AB0455 FACTORS ASSOCIATED WITH DAS28 RESPONSE IN BIOLOGIC-NAÏVE PATIENTS WITH RHEUMATOID ARTHRITIS: 10 YEAR FOLLOW-UP
Authors: Daniel Xavier Xibille Friedmann, Maricela Escobar Román, Sandra Miriam Carrillo Vazquez, José Luis Montiel Hernández
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Access to adequate care is limited in Mexico as biologics or targeted therapies are unavailable for a proportion of patients with rheumatoid arthritis (RA) and only methotrexate and other conventional (c)DMARDs are employed as therapeutic options in many cases. <h3>Objectives:</h3> To determine the factors associated to DAS28 response in patients with rheumatoid arthritis followed up to 10 years and who never received biologic or targeted therapy, being treated only with cDMARDs. <h3>Methods:</h3> We analyzed a prospective cohort of 543 patients with RA followed for 10 years (March 2006 to February 2016) at the Hospital General de Cuernavaca, in central México. Demographic data, shared epitope (SE; HLA-DR*0101, *0102, *0401, *0404, *0405, *0408, *0410, *1001, *1402) status, date since onset of disease and treatment, clinical and disease activity characteristics as well as treatment data was obtained and followed through time. Patients were seen by a rheumatologist every three months and blood samples obtained on each visit. The DAS28 score was determined on each visit and treatment adjusted accordingly. They were treated with prednisone (PDN; ≤10 mg/day), Methotrexate (MTX; 7.5-25 mg/week), Cloroquine (CLQ; 150-300 mg/day), Sulphasalazine (SSZ; 1-3 gr/day) or a combination of these. Descriptive statistics were used for the analysis of demographic data and parametric correlation tests (Spearman) were employed in the analysis. <h3>Results:</h3> Of the 543, 94.3% of patients were women; mean age at baseline was 54.1 years (23-89; SD 12.4), mean time since onset of disease was 6.6 years (0-49; SD 7.9) and mean time since onset of treatment was 3 years (1-9; SD 2.12). HLA was determined in 57 patients and 36.8% of these patients were SE positive (one or two alleles). Most patients received treatment on the baseline visit based mainly on MTX (72.7%) combined with CLQ (63%) and low-dose PDN (76.4%). Less than 5% was under treatment with a non-MTX cDMARD. Baseline mean DAS28 was 4.9 (0.9-8.3; SD 1.41). At 6 months since DMARD-onset mean DAS28 was 3.8 (0.42-8.0; SD 1.46), at 12 months mean DAS28 was 3.6 (0.14-7.6; SD 1.34). At 2 years of follow-up, mean DAS28 remained at 3.6 (1.27-7.43; SD 1.35). Over the course of the next 8 years patients maintained a mean DAS28 between 3.5-3.6, with no significant changes in spite of continuing cDMARD treatment. Apart from being under treatment, which correlated with a better DAS28 score, being female correlated with a poorer DAS28 response (p&lt;0.05). The other baseline factor significantly associated to an improved long-term outcome regarding disease activity was time since onset of disease, which correlated with a higher DAS28 score during the first two years of follow up but tapered after two years of follow-up (p&lt;0.001). One of the limitations of the study was the significant drop-out rate (&gt;20%) seen during follow up. <h3>Conclusion:</h3> DAS28 response occurs mainly in the first 2 years of treatment. After that, cDMARD treatment is associated to a stationary effect over DAS28 in patients with no access to biologics or targeted therapies. This is an important factor to consider when establishing long-term therapeutic strategy from a cost-effective point of view. <h3>References</h3> [1] Hazlewood, G. S. et al. Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying antirheumatic drugs for rheumatoid arthritis: abridged Cochrane systematic review and network meta- analysis. BMJ 353, i1777(2016). [2] Salliot, C. &amp; van der Heijde, D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann. Rheum. Dis. 68, 1100–1104 (2009). <h3>Disclosure of Interests:</h3> Daniel Xavier Xibille Friedmann Consultant for: Lilly, Abbvie, BMS, Speakers bureau: Lilly, Abbvie, Maricela Escobar Román: None declared, Sandra Miriam Carrillo Vazquez Consultant for: Roche, Lilly, BMS, Speakers bureau: Roche, Lilly, Abbvie, BMS, José Luis Montiel Hernández Grant/research support from: Pfizer