AB0219 Impact of early diagnosis on long-term effectiveness of first-line anti-tnf-alpha treatment in rheumatoid arthritispatients
Authors: D. Capocotta, S. Montalbano, D. Lubrano, E. Tirri
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> Aim of this work was to evaluate effectiveness and drug persistence of anti-tumour necrosis factor (TNF)-alpha therapies in early and late diagnosed rheumatoid arthritis (RA) patients naïve for biological disease-modifying antirheumatic drug (bDMARD) use. <h3>Methods</h3> Baseline and follow-up (FU) charts RA patients with disease onset later than 2002 and access to rheumatology care between <sup>January 2007</sup> and December 2016 were reviewed until December 2017. <sup>All patients fulfilled 2010</sup> ACR/EULAR classification criteria. At baseline, demographic, anamnestic and serological characteristics were collected. Based on lag time between onset of symptoms and definite diagnosis, RA patients were categorised into two groups: early diagnosed (less than 12 months) and late diagnosed (more than 12 months). Disease activity and treatment response were assessed every three months by Simplified Disease Activity Index (SDAI). Anti-TNF-alpha survival was defined as the length of time from initation to discontinuation of therapy due to loss of effectiveness over time. It was examined using Kaplan-Meier survival analysis. <h3>Results</h3> One hundred and fifteen RA patients (86.1% females, mean age 59.4) were included. The median disease duration between onset of symptoms and diagnosis was 25 months.<sup>20–43</sup> 68 patients (59.1%) were labelled as early diagnosed and 47 (40.9%) as late diagnosed. At baseline, no differences were found in age, gender, smoking habits, body mass index, and rheumatoid factor positivity. The most frequently used first-line anti-TNF drug was etanercept (30.4%), followed by adalimumab (20%), golimumab (18.3%), infliximab (16.5%), and certolizumab (14.8%). All patients received anti-TNF-alpha therapy in combination with csDMARD (methotrexate or leflunomide). Average steroid dosage was 5 mg/day of prednisone (or its equivalent) over time. The median time to initation of any anti-TNF-alpha treatment after definite diagnosis was 18 months.<sup>6–30</sup> Kaplan-Meier analysis showed a lower anti-TNF-alpha discontinuation rate for early diagnosed RA patients than late diagnosed (9 year retention rate of 29.5% and 12.7%, respectively; p=0.0049) (figure 1). <h3>Conclusions</h3> This small real-world retrospective, observational, cohort study demonstrates that early diagnosis of RA provides higher retention rate of anti-TNF-alpha treatment as first-line bDMARD. <h3>References</h3> [1] Aletaha D, Neogi T, Silman AJ, et al. 2010Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum2010 Sep;62(9):2569–81. [2] Aletaha D, Martinez-Avila J, Kvien TK, Smolen JS. Definition of treatment response in rheumatoid arthritis based on the simplified and the clinical disease activity index. Ann Rheum Dis. 2012Jul;71(7):1190–6. [3] Wijbrandts CA, Tak PP. Prediction of Response to Targeted Treatment in Rheumatoid Arthritis. Mayo Clin Proc. 2017Jul;92(7):1129–1143. [4] Soubrier M, Pereira B, Frayssac T, Fan A, Couderc M, Malochet-Guinamand S, Mathieu S, Tatar Z, Tournadre A, Dubost JJ. Retention rates of adalimumab, etanercept and infliximab as first-line biotherapy agent for rheumatoid arthritis patients in daily practice – Auvergne experience. Int J Rheum Dis. 2017Sep 13. <h3>Disclosure of Interest</h3> None declared