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1206 Figure 1SARS-CoV-2 IgG in SLE[Figure omitted. See PDF]ConclusionsMost patients with SLE and confirmed COVID-19 were able to produce a serologic response despite use of a variety of immunosuppressants. These findings provide reassurances regarding the efficacy of humoral immunity and possible reinfection protection in patients with SLE.AcknowledgmentsData presented on behalf of the NYU WARCOV investigators. We thank Leora Horwitz for her assistance with the ICD-10 query at NYU. We also acknowledge Tania Moin and Ranit Shriky for assistance in navigating regulatory matters.

ObjectivesIn lupus nephritis the pathological diagnosis from tissue retrieved during kidney biopsy drives treatment and management. Despite recent approval of new drugs, complete remission rates remain well under aspirational levels, necessitating identification of new therapeutic targets by greater dissection of the pathways to tissue inflammation and injury. This study assessed the safety of kidney biopsies in patients with SLE enrolled in the Accelerating Medicines Partnership, a consortium formed to molecularly deconstruct nephritis.Methods475 patients with SLE across 15 clinical sites in the USA consented to obtain tissue for research purposes during a clinically indicated kidney biopsy. Adverse events (AEs) were documented for 30 days following the procedure and were determined to be related or unrelated by all site investigators. Serious AEs were defined according to the National Institutes of Health reporting guidelines.Results34 patients (7.2%) experienced a procedure-related AE: 30 with haematoma, 2 with jets, 1 with pain and 1 with an arteriovenous fistula. Eighteen (3.8%) experienced a serious AE requiring hospitalisation; four patients (0.8%) required a blood transfusion related to the kidney biopsy. At one site where the number of cores retrieved during the biopsy was recorded, the mean was 3.4 for those who experienced a related AE (n=9) and 3.07 for those who did not experience any AE (n=140). All related AEs resolved.ConclusionsProcurement of research tissue should be considered feasible, accompanied by a complication risk likely no greater than that incurred for standard clinical purposes. In the quest for targeted treatments personalised based on molecular findings, enhanced diagnostics beyond histology will likely be required.

Background Although hydroxychloroquine (HCQ) is a mainstay of treatment for patients with Systemic Lupus Erythematosus (SLE), ocular toxicity can result from accumulated exposure. The introduction of highly sensitive tools has engendered even more concern. As the longevity of patients with SLE improves, additional data will help physicians accurately balance the risk of ocular toxicity and the risk of disease flare, especially in older patients who have stable/quiescent disease. Accordingly, this study was initiated to examine the safety of HCQ withdrawal in older SLE patients. Methods Data were obtained by retrospective chart review at three lupus centers. Twenty-seven patients met the following inclusion criteria:≥4 ACR criteria, disease duration ≥5 years, HCQ use of 200–400 mg per day ≥5 years, and discontinuation of hydroxychloroquine at ≥age 55 years. The comparator group comprised 39 age, gender and racial/ethnic matched patients who remained on HCQ. The primary outcome was a clinically meaningful flare within one year of HCQ withdrawal, defined as moderate or severe, using a revised version of the SELENA-SLEDAI Flare composite that separates mild from moderate flares, evaluates each organ system separately, and incorporates increases in corticosteroid dose and/or addition of immunosuppressive agents. Mild flares were considered secondary outcomes. Results Demographics are provided in table 1. There was a trend toward longer disease duration in the HCQ withdrawal group but no difference in prevalence of prior lupus nephritis between the groups. The reasons for HCQ withdrawal were maculopathy (n=13), presumed/biopsy proven cardiomyopathy (n=2), patient request (n=4), and miscellaneous other reasons (n=8). There was no difference in the primary or secondary outcomes between the groups (table 1). Two patients had a moderate flare after discontinuing HCQ, of whom one had arthritis treated with methotrexate and one had thrombocytopenia (>30K) and proteinuria of 2 grams/d (baseline 700 mg). Three patients had severe flares while continuing HCQ, of whom two were hospitalized, one for seizures and one for pericarditis; the third had worsening nephritis (urinary protein >4 g/d, requiring treatment). Two patients had moderate flares while remaining on HCQ, one of whom had a rash and arthritis treated with tofacitinib and one a rash treated with prednisone. Conclusions In this retrospective study of older patients with SLE on long-term HCQ, withdrawal did not increase the risk of moderate or severe flares. These data provide reassurance regarding the safety of withdrawing HCQ in stable older SLE patients.

Since the relationship of maternal autoimmunity and congenital heart block (CHB) was initially described in the late 1970s, investigators have attempted to identify additional factors associated with its development.1–4 Detection of CHB in the absence of cardiac structural abnormalities predicts the presence of maternal autoantibody responses against the ribonucleoproteins SSA/Ro and SSB/La in >85% of cases.5 CHB is associated with considerable morbidity and mortality, with a 17.5% case fatality rate and approximately 70% requiring permanent pacemaker placement.6 Sustained reversal of third-degree CHB has never been achieved and to date there is no approved medication for treatment or prevention of this disease. Recognising those mothers at increased risk of CHB in an offspring would provide insights into the pathogenesis of disease and help prioritise allocation of screening resources, including intense echocardiographic monitoring. In a recent publication in Lupus Science and Medicine , Tonello et al sought to identify maternal autoantibody profiles conferring high risk for CHB.7 Importantly, all serological evaluations were done during the pregnancies. The …