SAT0077 IMPACT OF THE COMBINED PRESENCE OF EROSIONS AND ACPA ON 6 AND 12 MONTHS CLINICAL OUTCOMES OF RHEUMATOID ARTHRITIS : RESULTS FROM THE METEOR REGISTRY
Authors: Sytske Anne Bergstra, Maura Couto, Nimmisha Govind, Arvind Chopra, Karen Solomon-Escoto, Elizabeth Murphy, Thomas Huizinga, Cornelia Allaart
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Despite efforts to predict treatment response, treatment of rheumatoid arthritis (RA) patients remains mostly a case of trial and error. Presence of erosions and ACPA are often considered poor prognostic factors based on their association with radiographic damage progression, but with the introduction of treat-to-target ever fewer patients develop significant radiographic damage. Therefore research into prognostic factors should focus on clinical outcomes. <h3>Objectives</h3> To investigate in newly diagnosed RA patients if presence of erosions and/or ACPA are associated with functional ability, disease activity and treatment survival during the first year of treatment in daily practice. <h3>Methods</h3> Newly diagnosed patients with a clinical diagnosis of RA, ≥3 months follow-up and available data on ACPA, erosions and medication were identified in the international, observational METEOR registry (n patients=4623). Timing and frequency of follow-up visits were according to daily practice. We focused at results after a maximum follow-up duration of 6 months or of 1 year from baseline. Associations between the presence of erosions and/or ACPA (4 groups) with the change of DAS and HAQ over time were assessed using linear mixed models. Time to treatment change during the first year of follow-up was compared between the ACPA/erosions groups using multiple failure-times Cox regression. Treatment change was defined as a change in type of treatment. A change in medication dose or tapering was not considered a treatment change. Missing data were imputed using multiple chained equations (40 cycles) and models were adjusted for the potential confounders age, gender, smoking, symptom duration, BMI, initial medication and country. In case of statistically significant effect modification (p&lt;0.20) by country, medication group (csDMARD monotherapy, csDMARD combination therapy, csDMARD + glucocorticoid and other) or symptom duration group (&lt;1 year, 1-2 years, 2-5 years and &gt;5 years), results were stratified. <h3>Results</h3> Baseline characteristics and follow-up duration of each ACPA/erosions group are shown in table 1. Baseline DAS and HAQ were slightly higher in erosions+ patients. Follow-up duration was similar between the 4 groups. We found statistically significant differences in DAS and HAQ change over time between the 4 groups, both after maximum follow-up durations of 6 months and of 1 year (table 1), but differences were small and not clinically relevant. Patients who were erosions-/ACPA- were less likely to switch treatment [HR (95% CI) 0.79 (0.69; 0.90)] compared to a reference group of erosions-/ACPA+ patients. Patients who were erosions+/ACPA- [HR (95% CI) 0.92 (0.79; 1.08)] or erosions+/ACPA+ [HR (95% CI) 1.01 (0.92; 1.10)] were not statistically significantly different from the reference group in their likelihood to switch treatment. No effect modification was found by country, medication or symptom duration. <h3>Conclusion</h3> In this analysis of worldwide real life data, we found statistically significant, but no clinically relevant differences in treatment response to initial DMARD therapies as measured by DAS and HAQ in ACPA-/erosions-, ACPA-/erosions+, ACPA+/erosions- and ACPA+/erosions+ RA patients. However, ACPA-/erosions- patients were less likely to switch treatment. Thus, in newly diagnosed RA patients who are treated according to modern treatment strategies, the (combined presence of) ACPA and erosions was no risk factor for worse disease activity or physical functioning, although ACPA-/erosions- patients had fewer treatment changes. <h3>Disclosure of Interests</h3> Sytske Anne Bergstra Grant/research support from: Bristol-Myers Squibb provided funding for the completion of this study and the development of the abstract., Maura Couto: None declared, Nimmisha Govind: None declared, Arvind Chopra Grant/research support from: Pfizer Inc, Karen Solomon-Escoto: None declared, Elizabeth Murphy Consultant for: Has received support from Roche to audit work on behalf of the Scottish Society for Rheumatology., Thomas Huizinga Consultant for: Merck, UCB, Bristol Myers Squibb, Biotest AG, Pfizer, GSK, Novartis, Roche, Sanofi-Aventis, Abbott, Crescendo Bioscience Inc., Nycomed, Boeringher, Takeda, Zydus, Epirus, Eli Lilly, Cornelia Allaart: None declared