Impact of BRAFV600E mutation on aggressiveness and outcomes in adult clonal histiocytosis

Histiocytoses encompass a wide spectrum of diseases, all characterized by tissue infiltration by CD68+ histiocytes. Most adult histiocytoses are considered clonal diseases because they highlight recurrent somatic mutations in the MAP-kinase pathway gene, primarily BRAF. The presence of BRAF mutation is associated with widespread disease in children with Langerhans cell histiocytosis (LCH) or cardiovascular/neurological involvement in Erdheim-Chester disease (ECD). Nevertheless, few data are available on adult clonal histiocytosis. This is why we have conducted a retrospective study of all patients with clonal histiocytosis in our institution and present the data according to the presence of BRAF mutation. Among 27 adult patients (10 ECD, 10 LCH, 5 Rosai-Dorfman disease (RDD), and 3 mixed ECD/LCH), 11 (39%) have BRAF mutation with gain of function (n = 9) and deletion (n = 2). Those patients had frequent multicentric disease with risk organ involvement, especially the brain and cardiovascular system. They had frequent associated myeloid neoplasms (mostly chronic myelomonocytic leukemia) and received more frequently targeted therapy as the front-line therapy. Nevertheless, its presence did not affect the overall survival or relapse-free survival probably due to the emergence of efficient therapies. To conclude, rapid and accurate molecular establishment in adult clonal histiocytoses is crucial because BRAFV600E mutation correlates with multicentric disease with organ involvement and incomplete metabolic response.

Stratégies innovantes de vaccination anti-pneumococcique par rapport au schéma standard chez les patients atteints de vascularites associées aux ANCA recevant du rituximab : essai contrôlé randomisé multicentrique (PNEUMOVAS)

Introduction

Les patients recevant des glucocorticoïdes et du rituximab (RTX) présentent un risque accru d’infections, en particulier d’infections invasives à pneumocoque. Les réponses vaccinales au virus de la grippe, au Streptococcus pneumoniae et au SARS-CoV-2 sous traitement par RTX sont fortement altérées. Chez les patients atteints de maladies auto-immunes recevant de tels traitements, en particulier ceux atteints de vascularites associées aux ANCA (AAV), il est donc nécessaire de développer des stratégies vaccinales anti-pneumococciques améliorées pour augmenter la réponse immunitaire et la protection vaccinale.

Patients et méthodes

Cet essai multicentrique de phase 2, randomisé, ouvert, a comparé deux stratégies innovantes de vaccin anti-pneumococcique « renforcées » au schéma de vaccination standard chez des patients atteints de VAA recevant un traitement par RTX. Des patients adultes atteints de VAA nouvellement diagnostiquée ou en rechute, présentant une maladie active (BVAS ≥ 3) et devant recevoir du RTX comme traitement d’induction (375 mg/m²/semaine pendant 4 semaines consécutives), ont été randomisés avec un rapport 1:1:1 dans trois bras parallèles : schéma standard associant une dose de vaccin pneumococcique conjugué 13-valent (PCV13) au jour 0 suivie d’une dose de vaccin non conjugué 23-valent (PPV23) au mois 5 (M5) (bras 1) ; double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose de PPV23 à M5 (bras 2) ; ou 4 doses de PCV13 au jour 0 suivies d’une dose de PPV23 à M5 (bras 3). Le critère d’évaluation principal était la réponse immunitaire à M6 contre les 12 sérotypes de pneumocoque communs aux vaccins PCV13 et PPV23, classée selon quatre catégories ordonnées de réponse : réponse positive en anticorps contre 0–3, 4–6, 7–9 ou 10–12 sérotypes. Une réponse positive par sérotype était définie par un titre ELISA d’IgG spécifiques ≥ 1 μg/mL et une augmentation de deux fois par rapport au jour 0. Le critère d’évaluation primaire a été analysé dans un modèle de régression logistique à chances proportionnelles avec une correction de Bonferonni pour les 2 bras innovants. Les critères d’évaluation secondaires étaient les réactions locales et systémiques sollicitées 7 jours après chaque vaccination et tout événement indésirable lié ou pouvant être lié à l’immunisation vaccinale.

