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Background:Rheumatoid arthritis (RA) and spondyloarthropathies (SpA) are chronic rheumatic diseases that can progress to disability if left uncontrolled. Biologic therapies can induce remission in patients with inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Due to the safety and economic concern, updated treatment recommendations now consider biologics discontinuation in patients with persistent remission. However, available data are still limited.Objectives:To evaluate the biologics effectivenss, drug survival, rate of discontinuation in real-life practice and to identify predictors of biologics discontinuation due to remission in RA and SpA.Methods:A total of 87 patients with RA and 49 patients with SpA, starting biologics between January 2005 and October 2020, were recruited from the Rheumatic Disease Prior Authorization (RDPA) registry of Siriraj hospital. Baseline data were recorded. Time-dependent rates in achieving remission were calculated. Cumulative probability of biologics discontinuation and predictive factors of drug discontinuation due to remission were analyzed.Results:The biologics used in RA patients were Etanercept (49.4%), Rituximab (44.8%), and Infliximab (5.7%). The 1- and 5- year remission rates were 8.5% and 23.9%, respectively. Drug survival rates were 33.6% for Etanercept, 40.7% for Rituximab, and 36% for Infliximab at five years. The main reasons for drug discontinuation were disease remission (32.1%), inadequate response (32.1%), and side effects (15.1%). Rituximab had the highest discontinuation rate due to remission (56.4%). There was no predictive factor for biologics discontinuation due to remission.SpA patients were treated with Etanercept (83.6%) and Infliximab (16.4%). The 1- and 5- year remission rates were 67.4% and 66.7%, respectively. Drug survival rates were 50.3% for Etanercept and 0% for Infliximab at five years. Biologics withdrawal due to side effects occurred in 16%, inadequate response in 10%, and disease remission in 10% of patients. The predictive factor for biologics discontinuation due to remission was disease duration < 5 years (Hazard ratio 6.92, 95%CI 1.10, 43.29)Conclusion:Biologic therapies are effective in patients with active RA and SpA despite csDMARDs treatment. The highest drug survival rates are Rituximab in RA and Etanercept in SpA. Infliximab has the shortest drug retention rate in SpA. Drug discontinuation due to remission is more successful in RA patients, particularly in the Rituximab group. The best predictor for biologics discontinuation due to remission in SpA is the disease duration of fewer than five years.Table 1.Effectiveness, Drug Survival and Causes of Biologic Discontinuation in RA and SpARA % (87 cases)BiologicsTotal % (N)5-year Remission rate %5-year Drug survival rate %Discontinuation % (N 53 cases)Total %(53)RemissionInadequate responseSide effectNon-adherence/ ReferDeathEtanercept49.4 (43)23.933.650.9(27)14.8(4)44.4(12)22.2(6)11.1(3)7.4(2)*Infliximab5.7 (5)365.7 (3)0(0)33.3(1)33.3(1)33.3(1)(0)Rituximab44.8 (39)40.743.4 (23)56.5(13)17.4(4)4.3(1)13.0(3)8.7(2)SpA %(49 cases)BiologicsTotal % (N)5-year Remission rate %Drug survival rate%Discontinuation % (N 23 cases)Total % (23)RemissionInadequate responseSide effectNon-adherence/ ReferDeathEtanercept83.6 (41)66.750.378.3(18)22.2(4)22.2(4)33.3(6)22.2(4)0(0)Infliximab16.4 (8)021.7 (5)20(1)20(1)40(2)20(1)0(0)*Cause of death: sudden cardiac death (1), intraabdominal infection (1)Cause of death: pneumonia (1), Lung cancer (1)Disclosure of Interests:None declared

Background SLE mostly affects the working-age population. The disease burden has a significant impact to the quality of life. Objectives To assess the HRQoL in SLE patients by using the EQ-5D and the LupusQoL and to evaluate their correlation. Methods 248 patients were recruited. Demographic and clinical data including the SLEDAI were collected. We also evaluated the patients9 preference in terms of the language, the precision of questions, and time consume. The correlation was examined by Pearson9s correlation. Results 94.6% of patients were female. Mean age was 37.5±11.9 with the median disease duration of 5.1 years. The mean SLEDAI score was 3.6±0.4. The mean of EQ-5D health value and VAS scores were 0.65±0.20 and 78.1±20.2. Most patients reported that SLE had mild effect to their health status. 28.1 and 18.3% of patients reported moderate to severe problems in the mental components of pain/discomfort and anxiety/depression. The mean LupusQoL score was 78.9±16.3. Both EQ-5D health value and VAS were significantly correlated with all LupusQOL domains, strongly correlated with physical health and pain but poorly correlated with planning and body image. The patients preferred to use the EQ-5D over LupusQoL. Conclusions HRQoL in most SLE patients was generally good. The EQ-5D score was significantly correlated with the LupusQoL score particularly in the domains of physical health and pain. The EQ-5D is a simple and more convenient tool to assess the general health and can be used as a brief evaluation of lupus-specific HRQoL in daily practice. Disclosure of Interest None declared

