross-sectional and longitudinal relationships between outcomes and allow the interpretation of a longitudinal relationship

Conclusion:

A higher level of back pain was associated with a worsening of the patient’s well-being in early axSpA, as were, though to a lesser extent, higher levels of fatigue, morning stiffness, peripheral joint pain and physical disability. Contextual factors like age, gender and educational level did not have an impact on these relationships. Thus, the previously proposed framework of disease outcomes also applies to patients with early axSpA and to outcomes over time.

References:

[1]Machado, P. ARD 2011.

Disclosure of Interests:

Fumio Hirano Paid instructor for: Ono pharmaceuticals, Astellas Pharma Inc, Sumitomo Dainippon Pharma, Chugai Pharmaceutical Co., Ltd., Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Floris A. van Gaalen: None declared, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Cecile Gaujoux-Viala: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis

Risk of fracture and low bone mineral density in adults with inflammatory bowel diseases. A systematic literature review with meta-analysis

Inflammatory bowel diseases (IBDs) are associated with a decreased bone mineral density, but the impact on fractures is unknown. In our study, global risk of fracture is increased for patients with IBDs versus controls. This result will help to determine the appropriate assessment with early screening and management of osteoporosis. Inflammatory bowel diseases (IBDs), such as Crohn's disease (CD) and ulcerative colitis (UC), are associated with a decreased bone mineral density (BMD). However, the impact on fracture risk is unknown and data are contradictory across studies. In this systematic review and meta-analysis, we aimed to assess the risk of fracture and presence of low BMD in patients with IBDs compared to healthy controls. A systematic search of literature was conducted of MEDLINE, EMBASE, the Cochrane library and abstracts from appropriate scientific congresses. Studies were selected if they compared the incidence of fractures and/or BMD measurement by dual-energy X-ray absorptiometry in patients with IBDs and healthy sex- and age-matched controls. Data were extracted by two independent investigators. Meta-analysis was performed with the inverse variance approach to estimate pooled odds ratios (ORs) and risk ratios (RRs) with their 95% confidence intervals (CIs). Twenty-four studies met the inclusion criteria. On the basis of nine studies, global risk of fracture was increased for patients with IBDs versus controls (RR = 1.38, 95% CI 1.11-1.73; p = 0.005). Fracture risk with IBDs was significantly increased for vertebral fractures (OR = 2.26, 95% CI 1.04-4.90; p < 0.001), but not for any other site. The analysis of 16 studies evaluating BMD showed a significant decrease in mean BMD and Z-scores for IBD patients versus controls at all sites. In our meta-analysis, patients with IBDs have an increased risk of fractures, especially in the spine, and significant decreased BMD at all sites, which suggests the need for identifying high-risk individuals among this population.

Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis

OBJECTIVES

To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA) to inform the European League Against Rheumatism(EULAR) Task Force treatment recommendations.

METHODS

Medline, Embase and Cochrane databases were searched for articles published between January 2009 and February 2013 on infliximab, etanercept, adalimumab, certolizumab-pegol, golimumab, anakinra, abatacept, rituximab, tocilizumab and biosimilar DMARDs (bsDMARDs) in phase 3 development. Abstracts from 2011 to 2012 American College of Rheumatology (ACR) and 2011-2013 EULAR conferences were obtained.

RESULTS

Fifty-one full papers, and 57 abstracts were identified. The randomised controlled trials (RCT) confirmed the efficacy of bDMARD+conventional synthetic DMARDs (csDMARDs) versus csDMARDs alone (level 1B evidence). There was some additional evidence for the use of bDMARD monotherapy, however bDMARD and MTX combination therapy for all bDMARD classes was more efficacious (1B). Clinical and radiographic responses were high with treat-to-target strategies. Earlier improvement in signs and symptoms were seen with more intensive initial treatment strategies, but outcomes were similar upon addition of bDMARDs in patients with insufficient response to MTX. In general, radiographic progression was lower with bDMARD use, mainly due to initial treatment effects. Although patients may achieve bDMARD- and drug-free remission, maintenance of clinical responses was higher with bDMARD continuation (1B), but bDMARD dose reduction could be applied (1B). There was still no RCT data for bDMARD switching.

CONCLUSIONS

The systematic literature review confirms efficacy of biological DMARDs in RA. It addresses different treatment strategies with the potential for reduction in therapy, particularly with early disease control, and highlights emerging therapies.