AB0215 EARLY IMPROVEMENT OF THE POWER DOPPLER SIGNAL CAN PREDICT TO CONTINUE THE BIOLOGICAL DMARDS AFTER 1 YEAR.
Authors: T. Okano, K. Mamoto, Y. Yamada, K. Mandai, S. Anno, K. Inui, T. Koike, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2020)

Background: In rheumatoid arthritis (RA), biologics treatment is one of the effective treatment options. On the other hand, the effects of biologics cannot be obtained satisfactorily in all patients, and there are some cases in which treatment is interrupted due to ineffective or adverse events. However, the useful predictive markers of the biologics have not been found in the early phase of treatment in RA. Recently, ultrasound (US) has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA. Objectives: In this study, we investigated whether continuation of biologics treatment can be predicted by ultrasonographic findings in the early phase. Methods: Fifty-four RA patients who started the first biologics from September 2016 to December 2018 were included. All the patients were performed clinical examination, blood tests and US examination of hand and foot at baseline, 4, 12, 24, 36 and 52 weeks. US examination was performed on MCP joints, PIP joints, wrist and MTP joints. Results: Among 54 cases, 42 cases were able to continue treatment until one year later, and the continuation rate was 80.8%. Of the 12 patients who discontinued first biologics treatment, 5 were changes to other biologics due to inadequate response, 4 were their wishes, and 3 were adverse events. Multiple regression analysis was performed with treatment continuation as the dependent variable and improvement of CRP, MMP-3, DAS28-CRP, grayscale score and power Doppler score in 4 weeks as explanatory variables. Only improvement of power Doppler score was extracted as a significant predictor (p = 0.045). In the continuation group, the improvement of the power Doppler signal at week 4 was 36% compared with the baseline, compared with 10% in the discontinuation group. Conclusion: The early improvement of power Doppler signal in 4 weeks could be a predictive factor for the continuation of 1-year biological treatment. References: [1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46. [2]Atzeni F, Talotta R, Masala IF, Bongiovanni S, Boccassini L, Sarzi-Puttini P. Biomarkers in Rheumatoid Arthritis. Isr Med Assoc J. 2017;19:512-6. Table 1. Multivariate regression analysis of predictive factors for continuation of biologics treatment in 1-year. Improvement ratio of 0 to 4 weeks beta P value CRP -0.122 0.465 MMP-3 0.228 0.103 DAS28 CRP 0.280 0.103 Ultrasound grey scale score -0.342 0.119 Ultrasound power Doppler score 0.442 0.045 Acknowledgments: We thank Emi Yamashita, Yuko Yoshida, Asami Fujii and Shingo Washida who performed ultrasound examination. Disclosure of Interests: Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.