Sedat Capar

A retrospective evaluation of analgesic exposures from Izmir, Turkey

The objective of this study is to analyze exposures concerning analgesics that were reported to Dokuz Eylul University Drug and Poison Information Center (DPIC) and admitted to the Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU) between 1993 and 2004. Demographics of the patients, characteristics of analgesic exposures, performed treatment attempts and outcome of the poisoned patients were recorded on standard data forms and were then entered into a computerized database program. Statistical analysis was performed by using the chi-square test. The DPIC recorded 55 962 poisoning calls, 48 654 (86.9%) of them related to medicines. Analgesics accounted for 16.3% (7 939 cases) of all medicine-related exposures; among them 446 exposures were admitted to EMDEU. More than half of the analgesic exposure calls and admitted cases involved adults (55.9%, 4 440). Females dominated in all age groups (70.3%, 5 578). Mean age was 20.2 ± 11.8. The most involved analgesics were paracetamol (47.9%), propionic acid derivatives (16.1%) and salicylates (13.7%). Most of the poisonings were intentional (75.1%), especially in 19—29 years age group of adults and 13—18 years age group of children. Most of the patients reported to DPIC and admitted to EMDEU were asymptomatic (84.4% and 54.7%, respectively). Gastrointestinal decontamination methods were performed more frequently for admitted poisoning cases before hospital admission than reported poisoning cases (61% vs. 23%). Paracetamol ingestion was the most common cause of analgesic exposures reported to our DPIC. Most of the analgesic exposures reported to DPIC were asymptomatic or mild. DPICs have an important role for the referral of analgesic exposures without unnecessary gastrointestinal decontamination procedures. Human & Experimental Toxicology (2007) 26, 629—636

SAT0184 The effect of smoking on response to tumor necrosis factor-alpha inhibitor treatment in ankylosing spondylitis patients: results from the turkbio registry

Background: Although there is good evidence that smoking has a dose-dependent impact on structural damage progression in ankylosing spondylitis (AS) the evidence is poor for its impact on disease activity, physical mobility, life quality and treatment response. Objectives: We aimed to investigate the impact of smoking on disease acitivity, treatment adherence and treatment response in Turkish patients with AS treated with their first tumour necrosis factor-alpha inhibitor (TNFi) therapy in a real-life cohort. Methods: 561 patients fulfilling the modified New York criteria for AS and treated with their first TNFi therapy since 2011 from 8 centers in Turkey were included in the analysis. Treatment response was evaluated as achievement of “BASDAI50” or “ASDAS Clinically important improvement (CII)” at the 3-months’ and 6 months’ visits. Clinical and demographic parameters were compared between current/never and current/previous smoker groups. Demographic and descriptive data are presented by medians/interquartile ranges (IQRs). Groups were compared by non- parametric tests (x2, Kruskal Wallis and Mann Whitney tests). Kaplan Meier plots, Cox and logistic regression analyses were calculated for treatment adherence and treatment response. Results: Among 561 AS patients included in the study, 506 (90%) had known smoking status (37% current, 35% never, 17% previous smokers). The median follow-up time was 1.9 years (IQR 0.85–3.5) and disease duration was 3.1 years (0,6–7,7). At baseline, current smokers were younger (34, IQR 29–41) compared with never (38, IQR 30–46 p=0.007) and previous smokers (42, IQR 34–49 p<0,001). Current smokers had male predominance (n=148, 43.9%; n=85, 25.2%); lower erythrocyte sedimentation rate (28 mm/h (13–42); 34 mm/h, (20–49) and higher change in BASMI (40, IQR 10–57.5; 10, IQR 4–30) compared with never smokers (all p<0.005). HLA status, body mass index, CRP, baseline disease indexes (BASDAI, BASFI, BASMI, HAQ, ASDAS) and treatment response was not found to be different between current and never smoker patients in our population (table 1). In multivariate analysis, male (OR:1,98; 95% CI (1,39–2,82), p<0,01), HLA positive (OR:1,54; 95%CI (1,08–2,18), p=0,016) and active DMARD user (OR:1,84; (95%CI 1,12–3,01) p=0,015) patients had better treatment response and treatment adherence ((HR:1,93; 95% CI (1,36–2,73); HR:1,60; 95% CI (1,13–2,27); HR:1,80; 95% CI (1,10–2,95) all p<0,005) but smoking status were not significant (p>0,05). Conclusions: In this study of TNFi-treated AS patients in clinical practice, smoking was not found to be associated with disease activity, treatment response and treatment adherence. Disclosure of Interest: None declared

