, contributed to support the research contract of MNN. Contributors LN designed the registry and managed data collection. LN, MNN and AB designed and drafted the work, with analysis and interpretation of data, revising it critically for important intellectual content. All coauthors made substantial contributions to acquisition of data. All coauthors revised and approved the version to be published.

Background: Currently, there is contradictory evidence regarding the best strategy to follow after discontinuation of a first biological agent in patients with rheumatoid arthritis (RA). We aimed to compare the long-term efficacy of switching to a second tumor necrosis factor inhibitor (TNFi) versus biopharmaceuticals with other mechanisms of action (non-TNFi) in patients with RA who previously failed a first TNFi. Methods: This prospective cohort study analyzed data from 127 patients who discontinued a previous TNFi between 1999 and 2016. Disease activity was assessed at baseline and at 6, 12, and 24 months (m-6, m-12, m-24) after switching. Primary outcome was the proportion of patients achieving good/moderate EULAR response (E-resp). Factors associated with clinical outcomes were assessed using univariate and multivariate logistic regression models. Results: Seventy-seven (61%) patients received a second TNFi and 50 (39%) switched to a non-TNFi. At m-6 and m-12, no differences were observed between groups; nevertheless, at m-24, the proportion of patients with E-resp was higher in the non-TNFi group (49% TNFi group versus 77% non-TNFi group; p = 0.002). In regression models, switching to a non-TNFi was significantly associated with E-resp at m-24 (odds ratio = 3.21; p = 0.01). When assessing the response to the second biological agent based on the reason for discontinuation of the first TNFi, similar results were obtained; at m-24, patients who discontinued the first TNFi due to inefficacy (either primary or secondary) experienced a better E-resp if they had switched to a non-TNFi (primary inefficacy: 52% TNFi group versus 79% non-TNFi group, p = 0.09; secondary inefficacy: 50% versus 76%, p = 0.03). Conclusion: In our cohort of RA patients who discontinued a first TNFi, those who switched to a non-TNFi were three times more likely to attain a sustained clinical response, regardless of whether they had discontinued the first biologic due to a primary or secondary inefficacy.

BackgroundThe majority of patients with axial spondyloarthritis (SpA) response to anti-TNF therapy. However, discontinuation of this therapy due to different reasons is still a relevant problem. Currently, there is not enough data to know exactly which is the prevalence and causes of interruption of anti-TNF therapies in clinical practice.ObjectivesFirst, to evaluate the frequency and causes of discontinuating adalimumab or infliximab as the first anti-TNF in patients with axial SpA in clinical practice. Second, to investigate the influence of anti-drug antibodies (ADA) on these causes.MethodsA total of 326 patients with axial SpA who had received adalimumab (34%) or infliximab (66%) as a first anti-TNF therapy were included in this retrospective, observational study performed in a tertiary hospital. Disease activity (BASDAI, ASDAS, CRP and ESR) was measured before starting anti-TNF therapy, after 6 months and when interrupting the therapy to assess properly whether the reason for discontinuation was primary or secondary failure. Serum drug levels and/or ADA were measured at 6 months visit and at the end of anti-TNF treatment.ResultsA total of 99 (30.4%) patients discontinued treatment. Mean (SD) under anti-TNF therapy until discontinuation was 2.5 (2.9) years. Characteristics of these patients when initiating anti-TNF therapy are shown in Table 1. The reason to interrupt treatment was: primary failure in 22.2%, secondary failure in 36.4%, side effects 32.3%), and other reasons in 9.1%. Serum drug levels and ADA were available