Potential efficacy of T and B lymphocyte-targeted therapies on articular involvement of patients with rheumatoid arthritis and systemic sclerosis overlap syndrome. Results from a 2-centre series of 22 cases

OBJECTIVES

To analyse in routine practice the efficacy of targeted therapies on joint involvement of patients with rheumatoid arthritis/systemic sclerosis (RA/SSc) overlap syndrome.

METHODS

This was a retrospective analysis of medical records of two academic centres over a 10-year period. Joint response to targeted therapies was measured according to EULAR criteria based on Disease Activity Score (DAS)-28. In addition, changes in CRP level and glucocorticoid consumption were recorded.

RESULTS

Nineteen patients were included. Methotrexate (n=11) and hydroxychloroquine (n=4) were the most used first-line treatments. Targeted therapies were frequently used (n=14). Tocilizumab was the most selected therapy (n=8), then rituximab (n=5), abatacept and anti-tumour necrosis factor (n=4). Twenty-one treatment sequences were assessed, including 18 with EULAR response criteria. Responses were "good" or "moderate" in 100% (4/4) of patients treated with abatacept, 80% (4/5) with rituximab, 40% (2/5) with tocilizumab, and 25% (1/4) with anti-TNF. T and B lymphocyte-targeted therapies (abatacept, rituximab) resulted more frequently in a "good" or "moderate" response compared to cytokine inhibitors (tocilizumab, etanercept, infliximab) with a significant decrease in DAS-28 at 6 months (-1.75; p=0.016) and a trend to a lower consumption of glucocorticoids.

CCONCLUSIONS

In patients with RA/SSc overlap syndrome refractory to conventional synthetic-DMARDs, T and B lymphocyte-targeted therapies seem to be a promising therapeutic option to control joint activity.

Novel insights into the anatomy and histopathology of the sacroiliac joint and correlations with imaging signs of sacroiliitis in case of axial spondyloarthritis

For a better understanding of the pathophysiology of spondyloarthropathy (SpA), a detailed anatomical description of the sacroiliac joint is required because sacroiliitis is the earliest and most common sign of SpA and an essential feature for the diagnosis of ankylosing spondylitis. Beyond the anatomy, the histopathology of sacroiliac entheses and immunological mechanisms involved in sacroiliitis are crucial for a better understanding of disease causation. In this narrative review, we discuss the core anatomical, histological, and immunohistological observations involved in the development of sacroiliitis, focusing particularly on imaging-based information associated with sacroiliitis. Finally, we try to answer the question of whether at the sacroiliac joint, enthesitis precedes synovitis and subchondral bone changes in SpA.

POS1333 STUDY OF THE RELATIONSHIP BETWEEN THE TREATMENT TYPE AND THE THERAPEUTIC RESPONSE ACCORDING TO THE SAPHO SYNDROME CLINICAL FORM IN ADULTS FROM A RETROSPECTIVELY ANALYSED MULTICENTER COHORT

Background

SAPHO syndrome (Synovitis, Acne, Palmoplantar Pustulosis, Hyperostosis and Osteitis) is a radio-clinical entity associating joint, bone and inflammatory skin disorders. The clinical presentation is very heterogeneous making the diagnosis difficult. The therapeutic strategy in SAPHO syndrome is poorly defined. The first-line treatment remains NSAIDs on demand, which are effective in treating painful flare-ups but rapidly become insufficient in 60% of cases during the course of the disease. TNF-αNF-O syndrome (S necrosis factor-alpha) are reserved for refractory forms and their efficacy is uncertain [1]. Bisphosphonates (BPs) seem to have potential interest [2].

Objectives

The main objective of this study was to investigate the response to treatment with BPs and/or immunosuppressive drugs (DMARDs - Disease modifying anti-rheumatic drugs), conventional synthetic cs-DMARDs or biologic (b-DMARDs), according to the clinical form of rheumatological SAPHO (bony predominantly versus articular or mixed predominantly.

Methods

All patients aged 18 years or older with SAPHO syndrome meeting Benhamou’s criteria whose clinical, biological and radiological data were available in the files and who received at least one DMARD or BP treatment for their disease were included in Rouen (thanks to the health data warehouse), Caen, Le Havre/Lillebonne and Dieppe Centres. Each imaging examination was reviewed blinded to the treatments by a radiologist with expertise in osteoarticular disease. Patients were classified into 2 groups (bony versus joint/mixed) according to imaging data and clinical history. The response to treatment was considered positive if symptoms were improved by at least 50% (cut-off used in the literature). An χ2 patients aged 18 years or older with SAPHO syndrome meeting Benhamou’s criteria whose clinical, biological and a Mann-Whitney test for quantitative variables using SPSS software.

