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SAT0331 itnfα Agents in Refractory Non-Infectious Aortitis: Study on 19 Patients
  1. C. Fernández-Díaz1,
  2. J. Loricera1,
  3. R. Blanco1,
  4. J.L. Hernández1,
  5. S. Castañeda2,
  6. A. Humbría2,
  7. S. Melchor3,
  8. P. Collado4,
  9. J. Calvo-Catalá5,
  10. E. Rubio6,
  11. J. Rosas7,
  12. R. Ariza8,
  13. Í. Rúa-Figueroa9,
  14. E. Peirό1,
  15. V. Calvo-Río1,
  16. C. González-Vela1,
  17. M.Ά. González-Gay1
  1. 1Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander
  2. 2Rheumatology, Hospital Universitario la Princesa
  3. 3Rheumatology, Hospital Universitario 12 de Octubre
  4. 4Rheumatology, Hospital Universitario Severo Ochoa, Madrid
  5. 5Rheumatology, Hospital General Universitario de Valencia, Valencia
  6. 6Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla
  7. 7Rheumatology, Hospital Marina Baixa, Villajoyosa
  8. 8Rheumatology, Hospital Universitario Virgen Macarena, Sevilla
  9. 9Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain

Abstract

Background Non-infectious aortitis is often refractory to standard immunosuppressive therapy. In these cases, the use of inhibitors of TNF-α (iTNF-α) had been reported.

Objectives Our aim was to assess the efficacy of iTNF-α in a series of patients with refractory non-infectious aortitis.

Methods Retrospective multicenter study of patients diagnosed with aortitis refractory to traditional immunosuppressive agents and who received iTNFα. The diagnosis of aortitis was based on imaging techniques (MRI-angiography, computed tomography, PET scan, ultrasonography and/or arteriography).

Results We studied 19 patients (15 women/4 men) with a mean age of 42±13 years. The iTNFα used were: infliximab (IFX) (n=14), adalimumab (ADA) (n=3) and etanercept (ETN) (n=2). The underlying conditions were: Takayasu arteritis (TA) (n=11), giant cell arteritis (GCA) (n=2), relapsing polychondritis (RP) (n=1), ulcerative colitis (n=1), Crohn's disease (n=1), Behçet's disease (n=1), sarcoidosis (n=1) and psoriatic arthritis (n=1). Seventeen patients were previously treated with traditional immunosuppressive agents [methotrexate (MTX) (n=15), azathioprine (AZA) (n=7), cyclophosphamide (CPM) (n=5), mycophenolate mofetil (MM) (n=3), chlorambucil (n=1), cyclosporine A (n=1), tacrolimus (n=1)]. Two patients needed a switching between biologic agents (a female with TA who switched from IFX to ETN; and a male with psoriatic arthritis who switched from ETN to ADA; in both cases switching was due to inefficacy of the first biologic drug). After a median follow-up of 16 [12–36] months, most patients experienced clinical improvement, showing a reduction of erythrocyte sedimentation rate from 37.5 [30–56] mm/1st hour at baseline, to 20.5 [10–24] mm/1st hour at the last visit. Besides, C-reactive protein decreased from 1.5 [0.1- 2.6] mg/dL to 0.3 [0.1–0.8] mg/dL. After 3 months of treatment, 55% of patients had experienced clinical improvement (p<0.01); and at 12 months, clinical improvement was attained by 94% of the patients (p<0.01). A corticosteroid sparing effect was also achieved (from 25.7±22.0 mg/day of prednisone at iTNFα onset, to 6.6±5.4 mg/day at the last visit). Improvement on imaging techniques was also observed in 10 out of 13 patients (77%) who underwent a follow-up imaging procedure. Three patients had to discontinue the iTNFα agent (IFX in the 3 cases) due to inefficacy (n=1), recurrent pneumonia (n=1) and severe infusional reaction (n=1).

Conclusions iTNFα therapy appears effective and relatively safe in patients with non-infectious aortitis refractory to traditional immunosuppressive drugs.

Acknowledgement This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain).

Disclosure of Interest None declared

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