AB0284 RHEUMATOID ARTHRITIS REFRACTORY TO BIOLOGICAL TREATMENT
Authors: R. Caparrós-Ruiz, C. M. Romero-Barco, N. Mena-Vázquez, R. Redondo, M. D. C. Ordoñez Cañizares, A. Fernandez-Nebro
Journal: Annals of the Rheumatic Diseases (2020)

Background: In Rheumatoid arthritis (RA), between 20% and 40% of patients do not achieve a 20% improvement in American College of Rheumatology (ACR) criteria, another similar percentage loses response over time or experience adverse events that forces them to the suspension of treatment. Those patients who have failed one or more therapeutic strategies, are more refractory patients and the response to successive targets is usually lower than naive patients, with 50% ACR20 response percentages. Objectives: To describe the clinical-analytical characteristics and response to the last treatment, in rheumatoid arthritis (RA) refractory to biological disease modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs). To identify possible factors related to refractoriness to bDMARDs and tsDMARDs. Methods: Retrospective multicentre, controlled study of patients with RA refractory to bDMARDs and tsDMARDs. Control group was formed by patients with non-refractory RA; matched by gender, age and diseaseduration. Refractoriness was defined as failure to more than 2 different targets of bDMARDs or tsDMARDs. Demographic, clinical-analytical data and rates of disease activity and physical function were collected. A descriptive analysis, a bivariate analysis and a binary logistic regression were performed to see the variables associated with refractoriness. Results: A total of 94 patients were selected from HRUM and HCUVV: 47 with refractory RA and 47 with non-refractory RA. The clinical-epidemiological characteristics of both groups are classified in Table 1. The majority were women with a mean age of 57 years. There was a greater proportion of patients with multimorbidity and cardiovascular risk factors among the refractory to FAMEb. All patients affected a significant improvement with the new treatment in activity and physical function at 6 months compared to baseline. Refractoriness is associated with a higher body mass index [OR(IC95%), 7.73 (1.56-8.42); p=0.012], and depression [OR(IC95%), 1.11 (1.24-1.83); p=0.035]. Table 1. Clinical-epidemiological characteristics of patients. Variable Refractory RA (N=47) Non-refractory RA (N=47) p-value Sex (female), n (%) 38 (80,9) 38 (80,9) 1,000 Age, means (SD) 57,1 (10,8) 57,4 (10,8) 0,896 Caucasian race, n (%) 45 (95,7) 44 (93,6) 0,646 Body mass index, means (SD) 30,4 (6,8) 26,5 (3,8) 0,002 Non-smoker, n (%) 26 (55,3) 28 (59,6) Former smoker&gt;6 months, n (%) 16 (34,0) 7 (14,9) Smoker, n (%) 5 (10,6) 12 (25,5) Rheumatoid Factor, n (%) 40 (85,1) 42 (89,4) 0,536 Anti-cyclic citrullinated peptide, n (%) 37 (78,7) 38 (80,9) 0,797 Erosions, n (%) 33 (70,2) 28 (59,6) 0,280 Hypertension, n (%) 24 (51,1) 20 (42,6) 0,408 Obesity, n (%) 19 (40,4) 9 (19,1) 0,024 Diabetes Mellitus, n (%) 10 (21,3) 6 (12,8) 0,272 Dyslipidemia, n (%) 20 (42,6) 15 (31,9) 0,286 Neoplasia, n (%) 2 (4,3) 0 (0,0) 0,153 Fibromyalgia, n (%) 4 (8,5) 1 (2,1) 0,168 Depression, n (%) 18 (38,3) 4 /8,5) 0,001 Multicomorbidity, n (%) 17 (36,2) 6 (12,8) 0,008 Comorbidities number, median (IQR) 2,0 (1,0-3,0) 1,0 (0,0-2,0) 0,002 Conclusion: Patients with refractory RA have an adequate response to subsequent treatment lines. These patients have a remarkable percentage of associated comorbidities. Disclosure of Interests: None declared