Results

Thirty-four patients with SAPHO who had received DMARD or BP treatment were included and classified as follows: 13 in the bone group and 21 in the joint or mixed group. The 2 groups were comparable on demographics, duration of follow-up, previous chest involvement, existence of associated dermatological or inflammatory bowel disease, exposure to smoking, duration of exposure to a previous NSAID or antibiotic. Only the age of onset of symptoms differed between the two groups, with a younger onset of disease in the bone group (p=0.043). The prescribers’ therapeutic attitude differed significantly between the 2 groups (p=0.043) with a greater prescription of BPs as first line in the bone group (5/13 patients) and a DMARD in the joint/mixed group (19/21). Regarding treatment efficacy, 10/13 patients had effective treatment without escape during their follow-up in the bone group, which was not significantly different from the joint/mixed group (17/21). BPs achieved escape-free efficacy in significantly more cases in the bone group than DMARDs in the joint or mixed group (p= 0.002). The bone group used significantly fewer specific treatment lines (DMARDs or BP) than the joint/mixed group (1 specific line vs. at least 2) (p =0.046).

Conclusion

BPs appear to be more effective in SAPHO with predominantly bone involvement. This appears to be easier to treat compared to SAPHO with articular or mixed forms.

References

[1]Daoussis D, Konstantopoulou G, Kraniotis P, et al. Biologics in SAPHO syndrome: A systematic review. Seminars in Arthritis and Rheumatism 2019;48:618–25. doi:10.1016/j.semarthrit.2018.04.003

[2]Wu N, Zhao Y, Tao W, et al. A single cohort, open-label study of the efficacy of pamidronate for palmoplantar pustulosis in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Clin Exp Rheumatol 2020;38:1263–4.

Disclosure of Interests

None declared

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

Background

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

Objectives

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

Methods

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

Results

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

Table 1.

Baseline characteristics and effectiveness at 12 months Patient characteristics

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

Conclusion

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

References

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

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

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

Acknowledgements

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

Disclosure of Interests

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

POS1186 STUDY OF SPONDYLODISCITIS WITHOUT BACTERIOLOGICAL DOCUMENTATION FROM A COHORT OF 142 PATIENTS WITH SUSPECTED INFECTIOUS SPONDYLODISCITIS ON IMAGING

Background

The incidence of infectious spondylodiscitis was estimated at 2.4/100,000 people in 2002. When faced with an image of spondylodiscitis on imaging, infectious spondylodiscitis is the most feared etiology. In recent years, several non-infectious spondylodiscitis etiologies have been described: Andersson lesion, crystal-induced discopathy, degenerative changes, etc (2). The identification of the germ by blood cultures or disc-vertebral puncture-biopsy allows the treatment to be best adapted antibiotic. Bacteriological investigation is inconclusive in about 30% (1). More and more undocumented spondylodiscitis are described.

Objectives

The aim of this study is to describe a cohort of spondylodiscitis without bacteriological documentation and to compare it to spondylodiscitis with bacteriological documentation.

Methods

Using a “clinical data warehouse”, we searched for the key word “spondylodiscitis” in the documents associated with hospitalisations in the Rheumatology department of the Rouen University Hospital between 2010 and 2020. Four hundred and twenty-two records were analysed: 196 were excluded because they were not hospitalizedn in Rheumatology, among the 226 suspected spondylodiscitis, imaging allowed us to exclude 84 records for which there was no infectious spondylodiscitis and to retain 142 records. We collected demographic data, history, clinical symptoms, results of imaging, biological and bacteriological examinations. Statistical analysis was performed by Fisher’s exact test for qualitative data and by Mann-Whitney test for quantitative data.

Results

Four hundred and twenty-two patients were collected, 142 were analyzed. The average age was 65.5 +/- 14 years, 64.1% were male. Spinal pain was present in 96.5% of the cases without any difference between the two groups. One hundred and nine cases of spondylodiscitis were documented, of which 72 were confirmed by blood cultures and 36 by spinal disc biopsy. Thirty-three were not documented. Documented spondylodiscitis was more often febrile (41.3% vs 15.21% in undocumented cases, p = 0.006), had a greater biological inflammatory syndrome (mean CRP 152.4 +/- 112.6 mg/L versus 73 +/- 73.1 mg/L, p < 0.0001), and had been evolving for a shorter period of time than undocumented spondylodiscitis (54.1% vs 24.2% less than one month). Staphylococcus aureus was the most frequently retrieved bacteria 27.5%, followed by coagulase-negative staphylococci and streptococci (18.3% and 19.3% respectively). One hundred and twenty-one patients (85%) had an MRI at diagnosis; one hundred and two (71.8%) had a CT scan; and 81 patients (57%) had both examinations. The imaging analysis showed that there was no difference in soft tissue infiltration, erosions and abscesses. Probabilistic antibiotic therapy was proposed in 28/33 (84.5%) of cases. After collegial discussion, the alternative diagnoses retained were degenerative disc disease (4 cases), spinal gout (1 case), spondyloarthritis (1 case).