in 83 patients. In most patients with ADA positive (14/17), the reason for discontinuation was secondary failure. Out of those patients who discontinued due to secondary failure, 38.9% had ADA positive.ConclusionsIn our cohort of patients with axial SpA treated with adalimumab/infliximab, 30% of patients discontinued anti-TNF therapy. The main reason to discontinue treatment was secondary failure, which was related to the presence of ADA in almost 40% of patients.Disclosure of InterestE. Moral Grant/research support from: Funded by an unrestricted medical grant from Pfizer, C. Plasencia: None declared, V. Navarro-Compán: None declared, D. Pascual Salcedo: None declared, T. Jurado: None declared, C. Tornero: None declared, A. Pierens: None declared, M. B. Paredes: None declared, P. Bogas: None declared, I. Monjo: None declared, E. Martin Mola: None declared, A. Balsa: None declared

BackgroundTocilizumab (TCZ), a humanized anti-IL-6 receptor antibody, represents a new treatment strategy for RA patients.Several studies have demonstrated the association between high serum levels of TNF-inhibitors and a good clinical response in patients with RA. Little evidence exists on this relationship for other biological therapies.ObjectivesTo evaluate the association between TCZ serum through levels and disease activity in a cohort of RA patients after one year of treatment with TCZ.Methods34 RA patients treated with Tocilizumab were included. Clinical activity was assessed using the Disease Activity Score 28 (DAS28-ESR) and the Clinical and Simplified Activity Index (CDAI and SDAI), serological improvement by C-Reactive Protein- CRP- and Erythrocyte Sedimentation Rate-ESR, clinical improvement by the delta-DAS 28 and response to treatment using EULAR criteria at baseline and after one year of treatment. We stratified all patients into quartiles according to the tocilizumab levels (μg/ml) as follows: IQR1: <3,4, IQR2: 3,4–11,2, IQR3: 11,2–18,5 and IQR4 >18.5. A last observation carried forward analysis (LOCF) was performed at the first year of treatment, so patients that dropped out of the therapy before this period were included. Blood samples were collected just before intravenous (i.v) infusion. Serum drug levels were determined by a capture enzymelinked immunosorbent assay (ELISA).ResultsThe baseline demographic and clinical characteristics are shown in Table 1. When patients were categorised into quartiles, IQR1 comprised 8 (24,2%) patients; IQR2, 7 (21,2%); IQR3, 8 (24,2%) and IQR4, 10 (30,3%). Clinical activity (DAS28, CDAI and SDAI) was statistically significant higher in patients with lower serum through levels at the first year [DAS28 (IQR1: 4,46 ±1,5, IQR2: 2,58 ± 0,87, IQR 3: 3,6± 0,79; IQR4: 2,17 ± 0,74; p=0,001), CDAI (IQR1: 23±13,9, IQR2: 7,72 ± 4,44, QIR 3: 13,38± 4,35, IQR4: 6,33 ± 4,62; p=0,003) and SDAI (IQR1: 19,46 ±15,5, IQR2: 9,51± 7,4, IQR3: 12,59 ± 6,31, IQR4: 4,55 ± 3,73; p=0,005)] and also was the number of swollen joints (IQR1: 7,5 ± 6,6, IQR2: 2,29 ±2,06, IQR3: 5,63 ± 4,3, IQR4: 1,1 ± 1,6, p=0,013) and tender joints (IQR1: 5,5 ± 5,7, IQR2: 1,71 ± 2,06, IQR3: 3,13 ± 2,8, IQR4: 0,8 ± 0,9, p=0,014). In addition, the EULAR reponse was worse in those patients with lower serum drug levels [non-responders: 4 (66,7%) in IQR1 vs 1 (16,7%) in IQR2 vs 1 (16,7%) in IQ3 vs 0 (0%) in IQR4, moderate responders: 3 (37,5%) in IQR1 vs 0 (0%) in IQR2 vs 4 (50%) in IQR3 vs 1 (12,5%) in IQR4 and good responders: 1 (5,3%) in IQR1 vs 6 (31,6%) in IQR2 vs 3 (37,5%) in IQR3 vs 9 (47,4%) in IQR4, p=0,006]. In terms of acute-phase reactants, the mean ESR tended to be higher in patients with lower TCZ levels (IQR1: 22,6±14,8 vs IQR2: 5,6±1,6 vs IQR 3: 9,4 ±3,5 vs IQR4: 6,4 ± 3,5, p=0,005), and also CRP levels (RIQ1: 10,2±17,4 vs RIQ2: 2,3 ± 3,4 vs RIQ3 0,56 ± 0,4 vs RIQ 4: 0,42 ± 0,66, p=NS)].ConclusionsThe presence of low serum Tocilizumab levels correlates with a worse clinical disease activity. Consequ...

