The data project: a shared approach between stakeholders of the healthcare system in definition of a therapeutic algorithm for inflammatory arthritis

Rheumatic musculoskeletal diseases or RMD [rheumatoid arthritis (RA) and spondyloarthritis (SpA)] are systemic inflammatory diseases for which there are no biomarkers capable of predicting treatments with a higher likelihood of response in naive patients. In addition, the expiration of the anti-TNF blocking drugs' patents has resulted in the availability of anti-TNF biosimilar drugs with the same efficacy and safety than originators but at significantly reduced prices. To guarantee a personalized therapeutic approach to RMD treatment, a board of rheumatologists and stakeholders from the Campania region, Italy, developed a clinically applicable arthritis therapeutic algorithm to guide rheumatologists (DATA project). The general methodology relied on a Delphi technique forecast to produce a set of statements that summarized the experts' consensus. Selected clinical scenarios were discussed in light of the available evidence, and there were two rounds of voting on the therapeutic approaches. Separate discussions were held regarding rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The decision-making factors for each disease were clinical presentation, demographics, and comorbidities. In this paper, we describe a virtuous process between rheumatologists and healthcare system stakeholders that resulted in the development of a shared therapeutic algorithm for RMD patients naive to bDMARDs.

AB0936 Neuropathic pain in Psoriatic Arthritis: analysis of populations treated with anti TNF and anti IL17

Background

Psoriatic arthritis (PsA) is a disease characterized by chronic pain and it is often associated with the presence of fibromyalgia (FMS) with an estimated prevalence of 18%. Several studies demonstrated the central role of neuropathic pain in FMS. However, patients with inflammatory diseases such as PsA frequently complain of complex pain symptoms, with neuropathic characteristics. Therefore, in PsA we can recognize both an inflammatory pain and a neuropathic pain that can be exacerbated both by the concomitant fibromyalgia or depending only on the PsA itself. In fact, In the context of PsA, the presence of neuropathic pain features has been documented in 28% of patients. This could be a reason why the low remission rate in these patients. Finally, Studies on murin models revealed a possible role of IL17, key cytokine of PsA pathogenesis, in mechanism of neuropathic pain.

Objectives

To evaluate the role of anti-TNF and antiIL-17 in neuropathic pain in PsA patients treated with the first biological drug (bDMARDS).

Methods

A cross-sectional evaluation was conducted on 38 PsA patients classified by Classification criteria for Psoriatic Arthritis (CASPAR), referred to the PsA outpatient clinic of “University of Campania Luigi Vanvitelli”. Thirty patients were treated with anti-TNF (mean age 53 years, 17F, 13M), 8 were treated with anti-IL17 (mean age 50 years, 5F, 3M), for almost 6 months. For each patient, an assessment of disease activity using DAPSA and physical function was carried out. The presence of comorbid fibromyalgia syndrome (FMS) was evaluated according to ACR 2016 criteria. We investigated neuropathic pain features through the PainDETECT Questionnaire (PDQ).

Results

Nine patients treated with anti TNF were in DAPSA remission; 18 patients had low disease activity, 3 had High disease activity, FMS was detected in 11 of 30 patients, no one in DAPSA remission for PsA. Characteristics of neuropathic pain (PDQ ≥ 19) were found in 13 (43.3%) patients overall; unlikely neuropathic pain (PDQ < 12) in 16 (53.3%) patients. In the first group 7 patients had FMS, in the second group 3 had FMS. So, our analysis revealed the presence of neuropathic pain in 6 patients (54,5%) with PsA treated with antiTNF with no FMS; all of them were in low disease activity. The same analysis was conducted on anti IL17 treated population: 4 patients were in DAPSA remission, 2 patients in low disease activity, 2 patients in high, disease activity. FMS was diagnosed in 3 patients, 1 of them was in DAPSA remission for PsA. PDQ>19 was found only in 1 patient, who had FMS in comorbidity; the others had no neuropathic pain. So, we had no PsA patient treated with antiIL17, that manifested symptoms of neuropathic pain.

Conclusion

The contribute of IL-17 in developing of neuropathic pain suggests the possible role of anti IL17 as therapy; our results support this tesis suggesting a possible role of anti IL17 in treatment of neuropathic pain. A limit to our work is given by the low sample size for which further studies are necessary to confirm this data.

