SAT0092 LOW SERUM LEVEL OF VITAMIN D AT TIME OF DIAGNOSIS IS ASSOCIATED WITH HIGHER ONE-YEAR REMISSION RATE IN PATIENTS WITH NEWLY DIAGNOSED RA, TREATED AGGRESSIVELY DURING FOLLOW-UP: POST-HOC ANALYSES OF THE CIMESTRA TRIAL
Authors: Mette Herly, Kristian Stengaard-Pedersen, Peter Vestergaard, Robin Christensen, Mikkel Östergaard, Peter Junker, Merete L. Hetland, Kim Hørslev-Petersen, Torkell Ellingsen
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Vitamin D is often low in Rheumatoid Arthritis(RA), and immunomodulatory properties of vitamin D might be associated with disease-course in RA.(1) <h3>Objectives</h3> To evaluate association between baseline vitamin D metabolites and one-year remission, in newly diagnosed, treatment-naïve RA patients, aggressively treated during follow-up. <h3>Methods</h3> The CIMESTRA-cohort comprises 160 newly diagnosed RA patients, treated aiming at remission with methotrexate and intraarticular steroid, further randomized 1:1 to ciclosporine or placebo-ciclosporine.(2) A total of 158 patients had vitamin D metabolites measured at time of diagnosis. Dietary vitamin D supplementation was recommended in accordance with the national guidelines. Serum vitamin D<sub>total</sub> (sum of 25OHD<sub>2</sub> and 25OHD<sub>3</sub>) and 1,25(OH)<sub>2</sub>D at time of diagnoses were measured by LC-MS/MS or RIA. D<sub>total</sub> were dichotomized at 50 nmol/l, and 1,25(OH)<sub>2</sub>D categorized in tertiles. Primary outcome was remission (DAS28-CRP ≤ 2.6) after one year. Associations were calculated using logistic regression, presented as Odds Ratios with 95% Confidence Intervals (95%CIs). Adjustment of analyses included sex, age, symptom duration prior to diagnosis, DAS28-CRP and season of diagnosis. <h3>Results</h3> In univariate analyses, neither D<sub>total</sub> nor 1,25(OH)<sub>2</sub>D at time of diagnosis predicted remission at year one. In adjusted analysis, D<sub>total</sub> &lt; 50 nmol/l at time of diagnosis showed better odds for achieving one-year remission, compared to sufficient D<sub>total</sub>; OR 2.56, 95%CI (1.11; 5.90) p = 0.03. 1,25(OH)<sub>2</sub>D was not associated to remission. <h3>Conclusion</h3> Low D<sub>total</sub> at time of diagnosis is associated to increased odds for achieving remission at year one in early, treatment naïve RA patients, treated aggressively during follow-up. <h3>References</h3> [1] Jeffery LE, et al. Vitamin D in rheumatoid arthritis-towards clinical application. NatRevRheumatol. 2015. [2] Hetland ML, et al. Combination treatment with methotrexate, cyclosporine, and intraarticular betamethasone compared with methotrexate and intraarticular betamethasone in early active rheumatoid arthritis: an investigator-initiated, multicenter, randomized, double-blind, parallel-group, placebo-controlled study. Arthritis Rheum. 2006;54:1401-9. <h3>Acknowledgement</h3> Sören Möller, biostatistician at OPEN, Odense, for statistical support <h3>Disclosure of Interests</h3> Mette Herly Grant/research support from: Pfizer Denmark, unrestricted grant, used for salary. The Danish Rheumatism Association, patient association, 6 months salary as part of PHD study, Speakers bureau: The Danish Rheumatism Association, patient association, speakers Fee 500 Euro, Kristian Stengaard-Pedersen: None declared, Peter Vestergaard Speakers bureau: Amgen, Eli Lilly, Novartis, MSD, Servier, Robin Christensen Grant/research support from: AbbVie Inc, and the Oak Foundation, Speakers bureau: Roche, Mikkel Östergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Peter Junker: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis, Kim Hørslev-Petersen Grant/research support from: AbbVie during the conduct of the study, Torkell Ellingsen: None declared