SAT0080 Secular trends prior to-and after dissemination of best practice recommendations showed earlier intensified medication strategies and improved outcomes in canadians with early inflammatory arthritis
Authors: O. Schieir, S.J. Bartlett, M.-F. Valois, J.E. Pope, C. Thorne, C. Hitchon, B. Haraoui, G. Boire, D. Tin, E.C. Keystone, V.P. Bykerk
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> International and local best-practice recommendations released in 2010–11 aimed to improve outcomes in early RA via earlier diagnosis and a treat-to-target approach. These should be associated with improved outcomes. <h3>Objectives</h3> To examine secular trends in patient characteristics and treatment strategies at RA diagnosis and disease activity outcomes in the 1 st year of follow-up comparing earlier (2007–2010) and later (2011–2016) time periods, prior to and following dissemination of 2011 guidelines in a large Canadian early inflammatory arthritis (EIA) cohort of RA patients. <h3>Methods</h3> Data were from patients with early classifiable (87%) or probable (13%) RA (&lt;1 year of symptoms) enrolled each year in an ongoing prospective multi-centre cohort study between 2007–2016 with ≥12 M follow-up undergoing 3-monthly visits including clinical assessments, questionnaires, and laboratory tests in the 1 st year. Treatment was decided by their rheumatologist. These were cohort investigators who met annually to discuss means to improve outcomes. Descriptive statistics compared patient characteristics, early treatment strategies with conventional synthetic(cs) and biologic(b) DMARDs and disease activity (DAS28) outcomes. Differences in DAS28 targets achieved per time period were compared using Chi-Squares and medication doses by Cochrane Hermitage trend tests. <h3>Results</h3> Of 2227 patients enrolled in CATCH (Canadian Early Arthritis Cohort), symptom duration was 6 (3) months. There was a slight increase in number recruited, education and income and slight decrease in baseline symptom duration from early to later time periods. Baseline smoking, obesity rates, comorbidities, positive serology, inflammatory markers and joint counts did not differ significantly between time periods. Baseline erosions were less frequent (17% vs. 24%, p&lt;0.0001) and mean symptom duration decreased slightly (5.6 vs. 5.9 months, p=0.018) in earlier vs later periods. Most (87%) entered in moderate or high disease activity (MDA or HDA);disease activity at 3, 6 and 12 M markedly improved over calendar time (figure 1). Respective DAS28 REM/LDA rates at 12 M from early to late periods significantly increased (p&lt;0.01), 20% (p&lt;0.001)used higher doses of MTX (≥20 mg); and more used subcutaneous (sc) MTX, MTX combo therapies sooner and more rapidly escalation to bDMARDs all p’s&lt;0.05). <h3>Conclusions</h3> This 10 year Canadian prospective study of classifiable/probable RA patients, who were assessed for 1 year suggests that earlier, more intensified treatment promoted in practice recommendations were implemented and resulted in lower disease activity with a greater proportion of patients reaching targets of LDA and/or REM, although 25%–30% of patients still did not achieve LDA or REM by 12 M. <h3>Acknowledgements</h3> Sponsors: Amgen &amp; Pfizer-Founding sponsors 2007+; UCB, AbbVie 2011+; Medexus 2013+; Eli Lilly, Sanofi- Genzyme 2016+; Merck 2017+; BMS 2011–2014, Hoffmann-LaRoche, Janssen 2011–2016 <h3>Disclosure of Interest</h3> None declared