References

[1]Ramjeeawon A, Neuropathic-like pain in psoriatic arthritis: evidence of abnormal pain processing. Clin Rheumatol. 2019;

[2]Sun C, IL-17 contributed to the neuropathic pain following peripheral nerve injury by promoting astrocyte proliferation and secretion of proinflammatory cytokines. Mol Med Rep. 2017

[3]Martinez-Lavin M: Fibromyalgia is a neuropathic pain syndrome. J Rheumatol 2006;

Disclosure of Interests

None declared

POS1211 SEROLOGICAL RESPONSE TO BNT162b2 mRNA ANTI-SARS-CoV-2 VACCINATION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES: RESULTS FROM THE RHEUVAX COHORT

Background

To date, globally considered, the literature suggests that AIRD may be at higher risk of infection and death due to COVID19 compared to the general population. Vaccination against SARS-CoV-2 reduces the risk of hospitalization and mortality. However, immunological alteration associated with Autoimmune Inflammatory Rheumatic Diseases (AIRD) and immunosuppressive medications may impair the response to vaccination. Emerging data suggest that immunosuppressive treatment may negatively impact the response to anti-SARS-CoV-2 vaccines in the AIRD population; data are robust for some treatments, more controversial for others.

Identifying patients at higher risk of lack of protection is essential for shielding them and for adapting therapeutic protocol and vaccination timing.

Objectives

In the light of the current COVID19 epidemic and the availability of effective vaccines, this study aims to identify predictors of non-response to anti-SARS-CoV-2 vaccines in patients affected by AIRD.

Methods

An observational cross-sectional study was conducted evaluating the serological response and the persistence of antibodies at eight weeks in IRD patient cohort and non-IRD control.

IRD and age and sex-matched controls volunteer among the health professionals (CTRL) who underwent vaccination with two doses of BNT162b2 were recruited for this study. Anti-Trimeric Spike protein antibodies were assayed eight ± one week after the second vaccine dose. Univariate and logistic regression analyses were performed to identify predictors of non-response and low antibody titers.

Results

Samples were obtained from 237 IRD patients (m/f 73/164, mean age 57, CI 95% [56-59]): 4 autoinflammatory diseases (AI), 62 connective tissue diseases (CTD), 86 rheumatoid arthritis (RA), 71 spondylarthritis (SpA) and 14 vasculitis (Vsc). 232 CTRL were recruited (m/f 71/161, mean age 57, CI 95% [56-58]).

Globally, IRD had a lower seroconversion rate (88.6% vs 99.6%, CI 95% OR [1.61-5.73], p<0.0001) and lower antibody titer compared to controls (median (IQR) 403 (131.5-1012) vs 1160 (702.5-1675), p<0.0001). After logistic regression, age, corticosteroid (CCS), Abatacept (ABA), and Mycophenolate Mofetil (MMF) use were predictors of non-response.

The antibody titers eight weeks after the second dose of vaccine were lower in AIRD compared to controls, median (IQR) 403 (131.5-1012) vs 1160 (702.5-1675), p<0.0001 with no difference between sexes and age groups. CTD, RA and SpA had lower antibodies levels. However, the logistic regression model identified treatment with MMF, ABA, CCS, Methotrexate (MTX), Rituximab (RTX), Janus Kinase inhibitors (JAKi) and TNF inhibitors (TNFi) as independent predictors of serum titer. ABA, RTX, MMF, and MTX had the strongest effect size.

Conclusion

The response to anti-SARS-CoV-2 vaccines is often impaired in AIRD patients under treatment and may pose them at higher risk of severe COVID-19. Although this work focused on serological response, most of the treatment the impaired vaccine response are known to act on T cells, possibly also influencing the cellular response. Evidence-based protocols are required to time vaccination and treatment to improve immunization of AIRD patients.

References

[1]Kroon, F. P. B. et al. Risk and prognosis of SARS-CoV-2 infection and vaccination against SARS-CoV-2 in rheumatic and musculoskeletal diseases: a systematic literature review to inform EULAR recommendations. Ann. Rheum. Dis. (2021).

Acknowledgements

The authors would like to thank Dr Daniela Iacono, Dr Carlo Iandoli, Dr Alessandra Milone, Dr Anna Pellegrlino, Dr Elisabetta Seguino and Mrs Maria Puca, for their contribution in data and blood samples collection, Dr Giorgia Della Polla for the valuable suggestions on data analysis. The authors are grateful also to all patients and the volunteers for their contribution.

Disclosure of Interests

None declared

AB1174 ADVERSE EVENTS AFTER TWO DOSES OF BNT162b2 ANTI-SARS-CoV-2 VACCINE IN PATIENTS WITH RHEUMATIC MUSCULOSKELETAL DISEASES: RESULTS FROM A SINGLE CENTER ITALIAN STUDY

Background

Vaccination against COVID19 is the most important prevention tool against the current pandemic. However, since the approval of anti-COVID19 mRNA vaccines by EMA, safety and tolerability in patients with rheumatic musculoskeletal diseases has always been a much-discussed topic, given their novel, unprecedented mechanism of action and the concern for potential disease flares.

Objectives

To assess the safety and type of adverse events after two doses of BNT162b2 anti-SARS-CoV-2 vaccine in patients affected by rheumatologic diseases.

Methods

241 patients who received two doses of BNT162b2 were invited to take part to a follow-up live visit 2 months after completion of the primary vaccination cycle. Data regarding age, sex, diagnosis, treatment and adverse events after vaccination were collected for each patient during the visit. Pearson chi-square and Fisher exact tests were used to compare the distribution of each type of adverse event between male and female and among Rheumatoid Arthritis, Spondyloarthritis and Connective Tissue Disease patients.

Results

Mean age of recruited patients was 57 years (IQR 49-65) and F:M ratio was 2.49:1 (172 F/69 M). Number and percentage of individuals for each disease category were represented as follows: Rheumatoid Arthritis 87 (36,10%), Spondyloarthritides 72 (29,88%), Connective Tissue Diseases 65 (26,97%), Autoinflammatory Diseases 4 (1,66%), Vasculitides 13 (5,39%). 42 subjects (17,42%) reported no adverse events, whereas local reactions such as pain and swelling at injection site were the most commonly reported side effect, (154 subjects, 63,9%, Table 1). Constitutional symptoms, comprising fatigue, muscle and joint pain, fever, chills and headache, were described in 54,77% of the interviews (132 subjects, Table 1). No patient experienced severe allergic reactions after vaccination. Statistical comparison among disease categories showed no differences in the distribution of adverse events. When analysing for sex, joint pain appeared to be reported significantly more frequently in male patients (p=0.002), while chills were more present in female patients (p=0.033). None of the interviewed subjects reported any sign or symptom relatable to disease flares.

Table 1All pts n (%)Female n (%)Male n (%)RA n (%)SpA n (%)CTD n (%)24117269877265Local reactions154 (63,90)110 (63,95)44 (63,77)53 (60,92)46 (63,89)43 (66,15)-Pain152 (63,07)108 (62,79)44 (63,77)53 (60,92)45 (62,50)42 (64,62)-Swelling4 (1,66)3 (1,74)1 (1,45)1 (1,15)2 (2,78)1 (1,54)Constitutional symptoms132 (54,77)98 (56,98)34 (49,28)46 (52,87)38 (52,78)37 (56,92)-Fatigue75 (31,12)58 (33,72)17 (24,64)25 (28,74)21 (29,17)22 (33,85)-Headache35 (14,52)29 (16,86)6 (8,70)10 (11,49)10 (13,89)14 (21,54)-Muscle pain37 (15,35)28 (16,28)9 (13,04)14 (16,09)10 (13,89)12 (18,46)-Joint pain14 (5,81)5 (2,91)9 (13,04)7 (8,05)4 (5,56)1 (1,54)-Fever35 (14,52)24 (13,95)11 (15,94)15 (17,24)5 (6,94)11 (16,92)-Chills22 (9,13)20 (11,63)2 (2,90)7 (8,05)8 (11,11)6 (9,23)Gastrointestinal symptoms19 (7,88)14 (8,14)5 (7,25)7 (8,05)5 (6,94)5 (7,69)-Nausea17 (7,05)13 (7,56)4 (5,80)5 (5,75)5 (6,94)5 (7,69)-Vomiting1 (0,41)1 (0,58)0 (0,00)0 (0,00)0 (0,00)1 (1,54)-Diarrhea3 (1,24)2 (1,16)1 (1,45)2 (2,30)0 (0,00)1 (1,54)Lymphoadenopathy2 (0,83)2 (1,16)0 (0,00)0 (0,00)0 (0,00)2 (3,08)Severe allergic reactions0 (0,00)0 (0,00)0 (0,00)0 (0,00)0 (0,00)0 (0,00)Other5 (2,07)4 (2,33)1 (1,45)2 (2,30)1 (1,39)2 (3,08)None42 (17,43)29 (16,86)13,00 (18,84)19 (21,84)12 (16,67)9 (13,85)

