SAT0229 Rheumatoid arthritis treatment with combination of three conventional synthetic disease modifying anti-rheumatic drugs (CSDMARDS) and its effectiveness on disease control in a short term compared to biologic dmards treatment after propensity score matching procedure implemented
Authors: I. Yoshii, T. Chijiwa
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Rheumatoid arthritis (RA) treatment has now many variations with use of biologic or targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs) and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs). In these, triple csDMARD combination therapy (tri-TX), that has comparable disease activity control effectiveness compared to anti-TNF therapy is one of alternative [1]. <h3>Objectives:</h3> Aim of this study is to evaluate the effectiveness of tri-TX compared to bDMARD with methotrexate treatment (bm-TX) for RA statistically, with the use of propensity score matching (PSM) technique. <h3>Methods:</h3> Five hundred and fifty RA patient had been treated for more than one year in our clinic. In these, 74 patients had been treated with tri-TX and 135had been treated with bm-TX, were recruited. Their sex distribution (Sex), anti-cyclic citrullinated peptide antibodies (ACPA), age, 28-joints disease activity score with C-reactive protein (DAS28-CRP), Health Assessment Questionnaire Disability Index (HAQ-DI), Sharp/van der Heijde Score (SvdHS), and pain score measured with visual analog scale (PS-VAS) at start of the treatment were measured for each patient, and their values were compared for each group. Thus, sample selection was performed with PSM technique in order to reduce bias on each of treatment groups. After selection, change of DAS28-CRP, HAQ-DI, PS-VAS for every three months until one year since start, and SvdHS at one year after were compared statistically with Mann-Whitney U test. <h3>Results:</h3> After selection, twenty-three patients for each treatment group were harvested, and there demonstrated no significant difference in Sex, ACPA, DAS28-CRP, HAQ-DI, PS-VAS, and SvdHS at start of the treatment (table 1). Average DAS28-CRP demonstrated 2.76, 1.88, 1.91, 1.77, and 1.67 in bm-TX, while 2.71, 2.03, 2.41, 2.56, and 2.39 in tri-TX, at start, 3 month, 6 month, 9 month, and 1 year, respectively. There is no statistical significant difference between the two groups, but bm-TX demonstrated more significant improvement at every time after six month than tri-TX (&lt;0.05), while no significant difference demonstrated in PS-VAS. Average HAQ-DI demonstrated 0.603, 0.579, 0.598, 0.609, and 0.625 in bm-TX, while 0.707, 0.654, 0.619, 0.594, and 0.567 in tri-TX, respectively. HAQ-DI showed tendency that improved more in tri-TX compared to bm-TX, whereas significant more improvement for tri-TX than for bm-TX had demonstrated at one-year (&lt;0.05), however until then there demonstrated no statistical significance for both of absolute value and improvement. SvdHS demonstrated 62.4 to 61.6 from start to one year in bm-TX, while 75.6 to 78.7 in tri-TX. Improvement of SvdHS demonstrated better result in bm-TX than in tri-TX significantly (&lt;0.05). <h3>Conclusions:</h3> PSM is useful technique to diminish artificial bias. tri-TX is one choice for RA patient, but not superior for clinical results compared to bm-TX. <h3>Reference</h3> [1] Matsuno H, et al. The usefulness of a new triple combination treatment utilizing methotrexate, salazosulfapyridine, and bucillamine in rheumatoid arthritis. Modern rheumatology2016Jan 2;26(1):51–6. <h3>Disclosure of Interest:</h3> None declared