Résultats

Quatre-vingt-quinze participants ont été analysés dans la population modifiée en intention de traiter (âge moyen 60 ± 16,6 ans, 50 % d’hommes, 74 personnes atteintes d’une maladie nouvellement diagnostiquée, 66 d’une granulomatose avec polyangéite et 29 d’une polyangéite microscopique, BVAS moyen 15,3 ± 6,9), dont 30 affectés au bras 1, 32 au bras 2 et 33 au bras 3.

À M6, une réponse immunitaire contre 0–3, 4–6, 7–9 ou 10–12 sérotypes était observée chez 83,3 %, 13,3 %, 3,3 % et 0 % dans le bras 1 ; 56,3 %, 28,1 %, 15,6 % et 0 % dans le bras 2 ; et 60,6 %, 33,3 %, 6,1 % et 0 % dans le bras 3. Les patients du bras 2 étaient significativement plus susceptibles de se trouver dans une catégorie de réponse supérieures par rapport au régime standard après ajustement sur l’âge, avec un odds ratio proportionnel (pOR) de 4,1 (IC97,5 % : 1,1–15,9, p = 0,018), tandis que le bras 3 montrait une tendance non significative à améliorer les réponses vaccinales (pOR : 3,1, IC97,5 % : 0,8–11,9, p = 0,062). Une analyse de sensibilité sur une population per-protocole excluant les patients ayant subi des vaccinations ou des prises de sang hors des délais donnait des estimations concordantes.

Les réactions locales et/ou systémiques dans les 7 jours après chaque vaccination, et tout événement indésirable lié ou possiblement lié à la vaccination au cours des 6 premiers mois, sont survenus en plus grand nombre avec les schémas renforcés mais étaient principalement des réactions locales de grade 1 ou 2. Aucun événement indésirable grave lié à la vaccination n’a été observé.

Au cours du suivi, 8 poussées de vascularite sont survenues chez 6 patients, en médiane 87 jours après la dernière vaccination : un patient dans le bras 1, 2 dans le bras 2, et 3 dans le bras 3.

Conclusion

Chez les patients atteints de VAA recevant un traitement par RTX, une stratégie innovante de vaccination anti-pneumococcique renforcée, basée sur une double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose unique de PPV23 à M5, améliore significativement les réponses en anticorps contre Streptococcus pneumoniae par rapport au schéma standard.

Driving Equitable Access to Cancer Services Through the Engagement of People Living With Cancer: Regional Perspectives

Towards further recognition of people living with cancer in LMICs as a prerequisite for driving equitable access

POS0494 ARTERIAL WALL DENDRITIC CELLS IN GIANT CELL ARTERITIS (GCA) AND POLYMYALGIA RHEUMATICA (PMR)

Background

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease (1) associated in 16 to 21% of cases with giant cell arteritis (GCA). The association of these two conditions raises the question of a pathophysiological continuum between PMR and GCA. An early study reported mature arterial wall dendritic cells (DC) in patients with GCA or PMR leading, during GCA, to CD4+ T cell recruitment and the development of vasculitis (2). However, these data have never been confirmed in other studies. There are 3 main types of DC: plasmacytoid DC (expressing CD123), conventional DC (cDC) expressing CD141 (cDC1) or CD1c (cDC2) and monocyte-derived DC (mo-DC) expressing CD14.

Objectives

The aim of this study was to describe the arterial wall infiltrating DCs, their phenotype and maturation state, during PMR and GCA.

Methods

Using temporal artery biopsies (TAB) from patients with PMR, GCA and healthy controls, the level of expression of CD11c, CD83, CCR7, CCR6, CD1c, CCL18, CCL19, CCL20, CCL21, GM-CSF, CD3, CD68 genes was assessed by RT-PCR. Expression of markers of DC lineage (CD209), DC maturation state (CD83 and CCR7) and DC origin (CD14, CD68, CD1c, CD141) were studied by confocal microscopy.

Results

Fourty-one patients were included (14 GCA, 16 PMR, 11 controls). Within the arterial wall, DCs were identified in GCA patients, with a mature DC phenotype (CD209+CD83+CCR7+). DC were present in all three layers of the arterial wall and also expressed CD14 and often CD68 but neither CD1c nor CD141, which could be explained by a monocytic/macrophage origin. TAB from GCA patients were characterized by a high level of expression of CD83, CCR7, CCR6, CCL18, CCL19, CCL20, CD11c, GM-CSF, CD3 and CD68 gene. This expression was significantly higher (p<0.05) compared to the control and PMR groups.

