AB0410 DISCONTINUATION OF ORAL GLUCOCORTICOID AFTER INITIATION OF BIOLOGICAL DMARD DUE TO A HIGHER DOSE OF METHOTREXATE; A RETROSPECTIVE OBSERVATIONAL STUDY BASED ON DATA FROM A JAPANESE MULTICENTER REGISTRY STUDY
Authors: Mochihito Suzuki, Toshihisa Kojima, Nobunori Takahashi, Naoki Ishiguro
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> In the treatment of rheumatoid arthritis, glucocorticoid that provide anti-inflammatory effects in the early stage of treatment is an important drug. We recommend discontinuing of glucocorticoid as much as possible within 6 months[1], but many patients have taken oral glucocorticoid for the long term in daily clinical practice. The frequency of use of glucocorticoid has gradually declined, and there are several reports on discontinuation of glucocorticoid due to the initiation of bDMARD[2, 3]. However, there is no report showing the relation between discontinuation of glucocorticoid and MTX dose. <h3>Objectives</h3> The aim of this study is to examine association of methotrexate (MTX) dose with discontinuation of glucocorticoid after one year since initiation of biological DMARD (bDMARD) as 1<sup>st</sup> bDMARD. <h3>Methods</h3> We established the large observational cohort, the Nagoya University orthopedic facility multicenter study (TBCR), and a total of 3119 patients used biological DMARD. 564 patients who used glucocorticoid and MTX when bDMARD was initiated as 1<sup>st</sup> bDMARD were enrolled. In the first study, we examined predictive factors of discontinuation of glucocorticoid after one year since initiation of bDMARD by using multivariate analysis in the two groups, which patients continued to use glucocorticoid and discontinued to use glucocorticoid. In the second study, we adjusted the background at the time of initiation of bDMARD by using propensity score matching (PS) in the two groups, MTX≤8mg (L group) and MTX&gt;8mg (H group). <h3>Results</h3> 400 patients continued to use glucocorticoid and 164 patients discontinued to use glucocorticoid. In the multivariate analysis, age (Odds ratio (OR)0.98), MTX dose (OR1.09) and glucocorticoid dose (OR0.88) were independently predictive factors of discontinuation of glucocorticoid. When we adjusted age, disease duration, sex, disease activity, RF/ACPA, glucocorticoid dose by using PS matching, 105 pairs were extracted. There were obvious significant differences between 24 patients (22.9%) in the L group and 43 cases (41.0%) in the H group (P = 0.007), where glucocorticoid was discontinued at one year after the initiation of bDMARD. <h3>Conclusion</h3> This cohort study investigated the association with discontinuation of oral glucocorticoid and MTX dose in the patients treated with bDMARD. TBCR revealed that, in the clinical practice, glucocorticoid use was decreasing in the patients treated with bDMARD. MTX dose at the time of initiation of bDMARD was predictive factor of discontinuation of glucocorticoid. A higher dose of MTX associated with discontinuation of glucocorticoid in the patients treated with bDMARD. <h3>References</h3> [1] Smolen JS, Landewe R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017 Jun; 76(6):960-977. [2] Shimizu Y, Tanaka E, Inoue E, Shidara K, Sugimoto N, Seto Y, et al. Reduction of methotrexate and glucocorticoids use after the introduction of biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis in daily practice based on the IORRA cohort. Mod Rheumatol. 2018 May; 28(3):461-467. [3] Seror R, Dougados M, Gossec L. Glucocorticoid sparing effect of tumour necrosis factor alpha inhibitors in rheumatoid arthritis in real life practice. Clin Exp Rheumatol. 2009 Sep-Oct; 27(5):807-813. <h3>Disclosure of Interests</h3> Mochihito Suzuki Speakers bureau: Bristol-Myers Squibb, Toshihisa Kojima Grant/research support from: Chugai Pharmaceutical (Investigator Initiated Study), Novartis, Nippon Kayaku, Eli Lilly, Eisai, Speakers bureau: Chugai Pharmaceutical, Takeda Pharmaceutical, Pfizer, Eli Lilly Japan, Bristol Myers Squibb, Ono Pharmaceutical, Daiichi Sankyo, Astelas, UCB, Janssen Pharmaceutical, Tanabe Mitsubishi, Nobunori Takahashi Speakers bureau: AbbVie, Bristol-Myers Squibb, Chugai, Eisai, Mitsubishi Tanabe, and Pfizer. YS has received speakers' fees from Astellas, Bristol-Myers Squibb, and Ono, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant for: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama