Evaluation of discontinuation for adverse events of JAK inhibitors and bDMARDs in an international collaboration of rheumatoid arthritis registers (the 'JAK-pot' study)

BACKGROUND

In a clinical trial setting, patients with rheumatoid arthritis (RA) taking the Janus kinase inhibitor (JAKi) tofacitinib demonstrated higher adverse events rates compared with those taking the tumour necrosis factor inhibitors (TNFi) adalimumab or etanercept.

OBJECTIVE

Compare treatment discontinuations for adverse events (AEs) among second-line therapies in an international real-world RA population.

METHODS

Patients initiating JAKi, TNFi or a biological with another mode of action (OMA) from 17 registers participating in the 'JAK-pot' collaboration were included. The primary outcome was the rate of treatment discontinuation due to AEs. We used unadjusted and adjusted cause-specific Cox proportional hazard models to compare treatment discontinuations for AEs among treatment groups by class, but also evaluating separately the specific type of JAKi.

RESULTS

Of the 46 913 treatment courses included, 12 523 were JAKi (43% baricitinib, 40% tofacitinib, 15% upadacitinib, 2% filgotinib), 23 391 TNFi and 10 999 OMA. The adjusted cause-specific hazard rate of treatment discontinuation for AEs was similar for TNFi versus JAKi (1.00, 95% CI 0.92 to 1.10) and higher for OMA versus JAKi (1.11, 95% CI 1.01 to 1.23), lower with TNFi compared with tofacitinib (0.81, 95% CI 0.71 to 0.90), but higher for TNFi versus baricitinib (1.15, 95% CI 1.01 to 1.30) and lower for TNFi versus JAKi in patients 65 or older with at least one cardiovascular risk factor (0.79, 95% CI 0.65 to 0.97).

CONCLUSION

While JAKi overall were not associated with more treatment discontinuations for AEs, subgroup analyses suggest varying patterns with specific JAKi, such as tofacitinib, compared with TNFi. However, these observations should be interpreted cautiously, given the observational study design.

Oral glucocorticoid use in patients with rheumatoid arthritis initiating TNF-inhibitors, tocilizumab or abatacept: Results from the international TOCERRA and PANABA observational collaborative studies

OBJECTIVE

To evaluate and compare the use of oral glucocorticoids with three classes of bDMARDs in patients with rheumatoid arthritis (RA).

METHODS

We included patients from 13 observational registries treated with a TNF-inhibitor, abatacept or tocilizumab and with available information on the use of oral glucocorticoids. The main outcome was oral glucocorticoid withdrawal. A McNemar test was used to analyse the change in the use of glucocorticoids after 1 year. Kaplan-Meier estimates and Cox regressions, adjusted for patient, treatment, and disease characteristics, were used to evaluate glucocorticoid discontinuation in patients with glucocorticoids at baseline. Because of heterogeneity, analyses were done by registers and pooled using random-effects meta-analysis.

RESULTS

A total of 12,334 participants treated with TNF-inhibitors, 2100 with tocilizumab and 3229 with abatacept were included. At one-year, oral glucocorticoid use decreased in all treatment groups (odds ratio for stopping vs. starting of 2.19 [95% CI 1.58; 3.04] for TNF-inhibitors, 2.46 [1.39; 4.35] for tocilizumab; 1.73 [1.25; 2.21] for abatacept). Median time to glucocorticoid withdrawal was ≈2 years or more in most countries, with a gradual decrease over time. Compared to TNF-inhibitors, crude hazard ratios of glucocorticoid discontinuation were 0.65[0.48-0.87] for abatacept, and 1.04 [0.76-1.43] for tocilizumab, and adjusted hazard ratios were 1.1 [0.83-1.47] for abatacept, and 1.30 [0.96-1.78] for tocilizumab.

CONCLUSION

After initiation of a bDMARD, glucocorticoid use decreased similarly in all treatment groups. However, glucocorticoid withdrawal was much slower than advocated by current international guidelines. More effort should be devoted to glucocorticoid tapering when low disease activity is achieved.

After JAK inhibitor failure: to cycle or to switch, that is the question - data from the JAK-pot collaboration of registries

OBJECTIVES

The expanded therapeutic arsenal in rheumatoid arthritis (RA) raises new clinical questions. The objective of this study is to compare the effectiveness of cycling Janus kinase inhibitors (JAKi) with switching to biologic disease-modifying antirheumatic drug (bDMARD) in patients with RA after failure to the first JAKi.

METHODS

This is a nested cohort study within data pooled from an international collaboration of 17 national registries (JAK-pot collaboration). Data from patients with RA with JAKi treatment failure and who were subsequently treated with either a second JAKi or with a bDMARD were prospectively collected. Differences in drug retention rates after second treatment initiation were assessed by log-rank test and Cox regression analysis adjusting for potential confounders. Change in Clinical Disease Activity Index (CDAI) over time was estimated using a linear regression model, adjusting for confounders.

RESULTS

365 cycling and 1635 switching patients were studied. Cyclers were older and received a higher number of previous bDMARDs. Both strategies showed similar observed retention rates after 2 years of follow-up. However, adjusted analysis revealed that cycling was associated with higher retention (p=0.04). Among cyclers, when the first JAKi was discontinued due to an adverse event (AE), it was more likely that the second JAKi would also be stopped due to an AE. Improvement in CDAI over time was similar in both strategies.

CONCLUSIONS

After failing the first JAKi, cycling JAKi and switching to a bDMARD appear to have similar effectiveness. Caution is advised if an AE was the reason to stop the first JAKi.

Effectiveness of TNF-inhibitors, abatacept, IL6-inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the 'JAK-pot' collaboration

BACKGROUND

JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers.

METHODS

In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk.

RESULTS

We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA.

CONCLUSION

The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.

DISEASES OF THE ORAL MUCOSA IN PATIENTS IN THE POST-COVID PERIOD

The impact of SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus-2) on the entire human body causes irreversible changes in all organs and systems. Complications in the form of chronic diseases require the treatment of clinicians in various fields of medicine. Dentists are faced with diseases of the oral mucosa in apparently healthy patients who are not predisposed to them but have undergone COVID-19. Purpose of the study - to assess the impact of the coronavirus infection (COVID-19) on the course of diseases of the oral mucosa. We examined 51 patients aged 20 to 75 who had undergone COVID-19 with various diseases of the oral mucosa. The study used clinical and laboratory methods. The features of the clinical course of certain diseases of the oral mucosa were revealed, the dynamics of the local immune defense of the oral cavity in the post-covid period was determined.

AB0306 PNEUMOCOCCAL VACCINATION REDUCES THE RISK OF RESPIRATORY INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TARGETED THERAPY. DATA FROM MOSCOW UNIFIED ARTHRITIS REGISTRY (MUAR)

Background

The incidence of infections, mainly pneumonias, is significantly increased in patients with rheumatoid arthritis (RA). The risk increases more in persons treated with targeted anti-inflammatory drugs (tDMARDs), biological or targeted synthetic.

Pneumococcal vaccination is recommended for most patients with rheumatic diseases. However, only the immunological effectiveness of such vaccination has been sufficiently confirmed. There is sparse evidence of its clinical efficacy in patients with rheumatic diseases.

Objectives

to evaluate the effect of 23-valent pneumococcal polysaccharide vaccine (PPV23) and 13-valent pneumococcal conjugate vaccine (PCV13) on the risk of infections in RA patients receiving tDMARDs.

Methods

The data from the Moscow Unified Arthritis Registry (MUAR) for the period 2018-2020 were analyzed. We included patients with RA, over 18 years old, received tDMARDs (all available biologics or tofacitinib).

The analysis included episodes of observation from the moment of vaccination with pneumococcal vaccine until the development of the analyzed event (any infection, respiratory infection or serious infection) or until the end of follow up. For unvaccinated patients, episodes began since October 20, 2018 (the average date of vaccination of persons who received immunization).

The risks were compared using Cox regression. An adjustment was made for confounders identified in an earlier study: age and smoking.

Results

The analysis included 832 patients: 40 were vaccinated with PCV13, 35 – with PPV23. There were 144 men (17.3%). The mean age was 55.4 ± 12.1 years. The duration of observation was 319 ± 198 days.

A total of 237 infectious events were registered, of which 201 were respiratory and 21 serious (Table 1). There was a significantly lower risk of any infection (relative risk (RR) – 0.39 CI: 0.18 - 0.84, p = 0.015) and the risk of respiratory infection (RR - 0.32; CI: 0.13 -0.79; p = 0.014) in the group of patients vaccinated with PCV13 compared with unvaccinated. The differences remained statistically significant after adjusting for the age and smoking, Figure 1.

Table 1.

Registered infectious events

Event groupsLocalisationNumberOf them seriousRespiratory infectionsEar, paranasal sinuses, tonsils162Upper respiratory tract1660Pneumonia1814Lung abscess11Other infectionsEye and appendages30Skin and subcutaneous tissue71Bones and joint22Urogenital tract60Digestive system, including the oral cavity21Herpes infections*160

* - events are included in the group, regardless of localization, these events were not included in other sections

Figure 1.

Survival without infectious events (A) and without respiratory infections (B) adjusted for age and smoking

The interaction of the effects of vaccination with the factor of the used tDMARD, as well as with the factor of the use of methotrexate in their effect on the risk of any and respiratory infections was evaluated. There was no significant interaction between these variables.

There were no significant differences in the risk of serious infections due to a small number of events of this kind. No serious infections were registered among patients vaccinated with PCV13.

Conclusion

Vaccination with 13-valent conjugated pneumococcal vaccine in patients with rheumatoid arthritis receiving tDMARDs can significantly reduce the risk of infectious complications, mainly due to acute respiratory infections. We found no significant effect of targeted drug and treatment with methotrexate on the effectiveness of vaccination.

Disclosure of Interests

Evgeniy Zhilyaev Speakers bureau: UCB Pharma, Biocad, Galina Lukina Speakers bureau: Pfizer, MSD, Biocad, Ekaterina Koltsova: None declared, Dzhamilya Murtazalieva: None declared, Evgeniya Shmidt: None declared, Karine Lytkina Speakers bureau: UCB Pharma, Anna Shmitko: None declared, Dmitry Blagovidov: None declared, Mikhail Kostinov: None declared

POS1310 LONG - TERM OUTCOMES IN ADULT PATIENTS WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS

Background

Systemic juvenile idiopathic arthritis (sJIA) debuts in childhood and persists throughout the patient’s lifetime. Currently there is not enough information about the course and therapeutic approaches in patients who have reached the age of 18 and moved from pediatric service to adult healthcare system.

Objectives

Evaluate long - term outcomes in patients with sJIA over 18 years of age.

Methods

Thirty - two patients with sJIA have been analyzed after their transition to adult rheumatological chain. The following parameters have been estimated: clinical manifestations, disease duration, radiological changes, medication intake, disease activity, number of arthroplasties, pregnancy, level of education. Disease activity has been assessed using a standardized DAS28 index (remission - less than 2.6, low activity - from 2.6 to 3.2, moderate activity - from 3.2 inclusive to 5.1, high activity - more than 5.1) and counting systemic manifestations.

Results

Among patients included in the study, there were 11 men (34.38%) and 21 women (65.62%); the average age at the time of inclusion was 23.68 (±5.93). In 13 (40.63%) patients the onset of the disease occurred before the age of 5, in 7 (21.87%) - from 6 to 10 years and in 12 (37.50%) - after 11 years. In 9 (28.13%) patients the duration of the disease was less than 10 years, in 23 (71.87%) patients – more than 11 years. The onset of the disease was accompanied by the following symptoms: fever - 28 (87.50%) patients, arthritis - 21 (65.63%), rash - 17 (53.13), arthralgia - 6 (18.75%), pericarditis - 4 (12.50%), sore throat - 4 (12.50%), lymphadenopathy - 3 (9.38%), hepatomegaly - 2 (6.25%). Among patients with arthritis 11 (52.38%) had oligoarthritis, 10 (47.62%) had polyarthritis. 2 patients (6.25%) were diagnosed with uveitis. According to the X-ray examination (Steinbrocker’s classification of radiographic changes): 5 (15.63%) patients had the I stage, 13 (40.62%) - the II stage, 4 (12.50%) - the III stage, 6 (18. 75%) - the IV stage and 4 (12.50%) had no radiological changes. Three (9.38%) were diagnosed with aseptic necrosis and these patients underwent arthroplasty. Four (12,50%) patients had pregnancy.

Education: 17 (53.13%) people study at higher educational institutions. Two (6.25%) have a higher educational level.

Disease activity: 24 (75%) patients are currently in low activity or disease remission, 8 (25%) are in moderate activity. Twenty (62.50%) patients receive therapy with disease - modifying antirheumatic drugs (DMARDs), 14 of them take methotrexate at an average dose of 12.68 (±3.98) mg. 6 (18.75%) patients take glucocorticoids at a dose of 1 to 8 mg per day. Non - steroidal anti - inflammatory drugs (NSAIDs) are received by 2 (6.25%) patients. Biological disease - modifying antirheumatic drugs (bDMARDs) are used by 27 (84.38%) patients, 18 (66.67%) of whom are on therapy with tocilizumab.

Among the patients with low activity and disease remission: 15 out of 24 (62.50%) are treated with tocilizumab, 3 (12.50%) – with canakinumab, 3 (12.50%) – with etanercept, and 1 (4.17%) – with adalimumab; 2 (8.33%) patients don’t take bDMARDs.

Conclusion

The use of bDMARDs helps successfully control the disease in patients with sJIA, maintain long - term remission and improve long - term outcomes in adult patients with sJIA.

Disclosure of Interests

None declared

POS1056 PREDICTORS OF RISK OF ANTI-TNF TREATMENT WITHDRAWAL IN PATIENTS WITH PSORIATIC ARTHRITIS – DATA FROM MOSCOW UNIFIED ARTHRITIS REGISTRY (MUAR)

Background

Retention on therapy is the most important integrative indicator of the success of the drug, reflecting both the effectiveness and tolerability and general acceptability of treatment. This indicator can be evaluated with high accuracy in observational trials.

Objectives

to identify predictors of TNF inhibitors withdrawal risk in patients with PSA.

Methods

Patients with (PSA) from Moscow Unified Arthritis Registry (MUAR) treated with TNF inhibitors were analyzed. All treatment episodes interrupted due to non-medical reasons were excluded from the study. Breaks in biologic therapy up to 4 months were allowed (for infliximab a break in therapy up to 6 month was considered possible)

The search for predictors of treatment withdrawal risk was carried out in two steps. At the first step possible predictors of the risk of TNF inhibitors therapy discontinuation were selected in univariate сorrelations. At the second step significant predictors of retention on TNF inhibitors therapy were selected by forward stepwise variable selection within multivariate Cox regression. The relationship between the line of anti-TNF treatment and the risk of therapy discontinuation was analyzed separately.

Results

We analyzed 371 treatment episodes in 239 patients with PSA enrolled in MUAR, 97 male (40.6%), 50.2±12.1 years old. The age of disease onset was 36.8 ± 12.7 years. The patients received adalimumab (ADA) (101 treatment episodes), golimumab (GOL) (n=32), infliximab (INF) (n=55), certolizumab pegol (CER) (n=31), etanercept (ETA) (n=152). There were 187 (50.4%) completed treatment episodes.

The relationship between risk of TNF inhibitors discontinuation and the drug line was analyzed. We found that the withdrawal risk on the second TNF inhibitor didn’t significantly differ from the withdrawal risk on the first line anti-TNF drug (p=0,201). The third and subsequent lines of TNF inhibitors where associated with the significantly higher risk of withdrawal. Direct step-by-step selection of variables made possible to identify the following significant predictors of retention on therapy – social status, the presence of HLA B-27, fever during the disease, pain in sacral zone at the onset of the disease, coccidinia during the disease, patient reports on the association of the onset of the disease with a genital infection (uretritis, adnexitis, prostatitis, endometritis) (Table 1)

Table 1.

Independent predictors of anti-TNF treatment discontinuation

PredictorsDirection of association with the dicontinuitation riskpSocial statusWorking patients had a lower risk0.038The presence of HLA-B27HLA-B27 positive patients had lower risk0.005Temperature elevation during the diseasePatients WHO reported an increase in body temperature during the disease had an increased risk< 0.001Sacral pain at the onset of the diseasePatients who reported sacral pain at the onset of the disease had an increased risk0.037Coccygeal pain during the diseasePatients who reported pain in the coccyx during the disease had an increased risk0.026Presence of genital infectionsPatients who reported a link between the onset of the disease and a history of urethritis or endometritis had a high risk0.011

After adjusting for the line of therapy and the identified predictors of the risk of drug withdrawal it was found that retention on all analyzed TNF inhibitors in patients with PSA didn’t differ significantly (Figure 1)

Conclusion

The identified significant mutually independent predictors of the risk of discontinuation of treatment may be useful when choosing biological therapy in patients with PSA.

Discontinuation therapy risk of various TNF inhibitors does not differ significant.

The risk of withdrawal therapy with the second TNF inhibitor is not significantly differ from the first one. Thus, in case of failure of the first attempt of treatment with an TNF inhibitor, a second attempt can be made The probability of success of subsequent attempts seems to be very low

Figure 1.

Adjusted analysis of treatment survival on TNF inhibitors

Disclosure of Interests

None declared

OP0266 TREATMENT DISCONTINUATION DUE TO ADVERSE EVENTS AS AN OVERALL MEASURE OF TOLERANCE AND SAFETY OF JAK-INHIBITORS: AN INTERNATIONAL COLLABORATION OF REGISTRIES OF RHEUMATOID ARTHRITIS PATIENTS (THE “JAK-pot” STUDY)

Background

The recently presented “ORAL Surveillance Study” has suggested increased risk of serious adverse events (AEs) with tofacitinib, a JAK-inhibitor (JAKi), compared to a comparator TNF-inhibitor (TNFi). Currently, there is limited real world evidence for the tolerability and safety of JAKi (1).

Objectives

To assess the safety of JAKi compared to other biologic agents in rheumatoid arthritis (RA) patients in a real-world population, by evaluating treatment discontinuation for AEs.

Methods

Pooled patient database from 16 national RA registries from across Europe, Québec (Canada), Turkey, and Israel were used. Treatment discontinuation due to AEs by treatment groups, JAKi versus (vs) TNFi and JAKi vs bDMARDs with other modes of action (OMA), were compared as an overall measure of tolerability and safety of JAKi. Standard descriptive statistics were used for baseline characteristics. We plotted unadjusted cumulative incidence, then the cause-specific Cox model was used to account for competing risks, and to obtain association between covariates and the instantaneous hazard rate for AEs. Variables listed in Table 1 were used for adjustment in the fully-adjusted cause-specific Cox model.

Table 1.

Baseline characteristics of the study population

JAKi1(BARI, FILGO,TOFA,UPA)OMA2(ABA, ANAK, SARI, TOCI)TNFi3(ADA, CERT, ETAN, GOL, INFL)n = 9208n = 16737n = 64533Treatment duration* (yrs)0.7 [0.2, 1.7]1.1 [0.4, 2.8]1.5 [0.5, 3.9]Age57.556.853.2Female (%)81.380.773.2Disease duration (yrs)9.913.110.7Seropositivity (%)78.775.969.8Previous b/tsDMARD (%) 034.030.859.7 120.925.924.3 216.621.710.4 3 or more28.521.55.6Concomitant GC (%)44.650.741.3Concomitant CsDMARD (%)  MTX22.622.028.8  MTX + other9.59.713.1  None50.552.543.5  Other17.415.914.7CRP13.2 (24.1)13.3 (25.6)12.3 (24.1)CDAI23.7 (13.8)22.9 (13.5)22.6 (14.0)DAS 284.7 (1.5)4.7 (1.6)4.6 (1.6)HAQ1.2 (0.7)1.2 (0.7)1.1 (0.7)BMI27.1 (5.9)26.8 (5.8)26.8 (5.8)Patients with at least one Comorbidity (%)51.753.949.6

csDMARDs = classical synthetic DMARDs, MTX = methotrexate, GC = glucocorticoids, CRP = C-reactive protein, CDAI = Clinical Disease Activity Index, DAS 28 = Disease Activity Score 28, HAQ = Health Assessment Questionnaire, BMI = Body Mass Index, *Treatment duration (median [IQR]) = Last visit date – start date (if treatment is ongoing), treatment stop date – treatment start date (if treatment has stopped)

. 1BARI (baricitinib; 44.41 %), FILGO (filgotinib; 0.23%), TOFA (tofacitinib; 49.59%), UPA (upadacitinib; 5.78%); 2ABA (abatacept; 39.96%), ANAK (anakinra; 2.64%), SARI (sarilumab; 3.14%), TOCI (tocilizumab; 52.55%); 3ADA (adalimumab; 31.00%), CERT (certolizumab; 8.33%), ETAN (etanercept; 38.83%), GOLI (golimumab; 9.36%), INFL (infliximab; 12.56%)

Results

90,478 treatment courses were included in the analysis (Table 1). We observed similar crude incidence rate of treatment discontinuation due to AEs between JAKi and TNFi, but less in JAKi vs OMA (Figure 1). The fully adjusted hazard rate of treatment stop for AEs was also similar in JAKi vs TNFi (HR = 1.02 (95% CI 0.92 – 1.13)), and in JAKi vs OMA (HR= 1.08 (95% CI 0.97 – 1.20)). The rate of treatment stop for AEs was higher in women (HR = 1.29 (95% CI 1.21 – 1.37)) and with an increasing number of previous b/tsDMARDs (HR = 1.50; 1.48; 1.68 for 1, 2, and 3 or more previous b/ts DMARDs, respectively).

Figure 1.

Comparison of cumulative incidence of treatment discontinuation for adverse events in JAKi, TNFi, and OMA group

Conclusion

After adjusting for potential confounders, the rate of treatment discontinuation for AEs was comparable between JAKi and OMA or TNFi. Treatment discontinuation for AEs comprises a wide range of AEs; future analyses will be performed to investigate specific AEs, such as cancer, serious infections or major adverse cardiovascular events.

References

[1]Ann Rheum Dis 2022. doi: 10.1136/annrheumdis-2021-221915.

Disclosure of Interests

Eric Nham: None declared, Romain Aymon: None declared, Denis Mongin: None declared, Sytske Anne Bergstra: None declared, Denis Choquette Speakers bureau: DC reports speaker or consultant fees from Abbvie, Amgen, Eli Lilly, Fresenius-Kabi,Pfizer, Novartis, Sandoz, Tevapharm, Consultant of: Stated above, Catalin Codreanu Speakers bureau: CC reports speaker/consulting fees from AbbVie, Amgen, Astra Zeneca, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Richter, Consultant of: Stated above, Ori Elkayam Consultant of: OE has received consultant and honorary fees from Pfizer, Lilly, Abbvie, Novartis, Jansen, BI, Kimme Hyrich Speakers bureau: KLH has received speaker honoraria from Abbvie, Grant/research support from: KLH has received grant income from Pfizer and BMS, Florenzo Iannone Speakers bureau: FI has received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, SOBI, Roche and UCB, Consultant of: Stated above, Nevsun Inanc Speakers bureau: NI has received consultant and speaker/honoraria from Abbvie, Lilly, MSD, Novartis, Pfizer, Roche, Amgen, Celltrion,UCB., Consultant of: Stated above, Lianne Kearsley-Fleet: None declared, Eirik kristianslund: None declared, Tore K. Kvien Speakers bureau: TKK has received fees for speaking and/or consulting from several companies among them Pfizer, AbbVie, Lilly and Galapagos/Gilead, Consultant of: Stated above, Burkhard Leeb Speakers bureau: BFL has received speaker honoraria from Sandoz, Abbvie, Eli-Lilly, Pfizer, Roche, Grünenthal, Biogen, Celgene, Galina Lukina Speakers bureau: GVL has received speaker fees from Abbvie, Lilly, Novartis, MSD, Roche, Pfizer, Dan Nordström Consultant of: DCN has acted as consultant for AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Karel Pavelka Speakers bureau: KP has received honoraria for lectures: MSD, Pfizer, Roche, Eli Lilly, Medac, UCB, SOBI, Biogen, Sandoz, Viatris, Manuel Pombo-Suarez Speakers bureau: MPS reports advisor and speaker honoraria from Janssen, Lilly, MSD, Novartis, Sanofi, Consultant of: Stated above, Ziga Rotar Speakers bureau: ZR has received fees for speaking/consulting from several companies among them Pfizer, AbbVie, and Eli Lilly, Consultant of: Stated above, Maria Jose Santos Speakers bureau: MJS has received speaker fees from Abbvie, AstraZeneca, Lilly, Novartis and Pfizer, Delphine Courvoisier: None declared, Kim Lauper Speakers bureau: KL reports speakers fees for Pfizer, Viatris and Celltrion, Consultant of: KL reports consulting fees for Pfizer, Axel Finckh Speakers bureau: AF reports honoraria and consultancies from Pfizer, BMS, MSD, Eli-Lilly, AbbVie, Galapagos, Mylan, UCB, Viatris, Consultant of: Stated above, Grant/research support from: AF reports grants from Pfizer INC, AbbVie, Galapagos, Eli Lilly

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Disclosure of Interests

None declared

AB0403 EVALUATION OF THE SAFETY AND EFFICACY OF 13-VALENT PNEUMOCOCCAL VACCINE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Rheumatoid arthritis (RA) is accompanied by a significant increase in the risk of infection and serious infections, among which pneumonia occupies a leading place. (1) The use of targeted anti-inflammatory drugs is accompanied by an additional increase in the risk of infectious complications. In this regard, vaccination is crucial in the management of such patients.

Objectives

To evaluate the safety and efficacy of the 13-valent pneumococcal vaccine in patients with RA undergoing various types of antirheumatic therapy.

Methods

The study included 60 patients with a reliable diagnosis of RA, according to the criteria of ACR/EULAR, among them 8 men and 52 women, average age 63 years (from 29 to 69 years) with disease activity at the time of inclusion of Das-28 – 4.9 (2.2-7.7), bionaive patients with insufficient response to DMARDs who will be prescribed tofacitinib (TOFA) for the first time or receiving TOFA for at least 3 months (30 patients in each group). Both groups of patients were further subdivided into two groups, 15 vaccinated and unvaccinated patients in each. The exclusion criteria were: age over 70 years; patients with infectious diseases in the acute stage; having a history of intolerance to diphtheria toxoid, patients who had previously been vaccinated with pneumococcal vaccines. For the prevention of pneumococcal infection, a pneumococcal 13-valent polysaccharide conjugated adsorbed vaccine was used. Visits to assess the condition were made in the period of 0-3-12 months. The activity of the disease was assessed by the DAS 28, CDAI, SDAI indices.

Results

Among vaccinated patients with PCV 13 the most common adverse events were: pain at the injection site (16%), fever up to 37.6C (13%), redness at the injection site (6%), infiltration at the injection site (2%), myalgia (2%). These adverse events resolved spontaneously within 3 days. In a comparative assessment of infectious events during 12 months before vaccination and the next 12 months after it, there were no significant differences between vaccinated and unvaccinated patients. In patients who had a history of pneumococcal etiology infections after vaccination, the incidence decreased by 33%.

Conclusion

Vaccination against pneumococcal infection is a safe and effective method of preventing pneumococcal infection in patients with rheumatoid arthritis.

References

[1]Koivuniemi R., Leirisalo-Repo M., Suomalainen R., etc. Infectious causes of death in patients with rheumatoid arthritis: an autopsy study. Scand J Rheumatol 2006; 35)4): 273-6

Disclosure of Interests

Galina Lukina Speakers bureau: Ebbvie, Biocad, Pfizer, Roche, Dzhamilya Murtazalieva: None declared, Ekaterina Koltsova: None declared, Mikhail Kostinov: None declared, Anna Shmitko: None declared, Dmitry Blagovidov: None declared, Evgeniy Zhilyaev Speakers bureau: Ebbvie, Biocad, Pfizer, Roche

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusion

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

References

None

Disclosure of Interests

None declared

AB0771 Evaluation of the efficacy of inhibitors of tumor necrosis factor alpha for patients with ankylosing spondylitis in real clinical practice

Background

The question of the comparative efficacy of tumor necrosis factor-alpha (TNF-α) inhibitors is topical today, because the research data that were distributed in random sequence mainly reflect the efficacy of the only specific drug, and the available data obtained in the ankylosing spondylitis (AS) treatment use of a network meta-analysis are limited.

Objectives

To make a comparative evaluation of the efficacy of various TNF-α inhibitors for patients with AS in real clinical practice.

Methods

The study involved patients with a reliable diagnosis of AS (according to the 1984 New York criteria) who received TNF-α inhibitor during the 12-month course of therapy, from 2018 to 2022. The efficacy of the drugs was evaluated by the ASDAS (CRP) (Ankylosing Spondylitis Disease Activity Score) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) – disease activity indices obtained 6 and 12 months after the start of therapy. Comparison of indicators between drugs was carried out using a non-parametric Kruskal-Wallis test, designed to test the equality of the medians of several samples.

Results

The study involved 257 patients with AS who were treated with various TNF-α inhibitors, among which Adalimumab was taken by 77 patients (29.96%), Golimumab - 20 (7.78%), Infliximab - 15 (5.84%), Certolizumab pegol - 27 (10.51%) and Etanercept - 118 (45.91%). The mean age of the involved patients was 46.1 ± 11.4 years old, the mean age at the onset of the disease was 28.7 ± 11.7 years old. The majority of patients were males - 167 (64.98%), 143 (55.64%) had Higher education, 163 (63.42%) were married, 103 (40.08%) have been working and - 150 patients (58.37%) had never smoked before the study. Mean ASAS (CRP) and BASDAI, disease activity indices, values ​​for each drug before therapy, 6 and 12 months after the start of therapy are presented in Table 1. «Head-to-head» comparison of medical preparations revealed no significant differences between TNF-α inhibitors in terms of the studied parameters (p > 0.05).

Table 1.Months since start of therapyBASDAIASDAS (CRP)Adalimumab05,843,3863,521,91124,112,24Golimumab05,913,2965,172,91124,612,68Infliximab03,562,2562,591,08122,201,39Certolizumab pegol06,573,8063,382,17123,502,81Etanercept06,133,7963,752,20123,802,28

ASDAS - Ankylosing Spondylitis Disease Activity Score; BASDAI - Bath Ankylosing Spondylitis Disease Activity Index; CRP - C-reactive protein

Conclusion

The studied TNF-α inhibitors demonstrate similar clinical efficacy in real clinical practice. A direct comparison of drugs didn’t reveal significant differences between TNF-α inhibitors.

Disclosure of Interests

None declared

AB1475 SERUM LEVELS OF INFLAMMATORY BOWEL DISEASE-SPECIFIC ANTIBODIES IN ANKYLOSING SPONDYLITIS

Background

Ankylosing spondylitis (AS) is an immune-mediated inflammatory disease of the musculoskeletal system, that is often accompanied with a subclinical intestinal inflammation. Inflammatory bowel diseases (IBD), including, Crohn’s disease (CD) and ulcerative colitis (UC), are the most frequent extra-articular manifestation in patients (pts) with AS. Several autoantibodies and antimicrobial antibodies are used as additional non-invasive serological markers for the diagnosis of CD and UC [1]. The evaluation of IBD-associated antibodies in AS pts provided conflicting results [2, 3].

Objectives

The aim of the study was to determine the serum levels of IBD-specific antibodies in AS.

Methods

We studied 51 pts with AS fulfilled modified New York criteria (1984); (40M/11F); median and interquartile range (25th—75th percentile) of age 44.0; 34.0-49.0 years; disease duration 12.0; 5.0-20.0 years; BASDAI - 5.3; 4.5-6.4; ASDAS ESR - 3.6; 3.0-4.4; ASDAS CRP - 3.7; 2.8-4.5; 40% HLA-27 positive. In 22% of pts with AS, IBD (CD and UC) were diagnosed. The control group included 44 healthy donors (HC). Atypical perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) were detected using indirect immunofluorescence. The serum levels of IgA/IgG antibodies to Saccharomyces cerevisiae (ASCA), IgA/IgG antibodies to glycoprotein 2 (GP2), IgG antibodies to cathepsin G, lactoferrin, elastase and bactericidal permeability-increasing protein (BPI) were detected by ELISA.

Results

AS pts without signs of IBD and AS with IBD (AS/IBD) pts had significantly higher serum levels of IgA ASCA, IgA anti-GP2, anti-elastase antibodies than HC (4.5; 2.6-6.4 U/ml and 4.9; 3.7-7.3 U/ml vs 1.9; 0.6-2.6 U/ml, p=0.0008, p=0.001; 1.2; 0.8-5.5 U/ml and 1.2; 0.9-11.8 U/ml vs 0.7; 0.6-1.3 U/ml, p=0.007, p=0.02; 8.2; 5.9-9.9 U/ml and 9.1; 8.5-10.5 U/ml vs 5.6; 4.7-8.3 U/ml, p=0.01, p=0.003). The median concentration of anti-cathepsin G antibodies was greater for AS/IBD pts than AS pts (0.8; 0.5-1.0 U/ml vs 0.4; 0.3-0.6 U/ml, p=0.02). In AS and AS/IBD, the occurrence of anti-elastase antibodies (23.0%, 33.0%) was higher than for HC (0%, p=0.05, p=0.01). The positivity rate of IgA anti-GP2 in AS/IBD exceeded that in HC (27.0% vs 0%, p=0.025). AS/IBD pts demonstrated a higher prevalence of pANCA (36.0%), and anti-BPI antibodies (36.0%), when compared to AS alone (4.8%, p=0.005, and 8.0%, p=0.02) and HC (0%, p=0.0001, and 0%, p=0.008).

Conclusion

Our findings indicate that elevated serum levels of IgA ASCA, IgA anti-GP2, anti-elastase antibodies in AS did not differ from those in AS/IBD and may serve as potential biomarkers for predicting intestinal inflammation at an early stage. For AS/IBD, the most useful diagnostic markers were atypical pANCA, IgA ASCA, IgA anti-GP2, anti-elastase and anti-BPI antibodies.

References

[1]Prideaux L, De Cruz P, Ng SC, Kamm MA. Serological antibodies in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2012; 18(7):1340-55.

[2]Benfaremo D, Luchetti M, Gabrielli A. Biomarkers in inflammatory bowel disease-associated spondyloarthritis: state of the art and unmet needs. J Immunol Res. 2019 May 30; 2019:8630871.

[3]De Vries M, Van Der Horst-Bruinsma I, Van Hoogstraten I., et al. pANCA, ASCA, and OmpC antibodies in patients with ankylosing spondylitis without inflammatory bowel disease. J Rheumatol. 2010; 37(11):2340–4.

Disclosure of Interests

None declared

AB0162 PREDICTION OF TREATMENT DISCONTINUATION DUE TO ADVERSE EVENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS USED BIOLOGICAL DMARDs AND TARGETED SYNTHETIC DMARDs

Background

The main goal of rheumatoid arthritis (RA) patients therapy is to achieve low activity or remission of the disease (T2T strategy). However, it is sometimes necessary to interrupt effective treatment due to the development of adverse events.

Objectives

To reveal predictors of target drug withdrawal due to adverse RA.

Methods

The study includes patients with RA used bDMARDs, total 1217 treatment events. Search for predictors was carried out in two steps. At the first step were selected variables which demonstrated significant correlation with time to treatment discontinuation in Kaplan-Meier analysis. At the second step selected factors were included in the Cox regression model. The final set of independent significant predictors was obtained by backward stepwise variable selection.

Results

Of 661 patients 85,8% were women, the mean age of onset disease 58,7 ± 12,9 years, the mean disease duration 14,6 years. The longest mean time till withdrawal due to adverse events had Abatacept, Toficitinib, Tocilizumab, the shortest time had Infliximab. There were 146 cases of therapy discontinuation due to adverse events. The side effects that caused the cancellation of treatment were: infections of respiratory system, skin, urinary system, allergic and infusion reactions, drug-induced hepatitis, changes in the hematopoietic system, death and other. Рresence of rheumatoid nodules (p < 0.001), higher doses of glucocorticoids (p<0.001), lower doses of methotrexate (p = 0.009) were independent significant predictors of increased risk of bDMARDs withdrawal due to adverse events. Used target drug also showed independent significant correlation with this risk. Relative risk (compared to Etanercept) was for Infliximab - 6.57 (CI: 3.69-11.73), Certolizumab pegol - 2.61 (CI: 1.23-5.56), Abatacept - 1.23 (CI: 0.65-2.30), Adalimumab - 1.37 (CI: 0.75-2.50), Rituximab - 0.56 (CI: 0.26-1.20), Tofacitinib - 0.46 (CI: 0.15-1.40), Tocilizumab - 0.77 (CI: 0.37-1.60).

Conclusion

Growth glucocorticoid doses for every 1 mg increases the risk of discontinuation of therapy by 8.7%. Reducing the methotrexate doses for every 1 mg increases the risk of discontinuation of bDMARDs and tsDMARDS by 3%. There are significant differences between target drugs for the risk of cancellation due to adverse events. High risk of infliximab discontinuation was associated more with infusion reactions and infection, discontinuation of certolizumab pegol was associated with infection.

References

[1]The identified predictors for the treatment withdrawal due to side effects may be discussed to identify measures necessary to prevent adverse events in patients with RA who are using bDMARDs and tsDMARDs. These measures are: the use of full doses of methotrexate, avoid long-term use of glucocorticoids, or prescription of the targeted drug with lower risk of adverse events.

Disclosure of Interests

None declared

AB0853 The role of IL-17, IL-23 serum levels in patients with ankylosing spondylitis with inflammatory bowel diseases

Background

Currently, there is a lot of interest in the frequency and risks of developing of inflammatory bowel diseases (IBD) in patients with ankylosing spondylitis (AS) [1]. IL-17 and IL-23 are one of the key pathogenetic markers of AS [2]. A lot of studies also showed that the average number of IL-17 cells was significantly increased in active Ulcerative colitis (UC) and Crohn disease (CD) patients [3]. According to some studies cytokines, such as IL-17 and IL-23, play crucial role in intestinal protection and homeostasis [4].

Objectives

The aim of this study was to evaluate IL-17 and IL-23 serum levels in patients with AS without IBD and with AS and IBD.

Methods

In the analysis were included 50 patients with AS, fulfilling the modified New York criteria, among them man-36 (72%), woman-14 (28%), mean age of patients was 42.5±9.9, mean disease duration – 13.4±8.7 years. All patients were examined with ESR, CRP, esophagogastroduodenoscopy, colonoscopy, IL-17 and IL-23, using enzyme-linked immunosorbent assay for the quantitative measurement of IL-17 and IL-23 in serum ELISA kit. IL-17 and IL-23 levels were also studied in control group (13 healthy donors), mean IL-17 was 1.16±1.02 pg/mL, mean IL-23 was 33.03±18.02 pg/mL.

Results

All patients had a high disease activity, mean BASDAI was 5.3± 1.8, mean ASDAS CRP 3.7±1.01, mean ASDAS ESR 3.6±1.01. IBD were diagnosed in 11 cases: 6 patients (12%) with CD and 5 patients (10%) - UC, in the remaining cases (78%-39 patients) was no intestinal pathology. Patiens with AS had higher levels of IL-17(10.4±9.1 pg/ml) and IL-23(188±156 pg/ml), than the group of healthy donors. Patients with AS and IBD had slightly lower IL-17(6.7±4.5 pg/ml) and IL-23(155.5±97 pg/ml) levels than patients with AS without IBD(p=0.03). IL-23 was positively correlated with ESR (r=0.5) and CRP (r=0.5) (p <0.001) levels, however IL-17 level had negative correlation with ESR and CRP level (r=-0.2) (p<0.001).

Conclusion

IL-23 and IL 17 serum levels in patients with AS and IBD was lower than in patients with AS without IBD. There is a significant association between the CRP, ESR and IL-23 level, but not with IL-17.

References

[1]Lukina G.V., Kulakova P.I., Novikov A.A., Savenkova N.A., Alexandrova E.A., Volnukhin E.V., Kovshik A.N. Frequency of inflammatory bowel diseases in patients with ankylosing spondylitis. Medical alphabet. 2019;2(37):12-15. https://doi.org/10.33667/2078-5631-2019-2-37(412)-12-15.

[2]Sherlock JP, Taylor PC, Buckley CD. The biology of IL-23 and IL-17 and their therapeutic targeting in rheumatic diseases. Curr Opin Rheumatol. 2015 Jan;27(1):71-5.doi:10.1097/BOR.0000000000000132.

[3]Fujino S, Andoh A, Bamba S, et al. Increased expression of interleukin 17 in inflammatory bowel diseases. Gut.2003;52:65-70.

[4]Shen W, Durum SK. Synergy of IL-23 and Th17 cytokines: new light on inflammatory bowel disease. Neurochem Res. 2010 Jun;35(6):940-6. doi: 10.1007/s11064-009-0091-9

Disclosure of Interests

None declared

EVALUATION OF CHANGES IN THE PROFILE OF THE FACE DURING ORTHODONTIC TREATMENT OF DISTAL OCCLUSION CAUSED BY ANTEPOSITION OF THE UPPER JAW

Distal occlusion of the dentition is one of the most common anomalies in the Eastern European population. The widespread use of conservative treatment methods creates the need to predict the results of tooth movement. The problem of the influence of orthodontic treatment on the configuration of the soft tissues of the face is of paramount importance for the orthodontist. Purpose of the study: to evaluate changes in the profile of the face during orthodontic treatment of distal occlusion due to anteposition of the upper jaw. 13 patients aged 18-30 years with distal occlusion caused by anteposition of the upper jaw were examined and treated. A standard examination was carried out, including clinical, anthropometric and radiological diagnostic methods. Orthodontic treatment of all patients was carried out, including the removal of individual teeth in the upper jaw. The study shows the features of changing the configuration of the soft tissue profile of the face in the treatment of patients with distal occlusion of the dentition. As a result of orthodontic treatment, the position of the jaws in the sagittal and vertical planes remained practically unchanged. The soft tissue profile of the face was affected by a change in the position of the incisors. A thorough diagnosis of dentoalveolar anomalies, identification of facial configuration features and knowledge of the changes that accompany orthodontic movements will lead not only to the normalization of occlusion and function, but also to the harmonization of the soft tissues of the face.

CLINICAL AND RADIOGRAPHIC CHANGES FOLLOWING ORTHODONTIC INTRUSION OF OVERERUPTED MAXILLARY MOLARS WITH TWO MINI-IMPLANTS

Objective - to evaluate clinical and radiographic changes of orthodontic intrusion of upper first molars with two mini-implants, using light intrusion forces, to create the space for prosthetic rehabilitation on the lower jaw. In 20 patients (aged between 26.8 and 45) with secondary deformities in the lateral region in the vertical direction, associated with partial absence of teeth in the lower jaw, and orthodontic preparation for subsequent prosthetics was performed. Each subject was missing 1-2 teeth in the lateral segment. All patients were divided into two groups: with intrusion mechanics with orthodontic implants (20 people) and intrusion with an orthodontic shape memory arch (20 people). The radiographic changes in male and female groups were assessed and compared based on the panoramic radiographs and CBCT data before and after intrusion. In the study 28 molars were fully intruded and their position was normalized with two mini-implants placed palatally and buccally. Mean extrusion time was 7.86±0.42 months (P<0.001), mean intrusion length was 2.97±0.15 mm (P<0.001), and mean change of mesial molar inclination was 2.02±0.44 degrees (P<0,005). The degree of root resorption was evaluated according to CBCT data in Multiplanar reconstruction (MPR); 50% of molars had grade 0 of resorption, 42.85% had grade 1, and 7.15% of molars had grade 2. There was no resorption in the trifurcation area. Intrusion of molars can be successfully accomplished with 2 mini-implants, placed palatally and buccally, with a light traction force (30-50 g) of an elastic chain.

BIOMECHANICS OF CHANGING THE POSITION OF PERMANENT TEETH WITH EARLY LOSS OF THE FIRST TEMPORARY MOLARS

Premature removal of baby teeth is one of the main causes of deformation of the dentition. The loss of the first temporal molars is most often reported (39.9±4.8%), which leads to displacement of the teeth bordering on the defect, narrowing and shortening of the dental arch, which then leads to retention of premolars, cutting out permanent canines outside the dental arch, pathology of cutting out permanent molars. The aim of the study was to evaluate the biomechanics of permanent teeth migration in patients who prematurely lost their first temporal molars. An anthropometric study of jaw models and orthopantomograms was conducted in 25 patients (age 7-12 years) who had premature loss of the first temporal molars of the upper and lower jaws (age 7-12 years). Complications were evaluated, regularity was revealed and the biomechanics of permanent teeth displacement as a result of the prolonged absence of temporary molars were determined.

AB0703 THE COURSE OF COVID-19 INFECTION IN PATIENTS WITH ARTHRITIS RECEIVING TARGETED DMARDS

Background:

WHO declared the COVID-19 outbreak as a pandemic on March 12th, 2020. Assessing the risk of severe course in patients with rheumatic diseases, especially those who receive targeted immunosuppressive treatment, is an urgent problem for rheumatologists.

Objectives:

determine the relationship between used targeted biologic and synthetic DMARDs (tDMARDs) and the severity of course of COVID-19 infection.

Methods:

The analysis included the data of patients with chronic arthritis and COVID-19, used tDMARDs. COVID-19 infection was confirm by serology tests or immune system molecules (immunoglobulins/antibodies). The presence of symptoms, the need for hospitalization, and the need for oxygen therapy were considered as indicators of the severity of the infection. We also analyzed the spread of the lung involvement according to CT data, symptoms during the disease (fever, cough, anosmia, diarrhea).

Results:

Analyses included 78 patients, among them 32 patients has ankylosing spondylitis, 31 patients - rheumatoid arthritis, 12 patients has psoriatic arthritis, 3 patients - juvenile arthritis. The average age of the included patients was 51,8 ± 11,69. Most of patients used TNF inhibitors - 43 (Adalimumab -10, Golimumab -4, Infliximab – 4, Certolizumab pegol -3, Etanercept – 22), JAK inhibitor tofacitinib used 13 patients, 5 patients each was treated with Abatacept and Tocilizumab, 3 patients used Rituximab and 2 patients each used Netakimab and Ustekinumab (Table 1). None of the patients included in the analysis required treatment in the ICU and/or mechanical ventilation. The course of the disease in patients treated with tDMARDs did not seem to be more severe than in 5 patients with arthritis who stopped treatment with tDMARDs before the onset of the pandemic. There was a direct correlation between the severity of the infection and the age of the patients (p=0.007). There were no significant differences in the severity of the infection depending on the drug, including when adjusting for age.

Conclusion:

COVID-19 does not look extremely dangerous in patients with rheumatic diseases, used target DMARDs. Used of tsDMARDs doesn’t reliably increase the risk of COVID-19 severity. There is reliable correlation between age and COVID-19 severity.

Table 1.

Cohort characteristics

DrugsMean ageNumber ofpatientsPatientswithsymptomsHospitalized patientsAsymptomaticcourseAdalimumab41,0±11,410921Golimumab51,0±11,034400Infliximab42,7±11,84004Certolizumab41,6±11,73300Etanercept50,7±11,4222062Tofacitinib56,8±10,4131221Abatacept57,4±10,95411Tocilizumab48,8±10.95312Rituximab55,6±10,73310Netakimab44,0±15,82210Ustekinumab48,0±10,52101

Disclosure of Interests:

None declared

AB0245 ANALYSIS OF THE CLINICAL AND ANTIDESTRUCTIVE EFFECTS OF RITUXIMAB DEPENDING ON GENDER IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation of the synovial tissue and destruction of the underlying cartilage and bones. It was found that RA more often affects women than men, with a sex ratio of 3: 1. And the question of the influence of gender on the outcomes and course of RA remains controversial, there is no consensus on whether RA is worse in women or men. Recent reports indicate that women are less likely to achieve remission than men. Women suffer from RA at an earlier age and have higher markers of disease activity such as DAS28 and HAQ. Rituximab is a chimeric monoclonal antibody that targets the CD20 molecule expressed on the surface of B cells, it has been successfully and widely used for the treatment of rheumatoid arthritis, so it is of interest to assess whether gender influences the therapeutic and radiological effects of RTX.

Objectives:

The aim of this study was to analyze the impact of gender on the response to rituximab (RTX) in patients with RA.

Methods:

Initially, 221 women(w), 27 men(m), were examined to assess the clinical and X-ray effect (88w/6m), who received RTX treatment (1000 mgx2 or 500 mgx2). Both groups were comparable in terms of the main clinical and laboratory characteristics (age, duration of the disease, the number of preceding DMARDs, in both groups most patients were RF + and ACCP +, a high degree of activity according to DAS 8 - men - 5.6 [4.6-6.7], women - 6.04 [5.2-6.63] Initially, the degree of radiological changes in men is slightly higher than in women (p> 0.05). Clinical effect was scored by EULAR criteria, radiographic progression was assessed using Sharp/van der Heijde modified scoring method.

Results:

When assessing the clinical effect after 48 weeks in men, a significantly better effect of RTX treatment was noted in comparison with women (Δ DAS28, a significantly better effect was noted in men - Δ DAS28 =3.75[2.8-4.14], and Δ DAS28=1.3[0.37-2.72] in women, (p=0.04). Analyzing the X-ray effect after 48 weeks of RTM treatment: the absence of progression in terms of the total score in 83.33% of men and 60.98% of women; there was no progression in narrowing of the joint space in 83.33% of men and 65.85% of women, noteworthy that the account of erosion practically reaches statistical significance - inhibition of destruction in 100% of men and 74.31% of women (p = 0.06).

Conclusion:

Thus, having analyzed the clinical and antidestructive effects of RTM therapy depending on gender, we can conclude that the effect is significantly higher in the male group. Also, there is a tendency towards more effective inhibition of radiographic progression in men.

Disclosure of Interests:

None declared

AB0209 SERIOUS INFECTIOUS COMPLICATIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH BIOLOGICS

Objectives:

To study infectious complications of therapy with biologics, analyze the frequency of withdrawal of bDMARDs due to infectious complications.

Methods:

The ambispective analysis included data on 505 cases of prescribing biologics with different mechanism of action in 188 patients with rheumatoid arthritis (160 women, 28 men).

Results:

Patients in the study group received from 2 to 5 bDMARDs, mediana (25% -75%) 2 (2-3). Biologics were discontinued 326 times, of which due to the development of serious adverse reactions - 70 times, of which due to the development of infectious complications - 16 times (5% of all cases of discontinuations, 29% of all serious adverse reactions). During treatment with the first bDMARD, infectious complications that required discontinuation of the drug developed in 5.3% of cases (N = 10), with the second bDMARD - in 5.2% of cases (N = 4), no statistical differences were found between these groups. On the background of treatment with the third bDMARD, infectious complications led to the withdrawal of treatment in 14.3% of cases (N = 1), in the fourth - 0%, and in the fifth - 33.4% of cases (N = 1). There was no correlation between the number of sequentially prescribed biologics and the incidence of infectious complications. Most often, serious infections developed during treatment with drugs of the TNF-α inhibitor group (infliximab, etanercept, adalimumab, golimumab, certolizumab pegol) and tofacitinib. Out of 16 cases of infectious complications, 5 were associated with tuberculosis infection.

Conclusion:

Infectious complications make up a significant proportion (29%) of all serious adverse reactions leading to the discontinuations of biologics in patients with rheumatoid arthritis. The frequency of discontinuation of bDMARDs due to infectious complications was about 5% and did not change during treatment with both the first and second biologics. It is necessary to remain alert about tuberculosis infection and examine patients before prescribing and during treatment with bDMARDs.

Disclosure of Interests:

None declared

AB0241 FACTORS THAT DIFFERENTLY ASSOCIATE WITH THE RETENTION ON TARGETED THERAPY OF PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

A personalized approach to prescribing targeted drugs implies the availability of data that can be used to suggest that a particular drug is better suited for a given patient than others. Retention on the treatment can be considered as an integral indicator of the acceptability of the drug in real practice. For the purposes of treatment personalization, the indicators that are associated with better retention on some drugs and with worse retention, or that do not have a clear association with retention on others, are of particular interest.

Objectives:

to identify predictors those are differently associated with retention on different targeted drugs for the treatment of rheumatoid arthritis.

Methods:

Data of the patients with rheumatoid arthritis (RA) from the Moscow Unified Register of Arthritis (MUAR) were used. The analysis includes episodes of treatment with biological or synthetic targeted drugs (tDMARDs) that continue or end during the patient’s follow-up in the registry. Within the framework of the Cox proportional risk regression model, significant independent predictors of tDMARDs cancellation were identified. These indicators were later considered as confounders. Further, in the generated linear regression risk model, all available indicators were tested for the presence of a statistically significant interaction with the factor of used tDMARD.

Results:

The study included 944 episodes of tDMARDs treatment (Table 1.) in 832 patients. The average age is 55.3 + 12.4 years. There were 131 males (16.1%). The average duration of the disease is 13.1 + 9.4 years. Smoking, family history of RA, and the nature of RA onset (acute or gradual) were identified as reliable mutually independent predictors of retention on tDMARDs treatment. As a result of the search for indicators that reliably interact with used tDMARD, patient’s reports of the association of the onset of arthritis 1) with symptoms of intestinal dyspepsia (p < 0.001), 2) with genital inflammatory disease (p = 0.002) were revealed. Most strongly associated with factor 1) was retention on abatacept (ABA), rituximab (RIT), and tofacitinib (TOFA). The second indicator was most strongly associated with retention on ABA, adalimumab (ADA) and TOFA (Picture 1).

Table 1.

Description of treatment episodes included in the analysis

ABAADACERETAтGOLINFRITTOCTOFATotalNumber of episodes1751503418685513011393944Completed (%)39 (22,3%)51 (34,0%)13 (38,2%)55 (29,6%)2 (25,0%)39 (70,9%)31 (23,8%)14 (12,4%)9 (9,7%)253 (26,8%)Line of treatment 183 (47,4%)24 (70,6%)113 (60,8%)120 (80,0%)3 (37,5%)50 (90,9%)70 (61,9%)66 (50,8%)35 (37,6%)564 (59,7%) 262 (35,4%)6 (17,6%)52 (28,0%)24 (16,0%)2 (25,0%)4 (7,3%)22 (19,5%)39 (30,0%)30 (32,3%)241 (25,5%) 322 (12,6%)1 (2,9%)13 (7,0%)6 (4,0%)1 (12,5%)1 (1,8%)15 (13,3%)21 (16,2%)14 (15,1%)94 (10,0%)>  38 (4,6%)3 (8,8%)8 (4,3%)0 (0,0%)2 (25,0%)0 (0,0%)6 (5,3%)4 (3,1%)14 (15,1%)45 (4,8%)

ABA – abatacept, ADA – adalimumab, CER – certolizumab paegol, ETA- etanercept, GOL – golimumab, INF – infliximab, TOC- tocilizumab, TOFA – tofacitinib.

Conclusion:

Anamnestic indications of the association of the onset of rheumatoid arthritis with symptoms of intestinal dyspepsia and with preceding genital inflammation are differently associated with retention on different targeted drugs in patients with RA. These indicators can be used to personalize the treatment.

Picture 1.

Retention on the abatacept depending on the features of the onset of rheumatoid arthritis

Disclosure of Interests:

None declared

AB0837 SERUM YKL-40 LEVELS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS: RELATION TO DISEASE ACTIVITY AND JOINT DESTRUCTION

Background:

YKL-40 (chitinase-3-like 1 protein, human cartilage glycoprotein 39) is one of the major proteins secreted locally in the arthritic joint by activated macrophages, chondrocytes, synoviocytes and neutrophils, YKL-40 an important marker for inflammation, cartilage remodelling and synovial hyperplasia is recognized as a possible auto-antigen in rheumatoid arthritis (RA).

Objectives:

The aims of the study were to determine the serum level of YKL-40 in early RA and investigate his relationship with biomarkers of disease activity and joint destruction.

Methods:

We studied 22 patients with early RA (ACR/EULAR 2010 classification criteria); 4 males, 18 females; median and interquartile range (25th—75th percentile) of age 55,0 (43,0-64,0) years, disease duration 7,0 (5,0-11,0) months, DAS28 4,9 (4,3-5,8); 86% IgM rheumatoid factor (IgM RF) +; 91% anti-cyclic citrullinated peptide antibody (anti-CCP) +. All patients were treated with methotrexate (MTX). Three (14 %) patients received low oral doses of steroids and intra-articular injections. The control group included 22 healthy donors (HC). Radiographs were scored according to the van der Heijde-modified Sharp score. YKL-40, matrix metalloproteinase-3 (MMP-3), anti-CCP were detected using commercially available enzyme-linked immunosorbent assays (ELISA). The serum levels of IgM RF, C-reactive protein (CRP), serum amyloid A (SAA) were measured by immunonephelometry.

Results:

RA patients had significantly higher serum level of YKL-40 than HC (92,1; 68,5-153,1 pg/ml vs 54,0; 41,7-83,2 pg/ml, p<0.01). Serum YKL-40 concentration was positively correlated with DAS 28 (r=0,5; p<0,05), erythrocyte sedimentation rate (ESR) (r=0,5; p<0,05), CRP (r=0,8; p<0,05), SAA (r=0,6; p<0,05) and MMP-3 (r = 0,6; p<0,05). We found no relationship between the level of YKL-40 and articular radiographic changes.

Conclusion:

Elevated serum concentration of YKL-40 in early RA is associated with clinical and laboratory indicators of disease inflammatory activity and increased level of MMP-3 - an immunological marker of joint destruction.

Disclosure of Interests:

Elena Aleksandrova: None declared, Alexander Novikov: None declared, Elena Luchikhina Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Consultant of: Abbvie, Biocad, Sanofi, Celgene, Dmitriy Karateev Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Lilly, Bayer, Paid instructor for: Abbvie, Pfizer, Biocad, Sanofi, Novartis, Lilly, Galina Lukina Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Paid instructor for: Abbvie, Biocad, Sanofi, Celgene

AB0111 FAMILIAL RHEUMATOID ARTHRITIS WITH LATE ONSET (50 YEARS AND OLDER) IN CLINICAL PRACTICE ACCORDING TO THE ALL-RUSSIAN ARTHRITIS REGISTER (OREL)

Background:

Relatives of the 1st degree of relationship (RFDR) of a patient with rheumatoid arthritis (RA) have the higher risk for the development of RA, associated with a 2-5 fold increase.

Objectives:

Clinical characteristics of probands with RA onset at an older age (50 yrs and older) and their RFDR, which had RA, other rheumatic diseases (RD) and other autoimmune diseases (AID).

Methods:

2766 RA pts with onset of the disease at the age of 50 yrs and older, residents of Moscow and the Moscow region, were included in the Russian register of arthritis OREL in the period from 01.06.2012 to 31.12.2018. 67 probands with RA (2.4%) had RFDRs with RA, other RDs, other AIDs (86 RFDRs in total). Disease activity (by DAS-28), X-ray stage - (by modified Steinbrocker), functional disorders (by functional class - FC), immunological characteristics (RF, ACPA), etc., characterizing the clinical manifestations of RA were evaluated in accordance with the requirements of the current national working RA classification. RFDRs were divided into groups depending on relation to proband father, mother and siblings with RA, RFDRs withr other RD and RFDR with other AID; serological affiliation to RF and ACPA; association with concordant and discordant RFDR, as well as on number of RFDRs (1 and 2 or more).

Results:

67 probands with RA were investigated: 9 men, 58 women, average age in debut (m ± δ) 58.78 ± 6.23 yrs; the average age at the time of the last study was 68.8 ± 6.38 yrs, average duration of RA was 10.14 ± 5.69 yrs. 6 (9%) probands had FC1, 45 (69%) - FC2, 13 (20%) - FC3, 1 (2%) - FC4, 2 - without data; 34 (53%) had high activity, 23 (36%) -medium, 6 (9%) - minimal, 1 (2%) - remission, 3 without data; RF-positive (RF+) - 77.6%, ACPA-positive (ACPA+) - 71.7%. 19 probands (32%) had 1-2a X-ray stage, 27 (46%) - stage 2b, 10(17%) - stage 3, 3 (5%) - stage 4, 8 - without data. 61 (91%) had advanced clinical stage, 6 (9%) - late. Among 86 RFDRs (67 - RF+, 19 - RF-) 10 had father with RA (8 RF+ probands, 2 - RF-), 2 - father with other RDs (all RF+), 10 - mother with RA (all RF+), 7 - mother with other RDs (4 - RF+, 3 - RF-), 26 - siblings with RA (20 - RF+, 6 - RF-), 11 - siblings with other RDs (9 - RF+, 2 - RF-), 20 - RFDR with other AIDs (14 - RF+, 6 - RF-). Probands with concordant RFDRs had more pronounced changes: high activity (56% versus 32%), X-ray erosive stages (67% versus 60%) and stages III and IV (32% versus 6%); FC3 and FC4 (23% versus 12%) and a tendency towards more frequent development of the late clinical stage (11% versus 2%). Comparison of clinical signs in probands with 1 RFDR (49 cases) and probands with 2 or more RFDRs (17 cases) showed a significant predominance of high inflammatory activity (61% versus 41%), erosive arthritis (77% versus 57%), and a tendency to development of a late clinical stage (10% versus 6%) in probands with 1 RFDR. In probands with RF-positive RA, the predominance becomes more significant: high inflammatory activity (69% versus 43%), erosive arthritis (90% versus 54%), late clinical stage (13% versus 7%), and a tendency to severe functional impairment - FC3 and FC4 (22% vs. 15%). ACPA-positive probands showed the same tendency as RF-positive.

Conclusion:

The clinical picture of probands with RFDRs with RA, other RDs, other AIDs is generally characterized by more pronounced changes in probands with RA who have RFDRs with concordant diseases in the form of more often high inflammatory activity, less often moderate, erosive arthritis, more frequent development of advanced 3 and 4 X-ray stages (every fifth). Also, more pronounced changes develop in probands with RA who have only 1 RFDR compared to probands with 2 or more RPSRs. In this group, the differences are even more pronounced in the case of RF-positive probands. In cases with ACPA-positive probands, the same trends persist. Careful interview of a proband with RA about the presence of RFDRs with RA, other RDs and other AIDs will make it possible to predict its course more correctly and facilitate planning of rational therapy.

Disclosure of Interests:

None declared

POS0093 HETEROGENEITY IN ADVERSE EVENT ASSESSMENT BETWEEN COUNTRIES PARTICIPATING IN AN INTERNATIONAL COLLABORATION OF REGISTRIES OF RHEUMATOID ARTHRITIS PATIENTS USING JANUS KINASE INHIBITORS (THE JAK-POT STUDY)

Background:

Industry, regulators, and the rheumatology community have recognized the need for observational studies to monitor the safety of new antirheumatic agents. Registries provide a unique opportunity to understand the safety of newer therapies, but pharmacovigilance studies require large number of patients to evaluate rare drug-related adverse-events (AEs). Because JAK-inhibitors (JAKi) have only recently been approved for the treatment of rheumatoid arthritis, it makes sense to combine data from several registries in order to obtain a sufficiently large sample size to promote earlier detection of adverse events.

Objectives:

The purpose of this analysis was to evaluate how AEs are assessed in the various registries in preparation for a collaborative pharmacovigilance analysis, and present preliminary results.

Methods:

The “JAK-pot” collaboration includes 19 RA registries. The principal investigators of the participating registries were sent a structured questionnaire on AE assessment and 18 (94%) provided complete responses on the AE assessment procedures of their registries. We present simple descriptive statistics of the AE assessment procedures employed by the participating registries.

Results:

The 19 registries represent 7186 patients initiating a JAKi (Table 1), who are on average 57 years old, with a mean disease duration 11 years, seropositive (83%), female (82%) and with moderate disease activity at treatment initiation.

Table 1.Country, registryN° of patients on JAKi includedAustria, BIOREG87Belgium, TARDIS2113Canada, RHUMADATA363Czech Republic, ATTRA197Denmark, DANBIO506Finland, ROB-FIN229Germany, RABBIT620Italy, GISEA244Israel, I-RECORD96Netherlands, METEOR4Norway, NOR-DMARD97Portugal, REUMA.PT44Romania, RRBR252Russia, ARBITER428Slovenia, biorx.si141Spain, BIOBADASER139Switzerland, SCQM738Turkey, TURKBIO404UK, BSRBR484

After ineffectiveness, AEs was the second most common reason for JAKi discontinuation (25.5%), with large differences between registries (Figure 1).

Of the participating registries, 2 registries do not collect AEs, while 16 (89%) assess incident AEs, by means of a pre-specified extraction form (3 registries), by free text (5 registries), by a combination of both (6 registries) and/or the use of linkage to external electronic records (3registries). AEs are coded using a predefined coding system by 11 registries (MeDRA (8), other (3)), but nearly all are recording the severity of the AE (15, 94%), AE related-death (15, 94%), or AE-related hospitalisation (15, 94%). AEs of special interest, such as serious infections (15, 94%), thromboembolic events (15, 94%), or shingles (9, 56%), are recorded by most registries. Incident AEs are linked by the treating physician to specific therapies in 11 registries (69%), while the other 5 registries extrapolate potential causal associations based on therapy start and stop dates. A pre-specified adjudication process for AEs is made only by 5 registries (31%).

Conclusion:

Substantial heterogeneity exists among registries regarding AE assessment within the JAK-pot collaboration. These differences must be taken into account when analysing the safety of JAKi across different countries in collaborative studies. For comparative analyses, stratified analyses by country are required to account for differential AE assessment and varying degrees of potential under-reporting.

Disclosure of Interests:

Kim Lauper: None declared, Denis Mongin: None declared, Sytske Anne Bergstra: None declared, Denis Choquette: None declared, Catalin Codreanu: None declared, Diederik De Cock: None declared, Lene Dreyer: None declared, Ori Elkayam: None declared, Kimme Hyrich: None declared, Florenzo Iannone: None declared, Nevsun Inanc: None declared, Eirik kristianslund: None declared, Tore K. Kvien: None declared, Burkhard Leeb: None declared, Galina Lukina: None declared, Dan Nordström: None declared, Karel Pavelka: None declared, Manuel Pombo-Suarez: None declared, Ziga Rotar: None declared, Maria Jose Santos: None declared, Anja Strangfeld: None declared, Delphine Courvoisier: None declared, Axel Finckh Speakers bureau: Eli-Lilly, Pfizer, Consultant of: Eli-Lilly, Pfizer, Grant/research support from: BMS, Pfizer.

AB0475 COMPARATIVE EFFECTIVENESS OF BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN REAL CLINICAL PRACTICE ACCORDING TO THE MOSCOW UNIFIED ARTHRITIS REGISTER (MUAR)

Background:

This study is the first analysis of biological disease-modifying antirheumatic drugs (bDMARDs) for ankylosing spondylitis (AS) within the Moscow Unified Arthritis Register (MUAR).

Objectives:

to compare the effectiveness of bDMARDs in patients with AS using data from the MUAR.

Methods:

The analysis included the data of patients with AS who were included in the MUAR and received biological therapy for at least 6 months. The effectiveness of the drugs was assessed by the achieved values of the indices of diseases activity and its manifestations: ASDAS(C-RP), BASDAI, LEI, MASES, indicators of the functional ability of patients (BASFI, HAQ) at the last completed visit. Comparison of indicators between drugs was in a general linear model, adjusted for the identified confounders. The search for confounders was in 2 stages: first, by univariate analysis, were identified indicators significantly related to the achieved ASDAS. Then, within the multivariate general linear model, by backward stepwise selection were determinate variables significantly and independently associated with ASDAS.

Results:

The current study included 363 episodes of treatment with bDMARDs in 361 patients. There were 240 men (66.5%). The average age of the included patients was 46.3 ± 11.2, the age at the onset of the disease was 27.3 ± 11.4. The average duration of a treatment episode until the patient was assessed 1135 ± 900 days. Significant differences of the values of ASDAS(p = 0.033) and ESR (p = 0.007) between bDMARDs were revealed. In pairwise comparisons of the achieved ASDAS using the Shidak adjustment, demonstrated that the values on infliximab and adalimumab were significantly lower than on certolizumab pegol (p = 0.009 and p = 0.041, respectively). Also significantly higher ESR values on certolizumab compared to all other drugs (p < 0.001 for all) were found. There were no statistically significant differences between the drugs for other studied parameters.

Conclusion:

The studied bDMARDs (infliximab, adalimumab, etanercept, certolizumab pegol, golimumab, secukinumab) demonstrate generally similar clinical efficacy in real clinical practice. The effect of golimumab and sekukinumab which have been recently introduced into clinical practice doesn’t differ significantly from the effect of TNF inhibitors which has been used for a long time.

Table 1.

Achieved values of the indices of activity and functional ability against the background of treatment with bDMARDs.

ASDAS(С-RP)BASDAIHAQBASFIunadjustedadjustedunadjustedadjustedunadjustedadjustedunadjustedadjustedADA1,89 ±0,891,54 ± 0,293,07 ± 1,612,89 ± 0,250,63 ± 0,420,60 ± 0,073,25 ± 2,023,09 ± 0,32GOL2,08 ± 0,992,22 ± 0,313,09 ± 1,963,44 ± 0,490,66 ± 0,610,78 ± 0,143,74 ± 2,934,00 ± 0,63INF1,57 ± 0,821,29 ± 0,322,64 ± 1,552,19 ± 0,380,56 ± 0,520,57 ± 0,112,81 ± 2,292,93 ± 0,49ETA1,96 ± 0,851,94 ± 0,243,19 ± 1,693,44 ± 0,190,65 ± 0,530,72 ± 0,063,39 ± 2, 263,88 ± 0,24CER2,69 ± 1,032,95 ± 0,464,07 ± 2,283,65 ± 0,521,12 ± 0,820,84 ± 0,155,07 ± 2,954,19 ± 0,67SEK2,69 ± 1,311,66 ± 0,513,72 ± 2,223,71 ± 0,490,85 ± 0,470,85 ± 0,143,46 ± 2,133,46 ± 0,63

ADA – Adalimumab, GOL – Golimumab, INF – Infliximab, ETA – Etanercept, CER – Certolizumab pegol, SEK – Sekukinumab, ASDAS - Ankylosing Spondylitis Disease Activity Score, BASDAI Bath Ankylosing Spondylitis Disease Activity Index, BASFI - Bath Ankylosing Spondylitis Functional Index, HAQ - Health Assessment Questioner, C-RP – C-reactive protein.

Disclosure of Interests:

None declared.

POS0937 TREATMENT SURVIVAL ON BIOLOGICS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS – DATA FROM MOSCOW UNIFIED ARTHRITIS REGISTRY (MUAR)

Background:

The number of new biologics in treatment of axial spondyloarthritis (axSpA) is rapidly increasing. It is important to assess timely their place in the treatment of axSpA, especially with regard to retention on therapy.

Objectives:

To compare retention on therapy with different biologics in patients with axSpA.

Methods:

We retrospectively analyzed the data of axSpA patients receiving biologics from the MUAR register. Predictors of retention on therapy were selected by forward stepwise variable selection within Cox regression proportional hazard model. These predictors were considered as confounders when comparing the risks of biologics withdrawal.

Results:

990 treatment episodes in 640 patients with axSpA were analyzed (non-radiographic axSpA – 4.1%, ankylosing spondylitis - 95.9%). The duration of episodes was 824±920 days. Men were 66,6%, mean age 46,4±11,4.The patients were treated with Adalimumab (ADA) (n= 252 treatment episodes), Golimumab (GOL) (n=82), Infliximab (INF) (n=167), Netakimab (NET) (n=9), Secukinumab (SEC) (n=75), Certolizumab pegol (CER) (n=66), Etanercept (ETA) (n=339).

The following predictors of withdrawal risk were identified –

1.The total duration of the disease

2.The duration of the disease before the onset of biologic treatment

3.Gender

4.Family history of non-inflammatory spondylopathy (degenerative spinal disease)

5.The line of biologic treatment

6.The level of education

The severity of radiographic sacroiliitis and HLA B-27 positivity were not associated with the risk of discontinuation of biologics.

The identified predictors were further considered as confounders. Adjusted for confounders, ETA had the lowest treatment withdrawal risk (Figure 1). ADA, GOL, INF, SEC, CER had significantly higher risk of withdrawal compared with ETA (Table 1).

Conclusion:

Our analysis detected predictors associated with risk of biologics withdrawal in axSpA patients in real clinical practice. There are significant differences between biologics regarding retention on treatment.

Table 1.

Hazard ratio for treatment withdrawal

DrugHazard ratio (Exp B)pADA1.52*0.004GOL2.95*0.000INF2.574*0.000NET3.680*0.073SEC2.133*0.005CER2.922*0.000

*- withdrawal risk relative to ETA

Figure 1.

Picture 1. Treatment withdrawal risk

Disclosure of Interests:

None declared

POS1008 THE ROLE OF SERUM CALPROTECTIN IN THE DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Аnkylosing spondylitis (AS) and inflammatory bowel diseases (IBD) have many common features. Approximately one in two patients with axial spondyloarthritis have subclinical (histologically confirmed) inflammation of the intestine, and 5-10% of subclinical inflammation turns into Crohn’s disease (CD) or Ulcerative colitis (UC) [1]. Colonoscopy is usually used to diagnose IBD, but this procedure is invasive. Laboratory biomarkers, as fecal calprotectin (FC) and serum calprotectin (SC) can used to diagnosis of IBD. But there is no consensus regarding SC clinical utility. SC is exposed to proteolytic enzymes, but its level also increases with inflammation in the intestine and is associated with a higher disease activity [2]. SC levels positively correlate with CRP, ESR, disease activity in AS, but not as obvious as with FC [3,4].

Objectives:

The aim of this study was to evaluate the possibility of using SC in the diagnosis of IBD in patients with AS.

Methods:

In the analysis were included 50 patients with AS, fulfilling the modified New York criteria, among them man -36 (72%), woman -14 (28%), mean age of patients was 42.5 ±9.9, mean disease duration – 13.4±8.7 years. All patients were examined with ESR, CRP, FC (range: 100-1800 µg /g), esophagogastroduodenoscopy, colonoscopy and quantitative analysis of the SC level using ELISA (BUHLMANN MRP8/14 ELISA, range: 0.4-3.9 µg /ml).

Results:

All patients had a high disease activity, mean BASDAI was 5.3 ± 1.8, mean ASDAS CRP 3.7 ± 1.01, mean ASDAS ESR 3.6 ± 1.01. 80 % patients had high FC level (more than 100 µg / g), while only 18% patients had an increase of SC level. IBD were diagnosed in 11 cases: 6 patients (12 %) with CD and 5 patients (10 %) - UC, in the remaining cases (78%) was no intestinal pathology. Only 2 patients with IBD had a high SC level. SC level was more correlated with ESR (r=0.5) and CRP (r=0.5) (p <0.05) levels, than with FC level (r=0.4) (p <0.05).

Conclusion:

The results showed that there is currently insufficient data to assess the possibility of using SC in the diagnosis of IBD in patients with AS. There is a significant association between the SC, CRP and ESR, but not fecal calprotectin. Potentially SC may be more representative of systemic inflammation than an intestinal inflammation.

References:

[1]Klingberg, E., Strid, H., Stahl, A.et al. A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. Arthritis Res Ther 2017. 19(1):21

[2]Kalla R, Kennedy NA, Ventham NT, Boyapati RK, Adams AT, Nimmo ER, Visconti MR, Drummond H, Ho GT, Pattenden RJ, Wilson DC, Satsangi J. Serum Calprotectin: A Novel Diagnostic and Prognostic Marker in Inflammatory Bowel Diseases. Am J Gastroenterol. 2016 Dec;111(12):1796-1805

[3]Hu H, Du F, Zhang S, Zhang W. Serum calprotectin correlates with risk and disease severity of ankylosing spondylitis and its change during first month might predict favorable response to treatment. Mod Rheumatol. 2019 Sep;29(5):836-842.

[4]Azramezani Kopi T, Shahrokh S, Mirzaei S, Asadzadeh Aghdaei H, Amini Kadijani A. The role of serum calprotectin as a novel biomarker in inflammatory bowel diseases: a review study. Gastroenterol Hepatol Bed Bench. 2019;12(3):183-189.

Disclosure of Interests:

None declared.

The impact of seropositivity on the effectiveness of biologic anti-rheumatic agents: results from a collaboration of 16 registries

OBJECTIVES

RF and ACPA are used as diagnostic tools and their presence has been associated with clinical response to some biologic DMARDs (bDMARDs) in RA. This study compared the impact of seropositivity on drug discontinuation and effectiveness of bDMARDs in patients with RA, using head-to-head comparisons in a real-world setting.

METHODS

We conducted a pooled analysis of 16 observational RA registries. Inclusion criteria were a diagnosis of RA, initiation of treatment with rituximab (RTX), abatacept (ABA), tocilizumab (TCZ) or TNF inhibitors (TNFis) and available information on RF and/or ACPA status. Drug discontinuation was analysed using Cox regression, including drug, seropositivity, their interaction, adjusting for concomitant and past treatments and patient and disease characteristics and accounting for country and calendar year of bDMARD initiation. Effectiveness was analysed using the Clinical Disease Activity Index evolution over time.

RESULTS

Among the 27 583 eligible patients, the association of seropositivity with drug discontinuation differed across bDMARDs (P for interaction <0.001). The adjusted hazard ratios for seropositive compared with seronegative patients were 1.01 (95% CI 0.95, 1.07) for TNFis, 0.89 (0.78, 1.02)] for TCZ, 0.80 (0.72, 0.88) for ABA and 0.70 (0.59, 0.84) for RTX. Adjusted differences in remission and low disease activity rates between seropositive and seronegative patients followed the same pattern, with no difference in TNFis, a small difference in TCZ, a larger difference in ABA and the largest difference in RTX (Lundex remission difference +5.9%, low disease activity difference +11.6%).

CONCLUSION

Seropositivity was associated with increased effectiveness of non-TNFi bDMARDs, especially RTX and ABA, but not TNFis.

OP0231 COMPARATIVE EFFECTIVENESS OF JAK-INHIBITORS, TNF-INHIBITORS, ABATACEPT AND IL-6 INHIBITORS IN AN INTERNATIONAL COLLABORATION OF REGISTERS OF RHEUMATOID ARTHRITIS PATIENTS (THE “JAK-POT” STUDY)

Background:

In many countries, JAK-inhibitors (JAKi) have only recently been approved as treatment for patients with rheumatoid arthritis (RA).

Objectives:

To evaluate the effectiveness of JAKi compared to bDMARDs in RA patients in the real-world population in an international collaboration of registers (the “JAK-pot” collaboration).

Methods:

Patients initiating either JAKi, TNFi, IL-6i or abatacept (ABA) during a time period when JAKi were available in each country (19 registers, Table) were included. We compared the effectiveness of JAKi and bDMARDs in terms of retention using crude and adjusted survival analysis. Missing covariates were imputed using multiple imputation.

Results:

Among 25521 included patients, 6063 initiated a JAKi, 13879 a TNFi, 2348 ABA, and 3231 an IL-6i. Patients were on average 55 years old, with a mean disease duration 10 years, mostly seropositive (67%), female (77%) and with moderate disease activity at treatment initiation. The main reason of stopping treatment was ineffectiveness (49%), followed by adverse events (21%). Patients on JAKi were treated more often as monotherapy, had higher CRP and disease activity at baseline and had experienced more previous ts/bDMARDs. Crude median retention was 1.4 (95% CI 1.2-1.5) years for JAKi, 1.6 (1.6-1.7) for TNFi, 1.5 (1.3-1.7) for IL6i and 1.1 (1.0-1.3) for ABA. After adjustment, the hazard ratio (HR) for discontinuation tended to be lower for JAKi (HR 0.86 (0.65-1.13)) compared to TNFi, but comparable for ABA (1.02 (0.94-1.10)) and IL6i (0.99 (0.88-1.10)) (Figure 1). HRs differed notably between countries (Figure 2).

Table 1.

Registers

Country, registerNJAKi, n (%)Austria, BIOREG*Belgium, TARDIS62882113 (33.6)Canada, RHUMADATA528114 (21.6)Czech Republic, ATTRA374253 (67.6)Denmark, DANBIO4721506 (10.7)Finland, ROB-FIN807234 (29.0)Germany, RABBIT*Italy, GISEA757250 (33.0)Israel, I-RECORD40094 (23.5)Netherlands, METEOR16424 (0.2)Norway, NOR-DMARD50799 (19.5)Portugal, REUMA.PT79744 (5.5)Romania, RRBR593328 (55.3)Russia, ARBITER526483 (91.8)Slovenia, BIORX.SI583146 (25.0)Spain, BIOBADASER781139 (17.8)Switzerland, SCQM2956796 (26.9)Turkey, TURKBIO2150397 (18.5)UK, BSRBR111163 (5.7)

*Registers planning to participate in future studies but not included yet

Conclusion:

The adjusted overall drug retention of JAKi tended to be higher than for TNFi, with large variation between countries. Other measures of effectiveness, such as the evaluation of CDAI remission and low disease activity are planned to shape a more comprehensive picture of JAKi effectiveness in the real world.