BackgroundPatients with psoriatic arthritis (PsA) may have predominant axial (axPsA) or peripheral (pPsA) manifestations. The development of TNF inhibitors (TNFi) has changed the course of PsA. However, most published data is focused on pPsA but almost no data is available for TNFi response in axPsA.Objectivesto analyse the efficacy and the predictive factors of clinical response in patients with axPsA and pPsA starting treatment with TNFi in clinical practice.MethodsAn observational study analysing data from a prospective cohort including 93 patients (pts) with axPsA or pPsA treated with TNFi from 2002–2018 was conducted. Demographic information, disease activity indexes (ASDAS for axPsA and DAS28 for pPsA) and laboratory tests were collected before starting TNFi (baseline visit) and 6 months later (6 m visit). At 6 m, the percentage of pts achieving inactive disease (ASDAS <1.3) for axPsA or remission (DAS28 <2.6) for pPsA as well as the percentage of pts achieving clinical improvement (defined as ASDAS-clinically important improvement=delta-ASDAS>1.1 or delta-DAS28 >1.2) were determined. Baseline predictor factors of inactive disease/remission and clinical improvement at 6 m were identified using a univariable and multivariable binary regression models adjusted for confounder factors.ResultsOut of 93 included pts, 45 pts had predominant axPsA and 48 pPsA. Administered TNFi was etanercept for most pts (42%), infliximab in 29%, adalimumab in 22% and golimumab in 7%. Baseline characteristics are shown in table 1. Male sex was more frequent in axPsA vs pPsA (62% vs 42%; p=0.04, respectively). In axPsA, 55% clinically improved and 32% pts achieved inactive disease. After multivariable analysis, male gender (OR 25.8, p=0.01) and higher baseline ASDAS (OR 6.3, p=0.01) were associated as independent predictors of clinical improvement at 6 m. Also, male gender (OR 15.7, p=0.03) and lower BMI (OR 0.7, p=0.03) were associated as independent predictor factors for achieving inactive disease. In pPsA, 48% pts clinically improved and 33% pts were on remission at 6 m. The percentage of pts on remission tended to be higher in males than females (47% vs 20%; p=0.08, respectively). However, after running the regression analyses, none of the baseline predictor factors was significantly associated neither with clinical improvement nor with remission in patients with pPsA.Abstract AB0916 – Table 1 Total n=93p-value axPsA n=45pPsA n=48 Male, n (%)28 (62%)20 (42%)0.04BMI, Mean (SD)27.4 (5.5)26.4 (5.5)0.3Age (years), mean (SD)56 (12.9)60 (14.2)0.2Smokers, n (%)18 (41.9%)15 (31.9%)0.3Disease duration (years), mean (SD)19 (10.8)18 (8.4)0.6HLA B27, n/N (%)8/22 (36%)-RF, n/N (%)-3/44 (6.8%)ACPA, n/N (%)-0/45csDMARDs, n (%)25 (68%)24 (68%)0.9bASDAS, mean (SD)3.1 (1.2)-bDAS28, mean (SD)-4.7 (1,3)bCRP mg/L, mean (SD)13.2 (14.7)10.5 (15.3)0.3bESR, mean (SD)26.3 (20.9)27.8 (19.8)0.5ConclusionsIn clinical practice, 1 out of 3 pts with PsA is on remission 6 m after initiating a TNFi, and 1 out of 2 clinically improve; both proportions are similar...

