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BackgroundAlthough widely recognised as extra-articular manifestations of axial spondyloarthritis (axSpA), uveitis developing throughout anti-TNFα treatment is difficult to be classified as disease related or paradoxical event.ObjectivesWe aimed to evaluate the incidence of new onset or relapsing uveitis in patients with axSpA receiving TNF inhibitors.MethodsWe performed a cross-sectional retrospective study evaluating 126 consecutive active axSpA exposed to TNFα inhibitors according to the local recommendations, followed-up in a single rheumatology department. Patients identified with uveitis were systematically assessed based on a predefined protocol comprising (i) data about uveitis (de novo or flare; unique episode or recurrence; acute or chronic; anterior, posterior, intermediary or panuveitis; uni or bilateral; outcomes), (ii) responsible medication (drug exposure prior to uveitis, biologic-naïve or experimented axSpA, continuation or switching to another biologic) and (iii) rheumatic condition (activity, response to treatment, extra-articular manifestations, disease duration).Results91 biologic naïve axSpA and 35 receiving more than one anti-TNFα were recruited; among them, 318 patient-years exposed to etanercept, 225.37 patient-years to adalimumab, 113.52 patient-years to infliximab, 30.49 patient-years on golimumab. A history of uveitis was found in 27.77% (35 cases).We reported 12 patients developing at least one episode of uveitis during biologic treatment (7 de novo, 10 recurrent uveitis); etanercept was mostly associated with uveitis (8 episodes, 2.51 per 100 patient-years), but also monoclonal antibodies, 3 with golimumab (9.83 per 100 patien-years), 2 under infliximab (1.76 per 100 patien-years), surprisingly, 3 with adalimumab (1.33 per 100 patien-years). Only 3 axSpA had uveitis before starting anti-TNFs.Uveitis was described irrespective of the prior exposure to biologics, mainly in bio-experimented patients,9 aged between 26 and 72, with disease duration of 6 to 38 years, occurring any-time during biologics (2–116 months). Acute anterior uveitis was commonly reported, only one case of complicated panuveitis.3 cases (one infliximab, two golimumab) had benefit with switching to another TNF blocker, but in most reported cases uveitis was solved without anti-TNFα interruption. Further, continuation of the same anti-TNFα did not cause relapse in some cases.The underlying SpA was well controlled (ASDAS-CRP) when uveitis, patients being classified as responders compared to previous visit, suggesting paradoxical uveitis.ConclusionsAlthough rare, new onset or flare of uveitis may occur during anti-TNF therapy in axSpA. Surprisingly, not only TNF receptor but also monoclonal antibodies were responsible, etanercept being involved mainly in new onset uveitis.Disclosure of InterestNone declared

BackgroundAlthough the efficacy and long-term persistence of TNF inhibitors (TNF-i) are widely recognized in axial spondyloarthritis (axSpA), up to about one third of patients experience failure (loss of therapeutic response or toxicity) with the first biological agent requiring switching to another drug.ObjectivesThe aims of our study were to assess the 10-year survival of the first TNF-i, to compare retention rates of different anti-TNF drugs in real life settings and to identify factors associated with drug retention in active axSpA.MethodsWe performed a hospital-based retrospective cohort study on consecutive adult axSpA suboptimally controlled by standard therapy, starting their first biological agent with infliximab (IFX), adalimumab (ADA), etanercept (ETA) or golimumab (GLM) according to local policy, recruited at three academic centres between 2003 and July 2018.Drug efficacy (BASDAI, ASDAS-CRP) as well as reasons for discontinuation were evaluated every 24 weeks. Drug survival was calculated using the Kaplan-Meier analysis, while univariate and multivariate regression was used for predictors of persistence and withdrawal (p<0.05). Subanalysis was done according to discontinuation reasons.ResultsOf the 241 axSpa were recruited, 104 (43.15%) cases received ETA (original, biosimilar), 100 (41.49%) ADA, 26 (10.78%) IFX (original and biosimilar) and 11 cases (4.56%) GLM.Statistical significant improvement was demonstrated (ASDAS-CRP, BASDAI, BASFI) in all patients, those with higher disease activity and functional impairment at baseline presenting earlier and higher response rate (p<0.05).We reported high long-term persistence of the first TNF-i with a median survival rate of 8.1±2.1 years for IFX, ADA and ETA; furthermore, at 10 years, up to one third (36%) of axSpA remained on the initial drug achieving either stable remission (62.24%) or low disease activity (37.76%), while one out of five patients on the same drug after 140 months. The retention rates of ETA, ADA and IFX were 70%, 68% and 57% after 3 years; 68%, 48% and 53% after 5 years; 35%, 30% and 27% after 10 years. Overall, retention to ETA was superior to that of monoclonal antibodies (p<0.05), with a total drug-exposure of 625.43 patient-years for ETN, 415.26 for ADA, 221.53 for IFX.In addition, survival of the second TNF drug was good but inferior to the first TNF-I (p<0.05).Male sex, age under 40, high baseline C reactive protein, low initial BASFI and disease duration under 5 years were associated with retention rate in multivariate analysis (p<0.05), while the presence of syndesmophytes and obesity with higher withdrawal (p<0.05).ConclusionWe reported high long-term persistence of the first biological agent in axSpA, with superior retention for ETA compared to monoclonal antibodies. Predictors for high retention rate advocate the rationale for the drug choice in different axSpA settings.Disclosure of InterestsCODRINA ANCUTA Speakers bureau: Abbvie, Pfizer, Novartis, MSD, Roche, Biogen, UCB, Lilly, Cristina Pomirleanu Speakers bureau: Abbvie, Pf...

Background:Despite emerging vaccines, the world is in the midst of a coronavirus disease 2019 (COVID-19) pandemic. Outcomes of SARS-CoV2 infection remain a major concern in patients with rheumatic and musculoskeletal diseases, especially for those with uncontrolled disease.Objectives:We aimed to investigate trends and outcomes of COVID-19 occurring in patients with chronic inflammatory rheumatic conditions treated with biologics and targeted synthetic disease modifying antirheumatic drugs (bDMARDs, tsDMARDs).Methods:We included all confirmed cases of COVID-19 regardless of severity in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) undergoing bDMARDs or tsDMARDs treatment registered in our local COVID-19 reporting database. We collected relevant information about comorbidities, rheumatologic-related clinical activity (RAPID5, SDAI, BASDAI, DAPSA), type of DMARD and glucocorticoid use, as well as COVID-19 related data as severity (ranging from asymptomatic to life-threatening forms), medication, hospitalization, intensive care unit admission, invasive mechanical ventilation and death.We did a subgroup analysis among patients with a specific rheumatologic diagnosis, among different class of medication, patients who were or not hospitalized with COVID-19 looking how age, comorbidities, type of rheumatic condition and treatments impact COVID outcomes.Results:40 COVID-19 cases (positive PCR for SARS-CoV2) (4.67%) were identified during the 6-month study period among 855 patients registered in our database of patients under biologic treatment, including 20 RA, 18 SpA, 2 PsA patients. The majority were in either low disease activity or remission, only two patients had active uncontrolled disease at the onset of coronavirus infection.16 cases (40%) were asymptomatic and were tested RT-PCR-positive during routine follow-ups for their disease, 13 cases (32.5%) had mild and 8 cases (20%) moderate illness; severe pneumonia and critical disease with acute respiratory distress syndrome were reported in only 3 cases, 2 recovered after; the only patients who died was 69 years old, had cardiac disease, hypertension and diabetes, had undertaken regular rituximab perfusion one month before coronavirus infection and developed pulmonary embolism followed by septic shock.Extreme fatigue was the dominant COVID-19 associated symptom apart from the classical ones including fever, cough, shortness of breath, sore throat, nasal congestion, headache, anosmia and ageusia myalgias and anorexia.No specific pattern for patients requiring intensive care unit admission.Conclusion:The COVID-16 infection rate in patients with inflammatory rheumatic disorders receiving biologics and tsDMARDs is pretty low; although immunosuppressed, these patients seem not to be at risk for severe COVID-19 illness and outcomes. These findings might reflect a potential protective role of certain biologics and/or JAK inhibitors for development and severity of COVID-19 in patients.References:[1]WHO, COVID-19 clinical management, Living Guidance, 25 Jan 2021Disclosure of Interests:CODRINA ANCUTA Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Cristina Pomirleanu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Georgiana Strugariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Luiza Petrariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Eugen Ancuta: None declared, Codruta Bran Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Rodica Chirieac Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Claudia Mihailov Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz

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