THU0097 PREDICTIVE VALUE OF IMMUNOLOGICAL AND IMAGING BIOMARKERS ON ACHIEVING GOOD CLINICAL RESPONSE AT 6 MONTHS IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY INTRAVENOUS BDMARDS
Authors: S. Giuliani, B. Laurent, H. Mezghani, I. Duprat-Lomon, A. Luc, M. De Carvalho Bittencourt, C. Baumann, I. Chary Valckenaere, D. Loeuille
Journal: Annals of the Rheumatic Diseases (2020)

Background: RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment. Objectives: To investigate the value of biological and imaging biomarkers on predicting good clinical response at 6 months, in RA patients initiating IV bDMARD. Methods: From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence for the analysis. On 173 patients eligible to the study, 4 were loss to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data were collected when available at baseline. US examination was performed on 12 joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Good clinical response was defined by a DAS 28 &lt; 3.2 and/ or DAS 28 decrease &gt; 1.2 at 6 months. Only variables with a p&lt;0.2 in univariate analysis were included in the multivariate model. Results: On 155 RA patients, 11 present a disease duration &lt; 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)). Table 1. Characteristics of the patients (n=155) at baseline Variables N (%) Mean (SD) Clinical characteristics Age (years) 54.8 (12.2) Female 113 (72.9) Disease duration (months) 166.9 (118.8) DAS 28 5.2 (1) Treatment Corticosteroids / dose (mg/day) 99 (85.3) 10.9 (6) Monotherapy 56 (36.1) IV bDMARD Abatacept 27 (17.4) Infliximab 11 (7.1) Rituximab 84 (54.2) Tocilizumab 33 (21.3) Immunology ACPA + /titer(IU) 132 (85.2) 618.5 (791.0) RF + /titer (IU/ml) 114 (74.5) 184.7 (351.3) ANA + / level 87 (56.1) 1453 (3836) Radiography Sharp’s erosion score (n=110) 49.4 (46.2) US Nb Erosion (n=95) 3.0 (2.3) Nb B mode Synovitis (n=128) 6.0 (4.1) Nb PD+ Synovitis (n=130) 4.8 (3.8) Nb B mode Tenosynovitis (n=129) 1.6 (2) Nb PD+ Tenosynovitis (n=129) 1.3 (2.1) At 6 months, 87 patients (56.1%) were in good clinical response. Predictive values of biomarkers are presented in table 2. Table 2. Variables predictive of a good clinical response at 6 months Biomarkers Response Multivariate Logistic regression Analysis All N = 101 Response (N=60 ) OR (CI95% ) P value Immunology RF + 75 51 (68.0%) 5.1 (1.8-14.4 ) 0.002 ACPA + 87 56 (64.4%) ANA + 55 36 (65.5%) Radiography Erosive RA 74 48 (64.9%) Ultrasonography Erosive RA 88 55 (62.5%) Nb B mode synovitis 101 60 (59.4%) 1.2 (1.1-1.4 ) 0.002 Nb PD+ synovitis 101 60 (59.4%) All qualitative variables with a p value &lt;0.2 on bivariate analysis were incorporated in the multivariate model (RF +, ACPA +, US erosive RA, Nb B mode synovitis, Nb PD+ synovitis, RX erosive RA). Only patients with all data available are incorporated in the multivariate logistic regression analysis (n=101/155) Conclusion: We showed that positive RF was predictive of good clinical response to IV bDMARDs. For the first time, we demonstrated that number of US B-mode synovitis was also predictive to good clinical response. Disclosure of Interests: Stephane Giuliani Grant/research support from: BMS, Benjamin Laurent Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared