POS0251 TRANSCRIPTOMIC CHANGES INDUCED BY MAVRILIMUMAB VERSUS TOCILIZUMAB IN EX-VIVO CULTURED ARTERIES FROM PATIENTS WITH GIANT-CELL ARTERITIS

Background

Giant cell arteritis (GCA) is a chronic disease, and affected patients suffer from relapses and glucocorticoid (GC)-related toxicity. Targeted therapies are emerging with the aim of achieving better disease control and reducing GC exposure. Blocking IL-6 receptor with tocilizumab has been a major advance in the treatment of GCA. However, approximately 40% of patients treated with tocilizumab in combination with GCs experience a flare or tocilizumab-related adverse event. Blocking GM-CSF receptor α with mavrilimumab significantly reduced risk of relapse and improved sustained remission at week 26 vs placebo in a Phase 2 trial. Not all patients satisfactorily respond to any therapy, indicating heterogeneity in leading pathogenic pathways among patients. For these reasons, it is crucial to understand the specific impact of targeted therapies on vascular lesions.

Objectives

In this study we investigated transcriptomic changes induced by tocilizumab or mavrilimumab in ex-vivo cultured arteries from patients with GCA.

Methods

Temporal artery sections obtained for diagnostic purposes from 11 patients with histopathologically-confirmed GCA and 3 controls were cultured ex-vivo and exposed to placebo, mavrilimumab, or tocilizumab (both at 20 µg/mL) for 5 days. Of 11 GCA donors, 2 had received no treatment prior to biopsy, 2 had received a single prednisone (60 mg) dose, 1 had received 2 daily doses, and the remaining 6 had extended treatment; in prednisone-treated patients, mean (SEM) treatment duration was 17.9 ±8.7 days. A separate cohort of patients (consisting of five newly diagnosed patients with GCA, age- and sex-matched with the previous cohort) was used to validate 7 transcripts by real time PCR. Genes were selected for validation based on high level of expression and differential expression with each treatment. All samples were homogenized, and total RNA was extracted with TRIzol reagent. 100 ng of RNA per sample were processed with Nanostring Inflammation gene expression assay (256 transcripts) and hybridized using nCounter Prep Station. Barcode counts from nCounter Digital Analyzer were processed with nSolver 4.0 Software. Normalised data were analyzed using R Studio 4.0.5 and IBM SPSS 22.0, and paired Wilcoxon tests were applied individually to each treatment comparison group for each analysed gene. One µg of RNA per sample from the validation cohort was retrotranscribed; subsequent real time PCRs were normalised against endogenous control GUSb and analysed using SDS 2.3 software.

Results

67 out of 250 transcripts were differentially expressed between arteries from GCA patients and arteries from control patients (all placebo-treated). Of those, only 9 transcripts remained significant after correction for multiple comparisons, with a false discovery rate ≤0.05. 81 transcripts were differentially expressed in at least one comparison across groups (Figure 1A). 15 transcripts were lower, and 6 were higher in the mavrilimumab group vs placebo; 3 transcripts were lower, and 2 were higher in the tocilizumab group vs placebo. Most changes elicited between treatments were unique, but CXCL-1 was common (Figure 1B). None remained significant after correction for multiple comparisons. The effects of mavrilimumab and tocilizumab on GNAS, CXCL1, IL8, IL2, IRF3, MRC1 and BCL6 expression by Nanostring were consistent with the effect assessed using real time PCR in the separate validation cohort (Figure 1C).

Conclusion

Mavrilimumab and tocilizumab have a different transcriptomic impact on cultured arteries from patients with GCA, with some overlapping effects, although differential effects may have been attenuated by prior GC use. A better understanding of the impact of targeted therapies on vascular inflammation is needed to improve treatment options for patients with GCA.

Acknowledgements

The authors would like to thank: the Genomics core facility of the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Emily Plummer, PhD, Kiniksa Pharmaceuticals, for her invaluable contribution.

The study was funded by Kiniksa Pharmaceuticals, Ltd. With support from: Fundació Clínic Barcelona, Fundació Privada Cellex, IDIBAPS, Universitat de Barcelona, Vasculitis Foundation, Marie Curie Actions, and Gobierno de España, Ministerio de Economía, Industria, y Competitividad.

Disclosure of Interests

Marc Corbera-Bellalta: None declared, Farah Kamberovic: None declared, Ferran Araujo: None declared, Roser Alba-Rovira: None declared, Georgina Espigol-Frigole Consultant of: Consulting for Janssen and Hoffmann-La Roche;, Grant/research support from: Meeting attendance support from Boehringer Ingelheim, Marco Alba: None declared, Sergio Prieto-González Speakers bureau: Lecturing for Roche, Grant/research support from: Meeting attendance support from Italfarmo and CSL Behring, José Hernández-Rodríguez Speakers bureau: Lecturing for Novartis, Consultant of: Consulting for Sobi, Grant/research support from: Meeting attendance support from Sobi and Novartis, Patricia Pérez-Galán: None declared, Kent Bondensgaard Shareholder of: Kiniksa Pharmaceuticals Corp., Employee of: Kiniksa Pharmaceuticals Corp., John F. Paolini Shareholder of: Kiniksa Pharmaceuticals Corp., Employee of: Kiniksa Pharmaceuticals Corp., Maria C. Cid Speakers bureau: Educational from GSK and Vifor, Consultant of: Consulting for Janssen, GSK, and Abbvie, Grant/research support from: Research grant from Kiniksa; meeting attendance support from Roche and Kiniksa

POS0271 CLINICAL SYMPTOMS AT GIANT CELL ARTERITIS DIAGNOSIS AS PREDICTORS OF PERMANENT VISUAL LOSS

Background

Giant cell arteritis (GCA) is the most prevalent vasculitis in the elder. Nearly 20% of patients experience transient or permanent visual loss (PVL). It has been reported that erythrocyte sedimentation rate (ESR), haemoglobin (Hb), constitutional syndrome (CS) and fever are prognostic factors that predict PVL but models have shown poor diagnostic performance.

Objectives

To evaluate if clinical signs, symptoms and blood tests can predict PVL at GCA diagnosis.

Methods

We retrospectively included patients from the Spanish Vasculitis Registry (REVAS) from 2005 to 2009. Clinical and blood tests data were obtained from medical records. We randomly split the cohort using shrinkage function to create a derivation and a validation cohort. In the derivation set we compared data and we built a multivariable logistic regression model to predict PVL. Internal validity was evaluated with 1000 bootstrap. External validity was evaluated using the validation set of data. Performance of the model was determined using the area under the curve (AUC) with 95% confidence interval. Calculations were done using StataBE 17.0.

Results

We included 620 patients (derivation cohort: 397 patients). Clinical signs, symptoms and blood tests results according to the presence or absence of PVL (Table 1). Mean age at diagnosis was 76.3 years and PVL was present in 86 (21.7%) patients. Significant predictors at baseline were age (p=0.000), hypertension (p=0.04), fever (p=0.001), jaw claudication (0.000), transient visual loss (TVL, p=0.000) and decreased temporal artery (TA) pulse (p=0.004). Multivariable logistic regression showed that age older than 75 years (OR 2.7, p=0.000), jaw claudication (OR, 2.75; p=0.000) and TVL (OR 7.2, p=0.000) were risk factors for PVL. CS was the only protective factor (OR 0.57, p=0.017). Hypertension (OR 1.4, IC95%: 0.88 – 2.3) and diabetes (OR 1.63, IC95%: 0.94 – 2.8) were not statistically significant. Our model showed an AUC 0.8 (IC 95%: 0.75 – 0.84). A 1000 bootstrap analysis showed good internal validity (AUC 0.79, IC95%: 0.74 – 0.83). Validation cohort comprised 223 patients and the AUC of the model in this dataset showed an AUC 0.81. We compared our model to previously published models and we found that our model had a higher AUC (AUC 0.8, IC 95%: 0.75-0.84 vs. AUC 0.65, IC95%: 0.6 – 0.7; p < 0.0001).

Table 1.

Baseline date according to the presence or absence of permanent visual loss.

Permanent Visual LossNo Permanent Visual LossVariableMean/ProportionSDMean/ProportionSDSignificanceFemale69.8%72.0%0.68Age >75 y.o.72.1%53.4%0.000Hypertension64.3%51.6%0.04Diabetes25.9%16.9%0.06Fever18.6%36.8%0.001Constitutional syndrome42.4%53.2%0.075Polymyalgia40.7%39.7%0.87Headache79.1%79.2%0.987Jaw claudication68.2%39.7%0.000Tenderness of the TA38.6%31.4%0.22Transient visual loss39.0%10.5%0.000Stroke3.5%3.9%0.86Transient ischaemic attack0.0%4.2%0.053Decreased TA pulse66.7%48.0%0.004TA enlargement55.1%50.9%0.51Haemoglobin11.11.211.41.40.37Erythrocyte sedimentation rate95.026.296.426.80.67C Reactive protein9.76.210.48.60.8

SD: Standard deviation. TA: Temporal artery.

Conclusion

Age > 75 years, jaw claudication and TVL can predict PVL, being the CS a protective factor for this complication. Blood test data are not good PVL predictive factors.

References

[1]Nesher G. J Autoimm. 2014;48-49:73-75.

[2]Cid MC et al. Arthritis Rheum. 1998;41:26-32.

Acknowledgements

on behalf of the Spanish Resgistry of Systemic Vascuitis (REVAS)

Disclosure of Interests

None declared

AB1011 FACTORS RELATED TO GLUCOCORTICOID-INDUCED OSTEOPOROSIS AND FRAGILITY FRACTURES IN YOUNG SUBJECTS

Background

Glucocorticoid (GC) treatment is the most frequent cause of osteoporosis (OP) in young subjects. However, the factors related to the development of glucocorticoid-induced osteoporosis (GIOP) and fragility fractures (FF), and consequently, the therapeutic approach to GIOP in young populations is not well established.

Objectives

Analyze the prevalence of GIOP and FF in GC-treated patients and compare the risk factors related to their development according to age (< and ≥50 years).

Methods

127 patients (62±18 years) receiving chronic GC treatment were included (≥5 mg/day of prednisone, >3 months). The clinical data collected included: dose and duration of GC treatment, disease activity, previous FF, anthropometric data, bone metabolism parameters (including bone turnover markers and the presence of hypogonadism), bone mineral density (by DXA; defining densitometric OP: T-score ≤-2.5 or Z-score ≤-2, depending on the age of the patient), trabecular bone score (by DXA), and vertebral fractures (X-ray). GIOP was defined as densitometric OP and/or FF. Results were compared between subjects < and ≥50 years old.

Results

The prevalence of GIOP was similar in both age groups: <50 (n=36) 44.4% vs. 46.1% ≥50 years (n=91). Five subjects <50 (13.8%) and 30 ≥50 years (33%) presented FF (p=0.05). Young subjects with FF tended to be >40 years, have a higher body mass index (BMI) (25.4 vs. 23.3, p=n.s.), and inflammatory disease activity (CRP 0.90 vs. 0.06mg/dL, p=0.06). When analyzing the differential risk factors related to FF depending on age, a higher body mass index (BMI) (29.63 vs. 26.95, p=0.048) and inflammatory disease activity (PCR -0.87 vs. -2.51 [log scale], p=0.03) were observed in young subjects, while low lumbar T-scores (-1.08 vs.-0.06 DE, p=0.003) and higher cumulative GC-doses (9.11 vs. 8.56 g, p=0.03) were differential factors in subjects over 50. Hypogonadism was a risk factor independent of age (OR 4.89; 95%CI 1.36-17.59), being associated with the presence of FF in both age groups.

Conclusion

More than 40% of the patients receiving GC developed GIOP, with a similar prevalence in both age groups (< and ≥50 years); however, FF are less common in young subjects. Hypogonadism is a determining risk factor for FF independent of age. In addition, young subjects with FF tend to be older, with a higher BMI and disease activity, and, thus, evaluation of these risk factors can improve the identification of subjects at increased risk of fracture.

Disclosure of Interests

None declared

POS0270 DEVELOPMENT OF AORTIC ANEURYSM/DILATATION IN A PROSPECTIVE COHORT OF PATIENTS WITH BIOPSY-PROVEN GIANT-CELL ARTERITIS: EARLY IDENTIFICATION OF PATIENTS AT RISK

Background

Up to 10-33% of patients with giant-cell arteritis (GCA) develop aortic structural damage (ASD) (aneurysm or dilatation), typically involving the ascending aorta (1,2). Systematic use of imaging reveals radiological features of aortitis in 45-65% of patients at diagnosis (3). This finding has been associated with future aortic dilatation in retrospective studies (4).

Objectives

To investigate the prevalence of thoracic ASD in a large prospective cohort of patients with GCA subjected to periodic imaging. To evaluate the association between features at diagnosis with ASD development.

Methods

Patients were included in the study if consented, had biopsy-proven GCA and met the 1990 ACR criteria for GCA classification. Patients were prospectively followed and treated according to uniform criteria. Since 1995 patients were subjected to systematic imaging screening aimed to detect thoracic ASD. Until November 2006 it consisted of a chest X-ray that was performed at least 4 years after diagnosis and repeated every 4 years. When aortic dilatation was minimally suspected, patients underwent contrast-enhanced computed tomography (CT) scan. Since November 2006, most of patients were prospectively studied with CT angiography at diagnosis, after 1 year and every 4 years.

The diagnosis of ASD was confirmed by CT, defined as an aortic diameter > 4 cm at the ascending aorta or ≥4 cm at the aortic arch or the descending aorta.

Data regarding demographic characteristics, cardiovascular risk factors, GCA symptoms, laboratory tests, chronic medication at time of GCA diagnosis and corticosteroid tapering were recorded.

Kaplan-Meier survival plot was used to present the cumulated incidence of thoracic ASD over time and patients were censored at the time of ASD diagnosis or at the time of the last screening in those without ASD.

We also investigated which variables present at the time of GCA-diagnosis were associated with future development of ASD. Patients were classified in two groups according to whether they developed ASD or not during a follow-up period of 8 ± 1 years from the time of diagnosis.

Results

Thoracic ASD was confirmed by CT in 58 patients (21.6% of the patients with systematic screening diagnosed from 1994 to 2018) after a median follow-up of 4.7 years (0.05-7.5). Ascending aorta was involved in 56 patients (96.5%), followed by the aortic arch in 11 patients (18.9%), and descending aorta in 5 (8.6%). 14 patients (24.1%) had more than 1 aortic segment involved. Figure 1 shows the number of patients with thoracic ASD detected during follow-up.

Figure 1.

Thoracic ASD was detected within the first 4 years from GCA-diagnosis in 19 out of the 58 patients who developed ASD (32.7%) but was severe (≥ 50 mm) in only 3 (15.8% out of those 19 patients). Most ASD was detected between 5 and 9 years after GCA-diagnosis.

Patients who developed ASD during follow-up experienced less often cranial ischemic symptoms (14.8% vs 41.1%; p=0.003) or polymyalgia (33.3% vs 51.8%; p=0.057), and less frequently had a previous diagnosis of hypertension (66.7% vs 82.1%; p=0.081). Age, sex, clinical or laboratory findings or chronic therapies used at time of GCA-diagnosis were not significantly different between groups.

After multivariate analysis, the presence of cranial ischemic symptoms (HR 0.180, 95% CI 0.065-0.495, p=0.001) and polymyalgia rheumatica (HR 0.329, 95% CI 0.136-0.793, p=0.013) remained inversely associated with thoracic ASD development.

Conclusion

ASD is frequent and probably an underdiagnosed complication of GCA. There is no consensus yet regarding the optimal screening protocol during follow-up and early identification of patients at risk is crucial for this purpose. The presence of cranial ischemic symptoms or polymyalgia rheumatica were inversely associated with thoracic ASD development in our prospective cohort.

References

[1]García-Martínez A et al. Ann Rheum Dis 2014.

[2]Evans JM et al. Ann Intern Med 1995.

[3]Prieto-González S et al. Ann Rheum Dis 2012.

[4]Blockmans D et al. Rheumatology (Oxford) 2008.

Acknowledgements

Both first co-authors contributted equally to this work.

The research was supported MTV3 2014/20150730

Disclosure of Interests

None declared

Low serum osteocalcin levels are associated with diabetes mellitus in glucocorticoid treated patients

Bone turnover markers are decreased in GC-treated subjects with DM. Decreased OC levels in GC-treated patients were associated with an increased risk of DM. These results suggest the involvement of OC in glucose homeostasis regulation in DM.

INTRODUCTION

Osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function, decreased OC levels, and the development and/or worsening of pre-existing diabetes mellitus (DM). Whether decreased OC levels in GC-treated subjects contribute to DM is not well known. The aim of this study was to analyse whether OC levels in GC-treated patients are associated with the presence of DM.

METHODS

One hundred twenty-seven patients (aged 61.5 ± 17.9 years) on GC treatment were included. GC dose, treatment duration, presence of DM and bone formation (OC, bone ALP, PINP) and resorption markers (urinary NTX, serum CTX) were analysed. The cut-offs of each bone turnover marker (BTM) for the presence of DM were evaluated and optimised with the Youden index and included in the logistic regression analysis.

RESULTS

Among the patients, 17.3% presented DM. No differences were observed in GC dose or duration or the presence of fractures. Diabetics showed lower levels of OC (7.57 ± 1.01 vs. 11.56 ± 1; p < 0.001), PINP (21.48 ± 1.01 vs. 28.39 ± 1; p = 0.0048), NTX (24.91 ± 1.01 vs. 31.7 ± 1; p = 0.036) and CTX (0.2 ± 1.01 vs. 0.3 ± 1; p = 0.0016). The discriminating BTM cut-offs for DM presence were < 9.25 ng/mL for OC, < 24 ng/mL for PINP, < 27.5 nMol/mM for NTX and < 0.25 ng/mL for CTX. In a multivariate logistic regression model adjusted for GC dose, BMI, age and the above four BTMs, only OC remained independently associated with DM presence. Thus, in a model adjusted for GC dose, BMI and age, OC was significantly associated with DM (OR: 6.1; 95%CI 1.87-19.89; p = 0.001).

CONCLUSION

Decreased OC levels in GC-treated patients are associated with increased odds of DM, and only OC was independently associated with DM in a model including four BTMs.

POS0121 RESPONSE OF EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS TO MEPOLIZUMAB ACCORDING TO DISEASE MANIFESTATIONS. A SINGLE CENTRE EXPERIENCE

Background:

Eosinophilic granulomatosis with polyangiitis (EGPA) is a relapsing disease with frequent glucocorticoid (GC) dependence. Mepolizumab (MEPO) has been demonstrated to reduce flares and spare GC. However, EGPA is a heterogeneous disease and the effects of MEPO on specific disease manifestations has not been completely delimitated.

Objectives:

To analyze the impact of MEPO on manifestations derived from small-vessel vasculitis, ENT symptoms, asthma, eosinophilic tissue infiltration and ANCA status in a single-centre cohort of EGPA patients.

Methods:

Medical chart of EGPA patients treated with MEPO were reviewed to describe demographics, clinical characteristics, steroid dose at the initiation of MEPO and during follow-up, flares, disease activity, damage accrual and laboratory results.

Results:

Among 52 EGPA patients regularly controlled in our department, 11 patients were treated with MEPO. MEPO was prescribed when a) patients required prednisone (PDN) at ≥ 7.5 mg/d to maintain stability, or b) when maintained with < 7.5mg/d, presented at least 4 exacerbations/year requiring an increase in PDN dose. 6 were males and 5 females, with a mean age of 54 years at MEPO initiation. Baseline characteristics of the patients and course under treatment are presented in Table 1. ENT involvement, followed by asthma and eosinophil-related tissue-infiltration (ETI) were the most common symptoms when prescribing MEPO. Regarding treatment, patients received MEPO at 100-300mg SC monthly. The definition of flare was the same used in the MIRRA trial1. The mean time of treatment with MEPO was 34 months. All patients achieved a BVAS score of 0 points at 12 months or earlier. In general, patients reduced the number of flares, which tended to be milder, and all related to asthma or ENT manifestations. All improved their asthma control, but 3 of them persisted with recurrent ENT symptoms in spite of treatment with MEPO. None of them had vasculitic manifestations (cutaneous, neurological, gastrointestinal, renal) manifestations during treatment. All patients were able to tapper their PDN dose to ≤5 mg/day or less, except 3 patients. Of the 3 patients who required ≥5mg/d, 1 had severe asthma, but diminished the previous PDN dose (22.5 mg/d pre-MEPO, 10 mg/d currently) and the yearly rate of flares (8.2 pre-MEPO, 0.64 under-MEPO). The other one notably improved his asthma, but had ENT symptoms that responded unsatisfactorily to MEPO and required a maintenance PDN dose of 7.5 mg/d. The last one, improved her asthma control and was able to begin PDN tapering, but persisted with ENT symptoms. Regarding damage accrual, 6 patients remained stable during treatment, and 5 worsened. Two of three ANCA positive patients remained positive in spite of treatment.

Table 1.Baseline characteristics at diagnosisAt mepolizumab initiationAfter mepolizumab (last follow-up)Age, median (range) years49 (23-67)54 (35-69)-Male/Female, n (%)6/5 (54.5%/45.5%)--BVAS, median (range)11 (2-20)2 (0-6)0FFS, value (n, %)1 (1, 9.1%)--VDI, mean (range)-1.7 (0-5)2.3 (0-5)Asthma, n (%)11 (100%)3 (27.3%)0 (0%)ENT, n (%)10 (90%)4 (36.4%)3 (27.3%)SVV, n (%)4 (36.4%)0 (0%)0 (0%)ETI signs/symptoms, n (%)7 (63.6%)2 (18.2%)0 (0%)Constitutional symptoms, n (%)4 (36.4%)0 (0%)0 (0%)Eosinophils, mean (range) cells x1095500 (600-8850)240 (0-600)55 (0-200)ANCA positivity (IIF)7 (77.8%)32Anti-MPO titers, mean (range)286 (93-740)88 (3-739)7 (3-37)Yearly rate of flares-1,750.51Immunosuppressants, n-31Prednisone dose, mg/d (range)8 (7.5-25)11.4 (5-22.5)5.125 (0-10)

Conclusion:

MEPO was effective for the treatment of patients with EGPA, with a reduction in the number and severity of flares and a decrease in PDN doses. A worse response of ENT involvement was observed. No vasculitic flares were observed in spite of GC reduction. Mepolizumab did not prevent damage accrual during the treatment period.

References:

[1]Wechsler ME et al. MEPO or Placebo for Eosinophilic Granulomatosis with Polyangiitis. N Engl J Med. 2017.

Acknowledgements:

Funding: Plan Estatal de Investigación Científica y Técnica y de Innovación 2013-2016 (PI18/00461), co-funded by Instituto de Salud Carlos III (ISCIII) and Fondo Europeo de Desarrollo Regional (FEDER) and by Río Hortega program (ISCIII, CM19/00032).

Disclosure of Interests:

Roberto Ríos-Garcés: None declared, Sergio Prieto-González: None declared, José Hernández-Rodríguez: None declared, Maria C. Cid Paid instructor for: GSK and Vifor, Consultant of: GSK, Abbvie and Janssen, Grant/research support from: Kiniksa and Roche, Georgina Espígol-Frigolé Consultant of: Janssen, Grant/research support from: Roche

THU0305 PREVALENCE AND CLINICAL OUTCOME OF INTERSTITIAL LUNG DISEASE IN ANCA ASSOCIATED VASCULITIS

Background:

Lung involvement is frequent in ANCA-associated vasculitis (AAV). Classical lung manifestations consist of capillaritis with lung haemorrhage, inflammatory infiltrates and nodules. Interstitial lung disease (ILD) is increasingly recognized among patients with AAV. However, little is known concerning risk factors and clinical course of these patients.

Objectives:

The aim of our study was to characterize the prevalence and clinical course of ILD in patients with AAV.

Methods:

We have performed a clinical retrospective single-centre observational analysis (1990-2019) of all patients with the diagnosis of microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) diagnosed according to 2018 Draft Classification Criteria for GPA and MPA1. Demographic, clinical and immunologic data were reviewed. Radiologic pattern of ILD were assessed by high-resolution-CT. Main outcome evaluated was overall-all survival.

Results:

The study population consisted of 123 patients, 56% female, aged 59.3±18.2 years old at the time of diagnosis. Clinical diagnosis was of MPA in 54% of patients and GPA in 46%. While 108 (88%) ANCA positive patients had PR3 (n=25) or MPO (n=83), 15 (12%) patients had negative or atypical ANCA. Any lung involvement was present in 82 (71%) and ILD was identified in 24 (20%) of all patients. ILD pattern was of usual interstitial pneumonia (UIP) in 12 patients, non-specified interstitial pneumonia (NSIP) in 9 and chronic organizing pneumonia (OP) in 3. There was an association between the presence of ILD and ANCA specificity: MPO were present in 100% of patients with UIP and in 75% of patients with NSIP/OP (p=0.017). Bronchiectasis were more prevalent among patients with ILD (19/24; p<0.001). During the median follow-up time period of 68 (23-126) months, mortality was of 42% among patients with ILD-AAV compared with 11% in no ILD-AAV (log-rank p=0.0001). On the multivariate Cox regression model, ILD was an independent predictor of mortality HR 2.95 (95%CI 1.09-7.96; p=0.033).

Conclusion:

ILD is a frequent manifestation of MPA and GPA patients. The presence of ILD, particularly UIP, is associated with ANCA-MPO and is a predictor of mortality. Therefore, a better management of fibrotic lung involvement in AAV is warranted.

References:

[1]Robson JC, Grayson PC, Ponte C, et al. Draft classification criteria for the ANCA associated vasculitides. Ann Rheum Dis 2018;77 (suppl 2):60-1.

Disclosure of Interests:

João Fernandes Serodio: None declared, José Hernández-Rodríguez: None declared, Georgina Espígol-Frigolé: None declared, Marco Alba: None declared, Javier Marco-Hernández: None declared, Marcelo Sánchez: None declared, Fernanda Hernández-González: None declared, Jacobo Sellarés: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, Sergio Prieto-González: None declared

SAT0467 LOW SERUM OSTEOCALCIN LEVELS ARE ASSOCIATED WITH THE PRESENCE OF DIABETES MELLITUS IN GLUCOCORTICOID TREATED PATIENTS

Background:

Increasing evidence indicates that osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function and decreased OC levels and also with the development of CG-induced diabetes mellitus (GIDM). However, whether decreased OC levels in GC-treated subjects contribute to GIDM is not well known.

Objectives:

To analyse whether OC levels in GC-treated patients are associated with the presence of GIDM.

Methods:

127 patients (aged 62±18years, 63% women) on GC treatment for autoimmune diseases (≥5mg/day, >3 months) were included. Clinical and anthropometric data were analysed, including the GC dose and treatment duration, presence of GIDM, fragility fractures, densitometric osteoporosis and bone formation (OC, bone alkaline phosphatase [BAP], PINP) and resorption markers (urinary NTX, serum CTX). The cut-offs of each bone marker for the presence of GIDM were estimated and optimized with the Youden index and included in the logistic regression analysis (adjusted for BMI, age and GC doses).

Results:

17.3% of patients presented GIDM. Diabetic subjects were older (70.5±12.2 vs. 59.6±18.4, p=0.001) and had a higher BMI than non-diabetics (30±5.2 vs. 26±4.2, p=0.002). No differences were observed in GC dose or duration or in the presence of vertebral fractures. Diabetics showed lower levels of OC (7.57±1.01 vs. 11.56±1; p<0.001), PINP (21.48±1.01 vs. 28.39±1; p=0.0048), NTx (24.91±1.01 vs. 31.7±1; p=0.036) and CTX (0.2±1.01 vs. 0.3±1; p=0.0016) with similar BAP values. The best discriminating cut-offs for GIDM presence were: <9.25ng/mL for OC, <24ng/mL for PINP, <27.5nMol/mM for NTX and <0.25ng/mL for CTX. On multivariate analysis OC (<9.25) was the only marker related to the presence of GIDM (OR 6.1; CI95% 1.87-19.89; p=0.001).