Conclusion

Undocumented spondylodiscitis is a recurrent problem in hospital practice. Alternative diagnoses are increasingly reported, their diagnosis is based on a collegial discussion.

References

[1]Avenel G et Al. Eur J Clin Microbiol Infect Dis. 2021.

[2]Morales H. Semin Ultrasound CT MR. 2018.

Disclosure of Interests

None declared

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

Background

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

Objectives

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

Methods

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

Results

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

Table 1.

Real life safety data for tofacitinib according to age

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

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

Conclusion

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

References

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

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

Acknowledgements

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

Disclosure of Interests

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

AB0663 Bicentric observational study on the therapeutic management of patients with rheumatoid arthritis and systemic sclerosis overlap syndrome

Background

The rheumatoid arthritis (RA)/systemic sclerosis (SSc) overlap syndrome is a rare and understudied association. It affects 5% of patients with SSc. Only open studies evaluating biological drugs (bDMARDs) have reported encouraging results, particularly on joint involvement. The management of these patients is therefore not codified.

Objectives

The objective was to analyze in real conditions the therapeutic strategy and the response to bDMARDs, with a focus on joint involvement.

Methods

We retrospectively analyzed over a 10-year period the clinical, biological, radiographic characteristics and therapeutic management of patients meeting the ACR/EULAR diagnostic criteria for RA and SSc in two academic centers. Response to bDMARDs was assessed according to EULAR and if unavailable according to therapeutic maintenance. The evolution of lung function test was also evaluated.

Results

Twenty-two patients were identified. Interstitial lung involvement was common (n=11). Only 7 patients were treated with csDMARD alone. The most commonly used drug was methotrexate. The use of bDMARDs was frequent (15/22), significantly greater in patients with rheumatoid factors (OR 26.7; p=0.004) and with a trend in patients with higher levels of anti-CCP (160 vs 15 IU; p=0.11) or diffuse interstitial lung disease (OR 10.6; p=0.063). Tocilizumab was the most selected therapy (n = 8) followed by rituximab (n = 5), abatacept, and anti-TNFs (n = 4 respectively). We evaluated 21 treatment sequences, 19 of which were evaluated according to EULAR response criteria. bDMARDS that inhibits the activation of lymphocytes (abatacept, rituximab) generally resulted in a good or moderate response (n = 9/10) with a significant decrease in DAS28 at 6 months (-1.75; p = 0.016). Cytokine inhibitors (tocilizumab, etanercept, infliximab) were less likely to achieve good or moderate control of joint involvement (n = 3/9) with a smaller decrease in DAS28 at 6 months (-0.79; p = 0.36). Two tocilizumab sequences were stopped early due to intolerance and could not be evaluated. One patient received tofacitinib with a good clinical response but was discontinued at 9 months for intolerance. Lung function test data did not change significantly on bDMARD.

Conclusion

In patients with rheumatoid arthritis (RA)/systemic sclerosis (SSc) overlap syndrome, bDMARDS that inhibits the activation of lymphocytes (abatacept, rituximab) resulted in more frequent and greater improvement in joint involvement than cytokine inhibitors (tocilizumab, etanercept, infliximab).

Disclosure of Interests

None declared

Clinical and ultrasonographic evaluation of the window of opportunity for retreatment with rituximab in rheumatoid arthritis patients from a multicentre real-life study

OBJECTIVES

To determine a potential window of opportunity for retreatment with rituximab in patients with rheumatoid arthritis (RA) from a multicentre longitudinal real-life study based on tight monitoring with ultrasonography (US).

METHODS

Thirty RA patients treated with rituximab were included. US parameters were collected at each time (8 visits) of the 18-month follow-up, notably the global score of power Doppler (PD) activity. Clinical relapse was defined as a DAS28 ESR of >3.2 after 6 months in responders while US relapse was defined as an increase of ≥20% of the global score of PD activity. The decision of retreatment was based exclusively on clinical findings.

RESULTS

A total of 29 patients were analysed (mean (SD) age: 57.2 (12.2) years; female gender: 66%). The mean (SD) PD score decreased from 8.8 (5.2) at baseline to 4.9 (4.3) at 6 months (p <0.0001). A clinical response was observed at Month 4 or Month 6 for 93% of patients. A total of 19 patients had a first clinical relapse (with or without US relapse) after Month 6 (18 of them were retreated with rituximab). Among 10 patients without clinical relapse, 3 had US relapse (only one was retreated) and 7 had no US relapse (but 4 were retreated).

CONCLUSIONS

This study highlights a great heterogeneity in terms of sequence of clinical relapse, US relapse and retreatment in RA patients receiving rituximab. Therefore, US monitoring does not seem to be relevant to determine the best time for retreatment with rituximab.

Validation in the ESPOIR cohort of vitamin K-dependent protein S (PROS) as a potential biomarker capable of predicting response to the methotrexate/etanercept combination

Background

To validate the ability of PROS (vitamin K-dependent protein S) and CO7 (complement component C7) to predict response to the methotrexate (MTX)/etanercept (ETA) combination in rheumatoid arthritis (RA) patients who received this therapeutic combination in a well-documented cohort.

Method

From the ESPOIR cohort, RA patients having received the MTX/ETA or MTX/adalimumab (ADA) combination as a first-line biologic treatment were included. Serum concentrations of PROS and CO7 were measured by ELISA prior to the initiation of ETA or ADA, at a time where the disease was active (DAS28 ESR > 3.2). The clinical efficacy (response/non-response) of both combinations has been evaluated after at least 6 months of treatment, according to the EULAR response criteria with some modifications.

Results

Thirty-two were treated by MTX/ETA; the numbers of responders and non-responders were 24 and 8, respectively. Thirty-three patients received the MTX/ADA combination; 27 and 5 patients were respectively responders and non-responders. While there were no differences for demographic, clinical, biological, and X-rays data, as well as for CO7, serum levels of PROS tended to be significantly higher in responders to the MTX/ETA combination (p = 0.08) while no difference was observed in the group receiving MTX/ADA. For PROS, the best concentration threshold to differentiate both groups was calculated at 40 μg/ml using ROC curve. The theranostic performances of PROS appeared better for the ETA/MTX combination. When considering the response to this combination, analysis of pooled data from ESPOIR and SATRAPE (initially used to validate PROS and CO7 as potential theranostic biomarkers) cohorts led to a higher theranostic value of PROS that became significant (p = 0.009).

Conclusion

PROS might be one candidate of a combination of biomarkers capable of predicting the response to MTX/ETA combination in RA patients refractory to MTX.

Trial registration

ClinicalTrials.gov identifiers: NCT03666091 and NCT00234234.

Lymphoma complicating rheumatoid arthritis: results from a French case-control study

Objectives

To study the characteristics of B-cell non-Hodgkin’s lymphoma (NHL) or Hodgkin lymphoma complicating rheumatoid arthritis (RA) and to identify RA-related factors associated with their occurrence.

Methods

A multicentre case–control study was performed in France. Cases were patients with RA fulfilling ACR-EULAR 2010 criteria in whom B-cell NHL or Hodgkin lymphoma developed after the diagnosis of RA. For each case, 2 controls were assigned at random from the ESPOIR cohort and were matched on age at lymphoma diagnosis (cases)/age at the 10-year follow-up visit in the cohort (controls). Case and control characteristics were compared to identify parameters associated with the occurrence of lymphoma.

Results

54 cases were included and matched to 108 controls. Lymphomas were mostly diffuse large B-cell lymphoma (DLBCL, n=27, 50.0%). On immunochemistry, 4 of 27 (14.8%) lymphoma cases were positive for Epstein-Barr virus. On univariate analysis, factors associated with the occurrence of lymphoma were male sex (OR 3.3, 95% CI 1.7 to 6.7), positivity for ACPA (OR 5.1, 95% CI 2.0 to 15.7) and rheumatoid factor (OR 3.9, 95% CI 1.6 to 12.2), and erosions on radiographs (OR 3.8, 95% CI 1.7 to 8.3) and DAS28 (OR 2.0, 95% CI 1.5 to 2.7), both at the time of matching. Methotrexate, TNF blockers and a number of previous biologics were not associated with the occurrence of lymphoma. On multivariable analysis, erosions and DAS28 remained significantly associated with increased risk of lymphoma.

Conclusion

Lymphomas complicating RA are mostly DLBCL. Risk of lymphoma in patients with RA was increased with markers of disease activity and severity, which supports the paradigm of a continuum between autoimmunity and lymphomagenesis in RA.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

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

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

Figure 1.

Patients with LDA or remission at baseline and 6 months

Table 1.

Safety data

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

Acknowledgements:

To all investigators involved in this study.

Disclosure of Interests:

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

FRI0095 SARILUMAB IMPROVED PATIENT-PERCEIVED IMPACT OF RHEUMATOID ARTHRITIS WHATEVER THE BASELINE DISEASE ACTIVITY: FIRST RESULTS FROM AN INTERVENTIONAL NON CONTROLLED STUDY: SARIPRO, IN MODERATE AND SEVERE RHEUMATOID ARTHRITIS PATIENTS

Background:

Sarilumab, an anti-IL-6R antibody, is approved for the treatment of moderate to severe RA and shown efficacy on disease activity and patient-reported outcomes (PROs). Detailed analyses of drug efficacy from the patient point of view is important. SariPRO is a pragmatic interventional study close to the daily practice.