Disclosure of Interests:

Kim Lauper: None declared, Denis Mongin: None declared, Sytske Anne Bergstra: None declared, Denis Choquette Grant/research support from: Rhumadata is supported by grants from Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Consultant of: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Speakers bureau: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Diederik De Cock: None declared, Lene Dreyer: None declared, Ori Elkayam Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Novartis, Jansen, Kimme Hyrich Grant/research support from: Pfizer, UCB, BMS, Speakers bureau: Abbvie, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Nevsun Inanc: None declared, Eirik kristianslund: None declared, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Burkhard Leeb Grant/research support from: chairman of BioReg, Consultant of: AbbVie, Pfizer, Roche, Lilly, Grünenthal, Gebro,, Paid instructor for: Lilly, Biogen, Speakers bureau: Biogen, Lilly, Pfizer, Grünenthal, Astropharma,, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Dan Nordström Consultant of: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Speakers bureau: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Manuel Pombo-Suarez Consultant of: Janssen, Lilly, MSD and Sanofi., Speakers bureau: Janssen, Lilly, MSD and Sanofi., Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Maria Jose Santos Speakers bureau: Novartis and Pfizer, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Delphine Courvoisier: None declared, Axel Finckh Grant/research support from: Pfizer: Unrestricted research grant, Eli-Lilly: Unrestricted research grant, Consultant of: Sanofi, AB2BIO, Abbvie, Pfizer, MSD, Speakers bureau: Sanofi, Pfizer, Roche, Thermo Fisher Scientific

AB0273 PREDICTORS OF DRUG SURVIVAL OF bDMARDS IN BIO-NAIVE PATIENTS WITH RHEUMATOID ARTHRITIS (RA) DURING THE FIRST YEAR OF THERAPY

Objectives:

To investigate predictors of drug survival of bDMARDs in previously bio-naive patients (pts) with RA during the first year of therapy.

Methods:

204 adult bio-naive pts (173 women, 84.8%), with active RA, despite the concomitant DMARD therapy, were included into retrospective study. All of them initiated bDMARDs: infliximab (INF) - 65 pts (31.9%), rituximab (RTM) - 39 (19.1%), adalimumab (ADA) - 30 (14.7%), etanercept (ETA) - 28 (13.7%), abatacept (ABA) - 23 (11.3%), tocilizumab (TZ) - 15 (7.4%), certolizumab pegol - 4 (1.9%). The following indicators were used as survival predictors: sex, age and clinical form of RA. Pts were divided by age according to the classification adopted by the World Health Organization: 18-44 years (74 pts), 45-59 years (68 pts), 60-74 years (57 pts), 75 years or more (5 pts). Clinical forms of RA were presented: RA, seropositive by rheumatoid factor (RF), RA, seronegative by RF, RA with extra-articular manifestations, adult-oneset Still’s disease, juvenile RA. Predictors of therapy inefficiency or AE were investigated in Cox proportional risk model. Survival on drug was estimated using the Kaplan-Meier method and evaluation of difference significance using log-rank criterion.

Results:

A year later, 92 pts (45%) remained on bDMARDs and 112 pts had their treatment discontinued. The reasons of bDMARDs discontinuation during the first year of treatment were: lack of effectiveness (including primary inefficiency) - 50%, adverse events (AE) - 25%, administrative causes - 17%, remission - 6.25%, death due to reasons unrelated to the therapy - 1.75%. By the end of the observation period, the best survival was shown by RTM therapy (69.23% of patients continued treatment for a year), ETA (44.4% of patients) and ABA (43.48% of patients). Discontinuation of bDMARDs due to remission was achieved in 7 patients and proved to be significantly higher in the RTM group (10.26%, p < 0.05) compared to the ABA group (8.7%) and ADA group (3.45%). Although the number of women continued after a year was significantly higher than that of men (84.8% and 15.2% respectively), female sex was not a reliable predictor of drug survival. At the same time, the rate of discontinuation due to AE in women was higher (96.55%, p = 0.03). After a year, the number of pts continuing treatment in all age groups remained comparable, and the difference between them - statistically not significant: 1 group (18-44 years old, 29 pts) - 31.52% of pts, 2 group (45-59 years old, 36 pts) - 39.13%, 3 group (60-74 years old, 26 pts) - 28.26%, 4 group (75-90 years old, 1 pts). Discontinuation of bDMARDs due to inefficiency was noted in 1 group more often (46.43%, 26 pts, р =0.03), in other groups this indicator was 33.93% (19 pts) in the 2nd group, 19.64% (11 pts) in the 3rd group and 0% in the 4th group. Discontinuation therapy due to AE was also prevalent in 1 group (50%, 14 pts) than in 2 (14.3%, 4 pts), 3 (32.1%, 9 pts) and 4 (3.6%, 1 pts). Discontinuation of therapy due to inefficacy was more common in the group of seronegative RA - 59.1% (p < 0.05). In the seropositive RA group 24.8% of pts had interrupted bDMARDs for this reason, in the RA with extra-articular manifestations group it was 18.1%, in the adult-oneset Still’s disease group - 30% and in the juvenile RA group - 30%. Discontinuation of therapy due to remission was overwhelmingly observed in seropositive RA group (6 pts, 4%) and was significantly higher than in other groups (1 patient in RA with extra-articular manifestations group, 4.5%).

Conclusion:

Female sex, young age (18-44 years), RA, seronegative by RF were associated with less survival of bDMARDs due to lack of effectiveness and/or AE, and RTM and seropositive RA - with more frequency of discontinuation of therapy due to remission.

Disclosure of Interests:

Eugenia Aronova: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Galina Gridneva: None declared, Svetlana Glukhova: None declared, Anastasia Kudryavtseva: None declared

AB0341 SURVIVAL OF REMISSION OR LOW DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOFACITINIB. RESULTS OF RUSSIAN NATIONAL REGISTER

Background:

Tofacitinib is an oral Janus Kinase inhibitor for the treatment of rheumatoid arthritis (RA). The survival of remission or low disease activity (LDA) in RA patients, treated with tofacitinib remain unknown.

Objectives:

To evaluate the survival of DAS28 remission or low disease activity in RA patients treated with tofacitinib.

Methods:

Data from 102 patients from Russian national register of patients with RA treated with tofacitinib (OREL), achieved DAS28 remission (DAS28<2.6, n=92) or LDA (DAS28<3.2, n=102) were analyzed. Number of patients with increased disease activity, time of disease activation were registered. Statistical analysis performed with statistical programs SPSS2017 and GraphPadPrizm. p-value < 0.05 considered as significant.

Results:

Baseline characteristics of the patients are presented in table 1.

Table 2.

Treatment results in RA patients, received monotherapy of tofacitinib and tofacitinib with mtx, Mean±SD / n (%).

ParameterLDA (n=102)Remission (n=92)Male, n (%)19 (18.6)15 (16.3)Age, years (mean ±SD)53.55±13.4652.45±12.56Symptoms duration, month (mean±SD)170±111.92169±110.93Positive rheumatoid factor, n (%)41(40.19)36 (39.13)Erosions of hand joints (X-rays), n (%)43(42.15)41 (44.56)BMI, kg/m2(mean ±SD)25.67 ± 2.2226.87 ± 2.19Smokers (current and in the past), n (%)9 (8.82)9 (9.78)

p-value ≥ 0.05 for all the differences.

The remission failed in 45 from 92 patients (48.91%), LDA failed in 65 from 102 of patients (63.72%), table 2.

Table 1.Time, monthMeStandard error95% Confidential IntervalfromToLDA (n=102)12.0002.0218.03915.961Remission (n=92)10.3126.0000.7964.440

Proportions of survival of remission or LDA are presented at figure 1 and figure 2 respectively.

Figure 1.

Survival proportion in RA patients achieved LDA on tofacitinib (n=102).

Figure 2.

Survival proportion in RA patients achieved remission on tofacitinib (n=92).

In 28 from 45 cases of remission failure (62.22%) and in 34 cases from 65 cases of LDA loss (52.3%) the proposal reasons of treatment effect loss were non-medical (absence of reimbursement, changes in patients accommodation, low treatment compliance, etc.). Medical reasons (side effects, inefficacy, etc.) of decrease in remission or LDA survival rate were registered in 17 from 45 cases of remission loss (37.77%) and in 31 from 65 cases of LDA loss (47.69%).

Conclusion:

On-year survival of remission or low disease activity achieved in Rheumatoid arthritis patients treated with tofacitinib is 51.1% and 36.3 % respectively. The main reasons of treatment efficacy loss were associated with non-medical.

Acknowledgments:

Pfizer

Disclosure of Interests:

Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi, V Mazurov: None declared, Alexander Lila: None declared, Andrey Baranov Grant/research support from: Bayer, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Aida Babaeva: None declared, Elena Kalinina: None declared, Tatiana Salnikova: None declared, Valentina Sorotskaya: None declared, Ruzana Samigullina: None declared, Diana Chakieva: None declared, Iuliia Grabovetskaya: None declared, Irina Marusenko: None declared, Ekaterina Gaydukova: None declared, Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm

SAT0141 LONG-TERM EFFECTIVENESS OF TOFACITINIB IN CONVENTIONAL DMARDS NON-RESPONDERS WITH RHEUMATOID ARTHRITIS: RESULTS OF RUSSIAN NATIONAL REGISTER

Background:

Tofacitinib is an oral Janus Kinase inhibitor for the treatment of rheumatoid arthritis (RA).

Objectives:

To evaluate the three-year effectiveness of tofacitinib in RA conventional synthetic (cs) DMARDs non-responders.

Methods:

Data from 374 patients from Russian national register OREL of patients with RA treated with tofacitinib not less than 3 years after failure of conventional DMARDs were included in the statistical analysis. Clinical and laboratory data from 4 consecutive visits with an interval of 12 months between the visits (± 28 days) were analyzed. Treatment with any biologics ever was an exclusion criteria. Demographical (age, sex) and disease-related characteristics of RA (symptoms duration, RF- and ACCP positivity, presence of joint erosions, DAS28, CDAI, number of tender and swollen joints (NTJ, NSJ), erythrocytes sedimentation rate (ESR), C-reactive protein (CRP)) collected. Statistical analysis performed with statistical programs SPSS2017 and GraphPadPrizm. p-value < 0.05 considered as significant.

Results:

Baseline characteristics of RA patients, involved in the analysis are presented in table 1.

Table 1.

Baseline characteristics of the patients with RA (n=374).

ParameterCharacteristicsMale, n (%)92 (24.5)Age, years (mean±SD)53.4±13.38Symptoms duration, month (mean±SD)140±137Positive rheumatoid factor (RF), n (%)123(32.8)Positive antibodies to cyclic citrullinated peptide (ACCP), n (%)329(87.9)Erosions of hand joints (X-rays), n (%)372 (99.4)BMI, kg/m2(mean ±SD)26.8 ± 6.14Smokers (current and in the past), n (%)54 (14.4)

Changes in the diseases activity parameters in patients with RA, treated with tofacitinib not less than 3 years after cs DMARD failure are presented in table 2, figure 1, and figure 2.

Figure 1.

DAS28 of patients with RA, treated with tofacitinib (n=374) – 3-years follow-up (time-points are presented in years ± 28 days).

Figure 2.

DAS28 of patients with RA, treated with tofacitinib (n=374) – 3-years follow-up (time-points are presented in years ± 28 days).

Table 2.

Changes in RA parameters in patients treated with tofacitinib, n=374 (M±SE).

Disease characteristicsBaselineYear 1#Year 2#Year 3#C-RP, mg/L30.1±35.08.3±12.87.6±10.79.4±13.5ESR, mm/h35.2±21.222.7±17.221.9±17.722.3±17.3NTJ from 2811.2±6.54.6±4.94.8±5.03.9±3.8NTJ from 287.6±5.12.4±3.21.7±3.11.4±2.8

*difference with baseline is significant with p<0.000.#- ±28 days

Conclusion:

According to the real world data treatment with tofacitinib may provide good response rates in RA patients, refractory to the previous csDMARDs treatment in long-term perspective.

Acknowledgments :

Pfizer

Disclosure of Interests: :

Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi, V Mazurov: None declared, Alexander Lila: None declared, Andrey Baranov Grant/research support from: Bayer, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Evgeniy Zhilyaev Speakers bureau: Novartis, UCB, Pfizer, Biocad, Abbvie, MSD, Roche, Ekaterina Koltsova: None declared, Evgeniya Shmidt Speakers bureau: MSD, Novartis, Pfizer, Oxana Fomina: None declared, Irina Bondareva: None declared, Olga Anoshenkova: None declared, Aleksey Vasilenko: None declared, Elizaveta Vasilenko: None declared, Natalya Yudina: None declared, Larisa Knyazeva: None declared, Vyacheslav Poncratov: None declared, Ekaterina Gaydukova: None declared, Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm

THU0206 А VERY EARLY (7-28 DAYS) RESPONSE ON JAK INHIBITOR TOFACITINIB IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: EFFECT ON PAIN AND CENTRAL SENSITIZATION

Background:

The presence of central sensitization (CS) significantly burdens the course of rheumatoid arthritis (RA). JAK inhibitors block intracellular signal pathways including the ones responsible for synthesis of mediators and cytokines causing pain and CS. The application of JAK inhibitors is supposed to relieve pain and reduce CS severity promptly.

Objectives:

To evaluate JAK inhibitor effect on pain and signs of CS in patients with active RA 7 and 28 days after the start of therapy.

Methods:

Study group included 39 patients with RA, their age was 50.9±11.1, 79.5% of women, 89.7% of RF “+”, DAS28 5.8±0.6, receiving DMARDs (methotrexate 82.0% and leflunomide 18.0%), who were administered with tofacitinib 5 mg 2 times a day due to inefficiency or intolerance of genetically engineered biological drugs. There were assessed the pain severity using Brief pain inventory (BPI) questionnaire, the presence of neuropathic pain component (NPC) using PainDETECT questionnaire and signs of CS using Central Sensitisation Inventory (CSI) questionnaire at early time after tofacitinib administration.

Results:

Patients initially experienced a severe pain – 5.72±2.21 according to the visual analogue scale (VAS), 53.8% had signs of central sensitization (CSI ≥ 40), 17.9% had NPC (PainDETECT ≥18). 7 days after tofacitinib intake there was statistically reliable reduction of pain severity – up to 4.37±2.2 (р=0.01), pain decrease of 29.4±17.9% (BPI), NCP – PainDETECT from 12.9±5.5 to 10.6±5.6 (р=0.047) and CS – CSI from 43.1±12.8 to 35.9±11.2 (р=0.01). The effect had increased after 28 days: pain level (VAS) was 2.84±1.57 (р=0.000), pain decrease of 43.6±29.6% (BPI), PainDETECT 29.8±12.4 (р=0.000), CSI 26.4±13.9 (р=0.000).

During this period there were no serious adverse reactions.

Conclusion:

The application of JAK inhibitor tofacitinib allows to reach a fast analgesic effect, also due to impact on CS and NCP.

Source: National Registry patients with RA

Disclosure of Interests: :

Andrey Karateev: None declared, Ekaterina Filatova: None declared, Elena Pogozheva: None declared, Vera Amirdzhanova: None declared, Evgeny Nasonov: None declared, Alexander Lila: None declared, V Mazurov: None declared, N Lapkina: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Tatiana Salnikova: None declared, Ruzana Samigullina: None declared, Diana Chakieva: None declared, Irina Marusenko: None declared, Olga Semagina: None declared, Marina Semchenkova: None declared

AB0306 EXPERIENCE WITH RITUXIMAB BIOSIMILAR BCD-020 IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD CLINICAL PRACTICE ACCORDING TO DATA FROM MOSCOW UNIFIED ARTHRITIS REGISTRY (MUAR)

Background:

The introduction of perspective anti-rheumatic biologic agents into clinical practice has not only increased therapy efficacy and improved medical prognosis in patients with rheumatoid arthritis (RA), but also resulted in a dramatic increase in treatment cost and, therefore, in a reduced accessibility of the innovative treatment for patients. For this reason, over the last years, there has been a huge interest towards developing biosimilars [1,2].

Objectives:

To assess the effectiveness and safety of switching from reference rituximab (RTXref) to rituximab biosimilar (RTXbs) BCD-020 in patients with RA in real clinical practice according to the data from MUAR.

Methods:

Patients with RA who treated by RTXrefat the onset and then switched to RTXbs(BCD-020) were enrolled in the study. For all patients were performed: swollen and tender joints count, ESR, CRP, biochemistry and immunologic blood analyses. Assessment of dynamic of DAS28, RAPID3, HAQ-DI was performed. The great attention was given to the therapy safety assessment. RTXrefeffectiveness and safety profile was assessed at the moment of switching; data for RTXbs(BCD-020) were collected not earlier than 6 months after switching.

Results:

46 patients with RA were enrolled, 80.5% were women; the mean age was 59.5±12.2 years; 91.3% were RF-positive, 63% - ACCPA-positive, the disease activity at the moment of switching was moderate, the mean DAS28 was 3.5. The duration of RTXreftherapy until switching was 36.8 ± 26.8 months; the duration of the follow-up period for BCD-020 biosimilar was 12.1 ± 6.18 months. In 43.5% of patients, previously inefficiency or intolerance of other biologics was discovered. The proportion of patients who received concomitant therapy with glucocorticoids or methotrexate (MTX) was 45.7% and 43.5%, respectively. The mean MTX dose was 13.6 mg/wk. The mean dose of RTXref/BCD-020 was 1000 mg. The stability dynamic of clinical parameters was retained after switching to biosimilar (Tab.1) without significant difference between the rituximab products (р>0.05).

