AB0857 CERTOLIZUMAB PEGOL RELOADING SUCCESSFULLY CONTROLS INFLAMMATORY ARTHRITIS FLARES DURING PREGNANCY – A CASE REPORT

Background: Approximately 50% of patients with inflammatory arthritis (IA) experience worsening disease activity during pregnancy. 1,2 Given the evidence that increased immediately before or pregnancy is associated adverse outcomes, it imperative to maintain tighter control this period. 3 Treatment options are limited steroids disease-modifying anti-rheumatic drugs (DMARDs) compatible Certolizumab pegol (CZP) a humanized TNF-alpha inhibitor no minimal transplacental transfer, making suitable option 4 In who relapse while on treatment biologic, consideration can be given optimizing dose biologic. Studies in Crohn’s demonstrated increasing CZP from 400 mg Q4W Q2W viable strategy for recapturing efficacy. 5 Similar data not available rheumatology population Objectives: To describe successful juvenile (JIA) flares using reloading pregnant patient prior failure multiple conventional systemic (cs)DMARDs and biologics. Methods: This case report 31-year old female JIA presented flare 1 st trimester her 2 nd The was treated csDMARDs biologics since age 6. She experienced significant gastrointestinal side effects subcutaneous methotrexate leflunomide inadequate response hydroxychloroquine sulfasalazine. Subsequently, she initiated maintained etanercept 14 years until developed secondary loss had primary non-response golimumab abatacept severe allergic reaction infliximab. Since 2017, has been 200 good activity. Prior conception, low (Table 1). At 11 weeks gestation, noted activity, pain at 4/10, fatigue 7/10, morning stiffness 60 minutes, swollen joint count (SJC) 4/28, tender (TJC) 19/28. global assessment (PtGA) remained 4/10 physician (PhGA) health questionnaire disability index (HAQ-DI) 6/10 1.625, respectively reported symptoms worsen one week after injection more swelling hands, wrists, feet. declined addition hydroxychloroquine, sulfasalazine, due previous tolerability, lack efficacy, concerns about safety received loading doses Q2W. then continued Table 1. Disease conception CZP. Characteristic gestation 19 SJC (28 joints) TJC NA PhGA* 6 PtGA* HAQ-DI 1.5 1.625 Pain* Fatigue* 7 Morning (min) 20-30 *Assessed 10-point scale. Results: On follow-up 80% improvement reduction Pain were rated as 2/10 5/10, respectively. PtGA score PhGA Conclusion: Reloading IA may option. our knowledge, first optimization References: [1]van den Brandt S, et al . Arthritis Res Ther 2017;19(1):64. [2]Jethwa, H , Rheumatol. 2016;68 (suppl 10). [3]de Man Y, Curr Opin 2014;26:329–333. [4]Mariette X, al. Ann Rheum Dis. 2018 Feb;77(2):228-233. [5]Sandborn WJ, American College Gastroenterology Annual Scientific Meeting. 2009; Abstract 699 Disclosure Interests: Viktoria Pavlova Speakers bureau: Amgen, Abbvie, BMS, Jenssen, Lilly, Merk, Novartis, Roche, UCB, Pfizer, Consultant of: Grant/research support from: UCB