PO:15:212 | Anifrolumab induces a rapid improvement in joint inflammation in Systemic Lupus Erythematosus patients: an ultrasonographic study

Valeria Moretti, Fulvia Ceccarelli, Claudia Ciancarella, Valerio Fiorilli, Francesca Romana Spinelli, Fabrizio Conti | Sapienza Università di Roma, Italy

Objective. Data from the real-life use of anifrolumab (ANF) underline the excellent efficacy and rapidity of this drug in Systemic Lupus Erythematosus (SLE)-related skin manifestations, but very little is known about the drug's effectiveness on other manifestations. Among these, joint involvement is one of the most frequent features, characterized by a great heterogeneity in terms of severity, with possible development of erosive and/or deforming arthritis. In the present study we evaluated the efficacy of ANF on SLE-related arthritis by using ultrasonographic assessment.

Methods. We collected data about SLE patients treated by ANF for prevalent joint involvement. The drug was prescribed according to the current clinical practice. Treatment response was evaluated at baseline (T0) and after 1 month (T1) and three months (T2) by performing US assessment and by using clinimetric indices. Indeed, US, performed by using a MyLab Eight Exp (Esaote, Genoa, Italy) machine, was made at level of bilateral metacarpophalangeal and proximal interphalangeal of the hands. At each joint, according to the OMERACT definitions, we evaluated the presence of US inflammatory features (synovial effusion, synovial hypertrophy and Power Doppler - PD), each measured with a semiquantitative score (0–3), resulting in a total US inflammatory score (0–180). We also evaluated the total PD score (0-60). Furthermore, we evaluated disease activity (by using DAS28pcr, CDAI, SDAI and SLEDAI-2k) and glucocorticoids (GCs) dosage (PDN equivalent, mg/daily) during the follow-up.

Results. We evaluated 10 female patients [mean age 49 years (IQR 20.5), mean disease duration 222 months (IQR 141)]. US evaluation allowed to identify a significant reduction of mean inflammatory score after 1 months of treatment (T0: 50.6±34.4; T1: 30.7±28.4, p=0.006), maintained after 3 months (T3: 15.4±15.2; p=0.0005). Interestingly, we found a similar results for US power Doppler score (T0: 13.5±8.5; T1: 6.4±5.1; T3: 0.3±0.7; To versus T1 p=0.003; T1 versus T3 p=0.002). These results were graphically represented in Figure 1A and 1B. Table 1 reported data about changes in activity indices and GCs dosage. We found a significant decrease in SLEDAI-2k values at T1 and T3, while for the other indices we found a significant reduction only at T1.

Conclusions. Our study, made in a real-life scenario, suggests that ANF may be able to intervene in joint synovitis as shown by the reduction in US scores in the early stages of treatment. In particular, the rapid effect on PD signal could suggest the ability of this drug to prevent the development of erosive damage. The dissociation between US response and joint activity indices could be related to the systemic nature of SLE and the possible presence of other symptoms, such as myalgia and asthenia, that may influence the patient's response to disease activity.