Judith Sarano

Long-term Outcome of Lupus Nephritis Class II in Argentine Patients: An Open Retrospective Analysis.

BackgroundThere is controversy in medical literature over the outcome of patients with lupus nephritis (LN) class II. The aim of this study was to explore the risk of histological transformation (HT) and possible factors related to negative response to treatment in patients with mesangial LN class II. MethodsA retrospective and multicenter study was carried out that includes patients who had received a diagnosis of LN class II on their first renal biopsy. Creatinine, urine sediment, and proteinuria were recorded at the time of the first biopsy, 6 months, and 1, 2, and 5 years after the first biopsy. Response to treatment, HT, and long-term outcome were evaluated. ResultsForty-one patients were included. The manifestation at first biopsy was proteinuria greater than 0.5 g/d in 28 patients (68.29%; 8 [28.57%] of 28 patients had nephrotic syndrome), hematuria in 18 patients (43.90%), and deterioration of renal function in 3 patients (7.31%). During the follow-up (median, 8 years; range, 1–35 years), a new biopsy was performed in 18 patients (43.90%), and in 17 patients (17/18 [94.44%]), there was HT. Median time at rebiopsy was 32 months (range, 11–305 months). Of the 18 patients who had a second biopsy, 10 (55.55%) were on hydroxychloroquine versus 100% (19/19) of patients who did not undergo the procedure (P = 0.001). A year after the first renal biopsy, there are data available from 34 patients; of them, 24 patients (70.58%) had achieved response, and 10 patients (29.41%) had no response (NR) (missing data in 7). A higher 24-hour urinary protein at 6 months was predictor of worse outcome at 1 year, with statistical significance difference for the nonresponder group (median proteinuria, 2.3 g/d [range, 0–4.7 g/d]) compared with responders (median proteinuria, 0.28 g/d [range, 0–1.7 g/d]) (P = 0.0133).In the long-term follow-up (5 years), HT was the main cause of unfavorable outcome and was measured in 78.57% of patients (11/14 patients). ConclusionsThis series shows a high rate of HT in long-term follow-up. Proteinuria at 6 months made it possible to set aside patients who will have an unfavorable outcome in the long term and who will thus benefit from a more aggressive treatment. The results suggest that hydroxychloroquine had a nephroprotective effect.

SAT0488 Tuberculosis in A Registry of Rheumatic Patients Treated with Biological Drugs

Background Biologic therapies (bDMARDs) have improved the treatment of rheumatic diseases; however, the risk of tuberculosis (TB) infection or reactivation in patients treated with this drug class remains a concern. Objectives We investigated the clinical characteristics and prognostic factors of TB in an Argentine registry of rheumatic diseases patients treated with bDMARDS. Methods Database included demographics of patients, type and duration of treatments and clinical information of adverse events. A control group was included for comparison consisting of patients not treated with bDMARDs but similar demographics. Values are expressed as mean±standard deviation, median (ranges), and frequencies (percentages), as appropriate. Multivariate logistic regression analysis was used to identify variables associated with the occurrence of TB; OR and 95% CI were calculated by exponentiation of regression coefficients. Results As of January 2016, 3483 patients, 4762 treatments and 2580 adverse events were studied. Mean age 56.1±15,7 years; 2748 (78.9%) patients were women. Initial treatments were 1472 (42.3) bDMARD vs. 2011 (57.7) non-bDMARD. Main diagnosis: Rheumatoid arthritis (RA) 2706 (77.7), Psoriatic arthritis (PsA) 293 (8.4), juvenile idiopathic arthritis (JIA) and lupus with 117 (3.36) each. Of 4762 treatments, most frequent biological drugs were etanercept 119 (25,1), adalimumab 626 (13,2), and abatacept with 282 (5.9). Of 3483 patients, 18 (0.5) presented TB as an adverse event, their mean age was 52.9±2.8; 16 (88.9) had AR and 2 (11.1) had PsA; 16 (88.9) had initially received bDMARD vs. 2 (11.1) who had received non- bDMARD treatments. PPD test was performed in 2002/2883 (69.4) bDMARD treatments vs. 372/1879 (19.8%) non-bDMARD treatments, with 126 (6.3) vs 35 (9.4) positive tests, respectively. Median time from treatment commencement to TB was 15.1 (range 1.6–137.5) months. Treatments during which, TB was diagnosed were etanercept 5 (27.8), adalimumab 4 (22.2), non-bDMARD 3 (16.7), abatacept and infliximab with 2 (11.1) each and tocilizumab 1 (5.6), the distribution was not significantly different (Table 1). The risk of developing TB was higher in patients whose first treatment was bDMARDs (OR 5.6 95%CI 1.3–24.3). Conclusions A higher frequency of TB was seen in patients treated with bDMARDs; however, results should be interpreted cautiously because of registries inherent limitations. Disclosure of Interest None declared