Table notes. RA: Rheumatoid Arthritis; SpA: Spondyloarthritides; CTD: Connective Tissue Diseases; Other: comprising reports of increased heart rate, visual disturbances, conjunctival hyperaemia, transient hyperglycaemia.

Conclusion

Vaccination with two doses of BNT162b2 was safe and generally well tolerated. No reports of signs or symptoms of disease reactivation were found in our cohort.

Disclosure of Interests

None declared

POS1337 ADULT-ONSET STILL’S DISEASE WITH ELDERLY ONSET, RESULTS FROM A MULTICENTRE STUDY AND ASSESSMENT OF AGE INFLUENCE ON CLINICAL FEATURES AND DISEASE OUTCOMES

Background

Aging is a physiological, multidimensional, and irreversible process, occurring in humans over time. Interestingly, multiple lines of evidence have recently suggested that some diseases, generally affecting young adults, are nowadays described in the elderly, although possibly associated with different symptoms or complications. In this context, a possible occurrence of adult onset Still’s disease (AOSD) in elderly has been suggested. This is a rare inflammatory disorder of unknown origin usually observed in young adults [1-3].

Objectives

In this study, we aimed at describing the clinical characteristics, life-threatening complications occurrence, and mortality of AOSD patients with an elderly onset. The manifestations of these patients were also compared with those with a younger onset. Furthermore, the predictive role of age was evaluated on clinical features and disease outcomes. Finally, in these patients, an assessment of associated comorbidities was also performed.

Methods

A retrospective assessment of prospectively followed patients, from January 2001 to April 2021, was provided to analyse clinical features, life-threatening complications occurrence, and mortality in AOSD patients with onset in elderly. AOSD patients, who were included in multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort, were evaluated.

Results

Out of 221 assessed patients, 37 (16.7%) had an onset of the disease aged over than 60 years. When compared with younger patients, these were characterised by a higher prevalence of pericarditis (p=0.008), comorbidities (p<0.0001), and mortality (p=0.023).

Additionally, our analysis showed that pleuritis and pericarditis positively correlated with age (coefficient=0.227, p=0.001; coefficient=0.213, p=0.001, respectively). Furthermore, the occurrence of parenchymal lung disease was significantly related with age (coefficient=0.168, p=0.012). The presence of comorbidities positively correlated with age (coefficient=0.443, p<0.0001). Moreover, age was negatively related to the polycyclic pattern (coefficient=-0.209, p=0.002). A correlation between mortality and age was also retrieved (coefficient=0.158, p=0.019).

Age predicted the presence of serositis in both univariate (HR: 1.02, 95%CI: 1.01-1.03, p=0.007) and multivariate analyses (HR: 1.02, 95%CI: 1.01-1.04, p=0.007). Age was also a significant predictor of parenchymal lung disease in both univariate (HR: 1.03, 95%CI: 1.01-1.05, p=0.017) and multivariate analyses (HR: 1.03, 95%CI: 1.00-1.05, p=0.048). No significant results were observed assessing the predictive role of age on occurrence of macrophage activation syndrome. Furthermore, age resulted to be a negative predictor of polycyclic pattern only in univariate analysis (HR: 0.99, 95%CI: 0.97-1.00, p=0.048). Finally, age significantly predicted the mortality in both univariate (HR: 1.03, 95%CI: 1.00-1.06, p=0.034) and multivariate analyses (HR: 1.05, 95%CI: 1.01-1.08, p=0.012).

