AB1249 HOSPITAL ADMISSIONS IN PATIENTS WITH CHRONIC RHEUMATIC DISEASESRECEIVING ADALIMUMAB. DESCRIPTIVE STUDY OF A COHORT
Authors: Boris Anthony Blanco Cáceres, Fernando Perez-Ruiz, Paula García Escudero, Marta González Fernández
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Patients with chronic rheumatic diseases (CRD) treated with biological DMARDs may increase the risk of complications and hospitalizations for serious adverse reactions (SAR). Concomitant treatment with conventional DMARDs and corticosteroids may increase the risk of complications. <h3>Objectives:</h3> To describe the prevalence and characteristics of hospital admissions among patients with CRD who are currently receiving Adalimumab (ADL) in a hospital setting. <h3>Methods:</h3> Cross-sectional, retrospective, unicentric study. Data obtained from a cross-sectional study to determine levels of ADL and antidrug antibodies in patients currently receiving ADL. We clustered the income in SAR and income not related to bDMARD, describe the clinical and therapeutic data. Groups were compared using Student's t-test and Chi-squared test. <h3>Results:</h3> We included 103 patients on ADL treatment, 54.4% (56) men, 45.6% (47) women. The mean age was 54.6 years (SD ± 13.04). 38.8% diagnosed of rheumatoid arthritis, 42.7% spondyloarthritis, 15.5% psoriatic arthritis and 2.9% juvenile idiopathic arthritis. 33% (34) had at least one income, mean 2.29 SD ± 2.93 (1-17). Within this group, the mean age was 62.3 years (SD ± 9.93), the mean time of exposure to ADL was 98.9 months SD ± 43.68 (3.48-151.49). 44.1% (15) had a standard dose of ADL and 55.9% (19) had a minimum effective dose. 55.9% (19) also received scDMARD and 47.1% (16) oral corticosteroids with a mean dose of prednisone of 3.4 mg (SD ± 4.6). 78 incomes were produced, 7 (9%) by SAR and 71 (91%) not related to bDMARD. The average income per SAR was 0.50 SD ± 1.48. The mean time of exposure to ADL in the group of patients with SAR was 101.97 months SD ± 33.8, in contrast to patients without hospital admissions that was 65.02 months SD ± 50.17 (p &lt;0.01). Patients without incomes received a mean daily dose of prednisone of 2.45 mg/day SD ± 3.71 while those with SAR admission of 4.58 mg/day SD ± 4.00 (p &lt;0.05). <h3>Conclusion:</h3> 33% (34) of patients had at least one admission, they were older (62.3 years SD ± 9.93) than those without incomes. The mean of income was 2.29 SD ± 2.93 (1-17). 55.9% of patients also had a scDMARD prescribed and 47.1% oral corticosteroids. 9% of the admissions were by SAR with an average ADL exposure of 101.97 months SD ± 33.8 compared to patients without hospital admissions, mean 65.02 months SD ± 50.17 with statistically differences (p &lt;0.01). In addition, differences were found regarding the dose of prednisone, patients with admissions by SAR received 4.58 mg/day SD ± 4.00 unlike those without incomes who received 2.45 mg/day SD ± 3.71 (p&gt; 0.05). Weakness of the study is a selection bias since we include the data of patients with current ADL treatment, losing information of those in whom ADL was suspended. These results suggest a direct relationship between the time of exposure to ADL and concomitant use with DMARDs and corticosteroids at dose &gt;2.5 mg, similar findings are also described in other studies. <h3>References</h3> [1] Duquenne L, Gul H, Emery P. Safety evaluation of adalimumab in immune-mediated inflammatory disorders: a rheumatological point of view. Expert Opin Drug Saf. 2018 Nov 16:1-9. [2] Fleischmann R, Mysler E, Hall S, et al. Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial. Lancet. 2017 Jul 29;390(10093):457-468. [3] Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017 Jun;76(6):960-977. <h3>Disclosure of Interests:</h3> Boris Anthony Blanco Cáceres: None declared, Fernando Perez-Ruiz Grant/research support from: Asociación reumatólogos de Cruces, Consultant for: Grünenthal Horizon Menarini, Speakers bureau: Grünenthal, Menarini, Fundación Española Reumatologiá, Paula García Escudero: None declared, Marta González Fernández: None declared