Objectives The impact of patient background factors on changes in bone mineral density (BMD) and bone metabolic markers after treatment with once-weekly teriparatide (W-TPTD) has not been fully elucidated. To clarify the impact, I performed stratified analysis in addition to the efficacy and safety assessments to analyze treatment data with W-TPTD. Methods The primary endpoint of the efficacy was the rate of change of the lumbar spine BMD at 18 months after treatment. In the exploratory analysis, bone metabolic markers at baseline were used to divide the patients into 3 groups, by the first tertile and the second tertile. The rate of change in the lumbar spine/femoral neck BMD and bone metabolic markers in each group were analyzed by stratification. Results The rate of change in the lumbar spine BMD at 18 months was 9.0%, which represented a significant increase. The rate of change in the lumbar spine/femoral neck BMD in each group classified into tertiles by their baseline bone metabolic markers significantly increased, regardless of the type of bone metabolic markers and baseline value. For markers, all groups remained within the range of reference values at 18 months after treatment. Conclusions I demonstrated that W-TPTD significantly increased the BMD of the lumbar spine and femur, regardless of baseline values of the bone metabolic markers. In addition, W-TPTD was able to normalize bone metabolic markers. I considered that W-TPTD would be useful, independent of bone metabolic markers in patients, as an agent to improve BMD, and be a useful option for the treatment of osteoporosis.

Background:Yellow Fever (YF) is an endemic disease, in specific areas of Brazil. Since 1942, no new urban cycle cases have been observed. Yet, in early 2017, outbreaks of YF were reported in many states, outside the endemic areas, where YF was not considered a risk. Hence, new and some fatal cases have been reported including in highly populated areas close to the city of São Paulo. As it has been widely broadcasted, population searching for vaccination significantly increased and cases of inadvertent vaccination have been registered.Objectives:To analyze the consequences of inadvertent YF primo-vaccination in patients with immune mediated inflammatory diseases (IMID).Methods:Observational study (12/2017–01/2018).54 rheumatologists from private practice at different areas of São Paulo included specific YF information in their patients’ orientations and actively searched for IMID patients that have received YF vaccination (YFV) inputting the data in a web-based questionnaire.Results:56 patients received YFV; female 42 (75%), mean (±SD) age= 56±14 yr, median disease duration= 7 yr (6 months-45 yr), Diagnosis: RA (n=39; 72%), PsA (n=5), AS (n=4), 2 SLE, 3 vasculitis, 2 SS, one ReA and 2 UA. Treatment: 30 (54%) were considered under current strong immunosuppression (CE≥20 mg, MTX>20 mg, leflunomide, tofacitinib and biologic agents (BA); 18 (32%) were on biologic agents (9 anti-TNF, 2 abatacept, 3 tocilizumab, 1 rituximab, 1 patient each secukinumab and tofacitinib). Remaining patients were receiving csDMARDs isolated or in combination, with or without low CE (≤10 mg).Vaccination: 54 (96%) cases were primo YFV and 43 (80%) related inadvertent YFV. Adverse events (AE): 7 patients (13%) had AE after a median of 4 days (hours-60 days);3 of them were on BA, corresponding to 17% of the total subjects on various BA. Severity of AE:4 patients had mild AE (local pain, vertigo, fever, headache, myalgia), in 2 of them, symptoms promptly resolved while 2 needed medical assistance (one was on tocilizumab). Of the 3 remaining cases, one had severe reaction one hour after YFV (probably anaphylaxis); Finally, 2 patients had severe AE requiring hospitalization: one had meningitis (RTX+MTX) and other (ADA+MTX), abdominal pain, myalgia, fever, headache, vertigo and increased liver enzymes. No fatal events were observed. Concerning the vaccine effect on disease activity, only 5 (9%) patients related worsening of the disease after YFV, but 2 of them also presented AE.Conclusions:The small number of reports precludes any conclusion about rate/severity of AE and YFV in immunosuppressed rheumatic patients. Nevertheless, it emphasized the necessary awareness and careful analysis of the risk-benefice of YFV in this population. The interference of YFV on IMID disease activity seems to be marginal. On the other hand, this descriptive analysis clearly demonstrated persistence of patient’s unfamiliarity with concepts of immunosuppression and its consequences, disclosing another unmet need in the management of patients with RD.Disclosure of Interes...