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FRI0120 Evaluation of rituximab, tocilizumab and abatacept in a french multicenter rhupus cohort

Background Rhupus, a combination of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus, is a rare entity. Existing epidemiological and therapeutic data are limited. Objectives The aim of this study was to describe the therapeutic impact and safety of three biologic therapies: Rituximab, Tocilizumab and Abatacept in a french Rhupus cohort. Methods We have set up a transverse observational retrospective and multi-centric study. To be included in the cohort, patients had to present an overlap syndrome fulfilling criterias for rheumatoid arthritis and lupus, and to be treated at least by one of these three therapies. Enrollment has been made with a file available on the CRI website and the analysis of the French RA registers (AIR, REGATE and ORA). Primary endpoint was the median time in therapeutic maintenance for each biological agent. Results Forty patients from fifteen rheumatologic centres were included. The main demographic data for these patients are given in table 1. Thirty of them received a treatment with Rituximab, twelve with Tocilizumab and seven with Abatacept. Nine patients received 2 biologics at two different times of the disease. The medians of therapeutic maintenance were 82 months with Rituximab, 48 with Tocilizumab and 55 with Abatacept. The detailed analysis of clinical and biologic parameters revealed differences in effectiveness between therapies: corticosteroid doses decreased more in Rituximab group, VAS activity decreased more in Abatacept group, CRP decreased more in Tocilizumab group. Safety of biologics was similar to the data in literature for RA patients. RITUXIMAB (n=30) TOCILIZUMAB (n=12) ABATACEPT(n=7) Disease duration (years) 4.8 8.3 11.9 Median of therapeutic maintenance (month) 82 48 55 Average duration of treatment (month) 44.8 [5.8;83.8] 27.0 [4.3;49.7] 26.0 [-0.79;52.93] DAS 28 CRP evolution −1.03 [-2.73;0.67] −1.88 [-3.36;−0.38] −1.97 [-3.55;−0.41] Prednisone evolution (mg/d) −8.45 [-23.15;9.25] −5.15 [-10.95;0.65] −2.71 [-5.00;−0.43] VAS evolution (/100) −5.40 [-32.70;21.90] −18.50 [-3.53;35.04] −30.43 [-65.27;4.41] CRP evolution (mg/L) −14.46 [-46.46;17.54] −21.75 [-53.41;9.91] −12.86 [-25.95;0.26] Conclusions This study provides original data on the effectiveness and safety of non-TNF biologics, mostly rituximab, in a large cohort of patients with rhupus. We have not enough patients treated with Tocilizumab and Abatacept to conclude but the therapeutic maintenance of Rituximab in Rhupus is similar to the one usually observed in RA. Disclosure of Interest None declared