C.M. González Fernández

AB0926 Effectiveness of certolizumab pegol in psoriatic arthritis. relationship with smoking status and bmi

Background Previous literature have investigated that tobacco and weight in patients with psoriatic arthritis (PsA) is associated with a poorer response to antiTNF. Objectives To investigate the response and survival of Certolizumab pegol (CZP) in PsA patient in daily clinical practice according to their baseline smoking status and Body Mass Index (BMI). Methods Multicentric cohort of PsA patients treated with CZP according to routine clinical practice. This study was approved by local Ethics Committee. Maximum observation time was 12 months. Effectiveness variables: DAS28 (CRP). Survival rate: Kapplan-Meier. Results 262 patients with PsA were included: 43.5% male, mean (SD) age 49.9 (11.9) years, mean (Q1-Q3) disease duration 6.9 (1.9–9.3) years, and 14.9% of patients were HLAB27 positive. Among these, 229 (87.4%) had known smoking status (29.7% smokers and 70.3% never smokers) and 85 (32%) had known BMI (median 26.9 kg/m2, SD 4.7). Statistically significant differences in DAS28 were observed at last visit comparing to baseline in both groups according to BMI and smoking status (table 1). CZP retention rate was 78.5% in non-smokers and 76.7% in smokers. In patients with BMI <25 kg/m2 CZP retention rate was 78.6% compared to 78.9%in patients with BMI ≥25 kg/m2 (figure 1). No statistical differences were observed in both sub-groups.Abstract AB0926 – Table 1 DAS28 Baseline BMI<25 kg/m2 4.6 (0.9) BMI≥25 kg/m2 4.5 (0.8) Never smokers 4.6 (0.9) Smokers 4.6 (0.9) Last visit BMI<25 kg/m2 3.6 (1.1)* BMI≥25 kg/m2 3.9 (1.0)* Never smokers 3.9 (1.0)# Smokers 3.3 (0.8)# *p<0,05, Wilcoxon test; #p<0.001 T-Student’s test (last visit vs basal).Abstract AB0926 – Figure 1 CZP Retention Rate according to BMI and smoking status in PsA patients. Conclusions In this daily clinical practice study of patientes with PsA treated with certolizumab pegol there was a significant decrease in DAS28-CRP independent of smoking status and BMI. No differences were found in the retention rate of certolizumab pegol based on these two variables. Disclosure of Interest J. Campos Esteban: None declared, A. Conesa Mateos: None declared, M. Fernandez-Prada: None declared, R. Expósito-Molinero: None declared, P. Rubio Muñoz: None declared, J. R. Lamua-Riazuelo: None declared, P. Navarro-Alonso: None declared, P. Ahijado Guzmán: None declared, R. Garcia-Portales Consultant for: Celgene, Speakers bureau: UCB, Pfizer, Roche, A. Urruticoechea-Arana: None declared, C. Gonzalez Fernandez Consultant for: Celgene, MSD, Novartis, Janssen, Speakers bureau: UCB, Abbvie, Pfizer, BMS, Roche, Celgene, Janssen

AB0721 Transfer of systemic sclerosis after allogeneic bone marrow transplantation

Background It is accepted that donor-derived immunity is transferred with allogeneic bone marrow transplantation (BMT)1. Objectives To show evidence of the transfer of systemic sclerosis by allogeneic BMT. Methods In this report we describe a pacient with T acute lymphoblastic leukaemia who underwent BMT and developed systemic sclerosis. Results 34-year-old man in complete remission from a T acute lymphoblastic leukaemia treated with allogeneic BMT from his mother in february of 2012. First seen in november 2017 for digital ulcers that appeared one year before. He presented two necrotic ulcers: one on the second finger of the left hand and other on the third finger of the right hand (IMAGE 1). He was admited to receive intravenous prostaglandins and complete the study. After the BMT he developed Raynaud’s phenomenon and in the examination he only presented facial and corporal telangiectasia, attributed before to chronic graft versus host disease (cGVHD). The analysis showed ANA 1/640 centromere pattern, anticentromere antibodies, reumatoid factor (RF) (652 UI/mL) and C3 of 86.4 mg/dL. Previously to the BMT he had negative ANA, but we do not know the rest of the previous autoimmunity. On the videocapillaroscopy we observe an active scleroderma pattern (IMAGE 2–3). He was diagnosed with systemic sclerosis based on Raynaud’s phenomenon, digital ulcers, anticentromere antibodies and abnormal nailfold capillaries. He had not familiar background of connective tissue diseases, but his mother presented Raynaud’s phenomenon since she was thirty. So we studied her. She presented facial telangiectasia, puffy fingers and fingertip pitting scars and the same autoantibodies: ANA 1/320 centromere pattern, anticentromere antibodies, RF (159 UI/mL) and consumption of C3 (74.3 mg/dL) and C4 (7.6). We do not have previous autoimmune studies of her. On the videocapillaroscopy we observed a late scleroderma pattern (IMAGE 4–5). She was also diagnosed with systemic sclerosis, based on Raynaud’s phemomenon, puffy fingers, fingertip pitting scars and facial telangiectasia, anticentromere antibodies and abnormal naifold capillaries. Conclusions Experimental animal studies and human clinical reports have described the transfer of immune-mediated diseases from affected donors to unaffected recipients, because of that the importance of screening this diseases in the donor before a BMT2. To our knowledge, this will be the first described case of transmission of systemic sclerosis by this mechanism. However, other explanations should also be taken into consideration. This include recipient’s own persistent intrathymic lymphocyte population that may produce autoantibodies and autoimmunity in the context of cGVHD. However, this last hypothesis is not supported since there is a familiar background and presence of anticentromere antibodies. References [1] Sherer, Y. and Shoenfeld, Y. (1998). Autoimmune diseases and autoimmunity post-bone marrow transplantation. Bone Marrow Transplantation. [2] Hough, R.(2005). Haemopoietic stem cell transplantation in autoimmune diseases: a European perspective. British Journal of Haematology. Disclosure of Interest None declared