Confocal microscopy analyses of arteries from the PMR and controls did not detect the presence of DCs into the arterial wall. In addition, level of expression of CD83, CCR7, CCL18, CCL19, CCL21 and CD68 genes in temporal arteries was comparable between PMR and healthy controls.

Conclusion

This work confirms the presence of mature CD209+CD83+CCR7+ DCs within the arterial wall in GCA. The phenotype of these DCs mainly fits with DC of monocytic origin (mo-DCs). However, both by RT-PCR and confocal microscopy, we did not identify DCs in the arterial wall of PMR patients. This discrepancy with previous work (3) could be explained by a better diagnosis of GCA in PMR patients since the development of imaging techniques.

References

[1]Weyand CM, Goronzy JJ. Giant-Cell Arteritis and Polymyalgia Rheumatica. N Engl J Med. 2014;371:50-7.

[2]Samson M, Corbera-Bellalta M, Audia S, Planas-Rigol E, Martin L, Cid MC, et al. Recent advances in our understanding of giant cell arteritis pathogenesis. Autoimmun Rev. 2017;16:833-44.

[3]Ma-Krupa W, Jeon M-S, Spoerl S, Tedder TF, Goronzy JJ, Weyand CM. Activation of Arterial Wall Dendritic Cells and Breakdown of Self-tolerance in Giant Cell Arteritis. J Exp Med. 2004;199:173-83.

Disclosure of Interests

None declared.

L’augmentation du pourcentage de lymphocytes Th17 est associée à un risque d’évolution vers une forme grave d’infection à SARS-CoV-2

Introduction

Depuis décembre 2019, plus de 20 millions de français ont été infectés par le SARS-CoV-2 et plus de 130 000 en sont décédés. La physiopathologie de cette infection n’est pas totalement élucidée. Il a été démontré qu’elle provoquait une importante sécrétion de cytokines pro-inflammatoires, en particulier d’interleukine-6 (IL-6) [1]. Lorsque les patients infectés sont hospitalisés, ils reçoivent généralement de la dexaméthasone et parfois un traitement anti-infectieux. Si la maladie s’aggrave, le tocilizumab peut être ajouté [2]. Actuellement, seule l’évolution clinique incite à débuter le tocilizumab, mais parfois trop tardivement. Il manque aux cliniciens un marqueur précoce leur permettant de prédire le risque d’aggravation de la maladie. Cette étude, menée chez des patients hospitalisés pour infection à SARS-CoV-2 pendant la 2^e vague, avait pour objectif de rechercher un marqueur d’aggravation de la maladie en comparant la réponse lymphocytaire entre les patients évoluant vers une forme grave et les autres.

Patients et méthodes

Les patients hospitalisés pour infection à SARS-CoV-2 prouvée par RT-PCR datant de moins d’une semaine ont été inclus prospectivement dans cette étude monocentrique. Une infection grave était définie par un transfert en soins intensifs, en réanimation ou le décès. Des prélèvements sanguins ont été obtenus à l’admission à l’hôpital et avant de débuter la corticothérapie afin d’étudier les sous-populations lymphocytaires par cytométrie en flux et doser l’IL-6 plasmatique par immunofluorimétrie. Les données sont exprimées en nombre (%) ou médiane (espace inter-quartile).

Résultats

De septembre à décembre 2020, 37 patients (18 hommes, 19 femmes) hospitalisés pour infection à SARS-Cov2 ont été inclus : âge = 81,7 (70,3–87,5) ans, IMC = 25,7 (23,7–29) kg/m², hypertension artérielle (54 %), diabète (24 %), dyslipidémie (35 %), tabagisme (24 %), cardiopathie ischémique (8 %), maladie cérébrovasculaire (11 %). La durée de suivi était de 10 (8–15) jours. Parmi les 37 patients inclus, 11 (30 %) ont présenté une infection à SARS-CoV-2 grave dont 4 transferts en réanimation et 8 décès. À l’admission, les patients ayant une infection évoluant vers une forme grave étaient plus âgés (p = 0,021), avaient une créatininémie plus élevée (p = 0,003) et une diminution du pourcentage de lymphocytes B (p = 0,04), de lymphocytes T (p = 0,009) et de lymphocytes T CD4+ (p = 0,004) circulants parmi les lymphocytes totaux comparativement aux patients dont l’évolution était favorable. Parmi les sous-populations lymphocytaires T étudiées (mémoires, naïfs, Th1, Th2, Th17, Treg, Tc1, Tc17, T CD8 cytotoxiques), il n’y avait pas de différence significative entre les deux groupes en dehors du pourcentage de lymphocytes Th17 à l’admission qui était deux fois plus élevé chez les patients dont l’infection évoluait vers une forme grave (0,44 vs 0,23 % des LT CD4 totaux ; p = 0,028). Chez les patients ayant une infection évoluant vers une forme grave, l’IL-6 plasmatique à l’admission était plus élevée (39 vs 13,1 pg/mL ; p = 0,018) et la CRP à l’admission avait tendance à être plus élevée sans atteindre le seuil de significativité (58 vs 18,5 mg/L ; p = 0,17). En analyse multivariée (régression logistique binaire comprenant les variables : âge, créatininémie, CRP, hémoglobine, lymphocytes T CD4, Th17, Treg activés (CD4 + CD45RA-FoxP3high), lymphocytes B, IL-6 sérique), la seule variable associée au risque d’évolution vers une forme grave de l’infection était le pourcentage de lymphocytes Th17 circulants (p = 0,034). L’aire sous la courbe de la courbe ROC évaluant la sensibilité et la spécificité du pourcentage de lymphocytes Th17 pour prédire une forme grave d’infection à SARS-CoV-2 chez un patient hospitalisé était de 0,75 (intervalle de confiance à 95 % : 0,56–0,95). Enfin, le fait d’avoir un pourcentage de lymphocytes Th17 > 0,435 % des lymphocytes T CD4 totaux au moment de l’admission en hospitalisation était associé à une moins bonne survie (p = 0,024).

Conclusion

Cette étude suggère qu’une élévation du pourcentage de lymphocytes Th17 chez des patients hospitalisés pour infection à SARS-CoV-2 augmente significativement le risque d’évolution vers une forme grave de la maladie. Ce résultat est cohérent avec le fait qu’il a été démontré que le tocilizumab, qui est efficace dans le traitement des formes graves de COVID-19 [2], inhibe la réponse lymphocytaire Th17 [3]. Ces données méritent d’être confirmées chez un plus grand nombre de patients afin de confirmer ce résultat car cette mesure pourrait permettre de mieux cibler la population de patients à qui proposer précocement un traitement par tocilizumab pour diminuer le risque d’évolution vers une forme grave d’infection à SARS-CoV-2.

POS0252 MYOFIBROBLASTS MAINTAIN Th1 and Tc1 POLARIZATIONS IN GIANT CELL ARTERITIS

Background

Giant cell arteritis (GCA) is a large-vessel vasculitis mainly involving the aorta and cranial arteries. It is the most frequent vasculitis in adults over 50 years. When they are stimulated by interferon-gamma (IFN-γ), vascular smooth muscle cells (VSMC) contribute to GCA pathogenesis by producing chemokines triggering the recruitment of pro-inflammatory T cells and monocytes (1).

Objectives

Current knowledge about the interaction between resident cells of the vascular wall (VSMC, myofibroblasts [MF]) and immune cells is limited. The aim of our research was to better characterize the interactions between VSMC, MF and T cells in GCA.

