Kidney transplant recipients have an increased risk of bone fragility in the year following transplantation. Bisphosphonates and early corticosteroid discontinuation can improve BMD.

Objectives To evaluate the characteristics of patients (pts) with PsA treated by ustekinumab (UST) or secukinumab (SEK) and to compare real-world persistence of UST and SEK in PsA. Methods In this retrospective, national, multicentre cohort study, pts with PsA (CASPAR criteria or diagnosis confirmed by the rheumatologist) initiating UST or SEK with a follow-up ≥6 months were included from January 2011 to April 2019. The persistence between SEK and UST was assessed after considering the potential confounding factors by using pre-specified propensity-score methods. Causes of discontinuation and tolerance were also collected. Results A total of 406 pts were included: 245 with UST and 161 with SEK. The persistence rate was lower in the UST group compared with the SEK group [median persistence 9.4 vs 14.7 months; 26.4% vs 38.0% at 2 years; weighted hazard ratio (HR) = 1.42; 95% CI: 1.07, 1.92; P =0.015]. In subgroup analysis, the persistence rate of SEK associated with MTX was significantly higher than that of UST associated with MTX: HR = 2.20; 95% CI: 1.30, 3.51; P =0.001, in contrast to SEK vs UST monotherapy: HR = 1.06; 95% CI: 0.74, 1.53; P =0.75. Discontinuation due to inefficacy was reported in 91.7% (SEK) and 82.4% (UST) of pts. Discontinuation due to an adverse event was reported in 12.2% (SEK) and 7.7% (UST) of pts. Conclusion In this first study comparing UST and SEK, the persistence of SEK was higher than that of UST in PsA. In subgroup analysis, this difference was only found in association with MTX.

Introduction The main objective of this work was to assess the maintenance of effectiveness of subcutaneous tocilizumab 6 months after switching from intravenous to subcutaneous formulation in patients with rheumatoid arthritis (RA) in a real-world setting. Secondary objectives aimed to describe the characteristics of patients and disease, the effectiveness at 12 months after switching, the therapeutic maintenance, and to search for predictive factors of switching. Methods We analyzed all the RA patients of the shared medical file “RIC Nord de France”, treated with tocilizumab, switching or not from intravenous to subcutaneous tocilizumab, between April 2015 and January 2016. The primary effectiveness endpoint was the proportion of patients remaining in their DAS28-ESR category remission/low disease activity (LDA) or moving to an inferior DAS28-ESR category at 6 months. Since RoSwitch was an observational study, without randomization, a propensity score was built in a sensitivity analysis to balance on RA and patients’ characteristics at inclusion between switching and no-switching groups. Results An improvement of initial DAS28-ESR category or maintenance in DAS28-ESR remission/LDA at 6 months was shown in 203 of the 285 patients with an evaluation for the primary criterion (71.2%, 95% CI [65.6–76.4%]) without differences between groups (73.3%, 95% CI [63.0–82.1%] vs. 70.3%, 95% CI [63.3–76.6%]). The RoSwitch study showed the maintenance of effectiveness at 6 and 12 months. Similar therapeutic maintenance rates were observed for switch and no-switch patients. No clinical factor was associated with the switch in patients in remission/LDA at inclusion. Conclusions The RoSwitch study showed the maintenance of effectiveness at 6 months in RA patients switching from intravenous (IV) to subcutaneous (SC) tocilizumab. Funding Roche SAS and Chugai Pharma France. Electronic supplementary material The online version of this article (10.1007/s40744-018-0138-y) contains supplementary material, which is available to authorized users.

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BackgroundSeptic arthritis is a multidisciplinary emergency which poses diagnostic problems due to the lack of biological and clinical specificity, and variable treatment modalities in the absence of formal consensus.ObjectivesThe objective of this study was to describe epidemiology, management and evolution of rheumatologic septic arthritis over the past 50 years.MethodsThis epidemiological, retrospective, observational, single-center study, included patients hospitalized between 1997 and 2014 in one Rheumatology Department of a University Hospital, for septic peripheral arthritis of native joint. The diagnosis was determined according to Newman's criteria. After a first descriptive part, we tried to determine associated factors for joint morbidity (define by the use of a non-sparing surgery or functional sequelae) and mortality after a follow-up of 1 year. Finally, we compared the results with a previous study, conducted in the same Department between 1966 and 1993 over 176 cases.ResultsOn the 1997–2014 period, 198 patients were included corresponding to an annual incidence of 11 cases. The average age of patients was 56 years, with 57% men. Main comorbidities were arthropathy (37%), neoplasia (18%) and diabetes (17%). The most common presentation was monoarthritis (88%), of the knee (32%), caused by Staphylococcus aureus (56%). Nine percent of patients had received prior intra articular intervention. We noted 15% of arthritis with no identified pathogen. Endocarditis was found in 6% of patients. The support was multidisciplinary particularly between 2006 and 2014, with an increase of cooperation with bacteriologist (15% of cases between 1997–2005 versus 67% between 2006 and 2014, p<0.0001), and a decrease in antibiotic duration (97.1 days versus 75.5 days, p=0.002). The surgical treatment was required in 33% of cases. The death rate at 1 year was 6% and the joint morbidity rate was 20%. Mortality risk factors have been identified (endocarditis OR =12.6 [2.0 to 81.4], p=0.008); MRSA OR =13.8 [1.9 to 100.6], p=0.009). Patients receiving corticosteroids had an excess risk of joint morbidity (OR =3.0 [1.0 to 8.7], p=0.04). In comparison with the previous study, there were more comorbidities (p<0.01 for diabetes, neoplasia, rheumatoid arthritis), more bacterial identification and surgical care (p<0.01). Iatrogenic origin and mortality remain stable.ConclusionsIn the absence of formal recommendations, multidisciplinary cooperation could impact directly on the diagnostic and therapeutic management of septic arthritis. The management seems better than in the 60–90's period, with no change in mortality. Infective endocarditis appears to be an important risk factor for mortality and its research should be systematic.Disclosure of InterestNone declared