Phenotype Differences in HLA-B27 Positive Versus Negative Patients with Ankylosing Spondylitis in a Population That Show Relatively Weaker Association with HLA-B27

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AB1120 Comparison of Long-Term Drug Survival of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis and Psoriatic Arthritis: A Single Center Turkish Experience Over a Decade

Background The studies from different national biologics registries provide data on long term efficacy and safety of tumor necrosis factor inhibitors inhibitors (TNFi) for the treatment of rheumatic diseases in diverse patient populations. The data in this regard is lacking in Turkish population. Objectives To assess and compare the long term drug survival rates of TNFi in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic Arthritis (PsA) and to identify potential reasons for treatment discontinuation. Methods The analysis included all the patients treated with TNFi at our center since 2004. Persistence on anti-TNF in patients who were lost to follow-up were analyzed using the national prescription database. Patients with no prescription over the last 6 months were considered to have discontinued the treatment. The date of the last prescription was accepted as the date of discontinuation. These patients were tried to be contacted by phone to identify the reason for discontinuation. Kaplan-Meier plots and log rank tests were used to assess drug survival. Results Of the 351 patients in the study 222 had AS (26.1% females, mean age: 44.3±11.7 years, mean disease duration: 20±9.9 years, HLA-B27:(+): 71.1%), 96 had RA (78.2% females, mean age: 53±13.9 years, mean disease duration: 15.1±7.7 years, RF (+): 59.1%, anti-CCP (+): 67.9%) and 32 had PsA (62.2% females, mean age: 47±14.2, mean disease duration: 12.2±8.7). Etanercept (ETA) was started in 123 (35.1%) patients, infliximab in 116 (33.1%), adalimumab (ADA) in 98 (28%) and golimumab (GOL) in 13 (%3,7). Over an observational period of up to 10 years, biologic treatment was discontinued in 198 (56.4%) patients, of whom 137 (69%) were switched to another TNFi. Drug survival rate for all of the three anti-TNF-α agents is 48.6% for AS, 37.5% for RA, and 40.6% for PsA. Median drug survival time in AS was 67.4 (95% CI, 58.5-76.3) and seemed to be longer than in RA (51.6 months, 95%CI 37.8-65.4) and PsA (45.5 months, 95% CI 30.0-61.0). No difference was observed between different TNFi within the same disease category. In patients with RA, female patiens had a longer drug survival than male patients. The reasons for discontinuation were inefficacy in 86 patients (44.3%), adverse events in 45 (23.2%) (tuberculosis in 2 patients, malignancy in 4 patients), remission in 10 (5.2%) and other or unclear reasons in 55 (29.3%). During the observational period four patients died, one due to lymphoma which developed during anti-TNF therapy, one due to metastatic germ cell tumor which developed one year after the cessation of antiTNF therapy, two due to possibly not related to the anti-TNF therapy. Conclusions Our single center study indicate generally similar long term drug survival rates for TNFi within a disease category. The trend for a better long term drug survival in this study is in line with some previously published. Disclosure of Interest G. Can: None declared, S. Capar: None declared, P. Cetin: None declared, D. Solmaz: None declared, G. Kenar: None declared, H. Yarkan: None declared, S. Akar: None declared, M. Birlik: None declared, I. Sari: None declared, F. Onen: None declared, N. Akkoc Grant/research support from: Pfizer UCB, Consultant for: Pfizer UCB Abbvie MSD BMS, Speakers bureau: Pfizer UCB Abbvie MSD