AB0844 Efectiveness and retention rate of certolizumab pegol in spondyloarthritis. real life data

Background Certolizumab pegol (CZP) is available for patients with axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). The efficacy and the safety of CZP are well established from clinical trials. However, evidence of its effectiveness in regular clinical practice is limited. Objectives To evaluate the effectiveness and safety of CZP in a real word setting in axSpA patients. Methods Multicentric cohort of SpA patients treated with CZP according to routine clinical practice. The study was approved by the local Ethics Committee. Maximum follow-up was 12 months. Clinical response was evaluated through BASDAI, ASDAS, BASFI and MASES scores. Safety variables: discontinuation rate. Results 336 patients with axSpA were included: 56.5% male, mean age 45.8 (±12.1) years, median disease time 4.3 (0, 49.5) years, 68.5% of patients were HLAB27 positive, and never smokers 64.7%. Prior bDMARD received (27.2% none; 37.9% 1, 35%≥2). At baseline 36.8% had concomitant DMARDs and 82.8% NSAIDs. 31.8% of patients had peripheral arthritis and 42.7% entesitis at baseline. CZP retention time 10.3 months. Statistically significant differences in BASDAI, BASFI, ASDAS y MASES were observed at the last visit comparing to baseline (table 1). In the last observation, 41.0% of the patients achieved BASDAI50, 34% were in ASDAS remission (ASDAS <1.3) and 49% presented a minimal clinical improvement (ASDAS at least 1.1). 46.3% of patients had resolution of the enthesitis (MASES=0). According to Kaplan-Meier analysis, the drug survival of CZP was 83.3%, and no differences were observed in retention rates when CZP were used as first option (83.3%) or after failure to other biologicals (79.1%) (figure 1). 56/336 (16.7%) withdrawn CZP treatment: 34/336 (10.1%) due to lack of effectiveness, 16/336 (4.8%) due to adverse event and 6/336 (1.8%) for other reason. Serious adverse event was found in 23/336 (6.8%) patients.Abstract AB0844 – Table 1 Evolution of clinical variables of activity Baseline Last visit BASDAI evolution 6,2±1.6(n=263) 3,9±2.2(n=260)* BASFI evolution 5,6±2.1(n=225) 3,7±2.3 (n=241)* ASDAS evolution 3.7±2.7(n=322) 2,4±2.2 (n=321)* MASES score 3,9±2.7(n=78) 1,2±1.8(n=51)* *p<0,001, Wilcoxon’s testAbstract AB0844 – Figure 1 CZP Retention rate in axSpA patients without and with previous biological experience. Conclusions Real life experience from this nationwide rheumatology study, demonstrated the effectiveness and safety of CZP in patients with axSpA, with a significant reduction of BASDAI, BASFI, ASDAS and MASES scores. No differences were observed in the retention rate regardless previous biological treatment. Disclosure of Interest R. Expósito-Molinero: None declared, R. Garcia-Portales Consultant for: Celgene, Speakers bureau: UCB, Pfizer, Roche, J. R. Lamua-Riazuelo: None declared, A. Urruticoechea-Arana: None declared, P. Navarro-Alonso: None declared, J. S. Rey-Rey Speakers bureau: UCB, Abbvie, Pfizer, BMS, Roche, Celgene, M. Fernandez-Prada: None declared, C. Gonzalez Fernandez Consultant for: MSD, Janssen, Novartis, Celgene, Speakers bureau: Abbie, Janssen, MSD, Novartis, Roche, UCB, BMS

Tratamiento biológico de las enfermedades reumáticas

PUNTOS CLAVE Farmacos anti-TNF. El TNF-alfa es una potente citocina proinflamatoria y un regulador clave en la respuesta inmunologica innata. En este momento estan comercializados tres farmacos anti-TNF: adalimumab e infliximab que son anticuerpos monoclonales, y etanercept que es un receptor soluble de alta afinidad. Indicaciones de los farmacos anti-TNF. Infliximab y etanercept estan indicados en la AR resistente a otros farmacos, AR temprana, espondilitis anquilosante y artritis psoriasica. Etanercept y adalimumab en la artritis cronica juvenil poliarticular y este ultimo tambien en la AR resistente. Contraindicaciones. Estan contraindicados si existe riesgo de sepsis, infeccion grave activa o tuberculosis. Infliximab y adalimumab estan contraindicados si hay insuficiencia cardiaca moderada-grave. Efectos secundarios. Ademas de reacciones locales se debe estar vigilante ante el desarrollo de procesos infecciosos, principalmente tuberculosis, fenomenos autoinmunes y enfermedades desmielinizantes como esclerosis multiple. Farmacos anti-interleucina 1. Anakinra. Es un antagonista del receptor humano de la IL-1. Esta indicado en AR en combinacion con metotrexato en pacientes sin respuesta a este en monoterapia. El efecto secundario mas frecuente es reaccion local en el punto de inyeccion y neutropenia.