AB1197 TREAT-TO-TARGET IS FEASIBLE IN RHEUMATOID ARTHRITIS PATIENTS DURING PREGNANCY, FIRST RESULTS OF THE PreCARA COHORT
Authors: H. T. Smeele, E. Röder, H. Wintjes, L. J. Kranenburg - van Koppen, J. Hazes, R. Dolhain
Journal: Annals of the Rheumatic Diseases (2020)

Background: A treat-to-target approach results in better outcomes for Rheumatoid Arthritis (RA) patients [1]. Well controlled disease is important for pregnant RA patients and patients with a wish to conceive too. Not only for the welfare of the mother, but also because active disease is associated with a prolonged time to pregnancy and adverse pregnancy outcomes [2]. This is this first study to examine a treat-to-target approach during pregnancy. Objectives: To determine the feasibility of a treat-to-target approach in RA patients with a wish to conceive or pregnant. Methods: Patients were derived from the PreCARA cohort (first inclusion 2011, data shown up to November 2019). The PreCARA cohort is an ongoing, single center, prospective study on RA and pregnancy. Patients in this cohort were treated according to a treat-to-target approach, in which the obvious restrictions of pregnancy were taken into account. Study visits were scheduled before, during and after pregnancy and disease activity (DAS28CRP) was measured. Results of the PreCARA study were compared with results of the PARA study [3], a historic reference cohort on RA during pregnancy, with a similar study design (inclusion 2002 – 2010). Patients in the PARA cohort were treated according to the standards of that time. The PARA cohort represents the natural course of RA during pregnancy with limited treatment options. Results: 263 RA patients were included in the PreCARA cohort, up to now 154 children were born in this ongoing cohort. Mean age at inclusion was 32.3 (4.3 SD), 83.2 % was Rheumatoid Factor positive and/or ACPA positive. Mean disease activity in the PreCARA cohort is statistically significant lower than in the PARA cohort at every time-point: mean DAS28CRP in 3 rd trimester in the PreCARA cohort 2.22 (0.73 SD), in the PARA cohort 3.35 (1.12 SD) P &lt; 0.001 (figure 1). In the PreCARA cohort 73.3% of the patients were in low disease activity or remission before pregnancy increasing to 90.4 % in the third trimester, whereas in the PARA cohort these percentages were 32.2 % and 47.3% respectively (P &lt; 0.001) (figure 2). Medication use in the PreCARA cohort is shown in table 1 and in the PARA cohort in table 2. Medication Before pregnancy (%)* 1 st trimester (%) 2 nd trimester (%) 3 rd trimester (%) 6 weeks post-partum (%) 12 weeks post-partum (%) 26 weeks post-partum (%) MTX 5 0 0 0 15 19 15 Leflunomide 0 0 0 0 1 1 2 Abatacept 0 0 0 0 1 1 1 Hydroxychloroqine 63 51 51 50 49 43 31 Sulfasalazine 70 56 58 57 54 47 36 Prednisone 43 40 39 42 38 34 27 Azathioprine 1 2 1 1 0 1 1 Certolizumab 25 21 26 28 26 24 18 Adalimumab 10 5 0 0 3 3 4 Infliximab 5 8 3 0 1 1 1 Etanercept 13 10 9 3 10 11 9 Golimumab 0 0 0 0 0 0 1 Tocilizumab 3 1 0 0 3 2 3 * patients seen before pregnancy = 104 Medication Before pregnancy (%)** 1 st trimester (%) 2 nd trimester (%) 3 rd trimester (%) 6 weeks post-partum (%) 12 weeks post-partum (%) 26 weeks post-partum (%) MTX 0 0 0 0 18 30 36 Leflunomide 0 0 0 0 0 1 2 Hydroxychloroqine 6 2 2 2 4 8 7 Sulfasalazine 34 25 27 26 26 30 29 Prednisone 42 33 36 36 35 36 32 Azathioprine 1 0 0 0 1 1 1 Adalimumab 0 0 0 0 2 3 5 Infliximab 0 0 0 0 0 1 1 Etanercept 0 0 0 0 3 6 5 ** patients seen before pregnancy = 124 Conclusion: This first study on a treat-to-target approach in pregnant RA patients shows that low disease activity and remission are an attainable goal during pregnancy, with over 90% of patients achieving this in the 3 rd trimester. The effect of this approach on fertility and pregnancy outcomes should be the focus of further studies. References: [1]Smolen et al. Rheumatoid arthritis. Lancet 2016 [2]Smeele et al. Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Semin Arthritis Rheum 2019 [3]de Man et al. Measuring disease activity and functionality during pregnancy in patients with rheumatoid arthritis. A&amp;R 2007 Disclosure of Interests: Hieronymus TW Smeele: None declared, Esther Röder: None declared, Hetty Wintjes: None declared, Laura JC Kranenburg - van Koppen: None declared, Johanna Hazes: None declared, Radboud Dolhain Grant/research support from: unrestricted grant from UCB Pharma