SAT0017 COMPARISON OF IMMUNOREGULATORY WITH CONVENTIONAL DMARDS THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Qiao ling Guo, LI Bao Chen, LI Zhao-Hua, Yan Yan Wang, Xin Wang, Chong Gao, LI Xiaofeng, Caihong Wang
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by joint synovitis that ultimately leads to joint destruction and loss of function. Conventional therapy or standard medical treatment of RA involves the disease-modifying antirheumatic drugs (DMARDs). Because DMARDs act nonspecifically on the patient's immune cells, it can weaken the body's ability to fight infections. We previously reported that imbalance of effector and regulatory T cells (Tregs) that should be an important cause of RA. Therefore, we developed an immunomodulatory therapy for restoring the reduced Treg cells is the main direction for the treatment of RA.<sup> [1]</sup> <h3>Objectives:</h3> To compare the effects of new immunoregulatory therapy and conventional DMARDs therapy on disease remission and immune homeostasis in RA patients, and to investigate the efficacy of immunoregulatory therapy in the reconstruction of immune tolerance. <h3>Methods:</h3> The study included 184 patients with RA (meeting the diagnostic classification criteria for RA revised by ACR in 1987).According to the therapeutic regimen they have received, there were assigned to the immunoregulatory (144 patients, Sirolimus capsule, 0.5mg twice a week and Tretinoin tablets, 10mg once a day, for 12 weeks) and conventional DMARDs group (40 cases,Leflunomide tablets, 10 mg once a day for 12 weeks). Other drugs are similar between the two groups. The absolute numbers of Th17 and Treg cells in peripheral blood were measured by Flow Cytometer (FCM). <h3>Results:</h3> 1. There was no statistically significant difference in DAS28 score (P&gt;0.05) between the two groups. 2. In the immunomodulatory group, there were statistical differences in the number of Treg as compared with normal controls (P&lt;0.05). After immunoregulatory therapy, the absolute number of Treg cells was increased, leading to ratio of Th17/Treg decreased (Table1, Figure1). 3. Conventional DMARDs therapy reduced, significantly the number of Treg cells (P&lt;0.05), leading to a increase in the ratio of Th17/Tregs (Table 1, Figure 2). <h3>Conclusion:</h3> The results of this study show that the remission rates of immunomodulation group and conventional DMARDS group were 37.39% and 36.00%, respectively. There was no significant difference between the two groups. But as for the effects on their immune cells, immunomodulatory therapy can increase the level of Treg cells compared with conventional DMARDs. It also shows that immunomodulatory therapy may play an important role in restoring immune tolerance in patients with RA, which may help us find new ideas for treating RA. However, we need to enlarge the sample size and extend the treatment time to observe the long-term efficacy of the immunomodulatory therapy in the population. <h3>Reference</h3> [1] Benson R A, Patakas A, Mcqueenie R, et al. Arthritis in space and time – To boldly go![J]. Febs Letters, 2011, 585(23):3640-3648. <h3>Disclosure of Interests:</h3> None declared