Conclusion

Clinical features of AOSD patients with elderly onset were described in our multicentre cohort. Although the main clinical characteristics were similar comparing older and younger patients, patients aged over 60 years at disease onset were characterised by an increased prevalence of serositis, comorbidities, mostly cardiometabolic, and a higher mortality rate. Age predicted the presence of parenchymal lung disease and mortality, and it could be considered a further negative prognostic factor in AOSD.

References

[1]Mollaeian A, Chen J, et al. BMC Rheumatol. 2021;5(1):12.

[2]Maruyama A, et al. Mod Rheumatol. 2021;31(4):862-868.

[3]Suzuki E, et al. Tohoku J Exp Med. 2021;255(3):195-202.

Disclosure of Interests

None declared

POS1210 PREVALENCE OF COVID-19 AMONG PATIENTS WITH RHEUMATIC DISEASES: AN OBSERVATIONAL SURVEY DURING THE TWO WAVES IN ITALY

Background:

The new coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) is a source of concern for the management of patients suffering from rheumatic and musculoskeletal diseases (RMDs) treated with immunomodulatory therapies (1).

Objectives:

We aimed to analyze the prevalence of SARS-CoV-2 infection in patients with RMDs living in Italy.

Methods:

During the first wave (March-May 2020) and during the second wave (October-December 2020) of COVID-19, we conducted a survey to investigate the incidence of SARS-CoV-2 infection in patients with RMDs followed at the Rheumatology Unit of the University of Campania, Italy. The demographic data, medication use, the frequency of respiratory symptoms and the incidence of COVID-19 confirmed by nasopharyngeal swab were collected with questionnaires administered by phone. The prevalence of COVID-19 of our cohort was compared to that of the general population (2).

Results:

During the first wave, we collected data from 900 patients with RMDs (Table 1): 320 patients with rheumatoid arthritis (RA), 295 patients with spondyloarthropathies (SpA), 283 patients with systemic lupus erythematosus (SLE), 2 patients with vasculitis. 546 (60%) were treated with bDMARD/tsDMARDs. Overall, a total of 11/900 (1%) cases were tested for COVID-19 due to compatible symptoms. 2 (0.2%) adult patients treated with bDMARDs were registered as swab test positive by PCR for COVID-19. 2 patients without confirmed COVID-19 developed pneumonia that required admission to hospital. No deaths occurred among the patients with confirmed COVID-19.

During the second wave, data were collected from 470 patients who accepted to take part of the study (Table 1). 49 presented with symptoms that were compatible with COVID-19. 139 patients were tested whereas 30 patients (6%) had a swab confirmation of SARS-CoV-2 infection. Among them, 16 (53%) were treated with bDMARDs and a patient was treated with tofacitinib. we found no increase in COVID-19 prevalence in patients treated with bDMARD/tsDMARDs (p>0.05). A patient with SLE developed pneumonia that required admission to hospital and died.

Lacking distinct prevalence data between first and second waves, we found no differences in total COVID-19 prevalence between general population living in Campania (215.752/5.802.000; 3.7%) and patients with RMDs (32/900; 3.5%). However, we had a significant increase in COVID-19 prevalence in our cohort during the second wave compared to the first. Nevertheless, no increase in mortality or hospitalization was recorded, confirming the safety of immunomodulatory therapies in patients with RMDs.

Conclusion:

In this cohort of patients with RMDs in a geographical region with a high prevalence of COVID-19, the risk of SARS-CoV-2 infection does not appear different from that observed in the general population.

References:

[1]Wang L., Wang Y., Ye D. Int J Antimicrob Agents. 2020:105948.

[2]http://www.protezionecivile.gov.it/ (accessed 28.01.21)

Table 1.

Demographics and clinical characteristics of 900 patients with rheumatic diseases during the COVID-19 Pandemic.

