AB0407 HIGH REMISSION RATES IN PATIENTS WITH RHEUMATOID ARTHRITIS USING BIOLOGICS UNDER A TREAT TO TARGET STRATEGY AND A COMPREHENSIVE DISEASE-MANAGEMENT MODEL. FIVE YEAR FOLLOW-UP RESULTS FROM A REAL-LIFE SETTING
Authors: Pedro Santos-Moreno, Michael Cabrera, Diana Buitrago-Garcia, Eva Cardozo, Ivania Ramirez, Danny Gomez, Edwin Castillo, Sandra Farietta
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Treat to target (T2T) strategy for rheumatoid arthritis (RA) aims to achieve remission or low disease activity. On the other hand, biological disease-modifying antirheumatic drugs (bDMARDs) have shown to be effective to achieve clinical remission or, at least, low disease activity in patients with RA. On the other hand, comprehensive healthcare programs have demonstrated good clinical outcomes in patients with chronic conditions. <h3>Objectives:</h3> The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) in patients receiving biological therapy during 5 years, and who were subjected to a multidisciplinary care program. <h3>Methods:</h3> A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed during 2015-2017; those patients were followed-up under T2T standards and a multidisciplinary approach. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3-5 weeks (DAS28 &gt; 5.1), every 7-9 weeks (DAS28 ≥ 3.1 and ≤ 5.1), and every 11-13 weeks (DAS28 &lt; 3.1). Tender joint count (TJC), swollen joint count (SJC) and DAS28 were measured on each visit. Therapy had to be adjusted with DAS28 &gt; 3.2 unless patient's conditions don't permit it; we considered this follow-up type as implementation of a T2T strategy in patients with RA. Patients entered into a multidisciplinary program of care with periodic consultations not only to rheumatology but with a physiatrist, psychologist, physiotherapist, occupational therapy nutrition, and, a patient focused program. With a multidisciplinary model of care the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. We divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We compared disease activity at base line and at the end of follow-up. <h3>Results:</h3> 747 patients meet our inclusion criteria, 85% of our patients were women, median age was 57 years RIQ (50-64); The most prescribed bDMARD was certolizumab 25% followed by etanercept 14%, tocilizumab 12%, abatacept 12%, golimumab 10% rituximab 8%, adalimumab 7%, infliximab 6% and Tofacitinib 6%. At beginning 53% of patients were in moderate disease activity and, 25% in high disease activity while at the end of follow up 89% of patients had achieved remission. See Table 1. It was stablished statistical significance between changes in median DAS28 at beginning and, at the end of follow-up (P&lt;0.05). <h3>Conclusion:</h3> Biological therapy is effective for treating patients with RA, there was an evident global improvement of DAS28 in a cohort of RA patients. Also, our findings agree with other studies where T2T programs have shown improvements in disease activity in patients with RA. Thus, multidisciplinary T2T comprehensive healthcare programs should be widely implemented in patients with RA. <h3>Disclosure of Interests:</h3> Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Michael Cabrera: None declared, Diana Buitrago-Garcia: None declared, Eva Cardozo: None declared, Ivania Ramirez: None declared, Danny Gomez: None declared, Edwin Castillo: None declared, Sandra Farietta: None declared