Objectives:

To assess the effectiveness of sarilumab on several PROs using the RAID (Rheumatoid Arthritis Impact of Disease) score.

Methods:

The SariPRO study (NCT 03449758) was a French multicenter interventional study assessing the effects of sarilumab 200 mg on PROs in patients with moderately to severely active RA with an inadequate response or intolerance to conventional synthetic or biologic DMARDs. The primary endpoint was change in total RAID score from baseline to week 24 (RAID ranges 0-10 where 10 is maximal impact). Changes from baseline for RAID, DAS28-ESR and CDAI according to baseline disease activity were analyzed as secondary outcomes. Safety was assessed by monitoring adverse events (AE). All statistical analyses were descriptive, 95% CI was given when appropriate.

Results:

84 patients were included in 31 centers and 62 were evaluable and analyzed for effectiveness. They had similar characteristics to the 84 patients at baseline and were as expected for an RA population initiating a biologic: mean (SD) age: 59.9 (12.4) years, 71.0% female, disease duration 9.7 (10.3) years, rheumatoid factor positivity 82.5%, ACPA positivity 86.4%, and DAS28=4.9 (11). Total RAID score decreased significantly from 5.7 (2.0) at baseline to 3.3 (2.5) at W24; mean change was -2.4 [95% CI: -3.0; -1.8]. Furthermore, this improvement was noted both for highly and less active patients at baseline: for patients with DAS28-ESR < 5.1 (n=31), mean change was -1.56 [-2.28; -0.83] and for patients with DAS28-ESR≥5.1 (n=27), mean change was -1.98 [-2.91; -1.05]. Changes in DAS28-ESR and CDAI were significant (-2.8 [-3.2; -2.4] and -15.2 [-18.5; -11.8], respectively). AEs were consistent with the safety profile of anti-IL-6R antibodies and with results from RCTs (data not shown).

Conclusion:

In this real world study, treatment with sarilumab during 24 weeks in RA patients led to an improvement in the total RAID score irrespective of baseline levels of disease activity. This is the first time RAID score is used as the primary endpoint in a study.

References:

[1]Study was sponsored by Sanofi Genzyme

Disclosure of Interests:

Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, René-Marc Flipo Consultant of: Johnson and Johnson, MSD France, Novartis, Sanofi, Speakers bureau: Johnson and Johnson, MSD France, Novartis, Sanofi, Thierry Schaeverbeke: None declared, Christine Albert: None declared, Athan Baillet Consultant of: Athan BAILLET has received honorarium fees from Abbvie for his participation as the coordinator of the systematic literature review, marie-Christophe Boissier: None declared, Cyrille Confavreux: None declared, Gregoire CORMIER: None declared, Emmanuelle Dernis Speakers bureau: Lilly, Novartis, Elisabeth Gervais Solau: None declared, Sophie Godot: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Slim Lassoued: None declared, Thierry Lequerre: None declared, Frederic Lioté Consultant of: CME: Nordic Pharma, Christian Marcelli: None declared, Yves Maugars: None declared, Minh Nguyen: None declared, Aleth Perdriger: None declared, Yves-Marie Pers: None declared, Edouard Pertuiset: None declared, Lucile Poiroux: None declared, Carole Rosenberg: None declared, Christian Roux: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Martin SOUBRIER: None declared, Pascale Vergne-Salle: None declared, Charles Zarnitsky: None declared, Eric Fakra Consultant of: Janssen, Lundbeck, Otsuka, Sanofi, Hubert MAROTTE Grant/research support from: Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Consultant of: AbbVie, Amgen, Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Paid instructor for: Sanofi-Aventis, Speakers bureau: Sanofi-Aventis, Florence E Lévy-Weil Employee of: Sanofi Genzyme employee

FRI0325 UVEITIS OCCURRENCE IN EARLY INFLAMMATORY BACK PAIN. FIVE YEARS DATA FROM A PROSPECTIVE FRENCH NATIONWIDE COHORT

Background:

Uveitis is the most frequent extra rheumatological manifestation in axial Spondyloarthritis (SpA). DESIR is a prospective multicenter cohort of patients with early inflammatory back pain suggestive of SpA. We reported previously a 8.5% baseline prevalence of uveitis for the patients included in the cohort; this history of uveitis at the first visit of the cohort was associated with inflammatory bowel disease (IBD) and preceding infection (1).

Objectives:

The aim of the study was to evaluate the prevalence and incidence of uveitis over the first five years of prospective follow-up of the cohort, and to evaluate its associated factors.