Table 1.

Comparison of Efficiency Parameters for the Reference Rituximab and Biosimilar BCD-020

ParameterReference rituximabBiosimilar BCD-020DAS28 (ESR)3.393.34HAQ-DI1.481.44RAPID312.912.6

The safety profile of RTXrefand RTXbs(BCD-020) was also similar. None of the patients discontinued BCD-020 therapy for reasons related to safety or inefficiency.

Conclusion:

Within the framework of routine clinical practice, switching from reference rituximab to BCD-020 biosimilar is not accompanied by a change in efficiency and safety profile of the therapy and does not pose a risk of discontinuation, which is coherent with the results of the registration clinical trial for BCD-020. [3]

References:

[1]Edwards CJ, et al. Switching to biosimilars: current perspectives in immune-mediated inflammatory diseases. Expert Opin Biol Ther. 2019 Oct;19(10):1001-1014. doi: 10.1080/14712598.2019.1610381. Epub 2019 May 6.

[2]Dörner T, et al. The changing landscape of biosimilars in rheumatology. Ann Rheum Dis 2016;75:974–982. doi:10.1136/annrheumdis-2016-209166

[3]Nasonov EL, et al. The results of a phase III comparative clinical trial of rituximab (Acellbia and MabThera) in rheumatoid arthritis (the BIORA study). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(5):510-519 (In Russ.). doi:http://dx.doi.org/10.14412/1995-4484-2016-510-519

Disclosure of Interests:

Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Ekaterina Koltsova: None declared, Evgeniya Shmidt Speakers bureau: MSD, Novartis, Pfizer, Karine Lytkina Speakers bureau: Novartis, Eli Lilly, Pfizer, UCB, Abbvie, Biocad, MSD, Jonson&Jonson, Evgeniy Zhilyaev Speakers bureau: Novartis, UCB, Pfizer, Biocad, Abbvie, MSD, Roche

FRI0564 SERUM LEVELS OF IL-6 AND IL-8 IN ANKYLOSING SPONDYLITIS PATIENTS: ASSOCIATIONS WITH DISEASE ACTIVITY

Background:

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine and sacroiliac joints characterized by new bone formation (syndesmophytes) and ankyloses. In AS cases, along with the damage to the musculoskeletal system, impairment of other organs and systems is often observed (uveitis, inflammatory bowel and heart diseases). Pro-inflammatory cytokines (TNF-α, IL-6,-17,-23,-21,-22,-31) and chemokines (IL-8) are key pathogenic markers in AS.

Objectives:

The aims of the study were to determine the serum levels of IL-6 and IL-8 in AS and investigate their relationship with disease activity.

Methods:

We studied 140 patients (pts) with AS fulfilled modified New York criteria (1984); (102M/38F); median and interquartile range (25th—75th percentile) of age 43.0; 35.0-51.0 years; disease duration 6.0; 4.0-12.0 years; BASDAI - 5.4; 4.1-6.6; ASDAS ESR - 3.6; 2.6-4.4; ASDAS CRP - 3.8; 2.7-4.5; 86% HLA-27 positive. In 50% of pts with AS, inflammatory bowel diseases (IBD) (Crohn’s disease and ulcerative colitis) were diagnosed. The control group included 17 healthy donors (HC). The serum concentrations of IL-6 and IL-8 were detected by chemiluminescence immunoassay using IMMULATE 1000 analyzer (Siemens Healthcare Diagnostics, USA).

Results:

AS pts had significantly higher serum level of IL-6 than HC (4.3; 0.1-8.0 pg/ml vs 2.3; 0.1-2.7 pg/ml, p <0.006). The median concentration of IL-8 didn’t differ between AS pts and HC (10.5; 8.3-18.0 pg/ml vs 11.9; 8.2-18.3 pg/ml, p>0.05). The same levels of IL-6 and IL-8 were detected in AS with IBD and AS without signs of IBD (p>0.05). In AS pts, serum IL-6 concentration was positively correlated with ASDAS ESR (r = 0.3), ASDAS CRP (r = 0.3), ESR (r = 0.3) and CRP (r = 0.5) (p <0.05); IL-8 was negatively associated with presence of fecal calprotectin (r = -0.3) (p <0.05).

Conclusion:

Elevated serum concentration of IL-6 in AS is associated with clinical and laboratory markers of high inflammatory activity of the disease. The levels of IL-8 in the sera of AS patients were negatively correlated with the concentration of fecal calprotectin. Data on the relationship of IL-8 with the activity of the pathological process in AS require further study.

Disclosure of Interests:

Elena Aleksandrova: None declared, Alexander Novikov: None declared, Polina Kulakova: None declared, Aleksey Dorofeev: None declared, Nadezhda Savenkova: None declared, Evgeniy Volnukhin: None declared, Anton Kovshik: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche

FRI0116 COMPARABLE EFFICACY AND SAFETY OF TWO REGIMENS OF RHEUMATOID ARTHRITIS TREATMENT WITH TOFACITINIB: DATA FROM RUSSIAN NATIONAL REGISTRY

Background:

Current EULAR and national guidelines recommend use of synthetic target drug Tofacitinib (TOFA) for active rheumatoid arthritis (RA) treatment in case of resistance or intolerance to metotrexate (MTX) or other conventional DMARDs. Two treatment regimens are approved: TOFA mono-therapy and combination with conventional DMARD, preferably with MTX.

Objectives:

Aim of presented study was to compare efficacy and safety of TOFA given in two regimens: as mono-therapy and in combination with MTX.

Methods:

We analyzed data from Russian national registry of RA. 450 patients (pts) treated with TOFA in dose 10 mg daily have been enrolled in this investigation. Among them 169 pts have composed TOFA mono-therapy group (mono) and 281 pts treated with TOFA plus MTX have been included in combo-therapy group (combo). Period of treatment varied from 6 months to 3 years and even more. Treatment efficacy was evaluated on the basis of clinical and laboratory indices of RA activity: CDAI, SDAI, DAS28, HAQ, GPA (general pain assessment), TJC, SJC, CRP, ESR monthly during first 6 months, than in 1,2,3 years and after 3 year period of treatment.

Results:

There were no significant differences in pts demographic characteristic and disease longevity and/or severity in two separated groups. Majority of baseline indices were identical in these groups aside from SDAI, CRP (were higher in combo-group) and HAQ (was higher in mono-group). Pts monitoring have shown dramatically decrease of all used indices during the first several months of therapy in both groups. Moreover all clinical and laboratory parameters after 6-months treatment were comparable in mono- and combo- groups. Positive dynamics remained during further 3-year period in both groups. Significant differences between baseline and ultimate data after 3 year course therapy were revealed in CDAI, SDAI, DAS28, HAQ, GPA, TJC, SJC, CRP, ESR in both groups. In particular DAS28 index decreased from 5.38±0.08 to 2.88±0.07 (p<0.05) in mono-group and from 5.54±0.09 to 3.40±0.21 (p<0.05) in combo-group. Along with this comparing of endpoints in two analyzed groups have shown that levels of CDAI, SDAI, GPA were significant higher in combo-group than in mono-group (p<0.05). Adverse effects were registered in 4.73% pts from mono-group and in 4.98% pts from combo-group (p>0.05). Spectrum of adverse reactions was similar in compared groups: respiratory infection (in 2.96% and 3.36% cases respectively) and herpes infection (in 0.59% and 0.71% cases, respectively) were registered predominantly.

Conclusion:

Data gained from National RA registry have demonstrated that treatment with TOFA in mono-therapy regimen has the comparable efficacy with regimen of combined therapy, included MTX and TOFA. Safety of both regimens can be qualified as good. Obtained results confirm high efficacy and safety of target therapy with TOFA and prove the recommendation for use it in different regimens – mono-therapy or combination with MTX.

References:

[1]Smolen JS, et al. Ann Rheum Dis. 2017;0:1–18. doi:10.1136/annrheumdis-2016-210715

[2]Boyle DL, et al. Ann Rheum Dis. 2015;74:1311-1316. doi:10.1136/annrheumdis-2014-206028

Disclosure of Interests:

Aida Babaeva: None declared, Elena Kalinina: None declared, Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm, V Mazurov: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Antonina Davydova: None declared, Irina Semizarova: None declared, Olga Slyusar: None declared, Tatyana Rasevich: None declared, Ruzana Samigullina: None declared, Diana Abdulganieva: None declared

FRI0541 TEN-YEAR OUTCOME OF DIFFERENT SUBTYPES OF UNDIFFERENTIATED INFLAMMATORY ARTHRITIS

Background:

A group of patients with recent onset of arthritis always presents a certain difficulty for the practitioner due to its marked heterogeneity. This especially concerns the patients with undifferentiated inflammatory arthritis (UIA).

Objectives:

To characterize the long-term nosological outcome of clinical and immunological subtypes of early UIA.

Methods:

A cohort study of patients with recent onset of arthritis with a duration of not more than 12 months (n = 761, 82.8% females, 55.2% RF +) was initiated in 2003. All patients were referred to rheumatologist from GP with suspicion on inflammatory arthritis. Inclusion criteria: age 18 years or more, at least 1 swollen joint at 1stvisit and/or positive squeeze test or morning stiffness for at least 30 minutes. 243 patients were initially classified as having UIA: 46 (18,9%) males, 197 (81,1%) females, age (median, quartiles)- 44 [29;53] years, duration of symptoms- 3 [2;5] months, swollen joints count (66/68)- 2 [1;4], tender joints count 3 [2;6], 85 (35%) rheumatoid factor (RF)+, 63 (25,9%) anti-CCP+. Patients with UIA were followed up for at least 10 years.

Results:

28 (11,5%) of patients were lost to follow up. Long-term observation was conducted in 215 patients. 22 (10,2%) of them developed persistent spontaneous (without use of DMARDs) remission. Other patients were finally classified as having: rheumatoid arthritis (RA) 138 (64,2%) and non-RA (25,6%). The spectrum of diagnoses in non-RA group included: ankylosing spondylitis, osteoarthritis, gout, psoriatic arthritis, polymyalgia rheumatica, systemic lupus, mixed connective tissue disease, sarcoidosis, paraneoplastic syndromes. The following characteristics at baseline positively correlated with the development of RA: arthritis of 3 or more joints (p=0,011), arthritis of hand (p=0,005), high ESR (p<0,001), high CRP (p=0,003), PF-positivity (p<0,001), anti-CCP-positivity (p<0,001), older age of onset (p=0,019), higher levels of RF IgM (p=0,027) and anti-CCP (p<0,001). Development of persistent spontaneous remission negatively correlated with polyarthritis (p=0,033), PF-positivity (p=0,034), anti-CCP-positivity (p=0,001). Positive seroconversion was observed: of RF in 10 (4,7%) patients, 8 developed RA, of anti-CCP – in 3 (1,4%) patients, all developed RA.

Table.

Outcome of different subtypes of patients with UA after 10 years of follow up (n=215).

Subtypes of UAOutcomeP (Pearson chi-squared test)Non-RA (n=55)RA (n=138)Spontaneous remission (n=22)Mono- and oligo arthritis (n=140)40 (28,6%)81 (57,9%)19 (13,6%)0,016Polyarthritis (n=75)15 (20%)57 (76%)3 (4%)RF-negative AND anti-CCP-negative (n=90)34 (37,8%)41 (45,6%)15 (16,7%)<0,001RF+ OR anti-CCP+ OR low levels (<3 ULN) (n=92)20 (21,7%)65 (70,7%)7 (7,6%)High RF+ AND High anti-CCP+ (n=33)1 (3%)32 (97%)0

Conclusion:

Seronegative oligoarticular disease and highly seropositive disease are different subtypes of UIA. Combination of seronegativity and oligoarticular disease (n=52) associated with relatively rare development of RA (36,2%) and high proportion of spontaneous remission (22,4%). Patients who were highly positive (>3 ULN) for both RF and anti-CCP developed RA in 97% of cases and never remitted spontaneously.

Disclosure of Interests:

Elena Luchikhina Consultant of: Abbvie, Biocad, Sanofi, Celgene, Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Dmitry Karateev Consultant of: Abbvie, Pfizer, Biocad, Sanofi, Novartis, Lilly, Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Lilly, Bayer, Alexander Novikov: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Elena Aleksandrova: None declared, Natalia Demidova: None declared

AB0702 THE FREQUENCY OF INFLAMMATORY BOWEL DISEASES IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Аnkylosing Spondylitis (AS) is closely associated with inflammatory bowel disease (IBD). About 6-46% of patients with IBD have various lesions of the musculoskeletal system [1]. 5-10% of patients with spondylarthritis (SpA) eventually develop IBD, with Crohn’s disease (CD) being more common than Ulcerative colitis (UC) [2]. Determining the level of fecal calprotectin (FC) is a study that allows to diagnose IBD. The concentration of FC directly depends on the neutrophil infiltration of the intestinal mucosa and has a direct connection with the activity of the inflammatory process [3]. It is known that level of FC increases in 2/3 of patients with AS and is closely related to parameters reflecting higher disease activity [4].

Objectives:

The aim of this study was to evaluate the frequency of IBD in patients with AS using an assessment of FC level.

Methods:

In the analysis were included 40 patients with AS, fulfilling the modified New York criteria, among them man -26 (65%), woman -14 (35%), mean age of patients was 41.2 ±10.5, mean disease duration - 13±8.8 years. All patients were examined with ESR, CRP, esophagogastroduodenoscopy, colonoscopy and quantitative analysis of the fecal calprotectin levels using the method of lateral immunochromatography with the BUHLMANN Quantum Blue rapid test. Standart range: 100-1800 µg /g.

Results:

All patients had a high disease activity, mean BASDAI was 5.2 ± 1.7, mean ASDAS CRP 3.8 ± 1.1. 35 patients (87.5 %) had FC level more than 100 µg / g, the remaining 5 patients (12.5%) less than 100 µg /g. 12 patients (30 %) had FC level more than 1,800 µg / g, 23 (57.5 %) from 101 µg / g to 1800 µg / g. All patients with FC levels more than 100 µg / g showed an increase CRP (mean 28.4 mg / l) and ESR (mean 36.3 mm\h) levels. IBD were diagnosed in 9 cases (22.5%): 5 patients (12.5 %) with CD and 4 patients (10 %) - UC, in the remaining cases (77.5%) was no intestinal pathology.

Conclusion:

The results showed high frequency of IBD in patients with AS. Patients with high FC levels (more than 100 μg/g) had high disease activity (AS). In most cases, inflammatory bowel disease were diagnosed in patients with FC levels more than 100 µg/g.

References:

[1] Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001 Apr;96(4):1116-22.

[2] Klingberg, E., Strid, H., Stahl, A.et al. A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. Arthritis Res Ther 2017. 19(1):21

[3] Cypers H, Varkas G, Beeckman S, et al. Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis. Annals of the Rheumatic Diseases. 2016. 75:1357-1362

[4] Arzu Duran, Senol Kobak, Nazime Sen, et al. Fecal calprotectin is associated with disease activity in patients with ankylosing spondylitis. Bosnian Journal of Basic Medical Sciences. 2016. 16 (1):71-4

Disclosure of Interests:

Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Polina Kulakova: None declared, Nadezhda Savenkova: None declared, Evgeniy Volnukhin: None declared, Anton Kovshik: None declared, Elena Alexandrova: None declared, Alexandr Novikov: None declared

THU0563 IMMUNOGENICITY AND SAFETY OF 23-VALENT PNEUMOCOCCAL VACCINE IN PATIENTS WITH ANKYLOSING SPONDYLITIS (PRELIMINARY RESULTS)

Background:

For the treatment of patients with ankylosing spondylitis (AS), biological drugs are widely used, which can effectively control the activity of the disease and radically change the prognosis. However, the use of these drugs is associated with an increasing risk of infections, some of which can probably be prevented by vaccination.

Objectives:

The aim of the study was to evaluate the immunogenicity and safety of the 23-valent pneumococcal vaccine (PPV-23) in patients with AS.

Methods:

The study included 18 patients with AS: 14 men, 4 women, age 38.7±11.5 years, duration of the disease 16.2±10.8 years. 5 patients had a history of more than 2 episodes of lower respiratory tract infections (pneumonia, bronchitis). At the time of inclusion in the study in 89% of patients, activity of diseases was assessed as high (median BASDAI was 5.1 [4; 6.2]). All patients received non-steroidal anti-inflammatory drugs, 6 patients - sulfasalazine, 4 - methotrexate, 1 - glucocorticoids, 1 – etanercept. PPV-23 was administered in an amount of 1 dose (0.5 ml) subcutaneously against the background of therapy. In 14 patients vaccination was performed before the appointment of secukinumab; 2 of them continued to take methotrexate, 3 - sulfasalazine. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics s.r.o., Czech Republic) before vaccination, 1 and 3 months after vaccination. The duration of follow-up was 6.7±4.9 months.