First waveSecond waveWomen, n 660 (73 %) 366(77%)Age, years, median (range)56 (54-57)53 (51-55)Rheumatoid Arthritis320 (35.5%)143 (30%)Spondyloarthritis295 (32%)110 (23%)Systemic Lupus Erythematosus283 (31%)217 (46 %)Vasculitis2 (0.2%)1 (0.2%)Prior ILD56 (6%)22 (4.6%)Smokers220 (24%)118 (25%)Hydroxychloroquine215 (23%)155 (32%)Steroids337 (37%)194 (41%)Prednisone equivalent dose, median (range)5 (0-75)5 (0-50)bDMARD/tsDMARDs546 (60%)247 (52%)csDMARDS387 (43%)185 (39%)Angiotensin-converting enzyme (ACE) inhibitors178 (19.8%)101 (21%)Angiotensin II receptor blockers(ARBs)153 (17%)61 (13%)Fever64 (7%)30 (6.3%)Cough83 (9%)36 (7%)Shortness of breath34 (3%)15 (3%)Sore throat32 (3%)11 (2.3%)Rhinorrhoea36 (3%)11 (2.3%)Headache5 (0.5%)2 (0.4%)Anosmia10 (1%)24 (5%)Myalgia2 (0.2%)1 (0.2%)Gastrointestinal symptoms24 (2.6%)3 (0.6%)Pneumonia2 (0.2%)2 (0.4%)Admission to hospital2 (0.2%)9 (1.9%)Swab confirmation of SARS-CoV-2 infection230

Disclosure of Interests:

None declared.

SAT0435 SECUKINUMAB EFFICACY In PsA PATIENTS IS DEPENDENT ON PATIENTS’ BODY MASS INDEX

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis burdened by a series of metabolic comorbidities. Among them, obesity is very common in PsA, with a prevalence of 27%, as confirmed by a recent Spanish work (1). Obesity in PsA has been associated with higher disease activity and a worse effectiveness of biologic treatment in PsA. This has been certainly proven for anti-TNF-α as demonstrated by different studies reporting, in obese patients, a reduced treatment response and adherence. In particular, results coming from DAN-BIO and ICE-BIO registries, (2) point out that obesity is a risk factor for anti-TNF withdrawal due to poor response. Although a recent multi-centric, retrospective study in Spain has shown that obese subjects with psoriasis have a poor therapeutic response to secukinumab, (3) no data are currently available for secukinumab in PsA obese patients.

Objectives:

Our studies focused on the relationship between BMI and clinical response to secukinumab in PsA.

Methods:

We, retrospectively, analysed clinical data of 100 patients with PsA (57% female, median age 53 (49.2-55 years)) satisfying CASPAR criteria (4) for PsA, afferent to our clinic, who were treated with secukinumab. Patients were divided into 2 groups based on BMI (BMI<25 normal weight and BMI≥25 overweight/obese).

Results:

In the normal weight group 75% were female, median age was 50.5 (41-54.6), median BMI was 22 (20.2-23.3) and median DAPSA was 19.19 (15.6-24.2). The features of the overweight/obese patients were similar to the normal weight group (48% were female, median age 54 (50-59), median BMI 29 (27.4-30.1) and median DAPSA 21.2 (19-24.4)). Clinical response to therapy, evaluated as the achievement of low disease activity or remission according to DAPSA, was recorded 6 months after starting treatment. After 6 months of treatment, the variation of the DAPSA was inversely related to BMI: overweight/obese patients had in fact a better response to secukinumab compared to normal weight patients. By using a correlation coefficient (SPSS), to analyze the degree of association between BMI and DAPSA, we observed that BMI and DAPSA are inversely related in our PsA patients (p=0.05). Interestingly, analysis of serum levels of IL-17 in 20 obese patients compared to 20 non-obese patients, showed significantly higher serum levels of IL-17 in the former (Figure 1), indicating IL-17 as a key cytokine driving inflammation in PsA obese patients.

Conclusion:

These are the first data about clinical response to secukinumab in obese PsA patients. Our results support the relevance of IL-17 in driving systemic inflammation in obese PsA patients, also providing evidence that obese patients may have a better response to secukinumab compared to non-obese patients. Interestingly, this effect was not

References:

[1]Rubén Queiro, Lorenzo A, Tejón P et al. Obesity in psoriatic arthritis. Comparative prevalence and associated factors. Medicine 2019 Jul;98(28):e16400

[2]Pil Højgaard, Glintborg B, Kristensen LE et al. The influence of obesity on response to tumour necrosis factor-a inhibitors in psoriatic arthritis:results from the DANBIO and ICEBIO registries. Rheumatology (Oxford). 2016 Dec;55(12):2191-2199

[3]Jaime Notario, Deza G, Vilarrasa E et al. Treatment of patients with plaque psoriasis with secukinumab in a real-life setting: a 52-weeks, multicenter, retrospective study in Spain. Journ of Derm Treat 2019 Aug;30(5):424-429

[4]Taylor W, Gladman D, Helliwell P et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73.

[5]Lluís Puig. Cardiometabolic Comorbidities in Psoriasis and Psoriatic Arthritis. Int J Mol Sci. 2017 Dec 25;19(1).

Disclosure of Interests:

Ilenia Pantano: None declared, DANIELA IACONO Speakers bureau: PFIZER, BRISTOL MAYERS SQUIBB, SANOFI, ENNIO GIULIO FAVALLI: None declared, GIUSEPPE SCALISE: None declared, Luisa Costa: None declared, Francesco Caso: None declared, Giuliana Guggino Grant/research support from: Pfizer, Celgene, Speakers bureau: Celgene, Sandoz, Pfizer, Raffaele Scarpa: None declared, francesco ciccia Grant/research support from: pfizer, novartis, roche, Consultant of: pfizer, novartis, lilly, abbvie, Speakers bureau: pfizer, novartis, lilly, abbvie

AB0315 RETENTION RATE OF ABATACEPT MONOTHERAPY IN AN ITALIAN MULTICENTRIC RHEUMATOID ARTHRITIS COHORT

Background:

EULAR recommendations focus the importance of Methotrexate (MTX) therapy as a key element in the treatment of patients with Rheumatoid Arthritis (RA), alone as first line therapy and in combination with biological Disease Modifying Anti-rheumatic Drug (bDMARDs). Abatacept (CTLA4-Ig) in Europe is approved for the treatment of moderate to severe active RA in combination with MTX. Several patients, however, discontinue MTX for intolerance, side effects or contraindications, and real-life data demonstrate how, even in patients receiving therapy with MTX, compliance could be suboptimal. The only data on the use of abatacept in monotherapy come from the ORA-Registry, where a worse performance is observed in monotherapy patients.

Objectives:

To evaluate a multicenter cohort of RA patients treated with Abatacept in patients underwent combined MTX therapy vs monotherapy.

Methods:

We retrospectively evaluated RA patients, referring to 2 Italian rheumatology centers, treated with Abatacept monotherapy or in combination with MTX. We compared both persistence in therapy and the rate of remission/low disease activity according to Clinical Disease Activity Index (CDAI) between the 2 groups.

Results:

We enrolled 147 patients, out of them 66 patients were on monotherapy with Abatacept due to intolerance or controindications and 81 in therapy with Abatacept plus MTX. The two cohorts appeared homogeneous in age, gender, disease duration and baseline activity indexes, with the only difference being higher baseline Physician Global assessment (PhGA) values in monotherapy patients. During the follow-up (median duration 24±14 months), the retention rate of Abatacept treatment was 71.2% in MTX patients (median duration 27–15.6 months) and 62.1% in monotherapy patients (median duration 25.2–17.5; p=ns). No differences between the two groups in terms of retention rate, low-disease activity and CDAI remission (log rank p=ns), Breslow p=ns) were detected.

Conclusion:

In patients with RA with intolerance or contraindication to MTX use, Abatacept monotherapy could be an efficient and safe option even in the long term follow-up.

References:

[1]Abatacept monotherapy compared with abatacept plus disease-modifying anti-rheumatic drugs in rheumatoid arthritis patients: data from the ORA registry.Truchetet ME et al. Arthritis Res Ther. 2016 Mar 30;18:72.

Disclosure of Interests:

DANIELA IACONO Speakers bureau: PFIZER, BRISTOL MAYERS SQUIBB, SANOFI, Ilenia Pantano: None declared, domenico birra: None declared, GIUSEPPE SCALISE: None declared, Melania Alessia Coscia: None declared, VALENTINA MESSINITI: None declared, Gabriella Loi: None declared, Anna Merchionda: None declared, Paolo Moscato: None declared, francesco ciccia Grant/research support from: pfizer, novartis, roche, Consultant of: pfizer, novartis, lilly, abbvie, Speakers bureau: pfizer, novartis, lilly, abbvie

Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review

Background

Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series.

Methods

A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000–2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events.

Results

The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged.

Conclusion

Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.