Methods:

DESIR is a prospective observational cohort of patients with recent onset inflammatory back pain (more than 3 months, less than 3 years), suggestive of axial SpA, All available factors in the database were compared between patients with and without uveitis at 5 years, by uni and then multivariate analysis. Baseline factors associated with new cases of uveitis occurrence over the 5 years were also analyzed. Significance: p less than 0.05.

Results:

After 5 years, 91 patients (out of 480 with complete follow-up) had at least one uveitis episode, giving an estimated prevalence of 18.9% [95%CI: 15.4-22.4]. In multivariate analysis, uveitis was associated with dactylitis (OR 2.92 [2.06 – 4.14]; p=0.002**), ESR > 7mm (median value) (OR 2.19 [1.57 – 3.06]; p=0.018*).

New incident uveitis occurred in 31 cases over 5 years, giving an estimated incidence rate of 1.29 [0.84 – 1.74] / 100 patient-years. New incidence of uveitis was associated in multivariate analysis with the following baseline factors: diagnosis of SpA (OR 9.65 [3.21 – 28.96]; p=0.039*), total sacro iliac MRI inflammatory SPARCC score (central reading) over median (OR 3.98 [2.26 – 7]; p=0.015*), dactylitis (OR 4.7 [2.65 – 8.36]; p=0.007**), syndesmophyte score over median (central reading) (OR 0.22 [0.1 – 0.45]; p=0.039*).

No significant association was found with HLA-B27, cs or b DMARDs, BASDAI, ASDAS, BASFI.

Conclusion:

Five-years data of the DESIR cohort allowed an estimation of incidence rate of uveitis of 1.3/100p-y; over five years, uveitis was associated with dactylitis, biologic and sacro iliac MRI inflammation.

References:

[1]Wendling D, et al.Arthritis Care Res(Hoboken). 2012 Jul;64(7):1089-93.

Disclosure of Interests:

Daniel Wendling: None declared, Clément Prati: None declared, Thierry Lequerre: None declared, Corinne Miceli Richard: None declared, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB, xavier guillot: None declared

OP0125 LYMPHOMAS COMPLICATING RHEUMATOID ARTHRITIS: RESULTS OF A FRENCH MULTI-CENTRE CASE-CONTROL STUDY

Background:

Rheumatoid arthritis (RA) is associated with an increased risk of non-Hodgkin B-cell lymphoma (B-cell NHL).

Objectives:

1)To study the characteristics of B-cell NHL complicating RA

2)To identify the factors associated with their occurrence.

Methods:

A multi-centre case-control study was performed in France. Cases were patients with RA fulfilling the ACR-EULAR 2010 criteria, who developed a B-cell NHL after the diagnosis of RA. Cases were reported following a call for observations by the “Club Rhumatismes et Inflammation” network, registries from the French society of Rheumatology (AIR, ORA and REGATE) and the ESPOIR cohort. For each case, 2 control patients were drawn at random from patients in the ESPOIR cohort with RA fulfilling the ACR-EULAR 2010 criteria; cases and controls were matched on age (age at lymphoma diagnosis for cases and age at the 10-year ESPOIR visit for controls). Patients with associated Sjögren’s syndrome were excluded. Cases and controls characteristics were compared for parameters associated with the occurrence of lymphoma.

Results:

A total of 54 cases were included and matched to 108 controls. Lymphomas were mostly diffuse large B-cell lymphomas (n=26, 48.2%)(Figure 1). EBV positivity was found in 4 cases among 27 tested (14.8%). Cases had a mean age of 63.5 years (SD=10.9), and had a mean RA duration of 12.4 years (SD=10.5) at the time of diagnosis of lymphoma; there was no significant difference with controls (p=0.47 and p=0.40 respectively). The mean duration of follow-up after the diagnosis of lymphoma was 5.2 years (SD=5.8). In univariate analysis, factors associated with occurrence of B-cell NHL were: male gender (OR=3.3, 95%CI: 1.7-6.7), positive ACPA (OR=5.1, 95%CI: 2.0-15.7), positive Rheumatoid Factor (RF) (OR=3.9, 95%CI=1.6-12.2), erosions on X-rays (OR=15.4, 95%CI: 6.9-37.7) and DAS28 (OR=2.0, 95%CI: 1.5-2.7). Methotrexate, TNF-blockers and the number of previous biologics were not associated with the occurrence of B-cell NHL. Hydroxychloroquine and sulfasalazine were more frequent in cases versus control, which could be linked to a date bias. Erosions and DAS28 remained significant in multivariate analysis(Table 1).

Conclusion:

This study revealed an association between markers of activity (DAS28), severity (erosions) and autoimmune B-cell activation (RF and ACPA) and the risk of B-cell NHL in patients with RA, supporting the continuum between autoimmunity and lymphomagenesis in RA.