Background:Nailfold videocapillaroscopy is a non-invasive technique used to assess Raynaud syndrome. It is mainly used for the early diagnosis of connective tissue disorders (CTD) such as systemic sclerosis. There is some evidence that capillaroscopy findings may be altered by microcirculation abnormalities in patients with cardiovascular risk factors (CVRF).Objectives: to analyze the influence of cardiovascular risk factors on naildfold capillaroscopy in patients with Raynaud or suspect of CTD.Methods:An observational and descriptive study of consecutive patients that underwent a videocapillaroscopy examination for the study of Raynaud syndrome was conducted. A “Capiscope” model videocapilaroscope from Optilia was used, with a fixed magnification of 200x. Examination was made on 8 hand fingers, with 2 images per finger. The patients had to be at least 30 minutes in a fixed warm temperature room and without smoking 1 hour before the performance of the test. The following capillaroscopic parameters were considered: nailfold morphology, capillary loop enlargements, megacapillaries, microhaemorrhages, avascular areas and signs of neoangiogenesis. Demographic information (including age, gender and previous diagnosis) and cardiovascular risk factors (including arterial hypertension (HT), diabetes mellitus (DM), dyslipidemia (DL) and smoking habit), were collected. The influence of cardiovascular risk factors on naildfold capillaroscopy was analyzed, using univariate and multivariate logistic regression models, adjusted for possible confounders.Results:Out of the 136 included patients, 91% were women. Mean age was 54,6 ± 18,7 years. Raynaud syndrome was reported in 83% patients, with a mean duration of 6,1 ± 5,7 years and 12% of the patients had a previous diagnosis of CTD, including systemic lupus erythematosus (5%), systemic sclerosis (4%), undifferentiated connective tissue disorder (2%) and mixed connective tissue disease (1%). Regarding CVRF, HT was observed in 25%, DM in 7%, DL in 23% and past or current smoking habit in 32%. Capillaroscopic findings were: loop enlargements (81%), megacapillaries (30%), microhaemorrhages (46%), signs of neoangiogenesis (71%) and avascular areas (20%).Regarding the capillaroscopic pattern, 46% presented a normal or nonspecific pattern; 31% a microangiopathy pattern and 23% a scleroderma pattern (of which 58% had an early or active scleroderma pattern and 42% a late scleroderma pattern). A new diagnosis of CTD was made in 24 patients (18% of the cohort). In the group of patients without CTD, HT was associated with microhaemorrhages (p = 0.02) and avascular areas (p = 0.007), and there was a tendency to association between smoking habit and megacapillaries (p = 0.08). After adjusting for confounding factors for this group, an association between CTD and microhaemorrhages (OR = 1.9; p = 0.01) and avascular areas (OR = 2.12; p = 0.007) was found. The multivariate study showed no relationship between CVRF and capillaroscopy patterns.Conclusion:In our cohort we found an increased frequen...

BackgroundIn the last two decades the treatment in patients with rheumatoid arthritis (RA) has undergone major advances, especially due to the appearance of new therapies, the use of the “treat to target” strategy and a better understanding of the “window of opportunity” concept. However, data from clinical practise confirming the benefits of using these strategies are scarce.ObjectivesTo investigate whether the proportion of patients (pts) with RA in maintained remission (R) or low disease activity (LDA) after starting a first biological agent has increased over time and which factors are associated with this change.MethodsAnalysis of a database from a prospective cohort including 365 pts with RA starting a 1st biological agent (BA) (TNF inhibitor, abatacept or tocilizumab) in a tertiary hospital between 2000-2014. Demographic, clinical and analytical data were collected at the beginning of treatment and clinical activity (DAS28) was measured every 6 months. For this study, 3 groups were established according to BA initiation date: interval 1 (i1) (between 2000-2004), (i2) 2005-2009 and (i3) 2010-2014, with a minimum follow-up of 2 years at all pts. For each interval, the percentage of pts achieving maintained (at least 3 consecutive visits) R (DAS28 <2.6) or LDA (DAS28 <3.2) was