Conclusion:

Decreased OC levels in GC-treated patients are associated with an increased risk of GIDM, a finding that was not observed with other bone turnover markers, further confirming the involvement of OC in the glucose homeostasis regulation in this entity.

Disclosure of Interests:

None declared

AB0475 CLINICAL RELEVANCE OF CLINICOPATHOLOGICAL PHENOTYPE AND ANTIBODY SPECIFICITY IN ANCA-ASSOCIATED VASCULITIS

Background:

Classification of ANCA-associated vasculitis (AAV) has emerged in order to identify more homogenous subgroups of patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). However, the exact value of classifying patients according to antibody specificity (proteinase 3 [PR3] or myeloperoxidase [MPO]) is still unclear.

Objectives:

To assess demographic, clinical and prognostic differences among subgroups of AAV patients, according to clinicopathological classification (GPAvs. MPA) and antibody specificity (PR3vs. MPO) in a single-centre cohort.

Methods:

A clinical retrospective (1990-2019) observational analysis was performed. Among all patients with ANCA positivity, we analysed patients with GPA and MPA diagnosed according to 2018 Draft Classification Criteria for AAV1, who were homogeneously treated and followed by the authors. Demographic, clinical and laboratory data, as well as disease outcomes, particularly BVAS, disease relapses and survival, were reviewed.

Results:

Among a total 140 patients with any form of AAV, 32 were excluded for a diagnosis of isolated interstitial lung disease (n=10), cocaine-induced AAV (n=3), ANCA negative or undetermined disease (n=16), atypical ANCA or double PR3/MPO positivity (n=3). Finally, 108 patients with MPA (n=66) or GPA (n=42) were included (83 MPO, 25 PR3). GPA was associated with PR3 in 55% and MPO 45% of patients. MPA was associated with MPO in 97% and PR3 in 3% of patients. GPA patients with PR3 or MPO presented with similar clinical features, disease extent and BVAS. However, compared with GPA/PR3, GPA/MPO were more frequently women (p=0.002). MPA patients presented more frequent with renal involvement (p=0.008) and GPA patients with ENT/ocular involvement (p<0.001). Patients with MPO were older (p=0.028) and more frequently women (p=0.001) than PR3 patients. When antibody specificity was compared, differences on organ-specific manifestations were less clear than between clinical phenotypes (GPA vs. MPA), and were only seen in ENT/ocular involvement (more frequent in PR3 than in MPO patients) and in muscle biopsies disclosing vasculitis (more frequent in MPO than in PR3 patients). GPA and PR3 patients presented more frequent relapsing disease than MPA and MPO patients, respectively (GPA 60% vs. MPA 36%; p=0.018 / PR3 60% vs. MPO 41%; p=0.094). While GPA tended to have a better survival rate than MPA patients (p=0.066) (Graph1), the MPO-associated disease (GPA or MPA) had clearly worse survival prognosis than PR3-AAV (p=0.008) (Graph2), similarly to what occurred in GPA-MPO (compared with GPA-PR3).

Conclusion:

A high proportion of GPA patients with MPO-ANCA (45%) is observed in our series. GPA is associated with a more frequent relapsing disease than MPA. MPA and presence of MPO were more frequent in females and older patients. Clinical features were similar in GPA patients with PR3 or MPO. The presence of MPO (in GPA or MPA) seems to be the main factor associated with mortality in AAV.

Table 1.

Symptomatology and ultrasound findings in the patients examined. PMR: Polymyalgia Rheumatica

UltrasoundSymptomsCranial(n=17)PMR only(n=17)Non-specific symptoms (n=18)PMR (+) (n=7)PMR (-) (n=10)Temporal (+)7301Facial (+)2100Axilliary (+)0031

References:

[1]Robson JC, Grayson PC, Ponte C, et al.Draft classification criteria for the ANCA associated vasculitides. Ann Rheum Dis 2018;77 (suppl 2):60-1.

Disclosure of Interests:

João Fernandes Serodio: None declared, Sergio Prieto-González: None declared, Georgina Espígol-Frigolé: None declared, Marco Alba: None declared, Javier Marco-Hernández: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, José Hernández-Rodríguez: None declared

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