Figure 1.

Disclosure of Interests:

Joanna KEDRA: None declared, Raphaèle Seror Consultant of: BMS UCB Pfizer Roche, Philippe Dieudé: None declared, Arnaud Constantin: None declared, ERIC TOUSSIROT: None declared, Elias Kfoury: None declared, Charles Masson: None declared, Divi Cornec: None declared, Jean-Jacques Dubost: None declared, Laurent Marguerie: None declared, Sebastien Ottaviani: None declared, Franck Grados: None declared, Rakiba Belkhir: None declared, olivier fain: None declared, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Christelle Sordet: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Peggy Philippe: None declared, Muriel PIPERNO: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Olivier Lambotte Consultant of: BMS France, MSD, Astra Zeneca, Incyte, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Jérémie SELLAM: None declared, Thomas Sene: None declared, Guillaume Denis: None declared, Thierry Lequerre: None declared, Xavier Mariette Consultant of: BMS, Gilead, Medimmune, Novartis, Pfizer, Servier, UCB, Gaetane Nocturne: None declared

Relapse in rheumatoid arthritis patients undergoing dose reduction and withdrawal of biologics: are predictable factors more relevant than predictive parameters? An observational prospective real-life study

OBJECTIVE

To determine predictive/predictable factors of relapse in rheumatoid arthritis (RA) patients undergoing biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) dose reduction/discontinuation.

PATIENTS AND METHODS

RA patients receiving the same bDMARD for more than 1 year, in Simplified Disease Activity Index (SDAI) remission, were selected in an observational monocentric real-life study. The 18-month follow-up included spacing (6 months) and withdrawal (12 months) periods of bDMARD. Clinical, biological and ultrasonographic (US) parameters were collected regularly. Relapse was defined by SDAI>11.

RESULTS

Fifty-three RA patients (mean age: 58 years; 72% women; median duration: 11 years) were enrolled. Forty-two received anti-cytokinic bDMARD targeting tumour necrosis factor (n=39) or interleukin-6R (n=3) and 11 were treated by abatacept. The number of relapses during the spacing and discontinuation periods were 19 and 20, respectively. After 18 months of follow-up, among the 53 patients, 12 maintained bDMARD-free remission, 39 had relapsed and 2 were lost of follow-up. Median time to relapse was 11.8 months. In multivariate analysis, baseline factors predictive of relapse were corticosteroid intake, female gender, longer disease duration and no methotrexate intake with bDMARD. Concerning the survival analysis, also taking into account the factors of predictability, the main risk factor of relapse after discontinuation was an increase of SDAI >0 during the spacing period (p=0.03). US findings were not contributive.

CONCLUSION

In the context of RA in remission under bDMARDs, variation of SDAI during the dose-reduction phase is more relevant than baseline parameters to predict success of drug withdrawal.

Major remodeling of brain microvessels during neonatal period in the mouse: A proteomic and transcriptomic study

Preterm infants born before 29 gestation weeks incur major risk of subependymal/intracerebral/intraventricular hemorrhage. In mice, neonate brain endothelial cells are more prone than adult cells to secrete proteases under glutamate challenge, and invalidation of the Serpine 1 gene is accompanied by high brain hemorrhage risk up to five days after birth. We hypothesized that the structural and functional states of microvessels might account for age-dependent vulnerability in mice up to five days after birth and might represent a pertinent paradigm to approach the hemorrhage risk window observed in extreme preterms. Mass spectrometry proteome analyses of forebrain microvessels at days 5, 10 and in adult mice revealed 899 proteins and 36 enriched pathways. Microarray transcriptomic study identified 5873 genes undergoing at least two-fold change between ages and 93 enriched pathways. Both approaches pointed towards extracellular matrix, cell adhesion and junction pathways, indicating delayed microvascular strengthening after P5. Furthermore, glutamate receptors, proteases and their inhibitors exhibited convergent evolutions towards excitatory aminoacid sensitivity and low proteolytic control likely accounting for vascular vulnerability in P5 mice. Thus, age vascular specificities must be considered in future therapeutic interventions in preterms. Data are available on ProteomeXchange (identifier PXD001718) and NCBI Gene-Expression-Omnibus repository (identification GSE67870).

Variations in the metabolome in response to disease activity of rheumatoid arthritis

BACKGROUND

Anti-Tumor Necrosis Factor (TNF) therapies are able to control rheumatoid arthritis (RA) disease activity and limit structural damage. Yet no predictive factor of response to anti-TNF has been identified. Metabolomic profile is known to vary in response to different inflammatory rheumatisms so determining it could substantially improve diagnosis and, consequently, prognosis. The aim of this study was to use mass spectrometry to determine whether there is variation in the metabolome in patients treated with anti-TNF and whether any particular metabolomic profile can serve as a predictor of therapeutic response.

