SAT0508 Ace-inhibitors in arterial hypertension in ssc patients display a risk factor for scleroderma renal crisis – a eustar analysis

Background Scleroderma renal crisis (SRC) represents a rare but life-threatening manifestation in systemic sclerosis (SSc). Survival remains poor despite therapeutic use of ACE inhibitors (ACEi). Factors influencing the risk of SRC are not well characterised. In particular, ACEi are discussed as promoting but also as protecting SRC. Objectives To investigate the effect of ACEi on SRC incidence in prospectively collected data of a cohort of SSc patients. Methods EUSTAR database analysis with focus on arterial hypertension, antihypertensive medication and glucocorticoids. Subgroup analysis of a dataset with defined documentation of medication from January 2009 until November 2017. Results Out of 14’524 patients in the database we identified 7’648 patients with at least one follow-up after 2009. 102 patients developed SRC in 27’450 person-years (py), representing an incidence of 3.72 (3.06–4.51) per 1’000 py. In a multivariable time-to-event analysis adjusted for age, sex, disease severity and onset, arterial hypertension, tendon friction rubs, SCL70 and ACA positivity, 78 of 6083 patients developed SRC. Herein, use of ACEi displayed an increased risk for the development of SRC with a hazard ratio (HR) of 2.07 (95% confidence interval (CI):1.28–3.36). Calcium channel blockers (CCB), angiotensin receptor blockers, endothelin receptor antagonists and glucocorticoids did not influence SRC incidence. Medication strategies were not altered after renal crisis. Cumulative mortality 5 years after renal crisis was 18.6% (95% CI: 13.0%–26.3%). Conclusions This EUSTAR analysis supports the notion that ACEi should be avoided in arterial hypertension in SSc patients. Alternative antihypertensive drugs as CCB might be preferred. References [1] Hudson M, Baron M, Tatibouet S, Furst DE, Khanna D, International Scleroderma Renal Crisis Study I. Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the International Scleroderma Renal Crisis Survey. Seminars in arthritis and rheumatism2014;43(5):666–72. [2] Guillevin L, Berezne A, Seror R, Teixeira L, Pourrat J, Mahr A, et al. Scleroderma renal crisis: a retrospective multicentre study on 91 patients and 427 controls. Rheumatology (Oxford)2012;51(3):460–7. [3] Mouthon L, Bussone G, Berezne A, Noel LH, Guillevin L. Scleroderma renal crisis. The Journal of rheumatology. 2014;41(6):1040–8. [4] Shanmugam VK, Steen VD. Renal disease in scleroderma: an update on evaluation, risk stratification, pathogenesis and management. Current opinion in rheumatology2012;24(6):669–76. Acknowledgements We acknowledge the work of all participating EUSTAR centres for contributing to this work. Disclosure of Interest None declared