THU0105 DIVERSE DISEASE ACTIVITY MEASURES DEMONSTRATE THAT THE INITIATION OF TOFACITINIB LEADS TO SUSTAINED CLINICAL RESPONSES IN THE MAJORITY OF RHEUMATOID ARTHRITIS PATIENTS IN A CLINIC UTILIZING A TREAT TO TARGET STRATEGY
Authors: Craig Wiesenhutter
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Treating Rheumatoid Arthritis (RA) patients to target (T2T) has been shown to result in better outcomes in patients with RA [1] and offers the opportunity to analyze clinical responses and changes in certain laboratory parameters after treatment with specific therapeutic agents. <h3>Objectives</h3> To determine the frequency, magnitude, and duration of clinical responses and changes in certain laboratory parameters after initiating Tofacitinib in a single community rheumatology clinic (author's) utilizing a T2T strategy. <h3>Methods</h3> Patients at a community based rheumatology clinic undergo disease activity measure assessments (DAMs) on a routine basis as part of the implementation of the T2T strategy. These assessments include the disease activity score in 28 joints (DAS28CRP), and the more objective measures, the power Doppler joint count (UPDJC), which demonstrates hyper vascularization of the synovium, and the 12-multibiomarker disease activity test (MBDA), which incorporates 12 biomarkers in an algorithm leading to a single disease activity score. The UPDJC includes scoring at six dorsal wrist and six dorsal MCP sites [2]. The average duration of RA in patients at this clinic is &gt; 10 years. <h3>Results</h3> Fifty two patients were found to be in inadequate control at the clinic and were started on Tofacitinib. Ten patients discontinued treatment with Tofacitinib within the first year, four because of an inadequate response, and four because of adverse effects (two deaths, one with lung cancer and one with colon cancer), and two because of noncompliance or loss to follow up. Forty two patients remained on treatment with Tofacitinib for at least one year, and at this point in time, 21 patients have remained on the drug for two or more years. The DAM assessments and selected changes in certain laboratory parameters for two yearly time points are shown for these patients in Table 1. Clinical significance was determined by Paired-samples T tests. <h3>Conclusion</h3> Patients showed sustained significant clinical responses for two or more years by all three diverse DAMs and several other common measures of clinical response. The initiation of Tofacitinib in a Rheumatology clinic utilizing a T2T strategy clearly showed sustained clinical responses for up to two years for a significant number of patients. Significant changes in some of the cytokine components of the MBDA were also noted, including increases in leptin levels. The use of the T2T strategy offers a unique opportunity to obtain real time data on patients treated with specific therapeutic agents at a community rheumatology clinic. <h3>References</h3> [1] Smolen, J. et al. Treating Rheumatoid Arthritis to Target: Recommendations of an International Task Force. Ann. Rheum. Dis 2010;69:631-6372. [2] Shin-ya Kawashiri et. All. The power Doppler Ultrasonography Score from 24 Synovial Sites or 6 Synovial Sites, including the MCP joints, reflects the Clinical Disease Activity and Level of Serum Biomarkers in Patients with RA. Rheumatology (2011) 50 (5): 962-965. <h3>Disclosure of Interests</h3> None declared