METHODS

Blood samples were analyzed in 140 patients with active RA before initiation of anti-TNF treatment and after 6 months of Anti-TNF treatment (100 good responders and 40 non-responders). Plasma was deproteinized, extracted and analyzed by reverse-phase chromatography-QToF mass spectrometry. Extracted and normalized ions were tested by univariate and ANOVA analysis followed by partial least-squares regression-discriminant analysis (PLS-DA). Orthogonal Signal Correction (OSC) was also used to filter data from unwanted non-related effects. Disease activity scores (DAS 28) obtained at 6 months were correlated with metabolome variation findings to identify a metabolite that is predictive of therapeutic response to anti-TNF.

RESULTS

After 6 months of anti-TNF therapy, 100 patients rated as good responders and 40 patients as non-responders according to EULAR criteria. Metabolomic investigations suggested two different metabolic fingerprints splitting the good-responders group and the non-responders group, without differences in anti-TNF therapies. Univariate analysis revealed 24 significant ions in positive mode (p < 0.05) and 31 significant ions in negative mode (p < 0.05). Once intersected with PLS results, only 35 ions remained. Carbohydrate derivates emerged as strong candidate determinants of therapeutic response.

CONCLUSIONS

This is the first study describing metabolic profiling in response to anti-TNF treatments using plasma samples. The study highlighted two different metabolic profiles splitting good responders from non-responders.

Efficacy of rituximab in systemic manifestations of primary Sjogren's syndrome: results in 78 patients of the AutoImmune and Rituximab registry

OBJECTIVES

To evaluate the efficacy and safety of rituximab in patients with primary Sjögren's syndrome (pSS).

METHODS

The AutoImmune and Rituximab registry has included 86 patients with pSS treated with rituximab, prospectivey followed up every 6 months for 5 years.

RESULTS

Seventy-eight patients with pSS (11 men, 67 women), who already had at least one follow-up visit, were analysed. Median age was 59.8 years (29-83), median duration of disease was 11.9 years (3-32). Indications for treatment were systemic involvement for 74 patients and only severe glandular involvement in four patients. The median European Sjögren's Syndrome disease activity index (ESSDAI) was 11 (2-31). 17 patients were concomitantly treated with another immunosuppressant agent. Median follow-up was 34.9 months (6-81.4) (226 patient-years). Overall efficacy according to the treating physician was observed in 47 patients (60%) after the first cycle of rituximab. Median ESSDAI decreased from 11 (2-31) to 7.5 (0-26) (p<0.0001). Median dosage of corticosteroid decreased from 17.6 mg/day (3-60) to 10.8 mg/day (p=0.1). Forty-one patients were retreated with rituximab. Four infusion reactions and one delayed serum sickness-like disease resulted in rituximab discontinuation. Three serious infections (1.3/100 patient-years) and two cancer-related deaths occurred.

CONCLUSIONS

In common practice, the use of rituximab in pSS is mostly restricted to patients with systemic involvement. This prospective study shows good efficacy and tolerance of rituximab in patients with pSS and systemic involvement.

Altered gene expression in acute systemic inflammation detected by complete coverage of the human liver transcriptome

The goal of the current study was to provide complete coverage of the liver transcriptome with human probes corresponding to every gene expressed in embryonic, adult, and/or cancerous liver. We developed dedicated tools, namely, the Liverpool nylon array of complementary DNA (cDNA) probes for approximately 10,000 nonredundant genes and the LiverTools database. Inflammation-induced transcriptome changes were studied in liver tissue samples from patients with an acute systemic inflammation and from control subjects. One hundred and fifty-four messenger RNAs (mRNA) correlated statistically with the extent of inflammation. Of these, 134 mRNA samples were not associated previously with an acute-phase (AP) response. The hepatocyte origin and proinflammatory cytokine responsiveness of these mRNAs were confirmed by quantitative reverse-transcription polymerase chain reaction (Q-RT-PCR) in cytokine-challenged hepatoma cells. The corresponding gene promoters were enriched in potential binding sites for inflammation-driven transcription factors in the liver. Some of the corresponding proteins may provide novel blood markers of clinical relevance. The mRNAs whose level is most correlated with the AP extent (P <.05) were enriched in intracellular signaling molecules, transcription factors, glycosylation enzymes, and up-regulated plasma proteins. In conclusion, the hepatocyte responded to the AP extent by fine tuning some mRNA levels, controlling most, if not all, intracellular events from early signaling to the final secretion of proteins involved in innate immunity. Supplementary material for this article can be found on the HEPATOLOGY website (http://interscience.wiley.com/jpages/0270-9139/suppmat/index.html).