THU0293 DRUG RETENTION AND DISCONTINUATION REASONS BETWEEN SEVEN BIOLOGICS IN PATIENTS WITH TAKAYASU’S ARTERITIS: A SINGLE-CENTER EXPERIENCE
Authors: Corrado Campochiaro, Alessandro Tomelleri, Silvia Sartorelli, Giulio Cavalli, Giacomo De Luca, Elena Baldissera, Lorenzo Dagna
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Biologic disease-modifying anti-rheumatic drugs(bDMARDs) have been showed to be effective in refractory Takayasu arteritis(TA) [1]. Data about bDMARDs drug retention rate(DRR) in TA are scarce. <h3>Objectives</h3> To investigate DRR and reasons for discontinuation of 7 bDMARDs in a real-world setting <h3>Methods</h3> TA patients fulfilling the 1990 ACR criteria and treated with ≥1 bDMARD were selected. Data about disease duration, number of bDMARDs, reasons for bDMARDs discontinuation (classified as inefficacy, toxic reactions, non-toxic reasons), concomitant conventional synthetic (cs)DMARDs were collected. Survival curves were examined by the Kaplan-Meier method and compared using a stratified log-rank test. DRR was evaluated at 24 months. Hazard ratio(HR) for concomitant csDMARDs therapy and for previous bDMARDs was performed. A comparative sub-analysis between antiTNFα drugs and tocilizumab(TCZ) was performed <h3>Results</h3> We identified 50 patients and 86 bDMARD-courses. At baseline, mean age was 39.1±12.1 years, mean disease duration was 119.5±110.1 months. No significant differences were observed in age and disease duration between the 7 groups. 31 patients were treated with 1 bDMARD, 11 with 2, 4 with 3, 2 with 5, 1 with 6, 1 with 7. Infliximab was the most frequent first-line bDMARD(78.6%). At bDMARDs initiation all patients were on prednisone(mean dose 13.5±10.3 mg), 85.2% on csDMARD(53 methotrexate, 13 azathioprine, 6 sirolimus, 3 mycophenolate-mofetil, 1 sulfasalazine). 43% of treatment courses were stopped by 24 months. Table1 summarizes DRR and reasons for treatment discontinuation for each bDMARD. Golimumab had the highest DRR(71.4%), followed by infliximab (69%), adalimumab (56.3%), abatacept (50%), tocilizumab (41.1.%), anakinra (0%) and rituximab (0%), p=0.016. Only concomitant csDMARDs therapy (HR=2.87,95%CI=1.19-6.92,p=0.019) showed positive effects on DRR. AntiTNFα drugs had significantly higher DRR compared to TCZ (67.2% vs 41.1%,p=0.028). Even in these subgroups csDMARDs(HR=3.79,95% CI=1.49-9.6,p=0.005) showed positive effects on DRR <h3>Conclusion</h3> In our TA cohort, antiTNFα agents had the highest DRR and, notably, they had a higher DRR in a head-to-head comparison with TCZ. Concomitant use of csDMARDs had a significant positive effect on bDMARDs DRR <h3>References</h3> [1] Management of large-vessel vasculitis. Salvarani C, Hatemi G. Curr Opin Rheumatol. 2019 Jan;31 <h3>Disclosure of Interests</h3> Corrado Campochiaro Consultant for: Dr Corrado Campochiaro received consultation honoraria from Pfizer., Alessandro Tomelleri: None declared, Silvia Sartorelli: None declared, Giulio Cavalli Consultant for: Dr Giulio Cavalli received consultation honoraria from Pfizer, Novartis and SOBI., Giacomo De Luca Speakers bureau: Pfeizer, Sobi, Elena Baldissera Consultant for: Consultation honoraria from Novartis and Rottapharm, Speakers bureau: Pfeizer, Sobi, Novartis, Lorenzo Dagna Consultant for: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Sanofi-Genzyme, and SOBI.