AB0445 REMARKABLE OUTCOMES IN PATIENTS WITH RA USING CONVENTIONAL DMARDS UNDER A T2T STRATEGY AND A DISEASE MANAGEMENT MODEL – RESULTS FROM A FIVE YEAR REAL-WORLD REGISTRY
Authors: Pedro Santos-Moreno, Michael Cabrera, Diana Buitrago-Garcia, Eva Cardozo, Ivania Ramirez, Danny Gomez, Edwin Castillo, Sandra Farietta
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a common chronic inflammatory disease. Treat-to-target (T2T) is a management strategy for R that proposes as the therapeutic target a state of remission or low disease activity, additionally a multidisciplinary management of patients with RA has demonstrate to be an additional aid to achieve remission or low disease activity. Real-world evidence (RWE) refers to information coming from electronic health records, billing data, registries among others. RWE shows results that are difficult for clinical trials to demonstrate due to ideal conditions(1, 2). <h3>Objectives:</h3> The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy during 5 years in a cohort of patients receiving conventional DMARDs that attend to a specialized RA center. <h3>Methods:</h3> A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed during 2015-2017; those patients were followed-up under T2T standards and a multidisciplinary approach. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3-5 weeks (DAS28 &gt; 5.1), every 7-9 weeks (DAS28 ≥ 3.1 and ≤ 5.1), and every 11-13 weeks (DAS28 &lt; 3.1). Tender joint count (TJC), swollen joint count (SJC) and DAS28 were measured on each visit. Therapy had to be adjusted with DAS28 &gt; 3.2 unless patient's conditions don't permit it; we considered this follow-up type as implementation of a T2T strategy in patients with RA. Patients entered into a multidisciplinary program of care with periodic consultations not only to rheumatology but with a physiatrist, psychologist, physiotherapist, occupational therapy nutrition, and, a patient focused program. With a multidisciplinary model of care the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. We divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We compared disease activity at base line and at the end of follow-up. <h3>Results:</h3> During 5 years we included 2.128 patients. 83% were female and 17% were male, mean age was 57 years ±14. At baseline median DAS28 4.34 RIQ (3.76-5.06) and at 5 years 2.02 RIQ (1.46-2.38). At the end of our follow-up 81% were remission and 7% in LDA. See table 1. I our study DAS28 was not normally distributed, thus we performed a Wilcoxon test in order to compare the mean DAS28 at baseline/5-year showing statistical significance (P&lt;0.05). <h3>Conclusion:</h3> In our patients T2T improves associated with a disease management model improves disease activity in patients with RA. This evidence from a real-life setting that shows the advantages of treating RA patients with a multidisciplinary team under a T2T model with a low-cost treatment. It is important to explore other predictors that can improve disease activity. <h3>Disclosure of Interests:</h3> Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Michael Cabrera: None declared, Diana Buitrago-Garcia: None declared, Eva Cardozo: None declared, Ivania Ramirez: None declared, Danny Gomez: None declared, Edwin Castillo: None declared, Sandra Farietta: None declared