AB0315 High disease activity at baseline, not rf nor acpa status, predicts inadequate response to methotrexate (MTX) in patients with early rheumatoid arthritis in real world: a single centrecohort in japan
Authors: T. Aramaki, Y. Ueki, K. Kojima, S. Kurushima, Y. Tsuji, N. Kawachi, N. Iwamoto, K. Ichinose, K. Terada, K. Eguchi, A. Kawakami
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In 2016 update of the EUALR recommendations for management of rheumatoid arthritis (RA), the poor prognostic factors include moderate to high disease activity according to composite measures and presence of Rheumatoid factor (RF) and/or anti-citrullinated peptide antibodies (ACPA), especially at high levels. <h3>Objectives</h3> In this retrospective study, we investigated the association between baseline clinical prognostic factors and inadequate response to methotrexate for early RA in clinical practice. <h3>Methods</h3> Patients aged 18 years or over whose date of clinical onset of RA was within the previous 12 months to the first visit to our hospital from 2009 to 2016, who had at least 6 months of follow-up data and composite measure score (DAS-SER, DAS-CRP, SDAI, CDAI) recorded at 12 months from MTX treatment were included. Data collected included baseline demographics, rheumatoid factor (RF), ACPA status and the level of its titer, time from symptom onset to treatment and disease activity at baseline. In this study, we define that it was inadequate response to MTX (MTX-IR) when the patient didn't achieve low disease activity in at least three of four composite measures at 12 months after treatment, or was stopped to treat due to any reason or added biologic DMARDs (bDMARDs) in the observation period. Univariate and multivariate logistic regression of Inadequate response to MTX at 12 months after were performed. <h3>Results</h3> Data from 486 patients treated with MTX of 571 started to treat as early RA were analysed: 72.0% female; mean age 59.6 years (SD: 14.4); time from symptom onset to treatment is 7.3 months (SD 10.5); 66.1% RF-positive, 66.9% ACPA-positive. The number of patients is 138 (45.8% of ACPA positive) whose ACPA is in the higher level, over 150IU/ml. 411 patients were initially treated with MTX, and 75 were initially treated with other csDMARDs but added or changed to MTX within 1 years after treatment. Concomitant rate of corticosteroid at the start of MTX was 41.5% and mean dose of predonisolone was 5.7 mg/day. 270 (55.6%) patients were MTX-IR in 12 months after treatment. There is no significant difference between the dose of MTX at start in MTX-IR patients and that in others (6.70 versus 6.69 mg/week, respectively) but the dose at 12 months after treatment was 8.29 mg/w in MTX responders and significantly lower than that of MTX-IR, 8.68 mg/dl (p&lt;0.05). The strongest baseline predictor of Inadequate response were Low disese activity at baseline, but there was no statistically significant association with sex, age at onset, RF or ACPA status additionally the level of its titers. <h3>Conclusions</h3> In this observational study, patients with early RA at risk of inadequate response to MTX include only with high disease activity at baseline, and the level of ACPA titers or other baseline characteristics don't predict it. <h3>Disclosure of Interest</h3> None declared