Methods

Fresh fragments of temporal artery biopsies (TAB) performed at Dijon university hospital (France) were prospectively sent to our research unit. Fresh sections of positive and negative TAB were fixed and embedded in optimal cutting temperature OCT and stored at -80°C. Then, cryostat sections were fixed, permeabilized, blocked and incubated with primary antibodies (anti-alpha smooth muscle actin [α-SMA], anti-myosin heavy chain 11 [MHC11], anti-Desmin, anti CD90, anti-CD45, anti-HLA-DR, anti-phospho STAT1 [pSTAT1] and anti-pSTAT3) and secondary antibodies for confocal microscopy analyses. Fresh sections of healthy TAB were embedded in MATRIGEL and covered by DMEM to obtain vascular cells in culture. Cells were treated with trypsina-EDTA between each passage. Vascular cells were used after 4-7 doubling passages. Cells were analyzed by immunofluorescence, flow cytometry and RT-PCR and their proliferation was evaluated by impedancemetry (iCELLigence system). Peripheral blood mononuclear cells (PBMC) and vascular cells thus obtained were co-cultured for 7 days in different conditions. Vascular cells were cultured in the presence or absence of IFN-γ and tumor necrosis factor alpha (TNF-α) or interleukin-6 (IL-6) and soluble receptor of IL-6 for 72 hours. When cells reached confluence, they were cultured alone or with allogenic PBMC activated with anti-CD3/CD28 microbeads. After 7 days of culture, cells were separated with a treatment with EDTA and studied by flow cytometry.

Results

Confocal microscopy analyses of GCA arteries showed that neointima was mainly composed of myofibroblasts (MF) (α-SMA+Desmin+MHC11lowCD90+) in contact with CD45+ cells and that MF expressed HLA-DR, the phosphorylated form of STAT1 (pSTAT1) and in a lesser extent pSTAT3, strongly suggesting the activation of the IFN-γ signaling pathway rather than the IL-6 pathway. The phenotype of cultured vascular cells isolated from fresh TAB was consistent with MF. When MF were exposed to IFN-γ and TNF-α in vitro, their proliferation capacity decreased and their levels of expression of HLA-DR and CD86 increased (median fluorescence intensity [MFI] from 0 to 57 [p=0.03] and from 34 to 103 [p=0.03], respectively). In addition, co-cultures of MF and activated PBMC revealed that MF maintained the polarization of T cells into Th1 and Tc1 cells (p≤0.001) and to a lesser extent into Th17 and Tc17 cells (p=0.03). This effect was even more significant when MF were previously exposed to IFN-γ and TNF-α but not when they were exposed to IL-6.

Conclusion

Our results show that myofibroblasts are present in the neointima of GCA patients and that these MF activate signaling pathways indicative of IFN-γ exposure. Moreover, these MF, especially when exposed to IFN-γ, maintain the polarization of T cells into Th1 and Tc1 cells, which contributes to amplify the production of IFN-γ and thus initiate a pro-inflammatory amplification loop that likely participates in vascular inflammation and remodelling.

References

[1]Corbera-Bellalta M, Planas-Rigol E, Lozano E, Terrades-Garcia N, Alba MA, Prieto-Gonzalez S, et al. Blocking interferon gamma reduces expression of chemokines CXCL9, CXCL10 and CXCL11 and decreases macrophage infiltration in ex vivo cultured arteries from patients with giant cell arteritis. Ann Rheum Dis 2016;75:1177-86.

Disclosure of Interests

None declared

Further characterization of clinical and laboratory features occurring in VEXAS syndrome in a large-scale analysis of multicenter case-series of 116 French patients

BACKGROUND

A new autoinflammatory syndrome related to somatic mutations of UBA1 was recently described and called VEXAS syndrome.

OBJECTIVE

To describe clinical characteristics, laboratory findings and outcomes of VEXAS syndrome.

DESIGN

Case-series.

SETTING

Patients referred to a French multicenter registry between November 2020 and May 2021.

PATIENTS

116 patients with VEXAS syndrome.

MEASUREMENTS

Frequency and median of parameters and vital status, from diagnosis to the end of the follow-up.

RESULTS

Main clinical features were skin lesions (83.5%), non-infectious fever (63.6%), weight loss (62%), lung involvement (49.6%), ocular symptoms (38.8%), relapsing chondritis (36.4%), venous thrombosis (34.7%), lymph nodes (33.9%), and arthralgia (27.3%). Hematological disease was present in 58 cases (50%), considered as myelodysplastic syndrome (MDS, n= 58) and monoclonal gammapathy of unknown significance (n=12).UBA1 mutations included p.M41T (44.8%), p.M41V (30.2%), p.M41L (18.1%), and splice mutations (6.9%). After a median follow-up of 3.0 years, 18 patients died (15.5%), from infectious origin (n=9) and MDS progression (n=3). Unsupervised analysis identified 3 clusters: cluster 1 (47%) with mild-to-moderate disease; cluster 2 (16%) with underlying MDS and higher mortality rates; cluster 3 (37%) with constitutional manifestations, higher C-reactive protein levels and less frequent chondritis. Five-year probability of survival was 84.2% in cluster 1, 50.5 % in cluster 2, and 89.6% in cluster 3. UBA1 p.Met41Leu mutation was associated with a better prognosis.