determined. In addition, all variables collected were compared between groups by ANOVA and chi square test.ResultsOut of the 365 pts initiating a 1st BA, 133 started in i1, 122 in i2 and 110 in i3. Of these, 38% (n=137) achieved maintained R/LDA. This percentage increased significantly in successive intervals (31% in i1 vs, 38% in i2 vs 45% in i3, p=0.02). Baseline characteristics of pts achieving R/LDA are shown in table 1A. For patients in i2 and i3, compared to the previous interval (i1 and i2 respectively), a significant higher frequency of use of BA with different mechanisms of action (0% in i1 vs 2.2% in i2 vs 34% in i3, p<0.001), women (56% in i1 vs 76% in i2 vs 84% in i3, p=0.01) and concomitant methotrexate (56% in i1 vs 74% in i2 vs 81% in i3, p=0.03) was found. On the other hand, the percentage of optimized pts increased significantly over time (13% in i1 vs 32% in i2 vs 56% in i3, p<0.001; table 1B).ConclusionsThe percentage of pts with RA achieving maintained R/LDA after initiating a 1st BA has progressively increased over time. This is probably related to a greater use of BAs with different mechanisms of action and concomitant methotrexate. The sustained control of disease activity may allow using more frequently optimized doses of BA.Disclosure of Interest:None declared

BackgroundFactors contributing to an early referral to Rheumatologist and DMARDs initiation following symptom onset in rheumatoid arthritis (RA) patients are unclear. Recent data suggest that ACPA/RF double seropositivity is associated with delayed presentation to primary care and DMARDs initiation. Identification of these factors is mandatory to faciliate an early diagnosis and treatment of RA patients.ObjectivesTo determine whether time to DMARDs initiation and time to first visit at early arthritis clinic (EAC) following symptoms onset differs between RA patients according to autoantibody status.MethodsA prospective analysis of an EAC cohort including 1377 referred patients from 1993 to 2017 was undertaken for this study. Patients diagnosed of RA (according to physician’s diagnosis) were selected. Based on the serological status, we clasified patients in 4 groups: RF+/ACPA+, RF-/ACPA+, RF+/ACPA-, RF-/ACPA-. A baseline clinical assessment was completed including time (months) from symptoms onset to first assessment at EAC and to DMARD initiation. First, differences between serotypes were tested using chi-squared and student-t tests. Second, univariable and multivariable logistic regression models taking into account confounding factors (age, smoking and baseline DAS28)were employed to evaluate the association between autoantibody status and both periods: time to first visit at EAC and to DMARDs initiation.ResultsA total of 463 RA patients were included for analysis, of whom 292 (63.1%) were RF/ACPA double-seropositive (RF+/ACPA+),35 (7.6%)RF-/ACPA+,39 (8.4%) RF+/ACPA- and 92 (19.9%)RF-/ACPA-. Demographic and clinical data are shown in table 1. In the univariate analysis, statiscally significant differences were observed for both periods when patients were stratified by autoantibody serotype, where RF+/ACPA +individuals experienced the longer delay to presentation at EAC compared with RF-/ACPA- (5.0±4.6 vs 3.5±3.4 months;p<0.05). RF+/ACPA +patients experienced also significantly longer symptom duration before DMARD initiation than RF-/ACPA- (7.4±11.2 vs 4.9±5 months;p<0.05). In the univariable analysis, autoabtibody status (doble seropositive and RF-/ACPA +vsRF-/ACPA-) was signficantly asssociated with time to DMARDs initiation. However, after adjusting by confounding factors in the multivariable analysis, the autoantibody status did not remain significantly associated with time to initiate DMARDs (RF+/ACPA-; ß 0.186; p=0.1, RF-/ACPA+; ß 0.112; p=0.3, RF+/ACPA+; ß 0.228; p=0.1)Beta95% C.I. LowerUpper Non adjustedRFpositive,035−2,4624944ACPApositive,104,0387736Double-seropositive,120,1574791AdjustedRF positive,186−4,95226 414ACPA positive,112−14,51237 175Double-seropositive,228−2,52020 308DAS 28-,239−7,575,144Age-,073-,384,207Smoker-,066−14,9969118Former smoker-,081−19,05110 942Abstract THU0114 – Table 1Baseline characteristics of patients, stratified by autoantibody statusConclusionsIn our EAC cohort, time to EAC presentation and DMARD initiation following symptom onset in early RA does not differ according to pa...