WCIM 2014 SEOUL KOREA 241
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0744 Rheumatology
Anti-Drug Antibodies as a Predictor for the Discontin- uation of Anti-Tnf Agents in Patients with Axial Spon- dyloarthrtis
Jiwon HWANG1, Inyoung KIM2, Seulkee LEE2, Hyemin JEONG2, Hyung Jin KIM2, Jaejoon LEE2, Joong Kyong AHN1, Eun-Mi KOH2, Hoon-Suk CHA1
Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea1, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea2
Background: Tumor necrosis factor (TNF) inhibitors have made an advance in man- agement of axial spondyloarthritis (SpA) but a considerable proportion of patients fail to respond or lose the effi cacy. Likely explanation is the anti-drug antibodies (ADAb) against TNF inhibitors. The aim was to assess the ADAb and its clinical relevance in SpA patients treated with adalimumab (ADA) and infl iximab (IFX).
Methods: According to the Assessment of SpondyloArthritis international Society classification criteria for axial SpA, patients using ADA or IFX were recruited con- secutively. Samples were collected at the enrolment to measure the drug and ADAb levels. Ambispective observation was done for data including demographics, laboratory fi ndings, disease activity, concomitant medications, adverse events and drug discon- tinuation.
Results: Of 100 patients, the mean age was 34.8 years, the mean disease duration 11.1 years and, the mean duration of current drugs 22.3 months at the time of sampling.
Five of 74 ADA users had detectable ADAb while 5 of 28 IFX users (6.9% vs. 17.9%, p
= 0.13). ADAb positive patients had signifi cantly higher body mass index (BMI) in both ADA users (28.4 ± 5.9 kg/m² vs. 24.3 ± 2.9 kg/m², p = 0.01) and IFX users (25.9 ± 2.8 kg/m² vs. 22.6 ± 2.8 kg/m², p = 0.02). During follow-up, the drug discontinuation oc- curred more frequently in ADAb positive group (30.0% vs. 6.5%, p = 0.04). In logistic regression, the ADAb positivity (OR = 5.85, 95% confi dence interval (CI) 1.19 – 28.61, p = 0.029) and BMI (OR = 4.35, 95% CI 1.01 – 18.69, p = 0.048) were associated with the risk of stopping treatment.
Conclusions: Our result suggests that the presence of ADAb and higher BMI can pre- dict the subsequent drug discontinuation in SpA.
PS 0745 Rheumatology
Treatment with Tnf-a Inhibitor in a Ankylosing Spon- dylitis Patient with Secondary Amyloidosis Manifested with Diarrhea: A Case Report
Jae Hyun LEE1, Jinyoung MOON1, Sung Hae CHANG2, Eun Bong LEE1, Yeong Wook SONG1, Eun Young LEE1
Seoul National University Hospital, Korea1, Soonchunhyang University Hospital, Korea2
Secondary amyloidosis is accompanied by chronic inflammatory disease, mostly rheumatoid arthritis. When it occasionally occurs in patient with ankylosing spondy- litis, it usually involves kidney rather than gastrointestinal tract. We report a case of secondary amyloidosis in a patient with ankylosing spondylitis, which is manifested as diarrhea and improved by TNF-alpha inhibitor. A 70-year-old male diagnosed as rheumatoid arthritis in other hospital suffered from watery diarrhea for 2 months.
He underwent sigmoidoscopic biopsy and amyloidosis was confi rmed. He visited our hospital to control persistent diarrhea. With his laboratory fi nding and spine and pelvis X-ray, he was diagnosed as ankylosing spondylitis, not rheumatoid arthritis. Endoscop- ic biopsy showed a deposit of amorphous eosinophilic material as well as birefringence with polarizing, which means amyloid deposit on gastrointestinal tract. Echocardi- ography showed decreased ejection fraction (52%) and biventricular wall thickening with sparkling pattern, which strongly suggests cardiac amyloidosis. For treatment of ankylosing spondylitis with secondary amyloidosis, he was given 25 mg of etanercept twice a week and 100 mg of hydrocortisone daily, and steroid was tapered off to 5mg of prednisolone daily. He was discharged after his diarrhea decreased, and continued to take injection of etanercept in outpatient clinic. In the follow-up echocardiography after 2 years, ejection fraction increased to 62% and biventricular hypertrophy disap- peared. He is still on etanercept in outpatient clinic without recurrence of amyloidosis.
PS 0746 Rheumatology
Frequency of Radiological Hip Involvement and total Hip Replacement in A Large Single Center Spondyloar- thritis Cohort with Biological Treatments: HÜr-BIo Real Life Results.
Umut KALYONCU1, Abdulsamet ERDEN1, Omer KARADAG1, Levent KILIC1, Sule APRAS BILGEN1, Ali AKDOGAN1, Ali Ihsan ERTENLI1, Sedat KIRAZ1
Department of Rheumatology, Faculty of Medicine, Hacettepe University, Turkey1
Background: Total hip replacement (THR) is a favorable treatment option for severe ankylosing spondylitis (AS). Objective of this study was to assess frequency of THR and hip involvement in a single center spondyloarthritis (SpA) biological dataset.
Methods: HÜR-BIO(Hacettepe University Rheumatology Biologic Registry) is a single center biological registry since 2005. HÜR-BIO biological data set included demo- graphic data, co-morbidities, smoking status, baseline and follow-up disease activity parameters (such as BASDAI, BASFI, CRP, ESR). Available digital radiographic imaging of pelvis were reassesed for hip inolvement and THR. Kaplan-Meier plots and log rank tests were used to assess TNFi drug survival.
Results: 768 of 1290 (59.5%) SpA patients had available pelvis radiography. 450 of 768 (58.6%) patients were male and mean age was 41±11 years old, mean dis- ease duration 8.6±6.9 years, mean TNFi duration was 32±29 months. Frequency of hip involvement in spondyloarthritis is in Table 1. Radiological hip involvement and severe hip involvement found in 125 (16.3%) and 65 (8.4%) patients, respectively.
Patients with severe hip involvement was older age 47±11 vs 41±11, p<0.001, more disease duration 15±9 vs 8±6 years, p<0.001, more frequently male 47/65(72.3%) vs 402/702 (57.3), p=0.018), more frequently advanced spinal disease 18/52 (34.6%) vs 74/576 (12.8%), p<0.001. Baseline disease activity parameters were similar with and without severe hip involvement, however, last visit CRP (2.56±2.75 vs 1.06±1.97 mg/dl, p<0.001), ESR (24±25 vs 13±14 mm/hour, p<0.001) and BASFI (4.7±2.8 vs 2.4±2.1, p<0.001) were higher in severe hip involvement. Disease duration was found independent risk factor for severe hip inolvement (OR 1.13(95%CI 1.09-1.17). In all spondyloarthritis patients, TNFi drug survival was similar with and without severe hip involvement.
Conclusions: Severe hip involvemet was demonstrated either AS or other spondy- loarthritis. THR performed almost 5 percent of AS, PsA and enteropathtic arthritis. On the other hand, substantial of AS patients who need THR were not operated yet. The reasons of this delay may be responsible of patients’ perspective or physicians. TNFi may not refl ect any major unfavotrable effect of THR.