CONCLUSION

VEXAS syndrome displays a large spectrum of organ manifestations and shows different clinical and prognostic profiles. It also raises a potential impact of the identified UBA1 mutation.

Specific Follicular Helper T Cell Signature in Takayasu Arteritis

OBJECTIVE

Our aim was to compare transcriptome and phenotype profiles of CD4+ T cells and CD19+ B cells in patients with Takayasu arteritis (TAK), patients with giant cell arteritis (GCA), and healthy donors.

METHODS

Gene expression analyses, flow cytometry immunophenotyping, T cell receptor (TCR) gene sequencing, and functional assessments of cells from peripheral blood and arterial lesions from TAK patients, GCA patients, and healthy donors were performed.

RESULTS

Among the most significantly dysregulated genes in CD4+ T cells of TAK patients compared to GCA patients (n = 720 genes) and in CD4+ T cells of TAK patients compared to healthy donors (n = 1,447 genes), we identified a follicular helper T (Tfh) cell signature, which included CXCR5, CCR6, and CCL20 genes, that was transcriptionally up-regulated in TAK patients. Phenotypically, there was an increase in CD4+CXCR5+CCR6+CXCR3- Tfh17 cells in TAK patients that was associated with a significant enrichment of CD19+ B cell activation. Functionally, Tfh cells helped B cells to proliferate, differentiate into memory cells, and secrete IgG antibodies. Maturation of B cells was inhibited by JAK inhibitors. Locally, in areas of arterial inflammation, we found a higher proportion of tertiary lymphoid structures comprised CD4+, CXCR5+, programmed death 1+, and CD20+ cells in TAK patients compared to GCA patients. CD4+CXCR5+ T cells in the aortas of TAK patients had an oligoclonal α/β TCR repertoire.

CONCLUSION

We established the presence of a specific Tfh cell signature in both circulating and aorta-infiltrating CD4+ T cells from TAK patients. The cooperation of Tfh cells and B cells might be critical in the occurrence of vascular inflammation in patients with TAK.

OP0148 MEPOLIZUMAB FOR EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA): A RETROSPECTIVE REAL-WORLD EUROPEAN STUDY ON 142 PATIENTS

Background:

Evidence on the efficacy of Mepolizumab (MEPO) in Eosinophilic Granulomatosis with Polyangiitis (EGPA) is scarce [1].

Objectives:

To assess the efficacy and safety of MEPO in real-life clinical practice.

Methods:

We retrospectively included patients diagnosed with EGPA and treated with MEPO (100 or 300 mg/month). MEPO efficacy was evaluated in the first 12 months in terms of systemic disease and asthma control. The occurrence of any adverse event (AE) was recorded.

Results:

142 patients were included (38% males; median age 46.4 (IQR 36.7-54.4); 110 and 32 on MEPO 100 and 300 mg/month, respectively). General, ear-nose-throat, pulmonary, and neurological symptoms significantly decreased during treatment (table 1). MEPO accounted for a significant reduction in the BVAS (figure 1) and for a steroid sparing effect (figure 2). The proportion of patients with asthma attacks decreased by 90% at 12 months compared to t0, and asthma-related emergency accesses dropped from 17.4% to 2.3%. Overall, 21.1% of patients had a non-serious AE.

Table 1.

