FRI0296 AN ALTERNATIVE APPROACH TO SPONDYLOARTHRITIS TREATMENT: PAMIDRONATE CASE SERIES
Authors: Z. Toker Dincer, A. Y. Ayla, B. H. Egeli, S. Ugurlu
Journal: Annals of the Rheumatic Diseases (2020)

Background: Spondyloarthritis (SpA) is a common group of chronic inflammatory diseases with substantial morbidity seen in rheumatology clinics. Its standardized treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), TNF-alpha inhibitors and IL-17 inhibitors. However, some patients remain refractory to conventional treatments and these treatments are contraindicated in malignancies and infections, which indicates the need for new therapeutic approaches. Pamidronate, a bisphosphonate with antiosteoclastic action, has been found useful in a few studies (1-2). Objectives: The aim is to evaluate the effectiveness and safety of pamidronate treatment in SpA in a single tertiary center. Methods: SpA patients who were treated with pamidronate due to lack of response to standard treatment or in patients where standard treatment is contraindicated in 2014-2019 are evaluated retrospectively. Patients’ files were evaluated for the indications, efficacy and the side effects of pamidronate as well as for the clinical and demographic features. Pamidronate intravenous dose was 90 mg/month. Patient ID# Age Sex Comorbidities Previous treatments Duration of pamidronate treatment(mo) PGAS before treatment PGAS after treatment 1 48 M OP, FMF NSAID, IFX, ETN 6 9 1 2 66 F OP, Rectum cancer NSAID, SSZ 28 10 4 3 36 M Gastric cancer NSAID, SSZ, IFX 10 10 10 4 57 M CAD, IBD NSAID,SSZ,MTX, ADA, CZP 2 5 4 5 50 M none NSAID, IFX 6 9 2 6 69 M DM,HT,CMD, PsO NSAID, SSZ 37 9 1 7 62 M Bladder cancer NSAID 4 9 4 8 40 M none NSAID,GOL,ETN 2 6 6 9 46 M none NSAID,SSZ, MTX, ADA, CZP, IFX, ETN, ADA, GOL 8 5 2 10 40 M none NSAID,SSZ, ADA, GOL, CZP, ETN, IFX 3 8 6 11 58 F SLE NSAID, HCQ, MTX 3 8 7 Table. F: female M: male OP: osteopenia, FMF: familial Mediterranean fever, CAD: coronary artery disease, IBD: inflammatory bowel disease, DM: diabetes mellitus, HT: hypertension, CMD: chronic myeloproliferative disorder, PsO: psoriasis, SLE: systemic lupus erythematosus IFX: infliximab, ETN: etanercept, SSZ: sulfasalazine, NSAID: non-steroidal anti-inflammatory drug, MTX: methotrexate, ADA: adalimumab, CZP: sertolizumab, GOL: golimumab, HCQ: hydroxychloroquine, PGAS: Patient Global Assessment Score Results: There were 11 patients (9 male and 2 female). 4 patients were diagnosed as non-radiographic SpA. The mean disease duration was 29±12 years (range 12-49). The comorbidities of the patients included diabetes mellitus and hypertension in 1 patient, coronary artery disease in 1 patient, psoriasis in 1 patient, inflammatory bowel disease in 1 patient, Familial Mediterranean fever in 1 patient, systemic lupus erythematosus in 1 patient, and osteopenia in 2 patients. 3 of the patients had malignancies (bladder, rectum and stomach carcinomas) and 1 patient had chronic myeloproliferative disorder. 4 patients could never use the TNF-alpha inhibitors (1 rectum cancer, 1 bladder cancer, 1 systemic lupus erythematosus, 1 essential thrombocytemia). The median duration of pamidronate use was 6 (interquartile range 3-10). Mean Patient Global Assessment Score (PGAS) was 8±2 before the pamidronate treatment and 4±3 after the treatment (p&lt;0.001). The treatment of 6 patients was terminated due to inadequate response which is shown in Table. One patient died from bladder carcinoma during follow-up. Conclusion: In SpA patients, with biological agents (anti-TNF, IL-17) being contraindicated due to malignancies and tuberculosis in some patients, alternative treatment methods such as pamidronate should be considered bearing in mind the results of our study showing the effectiveness and safety of it. References: [1]Maksymowych WP et al. A six-month randomized, controlled, double-blind, dose-response comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis. Arthritis Rheum 2002;46:766–73. [2]Haibel H et al. Treatment of active ankylosing spondylitis with pamidronate. Rheumatology, Volume 42, Issue 8, August 2003, 1018–1020. Disclosure of Interests: None declared