SAT0213 Tight treatment of patients with rheumatoid arthritis in the early stages of disease leads to high levels of remission and reduced use of biologics
Authors: K. Levasseur, S. Raizada
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Early treatment with synthetic DMARDS has demonstrated favourable outcomes in patients with Rheumatoid Arthritis (RA). It leads to a reduction in inflammation, limits articular and extra-articular manifestations of RA, enables earlier functional improvement and causes less radiographic damage.<sup>1</sup> Treat to target (TTT) approaches have been used to adapt therapy according to disease activity in order to achieve clinical remission, providing a standardised treatment algorithm that allows for rapid treatment escalation when needed. <h3>Objectives:</h3> To evaluate the remission rate of patients in a real life TTT clinic at a district general hospital in the United Kingdom and to compare our local data to the United Kingdom 2015–2016 Healthcare Quality Improvement Partnership (HQIP) audit. To evaluate the proportion of patients starting biological therapy post follow up in a TTT clinic. <h3>Methods:</h3> The electronic records of patients referred to the TTT clinic between September 2012 and December 2015 were accessed retrospectively and data collected. All patients with a diagnosis of RA were included in data analysis. Patient demographics and clinical data were collected. Statistical analysis was performed using GraphPad Prism. Comparisons of outcomes for antibody status and smoking status were made using Fisher's exact test. <h3>Results:</h3> 242 patients were seen at least once in the TTT clinic. Follow-up data was available for 216 patients. 65% were female with a median age of 62 years (range 19–90). 69% patients were either rheumatoid factor or anti-CCP positive and 80% were started on combination therapy (Methotrexate and Hydroxychloroquine) at their first clinic appointment. Overall 46% of patients entered remission (disease activity score (DAS) of &lt;2.6). 49% of seropositive patients achieved remission compared to 39% of seronegative patients although this was not statistically significant (P=0.249, Fisher's exact test). A stastitically significant fewer number of people who were current smokers achieved remission (p=0.005, Fisher's exact test). Only 9 patients (4.2%) required the addition of biologic drugs within the first year of treatment. <h3>Conclusions:</h3> Our TTT clinic was successful in starting a significant proportion (80%) of patients on combination DMARDs (compared to an estimated national average of 46% based on HQIP data).<sup>2</sup> This approach also resulted in a higher proportion of patients entering DAS remission (46%, national average 31%), though understandably this was lower than the remission rate achieved in clinical trials.<sup>3</sup> Only 4.2% of patients went onto biological DMARDs within the first year, which is far less than the proportion commencing biologics prior to TTT. This data demonstrates that TTT approaches in a real life clinical setting are important in achieving remission in patients with RA and reducing the need for expensive biological treatment. <h3>References</h3> [1]Raza K, Buckley CE, Salmon M, Buckley CD. Treating very early rheumatoid arthritis. Best practice &amp; research Clinical rheumatology2006;20(5):849–863. [2]Healthcare Quality Improvement Partnership. National clinical audit for rheumatoid and early inflammatory arthritis. 2016. [3]Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised control trial. Lancet2004;364(9430):263–269. <h3>Disclosure of Interest:</h3> None declared