Results:

The dynamics of the concentration of antibodies to pneumococcal capsular polysaccharide is presented in the table.

Table.

Concentration of pneumococcal antibodies in patients with AS, U/ml, Me [25; 75 percentile]

1 visit (initial)2 visit (after 1 month)3 visit (after 1 month)78.2 [35.2; 246.3]246.7 [148.6; 266.1]*261.1 [214.1; 273,4]**

*p=0.04 **p=0.008

After 1 and 3 months after vaccination, the concentration of antibodies to pneumococcal capsular polysaccharide was significantly higher than the baseline values. None of the patients had lower respiratory tract infections. There was no exacerbation of disease. 83% of patients did not have any adverse effects of vaccination. Reactions at the injection site (pain, swelling and hyperemia of the skin up to 2 cm in diameter), resolved independently after 3-5 days, were noted in 2 patients. One patient registered a severe local reaction (infiltration and hyperemia of the skin up to 8 cm in diameter, pain in the arm), accompanied by low-grade fever for 2 days, which required the appointment of antihistamine drugs.

Conclusion:

Preliminary results indicate satisfactory immunogenicity and safety of the PPV-23 in patients with AS. Further research is needed to better assess the immunogenicity, efficacy and safety of the vaccine.

Disclosure of Interests:

Natalia Muravyeva: None declared, Boris Belov: None declared, Galina Tarasova: None declared, Maria Cherkasova: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche

AB0303 PREDICTORS OF SERIOUS INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TARGET THERAPY

Background:

The problem of infectious complications in patients receiving bDMARDs deserves special attention. Serious infectious adverse events (SIAE) are a most important issue. To develop measures for their prevention it is necessary to know the predisposing factors.

Objectives:

to detect predictors of serious infections among patients with rheumatoid arthritis receiving targeted therapy

Methods:

The study includes patients with rheumatoid arthritis from the Moscow Unified Arthritis Registry (MUAR), receiving treatment with biologics or tofacitinib. Search for predictors was carried out in two steps. At first step we selected patient related predictors (confounders) that significantly correlate with risk of SIAE. At the second step in the Cox risk regression model by forward stepwise selection were identified independent significant predictors of risk. which demonstrated significant correlation with development of serious infections. Then data about the treatment was added to the generated model: used targeted DMARDs, doses of glucocorticoids (GC), doses of methotrexate (MTX).

Results:

Analysis includes 1052 treatment events in 772 patients. There were 44 serious infections. The mean age was 57,1 ± 12,8 years. The mean observation time – 5.3 years. Independent patient related predictors of SIAE risk were the age RR - 1.12 per year (CI: 1.06-1.19), the age of onset disease RR - 0.94 per year (CI: 0.90-0.98), the year of inclusion in the registry RR - 0.64 per year (CI: 0.49-0.85). The dose of MTX and the doses of GC positively correlate with SIAE risk. RR for MTX is 1.05 per mg (CI: 1.005-1.109), RR for GC - 1.11 per mg (CI: 1.004-1.236).

Used targeted DMARD didn’t show any significant correlation with SIAE risk.

Conclusion:

Higher doses of methotrexate and glucocorticoids are independent significant predictors of serious infections in RA patients receiving targeted DMARDs.

Disclosure of Interests:

Ekaterina Koltsova: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Evgeniya Shmidt Speakers bureau: MSD, Novartis, Pfizer, Karine Lytkina Speakers bureau: Novartis, Eli Lilly, Pfizer, UCB, Abbvie, Biocad, MSD, Jonson&Jonson, Evgeniy Zhilyaev Speakers bureau: Novartis, UCB, Pfizer, Biocad, Abbvie, MSD, Roche

SAT0161 THE ANALGESIC EFFECT OF TOFACITINIB MAY HAVE CLINICAL SIGNIFICANCE IN PATIENTS WITH RHEUMATOID ARTHRITIS. DATA FROM THE MOSCOW UNIFIED REGISTER OF ARTHRITIS (MUAR)

Background:

Some theoretical data suggest that the JAK-kinase blocker tofacitinib (TOFA) may have a direct analgesic effect.

Objectives:

to evaluate the clinical significance of the analgesic effect in patients with rheumatoid arthritis (RA) in real clinical practice.

Methods:

Hypothesis being tested: the analgesic effect of TOFA may be manifested by a decrease in the ratio of subjective to objective indicators of arthritis activity.

Data from RA patients receiving biologics (bDMARD) and/or TOFA and included in the MUAR register were analyzed. The tender joints count (TJC), the HAQ-DI functional ability index, and the RAPID3 disease activity index were considered as subjective estimates. The swollen joints count (SJC) and the level of CRP were treated as objective indicators. The estimation of quotients from the division of subjective indicators into objective ones in all combinations is made.

Taking into account the observational nature of the study, we searched for confounders for each of these ratios. Comparison of the calculated indices during the treatment with various targeted DMARDs (tDMARDs) was made with an adjustment for the detected confounders.

Results:

the analysis included 944 treatment episodes in 832 patients, including 93 episodes of TOFA treatment. The average age was 55.3 ± 12.4 years, women - 698 (83.9%), seropositive for RF -672 (80.8%). The analysis of the adjusted values showed that the ratios of the TJC, HAQ-DI and RAPID3 to the SJC during the treatment with TOFA was significantly lower than with tDMARDs on average. There were no significant differences in the ratios of objective indicators to the CRP level (Table).

Table.

Ratios of objective and subjective indicators during the treatment with tofacitinib and with tDMARDs therapy in general

Conclusion:

the severity of subjective feelings and functional disorders in RA patients receiving TOFA may be less with the same level of objective signs of arthritis compared with bDMARDs.

Disclosure of Interests:

Evgeniy Zhilyaev Speakers bureau: Novartis, UCB, Pfizer, Biocad, Abbvie, MSD, Roche, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Ekaterina Koltsova: None declared, Evgeniya Shmidt Speakers bureau: MSD, Novartis, Pfizer, Karine Lytkina Speakers bureau: Novartis, Eli Lilly, Pfizer, UCB, Abbvie, Biocad, MSD, Jonson&Jonson

Comparative effectiveness of subcutaneous tocilizumab versus intravenous tocilizumab in a pan-European collaboration of registries

Objective

To compare the real-word effectiveness of subcutaneous tocilizumab (TCZ-SC) and intravenous tocilizumab (TCZ-IV) in rheumatoid arthritis (RA).

Methods

Patients with RA with TCZ from eight European registries were included. Drug retention was compared using unadjusted Kaplan-Meier and Cox models adjusted for baseline patient, disease and treatment characteristics, using a strata term for year of treatment initiation and country of registry. The proportions of patients achieving Clinical Disease Activity Index (CDAI) remission and low disease activity (LDA) at 1 year were compared using samples matched on the same covariates and corrected for attrition using LUNDEX.

Results

3448 patients were retrieved, 2414 with TCZ-IV and 1034 with TCZ-SC. Crude median retention was 3.52 years (95% CI 3.22 to 3.85) for TCZ-IV and 2.12 years for TCZ-SC (95% CI 1.88 to 2.38). In a country-stratified and year of treatment initiation–stratified, covariate-adjusted analysis, hazards of discontinuation were similar between TCZ-SC and TCZ-IV treated patients (HR 0.93, 95% CI 0.80 to 1.09). The average adjusted CDAI change at 1 year was similar in both groups (−6.08). After matching, with 560 patients in each group, CDAI remission corrected for attrition at 1 year was also similar between TCZ-SC and TCZ-IV (10.4% in TCZ-IV vs 12.8% in TCZ-SC (difference: 2.4%, bootstrap 95% CI −2.1% to 7.6%)), but CDAI LDA was lower in TCZ-IV patients: 41.0% in TCZ-IV versus 49.1% in TCZ-SC (difference: 8.0 %; bootstrap 95% CI 2.4% to 12.4%).

Conclusion

With similar retention and effectiveness, TCZ-SC is an adequate alternative to TCZ-IV for RA. When possible, considering the costs of the TCZ-IV route, TCZ-SC should be the preferred mode of administration.

Smoking and response to rituximab in rheumatoid arthritis: results from an international European collaboration

OBJECTIVES

To investigate whether smoking habits predict response to rituximab (RTX) in rheumatoid arthritis (RA).

METHOD

We included patients from the CERERRA international cohort receiving the first treatment cycle with available smoking status (n = 2481, smokers n = 528, non-current smokers n = 1953) and at least one follow-up visit. Outcome measures were change in Disease Activity Score based on 28-joint count (ΔDAS28) and European League Against Rheumatism (EULAR) good response at 6 months, with non-current smokers as the referent group.

RESULTS

Compared with non-smokers at baseline, smokers were more often rheumatoid factor (RF)/anti-citrullinated protein antibody (ACPA) positive and males, had shorter disease duration, lower DAS28 and Health Assessment Questionnaire (HAQ) score, a higher number of prior biological disease-modifying anti-rheumatic drugs, and were more likely to receive concomitant conventional synthetic disease-modifying anti-rheumatic drug (csDMARDs). Disease activity had decreased less in smokers at 6 months (ΔDAS28 = 1.5 vs 1.7, p = 0.006), although the difference was no longer significant after correction for baseline DAS28 (p = 0.41). EULAR good response rates did not differ between smokers and non-smokers overall or stratified by RF/ACPA status, although smokers had lower good response rates among seronegative patients (ACPA-negative: 6% vs 14%, RF-negative: 11% vs 18%). Smoking did not predict good response [odds ratio (OR) = 1.04, 95% confidence interval (CI) = 0.76-1.41], while ACPA, DAS28, HAQ, and concomitant csDMARDs were significant predictors for good response. However, when stratified by country, smokers were less likely to achieve good response in Sweden (unadjusted OR = 0.24, 95% CI = 0.07-0.89), and a trend was seen in the Czech Republic (OR = 0.45, 95% CI = 0.16-1.02).

CONCLUSION

In this large, observational, multinational RA cohort, smokers starting RTX differed from non-smokers by having shorter disease duration and lower disease activity, but more previous treatments. The overall results do not support smoking as an important predictor for response to RTX in patients with RA.

Comparative effectiveness of tocilizumab versus TNF inhibitors as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis after the use of at least one biologic disease-modifying antirheumatic drug: analyses from the pan-European TOCERRA register collaboration

OBJECTIVE

To compare the effectiveness of tocilizumab (TCZ) and tumour necrosis factor (TNF) inhibitors (TNFi) as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) after the use of at least one biologic DMARD (bDMARD).

METHODS

We included patients with RA having used at least one bDMARD from 10 European registries. We compared drug retention using Kaplan-Meier and Cox models and Clinical Disease Activity Index (CDAI) change over time with mixed-effects models for longitudinal data. The proportions of CDAI remission and low disease activity (LDA) at 1 year were compared using LUNDEX correction.

RESULTS

771 patients on TCZ as monotherapy (TCZ mono), 1773 in combination therapy (TCZ combo), 1404 on TNFi as monotherapy (TNFi mono) and 4660 in combination therapy (TNFi combo) were retrieved. Crude median retention was higher for TCZ mono (2.31 years, 95% CI 2.07 to 2.61) and TCZ combo (1.98 years, 95% CI 1.83 to 2.11) than TNFi combo (1.37 years, 95% CI 1.30 to 1.45) and TNFi mono (1.31 years, 95% CI 1.18 to 1.47). In a country and year of treatment initiation-stratified, covariate-adjusted analysis, hazards of discontinuation were significantly lower among patients on TCZ mono or combo compared with patients on TNFi mono or combo, and TNFi combo compared with TNFi mono, but similar between TCZ mono and combo. Average adjusted CDAI change was similar between groups. CDAI remission and LDA rates were comparable between groups.

CONCLUSION

With significantly longer drug retention and similar efficacy to TNFi combo, TCZ mono or combo are reasonable therapeutic options in patients with inadequate response to at least one bDMARD.

Tuberculosis and viral hepatitis infection in Eastern Europe, Asia, and Latin America: impact of tumor necrosis factor-α inhibitors in clinical practice

Tumor necrosis factor-α (TNF-α) inhibitors are increasingly becoming the standard of care for treating a number of inflammatory diseases. However, treatment with TNF-α inhibitors carries an inherent risk of compromising the immune system, resulting in an increased susceptibility to infections and malignancies. This increased risk of infection is of particular concern in Asia, Eastern Europe, and Latin America where tuberculosis (TB) and viral hepatitis are endemic. In this brief review, we examine the literature and review the impact of TNF-α inhibitors on the incidence and the reactivation of latent disease with respect to TB, hepatitis C infection, and hepatitis B infection. Our findings show that TNF-α inhibitors are generally safe, if used with caution. Patients should be screened prior to the initiation of TNF-α inhibitor treatment and given prophylactic treatment if needed. In addition, patients should be monitored during treatment with TNF-α inhibitors and after treatment has stopped to ensure that infections, if detected, are treated promptly and effectively. Our analysis is consistent with other reports and guidelines.

Rituximab Retreatment in Rheumatoid Arthritis in a Real-life Cohort: Data from the CERERRA Collaboration

Objective.

Several aspects of rituximab (RTX) retreatment in rheumatoid arthritis (RA) need to be further elucidated. The aim of this study was to describe the effect of repeated courses of RTX on disease activity and to compare 2 retreatment strategies, fixed-interval versus on-flare retreatment, in a large international, observational, collaborative study.

Methods.

In the first analysis, patients with RA who received at least 4 cycles with RTX were included. In the second analysis, patients who received at least 1 RTX retreatment and for whom information about the strategy for retreatment was available were identified. Two retreatment strategies (fixed-interval vs on-flare) were compared by fitting-adjusted, mixed-effects models of 28-joint Disease Activity Score (DAS28) over time for first and second retreatment.

Results.

A total of 1530 patients met the eligibility criteria for the first analysis. Significant reductions of mean DAS28 between the starts of subsequent treatment cycles were observed (at start of first treatment cycle: 5.5; second: 4.3; third: 3.8; and fourth: 3.5), suggesting improved response after each additional cycle (p < 0.0001 for all pairwise comparisons). A total of 800 patients qualified for the second analysis: 616 were retreated on flare and 184 at fixed interval. For the first retreatment, the fixed-interval retreatment group yielded significantly better results than the on-flare group (estimated marginal mean DAS28 = 3.8, 95% CI 3.6–4.1 vs 4.6, 95% CI 4.5–4.7, p < 0.0001). Similar results were found for the second retreatment.

Conclusion.

Repeated treatment with RTX leads to further clinical improvement after the first course of RTX. A fixed-interval retreatment strategy seems to be more effective than on-flare retreatment.

Effectiveness of tocilizumab with and without synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: results from a European collaborative study

OBJECTIVES

To examine the effectiveness of tocilizumab (TCZ) with and without synthetic disease-modifying antirheumatic drugs (sDMARDs) in a large observational study.

METHODS

Patients with rheumatoid arthritis treated with TCZ who had a baseline visit and information on concomitant sDMARDs were included. According to baseline data, patients were considered as taking TCZ as monotherapy or combination with sDMARDs. Main study outcomes were the change of Clinical Disease Activity Index (CDAI) and TCZ retention. The prescription of TCZ as monotherapy was analysed using logistic regression. CDAI change was analysed with a mixed-effects model for longitudinal data. TCZ retention was analysed with a stratified extended Cox model.

RESULTS

Multiple-adjusted analysis suggests that prescription of TCZ as monotherapy varied according to age, corticosteroid use, country of the registry and year of treatment initiation. The change of disease activity assessed by CDAI as well as the likelihood to be in remission were not significantly different whether TCZ was used as monotherapy or in combination with sDMARDs in a covariate-adjusted analysis. Estimates for unadjusted median TCZ retention were 2.3 years (95% CI 1.8 to 2.7) for monotherapy and 3.7 years (lower 95% CI limit 3.1, upper limit not estimable) for combination therapies. In a covariate-adjusted analysis, TCZ retention was also reduced when used as monotherapy, with an increasing difference between mono and combination therapy over time after 1.5 years (p=0.002).

CONCLUSIONS

TCZ with or without concomitant sDMARDs resulted in comparable clinical response as assessed by CDAI change, but TCZ retention was shorter under monotherapy of TCZ.