Control of clinical symptoms

MEPO beginning (t0)3 monthsp-value(t3 vs t0)6 monthsp-value(t6 vs t0)12 monthsp-value(t12 vs t0)N obsN=142N=135N=123N=89General symptoms40 (28.2%)17 (12.6%)<0.00119 (15.5%)<0.00113 (14.6%)0.002Cutaneous manifestations13 (9.2%)6 (4.4%)0.0085 (4.1%)0.0254 (4.5%)0.180ENT manifestations106 (74.7%)52 (38.5%)<0.00144 (35.8%)<0.00129 (32.6%)<0.001Pulmonary manifestations130 (91.6%)59 (43.7%)<0.00139 (31.7%)<0.00128 (31.5%)<0.001Cardiac manifestations6 (4.2%)2 (1.5%)0.0832 (1.6%)0.08300.157Intestinal manifestations10 (7.0%)1 (0.7%)0.0054 (3.3%)0.0593 (3.4%)0.059Renal manifestations5 (3.5%)3 (2.2%)0.41400.0461 (1.1%)0.317Neurological manifestations36 (25.4%)22 (16.3%)0.01218 (14.6%)0.00310 (11.2%)0.035Figure 1.

Changes in BVAS

Figure 2.

Steroid treatment

Conclusion:

MEPO effectively controlled systemic and respiratory EGPA symptoms in a large European cohort, with no major safety concerns.

References:

[1]Wechsler et al. MEPO or Placebo for Eosinophilic Granulomatosis with Polyangiitis. NEJM. 2017

Disclosure of Interests:

Alessandra Bettiol: None declared, Maria Letizia Urban: None declared, Federico Alberici: None declared, Carlo Agostini: None declared, Chiara Baldini: None declared, Enrica Bozzolo: None declared, Paolo Cameli: None declared, Nunzio Crimi: None declared, Stefano Del Giacco: None declared, Allyson Egan: None declared, Georgina Espigol-Frigole Consultant of: Roche and Janssen, Mara Felicetti: None declared, Marco Folci: None declared, Paolo Fraticelli: None declared, Marcello Govoni: None declared, Anna Kernder Grant/research support from: Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Carlo Lombardi: None declared, Giuseppe Lopalco: None declared, Claudio Lunardi: None declared, Aladdin J Mohammad Speakers bureau: lecture fees from Roche and Elli Lilly Sweden, PI (GiACTA study), Frank Moosig: None declared, Simone Negrini: None declared, Thomas Neumann: None declared, Pavel Novikov Grant/research support from: This work was supported by the 5-100 Project, Sechenov University, Moscow, Giuseppe Paolazzi: None declared, paola parronchi: None declared, Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Vito Racanelli: None declared, Carlo Salvarani: None declared, Maxime Samson: None declared, Jan Schroeder: None declared, Savino Sciascia: None declared, Renato A. Sinico: None declared, Benjamin Terrier: None declared, Paola Toniati: None declared, Domenico Prisco: None declared, Augusto Vaglio: None declared, Giacomo Emmi: None declared

Giant cell arteritis-related aortitis with positive or negative temporal artery biopsy: a French multicentre study

Objective: To compare the clinical presentation and outcome of giant cell arteritis (GCA)-related aortitis according to the results of temporal artery biopsy (TAB).Method: Patients with GCA-related aortitis diagnosed between 2000 and 2017, who underwent TAB, were retrospectively included from a French multicentre database. They all met at least three American College of Rheumatology criteria for the diagnosis of GCA. Aortitis was defined by aortic wall thickening > 2 mm on computed tomography scan and/or an aortic aneurysm, associated with an inflammatory syndrome. Patients were divided into two groups [positive and negative TAB (TAB+, TAB-)], which were compared regarding aortic imaging characteristics and aortic events, at aortitis diagnosis and during follow-up.Results: We included 56 patients with TAB+ (70%) and 24 with TAB- (30%). At aortitis diagnosis, patients with TAB- were significantly younger than those with TAB+ (67.7 ± 9 vs 72.3 ± 7 years, p = 0.022). Initial clinical signs of GCA, inflammatory parameters, and glucocorticoid therapy were similar in both groups. Coronary artery disease and/or lower limb peripheral arterial disease was more frequent in TAB- patients (25% vs 5.3%, p = 0.018). Aortic wall thickness and type of aortic involvement were not significantly different between groups. Diffuse arterial involvement from the aortic arch was more frequent in TAB- patients (29.1 vs 8.9%, p = 0.03). There were no differences between the groups regarding overall, aneurism-free, relapse-free, and aortic event-free survival.Conclusion: Among patients with GCA-related aortitis, those with TAB- are characterized by younger age and increased frequency of diffuse arterial involvement from the aortic arch compared to those with TAB+, without significant differences in terms of prognosis.