POS1114 INFECTION RISK AMONG RHEUMATIC PATIENTS RECEIVING DENOSUMAB THERAPY: SINGLE CENTRE EXPERIENCE

Background: Osteoporosis (OS) is common in rheumatic diseasas (RMD). OS fracture leads to morbidity and premature mortality. The treatment for well established with good long term safety profile. Oral bisphosphonate (BIS) recommended as initial option both postmenopausal glucocorticoid induced OS. Denosumab (DSB), the noninferior alternative option. Despite its efficacy, DSB was linked elevated infection risk non RMD. Yet, data RMD lacking. Objectives: To determine associated factors patients receiving DSB. Methods: This retrospective cohort study. Data extracted from medical database (between Jan 2010 & Dec 2018) at Selayang Hospital, Malaysia. Descriptive statistical analysis, logistic regression (LR) cox (proportional hazard) [CPHR] were analysis methods. Results: 50 cases analysed. 96% female. median age 72.5 ± 12.7 years. primary rheumatological disorders rheumatoid arthritis (48%), (24%) systemic lupus erythematosus (10%). 92% had ≥ 1 comorbidity including metabolic/cardiovascular diseases (74%), chronic lung (CLD) (40%) diabetes mellitus (DM) (22%). 54% disease modifying anti drug (DMARD) therapy; majority (59.2%) received single conventional synthetic DMARD. Only 7.4% combination biologic DMARD therapy. 28% prednisolone therapy, dose < 7.5mg OD 78.6%. initiation 71 12.4 38% history 88% previous treatment. In total, 13 episodes recorded. 26% incidence rate 134 per 1000 person-years. 84.6% required hospitalisation 38.5% severe cases. mortality 23.1%. mean duration first 15.46 11.9 months. Univariate LR showed higher longer duration, OR 1.062 (95% CI: 1.010 - 1.117), p = 0.018) 1.057 1.003 1.114, 0.037), respectively. These risks lower absence of steroid use, 0.2 0.051 0.784, 0.021) 0.215 0.052 0.889, 0.034), Additionally, CLD, 0.188 0.048 0.742, 0.017) without concomitant DM, 0.050 — 0.950, 0.043). multivariate did not infer above predictions, after adjustment made age, gender, diseases, comorbidity, therapy dosing. For case fatality, no predictive identified. CPHR use fatality risk, HR 0.077 0.007 0.864, 0.038). With confounding (age, comorbidity), observed difference insignificant. Conclusion: Risk could be duration. Concomitant comorbidities (CLD DM) might increase and/or hospitalisation. References: [1]Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. prevention fractures women osteoporosis. N Engl J Med 2009;361:756–65. [2]Watts NB, Roux C, Modlin JF, Brown JP, Daniels A, Jackson S, Smith Zack DJ, Zhou L, Grauer Ferrari S. Infections osteoporosis treated denosumab or placebo: coincidence causal association? Osteoporos Int. 2012;23(1):327–337. [3]Prabhakaran Pritchard C. Comparison rates denosumab, biologics alone a suburban rheumatology clinic [abstract]. Arthritis Rheumatol 2014;66 Suppl 10:S409. [4]Bray V, Bagley West Etzel Kremer Kolfenbach J. Infection among concurrent non-biologic therapy: An Consortium Acknowledgements: We would like thank Director General Health Malaysia his permission this poster presentation. Disclosure Interests: None declared.