Background Systemic lupus erythematosus (SLE) may vary in presentation and management approach in different geographies (1). A review of the literature describing the epidemiology of SLE in Asia-Pacific countries identified a dearth of information on the characteristics and perceived wide variability in management of lupus in the region (2). This study was designed to observe SLE patients and their care, from six countries in Asia-Pacific, under a common protocol, over a twelve month follow-up period. This abstract describes the baseline features of the cohort. Objectives The aim of the study is to describe patient characteristics, organ involvement, disease activity and severity, and management in a multi-national observational cohort. Methods Patients were invited to participate from lupus clinics in six countries (nine centres), between April and October 2012. Consecutive patients, 18 years or older, meeting at least four ACR criteria for diagnosis of SLE were eligible. Information describing organ system involvement, disease activity and severity, and management of the patients were recorded. Severe disease was defined as a) at least one of the major domains: cardiovascular, respiratory, renal or urological actively involved (biologically active eg proteinuria or symptomatic) at enrolment, and b) requiring more than 7.5mg/d of corticosteroids (prednisone equivalent dose) and/or immunosuppressant(s) and/or biological drugs. Results 553 patients (404, 92% women) were recruited. Mean age at SLE diagnosis was 28.8 (SD 11.4) years, and mean number of years since diagnosis was 9.2 (SD 6.7). For disease activity profile at entry into the study, the most common domain of active disease involvement was renal disease (17% of patients). Similarly, the domain most reported as being damaged (non-reversible change not related to active inflammation) since onset of lupus was renal (9%). 20% of the patients were classified as having severe disease, with Taiwan showing the highest proportion of severe disease (39%), and South Korea the lowest proportion (14%). Steroid use was reported in 81.6%, anti-malarials in 63.2%, immunosuppressants in 48.3% and a biological drug in one patient (0.2%). Conclusions We have provided a cross-sectional overview of the demographics, disease characteristics and therapies in a cohort of SLE patients seen at selected sites across 6 countries in Asia-Pacific. A high proportion of patients, at the time of enrolment, were managed with steroids, anti-malarials and immunosuppressants, with one patient receiving biological therapy. This sets the baseline for a one-year observational study utilizing a standard electronic case report form, in order to better understand the behavior and management practice of SLE in the region. References Danchenko et al. Epidemiology of systemic lupus erythematosus. Lupus 2006; 15: 308-18. Jakes RW et al. Systematic review of the epidemiology of systemic lupus erythematosus in Asia-Pacific. ACR 2012; 64: 159-168. Disclosure of Interest R. W. Jakes Shareholder of: GSK, Employee of: GSK, S. Navarra Grant/research support from: GSK, Speakers bureau: GSK, Roche, P. Jain Shareholder of: GSK, Employee of: GSK, W. Louthrenoo: None Declared, S.-C. Bae: None Declared, A. Hoi Grant/research support from: UCB, Eli Lilly, Suppremol, GSK, Consultant for: BMS, Speakers bureau: Abbott, BMS, MSD, Mundipharma, UCB, N. C. T. Kong Grant/research support from: GSK, A. Koolvisoot: None Declared, H.-Y. Lin: None Declared, P. Nash Grant/research support from: GSK, Consultant for: GSK, M.-Y. Weng: None Declared

Objectives To investigate the risk factors for chloroquine maculopathy (CM), and to explore factors associated with plasma chloroquine (CQ) and desethylchloroquine (DCQ) levels. Methods Two-hundred and thirty-three rheumatoid arthritis (RA) patients who had taken CQ at least 6 months with stable CQ dosage for at least 2 months were included between March 1, 2010 and September 30, 2011 at Siriraj Hospital, Thailand. CM was diagnosed by ophthalmologist utilizing dilated ocular examination and Humphrey visual field 10-2 white protocol. Plasma CQ and DCQ levels were determined by liquid chromatography tandem mass spectrometry method. Logistic regression models were applied to explore risk factors associated with CM. Results One hundred and ninety-three patients were included with median CQ duration (range) of 50.2 (6.0 – 269.8) months and cumulative dose of 137.4 (16.4-1226.5) gm. The prevalence of CM was 13.5%. One hundred and fifty seven plasma samples were available for determining the CQ and DCQ levels. Factors associated with developing CM identified from univariate analysis were age more than 60 years old, and poor creatinine clearance (CCl) with odds ratio (OR) (95%CI) of 5.79 (2.42,13.84), and 0.98 (0.96,1.00), respectively while current daily CQ dose from 2.5 mg/kg had marginal association, p=0.06. Plasma CQ and DCQ was not associated with CM with OR of 1.00 (1.00, 1.01) and 0.99 (0.98, 1.01), respectively. In multivariate analysis, older age, CQ exposure duration >5 years, and current daily dose of at least 2.5 mg/kg-IBW were the factors significantly associated with CM with OR of 5.89 (2.38, 14.57), 2.94 (1.10, 7.83), and 3.32 (1.04, 10.60), respectively while plasma CQ and DCQ showed no association with CM. With respect to plasma CQ and DCQ levels, current daily CQ dosage had the strongest positive correlation with both plasma levels as shown in the table. Conclusions Age more than 60 year-old, duration of CQ use more than 5 years and current CQ dose ≥2.5 mg/kg-IBW/day were the risk factors of CM. The plasma CQ or DCQ levels demonstrated no correlation in developing CM. The plasma levels were strongly associated with current daily dose of CQ. Funding Siriraj Research Development Fund, Faculty of Medicine Siriraj Hospital, Mahidol University. Disclosure of Interest None Declared