svr-posters-xxi-congreso-51
Clinical efficacy of biologic therapy in patients with psoriasis (Ps), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) with morbid obesity (BMI > 44.6): descriptive study based on three cases assessed in a multidisciplinary consultation of Rheumatology and Dermatology. Paz – Solarte, J.A. a , Trenor Larraz, Pilar a , González Delgado, Víctor b , De la Morena, Isabel a . a Reumatología, Hospital Clínico Universitario, Valencia, España. b Dermatología, Hospital Clínico Universitario, Valencia, España. Background : It is well – known that obesity is a cardiovascular risk factor and, moreover, constitute a risk for the development of Ps and spondyloarthritis (SpA) by itself . These entities are characterized by an increased in plasmatic cytokines levels which causes a proinflammatory chronic condition . In addition, obesity is a not response and low adherence predictor to theraphy . Obesity determine the dose of some drugs and, therefore, modify the response . It is commonly accepted that when body mass index (BMI) is over 40 it is classify as morbid obesity, implying a development of comorbidities . Objectives : Description of our experience about the efficacy of Secukinumab (IL 17 inhibitor) in three patients with Ps, PsA and axial SpA (axSpA), respectively, which had concomitant morbid obesity . Methods : Descriptive and retrospective study with 3 patients assessed in a multidisciplinary consultation of Rheumatology and Dermatology . We reviewed the medical history of each patient assessed in 2017 for 52 weeks . Every patient received secukinumab 300 mg by subcutaneous injection every month (previously administred induction doses) . We recorded the baseline demographic data, Psoriasis Area Severity Index (PASI), Disease Activity score (DAS 28 ), C reactive protein (CRP), Visual Analog Scale for Pain (VASP) . PASI in Ps was assessed by a Dermatologist and the activity index, DAS 28 – CRP for PsA, and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS – CRP (Ankylosing Spondylitis Disease Activity Score) for SpA, were caculated by a Rheumatologist . Serum biochemical variables were evaluated, including acute phase reactants : CRP and ESR (erythrocyte sedimentation rate) . We reviewed baseline data ( 0 week) and follow – up data at 16 , 48 and 52 weeks . Conclusions : this study has several limitations, being the most important that is a descriptive study . The sample is very low and the follow – up time is brief, but in our sample secukinumab was effective a has a safety profile, in spite of morbid obesity is a poor response predictor . Results : The mean BMI was 44 .67 and the mean age 49 . The mean weight was 123 .6 kg . The patients with cutaneous involvement had an initial PASI of 22 .7 (PsA) and 11 .9 (Ps) ; in weeks 16 and 48 PASI was 0 .0 in both patients and in 52 week of 0 .2 and 0 .8 respectively . In the patient with APs, the baseline DAS 28 – PCR was 5 .96 , at 16 weeks 4 .1 and at 48 weeks 3 .7 . In relation to the patient with axSpA, baseline BASDAI and ASDAS – PCR were 5 .4 and 3 .8 respectively . At 16 weeks 3 .6 and 2 .8 and at 48 weeks 2 .5 and 1 .9 respectively . Two patients showed a significant improvement in CRP after switching to Secukinumab . VASP improved progressively in patients with PsA and axSpA, from a baseline mean of 10 to 3 at the end of follow – up . Contacto: juanalbertopazsolarte@gmail.com se x a g e w e ig h t size B M I D M A R D b p re v io u s D M A R D s P sA F 4 9 1 1 8 1 5 9 4 6 ,6 8 N / A M T X P s F 4 6 1 1 6 1 6 5 4 2 ,6 E T N M T X a xS p A M 5 2 1 4 5 1 8 0 4 4 ,7 5 A D A SS Z 4 9 1 2 6 ,3 1 6 8 4 4 ,6 7 sex DAS28/PCR BASDAI ASDAS PCR EVAp DAS28/PCR BASDAI ASDAS PCR EVAp DAS28/PCR BASDAI ASDAS PCR EVAp PsA F 5,96 N/A N/A 10 4,1 N/A N/A 5 3,7 N/A N/A 3 axSpA M N/A 5,4 3,8 10 N/A 3,6 2,8 4 N/A 2,5 1,9 3 week 0 week 16 week 48 PASI sex PASI PCR PASI PCR PASI PCR PASI PCR PsA F 22,7 1,4 0 1,3 0 1,3 0,2 0,6 Ps F 11,9 8,5 0 8,4 0 11 0,8 8,1 axSpA M N/A 12,2 N/A 6,8 N/A 3,4 N/A N/A W eek 0 Week 16 W eek 48 Week 52