FRI0227 The Burden of Axial Spondyloarthritis: A Comparison of the Radiographic and Non-Radiographic Groups

Background Axial spondyloarthritis (axSpA) represents the whole clinical spectrum of ankylosing spondylitis (AS) including those at the non-radiographic (nr) stage of the disease. Although the disease burden associated with radiographic axSpA (classically known as AS) has been extensively studied, the burden associated with nr-axSpA is less well known. Objectives To assess and compare the burden of radiographic and nr-axSpA Methods This cross-sectional, observational study included consecutive AxSpA patients with varying disease severity, who attended our outpatient clinic between April 2014 and December 2014. During the visits, the following questionnaires were applied by trained health professionals:BASDAI, BASFI, HAQ-S, SF-36, ASQoL,Work Productivity and Activity Impairment (WPAI) and Work Productivity Survey (WPS). Results A total of 381 AxSpA patients (279 AS) were analyzed. Nr-axSpA group, were younger (39.4 vs 43.1, p=0.007), more likely to be female (54% vs 33%, p<0.001), had a shorter disease duration (10.1 vs 16.0 years, p<0.001) and lower CRP (5.9 vs 13.2, p<0.001) and less common use of biologics (41.2% vs 26.5, p=0.008) despite higher BASDAI scores (Table). Broadly similar results were found for the other clinical outcome measures. Of all the axSpA patients, 58% were employed, with non-manual (25%), mixed (19%) and manual works (14%). Only 1.1% of the patients could not work due to arthritis. Patients with nr-axSpA reported more work productivity loss at workplace and at home over the last month, but the difference was significant only for household activities. Subgroup analysis showed that this difference was only found in females. Table 1. Clinical variables related to disease burden in study participants. Data are presented as mean ± SD, unless otherwise stated Variable AS (n=279) nr-axSpA (n=102) P value BASDAI (0–100) 33.2±21.8 39.5±23.1 0.014 BASFI (0–100) 30.5±24.1 29.4±24.6 0.711 HAQ-S 0.7±0.6 0.8±0.6 0.606 SF36 PCS 41.3±9.3 39.2±10 0.111 SF36 MCS 46.1±10.5 43.3±11.4 0.060 ASqoL 5.6±5.4 6.2±5.6 0.331 Work productivity and impairment index (refers to the last week)  Absenteeism (%)* 8.7±25.5 12.3±30.3 0.374  Presenteeism (%)* 33.8±25.0 37.1±25.9 0.401  Overall work impairment (%)* 33.4±29.7 36.6±32.9 0.476  Daily activity impairment, (%) 33.5±22.9 34.6±23.6 0.672 Work productivity survey (refers to the last month)  Days of work missed* 1.4±4.6 3.0±6.6 0.090  Days with productivity at work reduced by ≥50%* 2.6±6.3 4.6±8.2 0.090  Rate of SpA interference on work productivity* 3.2±2.3 3.8±2.6 0.109  Days of household work missed 2.5±5.6 4.8±7.6 0.010  Days with household productivity reduced by ≥50% 3.1±2.1 3.6±2.3 0.048  Days with outside help 2.7±6.5 2.8±5.9 0.815  Rate of SpA interference with household work productivity (0-10 ) 3.1±2.1 3.7±2.3 0.052* Assessed in employed patients only. Conclusions Patients with AS and nr-AxSpA demonstrate similar degree of disease burden and prodcutivity, with a greater impairment of household work in females. Low rate of inability to work due to arthritis in this population with a relatively high prevalence of anti-TNF use may be a reflection of the effectiveness of such therapies. Disclosure of Interest None declared